Anatomy & Physiology - Helen McGuinness - Hodder Education (2018)

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Helen McGuinness
Anatomy &
Physiology
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ISBN: 978 1510 435179
© Helen McGuinness 2018
First published in 2018 by
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Contents
Acknowledgements iv
How to use this book vi
1 An introduction to anatomy and physiology: how the body is organised 1
2 Cells and tissues 10
3 The skin, hair and nails 37
4 The skeletal system 96
5 The muscular system 128
6 The cardiovascular system 173
7 The lymphatic system and immunity 211
8 The respiratory system 230
9 The nervous system 246
10 The endocrine system 278
11 The reproductive system 299
12 The digestive system 318
13 The renal system 341
Index 353
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Acknowledgements
Whilst preparing the original text of this book back in the early 1990s, I
never dreamed it would be in circulation for over 20 years and now be in its
fifth edition, with an accompanying workbook.
Firstly, I would like to extend my most significant thanks to my husband
Mark for his constant love, help, support and understanding, along with his
constructive comments made in the updating of this book.
To my late mum, Valerie, whose eternal love, words of encouragement and
belief in my abilities continue to motivate and inspire me to this day.
To my dear friend Dee Chase (aka Mum Dee), for her constant love, belief,
support and encouragement of my work and writing.
To Dr Nathan Moss, for help in checking the accuracy of the text on
pathologies.
I will always be greatly indebted to Deirdre Moynihan for her professional
help and contributions throughout the preparation of the original text back
in 1995 when the book was in its infancy.
Special thanks go to Linda Biles, Head of Beauty Therapy at Chichester
College, who has encouraged and supported the update of this latest edition
and offered her invaluable suggestions and constructive comments.
I would like to thank all the students, colleges and lecturers who have used
this book over the past 20 years and who have been most encouraging and
supportive of my work.
This book is devoted to our beautiful daughter, Grace.
Helen J. McGuinness
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How to use this book
Dear Colleague,
This book, now in its fifth edition, has been designed for those studying
beauty therapy, complementary therapies or any subject that requires a
sound foundation knowledge of anatomy and physiology.
This edition has been completely revised to bring it in line with the latest
anatomy and physiology specifications of the Technical/Advanced Level
qualifications.
As well as new and updated content, additional new features include an
expanded introductory chapter on how the body is organised, key word
glossaries at the end of the chapter, new and improved illustrations and
photographs, and expanded end-of-chapter revision summaries and test
your knowledge questions.
Each chapter gives an overview of a system and why it is of significance to a
therapist, has a list of learning objectives, and is full of interesting facts and
information to help stimulate your learning.
At the end of each chapter there is a link to other body systems to help
to put the subject into context, showing how the body systems work as a
whole to keep us in balance, along with a comprehensive revision summary
and test your knowledge questions in multiple choice and new exam-style
formats.
Once you have studied the contents of this textbook, there is a new
accompanying workbook available to help test your knowledge and prepare
you for assessments and examinations. Contents of the workbook include
a range of activities including additional multiple choice and exam-style
questions, labelling, matching the key words, sorting, and filling in the
blanks.
Anatomy and physiology is a fascinating subject and I sincerely hope that
this new edition provides you with an improved learning experience.
Helen J. McGuinness
Answers are available online at www.hoddereducation.co.uk/Anatomy-and-

Physiology-Extras
vi
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1 An introduction
to anatomy and
physiology: how the
body is organised
Introduction
Before we begin the fascinating journey of
learning about how the body works, let’s look at
the terminology associated with the study of the
human body.
● Anatomy is the study of the structure and
location of body parts.
● Physiology is the study of the function of
body parts.
It is very important to co-ordinate these two
subjects because knowledge of structure is
incomplete without the knowledge of function,
and the knowledge of function is incomplete
without the knowledge of structure.
● Pathology is the study of disease in the body.
At the end of each chapter in this book there is a
section on the common pathologies associated
with a system of the body.
OBJECTIVES
By the end of this chapter you will understand:
● anatomical directional terminology used to
give a precise description of a body part
● anatomical planes, which divide the body
into sections
● anatomical regional terms, which refer to
specific areas of the body
● the main body cavities that divide the body
and its internal organs into sections.
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Anatomy & Physiology
KEY FACT The body as a map

Knowing where parts of the The body may be likened to a map and the key to locating and
body are located will help your understanding the parts of the body is directional terminology.
understanding as you build up
a picture of how they function.
Anatomical terminology
When studying anatomy and physiology, you should use directional
In practice terminology to give precise descriptions when referring to the exact
Think of the structure of the location of a body part or structure. In anatomical terminology, all
heart and all its chambers and parts of the body are described in relation to other body parts using a
valves. Visualising the individual standardised body position called the anatomical position.
structures (the anatomy), can help In this position, the body is erect and facing forwards, arms to the side,
you to understand how the blood palms are facing forwards with the thumbs to the side, and the feet
flows through the heart and how slightly apart with toes pointing forwards. There is an imaginary line
the heart beats. You are relating running down the centre or midline of the body.
anatomy to function or physiology.
Learning anatomical terminology is like learning a new language!
Superior Medial Proximal Superficial
Anterior
(ventral)
Posterior
(dorsal)
Inferior Lateral Distal Deep
p Anatomical terms
Anatomical directional terms

The anatomical terms in Table 1.1 will help you to be specific when
describing the position of a body part.
Study tip
The directional terms have been organised into pairs for ease of learning;
once you know one term, it is easier to learn the opposite term.
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1 An introduction to anatomy and physiology: how the body is organised
Table 1.1 Anatomical directional terms
Anatomical
directional term Definition In practice
Anterior (or ventral) Front surface of the body, or structure The biceps muscle is on the anterior surface of
the upper arm
Posterior (or dorsal) Back surface of the body, or structure The triceps muscle is on the posterior surface
of the upper arm
Superficial Near the body surface The most superficial layer of the skin is the
epidermis
Deep Further from the body surface The dermis is deep to the epidermis
Lateral Away from the midline The radius is lateral to the ulna
Medial Towards the midline The ulna is medial to the radius
Superior Situated towards the head, or above a The shoulder joint is superior to the elbow joint
point of reference
Inferior Situated away from the head or below a The intestines are inferior to the stomach
point of reference
Central At or near the centre The brain and spinal cord are part of the central
nervous system
Peripheral Away from the centre; outer part of the Peripheral vision allows us to see things out of
body main focus
Proximal Nearest to the point of reference The wrist joint is proximal to the elbow joint
Distal Furthest away from the point of reference The shoulder joint is distal to the wrist joint
Prone Lying face down in a horizontal position When receiving a back massage a client lies
prone
Supine Lying face up in a horizontal position When receiving a facial a client lies supine
Caudal Away from the head, or below a point of The coccyx (tail bone) is an example of a caudal
reference position
Cranial (or cephalic) Relating to the head end or skull The brain is located in the cranial cavity
(cranium)
Palmar Relating to the palm side of the hand The thenar muscle is on the palmar surface of
the hand
Plantar Relating to the sole of the foot There is a central tendon on the plantar surface
of the foot
Ipsilateral On the same side as another structure The right radius and right humerus are
ipsilateral
Contralateral On the opposite side to another structure The right and left kidneys are contralateral
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Other directional terms

● Longitudinal: running in the direction of the length of the body or any
of its parts.
● Visceral: used when referring to any internal organs, specifically those
in the main body cavity (intestines, liver, stomach, for example).
Activity ● Parietal: used to refer to things within the body that are attached to
Make up a blank template the inside of the body cavity or a hollow structure.
of the face and body. Design ● Internal: near the inside.
some small labels, each with ● External: near the outside.
an anatomical region on it
(for example buccal, cervical). Anatomical terms applied to movement
Attach the labels onto the There are several anatomical terms relating to movement in the body,
facial/body template to indicate such as adduction and abduction. These are defined in Chapter 5, The
where each region is located.
muscular system.
The anatomical planes of the

body
In the study of anatomy, there are three planes that separate the body
into sections:
1 The median or sagittal plane: a vertical plane that divides the body
lengthwise into right and left sections.
2 The frontal or coronal plane: divides the body into a front (anterior)
portion and a rear (posterior) section.
3 The transverse plane: a horizontal plane that divides the body into
top (superior) and bottom (inferior) sections.
Sagittal plane Frontal/coronal plane Transverse plane
p Anatomical planes of the body
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The anatomical Table 1.4 Anatomical regions of the lower limbs
Anatomical term Area of the body

regions of the body Calcaneal Heel
Just like regions on a map, the anatomical regions of Crural Leg or thigh
the body refer to certain body areas. Digital/phalangeal Toes (and fingers, see Table 1.3)
The body is divided into: Femoral Thigh
● head and neck Patellar Knee cap
● trunk Pedal Foot
Plantar Sole of foot
● upper limbs (arms)
Popliteal Hollow behind knee
● lower limbs (legs).
Sural Calf
Tables 1.2, 1.3, 1.4 and 1.5 will help you to learn the
Tarsal Ankle
correct terminology for each region.
The head and neck The trunk

Table 1.2 Anatomical regional terms of the head and neck Table 1.5 Anatomical regional terms of the trunk (thorax and
abdomen)
Anatomical regional term Area of body
Buccal Cheek Anatomical regional term Area of body
Cephalic Head Abdominal Abdomen
Cranial Skull Axillary Armpit
Cervical Neck Coeliac Abdomen
Facial Face Costal Ribs
Frontal Forehead Gluteal Buttocks
Mental Chin Inguinal Groin
Nasal Nose Lumbar Lower back
Occipital Back of head/skull Mammary Breast
Ophthalmic/orbital Eyes Pectoral Chest
Oral Mouth Pelvic Pelvis/lower abdomen
Otic Ear Pericardial Heart
Perineal Between anus and
The upper and lower limbs external genitalia
Pubic Pubis (front of pelvis)
Table 1.3 Anatomical regions of the upper limbs Sacral Sacrum
Anatomical term Area of the body Thoracic Thorax (chest cavity)
Brachial Upper arm Umbilical Navel
Carpal Wrist Vertebral Spine/backbone
Cubital Elbow
Digital/phalangeal Fingers (and toes, see Table 1.4) Other general anatomical
Forearm Lower arm regional terms
Palmar Palm of hand Cutaneous: skin
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Occipital (back of skull)
Frontal
Cranial (skull)
(forehead)
Orbital (eye) Otic (ear) Facial Cephalic (head)
Nasal (nose) Buccal (cheek) (face)
Oral (mouth) Cervical (neck) Cervical (neck)
Mental (chin)
Pectoral (chest) Acromial (shoulder)
Costal (ribs)
Thoracic (chest) Dorsal (back)
Axillary (arm pit) Pericardial (heart)
Brachial (arm) Mammary (breast) Vertebral (spine)
Trunk
Abdominal
or coeliac Olecranal
Cubital (elbow) (abdomen) (back of elbow) U
Umbilical (navel) Antebrachial li
Antebrachial Coxal (hip) (forearm)
(forearm) Lumbar (lower back)
Pelvic (pelvis)
Carpal (wrist) Inguinal (groin) Sacral (sacrum)
Pollex (thumb) Pubic (pubis) Gluteal (buttocks)
Palmar
(palm of hand) Femoral Manual (hand)
(thigh)
Phalangeal
(fingers) Perineal (between anus
Occipital (back of skull) and external genitalia)
Frontal
Cranial (skull) Femoral (thigh)
(forehead) Patellar
Orbital (eye) (kneecap) Facial Cephalic (head) Popliteal (back of knee)
Otic (ear)
Nasal (nose) Buccal (cheek) (face)
Crucial (leg) Lower limb
Oral (mouth) Cervical (neck) Cervical (neck)
Sural (calf)
Mental (chin)
Pectoral (chest) Acromial (shoulder)
Costal (ribs)
Thoracic (chest) Dorsal (back)
xillary (arm pit) Pericardial (heart)
Calcaneal (heel)
Brachial (arm) Pedal (foot) Mammary (breast) Pedal Vertebral (spine)
Trunk
Hallux (big toe) Abdominal Phalangeal (foot)
or coeliac Olecranal Plantar (sole of foot)
(toes)
Cubital (elbow) (abdomen) (back of elbow) Upper
UmbilicalHallux
(navel)(big toe) Antebrachial limb
Antebrachial Coxal (hip) (forearm)
Anterior view Posterior view
(forearm) Lumbar (lower back)
Pelvic (pelvis)
Carpal (wrist) Inguinal (groin) Sacral (sacrum)
Pollex (thumb) Pubic (pubis) Gluteal (buttocks)
Palmar
(palm of hand) Femoral Manual (hand)
(thigh)
Phalangeal
(fingers) Perineal (between anus
and external genitalia)
Femoral (thigh)
Patellar
(kneecap) Popliteal (back of knee)
Crucial (leg) Lower limb

Sural (calf)
Calcaneal (heel)
Pedal (foot) Pedal
Hallux (big toe) Phalangeal (foot)
Plantar (sole of foot)
(toes)
Hallux (big toe)

Anterior view Posterior view
p Anatomical regional terms
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Body cavities It is separated from the abdominal cavity by

the diaphragm muscle
Body cavities are spaces within the body that contain ● the abdominopelvic cavity – consists of both
the internal organs. the abdominal and pelvic cavities; contains
There are two main cavities in the body: the liver, stomach, pancreas, spleen, gall
1 the dorsal cavity, located in the posterior (back) bladder, kidneys, and most of the small and
region of the body large intestines, as well as the bladder and
the internal reproductive organs
2 the ventral body cavity, occupying the anterior
● the abdominal cavity – contains the stomach,
(front) region of the trunk.
spleen, liver, gall bladder, pancreas, small
The dorsal cavity is subdivided into two cavities: intestine and most of the large intestine.
● the cranial cavity – encases the brain and is The abdominal cavity is protected by the
protected by the cranium (skull) muscles of the abdominal wall and partly by
● the vertebral/spinal cavity – contains the spinal the diaphragm and rib cage
cord and is protected by the vertebrae. ● the pelvic cavity – contains the bladder,
The ventral cavity is subdivided into: some of the reproductive organs and the
rectum. The pelvic cavity is protected by
● the thoracic cavity – surrounded by the ribs and
the pelvic bones.
chest muscles, the thoracic cavity contains the
lungs, heart, trachea, oesophagus and thymus.
Dorsal cavity
Cranial cavity
Spinal cavity
Ventral cavity
Thoracic cavity
Abdominal cavity
Abdominopelvic
cavity
Pelvic cavity
p Body cavities
9781510435179.indb 7 04/10/18 4:48 PM

Key words Median or sagittal plane: vertical plane that divides

the body lengthwise into right and left sections
Anatomical position: point of reference in anatomy; Medial: towards the midline
the body is erect and facing forwards, arms to the
side, palms facing forwards with the thumbs to the Palmar: relating to the palm side of the hand
side, and the feet slightly apart with toes pointing Parietal: relating to the inner walls of a body cavity
forwards Pathology: the study of disease in the body
Anatomy: study of the structure and location of Peripheral: away from the centre; outer part of the
body parts body
Anterior (ventral): front surface of the body, or Physiology: the study of the function of body parts
structure Plantar: relating to the sole of the foot
Caudal: away from the head, or below Posterior (dorsal): back surface of the body, or
Contralateral: on the opposite side to another structure
structure Prone: lying face down in a horizontal position
Cranial (cephalic): relating to the head end or skull Proximal: nearest to the point of reference
Deep: further from the body surface Superficial: near to the body surface
Distal: furthest away from the point of reference Superior: situated towards the head, or above
Frontal or coronal plane: divides the body into a Supine: lying face up in a horizontal position
front (anterior) portion and a rear (posterior) section
Transverse plane: horizontal plane that divides
Inferior: situated away from the head or below the body into top (superior) and bottom (inferior)
Ipsilateral: on the same side as another structure sections
Lateral: away from the midline Visceral: relating to the internal organs of the body
Revision summary
● Anatomy is the study of the structure and location of body parts.
● Physiology is the study of the function of those body parts.
● Pathology is the study of disease in the body.
● An anatomical position follows an imaginary line running down the centre of the body, with the body
erect and facing forwards, arms to the side, palms facing forwards with the thumbs to the side, and the
feet slightly apart with toes pointing forwards.
● By learning and using anatomical terms it will help you describe the specific position of a body part; for
instance the biceps muscle is located on the anterior (front) surface of the upper arm.
● There are three planes that separate the body into sections:
● Frontal or coronal plane: divides the body into a front (anterior) portion and a rear (posterior) section.
● Median or sagittal plane: a vertical plane that divides the body lengthwise into right and left sections.
● Transverse plane: a horizontal plane that divides the body into top (superior) and bottom (inferior)
sections.
● There are two main cavities, or spaces within the body that contain the internal organs:
● The dorsal body cavity, which is located in the posterior (back) region of the body and is subdivided into
two cavities: the cranial and spinal cavity.

● The ventral body cavity, which occupies the anterior (front) region of the trunk and is divided into the
thoracic cavity and the abdominal and pelvic cavities.
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Test your knowledge questions

Multiple choice questions 8 Which of these anatomical terms describes the
area of the body relating to the foot?
1 What does the study of physiology entail? a plantar
a study of disease in the body b pedal
b study of the function of body parts c pelvic
c study of the structure of body parts d popliteal
d study of anatomical terms
9 When describing a structure or body part that is
2 Which of the following defines the term proximal?
above, or near to the head, which is the correct
a at or near the centre
term to use?
b away from the centre
a inferior
c nearest to the point of reference
b ipsilateral
d furthest away from the point of reference
c contralateral
3 Which of these anatomical terms describes lying d superior
face down in a horizontal position?
10 Which of these options is used to describe the
a caudal
back surface of the body or of a structure?
b palmar
c prone a ventral
d supine b dorsal
c plantar
4 Which of these options describes the median or
d distal
sagittal plane?
a a vertical plane that divides the body Exam-style questions
lengthwise into right and left sections
b a horizontal plane that divides the body into 11 Describe the following directional anatomical
top (superior) and bottom (inferior) sections terms:
c a vertical plane that divides the body into top a lateral 1 mark
(superior) and bottom (inferior) sections b distal 1 mark
d a horizontal plane that divides the body c anterior 1 mark
lengthwise into right and left sections d prone. 1 mark
5 To which area of the body does the term cervical 12 Describe the following anatomical regional terms:
refer? a axillary 1 mark
a the skull b brachial 1 mark
b the head c cephalic 1 mark
c the neck d inguinal. 1 mark
d the cheek 13 Define the following terms in relation to
6 Cubital is an anatomical term relating to which anatomical position:
area of the body? a median or sagittal plane 1 mark
a the wrist b coronal or frontal plane. 1 mark
b the elbow 14 List the two main body cavities. 2 marks
c the forearm
15 State the anatomical regional area to which each
d the upper arm
of the following applies:
7 Where is the pericardial region of the body a calcaneal 1 mark
located? b cubital 1 mark
a the lungs c gluteal. 1 mark
b the chest
c the heart
d the navel
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2 Cells and tissues
Introduction
The human body is like a universe; it is made up
of very small structures that are organised to
function as a whole.
It is incredible to think that the human body, a
complicated and sophisticated machine, starts
its journey of life as a single cell. In order to
understand how the body functions as a whole,
we need to consider how the structure of the
body is organised on five basic levels:
1 chemical
2 cellular
3 tissue
4 organ
5 system.
All the body systems, and the tiny cells that are
the basic component parts of all organs and
tissues, are involved in maintaining health and
keeping the body in a state of balance.
OBJECTIVES
● the different levels of structural
organisation in the body
● the importance of metabolism and
homeostasis for body function
● the structure and function of the cell and
its parts
● the structure and function of the main
tissue types in the body
● how to identify the major systems of the
body
● the interrelationships between the cells,
tissues and body systems
● common pathologies associated with cells
and tissues.
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2 Cells and tissues
● A molecule is a particle composed of two or more

In practice atoms joined together; a common example is a
In order for a therapist to carry out the most water molecule (H2O), made of one oxygen atom
successful treatment possible for their client’s and two hydrogen atoms.
needs, they should have an understanding of
cells and tissues as the building blocks of the KEY FACT
human body. Molecules combine to form cells.
Examining cells and tissues is like looking at the

body from the inside out. Understanding how the Study tip
body functions at a cellular level will help you to To understand the relationship between atoms and
understand how the body functions in times of molecules, it can be helpful to think of the molecule
health and illness, and will enable you to link the as the wall, and the atoms as the bricks from which
structure and function of the body’s organs. the wall is built.
The different levels of 2 Cellular level

structural organisation Cells are the basic structural and functional unit
of all living organisms, including the human body.
in the body They are, therefore, the smallest units that show
characteristics of life.
Humans are organisms that contain many parts
making up the whole. In order to appreciate the There are many different types of cells in the
structure of the human body, we need to study body. These vary in structure, size and shape according
the five principal levels of structural organisation: to their function. An example is a white blood cell
chemical, cellular, tissue, organ and system. (leucocyte) which helps fight infection in the body.
KEY FACT
Study tip Cells combine to form tissues.
When learning the levels of structural organisation,
you may find it helpful to memorise this mnemonic:
Clever Carol takes organisation seriously! 3 Tissue level
chemical clever A tissue is a group of similar cells that perform a
cellular Carol particular function. You will learn about these tissue
tissue takes types: epithelial, connective, muscular and nervous tissue.
organ organisation
KEY FACT
system seriously
Two or more types of tissue combine to form
organs.
1 Chemical level
Every substance in the world is made up of basic 4 Organ level
particles called atoms and molecules. An organ is a specialised structure made up of
Atoms and molecules represent the lowest level different types of tissues that are grouped into
of organisational complexity in the body and are structurally and functionally integrated units.
essential for maintaining life. At the chemical level, The heart and the lungs are examples of organs.
the smallest unit of matter is the atom.
● An atom is the smallest particle of an element; KEY FACT
an example is a hydrogen or oxygen atom. Organs combine to form systems.
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KEY FACT 5 System level

Systems combine to form the A system is a group of organs that work together to perform specific
living organism, such as a
functions. The systems of the body include the circulatory, skeletal,
human.
skin, respiratory, reproductive, muscular, endocrine, nervous, renal and
digestive systems.
Macromolecules Cells
Organelles
Cellular level
2
Chemical level
Small 1
molecules
3
Tissue level
(epithelium)
Atoms
Salivary
gland
Mouth
Pharynx
Epithelial
(throat)
tissue
Layers of
smooth
muscle
4 Organ level
Stomach
(stomach)
Gall bladder
Large Pancreas
intestine
Whole body level Rectum
(human being)
Anus
5 System level
(digestive system)
p Levels of structural organisation in the body
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2 Cells and tissues
Homeostasis KEY FACT

The pH level of blood in the human body should
The body is divided into different systems according to be around 7.4.
their specific functions. However, the purpose of all the
systems working together is to maintain a constant If the pH level drops below 7.0 to an acidic level,
internal environment so that each cell survives. a condition known as acidosis results. If the pH
The body functions efficiently only when the goes above 7.8, the condition is called alkalosis.
concentrations of water, food substances, oxygen Both acidosis and alkalosis can be life threatening.
and wastes, and the conditions of heat and pressure, In order to maintain the blood at a pH of 7.4, the
remain within certain limits. The process by which body’s systems work together by producing buffer
the body maintains a stable internal environment substances (carbonate and bicarbonate), which
for its cells and tissues is called homeostasis; if function to regulate the pH level by absorbing
one of the variables such as temperature, blood excess hydrogen or hydrogen ions. The kidneys
pressure, and levels of oxygen or carbon dioxide are significant in homeostasis as they can detect
in the blood or tissues is not kept within normal if the pH of your body’s fluids is too low (too
limits, imbalance and illness may occur. acidic).
The human body is exposed to a constantly changing
Acidic Neutral Alkaline
external environment. These external changes are
counteracted by the internal environment of blood,
lymph and tissue fluids that bathe and protect the
cells, so that the body functions correctly. Examples 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
of homeostasis are regulation of blood sugar level p The pH scale
via insulin and control of body temperature via the
hypothalamus in the brain. KEY FACT
The process of homeostasis is like an automatic Part of the brain, the hypothalamus, is vital in
fine-tuning mechanism that restores balance in the homeostasis. Throughout the body, receptors
body’s systems. in blood vessels detect the blood’s pressure,
temperature, glucose level and pH. These
When the body’s systems are not balanced, whether
receptors send signals through the nervous
through stress, pain, infection or depleted oxygen systems to the hypothalamus, where changes
level, the body’s cells do not work optimally, leading initiate (start) to bring the body back to
to signs of disorder and disease. The body systems balance. An example is the stimulation by the
are constructed to work synergistically (together) to hypothalamus of the pancreas to secrete insulin
maintain homeostasis. when the blood sugar level gets too high.
Examples of homeostatic mechanisms in the body

include those that regulate: KEY FACT
● body temperature Homeostasis is maintained by adjusting the
metabolism of the body.
● blood pressure
● blood sugar level
● pH level. Metabolism
Regulating the pH balance Metabolism is the term used to describe the
physiological processes that take place in our bodies
The pH scale is a chemical rating used to measure the to convert the food we eat and the air we breathe
acid or alkaline (base) content of a substance. into the energy we need to function. Metabolism
● Acids have a pH from 0 to 6. is essentially the basic chemical workings of the
● Alkalis (bases) have a pH of 8 to 14. body cells; through metabolism, food substances are
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transformed into energy or materials that the body Elements and compounds occur in one of three
can use or store. states: gas, liquid or solid. It takes energy to change
Metabolism involves two processes: the state of an element or a compound.
1 Catabolism – the chemical breakdown of This can be illustrated by water, which is usually a
complex substances by the body to form simpler liquid (although it can become solid, as ice, or turn
ones, accompanied by the release of energy. The into steam, a gas). Salt and glucose are examples of
substances that are broken down include nutrients solids, and carbon dioxide is a gas.
in food (carbohydrates and proteins), as well as The body stores energy in chemical bonds between
the body’s storage products (glycogen). the elements that make up its compounds. This
2 Anabolism – the building up of complex molecules, energy, when released, may be used in a variety of
such as proteins and fats, from simpler ones by ways: for example to initiate chemical processes,
living things. to aid movement or for the body’s growth,
maintenance and repair.
Metabolic rate
The rate at which a person consumes energy for activity The chemical make-up
and body processes is known as the metabolic rate. of a cell
The minimum energy required to keep the body alive is
known as the basal metabolic rate. Chemically, a cell is composed of the major
elements carbon, oxygen, hydrogen and nitrogen,
How elements with trace elements of several other elements
such as sodium, calcium, chlorine, magnesium, iron,
contribute to the iodine, potassium, sulfur and phosphorus (Table 2.1).
body’s chemical KEY FACT

make-up Cells are made up of approximately
80% water, 15% protein, 3% lipids or fats,
1% carbohydrates and 1% nucleic acids.
It is important to consider how the body’s chemical
make-up (its most common major elements
and compounds) relates to its physiological
processes.
Table 2.1 Overview of chemical components of the cell

Major compound Elements present Main significance in body
Water Hydrogen and oxygen The body’s reservoir, water provides a universal solvent for
the facilitation of chemical reactions in the tissues
Helps transport substances around the body
Carbohydrates Carbon, hydrogen and oxygen Main fuel for the body
Proteins Carbon, hydrogen, oxygen, nitrogen Main building blocks of the body’s tissues
(may also contain sulfur)
Fats/lipids Carbon, hydrogen and oxygen Energy source for the body’s activities
Energy store
Nucleic acids Carbon, hydrogen, oxygen, nitrogen Important molecules found inside cells
and phosphorus Deoxyribonucleic acid (DNA) is the genetic material inside
the nucleus
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2 Cells and tissues
Cells Study tip

When studying cell structure it is helpful to think of
KEY FACT three parts:
Cytology is the scientific study of cells. 1 the outer part – the cell membrane
2 the inner part – containing the nucleus
The cell is the fundamental unit of all living 3 the middle layer – a semi-fluid substance called
organisms and is the simplest form of life that can cytoplasm which contains all of the cell’s
exist as a self-sustaining unit. Cells are, therefore, organelles.
the building blocks of the human body.
Cells in the body take many forms, the size and The outer part of the cell
shape being largely dependent on their specialised Cell membrane
function. For example, some cells help fight disease,
The cell membrane, or plasma membrane, is a fine
others transport oxygen or produce movement,
membrane that encloses the cell and protects its
some manufacture proteins or chemicals, and others
contents. This membrane is semipermeable, in that it
function to store nutrients.
selectively controls the movement of molecules into
KEY FACT and out of the cell. Oxygen, nutrients and hormones
are taken into the cell as needed and cellular waste,
Each type of cell has a structure that is suited to
its specific function. A muscle cell is long and such as carbon dioxide, passes out through the
thin with structures that enable it to contract membrane. As well as governing the exchange of
and shorten, while skin cells are flat and tough, nutrients and waste materials, its function is also
providing a waterproof covering. to maintain the shape of the cell.
The inner part of the cell

Cell structure
Nucleus
Although cells are the smallest units that show
The nucleus is the largest organelle in the cytoplasm.
characteristics of life, they are made up of
It acts as the control centre of the cell, regulating
different parts.
the cell’s functions and directing most metabolic
Cell organelles activities. The nucleus governs the specialised work
Cell organelles ('little organs') are the basic performed by the cell and the cell’s own growth,
component parts of cells and are formed from repair and reproduction. All cells have at least one
molecules that combine in very specific ways. Each nucleus at some time in their existence. The nucleus
organelle has particular functional significance is significant in that it contains all the information
within the cell. required for the cell to function and it controls all
cellular operations.
Study tip The information required by the cell is stored

in DNA, the genetic material. The DNA is found
When examining the function of each organelle, it
in a molecule called chromatin that condenses
is helpful to think of the cell as the ‘factory’ and the
organelles as ‘departments’ within the factory. Each to form thread-like structures known as
cell organelle is responsible for the production of a chromosomes.
certain product or substance that is used elsewhere Chromosomes carry the genetic information in
in the cell or body. the form of genes. The nucleus of a human cell
contains 46 chromosomes, 23 of which are from the
Despite the great variety of cells in the body, they all mother and 23 of which are from the father. Each
have the same basic structure. chromosome can duplicate an exact copy of itself
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at each cell division, so that every new cell formed The middle part of the cell
receives a full set of chromosomes.
Cytoplasm
KEY FACT Cytoplasm is the gel-like substance which is enclosed
DNA is often called the body’s blueprint, by the cell membrane. The cytoplasm contains the
as it is a record of a person’s inherited nucleus and the organelles.
characteristics – their height, bone structure,
Cell metabolism predominantly takes place inside
hair colour and body chemistry, for example.
When cells divide and multiply, DNA passes the cytoplasm. The cytoplasm, as part of its function,
on its hereditary information, ensuring new cells contains elements that aid metabolic operation and
are direct copies. break down waste.
If the spiral of DNA in the nucleus of just one The centrosome is an area of clear cytoplasm found
human cell were stretched out in a single line, next to the nucleus. It contains the centrioles.
it would extend more than 6 feet.
Centrioles
Chromatin Contained within the centrosome are the small
Chromatin is the substance inside the nucleus that spherical structures called centrioles. These are
contains the DNA and some proteins. associated with cell division, or mitosis. During cell
division, the centrioles divide and migrate to opposite
Nucleolus sides of the nucleus to form the spindle poles.
The nucleolus is a dense spherical structure inside
Chromatids are pairs of identical replicated strands
the nucleus, which contains ribonucleic acid (RNA)
of a chromosome. They are joined at the centromere
structures that form ribosomes.
and separate during cell division.
KEY FACT Ribosomes
RNA is the molecule that transports the genetic Ribosomes are tiny organelles made up of RNA
information out of the nucleus and allows and protein. They may be fixed to the walls of the
translation of the genetic code into proteins.
endoplasmic reticulum (ER) or may float freely in the
cytoplasm. Their function is to manufacture proteins
Nuclear membrane
for use within the cell and also to produce other
Surrounding the cell nucleus is a double-layered proteins that are exported outside the cell.
membrane called the nuclear membrane, or nuclear
envelope. This membrane separates the nucleoplasm, Endoplasmic reticulum
or fluid inside the nucleus, from the cytoplasm, or (smooth ER and rough ER)
fluid outside the nucleus. The ER is a series of membrane tubes that are
The function of the nuclear membrane is to regulate continuous with the cell membrane. It functions like
the materials that enter or exit the nucleus. an intracellular transport system, allowing movement
of materials from one part of the cell to another.
Nuclear pores are tiny passageways through the
It also links the cell membrane with the nuclear
nuclear membrane. They have a sophisticated
membrane and assists the movement of materials in
biological entry and exit control system, only
and out of the cell.
permitting selected chemicals to move in and
out of the nucleus. The ER contains enzymes and helps in the synthesis
of proteins, carbohydrates and lipids. It serves to store
material and to transport substances inside the cell,
Study tip
as well as to detoxify harmful agents. Some of the ER
A nuclear pore is a bit like a ticket gate, acting as
appears smooth, while some appears rough due to
a security control system that guards the barrier
the presence of ribosomes.
between the nucleus and the cytoplasm.
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2 Cells and tissues
Mitochondria of cells that are no longer functioning. This process is

Mitochondria (oval-shaped organelles) lie in varying known as lysis.
numbers within the cytoplasm and are the site of Vacuole
the cell’s energy production. Mitochondria supply Vacuoles are membrane-bound spaces within the
the majority of a cell’s adenosine triphosphate (ATP), cytoplasm that contain waste materials or secretions
a compound that stores the cell’s energy. produced by the cytoplasm. Vacuoles function as
Enzymes are protein catalysts that speed up chemical temporary storage, for transportation from one part of a
change. Mitochondria contain large amounts of cell to another, and for digestive purposes in some cells.
enzymes which power the cell’s activities through
Golgi body/apparatus
cellular respiration.
The Golgi body resembles a collection of flattened
Lysosome sacs and is located within the cytoplasm, typically
Lysosomes resemble round sacs and contain powerful near the nucleus and attached to the ER. The Golgi
enzymes capable of digesting proteins. They are apparatus stores the protein manufactured in the ER
present in the cytoplasm and work to destroy parts and later transports it out of the cell.
Rough
Lysosome endoplasmic
reticulum
Centriole
Smooth
endoplasmic
reticulum
Golgi body
Nucleus
Vacuole
Cytoplasm
Nucleolus
Chromatin
Ribosome
Cell
membrane
Nuclear membrane Mitochondrion
p Structure of a cell
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Summary of function of main cell organelles

Table 2.2 Summary of main cell organelles
Cell organelle Description Location Function

Cell membrane Fine membrane that encloses the cell Outer part Selectively controls the movement of
of cell molecules into and out of the cell
Nucleus Largest organelle in the cytoplasm, Inner part The control centre of the cell, regulating
containing DNA in chromosomes of cell its functions
Nuclear Double-layered membrane surrounding Inner part Regulates the materials that enter or
membrane the cell nucleus of cell exit the nucleus
Cytoplasm Gel-like substance that is enclosed by Middle part Substance that fills the cell
the cell membrane of cell Most cellular metabolism occurs within
the cytoplasm
Ribosomes Tiny organelles made up of RNA and Middle part Manufacture proteins for use within the
protein of cell cell and also to produce other proteins
that are exported outside the cell
Endoplasmic Series of membranes continuous with Middle part Intracellular transport system, allowing
reticulum the cell membrane of cell movement of materials from one part of
the cell to another
Mitochondria Oval-shaped organelles that lie within Middle part Provide the energy which powers the
the cytoplasm of cell cell’s activities
Golgi body Collection of flattened sacs within the Middle part Stores the protein manufactured in
cytoplasm of cell the endoplasmic reticulum and later
transports it out of the cell
Lysosome Round sacs located in the cytoplasm Middle part Destroy any part of the cell that is worn
of cell out
Activity Respiration
Draw a simple cell and label the following cell Every cell requires oxygen for the process of
organelles: respiration. Oxygen is absorbed through the cell’s
● cell membrane ● mitochondria semipermeable membrane and is used to oxidise
● nucleus ● endoplasmic reticulum nutrient material to provide heat and energy. The
● nuclear membrane ● Golgi body waste products of cell respiration include carbon
● ribosome ● lysosome. dioxide and water. These are passed out from the
cell through its semipermeable membrane.
Functions of cells Reproduction
In order for a cell to survive it must be able to carry When growth is complete in a cell, reproduction
out a variety of functions such as growth, respiration, takes place. The cells of the human body reproduce
reproduction, excretion, sensitivity/sensation, or divide by the process of mitosis.
movement and nutrition.
Excretion
Growth During metabolism, various substances are produced
Cells have the ability to grow until they are mature which are of no further use to the cell and can
and ready to reproduce. A cell can grow and repair be damaging. These waste products are removed
itself by manufacturing protein. through the cell’s semipermeable membrane.
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2 Cells and tissues
Sensitivity/sensation
A cell has the ability to respond to a stimulus (a cause or trigger of a
reaction), which may be physical, chemical or thermal. For example,
a muscle fibre contracts when stimulated by a nerve cell.
Movement
Movement may occur in the whole or in part of a cell. White blood cells,
for instance, are able to move freely.
Nutrition
The endoplasmic reticulum and Golgi apparatus manufacture different
substances such as protein and fats, either as needed internally by
the cell or according to its specific function. The cell utilises basic
nutrient molecules that are either dissolved in the cytoplasm or specific
substances contained within vesicles.
Carbohydrates are transported to the mitochondria, where they are
broken down to yield energy. In the process, high-energy ATP molecules
are manufactured and provide energy for other organelles.
In practice
Cell growth and reproduction requires favourable conditions such as an
adequate supply of food, oxygen, water, suitable temperatures and the
ability to eliminate waste.
Some factors, such as smoking, sun damage and air pollution, create
unfavourable conditions for the skin. These can impair cell function and
cells may be destroyed, resulting in loss of skin elasticity, lines, wrinkles
and dehydration.
In these cases, massage treatments can be beneficial. Massage
procedures encourage cell nutrition, as well as increasing elimination
of waste from the cells and tissues. Practitioners can advise clients to
have treatments regularly to aid cell regeneration.
The cell life cycle

For body growth and repair it is vital for living cells to reproduce.
Consequently, human body cells undergo many divisions from the
time of fertilisation/conception to the end of life. When a single cell
undergoes division for growth or repair, it forms two daughter cells that
are identical to the original cell. A cell may live from a few days to many
years, depending on its type.
Depending on the purpose of division, cells divide in one of two ways:
1 mitosis – division of one cell into two genetically identical daughter
cells
2 meiosis – division of one cell into four genetically different daughter
cells.
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1 Mitosis
Mitosis is when a single cell produces two genetically identical daughter
cells. It is the way in which new body cells are produced for both growth
and repair. Division of the nucleus takes place in four main phases
(prophase, metaphase, anaphase and telophase) and is followed by the
division of the cytoplasm to form the daughter cells.
Prophase Metaphase
Telophase Anaphase
p Stages of mitosis
Study tip Interphase (preparation for mitosis)

The acronym PMAT (prophase, A cell must prepare before it can divide into two identical daughter cells
metaphase, anaphase and with equal shares of DNA and organelles. A state known as interphase
telophase) can be helpful when (between phases) precedes mitosis. During interphase, the cell makes a
learning the stages of mitosis. copy of all its DNA. Once the cell has duplicated its DNA and organelles,
● Prophase = chromosomes it can proceed into mitosis.
condense
● Metaphase = chromosomes
Prophase
line up in the centre Chromatin condenses to give distinct chromosomes consisting of
● Anaphase = chromosomes pairs of chromatids joined at the centromere. Centrioles duplicate
separate and separate to form spindles.
● Telophase = chromosomes
Metaphase
de-condense
Chromosomes align themselves in the centre of the cell, midway
between the centrioles. The protective nuclear membrane breaks down.
The centromere of each chromosome then replicates.
Anaphase
Centromeres divide and identical sets of chromosomes move to opposite
poles of the cell
Telophase
This is the final stage of mitosis. A nuclear membrane forms around each
set of chromosomes, giving two new nuclei. The spindle fibres disappear.
The cytoplasm compresses and then divides in half in cytokinesis.
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2 Cells and tissues
Cytokinesis 2 Meiosis
Usually, after telophase, the cytoplasm divides and Meiosis is a type of cell division that produces
separates into two identical daughter cells. Each four daughter cells, each having half the number
daughter cell is an exact copy of the parent cell of chromosomes of the original cell. Meiosis
before the DNA was duplicated during interphase. forms eggs in females and sperm in males and is
p Mitosis and meiosis
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the preparation for formation of a new organism

through the fusion of one egg and one sperm.
Cell transport
As explained, cells export some materials out of the cell
Before fertilisation there are 23 chromosomes
cytoplasm and also receive substances from the outside.
present in the sperm and 23 in the egg. After
fertilisation has taken place, the egg and the sperm The body’s internal transport system, the blood,
fuse together to form a single cell called a zygote carries oxygen from the respiratory system and
with 46 chromosomes (23 from each parent). The nutrients such as glucose from the digestive system
zygote undergoes mitosis to make more and more to the cells. These are absorbed through the cell
cells, forming first an embryo, then a foetus and membrane in several different ways: diffusion,
eventually a baby. osmosis, active transport and filtration. When
certain molecules are needed, such as glucose, the
KEY FACT cell will actively take these in and may discard other
materials in order to preserve the equilibrium.
There is virtually no limit to the ways in which
a reproductive cell’s 23 chromosomes can
be combined during meiosis, meaning that
Diffusion
every sperm and every egg contains different If chemicals become concentrated outside the cell,
hereditary information. Consequently, the a flow of small molecules takes place through the
genetic characteristics of brothers and sisters are cell membrane until there is a balance between the
never the same (except for identical twins, who internal and external concentration. This process,
share the same genetic code).
in which small molecules move from areas of high
concentration to those of lower concentration, is
Cellular respiration called diffusion. Diffusion is the basis by which the
cells lining the small intestines take in digestive
All cellular functions depend on energy generation
products to be utilised by the body.
and transportation of substances within and
between cells. Diffusion
In order to function properly, a cell must maintain a

stable internal environment; therefore, the transport The cell
of materials has to be achieved without an excessive membrane
build-up of chemicals. Cell respiration refers to

the cell’s use of nutrients (such as oxygen and
glucose) to activate the energy needed for the cell
to function and the output of waste (such as carbon High Low Equal
dioxide). concentration concentration concentration
In order for cells to carry out their work, they Diffusion: the process in which small molecules move from
p

need to produce enough energy. Fuel for energy is an area of high concentration to lower concentration
provided by glucose from carbohydrate metabolism.
In order for the energy in glucose to be released, Osmosis
it is oxidised by oxygen that is absorbed from the This process refers to the movement of water through
respiratory system into the bloodstream (external the cell membrane from areas of low chemical
respiration). concentration (many water molecules) to areas of
Cells are bathed in a fluid known as tissue fluid or high chemical concentration (fewer water molecules).
interstitial fluid, which allows the interchange of This process allows for the dilution of chemicals, which
substances between the cells and the blood. This is are unable to cross the cell membrane by diffusion,
known as internal respiration. in order to maintain equilibrium within the cell.
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2 Cells and tissues
Osmosis 1 Pinocytosis
Pinocytosis is derived from pino, Greek for ‘to drink’
The cell and cytosis, ‘a transport mechanism’. It is a process
membrane
whereby small droplets are taken into the cell. The
cell encases the droplets inside vesicles that are
formed from parts of the cell membrane that have
been split off. This cell process is used for taking
Area of low Area of high Equal
chemical concentration chemical concentration concentration extracellular fluid into the cell.
Osmosis: the movement of water through the cell
p 2 Phagocytosis
membrane from low to high chemical concentration The word phagocytosis comes from the Greek
phago, meaning ‘to eat’. It describes the process
Active transport by which a cell engulfs (takes in) particles such as
This is an energy-dependent process in which certain bacteria and other micro-organisms, old red blood
substances (including glucose, ions, some drugs and cells and foreign matter.
amino acids) are able to cross cell membranes against The principal human phagocytes (cells that carry out
a concentration gradient (moving from an area phagocytosis) include the neutrophils and monocytes,
with a lower number of particles to an area with a which are types of white blood cells.
higher number of particles). This is the process, using
Pinocytosis and phagocytosis are similar processes,
chemical energy, by which the cell takes in larger
but have some key differences:
molecules that would otherwise be unable to enter in
sufficient quantities. Carrier molecules within the cell ● Larger materials such as bacteria, which are too
membrane bind themselves to the molecules, rotate big to be absorbed by pinocytosis, are absorbed
around them and release them into the cell. by phagocytosis.
● Solid materials are absorbed through
Filtration phagocytosis, while liquids and dissolved solutes
This is the movement of water and dissolved are ingested through pinocytosis.
substances across the cell membrane due to ● The liquid contents of small vesicles from
differences in pressure. The force of the weight of pinocytosis are deposited directly into the cell.
the tissue fluid pushes against the cell membrane, However, the vesicles from phagocytosis are
thereby moving molecules into the cell. One site bigger and the contents are not deposited directly
of filtration in the body is in the kidneys. Blood into the cell.
pressure forces water and small molecules through ● In order for the vesicle contents to be broken
plasma membranes of cells and the filtered liquid down during phagocytosis, the vesicles combine
then enters the kidneys for further processing and with lysosomes.
disposal through the renal system.
Pinocytosis and phagocytosis Tissues

Like us, cells can ‘drink’ (take in liquid) and ‘eat’ Tissues are defined as a group of similar cells that act
(take in particles). These processes are: together to perform a specific function.
1 pinocytosis
KEY FACT
2 phagocytosis.
The study of tissues is known as histology.
Study tip Due to the complexity of the human body, it is not

Remember: possible for every cell to carry out all the functions
● pinocytosis = cell drinking required by the body. Some cells, therefore, become
● phagocytosis = cell eating. specialised to form a group of cells or tissues.
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There are four major types of tissues in the human body:

1 epithelial tissue
2 connective tissue
3 muscle tissue
4 nervous tissue.
Table 2.3 gives an overview of the four major types of tissue in the body.
Table 2.3 Overview of tissue types
Type of tissue Main function

Epithelial tissue Provides a protective covering for surfaces inside
and outside the body
Connective tissue Protects, binds and supports the body and its organs
Muscle tissue Provides movement
Nervous tissue Initiates and transmits nerve impulses
KEY FACT
The four types of tissue have different rates of cellular
regeneration, related to their specific functions.
● Epithelial tissue is renewed constantly by the process of mitosis
(cell division).
● Bone tissue and adipose connective tissue have a very good
blood supply (described as being highly vascular tissue). A
supply of nutrients allows tissue to repair and heal quickly
through fast cell division.
● Muscle tissue takes longer to regenerate.
● Nervous tissue regenerates very slowly.
● Muscle and nerve cells divide more slowly as they are more
specialised in their function. Once cells in the body become
specialised, they take on structures unique to their specific
functions; these structures are not always compatible with cell
division.
● The less vascular forms of connective tissue, such as ligaments
and tendons, are even slower to heal than muscle tissue.
Cartilage is among the slowest to heal.
1 Epithelial tissue
Epithelial tissue consists of sheets of cells which cover and protect the
external and internal surfaces of the body, lining the insides of hollow
structures. They are specialised to move substances in and out of the
blood during secretion, absorption and excretion. As these tissues are
subject to considerable wear and tear, epithelial cells reproduce actively
to repair surfaces very quickly.
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2 Cells and tissues
Epithelial tissue usually has a very thin matrix (ground substance or

base). The matrix is a continuous sheet of cells, which are held very
tightly together. A thin, permeable basement membrane attaches
epithelial tissues to the underlying connective tissue. Epithelial tissue
cells, which are closely packed together, come in various shapes. There
are two categories of epithelial tissue:
● simple (single-layer) epithelial tissue
● compound (multi-layer) epithelial tissue
Simple epithelium
Simple epithelial tissue has only one layer of cells over a basement
membrane. Being thin, these tissues are fragile and are found only in
areas inside the body which are relatively protected. Examples are
the lining of the heart, blood vessels and the linings of body cavities.
Squamous epithelium Ciliated epithelium

Found in the heart Found in the respiratory tract
Types of
epithelial
tissue
Cuboidal epithelium Coumnar epithelium

Found in the kidneys Found in the intestines
Transitional epithelium Stratified keratinised epithelium

Found in the bladder Found in the skin
p Types of epithelial tissue
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They are also found lining the digestive tract and ● Keratinised stratified epithelium – this is found
in the exchange surfaces of the lungs, where their on dry surfaces, such as the skin, hair and nails. The
thinness is an advantage for speedy cross-membrane surface layers of keratinised cells are dead cells.
transport. There are four different types of simple They give protection and prevent drying out of the
epithelium, named according to their shape and the cells in the deeper layers from which they develop.
functions they perform: simple squamous, simple The surface layer of cells is continually being
cuboidal, simple columnar, simple ciliated (columnar). rubbed off and is replaced from below.
See Table 2.4.
Transitional epithelium
Compound epithelium Transitional epithelium is composed of several layers
The main function of compound epithelium is to of pear-shaped cells which change shape when they
protect underlying structures. Compound epithelium are stretched. This type of tissue is found lining the
contains two or more layers of cells. There are two uterus, bladder and pelvis of the kidney.
main types:
● stratified epithelium
2 Connective tissue
Connective tissue is the most abundant type of
● transitional epithelium.
tissue in the body. It connects tissues and organs by
Stratified epithelium binding the various parts of the body together, giving
Stratified epithelium is composed of a number of protection and support.
layers of cells of different shapes. In the deeper layers Connective tissue has three components: a matrix,
the cells are mainly columnar in shape and as they cells called fibroblasts and fibres made of protein.
grow towards the surface they become flattened. Connective tissue cells are often more widely
There are two types of stratified epithelium: separated from each other than those forming
● Non-keratinised stratified epithelium – this epithelial tissue; the space between cells is larger
is found on wet surfaces that may be subject and is filled with non-living matrix. There may or
to wear and tear, such as the conjunctiva of the may not be fibres in the matrix, which can be either
eyes, the lining of the mouth, the pharynx and the a semi-solid, jelly-like consistency or dense and rigid,
oesophagus. depending on the position and function of the tissue.
Table 2.4 The structure, location and function of the different types of simple epithelial tissue
Type Structure Location Function

Simple A single layer of flat, scale-like cells, Lining the alveoli of the lungs Allows for exchange of
squamous each with a central nucleus Lining blood and lymphatic nutrients, wastes and gases
The cells fit closely together, rather vessels and the heart
like a pavement, producing a very
smooth surface
Simple Single layer of cube-like cells Ovaries, kidney tubules, Secretion and absorption
cuboidal thyroid gland, pancreas and
salivary glands
Simple Single layer of tall, cylindrical column- Lining the small and large Secretion and absorption
columnar shape cells, each with a nucleus intestine, stomach and gall
situated towards the base of the cell bladder
Simple A form of columnar epithelium Lining the upper part of the Beating cilia carry unwanted
ciliated Single layer of rectangular cells that respiratory system particles, along with mucus,
(columnar) have hair-like projections (cilia) on Lining the uterine tubes out of the system
their surface Helps propel the ova towards
the uterus
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2 Cells and tissues
Cartilage Nervous
Extracellular
matrix
Bone
Muscle (skeletal)
Tendon Ligament
Blood Adipose tissue

White blood cells
Cytoplasm
Platelets
Red blood cells
p Types of connective tissue

There are several different types of connective tissue, which are
summarised in Table 2.5.
Table 2.5 Types of connective tissue

Areolar Most widely distributed type of Under the skin, between muscles, Provides strength and
connective tissue in the body supporting blood vessels and elasticity
A loose, soft and pliable tissue nerves, and in the alimentary canal Connects and supports
Contains collagen, elastin and organs
reticular fibres
Adipose A type of areolar tissue Surrounds organs such as kidneys Provides insulation, support
containing fat cells (adipocytes) and the heart and protection
Under the skin (subcutaneous layer) Emergency energy reserve
Between bundles of muscle fibres,
in the yellow bone marrow of long
bones and as a padding around joints
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White Strong connecting tissue made Forms tendons which attach muscle Provides strong attachment
fibrous up of mainly closely packed to bone, ligaments which tie bones between different structures
bundles of white collagenous together and as an outer protective
fibres, with very little matrix covering for some organs, such as
Contains cells called fibrocytes kidney and bladder
between the bundles
Yellow Consists of branching yellow Arteries, trachea, bronchi and lungs To allow the stretching of
elastic elastic fibres with fibrocytes in various organs, followed
the spaces between the fibres by a return to their original
shape and size
Lymphoid This tissue has a semi-solid In the lymph nodes, spleen, Forms part of the lymphatic
matrix with fine branching fibres tonsils, adenoids, walls of the large system whose function is
The cells contained within this intestine and glands of the small to protect the body from
tissue are specialised and are intestine infection
called lymphocytes
Blood Also known as liquid connective Contained within blood vessels Helps maintain homeostasis
tissue, it contains the blood cells by transporting substances
erythrocytes, leucocytes and throughout the body, by
thrombocytes which float within resisting infection and by
a fluid called plasma dispersing heat
Bone Hardest and most solid of all Bones Protects and supports other
connective tissues organs and soft tissues
Consists of tough, dense
compact bones and slightly less
dense cancellous bone
Cartilage Very firm tissue; matrix is quite solid See Table 2.6 See Table 2.6
Cartilage
For descriptive purposes, cartilage is divided into three types (see Table 2.6):
1 hyaline cartilage
2 white fibrous cartilage
3 yellow elastic fibrocartilage.
Table 2.6 Types of cartilage
Type of
cartilage Description Location Function
Hyaline Most abundant type of cartilage found Found on the surfaces of the Provides a hard-
cartilage in the body parts of bones which form joints wearing, low friction
A smooth, bluish-white, glossy tissue Forms the costal cartilage which surface within joints
Contains numerous cells called attaches the ribs to the sternum Provides flexibility
chondrocytes which produce cartilage Forms part of the larynx, trachea in the nose and
and bronchi trachea
White fibrous This type of cartilage is tough but It is found as pads between the Its function is one
cartilage slightly flexible bodies of the vertebrae, called of support and to
It is composed of bundles of the intervertebral discs, and in join together or fuse
collagenous white fibres in a solid the symphysis pubis which joins certain bones
matrix with cells scattered among them the pubis bones together
➜
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2 Cells and tissues
Type of
cartilage Description Location Function
Yellow elastic Consists of yellow elastic fibres It forms the pinna (lobe of the To provide support
fibrocartilage running through a solid matrix, ear) and the epiglottis and to maintain
between which chondrocytes are shape
situated
Muscle tissue transmitted as electrical signals. Nervous tissue has

the characteristics of excitability and conductivity.
Muscle tissue is very elastic and has the unique Its functions are to co-ordinate and regulate body
ability to provide movement by shortening as a activity.
result of contraction. This tissue is made up of Nervous tissue and neurones are discussed in more
contractile fibres, usually arranged in bundles and detail in Chapter 9, The nervous system.
surrounded by connective tissue. There are three
types of muscle tissue: 4 Membranes
1 voluntary (skeletal) muscle
A membrane is a thin, soft, sheet-like layer of tissue
2 involuntary (smooth) muscle that covers a cell, organ or structure, that lines tubes
3 cardiac muscle. or cavities or that divides and separates one part of
The different types of muscle tissue are discussed in a cavity from another. There are three basic types
more detail in Chapter 5, The muscular system. of membranes in the body (see Table 2.7):
● mucous membrane
3 Nervous tissue ● serous membrane
Nervous tissue consists of cells called neurones which ● synovial membrane.
can convert stimuli into nerve impulses that are
Table 2.7 Types of membrane
Type of
Membrane Description Location Function
Mucous Type of membrane that lines Lining the respiratory, As well as lining the openings to the
membrane body cavities and outer layer of digestive, urinary and external environment, secretes a viscous
organs reproductive tracts slippery fluid called mucus that coats
and protects underlying cells
Serous Type of membrane that lines The pericardium of the As well as lining body cavities that are
membrane body cavities which are not open heart not open to the external environment,
to the external environment and Pleural membranes they secrete a thin, watery (serous) fluid
that covers many of the organs in the lungs that lubricates organs to reduce friction
Serous membranes consist of The peritoneum lining as they rub against one another and
two layers: the abdominal organs against the wall of the cavities
● a parietal layer – lines the wall
of body cavities
● a visceral layer – provides an
external covering to organs in
body cavities
Synovial Type of membrane that lines the Lining the spaces Secretes synovial fluid which provides
membrane cavities of freely movable joints around certain joint nutrition and lubrication to joints so they
cavities (shoulder, hip can move freely without undue friction
and knee)
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Activity
Create a mind map that identifies the different type(s) of tissue found
in the following body parts:
● skin ● stomach ● spleen
● hair ● pancreas ● kidneys
● nail ● gall bladder ● bladder
● lungs ● small intestine ● uterus
● heart ● large intestine ● ovaries.
System level of organisation

of the body
A system is a group of organs that work together to perform specific
functions. Cells and tissues are the building blocks that make up the
body’s systems.
Although the subject matter on each body system is organised into
a separate chapter in this textbook, it is important to realise no one
system works independently of another. All the systems require the
support of and co-ordination with other systems to form a healthy
living human body.
Towards the end of each chapter you will find a section called
‘Interrelationships with other systems’. The information in these sections
will help you to understand how the body systems work together
to maintain balance.
Table 2.8 provides an overview of each body system’s function.
Table 2.8 Overview of body systems
Body system Function

Integumentary The body’s largest organ
system (skin, hair Protects us from the outside world by providing the first line of defence against bacteria,
and nails) viruses and other pathogens
Skeletal system Provides shape, support and protection for the body
Muscular system Enables movement of the body
Cardiovascular Provides a transport system of blood around the body
system
Lymphatic system Provides a filtering system for the blood and tissues
Respiratory system Enables gaseous exchange through the lungs
Nervous system Responsible for receiving and interpreting information from inside and outside the body
Endocrine system Secretes hormones to help regulate body processes
Reproductive system Responsible for producing human offspring to continue the species
Digestive system Responsible for the breakdown of food and absorption of nutrients
Urinary system Provides elimination of metabolic waste through the kidneys via the production of urine
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2 Cells and tissues
Study tip
The human body is extremely complex. When you start learning about the body’s systems, it can be helpful to
think of them in comparison to a house:
● The cells and tissues are the building blocks (bricks and mortar).
● The skin represents the outside of the house (a protective covering).
● The skeletal and muscular systems are the structural framework and support.
● The circulatory system is part of the plumbing, taking fluid to all parts of the house.
● The lymphatic system is also part of the plumbing system, helping to remove waste fluids.
● The respiratory system provides the home’s ventilation.
● The digestive system is the kitchen and sewerage system!
● The excretory system compares to the toilet and drainage.
● The endocrine system is like the heating thermostat, controlling the temperature (and keeping other
processes running smoothly).
● The nervous system is the electrical wiring.
● The reproductive system is the family within the house that has the potential to grow.
Common pathologies of cells

and tissues
Cancer/abnormal cell division
In practice
Cancerous diseases are characterised by the growth of abnormal cells
that invade surrounding tissues, followed by the process of metastasis The study of tumours is called
(the spread of cancerous cells to other parts of the body). oncology and a physician who
specialises in this field is called
When cells in an area of the body divide without control, the excess
an oncologist.
tissue develops into a tumour, growth or neoplasm.
A cancerous growth is called a malignant tumour and a non-cancerous
growth is called a benign tumour. Cancerous growths may eventually be
fatal. Benign tumours do not spread to other parts of the body, but they may
be removed if they interfere with a normal body function or are disfiguring.
The name of the cancer is derived from the type of tissue in which it
develops. Cancers are further classified according to their microscopic
appearance and the body site from which they arise.
Most human cancers are carcinomas. These are malignant tumours that
arise from epithelial cells. Examples are:
● melanoma – a cancerous growth of melanocytes, the skin cells that
produce the pigment melanin
● sarcoma – a general term for any cancer arising from muscle cells or
connective tissues (for example, osteogenic sarcoma (bone cancer)
is the most frequent type of childhood cancer; this destroys normal
bone tissue and eventually spreads to other areas of the body)
● leukaemia – a cancer of blood-forming organs characterised by rapid
growth and distorted development of leucocytes
● lymphoma – a malignant disease of lymphatic tissue such as the
lymph nodes, e.g. Hodgkin’s disease.
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Interrelationships with Respiratory

other systems A type of tissue called ciliated columnar epithelium
lines the respiratory tract. The cilia carry unwanted
Cells and tissues particles, such as bacteria, pollen and dust, out of
the system.
Cells and tissues are found in the following body
systems. Nervous
Neurones and neuroglia are the specialised cells
Skin that form the nervous tissue. They enable the body
Keratinised stratified epithelium (a type of tissue to receive and transmit nerve impulses in order to
containing layers of cells) is found on dry surfaces regulate and co-ordinate body activities.
such as the skin, hair and nails.
Endocrine
Skeletal The endocrine glands are made from epithelial
Bone is the hardest and most solid type of tissue. They secrete hormones directly into the
connective tissue in the body. It is needed for bloodstream to influence the activity of other
building the structures of the skeletal framework. organs or glands.
Muscular Digestive
There are three types of muscle tissue: The digestive system is lined with epithelial tissue.
1 skeletal muscle, which controls voluntary This contains goblet cells which secrete mucus to aid
movements the flow of material through the digestive system.
2 smooth muscle, which controls involuntary
movements Urinary
3 cardiac muscle, which makes up the heart. The bladder is lined with transitional epithelium
which allows the bladder to expand when full and
Circulatory deflate when empty.
Blood is a form of liquid connective tissue that
transports substances to and from the cells in
different parts of the body.
Key words Centrosome: an area of clear cytoplasm around the

nucleus which contains the centrioles
Cells Chromatid: a pair of identical strands of a replicated
chromosome that are joined at the centromere and
Active transport: the process by which molecules
which separate during cell division
move across a cell membrane from a lower to a
higher concentration using energy Chromatin: the substance inside the nucleus that
contains the DNA
Atom: the smallest particle of an element
Chromosome: the thread-like DNA structure in the
Cell: the basic unit of all living organisms
cell nucleus that carries the genetic information in
Cell membrane: a fine membrane that encloses the the form of genes
cell and protects its contents
Cytokinesis: the cytoplasmic division of a cell at
Cell respiration: the chemical processes that the end of mitosis or meiosis, bringing about the
generate most of the energy in the cell separation into two daughter cells
Centrioles: small spherical structures which are Cytoplasm: a gel-like substance enclosed by the cell
associated with cell division membrane that contains organelles
Centromere: the portion of a chromosome where Diffusion: the process in which small molecules
the two chromatids are joined move from areas of high concentration to those of
lower concentration
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2 Cells and tissues
Endoplasmic reticulum: a series of membranes that Pinocytosis: the method by which a cell absorbs
are continuous with the cell membrane and which small droplets outside the cell and brings them inside
allow movement of materials from one part of the Ribosome: a tiny organelle that may be attached
cell to another to the endoplasmic reticulum or may be within
Filtration: the movement of water and dissolved the cytoplasm; ribosomes manufacture proteins for
substances across the cell membrane due to use within the cell
differences in pressure System: a group of organs that work together to
Golgi body: a collection of flattened sacs within the perform specific functions
cytoplasm that is involved in protein production and Tissue: a group of similar cells that perform a
transport particular function
Homeostasis: the process by which the body maintains Vacuole: a membrane-bound space for storage
a stable internal environment for its cells and tissues within the cytoplasm of the cell
Lysosome: round sacs in the cytoplasm containing
powerful enzymes that are capable of digesting Tissues
proteins Adipose tissue: a type of connective tissue
Meiosis: the division of one cell into four genetically containing fat cells
different daughter cells Areolar tissue: the most widely distributed type of
Metabolism: a physiological process in the body connective tissue in the body, providing strength
that converts energy from food into fuel and elasticity
Mitochondria: oval-shaped organelles for energy Blood: a type of liquid connective tissue, containing
production, located in the cell’s cytoplasm the blood cells erythrocytes, leucocytes and
thrombocytes in a fluid called plasma
Mitosis: the division of one cell into two genetically
identical daughter cells Bone: the hardest and most solid of all connective
tissues
Molecule: a particle composed of two or more
atoms joined together Cartilage: a tough, elastic, firmer type of fibrous
connective tissue contained within joints
Nuclear membrane: a double-layered membrane
surrounding the nucleus which regulates the Ciliated epithelium: a form of columnar epithelium
materials that enter or exit the nucleus with a single layer of rectangular cells that contain
hair-like projections (cilia) from its surface
Nuclear pore: a tiny passage through the nuclear
membrane forming the system that controls entry Columnar epithelium: a type of simple epithelium
and exit into the nucleus with a single layer of tall, cylindrical column cells,
each with a nucleus situated towards its base
Nucleolus: a dense spherical structure inside the
nucleus, containing RNA Compound epithelium: a type of epithelium
containing two or more layers of cells
Nucleus: the control centre of the cell that regulates
the cell’s functions Connective tissue: a type of tissue that connects
tissues and organs by binding the various parts of
Organ: a specialised structure made up of different
the body together
types of tissue
Cuboidal epithelium: a type of simple epithelium
Osmosis: the movement of water through
with a single layer of cube-like cells, adapted for
the cell membrane from areas of low chemical
secretion and absorption
concentration to areas of high chemical
concentration Epithelial tissue: sheets of cells which cover and
protect the external and internal surfaces of the body
pH scale: a chemical rating scale used to measure
the acid or alkaline (base) content of a substance Histology: the study of tissues
Phagocytosis: the process by which a cell engulfs Homeostasis: the process by which the body
particles such as bacteria maintains a stable internal environment for its cells
and tissues
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Lymphoid tissue: a type of connective tissue with Stratified epithelium: a type of compound
a semi-solid matrix and fine, branching fibres; epithelium composed of a number of layers of cells
contains specialised lymphocytes of different shapes
Muscular tissue: a type of tissue made up of Synovial membrane: a type of membrane that lines
contractile fibres, usually arranged in bundles the joint cavities of freely movable joints
and surrounded by connective tissue Tissue: a group of similar cells that perform a
Mucous membrane: a type of membrane that particular function
lines body cavities and makes up the outer layer of Transitional epithelium: a type of compound
organs epithelium composed of several layers of pear-
Nervous tissue: a type of tissue that initiates and shaped cells which change shape when they are
transmits nerve impulses stretched
Serous membrane: a type of membrane lining White fibrous tissue: strong, connecting tissue
body cavities that are not open to the external made up of white, collagenous fibres to provide
environment (for example the heart has a serous strong attachment between different structures
membrane called the pericardium) Yellow elastic tissue: type of connective tissue
Simple epithelium: a type of tissue with only one consisting of branching yellow elastic fibres to
layer of cells over a basement membrane allow the stretching of various organs, followed by
Squamous epithelium: a type of simple a return to the original size and shape
epithelium; a single layer of flat, scale-like cells
with a central nucleus
Revision summary bodies to convert the food we eat and the air
we breathe into the energy our cells need to
Cells function.
● The human body has five levels of structural ● The minimum energy required to keep the body
organisation – atoms and molecules, cells, tissues, alive is known as the basal metabolic rate.
organs and systems. ● Major elements and compounds are involved
● Atoms and molecules are the lowest level of in the body’s make-up (e.g. oxygen, carbon,
organisational complexity in the body. hydrogen, nitrogen, calcium and phosphorus).
● Cells are the smallest units that show characteristics
● Chemically, a cell is composed of the major
of life.
elements carbon, oxygen, hydrogen and nitrogen.
● A tissue is a group of similar cells that perform a
● Cells are made up of approximately: 80% water,
certain function.
15% protein, 3% lipids or fats, 1% carbohydrates,
● An organ consists of tissues grouped into a
1% nucleic acids.
structurally and functionally integrated unit.
● A system is a group of organs that work together ● A cell is the basic, living, structural and functional
to perform a specific function. unit of the body.
● Homeostasis is the process by which the body ● The principal parts of the cell are the cell membrane
maintains a stable internal environment for its and its organelles, which play specific roles in
cells and tissues. cellular growth, maintenance, repair and control.
● Homeostatic mechanisms in the body include the ● The cell membrane encloses the cell and protects
regulation of body temperature, blood pressure, its contents. It is semipermeable and governs the
blood sugar level and pH. exchange of nutrients and waste materials.
● The term metabolism is used to describe the ● The nucleus controls the cell’s activities and
physiological processes that take place in our contains the genetic information.
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2 Cells and tissues
● The cytoplasm is the substance inside the cell absorbed from the respiratory system into the
between the cell membrane and the nucleus. bloodstream.
● The ribosomes are sites of protein synthesis. ● Cells are bathed in a fluid known as tissue fluid,
● The endoplasmic reticulum links the cell or interstitial fluid, which allows the interchange
membrane with the nuclear membrane and of substances between the cells and the blood,
assists movement of materials out of the cell. known as internal respiration.
● The Golgi body processes, sorts and delivers
proteins and lipids (fats) to the cell membrane, Tissues
via lysosomes and secretory vesicles. ● A tissue is a group of similar cells that are
● The lysosome is a round sac in the cytoplasm specialised for a particular function.
that contains powerful enzymes to help destroy ● The tissues of the body are classified into four
waste and worn-out cell materials. main types: epithelial, connective, muscular
● The mitochondria are the ‘powerhouses’ and nervous.
of the cell where respiration takes place to
● Epithelial tissue covers and lines many organs
produce energy.
and vessels.
● The centrosome is a dense area of cytoplasm,
● There are two categories of epithelial tissue:
containing the centrioles.
simple (single layer) and compound (multi-layer).
● The centrioles are paired small spherical
● There are four different types of simple epithelium:
structures associated with mitosis (cell division).
● The chromatids are a pair of identical strands squamous, cuboidal, columnar and ciliated.
● There are two different types of compound
of a chromosome that are joined at the
centromere and separate during cell division. epithelium: stratified and transitional.
● The centromere is the portion of a chromosome ● Connective tissue is the most abundant type of
where the two chromatids are joined. body tissue. It connects tissues and organs to give
● Functions of cells include respiration, growth, protection and support.
excretion, movement, sensitivity and ● Connective tissue consists of the following different
reproduction. types: areolar, adipose, white fibrous, yellow
● Cell division is the process by which cells elastic, lymphoid, blood, bone and cartilage.
reproduce themselves. ● Muscle tissue is elastic and is modified for
● Mitosis is cell division that results in an increase contraction. It is found attached to bones (skeletal
in body cell numbers and involves division of muscle), in the wall of the heart (cardiac muscle)
nuclei. and in the walls of the stomach, intestines, bladder,
uterus and blood vessels (smooth muscle).
● Meiosis is reproductive cell division and results in
the formation of eggs and sperm. ● Nervous tissue is composed of nerve cells called
neurones, which pick up and transmit nerve
● Cells function through the exchange of fluids,
signals.
nutrients, chemicals and ions which are carried
out by passive processes such as diffusion, ● Membranes are thin, soft, sheet-like layers of
osmosis and filtration, and active processes such tissue.
as active transport. ● Mucous membranes line cavities that open to
● Cell respiration is the use of nutrients such as the exterior, such as the digestive tract.
oxygen and glucose, and output of waste such as ● Serous membranes line body cavities that are
carbon dioxide, by the cell to produce the energy not open to the external environment (such as the
needed for the cell to function. lungs and the heart).
● The fuel required by cells is provided by glucose ● Synovial membranes line joint cavities of freely
from carbohydrate metabolism and oxygen movable joints such as the shoulder, hip and knee.
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Test your knowledge 6 Where would you find squamous epithelium?

a in the lungs
questions b in the brain
c in the kidneys
Multiple choice questions d in the ovaries
1 What is the name of the process by which the 7 Where would you find ciliated epithelium?
body maintains a stable internal environment of a in the kidney tubules
its cells and tissues? b in the eyes
a physiology c in the respiratory system
b metabolism d in the pancreas
c homeostasis 8 Where would you find columnar epithelium?
d anatomy a in the small and large intestine
2 A system is a b in the stomach
a group of similar cells that perform a particular c in the gall bladder
function d all of the above
b group of organs that work together to 9 Which is the most widely distributed type of
perform specific functions connective tissue in the body?
c a specialised structure made up of different a areolar tissue
types of tissues b adipose tissue
d a specialised structure made up of different c epithelial tissue
types of cells. d white fibrous tissue
3 What is the simplest form of life that can exist as 10 The control centre of the cell that directs nearly
independent self-sustaining units? all metabolic activities is the:
a tissues a mitochondria
b cells b Golgi body
c atoms c nucleus
d organs d cell membrane.
4 Which is the correct order of the five levels of
organisation in the human body, from the lowest Exam-style questions
to the highest? 11 List the five levels of organisation of the body.
a cells, atoms and molecules, organs, tissues, 5 marks
systems 12 List three functions of cells. 3 marks
b tissues, cells, atoms and molecules, organs,
13 State three functions of the cell membrane.
systems
2 marks
c atoms and molecules, cells, tissues, organs,
systems 14 Which part of the cell contains the genetic
d atoms and molecules, tissues, cells, organs, materials for replication? 1 mark
systems. 15 List the four major types of tissues in the human
5 Where is non-keratinised stratified epithelium body. 4 marks
found? 16 List the four different types of simple epithelium.
a bladder 4 marks
b intestines
c lining of mouth
d hair
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3 The skin, hair
and nails
Introduction
The skin is the largest of the body’s organs,
making up approximately 16% of a person’s
body weight and with a surface area of 1.8 m2.
It is a dynamic organ in a constant state of
change, as cells from the outer layers are
continuously shed and replaced by inner cells
moving up to the surface. Like a cell membrane,
the skin provides a barrier between the external
environment and our internal organs. Located
within its layers are several types of tissues that
carry out specific functions, such as protection,
temperature regulation and excretion.
A change in the surface appearance and texture
of the skin may be the first sign of a lack of
balance between skin and its related systems.
The nail is an appendage (an attachment or a
projecting part) of the skin and is a modification
of the stratum corneum (horny) and stratum
lucidum (clear) layers of the epidermis. Nails are
non-living tissue. Their two main functions are
protection for the fingers and toes and as tools
for the manipulation of objects.
Hair is also an appendage of the skin and grows
from a sac-like depression in the epidermis
called a hair follicle. The primary function of
hair is protection.
OBJECTIVES
● the structure and functions of the skin
● how the skin repairs itself
● the characteristics of the different skin

types and skin conditions
● the structure and functions of hair
● the structure and functions of nails
● common pathologies associated with the

skin, hair and nails
● the interrelationships between the skin and
other body systems.
9781510435179.indb 37 04/10/18 4:48 PM

In practice Heat regulation

It is important for therapists to have a The skin helps to regulate body temperature.
comprehensive knowledge of the structure and ● When the body is losing too much heat:
functions of the skin in order to understand ● The blood capillaries near the skin surface
the processes of skin cell renewal and product contract, to keep warm blood away from
penetration, so that they can offer the most effective the surface of the skin and closer to major
treatments and products for their client’s skin type. organs.
The skin is highly significant in that its condition ● The erector/arrector pili muscles raise the
reflects the body’s underlying health and wellbeing hairs and trap air next to the skin so that heat
and it is also the foundation on which all treatments is retained.
are undertaken. ● The adipose tissue in the dermis and the
subcutaneous layer helps to insulate the body
against heat loss.
The functions of the ● When the body is too warm:
skin ● The blood capillaries dilate to allow warm

blood to flow near to the surface of the
The skin is so much more than an external covering. skin, so heat can be lost in order to cool
It is a highly sensitive boundary between our bodies the body.
and the environment. The skin has several important ● The evaporation of sweat from the surface of
functions: the skin also assists in cooling the body.
● sensitivity
● heat regulation Absorption
● absorption The skin has a limited ability to absorb materials.
● protection Substances that can be absorbed by the epidermis
include fat-soluble molecules such as oxygen, carbon
● excretion
dioxide, fat-soluble vitamin A and steroids, along
● storage with small amounts of water.
● vitamin D production
● melanin formation. KEY FACT
The skin is capable of absorbing small particles
of substances such as essential oils due to the
Study tip fact that they contain fat-soluble and water-
It is helpful to think of the mnemonic SHAPES VM soluble components.
(from the initial letters of each of the words in the
list) to help you remember the functions of the
skin. Protection
The skin acts as a protective organ:
Sensitivity ● The film of sebum and sweat on the surface of the
The skin is an extension of the nervous system. It skin, known as the acid mantle, is an antibacterial
is very sensitive to various stimuli due to its many agent that acts as a barrier, preventing the
sensory nerve endings, which can detect changes multiplication of micro-organisms on the skin.
in temperature and pressure and which can register ● The fat cells in the subcutaneous layer of the skin
pain. The skin is most sensitive on the fingertips, the provide padding to help protect bones and major
tongue and the lips. organs from injury.
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3 The skin, hair and nails
● Melanin, which is produced in the stratum germinativum (basal layer) of the epidermis and
germinativum (basal cell layer) of the skin, underlying dermis and they are responsible for the
helps to protect the body from the harmful effects pigmentation of the skin.
of ultraviolet radiation.
● The cells in the horny layer of the skin overlap The structure of the
like scales to stop micro-organisms from
penetrating the skin and to prevent excessive skin
water loss from the body. Before looking at the structure of the skin,
let’s consider a few facts:
In practice ● The skin is a very large organ covering the whole
The mantle of the skin is acidic and varies in pH body (making up approximately 16% of your total
between 4.5 and 6.2 on the pH scale. It is important body weight).
for therapists to consider variations in skin pH, as
● It varies in thickness on different parts of the body.
treatment products with either a high or low pH
It is thinnest on the lips and eyelids, where it must
may be harmful to the skin and may disrupt the
be light and flexible, and thickest and roughest
barrier function, resulting in irritation.
on the soles of the feet and palms of the hands,
where friction is needed for walking and gripping.
Excretion ● The epidermis varies in thickness from 0.1 mm on
The skin functions as part of the excretory system, the eyelids to more than 1 mm on the palms and
eliminating waste through perspiration. The eccrine soles of the feet.
glands of the skin produce sweat, which helps to ● As the skin is the external covering of the body, it is
remove some waste materials from the skin such as easily irritated and damaged, and certain symptoms
urea, uric acid, ammonia and lactic acid. of disease and disorders may be observed.
Storage ● Each client’s skin varies in unique combinations

of colour, texture and sensitivity.
The skin also acts as a storage depot for fat and
water. About 15% of the body’s fluids are stored In practice
in the subcutaneous layer.
The appearance of the skin reflects a client’s
Vitamin D production physiology. Observation of a client’s skin can give
an indication of their nutritional and immune
The skin synthesises vitamin D when exposed to statuses, circulation, age, and genetics, as well as
ultraviolet light. Modified cholesterol molecules their exposure to environmental factors. These all
in the skin are converted by the ultraviolet rays play a significant role in the skin’s colour, condition
in sunlight to vitamin D. This is then absorbed and tone.
by the body for the maintenance of bones and
to facilitate the absorption of calcium and
There are two main layers of skin:
phosphorus from the diet.
1 the epidermis, which is the outer, thinner layer
Melanin formation 2 the dermis, which is the inner, thicker layer.
In the human skin, melanin formation is initiated by Below the dermis is the subcutaneous layer, which
exposure to ultraviolet light and helps to prevent attaches to underlying organs and tissues.
damage caused by this form of radiation. Melanin Although the skin is technically a single organ, these
forms in specialised cells called melanocytes. two main layers, the epidermis and the dermis, do
Melanocytes are especially abundant in the stratum have different structures and functions.
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Hair
Pain receptor
Touch receptor
(Meissner's corpuscle)
Capillary network
Sebaceous gland Epidermis
Erector pili muscle
Heat receptor
(Ruffini endings)
Hair follicle
Dermis
Cold receptor
(Krause corpuscle)
Motor nerve
Hair bulb
Vein
Artery Subcutaneous
layer
Nerve endings
Subcutaneous fat
Subdermal Deep Sweat (eccrine) Pacinian corpuscle

muscle layer fascia gland (pressure receptor)
p The structure of the skin

Dead cells
1 The epidermis Stratum corneum

(horny layer)
The epidermis is the most superficial layer of the
skin and consists of five layers of cells:
The Stratum lucidum
● the stratum germinativum (basal cell layer) – upward (clear layer)
the innermost layer movement Stratum granulosum
of cells (granular layer)
● the stratum spinosum (prickle cell layer) replaces
those lost
● the stratum granulosum (granular layer) from the Stratum spinosum
skin's (prickle cell layer)
● the stratum lucidum (clear layer) surface
● the stratum corneum (horny layer) – the
outermost layer.
Stratum germinativum
(basal cell layer)
Blood capillaries
of dermal papillae
p Layers of the epidermis
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The thickness of the epidermis varies in different Stratum spinosum

types of skin and on different parts of the The stratum spinosum or prickle cell layer is the
body. The average thickness of the epidermis is thickest layer of the epidermis. It is known as the prickle
0.1 mm, which is about the same thickness as cell layer because each of the rounded cells contained
one sheet of paper. The epidermis holds a large within it has short projections that make contact with
amount of water, with the basal cell layer being the neighbouring cells, giving them a prickly appearance.
approximately 80% water and the horny layer The tiny, hair-like structures on the prickle cells
being approximately 15% water. Water is held in eventually become desmosomes, which are small disc-
the spaces between the cells, and the inner layers shape attachments that provide strength and integrity
contain more water than the outer layers. The by holding the upper level of epidermal cells together.
skin’s capacity to retain water decreases with age, The cells of this layer are living and are therefore
making the skin more vulnerable to dehydration capable of dividing by the process of mitosis.
and wrinkles.
The cells of this layer make special fats called
Functions of the epidermis sphingolipids. When these cells reach the top layer
(stratum corneum) these lipids play an important
The epidermis has three primary functions:
role in the retention of moisture by the skin.
1 protecting the body from the external
It is in the stratum spinosum that the keratinocyte
environment, particularly from sunlight
has a major role to play in the skin’s barrier defence.
2 preventing excessive water loss from the body Keratinisation refers to the process that skin cells
3 protecting the body from infection. undergo when they change from living cells with
a nucleus to dead cells without a nucleus. The
Stratum germinativum keratinisation process begins in the upper cells of
The stratum germinativum or basal cell layer is this layer as the cells migrate upwards.
the deepest of the five layers, at the base of the The stratum spinosum is also responsible for cellular
epidermis. Also known as the Malpighian layer, transport of melanosomes (organelles containing
it consists of a single layer of column cells on a melanin). In this layer and in response to sunlight,
basement membrane which separates the epidermis melanocytes synthesise melanosomes full of melanin
from the dermis (the dermal–epidermal junction). and transfer them to neighbouring keratinocytes,
This layer of the epidermis is concerned with cellular providing protection against harmful ultraviolet rays. The
regeneration. The basal cells within this layer are melanin becomes part of the keratinocyte, which then
constantly producing new cells by division. As new continues its journey upwards to the horny layer and
cells are formed, they push adjacent cells towards onwards to desquamation (shedding of dead skin cells).
the skin’s surface. This layer also includes Langerhans cells, which set up
Approximately 95% of the cells within the epidermis an immune response to foreign bodies. These special
are keratinocytes, which deposit a protein called defence cells are spread out among the keratinocytes
keratin. Keratinocyte stem cells reside at the bottom and their role is to attack invading foreign bodies
of the rete ridges at the base of the basal cell layer. that have found their way into the body through the
Keratin makes the epidermal cells more resilient skin, then transporting them to be neutralised by
and protective as they are pushed towards the skin’s specialised white blood cells.
surface. Stratum granulosum
At intervals between the column cells, which The stratum granulosum or granular layer consists
divide to reproduce, are large star-shaped cells of distinctly shaped cells that resemble granules.
called melanocytes. These form the pigment They are filled with keratin and produce intercellular
melanin, the skin’s main colouring agent. This layer lipids (the substances that fill the spaces between
also contains tactile (Merkel) discs that are sensitive the upper epidermal cells) from structures called
to touch. lamellar bodies.
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These lipids form a strong cement-like substance Cells in this clear layer release lipids from the
that prevents the absorption of harmful substances bilayers (glue that holds the corneocytes together).
by the skin and helps maintain hydration of the These lipids play an important role in skin barrier
lower layers. This layer has an appearance of a wall defence by slowing down transdermal water flow and
of bricks (the cells) and mortar (lipids). maintaining hydration of epidermis.
As the cells move into the stratum granulosum, a number The stratum lucidum is very shallow in facial skin, but
of changes occur to the keratinocyte. The keratinocyte thick on the soles of the feet and the palms of the
becomes less flexible and more granular in appearance hands, and is generally absent in hairy skin.
and the keratin within the cell hardens completely,
Stratum corneum
thereby completing the keratinisation process. The
granular hardened structure of the keratinocyte helps The stratum corneum or horny layer is the outermost
prevent absorption of many substances by the skin and skin layer, consisting of dead, flattened keratinocytes,
assists maintaining hydration of lower layers. which are now known as corneocytes. The cells of this
layer form a waterproof covering for the skin and help
As the cells move further up into the granular
to prevent the penetration of bacteria.
layer, further changes occur in the keratinocytes.
The desmosomes begin to dissolve, preparing the The acid mantle rests on this outer layer and is the
corneocyte (dead skin cell) for desquamation. skin’s first line of defence. The acid mantle is a natural
hydrolipidic film which covers the entire surface of
the skin and is formed by substances secreted by the
In practice
sweat and sebaceous glands, epidermal lipids and
The intercellular lipids between the epidermal substances known as the natural moisturising factor.
cells are responsible for hydration, epidermal
The stratum corneum is the result of the changes
firmness and smoothness. They protect against
that occur when new living cells are produced in the
transepidermal water loss (TEWL), which can
basal layer and are pushed upwards by newer cells
result in dehydration. They also provide protection
until they reach the surface, where they die, dry out
against substances that may damage the skin.
and are sloughed off.
Ceramides belong to this group of intercellular
The outer layer of dead cells is continually being shed;
lipids, and they are also contained within the
this process is known as desquamation.
ingredients of some skin care products.
It is important to recognise that the cell renewal In practice
process is responsible for the production of these Knowledge of the stratum corneum layer of
essential lipids. If the cell renewal process slows the epidermis is crucial to understanding skin
down, the production of lipids also reduces, problems, as it is the part of the skin that is directly
resulting in dryness and dehydration. affected by the external environment.
It also plays a key role in helping to retain moisture
Stratum lucidum in the rest of the skin, and in regulating the natural
The stratum lucidum or clear layer consists of moisture flow from the deeper layers to the skin
transparent cells that let light through. The cells in surface where it is lost by evaporation. This natural
this clear layer are filled with eleidin, a substance moisture flow is known as TEWL.
that is produced from keratohyalin and which is Without adequate retained moisture, skin can
involved in the keratinisation process. become dry and unhealthy.
This layer is an important transitional stage in the Under normal conditions, up to 15% of the horny layer
development of the top layer of the epidermis consists of water, which is vital to enable the stratum
(the stratum corneum, see below). Keratinisation corneum to work effectively. The natural functions
is complete by the time the keratinocyte reaches of the skin are not as efficient when the horny layer
this layer, and the cell is almost ready to become a contains less than 10% of water, and it becomes dry.
flexible, mature corneocyte.
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The process of skin renewal

The process of renewal of the epidermal cells is continuous
throughout life and occurs in four stages:
● Stage 1 – cell regeneration and mitosis in the deepest layer of the
epidermis (stratum germinativum)
● Stage 2 – cell maturation and migration from the stratum
germinativum to the stratum spinosum
● Stage 3 – keratinisation in which the cells undergo change and die in
the stratum granulosum
● Stage 4 – desquamation when dead cells are sloughed off.
In normal skin, it takes approximately 28–30 days for a cell produced by

the stratum germinativum to move through the epidermis to the surface.
The rate of regeneration is partly determined by the rate at which the
outer layer is being desquamated.
With age, the speed of this process is greatly reduced. By the age of 50,
it may take in the region of 37 days to complete the same process.
Cell regeneration through the epidermal layers
In practice
Keratinocytes are the predominant cell type of the epidermis. In their
When the cells of the horny layer
upward journey, they undergo a series of chemical changes, transforming
are lost quickly (for instance
from soft cells into flat scales that are constantly rubbed off.
due to skin injury or sunburn),
As keratinocytes move up the layers of the skin, they go through the renewal process speeds up
several changes forming many other skin components, all of which as the cells are replaced more
play an important role in the skin’s barrier defence. It is important quickly from below.
to remember that healthy skin can only be formed by healthy
Removing the outer layers of
keratinocytes. A balance of all the essential skin substances (water and
the skin with a chemical peel
lipids, for example) is needed in order to ensure that the health of the
also speeds up replacement.
keratinocytes and skin is not impaired.
Table 3.1 Functions of epidermal layers in cell regeneration
Epidermal layer Function Significance

Stratum Cellular Keratinocytes begin their life cycle in this layer
germinativum regeneration As new cells are formed by division, they push adjacent cells towards the
(innermost layer) skin’s surface
Formation of the pigment melanin begins here, which helps protect skin
against harmful ultraviolet
Stratum spinosum Cellular Keratinisation begins here
transport of the In this layer and in response to sunlight, melanocytes synthesise
melanosome melanosomes and melanin, transferring them to neighbouring
keratinocytes to provide protection against harmful ultraviolet rays
The melanin becomes part of the keratinocyte, which then continues its
journey upwards towards the horny layer and eventual desquamation
Stratum Keratinisation, As cells move into the granular layer a number of changes occur in the
granulosum cellular change keratinocytes
and lipid Keratinisation becomes complete – the granular hardened structure of the
formation keratinocyte helps prevent absorption of many substances by the skin and
assists in maintaining hydration of lower layers
➜
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Epidermal layer Function Significance

Stratum lucidum Lipid release An important transitional stage in the development of the horny layer, cells
in this layer release lipids from the bilayers (glue that holds the corneocytes
together), maintaining hydration of the epidermis
Keratinisation is complete by the time cells have reached the clear layer
Stratum corneum Acting as skin The keratinocyte reaches its final destination, where it is now a corneocyte,
(outermost layer) barrier defence acting as first line of defence against injury, invasion of bacteria and as a
waterproof covering
Stem cells blood vessels, nerves, hair roots, sweat and sebaceous
Everyday activities cause wear and tear of skin. The glands. It is where the structural integrity and density
epidermis and skin appendages must be renewed of the skin is determined by the presence of collagen,
constantly to keep the skin in good condition. If you elastin and the extracellular matrix.
cut or damage your skin, it has to repair efficiently
in order to protect your body from the outside
The functions of the dermis
environment. The functions of the dermis include:
Skin stem cells make all this possible; they are ● providing nourishment to the epidermis
responsible for constant renewal (regeneration) of your ● removing waste products from the epidermis
skin and for healing wounds. Stem cells are found in ● giving a supporting framework to the tissues and
the stratum germinativum (basal cell layer) of the holding all its structures together
epidermis. They are active during skin renewal, which ● contributing to skin colour.
occurs throughout life, and in skin repair after injury.
The dermis has two layers: a superficial papillary layer
There are several different types of skin stem cells: and a deeper reticular layer.
● Epidermal stem cells – responsible for everyday
regeneration of the different layers of the The papillary layer
epidermis. These stem cells are found in the The superficial papillary layer is made up of fatty
stratum germinativum (basal layer) of the connective tissue and is connected to the underside
epidermis. of the epidermis by cone-shaped projections called
● Hair follicle stem cells – ensure constant renewal dermal papillae. These contain nerve endings and a
of the hair follicles. They can also regenerate the network of blood and lymphatic capillaries.
epidermis and sebaceous glands if those tissues The fine network of capillaries in this layer brings
are damaged. Hair follicle stem cells are found oxygen and nutrients to the skin, and carries waste
throughout the hair follicles. away. The many dermal papillae of the papillary layer
● Melanocyte stem cells – responsible for form indentations in the overlying epidermis, giving
regeneration of melanocytes, a type of pigment it an irregular or ridged appearance. It is these ridges
cell. Melanocytes produce the pigment melanin, that leave fingerprints on objects that are handled.
and play an important role in skin and hair follicle
pigmentation. KEY FACT
The key function of the papillary layer of the
dermis is to provide vital nourishment to the
2 The dermis living layers of the epidermis above.
The dermis lies below the epidermis and is the
deeper thicker layer of the skin. It can be as much The reticular layer
as 3 mm thick. The deeper reticular layer is formed of tough fibrous
The dermis contains several types of tissue that connective tissue, which gives the skin strength and
provide a supporting framework to the skin, as well as elasticity and helps to hold all structures in place.
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The protein collagen, which accounts for about 75% of Every skin layer depends on the ECM; if one part fails
the weight of the dermis, is organised in bundles running to function correctly there will be a knock-on effect
horizontally throughout the dermis and is buried in a to all other parts of the skin system.
jelly-like material called the ground substance. Collagen In both the papillary and reticular layers of the
is responsible for giving the skin resilience and elasticity. dermis, fibroblasts and fibrocytes (immature
The collagen bundles are held together by elastic fibroblasts) are responsible for laying down and
fibres running through the dermis. These are made of maintaining the ECM and, hence, determining the
a protein called elastin that makes up less than 5% structure of the dermis.
of the weight of the skin. Elastin contributes to the The ECM gives the dermis shape, structure and
elasticity of the skin by holding the collagen fibres support, providing the structural scaffolding and
together. Both collagen and elastin fibres are made by maintaining the tissue architecture. The ECM is
cells called fibroblasts, which are located throughout also important in cell-to-cell signalling, wound repair,
the dermis. cell adhesion and tissue function.
Hyaluronic acid is an important substance which forms
part of the tissue that surrounds the collagen and
Glycosaminoglycans
elastin fibres. This special substance has the ability to Glycosaminoglycans (GAGS) are polysaccharides
attract and bind hundreds of times its weight in water. of repeating amino sugars (a sugar linked with a
In this way, it acts as a natural moisturising ingredient protein). These water-binding molecules, found in
that plumps the skin’s tissues. Glycoproteins, found in the dermis, give skin its plumpness. Along with water,
the ground substance of the dermis, are also capable of GAGs create a fluid that fills the space between the
holding large amounts of water. collagen and elastin fibres in the dermis, giving it
turgidity (swelling due to high fluid content).
KEY FACT There are various GAGs in the dermis. The most
Damage to collagen and elastin fibres as they common ones are: hyaluronic acid, chondroitin
break down is the primary cause of skin ageing sulfate, keratin sulfate, dermatan sulfate, heparin
and the appearance of wrinkles. Also, the sulfate, and heparin.
amount of hyaluronic acid and glycoprotein
produced in the skin reduces with age. Hence the
skin becomes less resilient and loses elasticity. KEY FACT
GAGs are water-binding substances. The
GAGs in the ground substance of the dermis
In addition to fibroblasts, other cells present in the attract water (brought to the dermis by blood
dermis include: vessels), which diffuses to the lower layers of
the epidermis and eventually migrates upward
● mast cells, which secrete histamine (associated
through the epidermal layers.
with allergies) causing dilation of blood vessels to
bring blood to the area
● phagocytic cells (macrophages), a type of white In practice
blood cell, which are able to travel around the In skin care products, water-binding ingredients are
dermis destroying foreign matter and bacteria. known as humectants. They help keep skin moist
by attracting water from the atmosphere and the
The extracellular matrix (ECM) lower layers of the epidermis. This counteracts the
The dermis layer of skin has three crucial components: continuous loss of moisture from the epidermis
collagen, elastin and glycosaminoglycans (GAGs). as water evaporates into the air. TEWL amounts to
These form the bulk of an important support system several ounces a day.
called the extracellular matrix (ECM). This matrix,
consisting of structural proteins (collagen and elastin), Skin also loses water through sweating (from the
glycosaminoglycans and proteoglycans, is often sweat pores). Without constant rehydration, skin
referred to as the ‘ground substance’. dehydrates and wrinkles more easily.
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Hyaluronic acid is a glycosaminoglycan that exists roots, respond to touch and temperature changes.
naturally in the dermis layer of skin. It can hold Nerve endings in the dermal papillae are sensitive to
1000 times its molecular weight in water, which is gentle pressure and those in the reticular layer are
why it is such a popular hydrating and saturating responsive to deep pressure.
ingredient in skin care products.
Sensory nerves
Blood supply There are several different types of sensory nerve
Unlike the epidermis, the dermis has an abundant endings in the skin that are responsible for sensing
supply of blood vessels which run through the dermis touch, pressure, vibration, temperature and pain.
and the subcutaneous layer. The sensory nerve endings are also called cutaneous
Arteries and arterioles carry oxygenated blood to receptors, because they receive information about
the skin and these enter the dermis from below, the skin.
branching into a network of capillaries around active The different types of cutaneous receptors include:
or growing structures. These capillary networks are ● mechanoreceptors – detect sensations such as
found in the dermal papillae, where they provide the pressure, vibrations and texture
basal cell layer of the epidermis with nutrients and
● thermoreceptors – detect sensations of heat or cold
oxygen. They also surround the sweat glands and
erector pili muscles, two appendages of the skin. ● pain receptors (nociceptors) – detect discomfort
or injury.
The capillary networks drain into venules, small veins
which carry the deoxygenated blood away from the These receptors have overlapping roles, as seen in
skin and remove waste products. Table 3.2.
The dermis is, therefore, well supplied with capillary Table 3.2 Summary of cutaneous receptors
blood vessels to bring nutrients and oxygen to
Category of
the germinating cells in the basal cell layer of the
cutaneous receptor Type Sensation
epidermis and to remove their waste products.
Mechanoreceptors Merkel’s Sustained touch
disks and pressure
KEY FACT
The network of capillaries in the face and neck Meissner’s Changes in
is much denser than in the torso or the limbs. corpuscles texture, slow
As a result, the face and neck are the first body vibrations
parts to reflect alterations in blood flow by
Ruffini’s Stretching of the
changing colour.
corpuscles skin
Pacinian Deep pressure,
Lymphatic vessels corpuscles fast vibrations
There are numerous lymphatic vessels in the dermis.
Thermoreceptors Ruffini’s Detect hot
They form a network through the dermis, facilitating corpuscles temperatures
the removal of waste from the skin’s tissues. The
Krause Detect cold
lymphatic vessels in the skin generally follow the
corpuscles temperatures
course of the veins and are found around the dermal
papillae, glands and hair follicles. Pain receptors Free nerve Detect pain
(nociceptors) endings that is caused
Nerves by mechanical
stimuli (cuts),
Nerves are widely distributed throughout the dermis. thermal stimuli
Most nerves in the skin are sensory, meaning they (burns), or
are sensitive to heat, cold, pain, pressure and touch chemical stimuli
and send such information to the brain. Branched (poison from
insect stings)
nerve endings, which lie in the papillary layer and hair
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RUFFINI ENDINGS MERKEL DISKS PACINIAN CORPUSCLE
MEISSNER FREE NERVE KRAUSE END BULBS ROOT HAIR PLEXUS

CORPUSCLE ENDINGS
p Sensory receptors in skin
KEY FACT: KEY FACT: PAIN RECEPTORS

MECHANORECEPTORS There are over three million pain receptors
Merkel’s disks and Meissner’s corpuscles throughout the body, found in skin, muscles,
are generally found in non-hairy skin such bones, blood vessels and some organs. This
as on the palms, lips, tongue, soles of feet, type of receptor is able to detect pain caused
fingertips, eyelids and the face. Merkel’s by mechanical (injury), chemical (exposure to
disks are slowly adapting receptors, while strong chemicals) or thermal (touching a hot
Meissner’s corpuscles are rapidly adapting item) stimuli.
receptors. This is so the skin can detect the
moment you touch something and whether
you continue holding it. Motor nerve endings
The dermis also has motor nerve endings that relay
The ridges that make up your fingerprints are full of impulses from the brain and that are responsible for
sensitive mechanoreceptors which provide your brain the dilation and constriction of blood vessels, the
with an enormous amount of information about the secretion of perspiration from the sweat glands and
texture of objects. the contraction of the erector pili muscles attached
to hair follicles.
KEY FACT:
THERMORECEPTORS The subcutaneous layer
Thermoreceptors are found throughout the The subcutaneous layer, or hypodermis, is a thick
skin and are able to detect sensations of
layer of connective tissue found below the dermis.
heat and cold. The number and location of
thermoreceptors determines the degree of The type of tissue (fatty tissue) found in this layer
sensitivity of the skin to temperature change. helps support delicate structures such as blood
The highest concentration of thermoreceptors vessels and nerve endings. It also cushions the dermis
can be found in the face and ears; hence why from underlying tissues such as muscles and bones.
your nose and ears get cold faster than the rest The subcutaneous layer contains the same collagen
of your body.
and elastin fibres as the dermis and also the major
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arteries and veins which supply the skin by forming ● Once the clot starts to harden and dry out, a
a network throughout the dermis. The fat cells scab is formed. The scab protects the wound,
contained within this layer help to insulate the giving the skin underneath a chance to repair
body by reducing heat loss. during the proliferation phase.
The subdermal muscle layer lies below the ● Removing scabs too early disrupts the newly
subcutaneous layer. regenerated tissue growing underneath
and causes more skin damage, resulting
in a larger scar.
KEY FACT
As we grow older, the amount of fat starts ● Phase 3 – proliferation
to decrease in the subcutaneous layer and ● From 1 to 24 days after injury.
eventually results in a bonier look to the facial ● This phase begins with the skin cells laying
contours. down a foundation for long-term wound repair.
● Collagen is deposited by fibroblasts to
How the skin repairs strengthen the wound and new cells migrate
across the foundation tissue to close the wound.
itself ● Connective skin tissue forms to replace the
damaged skin (re-epithelialisation).
The layers of normal skin form a protective barrier
● If a scab is present, it will loosen and fall off.
against the external environment. Once the skin is
● In this phase, the wound contracts and reduces
broken, the process of wound repair starts. The skin
healing process involves four specific sequential, yet in size. A large wound can become 40% to 80%
overlapping, phases. smaller after contraction.
● Phase 1 – haemostasis ● Phase 4 – maturation
● Occurs within the first few minutes of an injury. ● From 14 to 365 days after injury.
● Platelets (thrombocytes) join together at the ● In this phase, the tissues are remodelled.
injury site to form a fibrin clot, which reduces ● The dermis and epidermis connect and contract
active bleeding (haemostasis). to close the wound.
● This helps stop the bleeding and creates a ● Maturation is the final phase when scar tissue
temporary barrier that prevents pathogens is formed.
from getting into the open wound. ● A stronger type of collagen is laid down
● Phase 2 – inflammation to replace the initial collagen that is now

● From 0 to 3 days after injury.
degrading. These new collagen fibres are
aligned in one direction, as opposed to the
● The inflammatory phase is both a defence
random basket-weave formation found in
mechanism and a crucial component of the
normal tissue.
healing process in which the wound is cleaned
● The unusual composition of scar tissue gives
and rebuilding begins.
scars a different appearance, texture and
● The tissues are red, inflamed, swollen and
flexibility to normal skin.
tender. During this phase, bacteria and cell
debris are removed from the wound by white
blood cells, and the wound is cleansed by
breakdown of the damaged tissue.
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Bleeding
Blood clot
Inflammatory
Scab
Fibroblast
Macrophage
Blood vessel
Proliferative
Fibroblasts
proliferating
Subcutaneous fat Remodeling
Freshly healed
epidermis
Freshly healed
dermis
p How the skin repairs itself
Appendages of the skin

The appendages are accessory structures that lie in the dermis of the
skin and project onto the surface through the epidermis. These include
the hair, erector pili muscle, sweat and sebaceous glands and the nail.
Hair
Hair is an important appendage of the skin which grows from a sac-like
depression in the epidermis called a hair follicle. Hair growth, a sexual
characteristic, occurs all over the body, with the exception of the palms of
the hands and the soles of the feet.
One of the primary functions of hair is physical protection. The eyelashes
act as a line of defence by preventing the entry of foreign particles into the
eyes and helping shade the eyes from the sun’s rays. Eyebrow hairs help to
divert sweat away from the eyes. Hairs lining the ears and the nose trap dust
and help to prevent bacteria from entering the body. Body hair acts as a
protective barrier against the sun and helps to protect us against the cold
with the assistance of the erector pili muscle.
Another function of hair is to prevent friction. Underarm and pubic
hair cushions against friction caused by movement. The structure and
functions of hair will be covered in more detail later in this chapter.
Erector (arrector) pili muscle

This is a small and weak smooth muscle. It is attached at an angle to the
base of a hair follicle and contracts to make the hair stand erect in response
to cold, or when experiencing emotions such as fright and anxiety.
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Sweat glands Genes (DNA sequences carried by chromosomes)

determine skin characteristics such as follicle size,
There are two types of sweat glands in the skin: skin thickness, and distribution of circulation and
eccrine and apocrine. The majority are eccrine glands nerve endings.
which are simple coiled tubular glands that open
The primary factors in determining skin type are:
directly onto the surface of the skin. There are several
● level of lipid (fat) secretions that are produced
million of them distributed over the skin’s surface,
between the skin cells (this determines how well
although they are most numerous in the palms of the
the skin retains moisture)
hands and the soles of the feet.
● the amount of secretion produced by the
The function of eccrine glands is to regulate body
sebaceous glands.
temperature and help eliminate waste products. Their
active secretion of sweat is under the control of the
sympathetic nervous system. Heat-induced sweating tends In practice
to begin on the forehead and then spreads to the rest of the Skin types are classified into broad categories
body. Emotionally-induced sweating, stimulated by fright, which are often streamlined in the skin care
embarrassment or anxiety, begins on the palms of the hands industry to allow clearer marketing of product
and in the axilla, then spreads to the rest of the body. lines.
Apocrine glands are connected to hair follicles and
are only found in the genital and underarm regions. Skin is generally classified into five main types:
They begin to function at puberty, producing a fatty 1 normal
secretion. Breakdown of the secretion by bacteria
2 dry
leads to body odour.
3 oily
Sebaceous glands 4 combination
Sebaceous glands are small sac-like pouches found all 5 sensitive.
over the body, except for the soles of the feet and the
palms of the hands. They are more numerous on the 1 Normal skin
scalp, face, chest and back. Few clients have normal skin, as this skin type is very
Sebaceous glands commonly open into a hair follicle, rare. Normal skin is balanced in that it has a good
but some open onto the skin surface. They produce oil and water balance. Children from birth up until
an oily substance called sebum which contains fats, puberty usually have normal skin.
cholesterol and cellular debris. Distinguishing features of normal skin:
Sebum is mildly antibacterial and antifungal, and ● neither too dry, nor too oily and so has perfect
coats the surface of the skin and the hair shafts. It hydration
reduces water loss, lubricates and softens the horny ● soft and supple to the touch
layer of the epidermis, and conditions the hair. The
● smooth texture, which is neither too thick nor
secretion of sebum is stimulated by the release of
too thin
androgen hormones.
● feels slightly warm due to a good blood supply
Skin types and their ● creamy pink in colour with a clear, even surface
that is free from blemishes
characteristics ● fine, almost non-apparent pores
Skin type is largely determined by genetics and so is ● firm to the touch and generally has good
linked to ethnicity. elasticity.
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● small and tight pores due to the lack of sebum

In practice production
Clients with normal skin usually report very few ● lacks elasticity.
skin problems.
The aim when treating this skin type is to maintain In practice
the skin’s balance and to protect it from damage. When questioned, clients with this skin type usually
report that their skin feels tight and dry. They may
2 Dry skin also complain of sensitivity and premature ageing.
The primary aim when treating dry skin is to balance
A dry skin is either lacking in sebum or moisture, or the moisture and oil content of the skin, soften the
both. It develops as a result of under activity of the texture of the skin, hydrate and moisturise. Dry skin
sebaceous glands. also needs a lot of sun protection.
The skin’s natural oil, sebum, lubricates the stratum
corneum and in the absence of this oily coating
the dead cells start to curl up and flake. The sebum
3 Oily skin
coating usually helps to prevent moisture loss by Oily skin is hereditary, and develops due to an
evaporation. If there is a lack of sebum, dry skin does overproduction of sebum from the sebaceous glands.
not retain inner moisture.
Although dry skin is hereditary, it can also develop as
a result of the ageing process.
p Oily skin
Distinguishing features of oily skin:
● large and noticeable pores due to a build-up of
sebum causing them to stretch open
● oily, with a characteristic shine, especially in the
p Dry skin T-zone (forehead, nose and chin area)

● firm, thick and coarse to the touch
Distinguishing features of dry skin: ● uneven texture
● dry, often parched ● sallow in colour as a result of excess sebum
● looks and feels papery production and dead corneum cells building up
● thin and coarse in texture with patches of flaking on the outer surface
skin ● blemishes are often very apparent, with blocked
● often sensitive and prone to the formation of pores, comedones, papules and pustules all being
dilated capillaries and milia around the eye and present to a greater or lesser degree
upper cheek area ● some scarring maybe evident from previous blemish
● ages prematurely due to dryness, with fine lines sites, leading to a very uneven surface colour
becoming evident around the eyes even as early as ● oily skin ages least prematurely
the early to mid-20s ● elasticity is generally good.
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In practice In practice
When questioned, clients with oily skin often When questioned, clients with combination skin
report that their skin develops a ‘shine’ during the usually report that they have all the problems of an
course of a day and make-up runs or ‘slips,’ with oily skin in the T-zone, but dryness and tightness on
foundation changing to a more orange colour. They the cheeks, neck and around the eyes.
may complain that their skin often feels thick and
dirty, due to the accumulation of sebum and dead
cells clogging the surface. They will also suffer from
5 Sensitive skin
blemishes. While sensitivity is a condition that may affect
The aim when treating an oily skin is to help any skin type, sensitive skin is more commonly
balance it by bringing the oil secretions under referred to in its own classification. Most product
control thorough cleansing and exfoliation. It is lines include products that are marketed specifically
still important to protect oily skin by moisturising for this skin type.
the surface with a water-based hydrating product
designed for oily skin.
There is a tendency for clients to over treat their oily
skin. However, this can compound the problem, as
excessive stimulation strips and irritates the skin
causing it to become dry and unbalanced. The
skin’s natural protection mechanism then responds
by producing more oil.
4 Combination skin
p Sensitive skin
This is actually the most common skin type.
As its name suggests, this skin is a bit of a mixture. Distinguishing features of sensitive skin:
Typically the T-zone is oily and the cheeks and neck ● pink tone, with or without dilated capillaries
are dry or normal. Combination skin can, therefore, ● thin and translucent appearance
be both dry and oily at the same time.
● warm to the touch
Distinguishing features of combination skin:
● high colouring, even after a gentle cleanse
● dry on the cheeks and neck, and oily on the
● prone to dry, flaky patches
T-zone
● easily irritated by skin products and other
● a mix of dry areas, feeling rough and fine, and oily
external factors such as heat, cold, wind and sun
areas that are thicker and coarse
● reddens easily following any form of stimulation.
● a patchy colour
● the T-zone may have blemishes, such as blocked
In practice
pores, comedones, papules and pustules
When questioned, clients with sensitive skin
● fine and small pores on the cheeks and neck, but
usually say their skin reacts to external stimuli
larger pores in the T-zone
by becoming red and blotchy, and may feel
● milia may be present around the dryer skin areas, uncomfortable when touched.
with some sensitivity and dilated capillaries
The aim when treating sensitive skin is to soothe
evident too
and calm the skin. Avoid harsh products and forms
● the skin’s tone and elasticity will vary, being poor of treatment or conditions (such as heat) that may
in the dry areas but good in the oily areas. cause irritation.
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stored in the cell nucleus, so that the quality of

KEY FACT
newly formed skin cells deteriorates.
All skins may be sensitive at times, due
to misuse of products, medication or the
environment. However, clients with genetically KEY FACT
determined sensitive skins have an impaired The body protects itself against free radicals
barrier function and reduced lipid protection, through antioxidant enzyme systems
making them more susceptible to allergens (commonly just called antioxidants). But from
and irritants. Caution is therefore essential the age of 20 onwards, these natural defence
when choosing products and suitable forms mechanisms gradually deteriorate, so that the
of treatment for this skin type. skin can no longer defend itself.
Many modern anti-ageing therapies supply
Male skin the antioxidants (and hormones) that are lost
through ageing.
Although there is not a typical ‘male’ skin type, there
are important general differences between male
Stress and lifestyle
and female skins. Testosterone, the male hormone,
Long-term stress and regular tension can cause
gives men a thicker epidermis (approximately 2 mm
sensitivity in the skin, as well as encouraging the
compared to 1.5 mm in women). Male skin does
formation of lines around the eyes and the mouth.
have a tendency to be tougher, more elastic and less
sensitive than female skin, although daily shaving Hormones
can increase the risk of skin rashes, infections and The body’s natural glandular changes have an effect
in-growing hairs. It is also more acidic, has a more on the condition of the skin throughout life.
efficient blood supply and greater sebum production.
● During puberty, the sex hormones stimulate
This means it tends to age better than women’s skin,
the sebaceous glands, which may cause some
remaining softer, firmer and more supple.
imbalance in the skin.
Factors that affect the skin ● At the onset of menstruation, hormones may
cause the skin to erupt.
There are many factors, both external and internal,
● During pregnancy, pigmentation changes may
which affect a client’s skin.
occur, but these usually disappear after the birth.
Internal factors ● During the menopause, the activity of the sebaceous
glands is reduced and the skin becomes drier.
Age
The natural process of ageing affects the skin, as Smoking
cell regeneration slows with age (see Table 3.3 on Smoking has been linked to premature ageing and
page 60 for information about the effects of ageing wrinkling of the skin. Nicotine in cigarette smoke
on skin). weakens the blood vessels that supply blood to the
tissues; this deprives the tissues of essential oxygen,
Free radicals making the skin appear dull and grey in colour.
Free radicals are highly reactive and damaging atoms Smoking creates free radicals and destroys vitamins B
that contribute to skin ageing. External factors, such and C, which are both important for a healthy skin.
as ultraviolet radiation, nicotine and substances in It dulls the skin by polluting the pores and increases
unhealthy foods, create free radicals from oxygen the formation of lines around the eyes and the
molecules. Because they are so reactive, free radicals mouth.
bond with many other chemical substances; they
attack collagen fibres, cellular membranes and the Medication
lipid layer of the skin. Free radicals also bond with Medication can affect the skin by causing
DNA, changing the inherited properties that are dehydration, sensitivity and allergies.
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Diet due to the fact that they produce large quantities of

The skin is a barometer of the body’s general health. long-wave ultraviolet light (UVA). Overexposure of
These vitamins are crucial to the maintenance of skin to artificial ultraviolet tanning procedures may
skin health: carry the same risks of photoageing as overexposure
to natural sunlight, and also an increased risk of some
● vitamin A – helps repair the body’s tissues and
skin cancers.
helps prevent dryness and ageing
● vitamin B – improves the circulation and the skin’s Environmental exposure
colour, and is essential to cellular oxidation Exposure to adverse weather conditions, pollutants,
● vitamin C – essential for healing and maintaining or poor air quality can affect the condition of the
levels of collagen in the skin skin, often resulting in dryness and dehydration.
● vitamin E – helps to heal damaged tissues and can Occupation
promote healing of structural damage to the skin.
The client’s occupation can be a factor in their skin
Water consumption condition. For instance, they might be working in
The skin is approximately 70% water. Drinking an a hot or humid environment, or in dusty and dirty
adequate amount of water (approximately 6–8 conditions.
glasses per day) aids the digestive system and helps Poor skin care routine
to prevent a build-up of toxins in the skin’s tissues.
Lack of proper skin care, or incorrect skin care for
Alcohol consumption the skin type, can adversely affect the skin. The use
Alcohol consumption has a dehydrating effect on of products that are too aggressive can strip the
the skin by drawing essential water from the tissues. skin and damage its barrier function. The correct use
Excessive consumption causes the blood vessels in of sunscreens provides the best protection against
the skin to dilate, resulting in a flushed appearance. premature ageing.
Exercise General terms associated
Regular exercise promotes good circulation,
with the skin
increasing oxygen intake and blood flow to the skin.
Allergic reaction
Sleep
This disorder occurs when the body becomes
Sleep is essential to physical and emotional
hypersensitive to a particular allergen. When
wellbeing, and is one of the most effective
irritated by an allergen, the immune system
regenerators of the skin.
produces histamine as part of the body’s defence
External factors reaction. The effects of different allergens are
diverse, and they impact different tissues and
Photoageing organs. For example, some cosmetics and chemicals
Photoageing is the accelerated ageing of skin after can cause skin irritation and rashes. Certain
exposure to ultraviolet light. Exposure to sunlight allergens such as pollen, fur, feathers, mould
(which contains ultraviolet radiation) is therefore and dust can cause reactions in the respiratory
a dominant factor in how the skin ages. system, leading to asthma and hayfever. If severe,
As we age, the collagen and elastin fibres in the allergies may be extremely serious can result in
dermis weaken. This natural weakening is accelerated anaphylactic shock. Symptoms occur in different
by frequent exposure to ultraviolet light, causing parts of the body at the same time and may include
wrinkling and sagging of the tissues. rashes, swelling of the lips and throat, difficulty
It is important to note that tanning machines and breathing, a rapid fall in blood pressure and loss of
sunbeds can also cause accelerated ageing of the skin consciousness.
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Blocked pores
In practice
This happens when sebum begins to build up in pores.
Some clients may have a nut allergy. In this case, The pore will appear enlarged and the sebaceous matter
the therapist must avoid nut-based ingredients inside will be evident. The excess sebum needs to be
(which are common in skin care products). released to prevent further build-up within the pore.
Therapists should be aware that it is possible for
Enlarged pores
clients to develop allergies to products after long-
term use. This can be confusing for clients who Pores become larger if excess oil and debris become
may not understand that the product they have trapped in the follicles, or they may expand due to
been using for years is suddenly responsible for loss of elasticity.
a reaction. Comedone
A comedone is a skin blemish caused by the
accumulation of waste particles, such as sebum
and keratinised cells, in the hair follicle. Comedones
are commonly referred to as either ‘blackheads’
(an open comedone contained within the follicle) or
‘whiteheads’ (closed comedones trapped underneath
the skin’s surface).
p Allergic reaction
If, during treatment, a client experiences a skin rash,

severe redness or a burning sensation, the appropriate p Comedones
action is to remove all traces of the product
immediately from the skin and to apply cool, wet In practice
compresses to soothe the skin. A comedone is a form of skin blockage and may be
The client should be advised to discontinue all use released manually, or with the use of a comedone
of products, preferably including make-up, until extractor.
the reaction has stopped and all symptoms of the
allergy have gone. Then, one by one, the client may Crow’s feet
be encouraged to use products on the skin, each These are fine lines around the eyes caused by
day adding another product to see if the offending habitual facial expressions and movements. They
product or ingredient may be identified. In the event are associated with the ageing of muscle tissue;
of a severe allergic reaction, advise the client to seek premature formation may be due to overexposure
immediate medical advice. to ultraviolet light or eye strain.
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Cyst Macule
This is an abnormal sac containing liquid or a semi-solid A macule is a small flat patch of increased
substance. Most cysts are harmless. pigmentation or discolouration, such as a freckle.
Erythema Milia
This is reddening of the skin due to the dilation Milia is sebum trapped in a blind duct with no
of blood capillaries just below the epidermis in surface opening. Usually found around the eye
the dermis. area, they appear as pearly, white and hard nodules
under the skin. Milia may be removed with a sterile
Fissure
microlance.
This is a crack in the epidermis exposing the dermis.
Keloid
A keloid is the overgrowth of an existing scar to a
size that is much larger than the original wound. The
surface may be smooth, shiny or ridged. Formation
is gradual and is due to an accumulation of collagen
in the immediate area. The colour varies from red,
fading to pink and white.
p Milia
Mole
Moles are also known as a pigmented naevi. They
appear as round, smooth lumps on the surface of the
skin. They may be flat or raised and vary in size and
colour from pink to brown or black. They may have
hairs growing out of them.
p Keloid scar
Lesion
A zone of tissue with impaired function, as a result
of damage by disease or wounding, is called a lesion.
p Mole
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Naevus Scar
This is a mass of dilated capillaries and may be A scar is a mark that is left on the skin after a wound
pigmented, as in the case of a birthmark. has healed. Scars are formed from replacement tissue
that is deposited during the healing of a wound.
Depending on the type and extent of damage,
the scar may be raised (hypertrophic), rough and
pitted (ice pick) or fibrous and lumpy (keloid). Scar
tissue may appear smooth and shiny or can have a
depression in the surface.
Telangiectasia
This term is used to describe persistent vasodilation
of capillaries in the skin. Often, it is caused by
extremes of temperature and overstimulation of the
tissues; sensitive and fair skins are more susceptible
p Naevus
to this condition.
Papule
A papule is a small raised elevation on the skin, less
than 1 cm in diameter, which may be red in colour.
It often develops into a pustule.
Pustule
This is a small raised elevation on the skin which
contains pus.
Skin tag
These are small growths of fibrous tissue that stand
up from the skin and which are sometimes are
pigmented (black or brown).
p Telangiectasia
Tumour
A tumour is formed by an overgrowth of cells. Almost
every type of cell in the epidermis and dermis is
capable of benign or malignant tumour formation.
Tumours are lumpy and often can be felt underneath
the surface of the skin even when they cannot be
seen.
Ulcer
p Skin tag An ulcer is a break in the skin that may extend to
every layer, causing an open sore.
In practice Urticaria
Skin tags may be surgically removed or may This condition is also known as ‘hives’. Red weals
be cauterised by a qualified electrologist with appear rapidly and turn white or disappear again
advanced training. They do not contraindicate skin within minutes or more. The process may happen
care treatments, although care should be taken to more gradually over a number of hours. The area
avoid catching them and causing discomfort. can be itchy or may sting.
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Urticaria may be caused by an allergic reaction to

certain foods such as strawberries and shellfish, or
Skin conditions
to other triggers such as penicillin, house dust and All skins, regardless of their type, may be affected by
pet fur. Other causes include stress and sensitivity one or more of the following skin conditions.
to light, pressure, heat or cold.
Ageing
Like all organs, the skin is affected by the ageing
process. Signs of skin ageing include:
● a decrease in the thickness of the skin (thinning
epidermis)
● loss of elasticity (elastosis) and muscle
tone, resulting in sagging, loose skin, lines
and wrinkles
● decreased tensile strength due to loss of collagen
and elastin
● dehydration caused by a reduction in the skin’s
ability to bind water
● rough texture because of reduced cell turnover.
Congestion
p Urticaria (hives) Congested skin presents with enlarged pores,
blocked pores and comedones due to build-up of
Vesicles
dead skin cells, sebum and cell debris. Congested
These are small sac-like blisters. A bulla, commonly skin tends to appear thick and dull. The solution
called a blister, is a vesicle that is larger than is regular cleansing and gentle exfoliation.
50 mm across.
Wart
Dehydration
Water intake is necessary for the healthy
Warts are well-defined benign tumours that vary
functioning of all cells, including skin cells.
in size and shape. (See viral infections for more
Dehydration means that there is a lack of moisture
information.)
in the intercellular system of the skin. Key
Weal indicators of dehydration are visible fine lines and a
A weal is a raised area of skin that contains feeling of tightness on the skin.
fluid. These may be white in the centre with Any skin type can become dehydrated, even oily
a red edge and are commonly seen in the skin. Oily skin can be dehydrated by use of products
condition urticaria. that are too harsh, stripping the skin of its protective
Wrinkles coating of sebum.
When the underlying structure of the skin has become Many skin types can suffer from temporary
damaged and the skin starts to lose its elasticity, dehydration, such as that caused through illness,
exaggerated lines and wrinkles start to form on the medication, overexposure to the elements
face and neck. These may form as a result of the (cold, wind, and heat), central heating and the
normal ageing process, but often occur prematurely effects of dehydrating drinks such as caffeine
due to sun and environmental damage. and alcohol.
Dehydrated skin presents a parched, dry looking
rough surface and tends to soak up any applied
product very quickly.
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Pigmentation problems Sensitivity

Pigmentation may be associated with a client’s Sensitivity is a condition that may affect any skin
ethnic skin type, or may be caused by environmental type, and should not be confused with genetically
or other factors. Pigmentation problems may result predisposed sensitive skin. Sensitivity usually manifests
from the uneven distribution of melanin over the as redness, itching or burning. Sensitivity reactions are
skin’s surface, either due to an accumulation of very complex and individual to each client.
pigment or because of uneven production by the Because the chemical composition of each person’s
melanocytes. skin varies, one client may react to an ingredient,
The melanocyte cells are located in the basal cell while another may not. A particular ingredient
layer of the epidermis, and they surround a large may not be sensitising as a rule, but can still cause
number of regular skin cells (keratinocytes). The sensitivity in an individual. An ingredient can only
melanocytes are responsible for producing melanin, be deemed sensitising if most clients react to it.
the black–brown pigment that gives the skin its Sensitivity and allergies may occur due to exposure
colour. Melanin production varies from individual to specific product ingredients, misuse of products,
to individual, and is greater in those with darker medication, diet, or other internal or external factors
skins. Melanin has a protective function, in that it (hot and cold weather, and the wind). Ingredients
acts as a filter to help protect the skin against the that are known to cause sensitivity are fragrances,
harmful effects of the sun’s radiation. Any surface preservatives and some chemical sunscreens.
irritation of the skin (including exposure to the
sun) is capable of increasing melanin production. How ageing affects the
Hyperpigmentation skin throughout life
This is an overproduction of the skin pigment
melanin, resulting in brown discolouration or
darkening of the skin. Overproduction of pigment
occurs when melanocytes produce a greater
amount of melanin in a given area of the skin, and/
or when the melanin is not properly absorbed by
the keratinocytes.
Hyperpigmentation is usually caused by exposure to
the sun or environmental damage, although another
type of hyperpigmentation may occur during
pregnancy (chloasma). Hyperpigmentation may also
result from injuries, rashes or chemical irritation,
and is especially common in clients with darker
skins.
Hypopigmentation
This condition presents as white, colourless skin
areas (an absence of pigmentation) resulting from
less than the normal melanin production. It may be
due to long-term sun exposure or irritation, which
causes a dysfunction in the melanocytes.
p Ageing skin
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Table 3.3 Characteristics of skin ageing
Age Skin ageing characteristics

Childhood Smooth, healthy and undamaged
Adolescence Increased sebaceous gland activity, which may result in
spots, comedones and pustules and for some may be
the start of acne
20s Collagen starts to diminish (by approximately 1% per
year), causing the start of fine lines and loss of elasticity
in skin of upper eyelid
30s Sagging due to stretching of the skin and continued
reduction in collagen, more fine lines and wrinkles, loss
of hydration, moderate decrease in dermal repair
40s Loss of elasticity is more apparent, lines deepen
in nasolabial folds, skin sags at the jaw line, forehead
wrinkles deepen, noticeable drop in skin hydration
level
Menopause Loss of oestrogen accentuates wrinkles and loss of
elasticity, slowing of ability to synthesise collagen,
lipid production is affected causing dehydration
50s Wrinkles and loss of elasticity in the neck more
apparent, reduction in supporting fat leads to bonier
appearance of face, skin tends to be drier
60s and beyond Loss of subcutaneous fat, skin becomes thinner,
increased sagging, dilated capillaries often present,
uneven pigmentation, age spots, skin tags, low
production of sebum and collagen, compromised
dermal repair, many wrinkles and deep lines
Summary of the main skin types

Table 3.4 Summary of skin types
Skin type Main recognition factors Pore size Elasticity

Normal Soft, supple, smooth, Fine Good; firm
Free from blemishes
Dry Papery, thin, flaky Small and tight Generally not good
Oily Shiny, thick, coarse and uneven Enlarged Good; firm
Sallow colouring
Blocked pores, comedones, papules
and pustules may be present
Combination Dry on cheeks and neck Variable; enlarged in T-zone Poor in dry areas; good
Oily/blemished in T-zone and fine and small on cheeks in oily areas
Sensitive Warm to touch, thin, dry and flaky Variable; tend to be small May be poor in areas
High colouring, easily irritated and tight of sensitivity
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Different skin types

All skin types vary in the degree of melanin they produce. Although different
ethnic groups have the same number of melanocytes cells, black skins have
melanocytes capable of making large amounts of melanin.
Table 3.5 Characteristics of ethnic skin types
Ethnic skin type Colouring Characteristics

White skin Generally, a fair/pale Relatively small amounts of melanin present
complexion Very susceptible to sensitivity, irritation and sunburn
Greater chance of skin cancer
Ages faster than black skin
Oriental/light Asian skin Creamy colour with a Rarely shows blemishes or normal signs of ageing
tendency to yellow and Scars are more likely to occur with hyperpigmentation,
olive tones causing unevenness, troughs, pits and hollows on the
More melanin present skin’s surface
Mediterranean skin Typically olive with light to Good degree of melanin present, which obscures the
dark brown tones, may also colour of the blood vessels
have reddish/pink tones. Tends to have a generous coating of sebum and is
therefore oily
Tans easily and deeply with less sun damage and
premature ageing
Skin is usually thicker, which often means fewer wrinkles
Dark Asian skin Very dark skin colour which Smooth and supple with minimal signs of ageing
is deeply pigmented with Sweat glands are larger and more numerous in this skin
melanin type which gives a sheen to the skin that is often mistaken
for oiliness
Deeply pigmented, it does not reveal the blood capillaries
Signs of ageing appear very late
Skin cancer is rare
Afro-Caribbean/black skin Darker skin with a higher Open pores

degree of melanin Oily with higher degree of sebaceous glands
Thick and tough
Desquamates easily
Forms keloid scars when damaged
Skin cancer is very rare
Signs of ageing appear very late
Mixed skin Clients with a mixed skin The shades of colour and characteristics vary greatly
usually have a combination
of characteristics of some or
all of the above skin types
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Medulla
Cortex The structure and functions
Cuticle
of the hair
The structure of hair
Hair is composed mainly of the protein keratin and, therefore, is a dead
structure. Longitudinally, the hair is divided into three parts:
1 hair shaft – the part of the hair lying above the surface of the skin
2 hair root – the part found below the surface of the skin
3 hair bulb – the enlarged part at the base of the hair root.
Internally, the hair has three layers (Table 3.6) which all develop from
p Structure of hair
the matrix (the actively growing part of the hair).
Table 3.6 The layers of the hair
Hair layer Location Description Function

Cuticle Outer layer Made up of transparent protective Protects the cortex and gives the hair its
scales which overlap one another elasticity
Cortex Middle layer Made up of tightly packed keratinised Helps to give strength to the hair
cells containing the pigment melanin,
which gives the hair its colour
Medulla Inner layer Made up of loosely connected Determines the sheen and colour of hair due
keratinised cells and tiny air spaces to the reflection of light through the air spaces
Hair colour is due to the presence of melanin in the cortex and

medulla of the hair shaft. In addition to the standard black colour,
the melanocytes in the hair bulb produce two colour variations of
melanin: brown and yellow. Blond, light-coloured and red hair has a high
proportion of the yellow variant. Brown and black hair possesses more
of the brown and black melanin.
The structure of a hair follicle

Hair shaft
Erector pili muscle

Connective tissue sheath
Inner root sheath

Outer root sheath
Upper bulb
Matrix
Dermal papilla
p A hair in a follicle

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The individual parts of a hair’s structure are described in Table 3.7.

Table 3.7 The structure of the hair
Structure Location Function

Connective Surrounds hair follicle and sebaceous gland Supplies follicle with nerves and blood
tissue sheath The connective tissue sheath is separated from Main source of sustenance for the follicle
the outer root sheath by a vitreous membrane
Vitreous Forms the basement membrane of the outer Separates the two; thickens during the catagen
or glassy root sheath; separates the outer root sheath phase of hair growth
membrane from the connective tissue sheath
Outer root Forms the follicle wall and is continuous with Provides a permanent source of growing cells
sheath the stratum germinativum (basal cell layer) of (hair germ cells) to enable the follicle to grow
the epidermis and renew cells during its life cycle
Dermal Elevation at the base of the hair bulb, which Crucial source of nourishment for hair, providing
papilla contains a rich blood supply the hair cells with food and oxygen
Inner root Originates from the dermal papilla at the Shapes and contours the hair, helping to anchor it
sheath base of the follicle and grows upwards with into the follicle
the hair (ceasing to grow when level with the
sebaceous gland)
The inner root sheath is made of three layers:
● Henle’s layer (outermost)
● Huxley’s layer (middle)
● the cuticle (innermost).
Hair bulb Enlarged part at the base of the hair root Area where the cells grow and divide by the
process of mitosis
Matrix Lower part of the hair bulb Area of mitotic activity of the hair cells
Types of hair
There are three main types of hair in the body: lanugo, vellus and
terminal hair (Table 3.8).
Table 3.8 Types of hair
Type of hair Description Where found in body

Lanugo Fine, soft hair; often unpigmented Found on a foetus
Grows from around the third to the fifth month
of pregnancy and is eventually shed to be
replaced by secondary vellus hairs, around the
seventh to eight month of the pregnancy
Vellus Soft downy hair; often unpigmented Found all over the face and body, except
Do not have a medulla, or a well-developed bulb for the palms of the hands, soles of the feet,
Lie close to the surface of the skin and, therefore eyelids and lips
have a shallow follicle
Terminal Longer, coarser hairs, most are pigmented Found on the scalp, under the arms, eyebrows,
Vary greatly in shape, diameter, length, colour pubic regions, arms and legs
and texture
Deeply seated in the dermis and have well-defined
bulbs
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Hair growth to the level of adrenocortical androgens circulating

in the blood. Androgens (male hormones) increase
● Hair begins to form in the foetus from the third in men and women during puberty.
month of pregnancy.
During pregnancy, levels of female hormones are
● The growth of hair originates from the matrix, raised and excess androgens are also produced,
which is the active growing area where cells resulting in fine hair growth on the lip, chin, neck
divide and reproduce by mitosis. and sides of the face. After the birth, the hormone
● Living cells, which are produced in the matrix, balance is usually restored and the excess hair
are pushed upwards away from their source of growth disappears.
nutrition. They die and are converted to keratin During the menopause, the ovaries slowly cease
to produce a hair. to respond to stimulation by the gonadotrophic
● Hair growth takes approximately four to five hormones of the anterior pituitary, allowing the
months for an eyelash hair and approximately male hormones (androgens) to become more
four to seven years for a scalp hair. dominant. This results in hyperstimulation of the
adrenal cortex by pituitary hormones, producing
Factors that affect hair an excess of hair-promoting androgens.
growth
Abnormal hormonal changes
Hair growth is affected by several factors, which are
outlined below. Polycystic ovary syndrome is an example of
abnormal ovarian function, which leads to the
Congenital development of ovarian cysts and to the secretion
Hair growth patterns can be passed on from parents: of large quantities of androgens.
for example, having a heavy beard may be inherited. Symptoms include excessive hair growth in the
Hair distribution, the type of hair and rate of growth male sexual pattern, irregular menstrual periods
can also vary with ethnicity. For example, Europeans and weight gain.
have a higher number of hair follicles than Japanese
and Chinese people. Emotional stress
Topical When the body is under stress, activity of the
adrenal glands is increased. The hypothalamus
The use of X-rays and the application of cortisone
triggers the anterior pituitary to produce more
creams can stimulate blood supply to the hair,
adrenocorticotrophic hormone. This, in turn,
causing increased growth.
stimulates the adrenal glands to produce adrenaline,
Climate which increases androgen production.
In hot climates hair tends to grow faster in order to When this kind of stimulation occurs over
protect the skin from heat, so a fine growth may be a prolonged period of time, superfluous hair
increased. growth may occur.
Hormonal (natural glandular changes) Medication
If stimulated by an increase in blood circulation Certain medications are known to stimulate hair
resulting from hormonal changes in the body growth. Some examples include cortisone (steroids)
(such as during puberty, pregnancy or menopause) and the birth control pill.
or medication, the shallow follicle of a vellus hair
can grow downwards to become a coarse, dark The growth cycle of hair
terminal hair. Each individual hair has its own growth cycle and
During puberty, hormone levels are unstable. The undergoes three distinct stages of development:
appearance of both pubic and axillary hair is due anagen, catagen and telogen.
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Anagen Catagen Telogen Telogen stage

● Hair is shed on to the skin’s surface.
● There is a short period during which the shortened
follicle rests.
● The follicle is stimulated once more and a new
replacement hair begins to grow.
Different types of hair growth

As there is a continuous cycle of hair growth, the
amount of hair on the body remains fairly constant.
However, hair growth varies from client to client
and from body area to area. A client wishing a hair
removal treatment should be made aware of the fact
that hair growth occurs in three stages, so there will
p The hair growth cycle be hair present at different lengths both above and
below the skin.
Anagen growth stage
● This is an active growing stage, which lasts from
In practice
a few months to several years.
While carrying out hair removal treatments, it is
● Hair germ cells reproduce at the matrix.
important to remember that the hair follicle is part
● A new follicle is produced which extends in depth of the skin’s structure. Therefore, any treatment
and width. which affects the hair also affects the skin.
● Hair cells pass upwards to form the hair bulb. Once a hair has been removed, blood is directed
● Hair cells continue rising up the follicle. As they straight to the area being treated to heal and
pass through the bulb, they differentiate to form protect the skin. This is a normal reaction of the
the individual structures of hair. skin and causes reddening. Extra blood that has
● The inner root sheath grows up with the hair, been sent to the treated area is diverted away
anchoring it into the follicle. within a few hours of treatment.
● When cells reach the upper part of the bulb they The treated area of skin will have open follicles
become keratinised. which offer bacteria easy entry into the body. It is
● Two-thirds of its way up the follicle, the hair vital that clients adhere strictly to aftercare advice
leaves the inner root sheath and emerges on to to avoid risk of infection.
the surface of the skin.
Catagen stage Common pathologies
● This transitional stage from active to resting lasts
approximately two to four weeks.
of the hair
● Hair separates from the dermal papilla and moves Alopecia areata, alopecia totalis and
slowly up the follicle. alopecia universalis
● The follicle below the retreating hair shrinks. ● Alopecia areata – a form of hair loss that can
occur at any age. It presents as patches of hair
● The hair rises to just below the level of the
loss which may be present on the scalp, beard,
sebaceous gland. Here the inner root sheath
eyelashes, eyebrows, and on the body or limbs.
dissolves and the hair can be brushed out.
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● Alopecia totalis – affects the whole scalp, causing

total hair loss on the head. Nails
● Alopecia universalis – the whole body and scalp The nail is an important appendage of the skin and is
are affected by hair loss. an extension of the stratum lucidum (clear layer) of
Alopecia can be genetic, but it can also be caused by the epidermis. It is composed of horny flattened cells
stress, shock, illness or medication (as in the case of which undergo a process of keratinisation, making
chemotherapy, for example). the nail quite hard. It is the protein keratin that helps
to make the nail a strong but flexible structure. The
Androgenetic (or pattern) alopecia visible part of the nail is dead as it has no direct
This is a genetically determined pathology – often supply of blood, lymph or nerves. All nutrients are
referred to as male-pattern or female-pattern supplied to the invisible living part of the nail via
baldness – that is characterised by gradual hair loss. It the dermis.
is an extremely common condition which affects both
men (50% over 50 years of age) and women (50% The functions of the nail
over 65 years of age). In women, the severity varies
from widespread thinning to complete baldness. The nail has two important functions:
The main hormone responsible for androgenetic ● It forms a covering at the ends of the phalangeal
alopecia is dihydrotestosterone, which causes the joints of the fingers and the toes, helping to protect
affected hairs to be reduced in diameter and length and support their delicate networks of blood
and to become lighter in colour. Eventually, the vessels and nerves.
follicle shrinks and ceases to produce hair. ● It is a useful tool enabling us to touch
and manipulate small objects, and scratch
Hypotrichosis
surfaces.
This is a condition of abnormal hair patterns, such
as hair loss or reduction. It occurs most frequently
as the growth of vellus hair in areas of the body
The structure of the nail
that normally produce terminal hair. Typically, the Free edge
individual’s hair growth is normal after birth, but
Hyponychium
soon the hair is shed and replaced with sparse,
abnormal hair growth. The new hair is fine, short
Nail bed Nail grooves
and brittle, and may lack pigmentation. Baldness
may be present by the age of 25. Nail plate Nail wall
Hypertrichosis
Lunula
Hypertrichosis is an abnormal amount of hair Nail matrix
growth over the body. The two distinct types of Cuticle
(eponychium) Proximal nail
hypertrichosis are generalised hypertrichosis, fold (nail
which occurs over the entire body, and localised mantle)
hypertrichosis, which is restricted to a certain area.

Hypertrichosis can be either congenital (present
at birth) or may occur later in life. p Cross-section of a nail
The excess of hair appears in areas of the skin that The nail has several important anatomical regions as
do not have androgen-dependent hair growth (that shown in Table 3.9.
is areas not in the pubic, face and axillary regions).
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Table 3.9 The anatomical regions of the nail
Structure Location Function

Nail matrix Situated immediately below the cuticle The nail’s most important feature, this is the
(germinal (eponychium) area where the living cells are produced
matrix) Has a good blood supply which delivers
oxygen to the nail and is vital in the
production of new cells
Area that determines the health of the nail
Nail mantle Deep fold of skin above the matrix Protects matrix or nail root from physical
or proximal damage
nail fold
Nail bed Located immediately below the nail plate, Provides nourishment and protection for
this is a continuation of the matrix the nail
Part of the skin on which the nail plate rests Richly supplied with blood vessels, lymph
vessels and nerves from the underlying
dermis
Cuticle A fold of overlapping skin that surrounds Protects the matrix and nail bed from
the base of the nail infection by stopping dirt and bacteria
There are three areas of the cuticle: from getting under the nail plate, forming
● the eponychium is the dead cuticle that a waterproof barrier
adheres to the base of the nail, near the
lanula
● the perionychium is the cuticle that
outlines the nail plate
● the hyponychium is the cuticle skin found
under the free edge of the nail
Lunula Light-coloured semicircular area of the nail, Area of the nail where cells start to harden;
that lies between the matrix and the nail the cells here are in a transitional stage
plate (between hard and soft)
Also known as the ‘half-moon’ Forms a bridge between the living cells of
the matrix and the dead cells of the nail plate
Nail plate Main visible part of the nail which rests on Offers protection for the nail bed
the nail bed and ends at the free edge
Is made up of tightly packed and hard
keratinised epidermal cells
Cell layers are packed closely together,
and are bound together by sulfur bonds,
moisture and fat
Nail wall The folds of skin overlapping the sides of Protects the edges of the nail plate from
the nails external damage
Nail groove Deep ridges under the sides of the nail Guides the growth of the nail up the
fingers/toes, helping the nail to grow
straight
Free edge Part of the nail plate that extends beyond This is the part of the nail that is filed
the nail bed and fingertip Protects the finger tips and the
hyponychium
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● It takes approximately six months for cells to

KEY FACT
travel from the lunula to the free edge of the nail
The underside of the nail plate is grooved – it
has longitudinal ridges and furrows that help for fingernails, and approximately nine to
keep it in place. A normal healthy plate curves 12 months for toenails.
in two directions:
1 transversely – side to side across the nail
Factors affecting nail growth
2 longitudinally – from base to the free edge. Nail growth may be affected by the factors which are
The nail plate contains three distinct layers: discussed below.
1 The dorsal layer is the uppermost layer and
is the hardest. KEY FACTS
2 The intermediate layer is the thickest layer The rate of growth of a nail is faster in the
making up 70–75% of the nail plate. summer due to an increase in cell division as a
result of exposure to ultraviolet radiation.
3 The ventral layer is the bottom layer that is
attached to the nail bed. It is only one or two Fetal nails start growing before the fourth month
cells thick and is composed of soft keratin. of pregnancy.
The growth rate of nails varies from person to
person and from finger to finger, with the nail
The process of nail growth of the index finger generally being the fastest
to grow.
KEY FACT The average growth rate of a nail is
approximately 3 mm per month.
A good blood supply is essential for healthy nail
growth; oxygen and nutrients are supplied to
the living cells of the nail matrix and nail bed. Activity
Nails grow more quickly on the dominant hand due
to increased activity and the resulting faster blood
KEY FACT
flow (so if you are right handed, the nails on your
Protein and calcium are good sources of
nourishment for the nails. right hand will grow faster than those on your left).
Age
The nail growth process is characterised by these steps:
During ageing, nail growth slows down due to the fact
● Nail growth occurs from the nail matrix by cell that the blood vessels supplying the matrix become
division. less efficient.
● As new cells are produced in the matrix, older Due to slower nail growth, imperfections in the nail
cells are pushed forwards and are hardened plate, such as ridges, become more visible with age.
by the process of keratinisation to form the
hardened nail plate. Diet and nutrition
● Translucent cells, when they first emerge from A poor diet lacking in nutrients, vitamins and
the matrix are plump and soft, but they keratinise minerals affects both the growth and appearance
(become harder and flatter) as they move of the nail.
towards the free edge. Hormones levels
● As the nail grows, it moves along the nail grooves Some hormonal changes can enhance nail growth,
at the sides of the nail. These grooves help to for instance pregnancy can speed up nail growth.
direct growth along the nail bed. However, some conditions such as thyroid disorders
● The top layers of the epidermis (stratum lucidum can adversely affect the health of the nail.
and stratum corneum) form the nail plate. Illness and medical condition
● The remaining three layers of the epidermis During a period of ill health, the body may reduce
(stratums germinativum, spinosum and the blood supply to the nails as it attempts to heal
granulosum) form the nail bed.
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other parts. This can result in changes to the nail complete removal of the nail. It could result in
structure (they may become ridged and paler) and permanent malformation of the nail if the nail bed is
growth overall is diminished. damaged.
Medication Skin texture
Some medication can affect nail growth, making As the nail is an appendage of the skin and its blood
it faster or slower, and may also influence nail supply is via the dermis, if the skin is in a poor
strength. condition this will affect the health and growth
of the nail cells.
Climate
Nails grow faster in the summer when it is warmer Current hand and nail care routine
and circulation is improved, and growth rate slows A regular and effective nail care routine will
down in winter when circulation is reduced. This help nails to grow stronger and longer. Correct
means that nails grow at different rates depending filing of the free edge, frequent use of cuticle oil
on the time of year. and regular manicures all help to maintain healthy
nail growth.
Lifestyle and stress level
A healthy lifestyle, along with a low stress level, Smoking
helps nails to grow quickly and strongly. Poor health As smoking deprives the body of oxygen, nails suffer
or an unhealthy lifestyle, coupled with a high stress as a result. Slow growth, brittle, dry, cracked, hooked,
level, will impact the nail structure and result in poor and peeling nails are all common in smokers.
growth.
Alcohol
KEY FACT Excess alcohol in the blood can deprive the nails of
vital nutrients. Brittle, pale and peeling nails are a sign
Unlike hair growth, nail growth does not follow
a growth cycle – nail growth is continuous that a person is consuming unhealthy amounts of
throughout life. Toe nails have a slower rate of alcohol.
growth than fingernails.
Chemotherapy
During chemotherapy treatment, clients may notice
Occupation some changes in the colour and thickness of their
Certain occupations may have an enhanced effect nails, and changes around the nail bed. The nail may
on nail growth (manual occupations can encourage look bruised, turning black, brown, blue or green.
nail growth as they promote blood flow). Some The nail may develop blemishes, such as horizontal
occupations may have a negative effect on nail or vertical lines, or small indentations. These marks
growth (chemicals used in jobs like cleaning can may reflect the timing of chemotherapy. They are
have a detrimental effect). not permanent and will grow out.
Trauma The nail may become dry, thin or brittle, and will tend
Any type of trauma (accidental or through poor to break more easily.
manicuring techniques) can slow the rate of nail Radiotherapy
growth if it affects the matrix. If a heavy pressure
During a course of radiotherapy, nails, may become
is applied when using a cuticle knife, damage may
discoloured or weak, and may break or lift off.
be caused to the matrix cells resulting in ridges to
Sometimes nails develop ridges which will grow
the nail. This damage may be temporary if new cells
out over time. For most people, nail changes are
produced in the matrix replace the affected ones
temporary. It may take about six months after
and the ridges may eventually grow out.
completion of treatment for nails to return to
Accidental damage, such as shutting a finger in a their usual condition.
door, may result in bruising and bleeding and even
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Natural nail shapes
Square Squoval Oval Fan
p Nail shapes
Table 3.10 Natural nail shapes
Nail shape Description

1 Square The nail is filed straight across at the free edge, creating a square shape
Very popular shape
Suits longer fingers with narrow nails and those with shorter nails or wide nail beds
Can be rounded at the edges to create the ‘squoval’ shape, see below
Low maintenance
2 Squoval This is a square shape with rounded edges
Shape helps to prevent breaks
Low maintenance
3 Oval The free edge is rounded and the nail forms an oval shape
A natural and highly desirable nail shape
Compliments shorter and wider nails
4 Fan The nail grows outwards at the free edge creating a fan-like shape
Fan nails are narrow at the eponychium and wide at the free edge
5 Hook (claw) The nail grows downward in a hook-like shape
See onychogryphosis (page 72)
6 Spoon The nail curves up and grows outwards at the free edge
See koilonychia (page 74)
Nail conditions
It is important to remember that nails originate in the epidermal layer of
the skin. Like hair, their condition is dependent on the individual’s overall
health.
Table 3.11 Nail conditions
Nail condition Recognition factors

Bitten Nail shape appears deformed with a bitten down and ragged free edge
Cuticle and skin may be chewed, and may appear red and sore
Nail biting is a nervous habit which may lead to permanent damage
There is a risk of transferring germs from fingers to mouth, which could cause disease
Brittle Nails are very hard and inflexible
May often break or crack easily
Have a thicker nail plate
May become curved as they grow longer
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Nail condition Recognition factors

Damaged Extremely thin, weak and soft (bendy)
May peel easily
Free edge disintegrates when filed
Growth rate is slow
Sensitive to the touch
Dehydrated Flaky, peeling and dull in appearance
Often have superficial ridges
Sometimes have a thickened nail plate
May be discoloured
Have a dragging feeling to the touch
Discoloured Nail may appear yellow, green, black, blue or brown, depending on cause
Stains may be caused by cigarette smoking, use of hair dyes or touching highly coloured vegetables
Discolouration can be caused by fungal infections or other medical conditions
Dry Dull in appearance, with a dragging feeling to the touch
Often have a flaking free edge.
May peel easily and have superficial ridges
The cuticles are usually very dry
Misshapen Nails can become misshapen due to:
● mechanical damage (poor treatment)
● an accident (shutting a hand in a door)
● a nail pathology such as koilonychia
● natural growth patterns (spoon-shaped nails)
Pitted Small depressions (shallow or deep) appear on the surface of the nails
Often found in clients suffering from psoriasis
Ridged Vertical ridges or furrows run from the tip of the fingernail down to the cuticle.
Often develop in older age, possibly due to a slowing of cell turnover
If vertical ridges are accompanied by a change in colour and texture, the cause maybe a medical
condition or iron deficiency (anaemia)
Deep horizontal ridges, called Beau’s lines, may be symptoms of a more serious condition such as
acute kidney disease, diabetes or thyroid disease
Split Can appear as a single horizontal split between layers of the nail plate at the growing end or as
multiple splits and loosening of the growing edge of the nail plate
Horizontal nail splitting may occur along with onychorrhexis, or with longitudinal ridging and
Horizontal splits at the origin of the nail plate may be seen in people with psoriasis, lichen planus or
in people who use oral medications made from vitamin A
Nail pathologies In practice

Diseases of the nail occur as a direct result of A therapist must be able to recognise diseases and
bacteria, fungi, parasites or viruses attacking the nail disorders so that the correct treatment or advice
or surrounding tissues. Nail diseases contraindicate may be given.
manicure or pedicure treatments due to the risk of
cross-infection.
Nail diseases
Nail disorders may be caused by illness, physical
and chemical damage, by general neglect or by Anonychia (an-uh-NIK-ee-uh)
poor manicuring techniques. Nail disorders do not This is a congenital disorder in which there is a total
contraindicate treatments. absence of a nail. It may affect all or some of the
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fingernails or toenails. Although typically congenital,

it may also be caused by infection, a severe allergic
reaction or trauma.
Onychatrophia (on-ee-chat-tro-fi-ah)
This is a condition in which the nail plate atrophies
(wastes away). Initially, the nail loses its lustre,
becomes smaller and may then separate completely
from the nail bed. The condition may be caused by
an injury to the matrix or by a disease.
p Onychogryphosis
Onycholysis (on-ee-KOL-e-sis)
This condition is characterised by loosening
or separation of part or all of a nail from its bed.
Causes include disease and physical damage (such as
insertion of a sharp instrument used under the free
edge), or it may occur spontaneously without any
apparent cause. Penetration of the flesh line can
allow bacteria and other infective agents to enter
p Onychatrophia
the nail bed.
Onychia (on-nik-ee-uh)
This is a generic term used to describe any disease of
the nail, but more specifically refers to inflammation
of the nail bed and a bacterial infection of the nail
fold. In this condition the nail matrix appears red with
swelling, tenderness and pus formation. The condition
may lead to shedding of the nail. Causes include wearing
false nails for too long, harsh manicuring, chemical
applications, a variety of infections and physical damage.
p Onycholysis
Onychomycosis (on-i-koh-me-KOH-sis)
p Onychia
This is a term given to the fungal infection of the nail
Onychogryphosis (on-e-koh-gri-foh-siss) commonly called tinea unguium or ringworm. It
This is the technical term for claw-shaped nails, attacks the nail bed and nail plate, presenting as white
in which the nails present as crooked, curved and or yellow scaly deposits at the free edge, which may
thickened. then spread down to invade the nail walls or bed. The
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nails become thickened, brittle, opaque or discoloured. Nail disorders and conditions
The nail plate appears spongy and furrowed.
Beau’s lines and other nail ridges
In its advanced stages, the nail plate may separate
from the nail bed (a condition known as onycholysis, Beau’s lines are deep, waxy, horizontal lines across
see above). There may also be accompanying the nail, often called transverse furrows, corrugations
dryness and skin scaling at the base of the fingers or ridges. Ridges in the nail may occur due to
and on the palms. irregular formation of the nail or to physical or
chemical injury of the nail matrix.
Beau’s lines can be indicative of abnormal nail
growth, a symptom of body malfunction or disease.
Deep Beau’s lines, especially when present across all
the nails, are associated with serious illness.
Vertical or longitudinal ridges are another type of ridge
– these are common in healthy nails due to uneven
development of the nail tissue, poor manicuring
techniques and the effects of harsh chemicals.
p Ringworm of the nail
Paronychia (parr-uh-NIK-ee-uh)
This is inflammation of the skin surrounding the
nail, commonly caused by bacterial, viral or fungal
infection. The tissues may be swollen and pus may
be present, which can develop into an abscess. p Beau lines
Prolonged immersion of the hands in water, poor
manicure techniques, nail biting, and picking at the
cuticle or the nail wall can all increase the risk of
infection.
p Longitudinal furrows
Bruised nail
A bruised nail, resulting from a heavy blow or
persistent trauma (for example in long distance
runners), presents as a blackened area where dried
p Paronychia blood is visible beneath the nail plate.
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The bruised area travels with the nail growth and will Koilonychia (keel-oh-NIK-ee-uh)
eventually grow out. However, a severely bruised nail This is the term given to concave, spoon-shaped
can cause the nail plate to lift from the nail plate. nails, resulting from abnormal growth at the nail
matrix. In this condition the nails are thin, soft
and hollowed. Koilonychia may be congenital or
it may be due to lack of iron or other minerals in
the diet.
p Koilonychia
p Bruised nail
Leukonychia (lou-con-ik-ee-uh)
Hang nail
This is a term given to white or colourless nails,
A hang nail is a small strip of skin that hangs loosely or nails with white spots, streaks or bands. There
at the side of the nail, or a small portion of the nail may also be evidence of ridging. Leukonychia may
itself that splits away. A hang nail may develop due be caused as a result of injury to the matrix or the
to dry, torn or split cuticles. Common causes are effects of disease. The white spots usually disappear
immersing hands in water for long periods, use of as the nail grows.
detergents and other chemicals, cutting the nails
too close, picking at the cuticles and improper filing.
p Leukonychia
Onychocyanosis (on-ee-choc-an-o-sis)
In this nail condition, which is also called blue nail, the
nail presents with a blue tinge, rather than a healthy
pink tone. It is usually the result of poor circulation, a
p Hang nail heart condition or other circulatory disorder.
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Onychorrhexis (on-i-ko-rek-sis)
This is the term given to dry, brittle nails. In this
condition the nails lose their moisture, becoming dry,
and the free edges may split. The nails may easily peel
into layers. There may be transverse or longitudinal
splitting of the nail plate and inflammation, tenderness,
pain, swelling and infection may also be present.
Frequent immersion in water and contact with
detergents and chemicals contribute to this condition.
It may also indicate an iron deficiency, anaemia, or
p Onychocyanosis incorrect filing which causes the nail plate to split.
Onychophagy (on-i-kof-uh-jee)
This is the technical term for nail biting in which
the free edge, nail plate and cuticle are bitten to
leave the hyponychium exposed and the cuticle and
surrounding skin ragged, inflamed and sore. Nail
biting is usually a nervous or stress-induced habit.
p Onychorrhexis
Onychocryptosis (on-i-koh-krip-toe-sis)
This is a term given to an ingrown fingernail or toe
p Onychophagy nail. The first signs are inflammation, followed by
tenderness, swelling and pain around the side of
Onychauxis (on-chor-ex-is)
the nail. Infection may aggravate the condition. It is
This is the medical term for extreme thickening of caused by ill-fitting shoes, cutting or filing nails too
the nail plate. short or too close to the skin.
Onychauxis may be a natural part of ageing, but can It may also be due to a malformation of the nail
also be caused by trauma (injury) or from wearing when it was beginning to grow.
tight shoes. However, it can also be caused by more
serious issues affecting the nail bed and the skin, such
as fungus or yeast infection.
p Onychauxis p Onychocryptosis
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Onychomalacia (on-ee-chom-al-a-c-ah) Pterygium (terr-e-gee-um)

This is a term given to eggshell nails – thin, white nails This is a condition in which the cuticle becomes
that are more flexible than normal. In this condition overgrown and grows forwards up the nail. The
the nail separates from the nail bed and curves at cuticle at the base of the nail becomes dry and split,
the free edges. The condition may be associated with and sticks to the nail plate. Pterygium may be due
illness, poor diet, mineral deficiency or stress. to faulty nail care or lack of nail care (neglect).
p Onychomalacia
Onychoschizia (ony-cho-sc-it-zee-a)
Onychoschizia or lamellar dystrophy is a term given
to nails which present as soft, thin, split or brittle. p Pterygium
Indicators of this condition include a dryness in the
nail plate, separation of nail layers, along with flaking
and peeling at the free edge. Splinter haemorrhage of nail
These haemorrhages present as thin, red to reddish-
brown lines of blood under the nails, running in the
direction of nail growth. They look as if there is a
splinter in the nail plate. Splinter haemorrhages can
develop after an injury or trauma to a fingernail
or toenail. Stubbing a toe or injuring a finger can
damage blood vessels along the nail bed and trigger
bleeding under the nail. If caused by injury, they
are not a reason for concern as they clear up as the
p Onychoschizia injury heals. However, if a splinter haemorrhage
persists it may indicate an underlying disease or
Pitting of the nail plate
disorder.
This nail condition presents with small depressions,
which resemble pin pricks, on the surface of the nail. The
depressions may be superficial or deep, and are often
found in clients suffering with psoriasis or eczema.
p Pitting of the nail plate p Splinter haemorrhage
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Blepharitis
Activity
Blepharitis is an inflammation of the eyelids,
Recognising nail diseases and disorders commonly caused by Staphylococcus bacterial
Cover up the written information in this book infection. The condition presents as eyelids that are
on nail diseases and disorders, leaving only the red, swollen, itchy and sore at the edges. Eyelids
photos visible. Test yourself or work in pairs to may be crusty or greasy, causing the eyelids to stick
see how many conditions you can identify. together. Eyes feel gritty and sensitive to light.
Common pathologies
of the skin
The skin is a complex organ and when symptoms of
disease and disorders occur, it can affect a client’s
health and wellbeing.
In practice p Blepharitis
It is essential that therapists are able to recognise
skin conditions that require medical attention, to Boil
advise the client to access treatment and to avoid A boil or furuncle occurs when a hair follicle becomes
possible cross-infection in the salon. deeply infected with Staphylococcus bacteria, usually
Therapists should also be knowledgeable about appearing suddenly as a painful pink or red bump. It
skin lesions and disorders so that treatment begins as a small inflamed nodule which then forms a
and advice is appropriate and referral to a large painful pustule around the base of a hair follicle
dermatologist can be made if necessary. or at a break in the skin.
Local injury or lowered immune resistance may
encourage the development of boils, along with stress
Bacterial infection and poor hygiene. A carbuncle is a cluster of boils.
Many types of bacteria can survive and reproduce
on the skin. Bacterial skin infections can affect a
small (localised) area or the whole of the body.
Whatever the extent of an infection, they are
contagious. If you treat a client with a bacterial
infection you:
● may make the client’s condition worse
● could contract the condition yourself, which
may prevent you from working
● risk passing it on to other clients. p Boil
Conjunctivitis
In practice
Conjunctivitis is a bacterial (staphylococcal)
In the case of an infectious skin condition, infection following irritation of the conjunctiva of the
no treatment can be carried out until all signs eye. The inner eyelid and eyeball appear red and sore
of infection have ceased. This is to prevent cross- and there may be a pus-like discharge from the eye.
infection and to prevent the condition spreading The infection spreads by contact with secretions from
and/or worsening. the eye of an infected person.
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Symptoms include an itchy or gritty feeling inside the Stye

eye, along with a sensitivity to light. A stye or hordeolum is an acute Staphylococcus
inflammation of the gland at the base of an eyelash.
The gland becomes hard and tender, and a pus-filled
cyst develops at the centre.
p Conjunctivitis
Folliculitis
This bacterial infection, usually Staphylococcus aureus,
p Stye
causes a small pustule at the base of a hair follicle.
There is redness, swelling and pain around the follicle.
Viral infections of the skin
Virus particles need a host (such as a person) to
reproduce, whereas bacteria can persist in the
environment.
Viral infections are very contagious so clients
should not receive treatments until the condition
has cleared. Remember that some viruses remain
dormant in the body even after signs of the infection
have gone. Note also that viral skin conditions
are more aggressive in people with compromised
p Folliculitis
immune systems.
Impetigo Herpes simplex
This is a contagious inflammatory disease in which Cold sores are caused by the herpes simplex virus.
weeping blisters are visible on the surface of the skin, They are normally found on the face and around the
particularly around the face, mouth and ears. Blisters lips, beginning with an itching sensation, followed by
dry to form honey-coloured crusts. Impetigo is caused erythema and a group of small blisters which weep
by Streptococcus and Staphylococcus bacteria which and form crusts. This condition generally persists for
are transmitted by dirty fingernails and contact with approximately two or three weeks but may reappear
towels, for example. at times of stress, ill health or exposure to sunlight.
p Impetigo p Herpes simplex (cold sore)
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Herpes zoster Plantar warts or verrucae occur on the soles of the

Shingles is a very painful infection along the sensory feet and are usually the size of a pea.
nerves due to herpes zoster, the virus that causes
chicken pox. Lesions resemble herpes simplex with
erythema and blisters along the lines of the nerves.
Affected areas are usually the back and upper chest.
Severe pain may persist at the site of the shingle
infection for months or even years after the apparent
healing of the skin.
p Plantar wart
Facial warts present as skin-coloured, benign growths
with a long thread-like appearance (similar to a
skin tag). They are common on the eyelid, neck and
surrounding areas.
p Herpes zoster (shingles)
Warts
A wart is a benign (non-harmful) growth on the
skin, caused by infection with the human papilloma
virus (HPV).
Plane warts are smooth in texture with a flat top and
are usually found on the face, forehead, back of the
hands and the front of the knees.
p Facial wart
Fungal infections of the

skin
Common fungal skin infections are caused by yeasts,
which multiply in damp, moist conditions. The
affected area of the skin usually presents as itchy, red
or scaly. It is essential to avoid contact with a fungal
infection until all signs of the infection have cleared.
Tinea corporis
Tinea corporis or ringworm of the body is a fungal
p Plane wart infection of the skin which begins as small red
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papules that gradually increase in size to form a ring.

The affected areas on the body vary in severity from
Infestation disorders of
mild and scaly to inflamed and itchy. the skin
Infestation disorders involve parasites that live on or
in the skin. These conditions are highly contagious.
Demodex
● Demodex brevis – a type of demodex mite
(a short-tailed, eight-legged parasite) that
is invisible to the naked eye and is found in
the sebaceous gland of hair follicles. It feeds
on sebum produced by the sebaceous gland.
Demodex brevis is known to make conditions such
as eczema and rosacea worse.
● Demodex folliculorum – a longer tailed demodex
mite that lives in the hair follicles.
Demodex is mostly found on the face, around the
p Ringworm eyelids and eyelashes. It causes an increase in the
number of skin cells in hair follicles, giving the
Tinea capitis appearance of scaly skin.
This is ringworm of the scalp. It appears as
Demodex does not usually produce symptoms but
painless, round, hairless patches on the scalp.
if there is a serious infestation, a condition called
Itching may be present and the lesion may
demodicosis occurs. This presents with red and
appear red and scaly.
scaly skin, skin irritation and rashes, eye irritation,
Tinea pedis thickening of the eyelid and loss of eyelashes.
Tinea pedis or athletes’ foot is a highly contagious
fungal condition which is easily transmitted in damp,
moist conditions such as swimming pools, saunas
and showers. Athletes’ foot appears as flaking skin
between the toes, which becomes soft and soggy.
The skin may also split and the soles of the feet may
occasionally be affected.
p Demodex mite
Pediculosis
This condition is commonly known as lice, a
contagious parasitic infection. The lice live off the
blood sucked from the skin. Head lice are frequently
seen in young children and, if not dealt with quickly,
may lead to a secondary infection of impetigo as a
result of scratching. With head lice, nits (egg cases)
may be found in the hair. These are pearl-grey or
brown oval structures found on the hair shaft close
to the scalp. The scalp may appear red and raw due to
p Tinea pedis scratching.
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is characterised by the presence of greasy, oily skin

with enlarged pores, inflammation in and around
the sebaceous glands, papules, pustules and, in more
severe cases, cysts and scars.
Acne is primarily androgen induced and appears most
frequently at puberty, often persisting for a considerable
period of time. Although acne is commonly associated
with teenage and adolescent skin, it can actually affect
p Pediculosis (lice) people in all age groups at different stages of life.
Body lice are rarely seen as they burrow into the surface There are two main categories of acne: acne simplex
of the skin; however they may cause intense itching. (non-inflammatory acne); and acne vulgaris
They occur on individuals with poor personal hygiene (inflammatory acne).
and live and reproduce in seams and fibres of clothing, The typical stages of acne development are as follows:
feeding off the skin. Lesions may appear as papules, ● Acne starts to develop when an increase in
scabs and, in severe cases, as pigmented, dry and scaly hormone production (commonly at puberty)
skin. Secondary bacterial infection may be present. A stimulates the sebaceous glands.
client who is affected by body lice may complain of ● Excess sebum production causes additional cell
itching, especially in the shoulder, back and buttock area. build-up in the follicles, which become comedones
Scabies (plugs of sebum and dead cells).
This is a contagious parasitic skin condition caused ● Blockage of the follicle opening results in
by the female mite burrowing into the horny inflammation and irritation, and in the formation
layer of the skin, where she lays her eggs. The first of papules.
noticeable symptom of this condition is severe ● The blockage of sebum and dead skin cells prevents
itching, which worsens at night. Papules, pustules and oxygen reaching the bottom of the follicle. In these
crusted lesions may also develop. Common sites of conditions, particular bacteria multiply (see Key
infestation are the ulnar borders of the hand, palms fact). The infected papules become pustules.
of the hands and between the fingers and toes. Other ● The bacteria excrete an inflammatory fatty acid
sites include the axillary folds, buttocks, breasts in the by-product which eventually blocks the follicle
female and external genitalia in the male. completely.
● The skin forms hardened tissue as it attempts to
prevent the spread of bacteria, creating cysts.
● The damage to collagen and elastin in the dermis
can lead to depressed and raised scars (the scars
resulting from cysts are called ice-pick scars).
KEY FACT
The scientific name of the bacteria that causes
acne vulgaris is Propionibacterium acnes. These
bacteria are anaerobic, which means that they do
not need oxygen to survive and grow. Although
these bacteria are present in all follicles in small
p Scabies numbers, they are prevented from excessive
reproduction by the oxygen that is provided by an
Acne open follicle. However, once the follicle becomes
Acne is a chronic inflammatory disorder of the blocked and the circulation of oxygen ceases,
sebaceous glands which leads to the overproduction these bacteria multiply and feed off the sebum
produced by the overactive sebaceous glands.
of sebum. It involves the face, back and chest and
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There are four different grades of acne, the grade being dependent on the
severity of the disorder (Table 3.12).
Table 3.12 Grades of acne
Grade Characteristics
Grade I Minor breakout: presence of a few papules and pustules
(acne simplex – non-inflammatory) Mainly open comedones present, with some closed comedones
Typical in a teenager just beginning puberty
Grade II Greater incidence of papules and pustules
(acne simplex – non-inflammatory) Presence of many closed comedones and more open comedones
Grade III Skin appears very red and inflamed, with many papules and
(acne vulgaris – inflammatory) pustules present
Grade IV Cysts present with comedones, papules, pustules
(acne vulgaris – inflammatory) Skin appears inflamed
In practice
Acne is a complex skin condition
and can range in severity from
mild breakouts to disfiguring scars
and cysts. It requires specialist
products and treatment.
Clients with acne which is
acutely inflamed (grade III or
IV) should be referred to their
GP and/or to a dermatologist
so that they receive the correct
treatment. This might include
medication for any infection
that has become impacted at
the base of the follicles. p Acne vulgaris
Therapists should liaise with other
skin care professionals (such as Rosacea
dermatologists) to ensure the This is a chronic inflammatory disease of the face in which the skin
correct aesthetic advice and appears abnormally red. The condition usually occurs in adults after the
treatment is given to the client. age of 40, but can begin as early as age 20.
The condition develops gradually, beginning with a seeming tendency
to blush easily, a red complexion or an extreme sensitivity to cosmetic
products.
The distinctive redness appears in a characteristic butterfly pattern
across the nose and cheeks. As the condition progresses there may be
KEY FACT papules and pustules present. Although the condition may resemble
As many of the symptoms acne, unlike acne, the condition rosacea is rarely if ever accompanied by
of rosacea look like those of comedones.
acne, the condition is often The other distinguishing factors of rosacea are the dry flaky patches that
misdiagnosed.
may accompany dry or oily skin.
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The redness of rosacea often persists after exposure to cold or to irritants

like soap. Over time, small blood vessels become more prominent,
making the redness more noticeable. Many patients feel stinging or
burning sensations and the skin feels tight (like mild sunburn) when
smiling, frowning, or squinting. For some clients, all products sting, burn
and irritate the face.
A progressive stage of rosacea is characterised by growth and swelling
of the nose and central facial tissues. The ears may also be involved. This
condition is known as rhinophyma and it can be very disfiguring.
Aggravating factors of rosacea include hot and spicy foods, hot drinks,
alcohol, menopause, weather elements and stress.
In practice
Rosacea is a skin condition in which both dermatological and skin care
treatments can be helpful. Clients with rosacea should be referred to a
dermatologist for diagnosis and management. If the right medication
is given, along with the correct skin care treatment, flare-ups can be
avoided and the condition can be stabilised.
It is important to avoid products that are harsh, abrasive, fragranced
and heavy, and to avoid excessive extraction, steam and very
stimulating massage.
Clients should be educated on avoiding known triggers, such as heat,
spicy foods and alcohol.
p Rosacea
Sebaceous cyst
This type of cyst, which develops from a sebaceous gland, is a round
nodular lesion with a smooth, shiny surface. They are usually found on
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the face, neck, scalp and back. They are situated in the
dermis and vary in size from 5 to 50 mm. The cause is
unknown.
In practice
A client who presents with a sebaceous cyst should
be referred to their medical practitioner, who may
recommend that it is removed surgically.
p Seborrhoea
Disorders of the sweat

glands
Hyperhidrosis
This is the excessive production of sweat, affecting
p Sebaceous cyst the hands, feet and underarms.
Seborrhoea
KEY FACT
Seborrhoea is defined as an excessive secretion of
Botox injections may be administered to help
sebum by the sebaceous glands. control hyperhidrosis.
In this condition the glands appear enlarged and
the skin appears greasy, especially on the nose and Pigmentation disorders
the centre zone of the face. It can resemble acne
in that there may be swellings and breakout. In practice
One of the main differences between acne and Pigmentation disorders do not necessarily
seborrhoea is that in seborrhoea the increased oil contraindicate all treatments, although care does
production is often accompanied by scaly, greasy, need to be taken to avoid overstimulation and
thickened skin, especially on the scalp. irritation of the skin, which could further exacerbate
Seborrhoea is common where there is a high an existing condition.
incidence of sebaceous glands (for instance on the Also, clients should be educated about adequate
scalp and the sides of the nose). Seborrhoea can protection of their skin from sunlight, to avoid
occur at any age, but is common in infancy (when it further skin damage.
is called ‘cradle cap’) and at puberty due to glandular
disturbances.
Albinism
This condition is caused by an inherited absence of
In practice pigmentation in the skin, hair and eyes, resulting
Depending on severity, clients with seborrhoea in white hair, very pale skin and pink eyes. The pink
may need to be referred to their medical colour is produced by the underlying blood vessels,
practitioner for topical medication to clear the which are normally masked by skin pigment. Other
condition. clinical signs of this condition include poor eyesight
and sensitivity to light.
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DPN is not a skin cancer, and it will not turn into a

skin cancer. The condition is chronic, with new lesions
appearing over time.
No treatment is necessary other than to alleviate
cosmetic concerns. In certain circumstances, if the
lesions are symptomatic (painful, inflamed, itchy or
catch on clothing) they can be treated via a minor
surgical procedure.
p Albinism
Chloasma
Chloasma is a pigmentation disorder with irregular
areas of increased pigmentation, usually on the face.
It commonly occurs during pregnancy and sometimes
when taking the contraceptive pill due to stimulation
of melanin by the female hormone oestrogen.
p Dermatosis papulosa nigra (DPN)
As black skin is thicker than white skin, it is prone

to congestion and comedones. Black skin generally
ages at a much slower rate than white skin,
mainly due to the extra protection afforded by the
melanin. A disadvantage of having more melanin is
that it makes the skin more ‘reactive’. This means
that almost any stimulus, such as a rash, scratch
or inflammation may trigger the production of
p Chloasma excess melanin, resulting in dark marks or patches
on the skin. This is known as post-inflammatory
Dermatosis papulosa nigra hyperpigmentation.
Dermatosis papulosa nigra (DPN) is a unique benign Occasionally some black skins develop a
skin condition that is common among people with decrease in melanin, or post-inflammatory
black skin. It is characterised by multiple, small, hypopigmentation in response to skin trauma.
hyperpigmented, asymptomatic papules. In either case (hypo- or hyperpigmentation),
Small, dark bumps most commonly affect the light or dark areas may be disfiguring and
the face, neck, chest and back. The cause of DPN may take months or years to fade. The increased
is uncertain. There is a strong genetic basis for the thickness of the horny layer of black skin can
disorder, and often the lesions can be seen in several lead to dehydration, which causes increased skin
members of the same family. Under the microscope, shedding. This can create a grey ‘ashen’ effect as
the lesions are revealed as a type of harmless the loose cells build up on the skin.
keratosis.
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Ephelides ● Strawberry naevus – a red raised lump above the

Ephelides is also known as freckles. These are small, skin’s surface. These usually develop before or shortly
harmless pigmented areas of skin. They appear where after a baby is born, but disappear spontaneously
there is excessive production of the pigment melanin before the child reaches the age of ten.
(after exposure to sunlight).
Lentigo
These are also known as ‘liver spots’. They are flat
dark patches of pigmentation found mainly in elderly
people on skin that has been exposed to light.
Vitiligo
Vitiligo is a patchy lack of pigmentation in areas
of the skin where the basal cell layer of the
epidermis no longer produces melanin. The cause
is unknown.
p Portwine stain
Hypertrophic disorders
Hypertrophic disorders refer to conditions that result
in an increase in size of a tissue or organ, caused by an
enlargement of the cells. Hypertrophic disorders of the
skin are caused by an enlargement of the skin cells.
Hyperkeratosis
Keratoses are generally defined as a build-up of cells.
Hyperkeratosis is a rare skin disorder in which there is a
gross thickening of the skin due to mass of keratinocytes
p Vitiligo that builds up to a horny overgrowth of skin cells.
Naevus
A naevus is a birthmark or other clearly defined
malformation of the skin. There are several different
types of naevi:
● Portwine stain – also known as a ‘deep capillary
naevus’. These are present at birth and may
vary in colour from pale pink to deep purple.
They have an irregular shape but are not raised
above the skin’s surface. Usually, they are found
on the face but may also appear on other areas
of the body.
● Spider naevi – a collection of dilated capillaries
radiating from a central papule. These often
appear during pregnancy or after ‘picking a spot’.
p Hyperkeratosis
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In practice In practice
Hyperkeratosis is a common problem for people Any client who presents with an abnormal growth,
with black skin. Because of the increased cell undiagnosed lump or suspicious bump on the skin
turnover, black skins desquamate dead skin cells should be referred to a medical practitioner.
more readily. The accumulation of dead skin
cells on the skin’s surface can give black skins Basal cell carcinoma
an ashen grey appearance. This is a common form of skin cancer that originates
Care needs to be taken during treatment to avoid in the basal cell layer of the epidermis. It is often
exfoliating too harshly to avoid irritation and found on the face and other sun-exposed areas
sensitivity. (especially in fair-skinned people).
The most common presentation of basal cell
Skin cancer carcinoma is a pearl-like bump, which may be pink
or slightly flesh coloured, often with small capillaries
Identifying skin cancers running through it.
It is important to be aware of the typical Superficial basal cell carcinomas appear red, flat and
characteristics of different skin cancers. Cancers can scaly and may be misdiagnosed as other conditions,
present as: such as eczema.
● an open sore of any size that bleeds, oozes, or crusts Basal cell carcinomas rarely spread to other tissues
and that remain open for three or more weeks or organs, and although not life threatening they can
produce unpleasant scarring if not detected early.
● a persistent non-healing sore
● a reddish patch or irritated area that doesn’t go Malignant melanoma
away, and fails to responds to moisturisers or A malignant melanoma is a deeply pigmented
treatment creams mole-like structure which is life threatening if not
● a smooth growth with a distinct rolled border and recognised and treated promptly. It presents as a
an indented centre blue–black module which increases in size, shape and
colour, and is most commonly found on the head,
● a shiny bump or nodule with a smooth surface
neck and trunk. Overexposure to strong sunlight is a
that can be pink, red, white, black, brown or purple
major cause and its incidence is increased in young
in colour
people with fair skins.
● a white patch of skin that has a smooth, scar-like
Melanomas can occur in an existing mole or they
texture; the area of white stands out from the
may arise from normal skin. As they spread very
surrounding skin and can appear clear and taut.
quickly early detection is essential.
In practice
There is an ‘ABCD’ rule to help in the identification
of skin cancer:
● Asymmetry – one part of the lesion is unlike
the rest
● Border – there is an irregular, scalloped border
around the lesion
● Colour – colour varies from one area to another,
and may appear with shades of tan, brown,
black, white, red or blue
● Diameter – the area is generally larger than 6 mm
across. p Malignant melanoma
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Rodent ulcer Inflammatory skin

This is a malignant tumour which starts off as a slow-
growing pearly nodule, often at the site of a previous
conditions
skin injury. As the nodule enlarges, the centre ulcerates
and will not heal. The centre becomes depressed and
In practice
the rolled edges become translucent, revealing many In the case of an inflammatory skin condition, care
tiny blood vessels. Rodent ulcers do not disappear and should be taken to avoid any form of stimulation
if left untreated may invade the underlying bone. This (through product or treatment method) that may
is the most common form of skin cancer. escalate the inflammation.
If there is severe inflammation and the skin
is broken, or there are any signs of infection,
treatment would be avoided and the client should
be referred to their medical practitioner.
Contact dermatitis
The term dermatitis literally means ‘inflammation
of the skin’. Contact dermatitis is caused by a primary
irritant which makes the skin red, dry and inflamed.
Substances which are likely to cause this reaction
include acids, alkalis, solvents, perfumes, lanolin,
detergent and nickel. Affected areas are prone to
skin infection.
p Rodent ulcer
Squamous cell carcinoma

This is a malignant tumour which arises from the
prickle cell layer of the epidermis. It is hard and warty,
and eventually develops a heaped-up ‘cauliflower’
appearance. It is most frequently seen in elderly people.
Unlike basal cell carcinomas, squamous cell carcinomas
can spread to other organs, or deeply within the skin.
Fortunately, 90% of squamous cell carcinomas are
detected and removed before they spread.
p Contact dermatitis
Eczema
This is a mild to chronic inflammatory skin condition
characterised by itchiness, redness and the presence
of small blisters that may be dry or weep if the
surface is scratched. It can cause scaly and thickened
skin, mainly at flexures such as the cubital area of
the elbows and the back of the knees. Eczema is not
contagious. Internal and external influences cause
p Squamous cell carcinoma eczema in people with a genetic predisposition.
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p Eczema
Psoriasis
Psoriasis is a genetic chronic inflammatory skin disease associated with a
malfunction of the immune system, which causes skin cells to reproduce
too quickly. A normal skin cell matures and falls off the body’s surface in
28 to 30 days. However, skin affected by psoriasis takes only three to four
days to mature and move to the surface. Instead of shedding, the cells pile
up and form lesions. The skin also becomes very red due to increased blood
flow.
Psoriasis may be recognised by the development of well-defined red
plaques, varying in size and shape, and covered by white or silvery scales.
Any area of the body may be affected by psoriasis but the most commonly
affected sites are the face, elbows, knees, chest and abdomen. It can also
affect the scalp, joints and nails.
Psoriasis is aggravated by stress and trauma, but is improved by exposure
to sunlight.
p Psoriasis
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Seborrheic dermatitis
This is a mild to chronic inflammatory disease of the hairy areas that are
well supplied with sebaceous glands. Common sites are the scalp, face, axilla
and in the groin. The skin may have a grey tinge or a dirty yellow colour.
Clinical signs include slight redness, scaling and dandruff in the eyebrows.
Autoimmune disorders of the skin

In autoimmune conditions the immune system mistakenly recognises a
part of the body as foreign and attacks it.
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease
of connective tissue which affects the skin and various internal organs.
It is an autoimmune disease that can be diagnosed by the presence of
abnormal antibodies in the bloodstream.
It is characterised by a red scaly rash on the nose and cheeks. Other
symptoms include joint pain, hair loss and swelling of the feet and fingers.
Discoid lupus erythematosus (DLE) is a form of the disease that primarily
affects the skin. Round, firm lesions with red raised bumps form around
the hair follicles. These are called discoids.
All forms of lupus are aggravated by sun exposure.
p Systemic lupus erythematosus
In practice
A client with lupus should be referred to their medical practitioner.
Lupus is not contagious and, following appropriate medical advice on
the client’s condition, skin care treatments may be offered.
If a skin care service is considered suitable, stimulating products and/
or treatments should be avoided. This condition has characteristics in
common with a sensitive skin type and should be treated accordingly.
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Interrelationships with Nervous

other systems There are numerous sensory nerve endings in the
skin that respond to touch, temperature, pain and
Skin, hair and nails pressure.
The skin, hair and nails link to the following body Endocrine
systems. Melanocyte stimulating hormone (MSH) secreted
Skeletal by the central lobe of the pituitary stimulates the
production of melanin in the basal cell layer of the
Vitamin D is produced by the skin when exposed
skin. The sex (gonadotrophic) hormones influence
to ultraviolet light. Vitamin D is needed in bone
skin and hair growth during puberty, pregnancy and
formation and maintenance.
the menopause.
Muscular
Muscles provide a supportive function to the skin. Digestive
Muscles lie directly under the skin and contribute to Adipose (fatty) tissue is stored in the subcutaneous
the skin’s tone and elasticity. layer of the skin when caloric consumption in the
daily diet is in excess of daily needs.
Circulatory
Blood clots at the site of an injury. In the case of Renal
an external injury, a scab forms on the surface of Water is lost from the skin as sweat. The kidneys
the skin. This allows the skin to heal and protects regulate fluid balance in the body to prevent
underlying structures from any further damage and the skin (and other organs) from becoming
from infection. dehydrated.
Respiratory
Oxygen that is absorbed into the lungs from inhaled
air is delivered to the cells of the skin, hair and nails
to aid their renewal.
Key words Cortex: the middle layer of a hair, contains the

pigment melanin
Acid mantle: a very fine, slightly acidic film on the Cuticle (hair): the outer layer of the hair, which gives
surface of skin which acts as a barrier to bacteria, the hair its elasticity
viruses and other potential contaminants
Cuticle (nail): the fold of overlapping skin that
Anagen: the active growing phase of the hair life cycle surrounds the base of the nail, providing a
Apocrine gland: a type of sweat gland found in the protective seal for the matrix
genital and underarm regions Dermal papilla: a raised elevation at the base of a
Carbuncle: a cluster of boils hair bulb, contains blood supply
Catagen: the transitional stage of hair growth from Dermis: the deeper thicker layer of the skin
active to resting Desmosome: a cell structure specialised for cell-to-
cell adhesion
Collagen: protein found in the dermis of the skin
Desquamation: the shedding of dead skin cells
Connective tissue sheath: the part of the hair
structure that surrounds the follicle and sebaceous Eccrine gland: a simple coiled, tubular sweat gland
gland, supplies the hair follicle with nerves and that opens directly onto the surface of the skin
blood Elastin: protein in the skin (dermis) which gives it its
Corneocyte: dead skin cell of the stratum corneum elasticity
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Epidermis: the outer thinner layer of the skin Lunula: lightly coloured semicircular area of the nail,
Eponychium: dead cuticle that adheres to the base commonly called the half moon, which lies between
of the nail, near the lanula the matrix and the nail plate
Erector/arrector pili muscle: a small, smooth, weak Mast cells: cells found in the reticular layer of dermis
muscle that attaches to the base of a hair follicle, that secrete histamine during an allergic reaction
and makes the hair stand erect in response to cold Matrix (hair): area of mitotic activity of hair cells,
Extracellular matrix (ECM): the support system located at the lower part of hair bulb
of the dermis, made up of collagen, elastin and Matrix (nail): area of nail where the living cells are
glycosaminoglycans (GAGs) produced, situated immediately below the cuticle
Free edge: part of the nail plate that extends Mechanoreceptors: sensory receptors in the
beyond the nail bed and fingertip skin used to detect sensations such as pressure,
Glycosaminoglycans (GAGs): water-binding vibrations and texture
molecules found in the dermis which give the Medulla: the inner layer of hair, which determines
skin its plumpness sheen and colour of hair
Hair: appendage of the skin which grows from a sac- Melanin: a dark brown to black pigment occurring
like depression called a hair follicle in the hair and skin: responsible for tanning of skin
Hair follicle: a sac from which the hair grows that is exposed to sunlight
Hair shaft: part of the hair lying above the surface Melanocyte: cells present in the epidermis and hair
of the skin follicles that produce melanin
Hair bulb: the enlarged part at the base of the hair root Melanosome: a melanin-producing granule in a
melanocyte
Hair root: the part found below the surface of the skin
Nail bed: part of the skin on which the nail plate
Hyaluronic acid: a glycosaminoglycan that exists rests
naturally in the dermis layer of the skin
Nail groove: deep ridges under the sides of the nail
Hydrolipidic film: an emulsion of fat and water, a
film of which normally covers the skin Nail mantle/proximal nail fold: a deep fold of
skin above the matrix, protecting the nail root from
Hyponychium: the thickened layer of epidermis physical damage
beneath the free edge of a nail
Nail plate: the main visible part of the nail which
Inner root sheath: part of the hair follicle that is rests on the nail bed and ends at the free edge
located between the outer root sheath and the hair
shaft; shapes and contours the hair Nail wall: a fold of skin overlapping the sides of the
nail
Keratin: a key structural protein material making
up hair, nails and the outer layer of skin; also the Nociceptors: pain receptors in the skin which
protein that protects epithelial cells from damage detect pain that is caused by mechanical, thermal or
or stress chemical stimuli
Keratinisation: the process cells undergo when they Outer root sheath: part of the hair structure that
change from living cells with a nucleus to dead cells, forms the follicle wall and provides a permanent
filled with keratin and without a nucleus source of hair germ cells
Keratinocyte: the predominant cell of the Papillary layer: the uppermost layer of the dermis
epidermis, which serves as a barrier between an Perionychium: the part of the cuticle that outlines
organism and its environment the nail plate
Langerhans cells: special defence cells in the Phagocytic cells: white blood cells that destroy
epidermis that set up an immune response to bacteria and other foreign matter found in the
foreign bodies dermis
Lanugo (hair): fine soft hair found on a foetus Reticular layer: the lower layer of the dermis
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Sebaceous glands: sac-like secreting pouches consists of small, tightly packed transparent cells
found all over the body, except for the soles of the that permit light to pass through
feet and palms of the hands Stratum spinosum: the binding and transitional
Sebum: oily substance produced by sebaceous layer between the stratum granulosum and the
glands, which lubricates the hair and skin stratum germinativum
Sphingolipids: fats in the stratum spinosum layer Subcutaneous layer: a thick layer of connective
of the epidermis that have an important role in the tissue found below the dermis
retention of moisture in the skin
Telogen: the resting stage of hair growth
Stem cells: a type of cell found in the stratum
germinativum (basal cell layer) of the epidermis, Terminal hair: coarse, pigmented hair found on the
involved in the process of skin renewal scalp, underarms, eyebrows, pubic regions, arms
and legs
Stratum corneum: the most superficial outer layer
of the epidermis, consisting of dead skin cells Thermoreceptors: sensory receptors in the skin
used to detect sensations related to temperature
Stratum germinativum: the deepest of the five
layers of the epidermis Vellus (hair): soft, downy hair found all over the face
and body, except for the palms of the hands, soles of
Stratum granulosum: the layer of epidermis linking
the feet, eyelids and lips
the living cells of epidermis to the dead cells above
Stratum lucidum: the epidermal layer below the Vitreous membrane: the basement membrane of
most superficial layer (stratum corneum), which the outer root sheath that separates the outer root
sheath from the connective tissue sheath
Revision summary ● stratum lucidum (clear layer) responsible for

lipid release
Skin, hair and nails ● stratum corneum (horny layer) responsible
for acting as a skin barrier defence.
● The skin and the appendages derived from
it (hair, glands and nails) make up one of the ● Cell regeneration occurs continuously in the
largest organs of the body, known as the basal cell layer and produces all other layers.
integumentary system. ● It takes approximately a month for a new cell
● Functions of the skin include protection, to complete its journey from the basal cell layer
regulation of body temperature, sensation, where it is reproduced, to the granular layer
excretion, storage, absorption and vitamin D where it is keratinised, to the horny layer where it
production. is desquamated or shed.
● The principal parts of the skin are the outer ● Stem cells are found in the stratum
epidermis and the inner dermis. Beneath the germinativum (basal cell layer) of the epidermis
dermis lies the subcutaneous layer. and are responsible for constant renewal
● The epidermis is the most superficial part and (regeneration) of skin and for healing wounds.
consists of five layers, from deepest to superficial: ● The dermis is the deeper layer of the skin and
● stratum germinativum (basal cell layer) is provides support, strength and elasticity.
the deepest layer and is concerned with cellular ● It has a superficial papillary layer and a deeper
regeneration reticular layer:
● stratum spinosum (prickle cell layer) is the
● superficial papillary layer – consists of adipose
next layer up, responsible for cellular transport connective tissue, dermal papillae, nerve endings
of the melanosome and a network of blood and lymphatic capillaries
● stratum granulosum (granular layer)
● deeper reticular layer – consists of tough
responsible for keratinisation, cellular change
fibrous connective tissue and contains
and lipid formation
collagen, elastin and reticular fibres.
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● The dermis layer of skin has three crucial ● the matrix, which is the living, growing area
components: collagen, elastin and of the nail
glycosaminoglycans (GAGs), which all form the ● the nail plate, which protects the nail bed from
bulk of an important support system called the damage
extracellular matrix (ECM). ● the nail bed, which provides nourishment and
● The ECM gives the dermis shape, structure and protection for the nail
support, providing the structural scaffolding ● the cuticle, which protects the matrix and nail
and maintaining the tissue architecture. bed from infection
● the nail mantle/proximal nail fold, which
● Once the skin is broken, the process of wound
protects the matrix from physical damage
repair is set in motion by four overlapping phases:
● the nail wall, which protects the edges of the
● haemostasis occurs when the platelets clot
nail plate from damage
and form a plug around the site of injury
● the lunula, which is the area where the cells
● the inflammatory phase is when bacteria and
start to keratinise
cell debris are removed from the wound by
● the nail groove, which guides the growth of
white blood cells
the nail up the fingers
● the proliferation phase occurs when the
● the free edge which protects the fingertips.
wound contracts and reduces in size, and new
connective tissue forms to replace what was ● Nail growth occurs from the nail matrix by cell
there before division.
● maturation is the final phase, when the tissues ● As new cells are produced in the matrix, older
are remodelled and scar tissue is formed. cells are pushed forwards and are hardened by
● Appendages of the skin include the hair, glands keratinisation to form the hardened nail plate.
(sebaceous and sweat) and nails. ● Other structures of the skin are the erector pili
● The hair is a dead keratinised structure, which muscle and the glands.
grows out of a hair follicle and is divided into ● The erector pili muscle is the weak muscle
three parts: hair shaft, root and bulb. associated with hair, which contracts when the
body feels cold or when experiencing emotions
● The role of a hair is protection.
such as fright or anxiety.
● Internally, the hair has three layers from the outer ● Sebaceous glands are also known as oil glands.
to inner layer: cuticle, cortex and medulla. They have ducts and are attached to hair follicles.
● The matrix in the hair bulb is the hair’s area of ● They secrete sebum, which is mildly
mitotic activity. antibacterial and antifungal, to lubricate the
● There are three main types of hair in the body: hair and the epidermis.
lanugo, vellus and terminal. ● Sweat glands are located in the dermis and
● Each hair has its own hair growth cycle. secrete sweat. There are two types of sweat
glands, eccrine and apocrine:
● Anagen is the active growing stage; catagen is
● Eccrine glands are the most numerous and
the transitional stage from active to resting; and
are found in largest concentration in the
telogen is the short resting stage.
palms of the hands, and soles of the feet.
● Nails are made up of mainly keratin and are a ● Apocrine glands are attached to the hair
modification of the horny and clear layers of the follicles and are located in the axilla and
epidermis. groin.
● The two main functions of the nail are protection ● Factors affecting the skin include diet, water
for the fingers and toes, and manipulation intake, sleep, stress and tension, exercise,
of objects. alcohol, smoking, medication, chemicals, climate,
● Parts of the nail’s anatomical structure include: environment, hormones and age.
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Test your knowledge 7 What is the function of the sebaceous gland?

a to secrete sweat
questions b to secrete sebum
c to regulate temperature
Multiple choice questions d to insulate
1 In which of these layers are epidermal cells 8 Which of the following is responsible for
constantly reproduced? protecting the deeper layers of the skin from
a stratum corneum ultraviolet damage?
b stratum granulosum a keratin
c stratum germinativum b melanin
d stratum lucidum c sebum
2 Desquamation occurs in which layer of the d carotene
epidermis? 9 Which type of sweat gland is widely distributed
a stratum lucidum throughout the body?
b stratum germinativum a apocrine
c stratum spinosum b eccrine
d stratum corneum c adipose
3 Which is the correct order of the layers of the d sebaceous
epidermis, from deepest to most superficial? 10 What do Merkel’s disks, a type of cutaneous
a stratum germinativum, stratum spinosum, receptor, detect?
stratum lucidum, stratum granulosum, a deep pressure, fast vibrations
stratum corneum b sustained touch and pressure
b stratum germinativum, stratum spinosum, c changes in texture, slow vibrations
stratum granulosum, stratum lucidum, d pain arising from mechanical stimuli
stratum corneum
c stratum germinativum, stratum corneum, Exam-style questions
stratum lucidum, stratum granulosum, 11 Name the cell types that make up 95%
stratum corneum of cells in the epidermis. 1 mark
d stratum germinativum, stratum granulosum, 12 Which layer of the epidermis is also
stratum lucidum, stratum corneum known as the Malpighian layer? 1 mark
4 Epidermal stem cells are found in which layer of 13 a Explain the term keratinisation. 1 mark
the epidermis? b In which layer of the epidermis does
a stratum germinativum keratinisation begin? 1 mark
b stratum spinosum 14 Describe the acid mantle of the skin. 2 marks
c stratum corneum
15 Briefly describe the stages of skin renewal.
d stratum granulosum
4 marks
5 Which is the thickest layer of the epidermis?
16 Which layer of the epidermis is responsible
a stratum spinosum
for acting as a skin barrier defence? 1 mark
b stratum granulosum
c stratum corneum
d stratum germinativum
6 The erector pili muscle affects:
a the hair
b the sebaceous gland
c motor nerves
d the capillary network.
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4 The skeletal
system
Introduction
The skeleton is made up of 206 individual bones,
which collectively form a strong framework for
the body. Bones provide support and protection.
They must, however, be linked together in order
to allow movement.
Joints provide the links between the bones of
the skeletal system. At joints, ligaments hold
bones together, offering stability while allowing
flexibility. Movement at joints is carried out by
associated muscles and tendons.
OBJECTIVES
● the functions of the skeleton
● the structure of bone
● the growth and development of bone
● the different types of bone in the body
● the names and positions of the bones of

the skeleton
● the different types of joints and their range
of movement
● the importance of good posture
● postural defects
● common pathologies of the skeletal system
● the interrelationships between the skeletal

and other body systems.
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4 The skeletal system
Shape
In practice
The bones of the skeleton give shape to structures
It is essential for therapists to have a good working such as the skull, thorax and limbs.
knowledge of the skeletal system. Bones are
like landmarks in the body and, by tracing their Formation of blood cells
outlines, we can be accurate in describing the Blood cells develop in red bone marrow, which is
position of muscles, glands and organs in the body. found in cancellous bone tissue.
Learning the positions of the bones of the skeleton Mineral reservoir
helps with an understanding of the positions and
The skeleton acts as a storage depot for important
functions of the muscles and joints.
minerals such as calcium, which can be released when
needed for essential metabolic processes such as muscle
Functions of the contraction and the conduction of nerve impulses.
skeleton The structure

The study of the structure and function of bones is
known as osteology. Before learning the individual
of bone
bones of the skeleton, it is important to understand Bone is one of the hardest types of connective
the functions of the skeleton as a whole. tissue in the body and, when fully developed,
is composed of:
Study tip ● water
When learning the functions of bones, it may be ● protein in the form of collagen fibres, which give
helpful to remember this memnomic – Pam’s bone its tensile strength (resistance to stretching
skeleton forces movement: protection, attachment, and tearing)
movement, support, shape, formation of blood
cells, mineral reservoir.
● mineral salts (calcium and phosphate), along with
the inorganic mineral hydroxyapatite, which give
bone its hardness.
Protection of vital organs and delicate
tissue Bone tissue is a type of living tissue that is made
from special cells called osteoblasts.
The skeleton surrounds vital organs and tissues with
a tough and resilient covering. For example, the rib There are two main types of bone tissue:
cage protects the heart and lungs, and the vertebral 1 compact
column protects the spinal cord. 2 cancellous.
Attachments for muscles and tendons All bones have both types of tissue, in different
Muscles and tendons are anchored to bones, which amounts depending on the type of bone.
provide strong sites of attachment.
Compact (dense) bone
Movement
This is the hard portion of the bone that makes up
This happens as a result of the co-ordinated action the main shaft of the long bones and the outer layer
of muscles on bones and joints. Bones are, therefore, of other bones. It protects inner cancellous (spongy)
levers for muscles. bone and allows the skeleton to provide a firm
Support framework.
The skeleton bears the weight of all other tissues. The bone cells in this type of bone (osteocytes) are
Without it we would be unable to stand up. located in concentric rings (called lamellae) around a
The bones of the vertebral column, pelvis, feet central Haversian canal. These canals are small tubes
and legs, for example, all support the weight which form a network in bone through which nerves,
of the body. blood and lymphatic vessels pass.
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vessels. The periosteum provides attachment for

KEY FACT
muscles, tendons and ligaments
Compact bone constitutes up to 80% of a
bone’s weight, with spongy bone making up ● hyaline/articular cartilage – smooth hyaline
the additional 20%, despite its much larger cartilage covers the articular surfaces of
surface area. the shaft endings of the long bones, where they
form a joint with another bone. This is a firm
Cancellous (spongy) bone but elastic type of cartilage which provides
shock absorbtion to the joint and has no neural
Cancellous bone is more porous and lighter in
or vascular supply.
weight than compact bone. It has an open sponge-
like appearance. It is found at the ends of long
Articular
bones and in the centre of other bones. It does not cartilage Epiphysis
have a Haversian system but consists of a web-like
Spongy
arrangement of spaces that are filled with red bone bone (cancellous)
marrow and separated by the thin processes of bone.
Space occupied by
Blood vessels run through every layer of cancellous red marrow
bone, conveying nutrients and oxygen.
Compact bone
Bone marrow Yellow marrow

Diaphysis
Bones contain two types of marrow – red and Medullary cavity
yellow: Periosteum
1 Red marrow manufactures red blood cells. It is

found at the end of long bones and at the centre
of the bones of the thorax and pelvis.
2 Yellow marrow is found chiefly in the central Epiphysis
cavities of long bones. Yellow bone marrow is
mainly a fatty tissue. Femur
Structure of a long bone p Structure of a long bone
A long bone consists of several sections: KEY FACT

● diaphysis – the long central shaft Children’s bones are more flexible than adults’
● epiphysis – the larger rounded ends of long bones since complete calcification has not yet taken
place, and their bodies contain more cartilage
● epiphyseal cartilage – the site of bone elongation and soft bone cells. In older adults bone cells
during the growing years, which is located outnumber cartilage cells and bone becomes
between the diaphysis and epiphysis. After we more brittle – it contains more minerals and
stop growing (between 18 and 25 years of age), fewer blood vessels. This explains why elderly
this cartilage is replaced by compact bone people’s bones are more prone to fracture and
are slower to heal.
● medullary canal/cavity – the hollow centre
of the bone shaft, which contains both red
and yellow bone marrow The development
● periosteum – except for the ends that form
joints, bones are covered with a thin membrane
of bone
of connective tissue called the periosteum. The The process of bone development is called
outer layer of the periosteum is extremely dense ossification. Fetal bones are made of cartilage rods.
and contains a large number of blood vessels. The These are changed into bone as the child develops
inner layer contains osteoblasts and fewer blood and grows. Ossification begins in the embryo near
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the end of the second month and is not complete until about the
twenty-fifth year of life.
KEY FACT
Teenagers often experience growth spurts during puberty due to
the influence of the sex hormones oestrogen and testosterone,
both of which promote the growth of long bones.
Ossification
Ossification takes place in three stages:
1 The cartilage-forming cells, called chondrocytes, enlarge and arrange
themselves in rows, to give a structure like that of the bone they
will eventually form.
2 Calcium salts are laid down by bone-building cells called osteoblasts.
3 A second set of cells called osteoclasts, known as cartilage-destroying
cells, bring about an antagonistic action, enabling the absorption
of any unwanted bone.
A fine balance of osteoblast and osteoclast activity helps to maintain the
formation of normal bone.
Osteocytes are mature bone cells that maintain bone throughout life.
Osteoblast
Marrow Blood vessel,
lymphatic vessel Matrix
and nerve
Osteocyte synthesize bone
Osteoclast
Osteoblast
Osteocyte
are formed
from osteoblasts
Collagen
Osteoclast
Osteon
breaks down
bone tissue
Bone
p Internal structure of bone
KEY FACT
Weight-bearing exercises (walking, running, cycling, weightlifting)
increase the activity of osteoblasts, regardless of age. Osteoblasts
are the bone-building cells that mature into osteocytes. An
increase in the number of bone cells makes bones stronger.
As your body is constantly replacing bone cells, you need calcium
throughout life and not just during childhood.
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Cartilage
Cartilage is a dense connective tissue that consists of collagen and elastin
fibres embedded in a strong gel-like substance. It is a flexible and durable
tissue, providing cushioning and absorbing shock, thereby preventing
direct transmission of damaging forces to bones.
There are three types of cartilage:
1 hyaline – covers the articular bone surfaces
2 fibrous – a strong and rigid type of cartilage found between the discs
of the spine
3 elastic – a very flexible type of cartilage found in the auditory canal
of the ear.
Cartilage has no blood supply and, therefore, does not repair or renew
itself as easily as bone.
Ligaments
Ligaments are dense, strong and flexible bands of white fibrous
connective tissue that link bones together at joints. They are inelastic
but flexible, stabilising the joint and allowing the bones to move freely
within a safe range.
Tendons
Tendons are tough, white and fibrous cords of connective tissue that
attach muscles to the periosteum (fibrous covering) of a bone. Tendons
enable bones to move when skeletal muscles contract.
Types of bone
Bones are classified according to their shape. They are classified as long
bones, short bones, flat bones, irregular bones and sesamoid bones.
Table 4.1 Overview of the different types of bone
Bone type Characteristics Examples

Long Weight-bearing bones, designed to Arms and legs
provide structural support
Short Look like blocks Wrist and ankle bones
Allow a wider range of movement
than larger bones
Flat Designed for protection Skull, scapula, ribs,
sternum, pelvic bones
Irregular Have a variety of shapes Vertebral column,
Usually have projections that some facial bones
muscles, tendons and ligaments
can attach to
Sesamoid Small rounded bone embedded Kneecap/patella
in a tendon
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Head (epiphysis)
of spongy bone
Medullary cavity
Long bones
Shaft (diaphysis)
of compact bone
Covering of articular cartilage
Short bones
Thin layer of
compact bone
Spongy bone
Irregular bones
Flat bones
Inner layer
of cancellous
bone
Very thin layer of
Cancellous compact bone
bone
Outer layer
of compact bone
p Classification of bones
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KEY FACT Irregular bones

The smallest bones in the body are in the ear; Irregular bones don’t fit into the three other
the hammer, anvil and stirrup. classifications (flat, long or short bones). Irregular
bones have a variety of shapes. Examples include
Long bones the vertebrae, hips and some of the bones found
Long bones are hard, dense bones that provide in the skull.
strength, structure and mobility. The thigh bone
(femur) is an example of a long bone. All limb bones Sesamoid bones
are long bones, except the wrist and ankle bones. These are small rounded bones that are embedded
Long bones have a long shaft (diaphysis) and one or in a tendon. The largest sesamoid bone is the
more endings or swellings (epiphysis). patella, which is embedded in the quadriceps
femoris tendon.
Short bones
Short bones are generally cube shaped with roughly The surfaces of bones
equal lengths and widths. Their primary function is to The surfaces of bones are not always smooth, and
provide support and stability with little to no movement. they have all kinds of bumps, lumps, dips and ridges.
The bones of the wrist and the ankle are examples of These have specific names that are often used in
short bones. the descriptions of bones and attachment points
for muscle (Table 4.2).
Flat bones
Flat bones are plate-like structures with broad
surfaces. Examples include the ribs and the scapulae.
Table 4.2 Types of bone surface
Description Example
Acetabulum Concave surface of a pelvis The head of the femur meets with the pelvis at the
acetabulum, forming the hip joint
Crest Large ridge of bone The iliac crest (ilium of the pelvis in the pelvic girdle)
Condyle Round (knuckle-shaped) prominence Condyles of the femur
or expansion at the end of a bone, most
often part of a joint
Depression – also A hollow, usually in a bone Mandibular fossa of the temporal bone in the skull
known as fossa(e)
Epicondyle Smaller expansion of bone or projection Medial epicondyle of the humerus
over a condyle
Facet Small, shallow depression, articulating Vertebral articular facet
with another bone
Foramen (plural An opening, hole, or passage, especially Intervertebral foramina – within the vertebral
foramina) in a bone column (spine), each bone has an opening at both
top and bottom to allow nerves, arteries and veins
to pass through
Head Rounded end of a bone Head of the fibula (bone of lower leg)
Process General term for any prominence or Spinal processes of vertebrae in spine
prolongation from a bone
➜
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Description Example
Protuberance Knob-like protrusion of a bone Occipital protuberance of the skull
Spine Sharp, slender projection of a bone Spine of the scapula
Trochanter Large, blunt bump-like projection Greater trochanter of the femur
Tubercle Rounded projection of bone, usually Lesser tubercle of the humerus
blunt and irregular
Tuberosity Large, rounded rough projection of Deltoid tuberosity
bone, usually serving as the attachment
point of muscles or ligaments
The bones of the skeleton

The skeletal system is divided into two parts:
1 the axial skeleton – made up of 80 bones, this forms the main axis or central core of the body
2 the appendicular skeleton – made up of 126 bones, this describes the appendages (limbs) and the places
where they attach to the axial skeleton.
Skull
Cervical vertebrae
Clavicle
Scapula
Sternum Scapula
Humerus
Ribs
Thoracic vertebrae
Ulna Vertebral
column
Lumbar vertebrae
Radius
Ilium
Sacrum
Carpals Pubis
Metacarpals Femur Coccyx
Patella
Phalanges
Fibula
Ischium
Tibia
Tarsals
Metatarsals
Phalanges
p Bones of the skeleton (anterior and side)
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The axial skeleton

As the central core of the body, the axial skeleton consists of the
following parts:
● skull ● sternum
● vertebral column ● ribs.
The bones of the skull

The skull (cranium) rests on the upper end of the vertebral column,
weighs around 5 kg and consists of 22 bones. Eight bones make up the
skull or cranium and 14 bones form the facial skeleton. The skull encloses
and protects the brain and provides surface attachment points for
various muscles of the face, jaw and neck.
Frontal Parietal
Sphenoid
Temporal
Occipital
p Bones of the skull
The eight bones of the skull are described in Table 4.3.
Table 4.3 The bones of the skull
Name and number

of bone(s) Position
Frontal × 1 Forms the anterior part of the roof of the skull,
the forehead and the upper part of the orbits
(eye sockets)
KEY FACT Parietal × 2 Form the upper sides of the skull and the back of the
(pa-ry-it-tal) roof of the skull
There are many openings
present in the bones of the Temporal × 2 Form the sides of the skull below the parietal bones
skull. These holes are passages and above and around the ears
for the blood vessels and
Sphenoid × 1 Located in front of the temporal bone and serves
nerves that enter and leave the
as a bridge between the cranium and the facial
cranial cavity. An example is
bones
the large opening at the base
of the skull called the foramen Ethmoid × 1 Forms part of the wall of the orbit, the roof of the
magnum through which the nasal cavity and part of the nasal septum
spinal cord and blood vessels
pass to and from the brain. Occipital × 1 Forms the back of the skull
(ox-sip-it-tal)
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Sutures Name and

A suture is a type of joint between the bones of the number of
skull in which the bones are held tightly together by bone(s) Position
fibrous tissue. Nasal × 2 These small bones form the bridge of
The four major sutures of the skull are: the nose
● coronal suture – joins the frontal bone to the Lacrimal × 2 These are the smallest of the facial
parietal bones bones
Located close to the medial part of the
● sagittal suture – joins the two parietal bones to orbital cavity
one another
Turbinate × 2 These are layers of bone located either
● lambdoid suture – separates the parietal bones side of the outer walls of the nasal
from the occipital bones cavities
● squamous suture – separates the parietal bone Vomer × 1 This is a single bone at the back of the
from the temporal bone. nasal septum
The bones of the face Palatine × 2 These are L-shaped bones which form
the anterior part of the roof of the
mouth
The hyoid bone

Ethmoid
Nasal
Although technically not a facial bone, the hyoid
Lacrimal
bone bone is a U-shaped structure located in the anterior
Zygomatic Turbinate
neck. It lies at the base of the mandible, where
Vomer it acts as a site of attachment for the anterior
Maxilla neck muscles.
Mandible
KEY FACT
A cleft palate occurs when the palatine bones
p Bones of the face do not fuse during foetal development.
Consequently, with the palatine unconnected,
There are 14 facial bones in total. These occur
an opening exists between the roof of the
mainly in pairs, one on either side of the face, mouth and the nasal cavity.
as shown in Table 4.4.
Table 4.4 The bones of the face The sinuses
Name and The sinuses are four pairs of air-containing spaces in
number of the skull and face.
bone(s) Position
Their functions are to lighten the head, provide
Maxilla × 2 These are the largest bones of the face mucus and act as a resonance chamber for sound.
Form the upper jaw and support the The pairs of sinuses are named according to the
upper teeth
closest facial bones:
Mandible × 1 This is the only movable bone of the skull ● frontal sinuses – located in the forehead, above
Forms the lower jaw and supports the
lower teeth
the eyes and nasal bridge
The mandible is the largest and ● ethmoidal sinuses – located behind the eyes
heaviest bone in the skull and in the deeper recesses of the skull
Zygomatic × 2 These are the most prominent of the ● sphenoidal sinuses – located behind the ethmoid
(zi-go-mat-ik) facial bones sinuses
Form the cheekbones
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● maxillary sinuses – the largest sinuses are skeleton, extending from the skull to the pelvis,
located on either side of the nostrils in the providing a central axis to the body. It consists
cheekbone area. of 33 individual irregular bones called vertebrae.
However, the bones of the base of the vertebral
Sphenoid sinus
column, the sacrum and coccyx, are fused to
Frontal sinus
give 24 movable bones in all.
The bones of the vertebral column are described in
Ethmoid sinuses
Table 4.5.
Functions of the vertebral

column
Maxillary sinus The vertebral column:
● provides a strong and slightly flexible axis to the
skeleton
p Paranasal sinuses ● provides a surface for the attachment of muscle
groups, by way of its differently shaped vertebrae
The vertebral column with their roughened surfaces
The vertebral column lies at the posterior of the ● has a protective function as it encases the delicate
nerve pathways of the spinal cord.
Table 4.5 The bones of the vertebral column
Vertebrae Number Position Description

Cervical 7 Vertebrae of the neck Smallest vertebrae in the vertebral column
The top two vertebrae, C1 (the atlas) and C2 (the axis) allow
the head and neck to move freely
Thoracic 12 Vertebrae of the mid spine, These vertebrae lie flatter and downwards to allow for
lie in the thorax where they muscular attachment of the large muscle groups of the back
articulate with the ribs They can be easily felt as you run your fingers down the spine
Lumbar 5 Found in the lower back These are much larger in size than the vertebrae above them
as they are designed to support more body weight
These vertebrae can be felt on the lower back due to their
large shape and width
Sacral 5 Lies between the pelvic This is a very flat triangular-shaped bone, consisting of five
(sacrum) bones bones which are fused together
A characteristic feature of the sacrum is the eight sacral
holes, through which nerves and blood vessels penetrate
Coccygeal 4 Base of spine below the These are made up of four bones which are fused together
(coccyx) sacrum and are sometimes referred to as the coccyx (tail bone)
KEY FACT
The intervertebral discs are pads of fibrocartilage that lie between
the vertebrae. These give the vertebrae a certain degree of
flexibility and also act as shock absorbers, cushioning against
mechanical stress.
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Atlas (first
cervical Cervical
Atlas (first
cervical The sternum
vertebra) vertebrae vertebra) This is commonly referred to as the breast bone.
It is a flat bone lying just beneath the skin in the
Axis (second Axis (second centre of the chest. The sternum is divided into
cervical cervical three parts:
vertebra) vertebra)
Thoracic
vertebrae
1 the manubrium, the top section, which articulates
with the clavicle and the first rib
2 the gladiolus, the main and longest part
located in the middle, which articulates with
Lumbar
the costal cartilages that link the ribs to the
vertebrae sternum
3 the xiphoid process, the bottom section,
Sacrum
which provides a point of attachment for
the muscles of the diaphragm and the
Coccyx
abdominal wall.
Anterior Posterior
p Bones of the vertebral column

The ribs
There are 12 pairs of ribs. They articulate
The thoracic cavity posteriorly with the thoracic vertebrae. Anteriorly,
the first 10 pairs attach to the sternum via the
This is the area of the body that is enclosed by the costal cartilages, the first seven attach directly
ribs, providing protection for the heart and lungs. (known as the true ribs) and the remaining three
attach indirectly (known as the false ribs). The last
Thoracic
vertebrae two ribs have no anterior attachment and are called
Manubrium the floating ribs.
The appendicular
Rib Body of
sternum
skeleton
The appendicular skeleton makes up and supports
Xiphoid
the body’s appendages. It consists of the following
process parts:
● the shoulder girdle
Costal
cartilage ● bones of the upper limbs
● bones of the lower limbs
p The thoracic cavity ● bones of the pelvic girdle.
Essential parts that make up the skeleton of this The shoulder girdle
cavity include: The shoulder girdle connects the upper limbs with
● the sternum the thorax and consists of four bones – two scapulae
● the ribs (singular: scapula) and two clavicles.
● 12 thoracic vertebrae.
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The head of the humerus fits into the shallow

glenoid cavity, providing the ‘ball’ to complete the
ball-and-socket joint.
Cervical ● The coracoid process is on the anterior side of
vertebrae the scapula and serves as an attachment point
for ligaments and muscles.
Clavicle
(collar bone) The clavicle
The clavicle is a long, slender bone with a double
Scapula curve. It forms the anterior portion of the shoulder
(shoulder
blade) girdle. At its medial end it articulates with the
top part of the sternum and at its lateral end it
Sternum
articulates with the scapula. The clavicle acts as
a brace to hold the arm away from the top of the
Humerus thorax.
The clavicle provides the only bony link between
Ribs the shoulder girdle and the axial skeleton. The
p Bones of the neck, chest and shoulder girdle arrangement of bones and the muscle attached to
the scapula and the clavicle allow for a considerable
The scapula amount of movement of the shoulder and the upper
The scapula is a large flat bone, triangular in outline, limbs.
which forms the posterior part of the shoulder girdle.
It is located between the second and the seventh rib. Bones of the upper limb
The scapula articulates with the clavicle and the The upper limb consists of the bones described
humerus, and serves as a point of muscle attachment in Table 4.6.
which connects the shoulder girdle with the trunk
and upper limbs. Table 4.6 The bones of the upper limb
The scapula has several distinct features: Bone(s) Description
● The acromion process is a large bony projection on Humerus Long bone forming the upper arm
the superior end of the scapula. It is an important
Radius Long bone of the forearm (thumb side)
landmark of the skeletal system and a muscle
attachment point that is essential to the function Ulna Long bone of the forearm
of the shoulder joint. The acromion also forms the (little-finger side)
acromioclavicular (ac) joint with the clavicle. Carpals Eight bones forming the wrist
● The spine of the scapula is a prominent projection Metacarpals Five long bones forming the palm
of bone that extends across the top of the dorsal of the hand
surface of the scapula.
Phalanges Fourteen bones forming the fingers
● The glenoid cavity is the shoulder structure that (fal-ann-g-ees) and thumb
serves as the ‘socket’ of the ball-and-socket joint.
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The wrist and hand

The wrist consists of eight small bones of irregular
size which are collectively called carpals. They fit
closely together and are held in place by ligaments.
Humerus The carpals are arranged in two groups of four. Those
of the upper row articulate with the ulna and the
radius, and those of the lower row articulate with the
metacarpals.
Ulna
Radius KEY FACT
Lunate Scaphoid The bones of the upper row nearest the forearm
Triquetral are called the scaphoid, lunate, triquetral and
Capitate
Hamate pisiform.
Pisiform Trapezoid
The bones of the lower row are called the
Trapezium
Carpals trapezium, trapezoid, capitate and hamate.
Metacarpals
● Metacarpals – there are five long metacarpal
Phalanges bones in the palm of the hand. Their proximal ends
articulate with the wrist bones and the distal ends
articulate with the finger bones.
p Bones of the upper limb ● Phalanges – there are 14 phalanges. These are
the finger bones; two are in the thumb or pollex,
Upper arm and three are in each of the other digits.
The humerus is the long bone of the upper arm. The
head of the humerus articulates with the scapula, The lower limb
forming the shoulder joint. The distal end of the
The lower limb consists of the bones shown in Table 4.7.
bone articulates with the radius and ulna to form
the elbow joint. Table 4.7 The bones of the lower limb
Forearm Bone(s) Description

The radius and ulna are the long bones of the forearm. Femur Long bone forming the thigh
The two bones are bound together by a fibrous ring. Patella Bone forming the kneecap
This allows a rotating movement in which the bones
pass over each other. The ulna is the bone of the Tibia Long bone of the lower leg (anterior,
medial side)
little-finger side and is the longer of the two forearm
bones. The radius is situated on the thumb side of the Fibula Long bone of the lower leg (lateral side)
forearm and is shorter than the ulna. The joint between Tarsals Seven bones forming the ankle
the ulna and the radius permits a movement called
Metatarsals Five bones forming the dorsal surface
pronation. This is when the radius moves obliquely
of the foot
across the ulna so that the thumb side of the hand is
closest to the body. The movement called supination Phalanges Fourteen bones forming the toes
takes the thumb side of the hand to the lateral side. (fal-ann-g-ees)
The radius and the ulna articulate with the humerus
at the elbow and the carpal bones at the wrist.
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The foot
Calcaneum (heel)
Femur
Tarsals
Talus
Navicular
Cuboid
Patella
Fibula Cuneiforms Metatarsals
Tibia
Phalanges
Tarsals
Metatarsals p Bones of the foot

Phalanges
There are seven bones in the foot which are collectively
p Bones of the lower limb called the tarsals. Each tarsal is an irregular bone
that slides over the next bone to collectively provide
The thigh motion. The individual tarsals are listed:
The femur is the bone of the thigh. It is the longest ● Talus – the main tarsal. This articulates with the
bone in the body and has a shaft and two swellings at tibia and fibula to form the ankle joint. The talus
each end. The proximal swelling has a rounded head is significant in that it bears the weight of the
like a ball, which fits into the socket of the pelvis to entire body when standing or walking.
form the hip joint. Below the neck are swellings called ● Calcaneum – also known as the heel bone. It is
trochanters which are sites for muscle attachment. the largest and most posterior tarsal bone. The
The distal ends of the femur articulate with the calcaneum is an important site for attachment
patella, or kneecap. of muscles of the calf.
The patella is located anterior to the knee joint. Its ● Cuboid – this bone is situated between the fourth
main function is to provide stabilisation, to cushion and fifth metatarsals and the calcaneum on the
the hinge joint at the knee and protect the knee by lateral (outer) border of the foot.
shielding it from impact.
● Cuneiforms – there are three cuneiform bones
The lower leg which are located between the navicular bone
The tibia and fibula are the long bones of the and the first three metatarsal bones. They are
lower leg. numbered from I through to III (the most medial
being I, the middle being II and the most lateral
● The tibia is situated on the anterior and medial
being III).
side of the lower leg. It has a large head where it
joins the knee joint and the shaft leads down to ● Navicular – the navicular bone is situated
form part of the ankle. The tibia is the larger of the between the talus bone and the three
two bones of the lower leg and thus carries the cuneiforms.
weight of the body. ● Metatarsals – there are five metatarsals which
● The fibula is situated on the lateral side of the form the dorsal surface of the foot.
tibia in the lower leg and is the shorter and ● Phalanges – 14 phalanges form the toes, two
thinner of the two bones. The end of the fibula of which are in the hallux, or big toe, and three
forms part of the ankle on the lateral side. of which form each of the other digits.
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Arches of the foot

The bones of the feet form arches which are designed to support body
weight and to provide leverage when walking. The arches of the foot
are maintained by ligaments and muscles. These give the foot resilience
when running or walking. The arches of the foot are the:
● medial longitudinal arch which runs along the medial side of the
foot from the calcaneum bone to the end of the metatarsals
● lateral longitudinal arch which runs along the lateral side of the foot
from the calcaneum bone to the end of the metatarsals
● transverse arch which runs between the medial and lateral aspect
of the foot and is formed by the navicular, three cuneiforms and the
bases of the five metatarsals.
Medial
Talus
cuneiform
Metatarsals Metatarsals
Calcaneum Lateral Medial

longitudinal longitudinal
arch arch Transverse
arch
p Arches of the feet
The pelvic girdle

The pelvic girdle consists of two hip bones (also known as innominate
bones) which are joined together at the back by the sacrum and at the
front by the symphysis pubis.
Sacrum
Iliac
crest
Ilium
Symphysis
pubis
Ischium
p Bones of the pelvic girdle

Each hip bone consists of three separate bones which are fused together,
as described in Table 4.8.
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Table 4.8 The bones of the hip
Pelvic bone Position Description

Ilium Forms the superior (upper) The largest and most superior pelvic bone in the pelvic girdle
part of the pelvic girdle The iliac crest is the upper border and is an important site of
attachment for muscles of the anterior and posterior abdominal walls
Ischium Forms the inferior (lower) The ischial tuberosity is a bony protrusion which is the part of the
and posterior (back) part of ischium that you sit on
pelvic girdle Receives the weight of the body when sitting and provides muscle
attachments for the muscles, such as the hamstrings and the adductors
Pubis Collective name for the two Two pubic bones resemble a wishbone and are linked via a piece of
pubic bones in the most cartilage called the symphysis pubis
anterior (forward) portion The pubic bones provide attachment sites for some of the abdominal
of the pelvis muscles and fascia
There are four joints or articulations within the pelvis:

Activity ● sacroiliac joints (×2) – located between the ilium of the hip bones,
Write down the names of the and the sacrum
individual bones of the skeleton
on separate pieces of card or ● sacrococcygeal symphysis – found between the sacrum and the coccyx
paper. Turn them face down ● pubic symphysis – located between the pubis bodies of the two
and mix them up. One by one, hip bones.
turn over each card and place it
into the correct category: Functions of the pelvic girdle
● Bones of the upper limb The pelvic girdle supports the vertebral column, bearing the body’s
● Bones of the lower limb weight, and offers protection by encasing delicate organs such as the
● Bones of the face uterus and bladder.
● Bones of the skull
● Bones of the vertebral

column
The joints of the body
● Bones of the pelvic girdle
A joint is formed where two or more bones (or sections of cartilage) meet
and is otherwise known as an articulation. Where a bone acts as a lever
in a movement, the joint is the fulcrum, or the support which steadies the
movement and allows the bone to move in certain directions.
Types of joint
Joints are classified according to the degree of movement they permit.
There are three main joint classifications:
1 fibrous – no movement is possible (so also known as a fixed joint)
2 cartilaginous – slight movement is possible
3 synovial – freely movable joints.
1 Fibrous joints
Fibrous joints are immovable joints with tough fibrous tissue between
the bones. Often the edges of the bones are dovetailed together, as in the
sutures of the skull. Some examples of fibrous joints include the joints
p A fibrous joint between the teeth, and between the maxilla and mandible of the jaw.
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2 Cartilaginous joints
Cartilaginous joints are slightly movable joints which have a pad of
fibrocartilage between the ends of the bones that make up the joint. The
pads act as shock absorbers. Some examples of cartilaginous joints are Intervertebral
those between the vertebrae of the spine and at the symphysis pubis, disc
between the pubis bones.
3 Synovial joints
Synovial joints are freely movable joints which have a more complex
structure than the fibrous or cartilaginous joints. p A cartilaginous joint
Before looking at the different types of synovial joints, it is important
to have an understanding of the general structure of a synovial joint.
The general structure of a synovial joint
Synovial Bone Hyaline

membrane cartilage
Joint cavity Capsular

filled with ligament
synovial
Bone
fluid Accessory
ligament
p A synovial joint
● A synovial joint has a space between the articulating bones. This is
known as the synovial cavity.
● The surface of the articulating bones is covered by hyaline cartilage,
which provides a hard-wearing surface that enables the bones to
move against one another with the minimum of friction.
● The synovial cavity and the cartilage are encased within a fibrous
capsule that helps to hold the bones together, enclosing the joint. The
joint capsule is reinforced by tough sheets of connective tissue called
ligaments – these bind the articular ends of bones together.
● The joint capsule is reinforced enough to resist dislocation but is
flexible enough to allow movement.
● The inner layer of the joint capsule is formed by the synovial
membrane which secretes a sticky, oily fluid called synovial fluid. This
fluid lubricates the joint and nourishes the hyaline cartilage.
● As the hyaline cartilage does not have a direct blood supply, it relies
on the synovial fluid to deliver oxygen and nutrients, and to remove
waste from the joint via the synovial membrane.
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Types of synovial joints

Synovial joints are classified into six different types according to their shape and the movements possible at
each one. The degree of movement possible at each synovial joint is dependent on the type of synovial joint
and its articulations (Table 4.9).
Ball and socket joint Hinge joint
Condyloid joint Pivot joint
Saddle joint Gliding joint
p Types of synovial joint
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Table 4.9 Types of synovial joints
Type of Description Movement Examples

synovial joint
Ball-and-socket Formed when the rounded Allows movement in many Hip and shoulder joints
head of one bone fits into a directions around a central point:
cup-shaped cavity of another flexion, extension, adduction,
bone abduction, rotation and
circumduction
Hinge Where the rounded surface Movement is only possible in one Knee and elbow joints
of one bone fits the hollow direction Joints between the
surface of another bone Allows flexion and extension phalanges
Condyloid The joint surfaces are shaped Although a condyloid joint allows Wrist joint
so that the concave surface movement in two directions, one Joint between the
of one bone can slide over movement dominates metacarpals and phalanges
the convex surface of another Movements include: flexion, (metacarpophalangeal
bone in two directions extension, adduction and joints)
abduction
Gliding Often referred to as synovial Allow only a gliding motion in Joints between vertebrae
plane joints as these occur various planes (side to side, and and sacroiliac joint
where two flat surfaces of back and forth)
bone slide against one another
Pivot Occurs where a process of Only permits rotation Joint between the first and
bone rotates in a socket second cervical vertebrae
One component is shaped (atlas and axis) and joint at
like a ring and the other the proximal ends of the
component is shaped so that radius and the ulna
it can rotate within the ring
Saddle Shaped like a saddle Movements include: flexion, Thumb joint
Articulating surfaces of bone extension, adduction, abduction
have both rounded and and a small degree of axial rotation
hollow surfaces so that the
surface of one bone fits the
complementary surface of
the other
Activity
Work with a partner to test your knowledge of joints.
Ask your partner to demonstrate the angular movements possible at
the following joints:
● ball-and-socket
● pivot.
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Glossary of angular movements possible at joints

Flexion Bending of a body part at a joint so that the
angle between the bones is decreased
p Flexion
Extension Straightening of a body part at a joint
so that the angle between the bones is
increased
p Extension
Dorsiflexion Upward movement of the foot so that feet
point upwards
p Dorsiflexion
Plantar flexion Downward movement of the foot so that
feet face downwards towards the ground
p Plantar flexion
Adduction Movement of a limb towards the midline
p Adduction
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Abduction Movement of a limb away from the midline
p Abduction
Rotation Movement of a bone around an axis
(180°)
p Rotation
Circumduction A circular movement of a joint (360°)
p Circumduction
Supination Turning the hand so that the palm is
facing upwards
p Supination
Pronation Turning the hand so that the palm is
facing downwards
p Pronation
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Eversion Soles of the feet face outwards
p Eversion
Inversion Soles of the feet face inwards
p Inversion
Posture
Posture describes body alignment and balance. It relies on the strength and
Through ear tone of the body’s muscles as they work against gravity.
Through shoulder
Good posture
Good posture is when the maximum efficiency of the body is maintained
with the minimum effort.
When evaluating posture, an imaginary line is drawn vertically through the
Through hip
body. This is called the centre of gravity line. From the front or back this line
should divide the body into two symmetrical halves.
In good standing posture the following are observed:
● with feet together, the ankles and knees touch
● hips are the same height
● shoulders are level
● the sternum and vertebral column run down the centre of the body in
line with the centre of gravity line
Through ankle ● head is erect and not tilted to one side.
Posture varies considerably in individuals and is influenced by factors such

Plumb line
as body frame size, heredity, occupation, habits and personality. Additional
p Good posture factors which may also affect posture include clothing, shoes and furniture.
The importance of good posture

Good posture is important as it:
● allows a full range of movement
● improves physical appearance
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● keeps muscle action to a minimum, thereby and the head moves forwards. A tightening of the
conserving energy and reducing fatigue pectoral muscles is common in this condition.
● reduces susceptibility to injury Lordosis
● helps the body’s systems to function efficiently. Lodosis is an abnormally increased inward curvature
of the lumbar spine. In this condition the pelvis tilts
Poor posture forwards and as the back is hollow, the abdomen
Poor posture: and buttocks protrude and the knees may be
hyperextended. Lordosis can cause tightening of
● produces alterations in body function and
the back muscles and weakening of the abdominal
movement
muscles. The anterior tilt of the pelvis can lead
● wastes energy to hamstring problems. Lordosis is commonly
● increases fatigue exacerbated by increased weight gain or pregnancy.
● increases the risk of backache and headaches Scoliosis (sko-lee-o-sis)
● impairs breathing This is a lateral curvature of the vertebral column,
● increases the risk of muscular, ligament or joint either to the left or right side. Evident signs of this
injury condition include unequal leg length, distortion
● affects circulation of the rib cage, unequal position of the hips or
● affects digestion shoulders and curvature of the spine (usually
in the thoracic region).
● gives a poor physical appearance.
Postural defects KEY FACT

Poor posture or misalignment of the body is
frequently found to be the cause of continued or
chronic pain as the body makes compensatory
changes which are habit forming.
Common pathologies
of the skeletal
system
In practice
Lordosis Kyphosis When treating clients with a joint disorder, position
the client so they are comfortable; remember that
extra cushioning and support may be required.
Ankylosing spondylitis
Scoliosis This is a systemic joint disease characterised by
p Postural defects inflammation of the intervertebral disc spaces,
costovertebral and sacroiliac joints (costovertebral
Kyphosis (ky-fo-sis) joints are those that connect the ribs to the thoracic
Kyphosis is an abnormally increased outward spine – a plane synovial joint that only permits gliding).
curvature of the thoracic spine. In this condition the Fibrosis, calcification, ossification and stiffening of joints
back appears round as the shoulders point forwards are common and the spine becomes rigid. Typically,
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clients with this condition complain of persistent or

intermittent lower back pain. Kyphosis is present when In practice
the thoracic or cervical regions of the spine are affected Passive and gentle friction movements (rubbing)
and the weight of the head compresses the vertebrae around the joint may be beneficial if the client
and bends the spine forwards. This condition can cause experiences minimal pain with the condition, but
muscular atrophy, loss of balance and falls. Typically this excessive movement may cause joint pain and
disease affects young male adults. damage.
Always ask the client to demonstrate the range of
In practice movement possible at each joint to guide you as to
Avoid forcibly mobilising ankylosed joints the limitations of treatment.
and in the case of cervical spondylitis avoid
hyperextending the neck. Arthritis – rheumatoid
This is a chronic inflammation of peripheral joints
Arthritis – gout
resulting in pain, stiffness and potential joint damage.
This is a joint disorder due to deposition of excessive It can cause severe disability. Joint swellings and
uric acid crystals in the joint cavity. It affects the rheumatoid nodules are tender.
peripheral joints, commonly the metatarsophalangeal
joint of the big toe. Kidneys can be affected. Other
cartilage may be involved including the ear pinna.
Arthritis – osteoarthritis
This is a joint disease, also known as degenerative
arthritis, which is characterised by the breakdown
of articular cartilage, growth of bony spikes and
swelling of the surrounding synovial membrane.
It involves varying degrees of joint pain, stiffness,
limitation of movement, joint instability and
deformity. This form of arthritis is common in
elderly people and takes a progressive course,
p Rheumatoid arthritis
usually affecting the weight-bearing joints – the
hips, knees, lumbar and cervical vertebrae.
In practice
Although therapeutic treatments such as massage
cannot cure arthritis, they can reduce discomfort
and help to prevent its progress through relaxation.
Take care when gently mobilising a joint and
always ensure the client is not feeling pain.
Treatments of shorter duration are suitable. Note
that, if the client is taking pain killers, they may be
unable to give adequate feedback about their level
of discomfort.
Bunion
This is a swelling of the joint between the big toe
and the first metatarsal. Bunions are usually caused
by ill-fitting shoes and are made worse by excessive
pressure.
p Osteoarthritis
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● complicated fracture – occurs when a broken

bone damages tissues and/or organs around it.
Simple
Compound
Comminuted
p Bunion
Bursitis
This condition is the inflammation of a bursa (small sac Greenstick
of fibrous tissue that is lined with synovial membrane
and filled with synovial fluid). It usually results from
injury or infection and produces pain, stiffness and
tenderness of the joint adjacent to the bursa.
Dupuytren’s contracture
Impacted
This is the forward curvature of the fingers (usually
the ring and little fingers) caused by contracture of
the fibrous tissue in the palm and fingers.
Fracture p Six types of fracture
A fracture is a breakage of a bone, either complete or Frozen shoulder (adhesive capsulitis)
incomplete. There are six different types: This chronic condition causes pain, stiffness and
● simple fracture (also known as a closed fracture) reduced mobility (or locking) of the shoulder joint.
– a clean break with little damage to surrounding This may follow an injury, stroke or myocardial
tissues and no break in the overlying skin infarction or may develop due to incorrect lifting or
● compound fracture – an open fracture where the a sudden movement.
broken ends of the bone protrude through the skin Hammer toe
● comminuted fracture – where the bone has A hammer toe is a deformity that causes a toe to
splintered at the site of impact and smaller bend or curl downwards instead of pointing forwards.
fragments of bone lie between the two main This deformity can affect any toe on the foot, but
fragments most often affects the second or third one. Although
● greenstick fracture – only occurs in children and a hammer toe may be present at birth, it usually
is a partial fracture in which one side of the bone develops over time due to arthritis, pressure from a
is broken and the other side bends bunion, a traumatic toe injury, an unusually high arch
● impacted fracture – where one fragment of bone or wearing ill-fitting shoes, such as tight, pointed
is driven into another high-heels.
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Osteoporosis Synovitis
This condition causes brittle bones and is due to the This is the inflammation of a synovial membrane in
fall in the level of the hormone oestrogen that occurs a joint.
with ageing. Oestrogen affects the body’s ability to
deposit calcium in the matrix of bone. Osteoporosis
Temporomandibular joint tension
can also result from prolonged use of steroids.
(TMJ syndrome)
Vulnerability to the condition can be inherited. Bones This is a collection of symptoms and signs produced
can break easily and vertebrae can collapse. by disorders of the temporomandibular joint. It is
characterised by bilateral or unilateral muscle
Women over the age of 50 are most at risk of
tenderness and reduced motion. It presents with
developing osteoporosis due to a change in hormones
a dull aching pain around the joint, often radiating
(the decline of oestrogen) and the fact they have
to the ear, face, neck or shoulder. The condition may
smaller, thinner bones than men.
start off with clicking sounds in the joint. There
may be protrusion of the jaw or hypermobility
In practice and pain on opening the jaw. It slowly progresses
Take care when handling clients with osteoporosis to decreased mobility of the jaw, and locking of
as they may have bone tenderness. the jaw may occur. Causes include chewing gum,
Avoid vigorous movements as there is a chance of biting nails, biting off large chunks of food, habitual
spontaneous bone fracture and be aware that any protrusion of the jaw, tension in the muscles of the
movement may cause pain. neck and back, and clenching of the jaw. It may also
There is the potential for vertebral damage, so take be caused by injury, especially whiplash, or other
particular care with the client’s comfort. trauma to the joint.
Whiplash
Spina bifida This condition is caused by damage to the muscles,
This is a congenital defect of the vertebral column in ligaments, intervertebral discs or nerve tissues of
which the halves of the neural arch of a vertebra fail the cervical region by sudden hyperextension and/
to fuse in the midline. or flexion of the neck. The most common cause is a
road traffic accident when acceleration/deceleration
Sprain
causes a sudden stretch of the tissue around the
A sprain is the injury to a ligament caused by cervical spine. It may also occur as a result of hard
overstretching or tearing. It occurs when the impact sports. It can present with pain and limitation
attachments to a joint are stressed beyond their of neck movements with muscle tenderness, which
normal capacity, resulting in pain and swelling. The can start hours to days after the accident and may
ankle joint and lower back are most often sprained. take months to recover.
Stress
Stress can be defined as any factor which affects In practice
physical or emotional health. Examples of excessive Whiplash may last for a few months or even
physical/mechanical stress on the skeletal system years; in the acute stages avoid manipulating and
include poor posture, stiff joints and repetitive strain vigorously moving the neck.
injuries.
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Interrelationships with other

systems
The skeletal system
The skeletal system links to the following body systems.
Skin
Vitamin D is produced in the skin. It has a role in helping bones absorb
calcium in order to keep them strong and healthy.
Muscular
Muscles pull on bones at joints in order to effect movement.
Circulatory
Erythrocytes are produced in the bone marrow of long bones.
Digestive
Food that is ingested in the digestive system is broken down and vital
nutrients, such as calcium and phosphorus, are carried in the blood to
the bones.
Nervous
Skeletal muscles require stimulation from a nerve impulse in order to
contract and produce movement.
Endocrine
Growth hormones produced by the pituitary gland are responsible for
the growth rate of bones in childhood.
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Key words Epiphysis: the larger rounded ends of long bones

Ethmoid: facial bones forming part of the wall of
The skeletal system comprises two parts: the orbit, the roof of the nasal cavity and part of the
● The axial skeleton forms the main axis or central nasal septum
core of the body and consists of the bones of the Femur: the long bone of the thigh
skull, vertebral column, sternum and ribs.
Fibrous joint: an immovable joint with tough
● The appendicular skeleton is the part of fibrous tissue between the bones
the skeleton that supports and makes up the
appendages or limbs. It consists of the shoulder Fibrous joint capsule: an envelope surrounding a
girdle, bones of the upper limbs, lower limbs and synovial joint
bones of pelvic girdle. Fibula: long bones of the lower leg (lateral side)
Ball-and-socket joint: a type of synovial joint that Frontal: the bone that forms the anterior part of the
allows multidirectional movement and rotation roof of the skull
(an example is the hip joint) Gliding joint: a type of synovial joint in which the
Bone: a form of dense connective tissue that makes opposed surfaces are flat or only slightly curved, so
up the majority of the skeleton that the bones slide against each other in a simple
Cancellous bone: a lightweight type of bone tissue and limited way
with an open sponge-like appearance that is found Hinge joint: a type of synovial joint that allows
at the ends of long bones or at the centre of other movement in only one plane, forwards and
bones backwards (the elbow, for example)
Carpals: eight irregular shaped bones forming the Humerus: the long bone forming the upper arm
wrist Hyoid: a U-shaped structure located in the anterior
Cartilage: flexible connective tissue found in the neck
articulating surfaces of joints Ilium: the largest and most superior pelvic bone in
Cartilagenous joint: a slightly movable joint which the pelvic girdle
has a pad of fibrocartilage between the end of the Ischium: the bone forming the inferior (lower) and
bones making up the joint posterior (back) part of pelvic girdle
Cervical vertebrae: vertebrae of the neck, made up Joint: the point at which two or more bones (or
of seven bones cartilage) meet
Chondrocytes: cells found in cartilage connective Kyphosis: a postural defect in which there is an
tissue abnormally increased outward curvature of the
Clavicle: a long slender bone that forms the anterior thoracic spine
portion of the shoulder girdle Lacrimal: smallest of the facial bones, located close
Coccyx (coccygeal vertebrae): the tail bone at the to the medial part of the orbital cavity
base of the spine, formed by four fused coccygeal Lateral longitudinal arch: one of the arches of the
vertebrae foot that runs along the lateral side of the foot from
Compact bone: type of hard bone tissue that makes the calcaneum bone to the end of the metatarsals
up the main shaft of the long bones and the outer Ligament: dense, strong flexible bands of white
layer of other bones fibrous connective tissue that link bones together
Condyloid joint: a type of synovial joint in which at a joint
the joint surfaces are shaped so that the concave Lordosis: a postural defect in which there is an
surface of one bone can slide over the convex abnormally increased inward curvature of the
surface of another bone in two directions lumbar spine
Diaphysis: the central shaft of a long bone Lower limb: part of the skeleton that includes the
Epiphyseal cartilage: the site of bone elongation, hip, knee and ankle joints, and the bones of the
located between the diaphysis and epiphysis thigh, leg and foot
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Lumbar vertebrae: vertebrae of the lower back (× 5) and hollow surfaces so that the surface of one bone
Mandible: the bone in the face forming the lower jaw fits the complementary surface of the other
Maxilla: bones of the face forming the upper jaw Scapula: a large, flat bone, triangular in outline,
which forms the posterior part of the shoulder
Medial longitudinal arch: one of the arches of the girdle
foot that runs along the medial side of the foot from
the calcaneum bone to the end of the metatarsals Scoliosis: a postural defect which presents with a
lateral curvature of the vertebral column, either to
Medullary canal/cavity: the hollow centre of the the left or right side
bone shaft containing both red and yellow bone
marrow Shoulder girdle: connects the upper limbs with the
thorax and consists of four bones – two scapulae
Metacarpals: five long bones forming the palm of and two clavicles
the hand
Sinuses: air-containing spaces in the skull and face
Metatarsals: five bones forming the dorsal (top)
surface of the foot Sphenoid: one of the bones of the skull located in
front of the temporal bone
Nasal: small bones that form the bridge of the nose
Sternum: flat bone lying in the centre of the chest
Occipital: the bone forming the back of the skull (also known as the breast bone)
Ossification: the process of bone development Synovial joint: a freely movable joint
Osteoblasts: cells that make bone Synovial cavity: the space between the articulating
Osteoclasts: cells that break down bone tissue bones of a synovial joint
Osteocytes: mature bone cells that maintain bone Synovial fluid: a viscous fluid found in the cavities
throughout life of synovial joints that helps to reduce friction
Osteology: the study of the structure and function between the articular cartilage of synovial joints
of bones during movement
Palatine: L-shaped bones which form the anterior Synovial membrane: specialised connective tissue
part of the roof of the mouth (× 2) that lines the inner surface of capsules of synovial
joints
Parietal: two bones that form the upper sides of the
skull and the back of the roof of the skull Tarsals: seven bones forming the ankle
Patella: the bone forming the kneecap Temporal: two bones that form the sides of the skull
above and around the ears
Pelvic girdle: a ring-like structure, located in the
lower part of the trunk and connecting the axial Tendon: tough white fibrous cords of connective
skeleton to the lower limbs tissue that attach muscles to the bone
Periosteum: the fibrous covering of a long bone Thoracic vertebrae: vertebrae of the mid spine (× 12)
Phalanges: bones forming the fingers and thumb Tibia: long bone of the lower leg (anterior, medial side)
Pivot joint: a type of synovial joint that permits Transverse arch: one of the arches of the foot that
rotation runs between the medial and lateral aspect of the
Pubis: the collective name for the two pubic bones foot and is formed by the navicular, three cuneiforms
in the most anterior (front) portion of the pelvis and the bases of the five metatarsals
Radius: the long bone of the forearm (thumb side) Turbinate: layers of bone located either side of the
outer walls of the nasal cavities
Ribs: a series of slender curved bones articulated in
pairs to the spine (12 pairs in humans), protecting Ulna: long bone of the forearm (little finger side)
the thoracic cavity Upper limb: part of the skeleton that includes the
Sacrum: a large, triangular bone at the base of the shoulder girdle, the arm, the forearm and the hand
spine that is formed by the fusing of sacral vertebrae Vomer: single facial bone at the back of the nasal
Saddle joint: type of synovial joint where the septum
articulating surfaces of bone have both rounded Zygomatic: facial bones that form the cheekbones
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Revision summary
The skeletal system
● The functions of the skeleton are support, shape, protection, movement, attachment for muscles and
tendons, formation of blood cells and mineral storage.
● Bone is the hardest type of connective tissue in the body.
● There are two types of bone tissue: compact (hard) and cancellous (spongy).
● The process of bone development is called ossification and is not complete until around the twenty-fifth
year of life.
● Cartilage is a strong and rigid type of connective tissue that cushions and supports bone.
● A ligament binds bones to other bones.
● A tendon attaches a muscle to bone.
● Bones are classified according to shape: long, short, flat, irregular and sesamoid.
● The axial skeleton forms the main core of the body and consists of the skull, vertebral column, sternum
and ribs.
● There are eight bones of the skull: one frontal, two parietal, two temporal, one sphenoid, one
ethmoid and one occipital.

● There are 14 bones of the face: two maxillae, one mandible, two zygomatic, two nasal, two lacrimal,
two turbinate, one vomer and two palatine.

● There are 33 bones in the vertebral column: seven cervical vertebrae in the neck, 12 thoracic
vertebrae in the mid spine, five lumbar vertebrae in the lower back, five sacral vertebrae (forming
the sacrum) and four coccygeal vertebrae (forming the coccyx at the base of the spine).
● The thoracic cavity protects vital organs in the chest and includes the sternum, 12 pairs of ribs and the
12 thoracic vertebrae.
● The appendicular skeleton supports and makes up the appendages or limbs and consists of the
shoulder girdle, bones of the upper and lower limbs and bones of the pelvic girdle.
● The shoulder girdle consists of two scapulae (posteriorly) and two clavicle bones (anteriorally).
● The upper limb consists of the humerus in the upper arm, radius and ulna in the forearm, eight carpals
in the wrist, five metacarapals in the palm and 14 phalanges in the fingers.
● The lower limb consists of the femur, bone of the upper leg, tibia and fibula in the lower leg, seven
tarsals in the ankle, five metatarsals in the dorsum of the foot and 14 phalanges in the toes.
● There are three arches in the foot designed to support body weight and to provide leverage when
walking – medial longitudinal arch, lateral longtudinal arch and transverse arch.
● The pelvic girdle consists of the ilium, ischium and the pubis.
● A joint is a point of contact between two or more bones.

● Ligaments hold bones together at joints, provide flexibility and facilitate movement.
● Structurally joints are classified as fibrous, cartilaginous or synovial.
● Fibrous joints are immovable, such as the sutures of the skull bones.
● Cartilaginous joints are slightly movable, such as between the vertebrae of the spine.
● Synovial joints are freely movable joints and there are several different types – ball-and-socket (hip),
hinge (knee and elbow), condyloid (wrist), gliding (between the vertebrae), pivot (between the first
and second cervical vertebrae), saddle (between the trapezium and metacarpal of the thumb).
● Features of synovial joints include a joint (synovial) cavity, a fibrous joint capsule and a synovial
membrane containing synovial fluid.
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Test your knowledge 7 How are the vertebrae classified?

a as irregular bones
questions b as short bones
c as long bones
Multiple choice questions d as sesamoid bones
1 How many bones make up the skeleton? 8 The appendicular skeleton consists of:
a 208 bones a the sternum, shoulder girdle and ribs
b 206 bones b the shoulder girdle, bones of the lower and
c 106 bones upper limbs and the pelvic girdle
d 80 bones c the skull, vertebral column, sternum and ribs
2 Which of the following statements is false? d the sternum, bones of the upper and lower
a The skeleton provides protection of vital limb, and the shoulder girdle.
organs. 9 Which of these makes up the main shaft of
b The skeleton produces blood cells in red bone a long bone?
marrow. a red bone marrow
c The skeleton stores vitamins. b compact bone
d The skeleton provides support for the weight c cancellous bone
of the body. d chondrocyte cells
3 Which skull bone forms the upper sides and the 10 Which of the following statements is true in
back of the roof of the skull? relation to cartilage?
a sphenoid a Cartilage receives a generous blood supply.
b occipital b Cartilage strengthens body structures.
c parietal c Cartilage is completely flexible.
d temporal d Cartilage cushions and absorbs shock.
4 How many bones are there in total in the skull?
a 11
Exam-style questions
b 14 11 State three functions of the skeletal system.
c 22 3 marks
d 24 12 Name the type of cell that makes bone tissue.
5 Which is the largest bone in the face? 1 mark
a zygomatic 13 Describe two differences between compact and
b lacrimal cancellous bone. 2 marks
c maxilla 14 State the structural and functional difference
d turbinate between a ligament and a tendon.
6 How many movable bones are there in the 2 marks
vertebral column? 15 Name the parts that make up the axial skeleton.
a 24 4 marks
b 33
c 12
d 9
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5 The muscular
system
Introduction
The muscular system comprises over 600
individual muscles which are primarily concerned
with movement and body co-ordination. There
is an intimate relationship between muscle and
bone, as both contribute to creating movement
in the body. From Chapter 4, you know that
bones and joints provide leverage for movement
but it is, in fact, muscles that provide the force
on the bones to effect movement. The key to
learning the anatomical positions and actions of
muscles is to first learn the individual positions
of the bones. It is then a logical step to learn the
muscle attachments in relation to each bone and
what movements those muscles create.
OBJECTIVES
● the functions of the muscular system
● the structure and functions of the different

types of muscle tissue
● how muscles contract
● the effects of temperature and increased

circulation on muscle contraction
● the definition of the terms muscle tone
and muscle fatigue
● the structure and function of the different
types of attachments of muscles
● the position and action of the main
superficial muscles of the face and body
● common pathologies of the muscular system
● the interrelationships between the

muscular and other body systems.
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5 The muscular system
The functions of the In practice

muscular system It is essential for therapists to
have a good working knowledge
Myology is the study of the muscular system, including the study of the of the muscular system as they
structure, function and diseases of muscle. primarily work on the muscles
The muscular system consists largely of skeletal muscle tissue, which and their associated connective
covers the bones on the outside of the body, and connective tissue which tissues. Together, these make
attaches muscles to the bones of the skeleton. Muscles, along with up about half of the body’s soft
connective tissue, help to give the body its contoured shape. tissue mass.
The muscular system has three main functions: Having knowledge of the
1 movement position, action and tone of
muscles allows therapists to be
2 maintaining posture
more accurate in their treatment
3 the production of heat. applications, ensuring effective
results
1 Movement
Understanding how muscles
Consider the action of picking up a pen that has dropped onto the contribute to movement in
floor. This seemingly simple action of retrieving the pen involves the the body helps therapists to
co-ordinated action of several muscles pulling on bones at joints to appreciate how pathological
create movement. Muscles are also involved in the movement of body disorders often result in muscle
fluids such as blood, lymph and urine. Heart muscle beats continuously dysfunction.
and tirelessly throughout life.
2 Maintaining posture
Some fibres in a muscle resist movement and create slight tension in order
to maintain body posture. This is essential, otherwise we would be unable
to maintain normal body positions, such as sitting down or standing up.
3 The production of heat

As muscles create movement in the body they generate heat as a
by-product, which helps to maintain our normal body temperature.
Muscle tissue
Muscle tissue makes up about 50% of your total body weight and is
composed of:
● 20% protein
● 75% water
● 5% mineral salts, glycogen and fat.
There are three types of muscle tissue in the body:
1 skeletal, or voluntary, muscle tissue which is primarily attached to bone
2 cardiac muscle tissue which is found in the walls of the heart
3 smooth (non-striated) or involuntary muscle tissue which is found
inside the digestive and renal tracts, as well as in the walls of blood
vessels.
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All three types of muscle tissue differ in their structure and functions
(Table 5.1) and the degree of control the nervous system has on them.
Table 5.1 Overview of the three types of muscle tissue
Muscle type Description Location Function

Voluntary/ Striped appearance with Attached to bones, Facilitates movement of bones
skeletal many nuclei skin or other muscles Moves blood and lymph
Held together by connective Heat production
tissue Maintenance of posture
Cardiac Striped appearance with Heart Provides a consistent flow of
branched structure blood throughout the body
Each cell has a single nucleus
Has intercalated discs
between cardiac muscle cells
Smooth/ Non-striated and shaped like In walls of stomach, Move substances through
involuntary spindles intestines, bladder, uterus the various tracts (digestive,
Each cell has a single nucleus and in blood vessels genito-urinary)
p Different types of muscle tissue in the human body
Voluntary (skeletal or striated)

muscle tissue
Voluntary muscle tissue is made up of bands of elastic or contractile
tissue bound together in bundles and enclosed by a connective tissue
sheath which protects the muscle and helps to give it a contoured shape.
Voluntary or skeletal muscle tissue has very little intercellular tissue.
It consists almost entirely of muscle fibres, held together by fibrous
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connective tissue and penetrated by numerous tiny blood vessels and

nerves. The long slender fibres that make up muscle cells vary in size.
Some are around 30 cm in length, whereas others are microscopic.
Each muscle fibre is enclosed in an individual wrapping of fine connective
tissue called the endomysium. These are further wrapped together in
bundles, known as fasciculi, and are covered by the perimysium (fibrous
sheath). These bundles are then gathered to form the muscle belly (main
part of the muscle) with its own sheath – the fascia epimysium.
Each striated muscle fibre is covered by a thin transparent extensible
plasma membrane called the sarcolemma.
The relatively inelastic parts of muscles are tendons and these are usually
made up from a continuation of the endomysium and perimysium.
Each muscle fibre is made up of even thinner fibres called myofibrils.
These consist of long strands of microfilaments, made up of two different
types of protein strands called actin and myosin. It is the arrangement of
actin and myosin filaments which gives the skeletal muscle its striated
or striped appearance when viewed under a microscope. Muscle fibre
contraction results from a sliding movement within the myofibrils in
which actin and myosin filaments merge.
Epimysium
Perimysium
Endomysium
Muscle fibres arranged in a fasciculus/bundle
Muscle fibre
Myofibril
A single myofibril
Myosin
Actin
p The structure of voluntary muscle tissue
Types of muscle fibres

Most skeletal muscles are made up of a combination of fast twitch and
slow twitch fibres.
Fast twitch fibres (white)
These have fast, strong reactions but tire quickly. They are well adapted
for rapid movements and short bursts of activity. They have a rich
blood supply and mainly use glucose as an energy store, which can be
transferred into mechanical energy without oxygen.
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Slow twitch fibres (red)

These fibres have greater endurance but do not produce as much force as
fast twitch fibres. They are, therefore, suited to slower and more sustained
movements and are relatively resistant to fatigue. Their energy comes from
the breakdown of glucose by oxygen and they depend on a continuous
supply of glucose for endurance. Slow twitch fibres have a good circulation
(the red colour comes from both the circulation and from the presence of a
red pigmented protein that stores oxygen).
During low-intensity work, such as walking, the body is working well
below its maximal capacity and only slow twitch fibres are involved. As
muscle intensity increases and exercise becomes more anaerobic, fast
twitch fibres are activated. Whatever the intensity of movement, only a
small number of fibres are used at any one time to prevent damage and
injury to the tissues.
KEY FACT
Each person is born with a set number of muscle fibres which
cannot be increased. An increase in the size of a muscle is due
to exercise, which causes an increase in the individual fibres.
However, with lack of use these shrink again as the muscle
atrophies. It is interesting to note that men are more able to
enlarge their muscles through exercise than women due to the
effects of male hormones.
The way in which the bundles of fibres lie next to one another in a
muscle will determine its shape. The contractile force of a muscle is
partly attributable to the architecture of its fibres. Common muscle fibre
arrangements are discussed below.
Parallel fibres
Muscles with parallel fibres can vary from short, flat muscles to spindle-
shaped (fusiform) muscles to long straps.
Convergent
This is where the muscles fibres converge towards a single point for
maximum concentration of the contraction. The direction of movement
is determined by which sections of the muscle are activated. The muscle
may be a triangular sheet (the pectoralis major muscle or the latissimus
dorsi, for example). These muscles often cross joints that have a large
range of possible movements. They provide a strong but steady pull,
fine-tuning the angle of movement, thus balancing movement with
continuing stability in the joint.
Pennate
This is where the fibres lie at an angle to the tendon and, therefore, also
to the direction of pull. They have lots of short fibres, so the muscle pull
is short but strong. They may be further classified as follows:
● uni-pennate – diagonal fibres attach to one side of the tendon only,
such as the soleus
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● bi-pennate – the fibres converge onto a central tendon from both

sides, such as the rectus femoris
● multipennate – the muscle has several tendons of origin, such as the
deltoid.
Parallel Fusiform Unipennate Multipennate Bipennate
p The six muscle shapes
Voluntary muscle works intimately with the nervous system so that

it will only contract if a stimulus is applied to it via a motor nerve. KEY FACT
Each muscle fibre receives its own nerve impulse so that fine and Every time a muscle is used,
the muscle fibres shorten
varied motions are possible. Voluntary muscles also have their own
along their length. Therefore,
small stored supply of glycogen, which is converted to glucose and tension often accumulates in
used as fuel for energy. Voluntary muscle tissue differs from other lines in the longer muscles
types of muscle tissue in that the muscles tire easily and need (particularly those with
regular exercise. parallel fibres such as the
paravertebral muscles). In
Cardiac muscle muscles with shorter fibre
pennates and convergent
Cardiac muscle is a specialised type of involuntary muscle tissue found fibres, tension is often in
only in the walls of the heart. Forming the bulk of the wall of each heart knots rather than in lines.
chamber, cardiac muscle contracts rhythmically and continuously to
provide the pumping action necessary to maintain a relatively consistent
flow of blood throughout the body. Cardiac muscle resembles voluntary
muscle tissue in that it is striated due to the actin and myosin filaments.
However, it differs in two ways:
1 It is branched in structure.
2 It has intercalated discs between the cardiac muscle cells,
forming strong junctions to assist in the rapid transmission
of impulses throughout an entire section of the heart, rather
than in bundles.
The contraction of the heart is automatic. The stimulus to contract is
stimulated from a specialised area of muscle in the heart called the
sinoatrial (SA) node which controls the heart rate.
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As the heart has to alter its force of contraction under different

conditions, its contraction is regulated not only by nerves but
also by hormones, such as adrenaline which can speed up
contractions.
Smooth/involuntary
(non-striated) muscle
Smooth muscle is also known as involuntary muscle, as it is not under
the control of the conscious part of the brain. It is found in the walls of
hollow organs such as the stomach, intestines, bladder, uterus and in
blood vessels.
The main characteristics of smooth muscle are that:
● the muscle cells are spindle shaped and tapered at both ends
● each muscle cell contains one centrally located oval-shaped nucleus.
Smooth muscle has no striations due to the different arrangement of the
protein filaments actin and myosin, which are attached at their ends to
p Cardiac muscle tissue the cell’s plasma membrane.
The muscle fibres of smooth muscle are adapted for long, sustained
contraction and, therefore, consume very little energy. One of the
special features of smooth muscle is that it can stretch and shorten to a
greater extent and still maintain its contractile function. Smooth muscle
will contract or relax in response to nerve impulses, physical stretching
or hormones but it is not under voluntary control.
Smooth muscle, like voluntary muscle, has muscle tone and this is
important in areas such as the intestines where the walls have to
maintain a steady pressure on the contents.
Muscle contraction
Muscle tissue has several characteristics which help contribute to the
functioning of a muscle:
● contractibility – the capacity of the muscle to shorten and thicken
● extensibility – the ability to stretch when the muscle fibres relax
● elasticity – the ability to return to its original shape after
contraction
p Smooth/involuntary muscle tissue ● irritability – the response to stimuli provided by nerve impulses.
Muscles vary in the speed at which they contract. The muscle in your
eyes will be moving very fast as you are reading this page, while
the muscles in your limbs assisting you in turning the pages will be
contracting at a moderate speed. The speed of a muscle contraction is,
therefore, modified to meet the demands of the action concerned and
the degree of nervous stimulus it has received.
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Stimulus to contract a nerve impulse, the end of the motor nerve fibre
secretes a neuromtransmitter substance called
Skeletal or voluntary muscles contract as a result of acetylcholine, which diffuses across the junction
nervous stimulus which they receive from the brain and stimulates the muscles fibre to contract.
via a motor nerve. Each skeletal fibre is connected
Cardiac and smooth muscle are innervated by the
to the fibre of a nerve cell. Each nerve fibre ends in a
autonomic nervous system.
motor point, which is the end portion of the nerve and
is the part through which the stimulus to contract is The contraction of voluntary
given to the muscle fibre. A single motor nerve may muscle tissue
transmit stimuli to one muscle fibre or to as many as
The functional characteristic of muscle is its ability
150, depending on the effect of the action required.
to transform chemical energy into mechanical
The site where the nerve fibre and muscle fibre meet energy in order to exert force. Muscles exert force
is called a neuromuscular junction. In response to by contracting or making themselves shorter.
Sarcomere
Myofibril or fibril (complex organelle Sarcomere (contractile unit of a myofibril)

composed of bundles of myofilaments)
Sarcomere Sarcomere
(relaxed muscle) (contracted muscle)
Thick (actin) filament Thick (myosin) filament
Normal aerobic
respiration
Thick filament ATP ATP

Thick filament
1 2 3
1. Myosin head (thick 2. Working stroke — the
3. ATP attaches to the myosin
filament) attaches to myosin head pivots and
head, causing it to detatch
actin (thin filament) bends, pulling the thin
from the actin filament.
filament towards the
The cycle then repeats
In death, with no ATP production, midline of the sarcomere
the cycle stops here (rigor mortis)
p Mechanism of muscular contraction
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The role of actin The energy needed for

and myosin muscle contraction
A voluntary or skeletal muscle consists of many long A certain amount of energy is needed to effect
cylindrical fibres. Each of these fibres is, in turn, filled the mechanical action of the muscle fibres. This is
with long bundles of even smaller fibres called myofibrils. obtained principally from carbohydrate foods which
A myofibril resembles stacked blocks. In each block are digested to glucose. Glucose is transported in
(or sarcomere) thick filaments containing the protein the arterial blood supply; any that is not required
myosin overlap thin filaments containing the protein immediately by the body is converted into glycogen
actin. Sarcomeres are the segments into which a fibril and is stored in the liver and the muscles. Muscle
of striated muscle is divided. Sarcomeres are divided glycogen, therefore, provides the glucose which is
into dark Z lines with their centres known as H zones. the fuel for muscle contraction. The process is as
As the muscle contracts, its sarcomeres shorten, follows:
reducing the distance between the Z lines and the ● During muscle contraction, glycogen is broken
width of the H zone. Muscle fibre contraction results down to glucose. This undergoes oxidation,
from a sliding movement within the myofibrils in in which glucose combines with oxygen and
which the actin and myosin filaments merge. Actin and releases energy. Oxygen is stored in the form
myosin affect contraction in the following way: of haemoglobin in the red blood cells and as
● During contraction, a sliding movement occurs within myoglobin in the muscle cells.
the contractile fibres (myofibrils) of the muscle in ● During oxidation, a chemical compound called
which the actin protein filaments move inwards adenosine triphosphate (ATP) is formed. Molecules
towards the myosin and the two filaments merge. of ATP are contained within voluntary muscle
● Cross-bridges of myosin filaments form linkages tissue and their function is to temporarily store
with actin filaments. energy produced from oxidation of glucose.
● This action causes the muscle fibres to shorten and ● When the muscle is stimulated to contract, ATP
thicken and then pull on their attachments (bones is converted to another chemical compound,
and joints) to effect the movement required. adenosine diphosphate (ADP) with the release of
the energy needed for muscle contraction.
● The attachment of myosin cross-bridges to actin
requires the mineral calcium. ● During the oxidation of glucose, a substance called
pyruvic acid is formed.
● The nerve impulses leading to contraction cause
an increase in calcium ions within the muscle cell. ● If plenty of oxygen is available to the body, as at
rest or undertaking moderate exercise, then the
● During relaxation, the muscle fibres elongate and
pyruvic acid is broken down into waste products,
return to their original shape.
carbon dioxide and water, which are excreted
The force of muscle contraction depends on the
into the venous system. This is known as aerobic
number of fibres in a muscle which contract
respiration.
simultaneously. The more fibres that are involved, the
● If insufficient oxygen is available to the body, as
stronger and more powerful the contraction will be.
in the case of vigorous exercise, then the pyruvic
KEY FACT acid is converted into lactic acid. This is known as
anaerobic respiration.
The basic contractile process is the same in
cardiac, smooth and voluntary muscles, with
movement being achieved through the action
of the protein filaments, actin and myosin.
Muscle fatigue
However, since the requirements are different The waste product lactic acid, which diffuses into
in terms of speed and force of contraction, the the bloodstream after vigorous exercise, causes the
structure of cardiac and smooth muscles are muscles to ache. This condition is known as muscle
slightly different to voluntary muscle tissue.
fatigue and is defined as the loss of the ability of
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a muscle to contract efficiently due to insufficient

KEY FACT
oxygen, exhaustion of energy supply and the
The conversion of lactic acid back into glucose is
accumulation of lactic acid. a relatively slow process and it may take several
hours to repay the oxygen debt, depending
The effects of increased on the extent of the exercise undertaken. This
situation can be minimised by massaging
circulation on muscle muscles before and after an exercise schedule,
contraction which will increase the blood supply to the
muscles and prevent formation of an excess
During exercise, muscles require more oxygen to of lactic acid.
cope with the increased demands made on the body.
The body initiates certain circulatory and respiratory
changes to meet the increased oxygen requirements
The effects of temperature
of the muscles. on muscle contraction
Exercising muscles produce heat, which is carried
Circulatory changes that occur away from the muscles by the bloodstream and
in the body during muscle is distributed to the rest of the body. Exercise
contraction is, therefore, an effective way to increase body
temperature. When muscle tissue is warm, the
During exercise, there is an increased rate of return
process of contraction occurs faster due to the
of venous blood to the heart, owing to the more
acceleration of the chemical reactions and the
extensive movements of the diaphragm and the
increase in circulation. However, it is possible for
general contractions of the muscles, which compress
heat cramps to occur in muscles that are exercising
the veins. With the increased heart rate and greater
at high temperatures, as increased sweating causes
output from each heartbeat, a greater volume of
loss of sodium in the body, leading to a reduction
blood is circulated around the body and lungs, which
in the concentration of sodium ions in the blood
leads to an increase in the amount of oxygen in the
supplying the muscle.
blood.
Cramp occurs when muscles overcontract and go into
More blood is distributed to the muscle and less
spasm. This is usually caused by an irritated nerve or
to the intestines and skin to meet the needs of the
an imbalance of mineral salts such as sodium in the
exercising muscles. During exercise, a muscle may
body. Cramp most commonly affects the calf muscles
receive as much as 15 times its normal flow of blood.
or the soles of the feet. Cramp can be very painful as
it is a sudden involuntary contraction of the muscle.
Respiratory changes
Treatment to relieve the pain of cramp includes
The presence of lactic acid in the blood stimulates
stretching the affected muscle group and using
the respiratory centre in the brain to increase the
soothing effluerage movements to help to relax the
rate and depth of breathing, producing panting. The
muscles. Conversely, as muscle tissue is cooled, the
rate and depth of breathing remains above normal
chemical reactions and circulation slow, causing the
for a while after strenuous exercise has ceased.
contraction to be slower. This causes an involuntary
Large amounts of oxygen are taken in to allow the
increase in muscle tone (known as shivering) that
cells of the muscles and the liver to dispose of the
increases body temperature in response to cold.
accumulated lactic acid by oxidising it and converting
it back to glucose or glycogen. Lactic acid is formed
in the tissues in amounts far greater than can be
Muscle tone
immediately disposed of by available oxygen. The Even in a relaxed muscle, a few muscle fibres remain
extra oxygen needed to remove the accumulated contracted to give the muscle a certain degree of
lactic acid is called the oxygen debt, which must be firmness. At any given time a small number of motor
repaid after the exercise is over. units in a muscle are stimulated to contract, while
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the others remain relaxed. This causes tension in the

muscle rather than full contraction and movement.
The groups of motor units functioning in this
way change periodically so that muscle tone is
maintained without fatigue.
This state of partial contraction of a muscle
is known as muscle tone and is important for
maintaining body posture. Good muscle tone is
apparent when muscles appear firm and rounded,
whereas poor muscle tone may be recognised by
muscles that are loose and flattened.
KEY FACT
An increase in the size and diameter of
muscle fibres, usually caused by exercise and/
or weightlifting, leads to a condition called
hypertrophy.
Muscles with less than the normal degree of
tone are said to be flaccid, and when muscle
tone is greater than normal the muscles
become spastic and rigid.
KEY FACT
Muscle tone varies from person to person and
largely depends on the amount of exercise p The Achilles tendon
undertaken. Muscles with good tone have
a better blood supply as their blood vessels
are not inhibited by fat.
Ligaments
Ligaments are strong, fibrous and elastic tissues, usually
Muscle attachments cord-like in nature. Their attachments to various
skeletal components help to maintain the bones in
In order to understand how skeletal muscles produce correct relationship to one another, stabilising joints.
movement, it is helpful to know how muscles are They are found lying parallel to or closely interlaced
attached to the rest of the body. with one another, which creates a shining white or
silvery effect. A ligament is pliant and flexible, so
Tendons as to allow good freedom of movement, but is also
Tendons are glistening white, tough fibrous bands or tough, strong and inextensible (does not stretch).
cords that link muscle to bone. They do not stretch or The orientation of a ligament’s fibres (parallel
contract like muscles do. They are mechanically strong, arrangements complemented by transverse fibres)
as their primary role is to transmit the contractile force gives the ligament an ability to resist stress in several
of the muscle to the bone. For this reason, tendons are different planes. Ligaments also contain a greater
relatively inflexible structures, designed to be strongest concentration of elastin than a tendon. This allows the
in the direction of tensile stress. ligament a small degree of ‘give’ before it pulls taut. This
Despite their great strength, tendons are susceptible to small amount of give is important because it helps to
excessive tensile stress injuries. A tendon’s blood supply prevent injury; if ligaments were as rigid and resistant
is limited, so it will not heal quickly or easily. Luckily to tensile stress as tendons, the frequency of ligament
complete tendon tears or ruptures are infrequent (the injuries would be much greater. The most common
most common ruptured tendon is the Achilles tendon). injury to a ligament is a sprain (torn ligament).
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When torn, ligaments heal slowly due to the fact that they have a relatively
poor blood supply compared to muscles and tendons.

p Skeleton hip with ligaments
Fascia
Fascia consists of fibrous connective tissue that envelops certain muscles and
forms partitions for others. Fascia is found all over the body – it packages, supports
and encloses all the body’s muscles and organs. It separates different muscle sets
allowing them to glide smoothly beside each other. The fascial planes provide
pathways for nerves, blood vessels and lymphatic vessels.
Fascia, therefore, plays a key role in maintaining the muscle health. When
these cellophane-like sheets become adhered to neighbouring muscle tissue,
efficiency and function can be significantly diminished. If the fascia becomes
torn or overstressed, its subsequent loss of elasticity will cause chronic tissue
congestion.
KEY FACT
One of the most problematic features of fascia is its response to
prolonged immobilisation. If the body is held in one position for long
periods of time, the fascia has a tendency to adapt to that position. This
is especially the case when the fascia is held in a shortened position – it
will structurally adapt to that position and resist attempts to return it to
its normal length.
Origins and insertions

Muscle attachments are called origins and insertions. Generally, the end of
the muscle closest to the centre of the body is referred to as the origin and
the insertion is the furthest attachment.
Origins are often shorter and broader and attach over a larger area, while insertions
are commonly longer and the fibres are more densely concentrated at a smaller
bone area. The insertion is generally the most movable point and, therefore, the
point at which the muscle work is done. Where a muscle divides into more than
one attachment at one end or has a long line of attachments at one end, a number
of actions are usually possible.
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Muscle movement
In the co-ordination of movement, muscles work in pairs of groups. Muscles are
classified by functions as:
● antagonists
● agonists (prime movers)
● fixators (stabilisers)
● synergists.
Although muscles are usually described as performing a particular action, they do
not act alone. All movement is the result of co-operation between a large number
of muscles, which are co-ordinated in the cerebellum in the brain for smooth and
efficient actions.
Antagonists
Antagonists are two muscles (or two sets of muscles) that pull in opposite
directions. They don’t actually work against one another, but function in a
reciprocal and complementary way, with one relaxing to allow the other to
contract.

p Antagonistic muscles
Agonists/prime movers
Agonists are the main activating muscles. Note that the term is used in
relation to a specific action. The roles are, therefore, relative to one another
and are interchangeable. An example is the action of the biceps and triceps of
the upper arm. Biceps are the agonist in flexion of the elbow joint and triceps
are the antagonist. In relation to extending or straightening the elbow the roles
are reversed.
Fixators
These are muscles that stabilise a bone to give a steady base from which the
agonist works. For the biceps and triceps to flex and extend the elbow joint,
muscles around the shoulder and upper back must control the position of the arm.
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Synergists Biceps brachii

muscle shortens
as agonist
This term refers to muscles on the same side of a joint that work together
to perform the same movement. An example of this is flexing the elbow. The deltoid will
stabilise the
The biceps actually work synergistically with the brachialis muscle that lies shoulder joint
underneath them. as a fixator
Muscle contraction in movement

R
Biomechanically, muscles do one of two things – stretch (relax) or shorten
(contract). Muscular contractions can be isometric or isotonic. Isotonic
contractions may be further classified as either concentric or eccentric. The
opposite of contracting is stretching, which extends the muscles.
Isometric contraction Elbow joint

Lengthening of triceps
This is when the muscle works but without creating actual movements (iso (antagonist)
means ‘same’ and metric means ‘length’). Postural muscles work by isometric
p Agonist and fixator
contraction.
Isotonic contraction
This term refers to a muscular contraction with constant force (tonic meaning
‘tone’ or ‘tension’) but where the muscle length changes. There are two types
of isotonic contraction:
1 Concentric contractions (towards the centre) – this type of contraction
occurs when the muscle shortens to move the attachment closer, such as
when the biceps bends up the forearm.
2 Eccentric contractions (away from the centre) – this type of contraction
occurs when a muscle is stretched as it tries to resist a force, pulling the
bones of attachment away from one another, such as when tensing the
biceps as someone pulls your forearm straight.
During many everyday actions, both isometric and isotonic contractions occur.
For example, when standing the quadriceps muscle straightens the knee to
keep you upright (isometric contraction), thereby preventing your knee from
bending. When you sit down slowly, the muscle is stretched and an eccentric
contraction controls the rate at which the knee bends to lower the body. If you
then stand up, the muscle works concentrically to straighten the knee again.
Study tip
Learning muscle names and positions can be daunting. It is helpful to break down the information into
manageable chunks, so you learn a few muscles at a time.
The following tips may help you when studying muscles:
● There is often a clue in the name of the muscle as to where it is located in the body. For example, the tibialis
anterior muscle is located alongside the tibia bone in the front of the lower leg.
● Picturing where the muscle is in your own body may help you to remember where it is located.
● Look for information that will help you remember the action for each muscle. See the key facts in the last
column of the muscle tables on pages 143 to 145.
● If you know where the muscle is located and attached, you can work out its action by moving that body part
and feeling the muscle contracting.
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Muscles of the head and neck
Frontalis
Occipitalis
p Frontalis and occipitalis
Frontalis
Temporalis
Corrugator
Orbicularis oculi
Procerus
Nasalis
Zygomaticus minor Levator labii superioris
Zygomaticus major Levator anguli oris

Masseter
Risorius Buccinator
Orbicularis oris
Depressor anguli oris

Mentalis (chin) Depressor labii inferioris
Platysma
Sternocleidomastoid
p Muscles of the head and neck
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Table 5.2 Muscles of the head and neck
Name of muscle Position Attachments Action(s) Key facts

Frontalis Extends over Attaches to the skin Wrinkles the The frontalis muscle is
(front-ta-lis) the front of the of the eyebrows and forehead and used when expressing
skull and across the frontal bone at the raises the surprise
the width of the hairline eyebrows
forehead
Occipitalis Back of the skull Attaches to the Moves the scalp The occipitalis muscle
(ok-sip-it-ta-lis) occipital bone and the backwards is united to the frontalis
skin of the scalp muscle by a broad
tendon called the
epicranial aponeurosis
which covers the skull
like a cap
Temporalis A fan-shaped Attaches to the Raises the Becomes overtight
(tem-po-ra-lis) muscle situated on temporal bone and to lower jaw when and painful in the
the side of the skull the upper part of the chewing condition known as
above and in front mandible TMJ syndrome
of the ear Also becomes
tightened with a
tension headache
Orbicularis oculi Circular muscle that Attached to the bones Closes the eye The orbicularis
(or-bik-you-la-ris surrounds the eye at the outer edge and oculi muscle is used
ock-you-ly) the skin of the upper when blinking or
and lower eyelids at winking
the inner edge It also compresses the
lacrimal gland, aiding
the flow of tears
Orbicularis oris A circular muscle Its fibres attach to the Closes the mouth The orbicularis oris
(or-bik-you-la-ris that surrounds the maxilla, mandible, the muscle is used when
or-ris) mouth lips and the buccinator shaping the lips for
muscle speech and when
kissing
Also contracts the lips
when tense
Corrugator Located between Attached to the frontalis Brings the Used when frowning
(kor-u-gay-tor) the eyebrows muscle and the inner eyebrows
edge of the eyebrow together
Procerus Located between Attached to the nasal Draws the Contraction creates a
(pro-ser-rus) the eyebrows bones and the frontalis eyebrows puzzled expression
muscle inwards
Nasalis (nay-sa-lis) Located at the sides Attached to the Dilates and Used when blowing
of the nose maxillae bones and compresses the the nose
the nostrils nostrils
Zygomatic major Lies in the cheek Extends from the Draws the angle Used when laughing
and minor area zygomatic bone to the of the mouth or smiling
or angle of the mouth upward and
zygomaticus laterally
(zi-go-mat-ik-us)
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Levator labii Located towards the Extends from the upper Raises the upper Used to create a
superioris inner cheek beside jaw to the skin of the lip and the corner snarling expression
(le-vay-tor lay-be- the nose corners of the mouth of the mouth
eye soo-pee-ri-o-ris) and the upper lip
Levator anguli oris Above the lip, Extends from the Elevation of the Contraction can result
(le-vay-tor ang-you- located at an angle maxilla (upper jaw) to angle of the in the teeth, especially
lie o-ris) above the side of the angle of the mouth mouth the canine teeth,
or the mouth becoming visible
caninus
(kay-ni-nus)
Depressor anguli Side of chin, Extends from the Depression of Contributes to the
oris (dee-pres-or extending down at mandible (lower jaw) the angle of the facial expression of
ang-you-lie o-ris) an angle from the to the angle of the mouth sadness or uncertainty
or side of mouth mouth
triangularis
Depressor labii Side of chin, Extends from the Depression of the Contributes to the
inferioris extending down mandible to the lower lip facial expressions of
(dee-pres-or lay-be- from lower lip midline of the lower lip sorrow, doubt or irony
eye in-fee-ri-o-ris)
Risorius Triangular-shaped Attached to the Pulls the corner Creates a grinning
(ri-sor-ri-us) muscle that lies zygomatic bone at one of the mouth expression
horizontally on end and the skin of the sideways and
the cheek, above corner of the mouth at upwards
the buccinator the other
muscles, joining at
the corners of the
mouth
Buccinator Main muscle of the Attached to both the Helps hold food Used when blowing a
(buk-in-a-tor) cheek upper and lower jaw, in contact with balloon or blowing a
its fibres are directed the teeth when trumpet
forwards from the chewing and A common site for
bones of the jaws to compresses the holding tension in the
the angle of the mouth cheek face
Mentalis Radiates from the Attached to the lower Elevates the Used when expressing
(men-ta-lis) lower lip over the jaw and the skin of the lower lip and displesaure and when
centre of the chin lower lip wrinkles the skin pouting
of the chin
Masseter Thick, flattened and Fibres extend Main muscle Tends to hold a lot of
(ma-sa-ter) superficial muscle at downwards from the of mastication, tension and can be
sides of jaw/cheek zygomatic arch to the raises the jaw felt just in front of the
mandible and exerts ear when the teeth are
pressure on clenched
the teeth when
chewing
➜
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Sternocleidomastoid Long muscle that Fibres extend upwards When working Spasm of this muscle
(ster-no-kli-do-mas- lies obliquely across from the sternum and together, they results in a condition
toyd) each side of the clavicle at one end to flex the neck known as torticollis or
neck the mastoid process of (pull the chin wryneck
the temporal bone (at down towards The only muscle that
the back of the ear) the chest) and moves the head but
when working is not attached to any
individually, they vertebrae
rotate the head to
the opposite side
Platysma Superficial muscle Extends from the Depresses the Used in yawning
(pla-tiz-ma) that covers the front chest (fascia covering lower jaw and and when creating a
of the neck the upper part of lower lip pouting expression
pectoralis major and
deltoid) up either side
of the neck to the chin
The pterygoids
Lateral pterygoid (lat-er-al ter-i-goyds) KEY FACT
● Position and attachments – this muscle extends from the sphenoid bone Tension in the lateral
to the mandible and temporomandibular joint. pterygoid may be
associated with
● Action – protraction of the mandible. dysfunction of the
temporomandibular
Medial pterygoids (mee-dee-al ter-i-goyd) joint (TMJ syndrome).
● Position and attachments – this muscle extends from the sphenoid bone
to the internal surface of the mandible.
● Action – elevation of the mandible. KEY FACT
Tension in the medial
pterygoid may be
associated with
dysfunction of the
temporomandibular
joint (TMJ syndrome).
Lateral pterygoid
Medial pterygoid
Mandible
p Medial and lateral pterygoids
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Muscles of the posterior of the neck
Splenius Splenius
capitis capitis
Splenius
cervicis
Superficial Deep
p Muscles of the posterior of the neck
Splenius capitis
(splee-knee-us kap-i-tis)
● Position and attachments – this is a long posterior neck muscle that
extends from the spinous processes of C7–T3 to the mastoid process of the
temporal bone and the occipital bone.
● Action – extension of the head and neck, and lateral flexion of the head
and neck.
KEY FACT
The splenius capitis muscle is shaped like a bandage and attaches
onto the head. The right and left splenius captitis muscles form a
V-shape. Due to this V-shape, they are sometimes referred to as the
‘golf tee’ muscles.
Splenius cervicus (splee-knee-us

ser-vi-sis)
● Position and attachments – this is a long posterior neck muscle
(with fibres slightly thinner and longer than splenius capitis) that extends
from the spinous processes of T3–T6 to the transverse processes of C1–C3.
● Action – extension of the neck, and lateral flexion of the neck.
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Muscles of the shoulder

Surface muscles Deep muscles
Levator scapula
Supraspinatus
Trapezius
Teres minor
Deltoid
Infraspinatus
Rhomboids
Teres major
p Muscles of the shoulder
Table 5.3 Muscles of the shoulder

Trapezius Large, Extends horizontally The upper fibres raise Commonly holds upper
(tra-pee-zee-us) triangular- from the base of the the shoulder girdle, body tension, causing
shaped muscle skull (occipital bone) the middle fibres pull discomfort and restrictions
in the upper and the cervical and the scapula towards in the neck and shoulder
back thoracic vertebrae to the vertebral column Carrying a bag on one
the scapula and the lower fibres shoulder can cause
Fibres are arranged in draw the scapula and tightness in the upper
three groups – upper, shoulder downward fibres of trapezius
middle and lower When the trapezius
is fixed in position
by other muscles,
it can pull the head
backwards or to one
side
Levator scapula A strap-like Connects the cervical Elevates and adducts Due to its attachments,
(le-vay-tpr skap- muscle that runs vertebrae to the the scapula tension in the levator
you-lee) almost vertically scapula scapula can effect mobility
through the of both the neck and the
neck shoulder
Rhomboids Fibres of these Attach to the upper Adduct the scapula Known as the ‘Christmas
(rom-boyds) muscles lie thoracic vertebrae tree’ muscles because
between the at one end and the the fibres are arranged
scapulae medial border of the obliquely like Christmas
scapula at the other tree branches
end Tension in the rhomboid
muscles often results
in aching and soreness
between the scapulae
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Supraspinatus Located in the Attached to the spine Abducts the humerus, One of the rotator cuff
(soo-pra-spy- depression of the scapula at one assisting the deltoid muscles (along with
nay-tus) above the spine end and the humerus infraspinatus, teres major
of the scapula at the other and subscapularis)
The only muscle of the
rotator cuff that does not
rotate the humerus
Infraspinatus Deep muscle Attaches to the Rotates humerus One of the four rotator
(in-fra-spy-nay- covering the middle two-thirds of laterally (outwards) cuff muscles (along with
tus) lower part of the scapula below supraspinatus, teres minor
the scapula the spine of the and subscapularis)
scapula at one end Tension here can affect the
and the top of the range of mobility in the
humerus at the other arm and the shoulder
Teres major Deep, small Attaches to the Adducts and medially Sometimes referred to as
(te-reez may-jor) muscle located bottom lateral edge (inwardly) rotates the ‘little helper’ of the
between the of the scapula at one humerus latissimus dorsi muscle
lower border of end and the back of because they run together
the scapula and the humerus (just between the scapula and
the humerus below the shoulder the humerus
joint) at the other
Teres minor Deep, small Attaches to the Rotates humerus One of the four rotator
(te-reez my-nor) muscle located lateral edge of the laterally (outwards) cuff muscles (along
above teres scapula, above teres with supraspinatus,
major major at one end, infraspinatus and
and into the top of subscapularis)
the posterior of the
humerus at the other
Subscapularis Large muscle Attaches to the inside Rotates the humerus One of the four rotator
(sub-skap-u-la-ris) located beneath surface of the scapula medially, draws the cuff muscles (along
the scapula to the anterior of the humerus forwards with supraspinatus,
top of the humerus and down when the infraspinatus and teres
arm is raised minor)
Often implicated in frozen
shoulder
Deltoid Thick, triangular Attaches to the Abducts arm, draws Has anterior, lateral and
(del-toid) muscle that clavicle and the spine the arm backwards posterior fibres that
caps the top of of the scapula at one and forwards give the shoulder its
the humerus end, and to the side characteristic shape
and shoulder of the humerus at the
other
KEY FACT
Although the teres major and minor may appear similar by
name, they wrap around the humerus in opposite directions and,
therefore, have opposite rotary actions.
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Muscles of the upper limbs
Coracobrachialis
Lateral head
Triceps brachii Long head
Medial head
Biceps brachii
Brachialis
p Muscles of the upper arm
Triceps contracted, Biceps contracted,

biceps relaxed triceps relaxed
(extended) (extended)
Biceps
Biceps
Triceps
Triceps
Tendon
p Biceps and triceps
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9781510435179.indb 150
Table 5.4 Muscles of the upper limbs

150

Coraco-brachialis On the upper arm Extends from the scapula to the Flexes and adducts The name coraco-brachialis indicates
(kor-a-ko-bra-key-al-is) between the shoulder middle of the humerus along its the humerus that this muscle is related to the
joint and elbow joint medial surface coracoid process (in the scapula) and
the brachium (the arm)
Biceps Anterior of the upper Attaches to the scapula at one end Flexes the forearm The action of this muscle is similar
(by-seps) arm (humerus) and the radius and flexor muscles at the elbow and to the action of twisting a corkscrew
of the forearm at the other supinates the forearm (supination) and pulling it from a wine
bottle (flexion)
Triceps Posterior of the upper Attaches to the posterior of the Extends (straightens) Also referred to as the ‘boxer’s muscle’ as
(try-seps) arm (humerus) humerus and outer edge of the the forearm it is used when delivering a punch
scapula at one end, and to the ulna
below the elbow at the other
Brachialis Lies beneath biceps Attaches to the distal half of the Flexes the forearm at A strong and fairly large muscle, which
(bray-key-al-is) anterior surface of the humerus at the elbow accounts for much of the contour
one end and the ulna at the other of the biceps muscle
Pronator teres Crosses the anterior Attaches to the distal end of the Pronates and flexes Due to the fact that the fibres of the
(pro-nay-tor te-reez) aspect of the elbow humerus and the upper aspect of forearm pronator teres cross the elbow joint,
the ulna at one end, and the lateral irritation and inflammation of this
surface of the radius at the other muscle may contribute to the condition
‘tennis elbow’
Supinator radii brevis Runs diagonally across Attaches to the lateral aspect of the Supinates the forearm Due to the fact that the fibres of the
(sue-pin-a-tor rade-ee forearm crossing the lower humerus and the radius supinator cross the elbow joint, irritation
brev-is) elbow joint to outer and inflammation of this muscle may
edge of radius also contribute to tennis elbow
04/10/18 4:51 PM
Flexors of the forearm
Brachioradialis
Pronator teres Supinator Supinator
Flexor carpi
radialis
Palmaris longus Flexor Flexor
digitorum digitorum
superficialis profundus
Flexor carpi
ulnaris
Flexor
pollicis
longus
Anterior view (superficial) Anterior view (middle) Anterior view (deep)
p Muscles of the anterior of the forearm (flexors)
Table 5.5 Flexors of the forearm
Name of flexor Position Attachments Action(s) Key facts

Brachioradialis Anterior of forearm; Connects the Flexes Can be felt as the bulge on
(bray-key-o-ray- connects the humerus humerus to the forearm at the radial side of the forearm
dee-al-is) to the radius radius; attaches to the elbow Sometimes nicknamed
the distal end of the the ‘hitchhiker muscle’ for
humerus at one end its characteristic action of
and the radius at the flexing the forearm in a
other end position halfway between
full pronation and full
supination
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Name of flexor Position Attachments Action(s) Key facts

Flexor carpi Extends along the From the medial end Flexes the Any of the flexor muscles
radialis radial side of the of the humerus to wrist in the foream can easily
(fleks-or kar-pie anterior of forearm radial side of forearm become inflamed due
ray-dee-a-lis) and the base of the to excess pressure and
second and third overwork, such as from
metacarpal working on a keyboard for
extended periods of time
Flexor carpi Extends along the From the medial end Flexes the Pain in this muscle mimics
ulnaris ulnar side of the of the humerus to the wrist the pain of a sprained wrist
(fleks-or kar-pie anterior of the forearm pisiform and hamate and is the most common
ul-na-ris) carpal bones and source of pain in the wrist
the base of the fifth and hand on the (ulnar) little
metacarpal finger side of hand
Flexor carpi In the forearm, Extends from the Flexes the Deep muscles whose
digitorum extending down to the medial end of the fingers tendons cross the palmar
(fleks-or kar-pie palm of the hands humerus, the anterior surface of each hand
dij-i-toe-rum ) of the ulna and
radius to the anterior
surfaces of second to
fifth fingers
Flexor digitorum In the forearm, wrist Originates near the Helps flex Weakness in the flexor
superficialis and hand elbow joint and four of the digitorum superficialis
(fleks-or dij-i-toe- inserts onto the fingers results in the muscle
rum soo-per-fish- middle bone of each (except the decreasing grip strength and
ee- ar-lis) of the fingers, except thumb) of wrist flexion strength
for the thumb each hand
Flexor digitorum Long, thin muscle Originates from the Flexes the Considered the most
profundus located in the forearm, front surface of the fingers, also important muscle for
(fleks-or dij-i-toe- hand, and fingers top part of the ulna, playing a separate movement of
rum pro-fun-dus ) extends down the role in the interphalangeal joints
forearm to the tip of flexion of
the phalanges, not the whole
including the thumb hand
Palmaris longus Between the flexor From lower end of Flexes wrist Dysfunction can cause the
(pal-mar-is long- carpi radialis and the humerus to the wrist ring and little finger to curl
us) flexor carpi ulnaris into the palm of the hand
Flexor pollicis Runs along medial From below the Flexes the Pain here is known as
longus anterior surface of the elbow, on medial side thumb weeder’s thumb because it is
(fleks-or) radius in the forearm of the radius to the often seen in gardeners and
down to the thumb base of distal phalanx horticulturists
of thumb
KEY FACT
Finger flexion is required for grabbing items,
such as a spoon or fork when you eat or a door
knob when you open a door.
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Extensors of the forearm
Extensor
carpi radialis
Extensor
Extensor carpi digitorum
carpi ulnaris
Extensor
Extensor pollicis longus
carpi digitorum
MEDIAL LATERAL
Posterior view (superficial) Posterior view (middle) Posterior view (deep)
p Muscles of posterior of forearm (extensors)

Table 5.6 Extensors of the forearm

Extensor carpi Extends along From above the lateral Extends the Can become easily inflamed
radialis the radial side end of the humerus to the wrist due to excess pressure and
(eks-ten-sor kar- of the posterior posterior of the base of the overwork, for example from
pie ray-dee-a-lis) of the forearm second metacarpal working on a keyboard for
extended periods of time
Extensor carpi Extends along From above the lateral end Extends the
ulnaris the ulnar side of the humerus to the ulna fingers
(eks-ten-sor kar- of the posterior and the posterior side of the
pie ul-na-ris) of the forearm base of the fifth metacarpal
Extensor carpi Extends along From the lateral end of the Extends the
digitorum the lateral side humerus to the second and fingers
(eks-ten-sor dij-i- of the posterior fifth phalanges
toe-rum) of the forearm
Extensor pollicis Posterior Extends from the ulna to the Extends the
longus surface of the tip of the thumb thumb
(eks-ten-sor poll- forearm
ik-kus long-us)
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KEY FACT Muscles of the hand

Dupuytren’s contracture is a
progressive disorder of the Palmar aponeurosis
hand, affecting one or more
fingers (typically the ring
(pal-mar app-an-nur-os-is)
and little fingers). It involves ● Position and attachments – a strong, triangular membrane overlying
a thickening and shortening the tendons in the palm.
of the palm muscles (palmar ● Action – firm attachment to the skin of the palm to improve the grip,
aponeurosis), causing the
and it protects the underlying tendons.
fingers to flex (without
extending) and impairing
hand functioning.
Thenar eminence
(thee-na emm-in-nen-s)
This is an eminence of soft tissue located on the radial side of the palm
of the hand. There are three muscles of the thenar eminence:
1 abductor pollicis brevis
2 flexor pollicis brevis
3 opponens pollicis.
● Action – all three muscles move the thumb.
Hypothenar eminence
(hi-po- thee-na emm-in-nen-s)
Palmar This is an eminence of soft tissue located on the ulnar side of the palm of
aponeurosis the hand. There are three muscles of the hypothenar eminence:
1 abductor digiti minimi manus
2 flexor digiti minimi manus
3 opponens digiti minimi.
p Palmar aponeurosis ● Action – all three muscles move the little finger.
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi
Flexor pollicis brevis
Abductor pollicis brevis
Opponens pollicis

p Hypothenar and thenar eminences
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Muscles of the lower limb
Tensor fasciae latae
Sartorius Pectineus
Rectus femoris Gracilis

Vastus
Adductors
intermedius Adductor
Quadriceps (deep to rectus longus
group femoris)
Adductor
Vastus lateralis
magnus
Vastus medialis
Semitendinosus
Hamstring
Semimembranosus group
Biceps femoris
Peroneus longus
Tibialis anterior
Extensor digitorum
longus
Gastrocnemius
Peroneus brevis
Soleus
Extensor digitorum
Extensor hallucis
brevis
Abductor hallucis
p Muscles of the anterior of the lower limb p Muscles of the posterior of the lower limb
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Table 5.7 Muscles of the lower limb

Quadriceps extensor Anterior Attached to the pelvic As a group they A group of strong
(quad-ri-cep-s ex-ten-soo-r) aspect of the girdle (rectus femoris) extend the muscles that are used
The quadriceps is made up of thigh and femur (vastus knee and flex for walking, kicking and
four muscles: rectus femoris, group) at one end to the hip raising the body from
vastus lateralis, vastus the patella and tibia at a sitting or squatting
intermedius, vastus medialis the other end position
Sartorius Crosses the Attached to the ilium Flexes the hip Flexes both the hip and
(sar-tor-ee-us) anterior of of the pelvis, crosses and knee and the knee as a result of
thigh the anterior of the rotates the its positioning
thigh to the medial thigh laterally Over contraction puts
aspect of the tibia (turns it pressure on the knee
outwards) and can lead to knee
problems
The longest muscle in
the human body
Adductors Situated on Attached to the lower As a group, The adductors are
(ad-duk-tors) the medial part of the pelvic adduct and important muscles in
A group of four muscles: aspect of the girdle at one end laterally rotate the maintenance of
adductor brevis, adductor thigh (pubic bones and the thigh posture
longus, adductor magnus the ischium) and the They also flex Groin strain is associated
and pectineus inside of the femur at the hip with these muscles
the other end
Gracilis Long, strap- Attached to the lower Adducts thigh, The second longest
(gra-sil-is) like muscle edge of the pubic flexes knee and muscle in the human
on medial of bone at one end and hip, medially body
thigh the upper part of the (inwardly)
medial aspect of the rotates the
tibia at the other end thigh and tibia
Hamstrings The posterior Attaches to the lower Flex the knee Contract powerfully
The hamstrings consist aspect of the part of the pelvis and extend the when raising the
of three muscles – two thigh (ischium), and the hip body from a stooped
situated on the inside of lower part of the position and when
the thigh (semitendinosus, posterior of the femur climbing stairs
sem-ee-ten-da-noo-sis and to either side of the
semimembranosus, sem- posterior of the tibia
ee-mem-braa-noo-sis) and
one on the outside of the
thigh (biceps femoris)
Tensor fascia latae Runs laterally Attached to the outer Flexes, abducts Attached to a broad
(ten-sor fash-ee-a la-tee) down the side edge of the ilium of and medially sheet of connective
of the thigh the pelvis and runs rotates thigh tissue (fascia lata
via the long fascia lata tendon) which helps
tendon to the lateral to strengthen the knee
aspect of the top of joint when walking and
the tibia running
➜
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Gastrocnemius A large, Attached to the Plantar flexes Provides the push
(gas-trok-nee-me-us) superficial lower aspect of the the foot and during fast walking and
calf muscle posterior of the femur assists in knee running
with two across the back of flexion
bellies (central the knee and runs via
portion of the the Achilles tendon
muscle) on the at the ankle to the
posterior of calcaneum at the back
the lower leg of the heel
Soleus Situated Attached to the Plantar flexes A thicker and flatter
(so-lee-us) deep to the tibia and fibula just the foot muscle than the
gastrocnemius below the back of gastrocnemius and
in the calf the knee at one end accounts for the
and runs via the contours of the
Achilles tendon to gastrocnemius being
the calcaneum at the so visible
other end
Tibialis anterior Anterior Attached to the outer Dorsiflexes and If this muscle becomes
(tib-ee-a-lis an-tee-ri-or) aspect of the side of the tibia at inverts the foot weak, it can lead to
lower leg one end and the rolling in of the lower leg
medial cuneiform due to the collapse of
and the base of the the medial longitudinal
first metatarsal at the arch of the foot
other end
Tibialis posterior Found on Attached to the Assists in Weakness in this
(tib-ee-a-lis pos-tee-ri-or) the posterior back of the tibia and plantar flexion muscle can cause the
aspect of the fibula at one end and inverts the feet to turn out from
lower leg, and to the navicular, foot the ankles rather than
very deeply third cuneiform and the knees, causing
situated in the second, third and the muscle to stretch
calf fourth metatarsals at and the medial
the other end longitudinal arch of
the foot to drop
Peroneus longus Situated on Attaches the fibula to Plantar flexes Going over on to the
(pero-knee-us long-us) the lateral the underneath of the and everts the outside of the ankle,
aspect of the first (longus) and fifth foot as in a trip or a fall, can
lower leg metatarsal (brevis) sprain the peroneal
muscles in the lower
leg; if the injury is not
treated properly it can
affect future stability of
the ankle joint
Peroneus brevis Lies under Extends from the Assists in The shorter and smaller
(pero-knee-us brev-is) the peroneus lateral surface of the plantar flexion of the peroneus
longus muscle fibula to the lateral and eversion of muscles
aspect of the fifth the foot
metatarsal
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Peroneus tertius Located on the Extends from front Assists with Pain in the lower leg,
(pero-knee-us ter-she-us) front of the surface of fibula dorsiflexion of ankle, heel and foot,
lower leg to head of fifth the foot at the and weak ankles can all
metatarsal ankle be a sign of peroneus
tertius muscle
dysfunction
Flexor digitorum longus Located on the Extends from the Flexes the toes, An indicator of flexor
(fleks-or dij-i-toe- inner side of middle third of the plantar flexes digitorum muscle
rum long-us) the leg by the posterior of the tibia to and inverts the dysfunction is a sharp
tibia the plantar surface of foot pain radiating across
the second to fifth toes the ball of the foot and
a deep ache at rest
Flexor hallicus longus Deep muscle Extends from the Flexes the big An indicator of flexor
(fleks-or hal-oo-sis long-us) found in the distal two-thirds of toe, plantar hallucis longus muscle
lower back the posterior fibula to flexes and dysfunction is pain in
region of the the plantar surface of inverts the foot the big toe and into the
leg the big toe ball of the foot under
the big toe
Extensor digitorum longus Situated along Extends from the Extends of An indicator of
(eks-ten-sor dij-i-toe-rum the outside of proximal two-thirds the second extensor digitorum
long-us) the lower leg, of the anterior of the to fifth toes, longus dysfunction is
just behind fibula to the dorsal dorsiflexes and pain and numbness
the tibialis surface of the second everts the foot in the top of the foot,
anterior to fifth toes extending from the
ankle to the bottom
of the lower leg, and
cramping in the foot.
Extensor digitorum brevis Located on the Attached to tendons Controls the An indicator of
(eks-ten-sor dij-i-toe-rum top of the foot that extend to the movements extensor digitorum
brev-is) toes of the all toes brevis dysfunction is
except the a condition known as
smallest toe ‘drop foot’ (a muscular
weakness which makes
it difficult to lift the
fingers and toes)
Extensor hallicus longus A thin muscle, Extends from the Extends the big The flexor and extensor
(eks-ten-sor hal-oo-sis situated middle third of the toe, dorsiflexes muscles of the lower
long-us) between anterior of the fibula and inverts the leg can become weak
the tibialis to the dorsal surface foot due to excess pressure
anterior and of the big toe and overuse in walking
the extensor and running
digitorum
longus
Abductor halluces Runs along the Originates from the Moves the big An indicator of abductor
(ab-duc-tor hal-ik-us) medial border medial part of the toe away from hallucis dysfunction is
of each foot heel bone and that the other toes overpronation of the
inserts into the first foot, and pain along the
phalanx of the big toe medial longitudinal arch
of the foot
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Peroneus
longus
Peroneus
brevis
Peroneus
tertius
p The peroneal muscles
Flexor hallucis longus
Tibialis posterior
Flexor digitorum longus
Tibialis posterior, flexor digitorum longus and flexor hallucis longus

p
Muscles of the pelvic floor

The levator ani and the coccygeus are the muscles that form the pelvic floor. These muscles support and elevate
the organs of the pelvic cavity, such as the uterus and the bladder. They provide a counterbalance to increased
intra-abdominal pressure, which would otherwise expel the contents of the bladder, rectum and the uterus.
During childbirth, these muscles can become weakened and need to be strengthened by pelvic floor exercises
as soon as possible after the birth.
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Muscles of the anterior aspect of the trunk

Pectoralis
Deltoid minor
Pectoralis Internal
major intercostal
Serratus
anterior
External Rectus
oblique abdominis
Internal
oblique
Transversus
abdominis
p Muscles of the anterior of the trunk
Table 5.8 Muscles of the anterior aspect of the trunk
Name of
muscle Position Attachments Action(s) Key facts
Pectoralis Thick, fan-shaped Attaches to the clavicle and Adducts arm, Tightness in this muscle
major muscle covering the sternum at one end and medially can cause restrictions of
(pek-to-ra-lis the anterior surface to the humerus at the other (inwardly) the chest and postural
may-jor) of the upper chest end rotates arm disortions such as
rounded shoulders
Pectoralis A thin muscle that Fibres attach laterally and Draws the Involved in forced
minor lies beneath the upwards from the ribs at shoulder expiration and is therefore
(pek-to-ra-lis pectoralis major one end to the scapula at downwards and an accessory respiratory
my-nor) the other end forwards muscle
Serratus A broad, curved Attaches to the outer Pulls the scapula Has a serrated appearance
anterior muscle located surface of the upper eighth downwards and which comes from
(ser-at-tus on the side of the or ninth rib at one end to forwards attaching onto separate
an-tee-ri-or) chest/rib cage the inner surface of the ribs
below the axilla scapula, along the medial
edge nearest the spine
External Laterally at the Fibres slant downwards Flexes, rotates The external oblique
obliques sides of the waist from the lower ribs to the and side-bends muscles are often referred
(eks-turn-al pelvic girdle and the linea the trunk, to as the pocket muscles
o-bleek) alba (tendon running from compresses the as their fibres run in the
the bottom of the sternum contents of the direction in which you put
to the pubic symphysis) abdomen your hands in your pocket
➜
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Name of
muscle Position Attachments Action(s) Key facts
Internal A broad, thin sheet Fibres run up and forwards Flexes, rotates The fibres of the internal
obliques of muscle located from the pelvic girdle to the and side-bends obliques are deeper and
(in-turn-al beneath the lower ribs the trunk, run at right angles to the
o-bleek) external obliques compresses the external obliques
contents of the
abdomen
Rectus Long, strap-like Attaches to the pubic bones Flexes the The rectus abdominis
abdominis muscle extending at one end and the ribs and vertebral has three fibrous bands
(rek-tus ab- medially along the sternum at the other column, flexes that give the muscle a
dom-i-nis) the length of the the trunk (as segmented appeearance
abdomen in a sit-up), and divides it into the so-
compresses the called ‘six pack’
abdominal cavity
Transversus Large, deep Attaches to the inner Compresses Often called the corset
abdominus muscle with fibres surfaces of the ribs (last six) the abdominal muscle because it wraps
(trans-ver- extending across and iliac crest at one end and contents and around the abdomen like
sus ab-dom- the anterior of the extends down to the pubis supports the a corset
i-nis) abdominal cavity via the linea alba (a long organs of the
tendon that extends from abdominal cavity
the bottom of the sternum
to the pubic symphysis)
Muscles of respiration
Table 5.9 Muscles of respiration

Diaphragm A large, dome- Attaches to the lower On contraction Unusual in that it is under
(di-a-fram) shaped muscle part of the sternum, the diaphragm both unconscious control
that separates lower six ribs and upper flattens to expand (from the brainstem)
the thorax from three lumbar vertebrae the volume of the in the regulation of
the abdomen Fibres converge to meet thoracic cavity to breathing and conscious
on a central tendon in the assist inspiration control (in that we can
abdominal cavity On relaxation and choose to override the
expiration it returns brainstem to hold our
to its dome shape breath, sigh, sing or talk)
External Superficial muscles that Help to elevate the Help to increase the
intercostals occupy and attach to the rib cage during depth of the thoracic
(eks-turn-al in- space between the ribs inhalation cavity
ter-kos-tals) (called external because
they are positioned on
the outside)
Internal Lie deeper than Occupy and attach to the Depress the rib Help to increase the
intercostals the external spaces between the ribs cage, which helps depth of the thoracic
in-turn-al in- intercostals to move air out of cavity
ter-kos-tals) (called internal the lungs when
because they are exhaling
positioned on
the inside)
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External
intercostals
Internal
intercostals
Diaphragm
p Muscles of respiration
Muscles of the posterior aspect of the trunk

Erector spinae
Quadratus lumborum
Latissimus dorsi
Gluteus medius
Gluteus minimus
Piriformis
Gluteus maximus Gluteus medius
p Muscles of the posterior of the trunk
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Table 5.10 Muscles of the posterior aspect of the trunk

Erector spinae Made up of Attaches to the Extends, A very important postural
(ee-rek-tor separate bands sacrum and iliac crest laterally flexes muscle as it helps to extend
spee-nee) of muscle that at one end to the and rotates the spine
lie in the groove ribs, transverse and the vertebral
between the spinous processes of column
vertebral colum the vertebrae and the
and the ribs occipital bone at the
other end of the ribs
Latissimus Large sheet Attaches to the Extends, adducts Often referred to as the
dorsi of muscle posterior of the iliac and rotates ‘swimmer’s muscle’ as it allows
(la-tis-i-mus extending across crest and sacrum, lower the humerus extension of the arm to propel
door-si) the back of the six thoracic and five medially the body in water
thorax lumbar vertebrae at one Implicated in lower back pian
end and the humerus at due to its pelvic attachments
the other end
Quadratus Deep muscle Attaches to the top Lateral flexion Excessive bending to the
lumborum located medially, of the posterior of (side-bending) side can strain and injure this
(quad-dra-tus either side of the the iliac crest at one of the lumbar muscle
lum-bor-um) lumbar vertebrae end to the twelfth vertebrae
rib and transverse
processes of the first
four lumbar vertebrae
at the other end
Gluteus A large muscle Attaches to the back Extends the hip, Sometimes referred to as
maximus covering the of the ilium along the abducts and the ‘speedskater’s muscle’ as
(gloo-tee-us buttock sacroiliac joint at one laterally rotates it is powerful in extending,
max-i-mus) end, and into the top thigh abducting and laterally
of the femur at the rotating the thigh
other Often implicated in postural
defects such as lordosis (excess
curvature in the lumbar spine)
Gluteus medius Situated on the Attaches to the outer Abducts thigh, When this muscle becomes
(gloo-tee-us outer surface surface of the ilium at medially rotates tight it can create postural
meed-ee-us) of the pelvis, one end and the outer thigh distortions, pulling and
partly covered by surface of the femur at depressing the pelvis towards
gluteus maximus the other end the thigh on that side, resulting
in a ‘functional short leg’ and a
compensatory scoliosis
Gluteus Lies beneath the Attachments are the Abducts thigh, When chronically tight,
mimimus gluteus medius same as for gluteus medially rotates can contribute to postural
(gloo-tee-us medius: outer surface of thigh conditions such as ‘functional
min-i-mus) the ilium at one end to short leg’ and compensatory
the outer surface of the scoliosis
femur at the other end
Piriformis Located deep Attaches to the anterior Lateral rotation Largest lateral rotator of the
(pi-ri-for-mis) in the buttock of the sacrum at one and abduction hip
(behind the end and the top of the of the hip If tight, it can restrict mobility
gluteus maximus) femur at the other in the hip
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Deep pelvic muscles

Psoas (so-as)
● Position and attachments – this is a long, thick and deep pelvic muscle. It
attaches to the anterior transverse processes of T12–L5 (twelfth thoracic
to fifth lumbar vertebrae) to the inside of the top of the femur at the other
end.
● Action – flexes the thigh.
Iliacus (i-lee-ak-us)
● Position and attachments – this is a large, fan-shaped muscle deeply
situated in the pelvic girdle. It attaches to the iliac crest at one end and to
the inside of the top of the femur at the other end.
● Action – flexes and laterally rotates the femur.
KEY FACT
The iliacus and psoas muscles are often considered as one unit
and may be referred to as the iliopsoas. Both muscles are primary
flexors of the thigh and, therefore, serve to advance the leg in
walking.
Psoas
Iliacus
p Deep pelvic muscles – psoas and iliacus
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Pectoralis major Coracobrachialis
Deltoid
Biceps
Flexors of forearm Pectoralis minor
Rectus abdominis
External oblique
Tensor fasciae latae

Internal oblique
Adductor
Transversus
abdominis
Sartorius
Quadriceps Rectus femoris

Vastus
intermedius Vastus lateralis
(deep to
rectus femoris)
Vastus medialis
Vastus intermedius
Tibialis anterior
Peroneus longus
Extensor digitorum
longus
p Anterior muscles of the body
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Supraspinatus
Trapezius
Rhomboid
minor
Rhomboids
Rhomboid
major
Deltoid
Infraspinatus
Erector spinae muscle

Latissimus dorsi
Triceps
Extensors of
forearm
Gluteus maximus Gluteus minimus
Gluteus medius
Semitendinosus
Hamstrings Biceps femoris
Semimembranosus
Flexor hallucis longus

gastrocnemius
Tibialis posterior
Soleus Flexor digitorum longus
p Posterior muscles of the body
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Common pathologies of the Activity

muscular system Discuss the main muscles used
in the following exercises and
Atony sports activities:
● sit-ups
This is a state in which the muscles are floppy and lack their normal
● side-bends
degree of elasticity.
● press-ups
Atrophy ● squats
This is the wasting of muscle tissue due to undernourishment, lack of use ● boxing
and diseases such as poliomyelitis. ● football.
Carpal tunnel syndrome

This syndrome is characterised by pain and numbness in the thumb
or hand, resulting from pressure on the median nerve of the wrist.
Pain and a pins-and-needles sensation may radiate to the elbow. It is
known to cause severe pain at night and can cause muscle wasting of
the hand. There is a higher risk of this condition in occupations
requiring repetitive strains of the wrist. Those at risk include massage
therapists and intensive computer users.
Fibromyalgia
This is a chronic condition in which the predominant symptoms
include widespread musculoskeletal pain, lethargy and fatigue. Other
characteristic features include a non-refreshing, interrupted sleep pattern
which leaves the patient feeling more exhausted than later in the day.
Other recognised symptoms include early morning stiffness, pins-and-
needles sensations, unexplained headaches, poor concentration, memory
loss, low mood, urinary frequency, abdominal pain and irritable bowel
syndrome. Anxiety and depression are also common.
Fibrositis
Fibrositis is an inflammatory condition of the fibrous connective tissues,
especially in the muscle fascia (also known as muscular rheumatism).
Muscle cramp
This is an acute, painful contraction of a single muscle or group of
muscles. Cramp is often associated with a mineral deficiency, an irritated
nerve or muscle fatigue.
Muscle fatigue
This is the loss of the ability of a muscle to contract efficiently due to
insufficient oxygen, exhaustion of energy supply and the accumulation of
lactic acid.
Muscle spasm
This is an increase in muscle tension due to excessive motor nerve
activity, resulting in a knot in the muscle.
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Muscular atrophy
This is the wasting away of muscles due to poor nutrition, lack of use or a
dysfunction of the motor nerve impulses.
Muscular dystrophy
This is a progressively crippling disease in which the muscles gradually
weaken and atrophy. The cause is unknown.
Myositis
This condition is the inflammation of a skeletal muscle.
Rupture
A rupture is the tearing of a muscle fascia or tendon.
Shin splints
This is a soreness in the front of the lower leg due to straining of the
flexor muscles used in walking.
Spasticity
This is characterised by an increase in muscle tone and stiffness. In severe
cases, movements may become unco-ordinated and involve a nervous
dysfunction.
Sprain
This is a complete or incomplete tear in the ligaments around a joint. It usually
follows a sudden, sharp twist to the joint, which stretches the ligaments and
ruptures some or all of its fibres. Sprains commonly occur in the ankle, wrist and the
back where there is localised pain, swelling and loss of mobility.
Strain
A strain is an injury that is caused by excessive stretching or working of a
muscle or tendon, resulting in a partial or complete tear. Symptoms include
pain, swelling, tenderness and stiffness in the affected area. Muscle strains are
common in the lower back and the neck.
Stress
Stress is excessive muscular tension resulting in tight, painful muscles
and restricted joint movements.
Tendinitis
This is the inflammation of a tendon, accompanied by pain and swelling.
Tennis elbow
This condition is the inflammation of the tendons (tendinistis) that
attach the extensor muscles of the forearm at the elbow joint.
Torticollis
This is a condition in which the neck muscles (sternomastoids) contract
involuntarily. It is commonly called ‘wryneck’.
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Interrelationships with It also transports waste products, such as carbon

dioxide and lactic acid, away from the muscles.
other systems
Respiratory system
The muscular system The respiratory system provides the working
The muscular system is linked to the following body muscles with vital oxygen, which is transported in
systems. the blood to be combined with glucose to release
energy.
Cells and tissues/histology
Nervous system
There are three types of muscle tissue in the body
– skeletal or voluntary muscle, smooth muscle and Muscles rely on nervous stimulation in order to
cardiac muscle. Fascia, tendons and ligaments are all function. Skeletal muscles are moved as a result of
made from connective tissue and serve a function in nervous stimulus, which they receive from the brain
muscle attachments. via a motor nerve.
Skeletal system Digestive system

Bones and joints provide the leverage in a The energy needed for muscle contraction is
movement and the muscles provide the pull on the obtained principally from carbohydrate digestion.
bone to effect the movement. Carbohydrates are broken down into glucose. Any
glucose that is not required immediately by the
Circulatory system body is converted into glycogen and stored in the
The circulatory system is responsible for delivering liver and muscle.
oxygen, glucose and water to the working muscles.
Key words Fasciculi: a small bundle of muscle fibres wrapped

by a layer of connective tissue
Actin: one of proteins (along with myosin) that is Fixators: muscles that stabilise a bone to give a
involved in contraction of muscle fibres steady base from which the agonist works
Agonist/prime mover: a muscle whose contraction Glycogen: a substance found in the liver and
moves a part of the body directly muscles that stores glucose, and provides the
Antagonists: when two muscles or sets of muscles energy for muscle contraction
pull in opposite directions to each other Insertion: the most movable part of the muscle
Cardiac muscle tissue: specialised type of during contraction
involuntary muscle tissue found only in the walls Isometric contraction: a type of muscle contraction
of the heart in which the muscle works without actual
Concentric contraction: type of contraction which movements, and there is no change in the length of
causes the muscle to shorten as it contracts the contracting muscle
Eccentric contraction: the opposite of concentric Isotonic contraction: a type of muscle contraction
contraction; occurs when the muscle lengthens as it in which the muscle changes length as it contracts
contracts and causes movement of a body part
Endomysium: a fine connective tissue sheath Lactic acid: a type of acid produced in the muscle
surrounding a muscle fibre tissues during strenuous exercise
Epimysium: a sheath of fibrous elastic tissue Ligament: a short band of tough, flexible fibrous
surrounding a muscle connective tissue which connects two bones or
Fascia: a sheet of connective tissue, primarily collagen, cartilages or holds together a joint
beneath the skin that attaches, stabilises, encloses, Linea alba: a long tendon that extends from the
and separates muscles and other internal organs bottom of the sternum to the pubic symphysis
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Motor nerve: a nerve carrying impulses from the Perimysium: the sheath of connective tissue
brain or spinal cord to a muscle or gland surrounding a bundle of muscle fibres
Motor point: a point at which a motor nerve enters Sarcolemma: thin, transparent, extensible
a muscle membrane covering every striated muscle fibre
Muscle fatigue: the loss of ability of a muscle to Sarcomere: one of the segments into which a fibril
contract due to insufficient oxygen, exhaustion of of striated muscle is divided
energy and the accumulation of lactic acid Skeletal/voluntary muscle tissue: a form of
Muscle tone: state of partial contraction of a muscle striated muscle tissue which is under ‘voluntary’
Myofibrils: the elongated contractile threads found control. Most skeletal muscles are attached to bones
in striated muscle cells by tendons.
Myosin: one of the proteins (along with actin) Smooth/involuntary muscle: a specialised type of
involved in contraction of muscle fibres involuntary muscle tissue found only in the walls of
the heart
Neurotransmitter: a chemical released from a nerve
cell which transmits an impulse from a nerve cell to Synergists: term referring to muscles on the same
a muscle side of a joint that work together to perform the
same movement
Origin: the fixed attachment site of a muscle that
does not move during contraction Tendon: a flexible but inelastic cord of strong
fibrous collagen tissue attaching a muscle to a bone
Revision summary
The muscular system
● The muscular system is comprised mainly of skeletal or voluntary muscle tissue that is primarily attached
to bones.
● The other types of muscle tissue are cardiac muscle tissue, which is found in the wall of the heart, and
smooth muscle tissue, which is located in the wall of the stomach and small intestines.
● Through contraction, muscle performs three important functions – movement, maintaining posture and
heat production.
● Voluntary or skeletal muscle tissue consists of muscle fibres held together by fibrous connective tissue
and penetrated by numerous tiny blood vessels and nerves.
● Voluntary muscle tissue is made up of bands of elastic or contractile tissue bound together in bundles and
enclosed by a connective tissue sheath.
● Each muscle fibre is enclosed in an individual wrapping of connective tissue called the endomysium.
● The muscle fibres are wrapped together in bundles, known as fasciculi, and are covered by the perimysium
(fibrous sheath). These are gathered together to form the muscle belly (main part of the muscle) with its own
sheath, the fascia epimysium.
● Each skeletal muscle fibre is made up of thin fibres called myofibrils which consist of two different types of
protein strands called actin and myosin. This gives skeletal muscle its striated, or striped, appearance.
● Skeletal muscle is moved as a result of nervous stimulus received from the brain via a motor nerve.
● Each nerve fibre ends in a motor point, the end portion of the nerve and is the part through which the
stimulus is given to contract.
● The muscle cells in smooth or involuntary muscle are spindle shaped and tapered at both ends with each
muscle cell containing one centrally located oval-shaped nucleus.
● Smooth muscle contracts or relaxes in response to nerve impulses, stretching or hormones.
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● Cardiac muscle is found only in the heart and, like skeletal muscle, it is striated. However, it is branched in
structure and has intercalated discs between each muscle cell.
● The contraction of cardiac muscle is regulated by nerves and hormones.
● During muscular contraction, a sliding movement occurs within the contractile fibres (myofibrils).
● The actin filaments move in towards the myosin and cause the muscle fibres to shorten and thicken.
● During relaxation, the muscle fibres elongate and return to their original shape.
● The energy needed for muscle contraction comes from glucose (stored as glycogen in the liver and the
muscles) and oxygen.
● If insufficient oxygen is available to a working muscle a waste product called lactic acid forms which can
cause a muscle to ache.
● The term muscle fatigue is defined as the loss of ability of a muscle to contract efficiently due to insufficient
oxygen, exhaustion of glucose and the accumulation of lactic acid.
● During exercise, the circulatory and respiratory systems adjust to cope with the increased oxygen
demands of the body. More blood is distributed to the working muscles and the rate and depth of
breathing is increased.
● When muscle tissue is warm, muscle contraction occurs faster due to the increase in circulation and
acceleration of chemical reactions.
● Conversely, when muscle tissue is cool, the chemical reactions and circulation slow down.
● The term muscle tone is the state of partial contraction of a muscle to help maintain body posture.
● Good muscle tone can be recognised by the muscles appearing firm and rounded.
● Poor muscle tone may be recognised by the muscles appearing loose and flattened.
● Tendons are tough bands of white fibrous tissue that link muscle to bone. Unlike muscle, they are inelastic
and therefore do not stretch.
● Ligaments are strong, fibrous, elastic tissues that link bones together and, therefore, stabilise joints.
● Fascia consists of fibrous connective tissue that envelops a muscle and provides a pathway for nerves,
blood vessels and lymphatic vessels. It, therefore, plays a key role in maintaining the health of a muscle.
● Muscle attachments are known as origin and insertion.
● The origin is the end of the muscle closest to the centre of the body and the insertion is the furthest
attachment.
● The insertion is generally the most movable point and is the point at which the muscle work is done.
● In movement co-ordination muscles work in pairs or groups.

● Muscles are classified by function as agonists (prime movers), antagonists, synergists and fixators
(stabilisers).
● Antagonists are two muscles or sets of muscles pulling in opposite directions to each other, with one
relaxing to allow the other to contract.

● The agonist/prime mover is known as the main activating muscle.
● Synergist refers to muscles on the same side of a joint that work together to perform the same movements.
● Muscular contractions can be isometric or isotonic.

● Isometric contraction is when the muscle works without actual movements (postural muscles).
● Isotonic contraction is when the muscles force is considered to be constant but the muscle length
changes.
● There are two types of isotonic contraction – concentric contractions (towards the centre) and
eccentric contractions (away from the centre).
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Test your knowledge c accumulation of lactic acid

d all of the above
Multiple choice questions 8 Which term describes the state of continuous
partial contraction of muscles?
1 Which of the following is not a function of the
a atrophy
muscular system?
b muscle tone
a movement
c hypertrophy
b exchanging of gases
d none of the above
c production of heat
d maintaining posture 9 Which of the following statements is false?
a During exercise, there is an increase in return
2 Which of the following applies a stimulus to
of venous blood to the heart.
cause a voluntary muscle to contract?
b During exercise, a muscle may receive as
a sensory nerve
much as 15 times its normal flow of blood.
b motor nerve
c The presence of lactic acid in the blood
c mixed nerve
stimulates the respiratory centre in the brain,
d none of the above
decreasing the rate and depth of breath.
3 A tendon attaches: d The rate and depth of breathing remains
a muscle to bone above normal for a while after strenuous
b muscle to ligament exercise has ceased.
c bone to bone
10 Which of the following statements is true?
d none of the above.
a Muscles with less than the normal degree
4 Where would you not find involuntary muscle of tone are said to be spastic.
tissue? b Muscles that appear firm and rounded
a stomach indicate good muscle tone.
b bladder c An increase in the size and diameter of muscles
c brain fibres leads to a condition called atrophy.
d heart d Poor muscle tone is a cause of muscle cramps.
5 Which of these provides the fuel for muscle
contraction? Exam-style questions
a ATP 11 State three functions of the muscular system.
b glucose 3 marks
c pyruvic acid 12 Briefly describe the following types of muscle
d actin and myosin
tissue and where they may be found in the body:
6 Which of the following statements is true? a cardiac muscle 2 marks
a On contraction voluntary muscle fibres b voluntary/striated muscle 2 marks
elongate. c involuntary muscle. 2 marks
b The attachment of myosin to actin requires
13 State the four characteristics of muscle tissue
the mineral sodium.
that contribute to its function. 4 marks
c The merging of actin and myosin filaments
causes muscle fibres to shorten and thicken 14 Define the term muscle tone. 1 mark
on contraction. 15 State one action of each of the following muscles:
d The force of muscle contraction depends on a Brachioradialis 1 mark
where the muscle fibres are located. b Extensor carpi radialis 1 mark
7 What causes muscle fatigue? c Quadriceps 1 mark
a insufficient oxygen d Sartorius 1 mark
b exhaustion of energy supply e Tibialis anterior 1 mark
f Flexor digitorum longus. 1 mark
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6 The cardiovascular
system
Introduction
The cardiovascular system is the body’s transport
system and comprises blood, blood vessels and
the heart. Blood provides the fluid environment
for our body’s cells and is transported in
specialised tubes called blood vessels. The
heart acts like a pump which keeps the blood
circulating constantly around the body.
OBJECTIVES
● the composition and functions of blood
● the structural and functional significance of

the different types of blood cells
● the structural and functional differences
between the different blood vessels
● the major blood vessels of the heart
● the pulmonary and systemic blood

circulation
● the main arteries of the head, neck and body
● the main veins of the head, neck and body
● blood pressure and the pulse rate
● common pathologies of the circulatory

system
cardiovascular and other body systems.
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● Group A – has only the A antigen on red cells (and

In practice B antibody in the plasma)
It is essential for therapists to have a good working ● Group B – has only the B antigen on red cells (and
knowledge of the cardiovascular system in order A antibody in the plasma)
to be able to understand the physiological effects
● Group AB – has both A and B antigens on red cells
of treatments. Treatments such as massage help to
(but neither A nor B antibody in the plasma)
improve circulation by assisting the venous flow
back to the heart. By enhancing blood flow, delivery ● Group O – has neither A nor B antigens on red
of oxygen and nutrients to the tissues is improved cells (but both A and B antibody are in the plasma)
Source: www.redcrossblood.org
and the removal of waste products is hastened.
There are very specific ways in which blood types
must be matched for a safe blood transfusion
Blood (Table 6.1).
Blood is the fluid tissue or medium in which all Table 6.1 Blood type matches
materials are transported to and from individual cells
in the body. Blood is, therefore, the chief transport Can receive blood Can donate
Blood group from blood to
system of the body.
A A and O A and AB
The composition of blood B B and O B and AB
The percentage composition AB Any of these groups AB

of blood O O only Any of these
groups
Blood is 55% plasma, a clear, pale yellow and slightly
alkaline fluid. The other 45% of blood is made up In addition to the A and B antigens, there is a third
of the blood cells: erythrocytes (red blood cells), antigen called the rhesus (Rh) factor, which can
leucocytes (white blood cells) and thrombocytes be either present (+) or absent (–). In general,
(platelets). Rh-negative blood is given to Rh-negative patients;
Plasma consists of: Rh-positive blood or Rh-negative blood may be
● 91% water given to Rh-positive patients.
● 9% dissolved blood proteins, waste, digested food
● The universal red cell donor has type O rhesus
materials, mineral salts and hormones. negative blood type.
Blood types ● The universal plasma donor has type AB
Although all blood has the same basic elements, not blood type.
all blood is alike. Blood types are determined by the
presence or absence of certain antigens, which are
The functions of the blood
substances that can trigger an immune response if Blood has four main functions:
they are foreign to the body. 1 transport
Safe blood transfusions depend on careful blood 2 defence
typing and cross-matching, since some antigens 3 regulation
can trigger the immune system to attack transfused
4 clotting.
blood.
The ABO blood group system 1 Transport
There are four major blood groups which are Blood is the primary transport medium for a variety
determined by the presence or absence of two of substances that travel throughout the body.
antigens – A and B – on the surface of red blood cells: ● Oxygen is carried from the lungs to the cells
of the body by red blood cells.
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6 The cardiovascular system
Carbon dioxide is carried from the body’s cells to

●
the lungs.
The process of blood
● Nutrients such as glucose, amino acids, vitamins clotting
and minerals are carried from the small intestine Blood clotting or coagulation is a process that can
to the cells of the body. stop bleeding. When a blood vessel is injured, there is
● Cellular wastes such as water, carbon dioxide, a rapid, localised response to help arrest the bleeding
lactic acid and urea are carried in the blood to and prevent excessive blood loss. This is known as
be excreted. haemostasis.
● Hormones, which are internal secretions that
help to control important body processes, are Haemostasis
transported by the blood to target organs. (heem-o-stay-sis)
Haemostasis is the process in which bleeding is
KEY FACT stopped. It involves three steps.
Red blood cells are called erythrocytes and they
contain the red protein pigment haemoglobin, 1 Vasoconstriction: narrowing of damaged blood
which combines with oxygen to form vessels to reduce blood loss. This is caused by
oxyhaemoglobin. The pigment haemoglobin contraction of the smooth muscle in the wall
assists the function of the erythrocyte in of vessels.
transporting oxygen from the lungs to the
2 Activation of platelets: activated platelets stick
body’s cells and in carrying carbon dioxide away.
to each other and to collagen fibres in the broken
walls of blood vessels, forming a platelet plug that
2 Defence temporarily blocks blood flow. The platelets also
White blood cells are collectively called leucocytes release chemicals that attract other platelets and
and they play a major role in combating disease and stimulate further vasoconstriction.
fighting infection. 3 Formation of a blood clot: the clot contains
fibres that trap the platelets and is stronger and
KEY FACT longer-lasting than the initial platelet plug. Clot
Some white blood cells are known as formation is summarised below.
phagocytes as they have the ability to ingest
micro-organisms which invade the body and HEMOSTASIS
cause disease. Other specialised white blood
cells, called lymphocytes, produce antibodies to Vessel injury
Red blood
protect the body against infection. cells
3 Regulation
Blood helps to regulate heat in the body by absorbing Vascular spasm Platelets
large quantities of thermal energy produced by the

liver and the muscles. This is transported around the
body to help maintain a constant internal temperature. Fibrin
Blood also helps to regulate the body’s pH balance. Formation of the

platelet plug
4 Clotting
Clotting is an effective mechanism for controlling
blood loss from blood vessels when they become The coagulation
Fibrin filaments,
red blood cells
and white blood
damaged, as in the case of a cut. Specialised blood cells the blood
clot is formed
cells called thrombocytes, or platelets, form a clot
around the damaged area to prevent blood loss and
to stop the entry of bacteria. p The stages of haemostasis
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Summary of the blood-clotting process ● Clotting factor XI plasma thromboplastin

component
The blood-clotting process is complex and involves
a long sequence of chemical reactions. However, the ● Clotting factor XII Hageman factor
process can be summarised in three steps: ● Clotting factor XIII fibrin stabilising factor
1 The damaged tissue releases thromboplastin (a
plasma protein that helps with blood coagulation)
Blood cells
and a prothrombin activator complex, which There are three types of blood cells:
converts a blood protein called prothrombin into 1 Erythrocytes – red blood cells
another protein called thrombin.
2 leucocytes – white blood cells
2 Thrombin converts a soluble blood protein
3 thrombocytes – platelets.
called fibrinogen into an insoluble protein
called fibrin. Table 6.2 Overview of the three types of blood cells
3 Fibrin exists as solid fibres which form a tight Type of
mesh over the wound. The mesh traps platelets blood cell Description Function
and other blood cells and forms the blood clot. Erythrocyte Disc-shaped Transport
(err-rith-ro- structures the gases of
KEY FACT sytes) Non-nucleated respiration
Prothrombin and fibrinogen are always present Red in colour due to
in our blood, but they aren’t activated until protein haemoglobin
a prothrombin activator is made in response Leucocytes Largest of all the Protect the
to injury. (loo-co-sytes) blood cells body against
White due to lack of infection
haemoglobin and disease
Clotting factors
Clotting factors are proteins in the blood that Thrombocytes Granular disc-shaped, Blood
or small fragments clotting
control bleeding. Many different clotting factors
platelets of cells
work together in a series of chemical reactions
to stop bleeding.
There are 12 clotting factors in human blood and 1 Erythrocytes
tissues, which are designated by roman numerals.
There are 13 numerals but only 12 factors (since
factor VI was subsequently found to be part of
another factor).
Most clotting factors are manufactured in the liver.
● Clotting factor I fibrinogen
● Clotting factor II prothrombin
● Clotting factor II thromboplastin
● Clotting factor IV calcium p An erythrocyte
● Clotting factor V proaccelerin Erythrocytes are disc-shaped structures that make

● Clotting factor VI/Va accelerin up more than 90% of the formed elements in blood.
They are made in red bone marrow and contain the
● Clotting factor VII proconvertin
iron–protein compound haemoglobin.
● Clotting factor VIII antihaemophilic factor A
Old and worn-out erythrocytes are destroyed in
● Clotting factor IX christmas factor/ the liver and the spleen. The haemoglobin is broken
antihaemophilic factor B down and the iron within it is retained for further
● Clotting factor X Stuart–Prower factor haemoglobin synthesis. Erythrocytes have a life span
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of only about four months and, therefore, have to be ● The B-cells produce antibodies that attack
continually replaced. invading bacteria, viruses and toxins.
● The T-cells destroy the body’s own cells
The function of erythrocytes is to transport the gases
of respiration (they transport oxygen to the cells and that have been taken over by viruses or
carry carbon dioxide away from the cells). become cancerous.
● Monocytes – can develop into two types of cell:
2 Leucocytes ● Dendritic cells are antigen-presenting
Leucocytes are the largest of all the blood cells and cells which are able to mark out cells with
appear white due to their lack of haemoglobin. They foreign antigens that need to be destroyed
have a nucleus and are generally more numerous than by lymphocytes.
erythrocytes. ● Macrophages are large scavenging
phagocytes that clean up areas of infection.
Leucocytes usually only survive for a few hours, but
Monocytes increase in number during
in a healthy body some can live for months or even
chronic infections. They are larger and live
years. The main function of leucocytes is to protect
longer than neutrophils.
the body against infection and disease via a process
known as phagocytosis, which means to engulf and WHITE BLOOD CELLS
digest microbes, dead cells and tissue.
Lymphocyte Basophil Neutrophil
There are two main categories of leucocytes:
granulocytes and agranulocytes.
● Granulocytes – these account for about 75% of
white blood cells and can be further divided into:
● Neutrophils – one of the first immune cell
types to travel to the site of an infection. Eosinophil Monocyte
Neutrophils help fight infection by ingesting

micro-organisms and releasing enzymes to kill
them. A neutrophil is a type of white blood
cell, a type of granulocyte, and a type of
phagocyte.
● Eosonophils – a type of immune cell that has
p White blood cells
granules (small particles) with enzymes that
are released during infections, allergic reactions 3 Thrombocytes
and asthma. An eosinophil is a type of white
blood cell and a type of granulocyte.
● Basophils – a type of immune cell that has
granules (small particles) with enzymes that
are released during allergic reactions and p Thrombocytes
asthma. A basophil is a type of white blood
cell and a type of granulocyte. Thrombocytes are also known as platelets. These
are small fragments of cells and are the smallest
● Agranulocytes – these can be divided into
cellular elements of the blood. They are formed
lymphocytes, which account for about 20% of all
in bone marrow and are disc-shaped with no nucleus.
white blood cells, and monocytes, which account
for about 5% of white blood cells. Thrombocytes normally have a short life span of just
● Lymphocytes – a type of white blood cell that five to nine days.
is crucial to our immune system. Lymphocytes They are very significant in the blood-clotting process
recognise antigens, produce antibodies, and as they initiate the chemical reaction that leads to
destroy cells that could cause damage.There the formation of a blood clot. Platelets stop the loss
are two main types of lymphocytes: of blood from a damaged blood vessel (see page 175).
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Blood vessels KEY FACTS

Arteries:
Blood flows round the body due to the pumping
action of the heart and is carried in vessels ● have thick muscular and elastic walls to
withstand pressure
called arteries, veins and capillaries.
● are generally deep-seated, except where they
● arteries – carry blood away from the heart
cross over a pulse spot
● veins – carry blood towards the heart
● have no valves, except at the base of the
● capillaries – unite arterioles and venules, forming pulmonary artery where they leave the heart
a network in the tissues. ● have a narrow lumen to carry blood under
high pressure
Blood vessel walls ● carry blood away from the heart, and carry
Blood vessels have to withstand the pressure of the oxygenated blood (except the pulmonary
blood as it is pumped continuously by the heart. To artery to the lungs)
resist this pressure, the walls of the blood vessels are ● carry blood under high pressure
constructed of three layers, known as tunics. ● give rise to small blood vessels called
1 Tunica adventitia (or tunica externa) is the outer arterioles, which deliver blood to the capillaries.
layer made up of fibrous tissue.
2 Tunica media is the middle layer made up of ARTERY AND VEIN
smooth muscle and elastic tissue. Vein Vein
3 Tunica intima (or tunica interna) is the innermost
Smooth Inner
layer made up of squamous epithelium (endothelial muscle layer Valve Valve
Outer layer
cells).
KEY FACT
The middle layer (tunica media) of arteries Smooth
muscle
Elastic Inner
layer layer
contains more smooth muscle than is found in Outer layer
veins, thus allowing arteries to constrict and
dilate to adjust the volume of blood supplied
to the tissues. Artery
Artery
p The structure of an artery and a vein

Lumens
Blood vessels such as arteries, veins and capillaries KEY FACTS
have a central void called a lumen, which is the space Veins:
through which the blood flows.
● have thinner muscular walls than arteries
Veins are generally larger in diameter, carry a greater
● are generally superficial, not deep-seated
volume of blood and have thinner walls in proportion
● have valves at intervals to prevent the
to the size of the lumen. The tunica media is smaller
backflow of blood
in relation to the lumen than in arteries.
● have a large lumen, allowing more blood to
Veins, therefore, have a wide lumen to accommodate flow with less resistance
the slow-flowing blood under low pressure.
● carry blood towards the heart
Arteries have thicker walls in proportion to their
● carry deoxygenated blood (except the
narrow lumen and carry blood under higher pressure
pulmonary veins) from the lungs
than veins.
● carry blood under low pressure
● form finer blood vessels called venules which
continue from capillaries.
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KEY FACTS KEY FACT

Capillaries: Both arteries and veins have
● are superficial microscopic blood vessels that form part of the three layers (external, middle
microcirculation and internal layers) but because
an artery must contain the
● have thin walls, only a single layer of cells thick, to enable the pressure of blood pumped
diffusion of dissolved substances to and from the tissues from the heart, its walls are
● have no valves thicker and more elastic.
● have a narrow lumen; this means that many capillaries can fit in
a small space, increasing the surface area for diffusion
● carry blood under low pressure, but higher than in veins
● carry both oxygenated and deoxygenated blood as they
exchange oxygen and carbon dioxide with tissues
● are responsible for supplying the cells and tissues with nutrients
● unite arterioles and venules, forming a network in the tissues.
Artery
to
Arterioles
to
Exchange of KEY FACT

substances
Capillaries Oxygenated blood flowing
between tissue to through the arteries appears
cells and blood
takes place bright red in colour due to the
colour of the oxygen-binding
pigment, haemoglobin.
Venules As haemoglobin moves
to
through capillaries in red
blood cells, it offloads some
oxygen and picks up carbon
dioxide, changing colour in
Vein the process. This explains
why blood flowing in veins
p Blood flow from an artery to a vein appears darker.
Vasodilation and vasoconstriction

Capillaries have the ability to narrow (vasoconstriction) or widen
(vasodilation), which allows for changes in body temperature.
● Vasoconstriction is the narrowing of the vessels, resulting in a
decreased vascular diameter and conservation of heat in the blood, so
the body keeps warm.
● Vasodilation is the widening of the vessels, resulting in an increased
vascular diameter and loss of heat from the blood through radiation,
cooling the body.
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The heart
The heart is a hollow organ made of cardiac muscle tissue which lies in
the thorax above the diaphragm and between the lungs.
Branches of ascending aorta
Arch of aorta
Right pulmonary artery
to right lung Branch of pulmonary artery
Left pulmonary artery

to left lung
Superior vena cava
Left pulmonary veins

from left lung
Right pulmonary veins Left atrium

from right lung
Bicuspid valve
Right atrium
Tricuspid valve Left ventricle
Right ventricle
Inferior vena cava
Descending aorta
p The structure of the heart
Composition of the heart

The heart is composed of three layers of tissue:
1 Pericardium (the outer layer) – this consists of an outer fibrous layer
and an inner, double-layered bag of serous membrane enclosing a
cavity that is filled with pericardial fluid. This fluid reduces friction as
the heart moves as it beats inside the bag.
2 Myocardium (the middle layer) – this is a strong layer of cardiac
muscle that makes up the bulk of the heart.
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3 Endocardium (the inner layer) – this thin layer lines the heart’s
cavities and is continuous with the lining of the blood vessels.
The heart is divided into a right and left side by a partition called a
septum, and each side is further divided into a thin-walled atrium above
and a thick-walled ventricle below. The top chambers of the heart (the
atria, plural) take in blood from the body from the large veins and pump
it to the bottom chambers. The lower chambers, the ventricles, pump
blood to the body’s organs and tissues.
There are four sets of valves that regulate the flow of blood though the
heart, as shown in Table 6.3.
Table 6.3 The valves of the heart
Valve Location
1 Tricuspid valve Between the right atrium
and the right ventricle
2 Bicuspid or mitral valve Between the left atrium
and the left ventricle
3 Aortic valve Between the left
ventricle and the aorta
4 Pulmonary valve Between the pulmonary
artery and the right
ventricle
The bicuspid and tricuspid valves (also known as the atrioventricular

valves) help to maintain the direction of blood flow through the heart
by allowing blood to flow into the ventricles while preventing it from
returning to the atria.
The aortic and pulmonary valves are known as the semilunar valves.
They control the blood flow out of the ventricles into the aorta and
the pulmonary arteries, and prevent any backflow of blood into the
ventricles. These valves open in response to pressure generated when the
blood leaves the ventricles.
The heart muscle is supplied by the two coronary arteries (right and left)
which originate from the base of the aorta.
KEY FACT
If either of the coronary arteries is unable to
supply sufficient blood to the heart muscle, a
heart attack occurs. The most common site of a
heart attack is the anterior or inferior part of the
left ventricle.
Blood flow through the heart

Blood moves into and out of the heart in a co-ordinated and precisely
timed rhythm.
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Aorta
Superior
vena cava
Pulmonary
Pulmonary artery
artery
Pulmonary Left
veins atrium
Right
Left
atrium
ventricle
Right
ventricle
Inferior
vena cava Septum
Descending
aorta
Deoxygenated Oxygenated
blood blood
Lungs
Right Left
atrium atrium Pulmonary
veins
Aorta
Right Left
ventricle ventricle
Head and arms
Systemic circulation
Liver Branches of
the aorta
Stomach and intestines
Kidneys, reproductive
organs, lower limbs
p Blood flow through the heart
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Blood flow through the heart can be considered in four stages:

● Stage 1 – deoxygenated blood from the body enters the superior and
inferior vena cavae and flows into the right atrium. When the right atrium
is full, it empties through the tricuspid valve into the right ventricle.
● Stage 2 – when the right ventricle is full, it contracts and pushes blood
through the pulmonary valve into the pulmonary artery. The pulmonary
artery divides into the right and left branch and takes blood to both
lungs, where the blood becomes oxygenated. The four pulmonary veins
leave the lungs carrying oxygen-rich blood back to the left atrium.
● Stage 3 – this process takes place at the same time as the process
described in stage 1. Oxygen-rich blood fills the left atrium. When
full, the blood passes through to the left ventricle via the bicuspid or
mitral valve.
● Stage 4 – this process takes place at the same time as the process
described in stage 2. When the left ventricle is full it contracts, forcing
blood through the aortic valve into the aorta and to all parts of the
body (except the lungs). The walls of the left ventricle are thicker than
those of the right in order to provide the extra strength to push blood
out of the heart and around the whole body.
Blood is transported in a double circuit which consists of two separate
systems (pulmanory and general/circulatory) which are joined only
at the heart.
Study tip
To study the blood flow through the heart, follow the arrows on the
diagram on the previous page.
Blue indicates the flow of deoxygenated blood and red shows the flow
of oxygenated blood.
Remember that although arteries carry oxygenated blood and veins
carry deoxygenated blood, there is an exception to the rule: the
pulmonary arteries carry deoxygenated blood and the pulmonary veins
carry oxygenated blood.
The function of the heart

The function of the heart is to maintain a constant circulation of blood
throughout the body. The heart acts as a pump and its action consists of
a series of events known as the cardiac cycle.
The cardiac cycle

The cardiac cycle is the sequence of events between one heartbeat and
the next, and is normally less than a second in duration.
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Superior Pulmonary
1 vena cava vein 2 Atria contract and
ventricles fill with
blood
Atria fill
with blood
Mitral
valve
Tricuspid valve
Inferior
vena cava
3 4
Pulmonary Pulmonary
valve artery Aorta
Aortic valve
Ventricles contract Ventricles relax

and blood is pumped to and cycle starts
lungs and around body again
p The cardiac cycle
● During a cardiac cycle, the atria contract simultaneously and force

blood into the relaxed ventricles.
● The ventricles then contract very strongly and pump blood out
through the aorta and the pulmonary artery.
● During ventricular contraction, the atria relax and fill up again with
blood.
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The heart rate is the number of cardiac cycles per minute. In an average
healthy person this is likely to be between 60 and 70 cycles, or beats per
minute.
KEY FACT
On average the heart beats 100 000 times a day. In an average
lifetime, that is around 2.5 billion heartbeats!
The heart has its own built-in rhythm. The co-ordinated rhythm of the
heart is initiated by the electrical system in the sinoatrial (SA) node, which
sets the pace of the heart rate. The signal originates in the right atrium
and travels to the left atrium, causing the atria to contract. At the precise
moment the atria have completed their contraction, the signal travels via
the atrioventricular (AV) bundle to the right ventricle and into the left
ventricle, causing the ventricles to contract.
KEY FACT
An electrical device known as a pacemaker can be implanted to
assist or take over initiation of the signal that starts a heartbeat. This
may be necessary if the SA node is diseased or damaged.
Heart sounds
Heart sounds may be heard through a stethoscope. Closure of the heart
valves produces two main sounds:
● The first sound is a low-pitched ‘lubb’ which is generated by the closing
of the bicuspid and tricuspid valves.
● The second sound is a higher-pitched ‘dubb’ caused by the closing of
the aortic and pulmonary valves.
Pulmonary circulation
The function of pulmonary circulation is to aid respiration. It consists
of the circulation of deoxygenated blood from the right ventricle of the
heart to the lungs, via the pulmonary arteries, and the circulation of
oxygenated blood from the lungs to the heart, via the pulmonary veins.
Blood dumps carbon dioxide and becomes oxygenated in the lungs, and
is then returned to the left atrium by the pulmonary veins to be passed
to the aorta for the general, or systemic, circulation.
Pulmonary circulation is essentially the circulatory system between
the heart and the lungs, where a high concentration of blood oxygen
is restored and the concentration of carbon dioxide in the blood is
lowered.
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Blood capillaries of the

upper part of the body
Ascending aorta
Blood capillaries
Blood capillaries
of the left lung
of the right lung
Pulmonary artery Aortic arch
Pulmonary vein
Superior vena cava Left atrium
Right atrium
Left ventricle
Right ventricle
Descending aorta
Inferior vena cava

Blood capillaries of the stomach
Blood capillaries of the liver
Portal vein Hepatic artery

Blood capillaries of the spleen
Blood capillaries of the intestines
Renal artery
Blood capillaries of the kidneys
Blood capillaries of the

lower part of the body
p The pulmonary and systemic circulation
In practice General or systemic circulation

The increase in blood flow The systemic circuit is the largest part of the double circulatory
during a massage can help system and it carries oxygenated blood from the left ventricle of the
to bring fresh oxygen and heart through the branches of the aorta and all around the body.
nutrients to the tissues via the Deoxygenated blood is returned to the right atrium via the superior and
arterial circulation and can aid inferior vena cavae, to be passed to the right ventricle, where it enters
the removal of waste products the pulmonary circuit. The function of the systemic circulation is to
via the venous circulation. By bring nutrients and oxygen to all systems of the body and to carry waste
boosting blood circulation, materials away from the tissues for elimination.
therefore, massage can help to
improve the condition of the
skin and muscle tone.
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Portal circulation
The portal circulation is located within the systemic circuit. It collects
blood from the digestive organs (stomach, intestines, gall bladder,
pancreas and spleen) and delivers this blood, via the hepatic portal
veins, to the liver for processing. The liver has a key function in
maintaining proper concentrations of glucose, fat and protein in the
blood. The hepatic portal system allows the blood from the digestive
organs to take a detour through the liver to process these substances
before they enter the systemic circulation.
Activity
The cardiovascular system
Remind yourself of the following blood vessels and parts of the heart:
● aorta
● pulmonary artery
● bicuspid valve
● right ventricle
● left ventricle
● tricuspid valve
● superior vena cava
● inferior vena cava
● pulmonary veins.
1 Write each one on a separate piece of card or paper.

2 Sort the cards into the correct order to represent the blood flow
through the heart.
3 Colour code the cards: use red to represent oxygenated blood and
blue to represent deoxygenated blood.
Main arteries
The aorta (a-orr-ta)
The aorta is the main artery of the systemic circuit and it carries
oxygenated blood around the body. It is the largest artery in the body,
beginning at the top of the left ventricle and then dividing into three
main sections, which branch further to supply the whole of the body:
1 The ascending part of the aorta has branches which supply the head,
neck and the top of the arms.
2 The descending thoracic part of the aorta has branches which supply
the organs of the thorax.
3 The descending abdominal part has branches which supply the legs
and organs of the digestive, renal and reproductive systems.
The names of most major arteries are derived from the anatomical
structures they serve. For example, the femoral artery is found close to the
femur. Arteries are generally deep seated and are found on both sides of
the body, identified as either right or left like the sides of the heart.
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External carotid artery

Internal carotid artery
Common carotid arteries
Subclavian artery
Aortic arch
Axillary artery
Brachial artery
Coeliac trunk
Common hepatic artery Splenic artery
Renal artery
Radial artery
Ulnar artery
Common iliac artery
Superficial/deep Internal iliac artery

palmar arches External iliac artery
Digital artery
Femoral artery
Popliteal artery
Anterior tibial artery
Posterior tibial artery
Deep plantar arch
p Main arteries
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Blood circulation to the ● The internal carotid artery passes through the
temporal bone of the skull to supply oxygenated
head and neck blood to the brain, eyes, forehead and part of the nose.
Blood is supplied to parts within the neck, head ● The external carotid artery is divided into branches
and brain through branches of the subclavian (facial, temporal and occipital arteries) which supply
and common carotid arteries. The common the skin and muscles of the face, and side and back
cartoid artery extends from the brachiocephalic of the head, respectively. This vessel also supplies
(innominate) artery. It extends on each side of the the superficial parts and structures of the head and
neck and divides at the level of the larynx into neck. These include the salivary glands, scalp, teeth,
two branches: nose, throat, tongue and thyroid gland.
Superficial temporal artery
Maxillary artery
Occipital artery
Internal carotid artery

Facial artery
External carotid artery
Lingual artery
Thyroid artery
Common carotid artery
p Blood flow to the head and neck
The vertebral arteries are main divisions of the vertebrae, where they unite to form a single basilar
subclavian arteries. They arise from the subclavian artery. The basilar artery then terminates by dividing
arteries in the base of the neck near the tip of into two posterior cerebral arteries that supply the
the lungs and pass upwards through the openings occipital and temporal lobes of the cerebrum.
(foramina) of transverse processes of the cervical
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Main arteries of the face and head

Table 6.4 Arteries of the face and head
Name of artery Location Area artery supplies

Common carotid artery Located on each side of the neck Divide into the external and internal carotid
(right and left) arteries
External carotid artery Branches off from the common carotid Provides blood supply to the scalp, face
artery and neck
Internal carotid artery Branches off from the common carotid Supplies blood to the brain
artery
Occipital artery Branch of the external carotid artery Supplies blood to the back of the scalp and
opposite the facial artery sternomastoid muscles, and deep muscles in
Path is below the posterior belly of the back and neck
digastric to the occipital region
Facial artery Branch of the external carotid artery a Supplies blood to the structures of the face
little above the level of the lingual artery
Maxillary artery Branches from the external carotid artery Supplies deep structures of the face
just deep to the neck of the mandible
Lingual artery Rises from the external carotid between Supplies the oral floor and tongue
the superior thyroid artery and facial artery
Located easily in the tongue
Superficial temporal Major artery of the head, arises from the Assists in delivering oxygenated blood from
artery external carotid artery in the neck the heart to regions within the neck and head
Thyroid artery In the neck Thyroid gland
Blood circulation to the arm and

hand
The blood supply to the arm begins with the subclavian artery (a branch
of the aorta). The subclavian artery becomes the axillary artery and then
the brachial artery, which runs down the inner aspect of the upper arm
to about 1 cm below the elbow, where it divides into the radial and ulnar
arteries.
The radial artery runs down the forearm and continues over the carpals
to pass between the first and second metacarpals into the palm. The
ulnar artery runs down the forearm next to the ulnar bone, across
the carpals into the palm of the hand.
Together, the radial and ulnar arteries form two arches in the hand
called the deep and superficial arches. From these arteries others
branch to supply blood to the structures of the upper arm, forearm,
hand and fingers.
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Main arteries of the arm and hand
Subclavian artery
Axillary artery
Brachial artery
Radial artery
Ulnar artery
Deep palmar artery

Superficial palmar arch
Digital arteries
p Arteries of the arm and hand
Table 6.5 Arteries of the arm and hand
Name of
artery Location Area artery supplies
Subclavian Below the clavicle Supplies oxygenated blood to the arm
artery
Axillary Passes through the axilla, just underneath the Conveys oxygenated blood to the lateral
artery pectoralis minor muscle aspect of the thorax, the axilla and upper limb
Brachial Runs down the inner aspect of the upper arm to Supplies main source of oxygenated blood for
artery about 1 cm below the elbow the arm
➜
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Name of
artery Location Area artery supplies
Ulnar artery Runs down the forearm next to the ulnar bone, Supplies the anterior aspect of the forearm
across the carpals into the palm of the hand
Radial Runs down the forearm and continues over the Supplies the posterior aspect of the forearm
artery carpals to pass between the first and second
metacarpals into the palm
Superficial Superficial branch of the ulnar artery, lies across the Supplies blood to palm and fingers
palmar arch centre of the palm
Deep Continuation of the radial artery, lies 1 cm proximal Supplies blood to palm and fingers
palmar arch to the superficial palmar arch, across centre of palm
Digital Between the second and third, third and fourth, Supplies blood to the second, third, fourth
arteries fourth and fifth fingers and fifth fingers
Blood circulation to the thoracic wall

The thoracic wall is supplied by branches of the subclavian artery
and the thoracic (descending) aorta. This branch of the aorta spans
from the level of T4 to T12, after which it becomes the abdominal aorta.
Branches of the thoracic aorta in descending order include the bronchial
arteries, mediastinal arteries, oesophageal arteries, pericardial arteries,
superior phrenic arteries, intercostal and subcostal arteries.
Blood circulation to the abdominal wall

The abdominal wall is supplied by branches of the abdominal aorta.
Table 6.6 Arteries of the abdominal wall
Name of artery Location Area it supplies

Celiac (coeliac) Branches from the abdominal aorta at the Supplies oxygenated blood to the liver, stomach,
artery twelfth thoracic vertebra abdominal oesophagus, spleen and the superior
half of both the duodenum and the pancreas
Hepatic artery Branch of the celiac trunk that arises from Supplies oxygenated blood to the liver, stomach,
the abdominal aorta at the level of the upper duodenum and pancreas
part of the first lumbar vertebra
Renal artery One of two blood vessels leading off from Supplies oxygenated blood to the kidneys
the abdominal aorta that go to the kidneys
Splenic artery Branched from the celiac artery (first major Supplies oxygenated blood to the spleen
branch of the abdominal aorta) and runs Has several branches that deliver blood to the
above the pancreas to the spleen stomach and pancreas
In addition to the main visceral branch of abdominal arteries above,

other arteries are:
● the superior and inferior mesenteric arteries which supply the small
and large intestines
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● the suprarenal arteries which supply the adrenal glands

● the gonadal arteries that supply the ovaries and the testes.
The parietal branch of arteries that feed the abdominal wall structures External iliac artery
include:
● the inferior phrenic arteries that supply the diaphragm
● the lumbar arteries that supply the spinal cord and muscles and skin
of the lumbar region Femoral artery
● the median sacral arteries that supply the sacrum, coccyx and the
rectum.
Popliteal artery
Blood circulation to the leg and foot
The abdominal aorta travels down the length of the trunk to the lower
abdomen, where it divides into two arteries (right and left common Anterior tibial artery
iliac arteries) which supply either leg. The common iliac arteries in turn
divide into the internal and external iliac arteries.
Posterior tibial artery
The internal iliac artery supplies most of the pelvic wall, and the
external iliac artery becomes the femoral artery in the leg.
The femoral artery is the artery in the thigh, named after the thigh
bone. At the knee the femoral artery becomes the popliteal artery,
which divides into two below the knee. One of these arteries runs down Plantar arch
the front of the lower leg and is called the anterior tibial artery, while
the other runs down the back of the leg and is called the posterior tibial p Arteries of the leg and foot
artery. This artery divides at the inside of the ankle becoming the medial
plantar artery on the inside of the foot and the plantar arch on the sole
of the foot. The anterior tibial artery becomes the dorsal metatarsal
artery on top of the foot.
Main arteries of the leg and foot

Table 6.7 Main arteries of the leg and foot
Name of artery Location Area it supplies

Common iliac Passes down along the brim of the pelvis and Supplies blood to the pelvic organs, gluteal
artery divides into two large branches region and legs
Femoral artery Main artery in the thigh (continuation of Supplies oxygenated blood to the tissues of
external iliac artery) the leg
Popliteal artery Behind the knee and the back of the lower leg Supplies oxygenated blood to the knee joint
Anterior tibial On anterior of lower leg, crossing the anterior Carries oxygenated blood to the anterior
artery aspect of the ankle joint, at which point it compartment of the leg and dorsal surface of
becomes the dorsalis pedis artery the foot, from the popliteal artery
Posterior tibial Branches off from the popliteal artery and runs Carries blood to the posterior compartment
artery down the leg, just below the knee of the leg and plantar surface of the foot, from
the popliteal artery
Plantar arch Runs from the fifth metatarsal and extends Supplies oxygenated blood to the underside,
medially to the first metatarsal (of the big toe) or sole, of the foot
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Main veins ● The inferior vena cava is formed by the right and
left iliac veins. It lies posterior to the abdominal
The major veins of the body are the superior and cavity and runs along the right side (with the
inferior vena cavae, which convey deoxygenated blood aorta to the left). It receives blood from the lower
from the other veins to the right atrium of the heart. parts of the body below the diaphragm.
● The superior vena cava originates at the junction Like arteries, veins are also named for their locations
of the two innominate (briachiocephalic) veins. and usually have two branches (right and left). Veins
It drains blood from the upper parts of the body are more superficially placed than arteries.
(head, neck, thorax and arms) above the diaphragm.
External jugular vein Internal jugular vein
Subclavian vein
Axillary vein
Cephalic vein
Brachial vein
Basilic vein
Hepatic vein
Splenic vein
Renal vein
Radial vein
Ulnar vein
Right and left common iliac veins
Internal iliac vein
Palmar venous arches External iliac vein
Digital veins
Long/great saphenous vein
Femoral vein
Popliteal vein
Short/small saphenous vein
Anterior tibial vein

Posterior tibial vein
Dorsal venous arch

Dorsal digital veins
p Main veins
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Venous drainage of the face and head

The majority of blood draining from the head is passed into three pairs of
veins:
1 external jugular veins
2 internal jugular veins
3 vertebral veins.
Within the brain, all veins lead to the internal jugular veins.
Superficial
temporal vein
Occipital vein
Maxillary vein
Facial vein
External jugular
vein
Internal jugular vein
p Venous drainage from the head and neck
The external jugular veins are smaller than the internal jugular veins
and lie superficial to them. They receive blood from superficial regions
of the face, scalp and neck. The external jugular veins descend on either
side of the neck, passing over the sternomastoid muscles and beneath
the platysma. They empty into the right and left subclavian veins in the
base of the neck.
The internal jugular veins form the major venous drainage of the
head and neck and are deep veins that run parallel with the common
carotid artery. They collect deoxygenated blood from the brain and pass
downwards through the neck beside the common carotid arteries to
join the subclavian veins.
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The vertebral veins descend from the transverse openings (or foramina)
of the cervical vertebrae and enter the subclavian veins. The vertebral
veins drain deep structures of the neck, such as the vertebrae and
muscles.
Main veins of the face and head

Table 6.8 Main veins of the face and head
Area of body it receives

Name of vein Location venous return from
External Situated on the side of the Drains most of the outer
jugular vein neck structures of the head,
including the scalp and
deep portions of the face
Internal Situated on the side of the Drains most of the cerebral
jugular vein neck veins and outer portions of
the face
Common Crosses the external carotid Drains most of the blood
facial vein artery and enters the from the face, draining
internal jugular vein at a directly into the internal
variable point below the jugular vein
hyoid bone
Anterior Lies behind the facial artery Drains blood from the face
facial vein before joining the common
facial vein
Maxillary Runs alongside the Drains blood from the
vein maxillary artery face, directs blood flow to
the internal and external
jugular veins
Superficial Side of the head Drains the forehead and
temporal vein scalp
Venous drainage of the arm

and hands
The venous return of blood from the hand begins with the palmar arch
and plexus, which is a network of capillaries in the palm. The veins that
carry deoxygenated blood up the forearm are the radial vein, ulnar vein
and median vein.
The radial vein runs parallel to the radius bone of the forearm, the ulnar
vein runs parallel to the ulna bone of the forearm and the median vein
runs up the middle of the forearm. Just above the elbow, the radial and
ulnar veins join to become the brachial vein and the median vein joins
the basilic vein,which originates just below the elbow along with the
cephalic vein.
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Right subclavian vein
Axillary vein
Brachial vein
Cephalic vein
Basilic vein
Ulnar vein
Radial vein
Deep palmar venous arch
Superficial palmar venous arch

Palmar digital veins
p Veins of the arm and hand

As the veins continue over the elbow, they link to form a network that
eventually divides with the basilic vein joining the brachial vein, which
then becomes the axillary vein. The cephalic vein travels up the arm
separately and becomes the subclavian vein in the upper chest.
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Main veins of the arm and hand

Table 6.9 Main veins of the arm and hand
Name of vein Location Area of body it receives venous return from

Subclavian vein Under the clavicle and anterior to the Upper extremities
subclavian artery
Axillary vein Runs along the medial side of the axillary Conveys blood from the lateral aspect of the
artery thorax, armpit and upper limb
Brachial vein In the arm between the shoulder and the Drains the muscles of the upper arm
elbow, runs alongside the brachial artery
Basilic vein Inner side of forearm area Drains the medial aspect of the upper limbs via
numerous superficial veins
Cephalic vein Runs up the lateral side of the arm from Drains the dorsal venous network of the hand
the hand to the shoulder
Ulnar vein Runs parallel to the ulna bone of the Drains oxygen-depleted blood from the medial
forearm aspect of the forearm
Radial vein Runs parallel to the radius bone of the Assists in draining oxygen-depleted blood from
forearm the hand and forearm
Palmar digital veins Run between the fingers Carry deoxygenated blood away from the fingers
Venous drainage of thoracic

and abdominal walls
The thoracic and abdominal walls are drained by branches of the
brachiocephalic veins.
Blood from the abdominal organs enters the hepatic portal system
(page 187) and then from the liver the blood is carried by the hepatic
veins to the inferior vena cava.
Main veins of the thoracic and

abdominal walls
Table 6.10 Main veins of the thoracic and abdominal walls
Name of vein Location Area of body it receives venous return from

Iliac vein Lower part of the abdomen, in the pelvic region Pelvis and lower limbs
Splenic vein Runs close to the course of the splenic artery The spleen, the stomach fundus and part of the
(above the pancreas to the spleen) pancreas (part of the hepatic portal system)
Renal vein Posterior of the abdominal wall, connects the Kidneys
kidneys to the inferior vena cava
Hepatic vein Connects to the liver in the upper right side Liver
of the abdominal cavity
Hepatic The upper right quadrant of the abdomen, All of the blood draining from the abdominal
portal vein originating behind the neck of the pancreas digestive tract, as well as from the pancreas, gall
bladder, and spleen (part of the hepatic portal system)
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In addition to the main visceral branch of abdominal veins already

mentioned, some other veins are:
● the superior and inferior mesenteric veins, which drain blood from the
small and large intestines
● the suprarenal arteries, which supply the adrenal glands
● the gonadal veins, which drain the ovaries and the testes.
The parietal branch of veins, which drain the abdominal wall structures
include:
● the inferior phrenic veins, which drain the diaphragm
● the lumbar veins, which drain the spinal cord, and the muscles and
skin of the lumbar region
● the median sacral veins, which drain the sacrum, coccyx and rectum.
Venous drainage of the leg and foot

There is a network of veins in the foot that becomes the dorsal venous
arch on top of the foot. This travels along the inside of the foot to the
ankle, where it becomes the small (short) saphenous vein. It continues
up the back of the whole leg to the thigh, where it is known as the great
(long) saphenous vein.
Two small veins called the anterior tibial veins travel up the front of the
lower leg, while two veins, the posterior tibial veins, run up the back.
These four veins converge just below the knee to become the popliteal
vein at the back of the knee and then eventually the femoral vein in the
thigh. The great saphenous vein and the femoral vein join at the groin
and return to the heart via the inferior vena cava.
External iliac vein
Femoral vein
Long/great saphenous vein
Popliteal vein
Short/small
saphenous vein
Anterior tibial vein

Posterior tibial vein
Dorsal venous arch
Dorsal digital veins
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Main veins of the leg and foot

Table 6.11 Main veins of the leg and foot
Main veins of the Leg Location Area of body it receives venous return from
Great (long) Longest vein in the human body, Drains blood from the inner part of the foot, the skin
saphneous vein extending from the top of the foot and fat of the front and inner aspect of the lower leg,
to the upper thigh and groin and the skin and fat of the inner part of the thigh
Small (short) Superficial vein in the posterior of Drains the lateral surface of the leg, and runs up
saphenous vein the lower leg the posterior surface of the leg to drain into the
popliteal vein
Femoral vein Large vein in the groin Carries blood back to the heart from the lower
(continuation of the popliteal vein) extremities
Popliteal vein Behind the knee and the back of Carries blood from the knee (as well as the thigh and
the lower leg calf muscles) back to the heart
Anterior tibial vein In the anterior of the lower leg Originates and receive blood from the dorsal pedis
veins, on the back of the foot, and empties into the
popliteal vein
Posterior tibial vein In the posterior of the lower leg Drains the posterior compartment of the leg and the
plantar surface of the foot to the popliteal vein, which
it forms when it joins with the anterior tibial vein
Dorsal venous arch Superficial vein that connects the Drains oxygen-depleted blood through the foot
small saphenous vein and the
great saphenous vein
Blood shunting The pressure in the arteries varies during each

heartbeat:
Along certain circulatory pathways, such as in the ● The maximum pressure of the heartbeat is known
intestines, there are strategic points where small as the systolic (sis-toll-ik) pressure and represents
arteries have direct connection with veins. When the pressure exerted on the arterial wall during
these connections are open, they act as shunts to active ventricular contraction. Systolic pressure
allow blood in an artery to have direct access to a can, therefore, be measured when the heart
vein. muscle contracts and pushes blood out into the
These interconnections allow for sudden and major body through the arteries.
diversions of blood volume, according to the physical ● The minimum pressure, or diastolic (dy-a-stoll-ik)
needs of the body. This means that treatment pressure, represents the static pressure against
should not be given after a heavy meal – increased the arterial wall during the pause between
circulation to the intestines results in a diminished contractions. Therefore, the mimimum pressure
supply to other areas of the body. is when the heart muscle relaxes and blood flows
into the heart from the veins.
Blood pressure KEY FACT
Blood pressure is the amount of pressure exerted by Blood pressure is regulated by sympathetic
blood on an arterial wall due to the contraction of nerves in the arterioles. An increase in
the left ventricle. Blood pressure may be measured stimulation of the sympathetic nervous system,
with the use of a sphygmomanometer. as in exercise, therefore results in a temporary
increase in blood pressure.
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Factors affecting blood ● the elbow (brachial artery)

the groin (femoral artery)
pressure ●
● the back of the knee (popliteal artery)

As blood pressure is the result of the pumping of the ● the ankle joint (posterior tibial artery)
heart in the arteries, anything that makes the heart
● the foot (dorsalis pedis artery).
beat faster will raise the blood pressure. Factors that
affect blood pressure include:
● excitement
Common pathologies
● anger of the cardiovascular
●
●
stress
fright
system
● pain In practice
● exercise Always take a detailed history of a client’s
● smoking and drugs. symptoms and medical or surgical treatment, so
A normal blood pressure reading is between 100 you are aware of any cardiac and/or circulatory
and 140 mm Hg systolic and between 60 and problems. If there is a history of cardiovascular
90 mm Hg diastolic. Blood pressure is measured illness, seek advice from the client’s GP before
in millimetres of mercury and is expressed as a treating, as this may determine the nature and
ratio between systolic and diastolic pressures, duration of the proposed treatment.
like this:120/80 mm Hg.
Anaemia
The pulse In anaemia, the haemoglobin level in the blood is
below normal. The main symptoms are excessive
The pulse is a pressure wave that can be felt in the tiredness, breathlessness on exertion, pallor and poor
arteries and which corresponds to the beating of the resistance to infection. There are many causes of
heart. The pumping action of the left ventricle of the anaemia. It may be due to a loss of blood resulting
heart is so strong that it can be felt as a pulse in some from an accident or operation, chronic bleeding,
arteries at a considerable distance from the heart. iron deficiency or due to a blood disease such as
The pulse can be felt at any point where an artery lies leukaemia.
near the body’s surface. The radial pulse can be found
Aneurysm
by placing two or three fingers over the radial artery
below the thumb. An aneurysm is an abnormal balloon-like swelling in
the wall of an artery. This may be due to degenerative
The average pulse in an adult is between 60 and
disease (congenital defects, arteriosclerosis) or any
80 beats per minute. Factors affecting the pulse
condition which causes weakening of the arterial wall,
rate include:
such as trauma, infection or hypertension.
● exercise
Angina
● heat
This is a pain in the left side of the chest and usually
● strong emotions such as grief, fear, anger or
radiating to the left arm. It is caused by insufficient
excitement.
blood flow to the heart muscle, usually on exertion
The pulse may be palpated (felt) in any place that or excitement. The pain is often described as
allows an artery to be compressed near the surface constricting or suffocating and can last for a few
of the body such as at: seconds or minutes. The patient may become pale
● the neck (carotid artery) and sweaty. This condition indicates ischaemic heart
● the wrist (radial artery) disease.
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● keeping weight down

In practice
● giving up smoking and cutting down on alcohol
Stress predisposes people to angina attacks. consumption
Massage and other relaxation therapies may help
● relaxation and leading a less stressful life.
alieviate symptoms by decreasing the activity of
the sympathetic nervous system. Low blood pressure
Since sudden exposure to extreme heat or cold can Low blood pressure is when the blood pressure
bring on an attack, keep the client warm. is below normal and is defined by the World
Health Organization as a systolic blood pressure
Arteriosclerosis of 99 mm Hg or less and a diastolic of less than
59 mm Hg. Low blood pressure may be normal for
Arteriosclerosis is a circulatory system condition that
some people in good health, during rest or fatigue.
is characterised by a thickening, narrowing, hardening
Very low blood pressure can mean that insufficient
and loss of elasticity of the walls of the arteries.
blood reaches the vital centres of the brain.
Treatment may be by medication, if necessary.
In practice
Clients with arteriosclerosis are prone to thrombus In practice
formation. Deeper manipulation should not be
High and low blood pressure do normally
used as it could encourage a thrombus to dislodge
contraindicate treatments but with GP referral and
and travel to the lungs, heart or the brain.
an adaptation of routine, some treatments may
Refer clients to their GP before any treatment if be possible. Correct positioning of the couch is
they have a history of stroke, heart attack, angina essential to maximise comfort of the client with
or thrombosis. If treatment is encouraged, use blood pressure problems. Make sure the client is
gentle methods and avoid overstimulation. not lying down too long and doesn’t get up too
fast.
High blood pressure
High blood pressure is when blood pressure at rest is Congenital heart disease
above normal levels. The World Health Organization This is a defect in the formation of the heart which
defines high blood pressure as consistently exceeding usually decreases its efficiency. Defects may take the
160 mm Hg systolic and 95 mm Hg diastolic. following forms:
High blood pressure is a common complaint and may ● ventricular septal defects – an opening between
lead to a stroke or a heart attack, due to the fact that the right and left ventricle
the heart is working harder to force blood through ● atrial septal defect – an opening between the
the system. Causes of high blood pressure include: right and left atrium
● smoking ● coarctation of the aorta – narrowing of the
● obesity aorta
● lack of regular exercise ● pulmonary stenosis – narrowing of the
● eating too much salt pulmonary artery
● excessive alcohol consumption ● patent ductus arteriosus – non-closure of the
communication between the pulmonary artery
● stress.
and the aorta that normally exists in the foetus
High blood pressure can be controlled by: until delivery
● anti-hypertensive drugs, which help to lower blood ● a combination of defects.
pressure
The symptoms may vary according to the severity
● decreasing salt and fat intake to prevent hardening of the defect.
of the arteries
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● Hepatitis B – also known as serum hepatitis, this

In practice is more serious than hepatitis A. It lasts longer and
Depending on the type of defect, surgery can lead to cirrhosis, cancer of the liver, and a carrier
undertaken and GP’s advice, it may be more state. (A carrier is someone who is infected but is free
appropriate and comfortable for the client to from disease symptoms.) It has a long incubation
be treated in a seated position. period of one and a half to two months. The
symptoms may last from weeks to months. The virus
Haemophilia is usually transmitted through infected blood, serum
Haemophilia is a hereditary disorder in which the or plasma; however, it can spread by oral or sexual
blood clots very slowly due to deficiency of either of contact as it is present in most body secretions.
two coagulation factors: ● Hepatitis C – this can cause acute or chronic
● factor VIII (the antihaemophiliac factor) hepatitis and can also lead to a carrier state
● factor IX (the Christmas factor). and liver cancer. It is transmitted through blood
The patient may experience prolonged bleeding transfusions or exposure to blood products.
following an injury, and in severe cases there is High cholesterol
spontaneous bleeding into the muscles and joints. Cholesterol is a fat-like material that is present
Haemophilia is controlled by a sex-linked gene, in the blood and most tissues. A high level of
which means it is almost exclusively restricted to cholsterol in the blood (due to a diet rich in animal
males. Women can carry the disease and pass it onto fats and refined sugars) is often associated with
their sons without being affected themselves. the degeneration of the walls of the arteries and
Haemorrhoids (piles) a predisposition to thrombosis.
This is an enlargement of the veins in the walls of Leukaemia
the anus. They usually form as a result of prolonged This term refers to any of a group of malignant
constipation. diseases in which the bone marrow and other
Heart attack (myocardial infarction) blood-forming organs produce an increased
number of certain types of white blood cells.
This is damage to the heart muscles which results
Overproduction of these white cells, which are
from blockage of the coronary arteries. It can cause
immature or of abnormal form, suppresses the
serious complications including heart failure.
production of normal white cells, red cells and
platelets, leading to increased susceptibility to
In practice infection. Other manifestations or signs include
After a heart attack, no treatment should be given enlargement of the spleen, liver and the lymph
until the client is fully recovered, and only in liaison nodes, spontaneous bruising and anaemia.
with their GP.
In practice
Hepatitis
Drainage of lymphatics (page 217) can spread
Hepatitis is an inflammation of the liver caused leukaemia. Refer to the client’s GP or consultant
by viruses, toxic substances or immunological for advice on appropriate treaments.
abnormalities. There are several forms:
Take care if applying pressure with massage to
● Hepatitis A – highly contagious and transmitted via avoid bruising; clients with leukaemia have a
the faecal–oral route by ingestion of contaminated tendency to bleed.
food, water or milk. The incubation period is from
Be aware that the lymph glands, liver and spleen
15 to 45 days.
can be very tender.
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Pacemaker
This is an artificial electrical device implanted under the skin that
stimulates and controls the heart rate by sending electrical stimuli to the
heart. It is usually installed to correct an abnormal heart rhythm (heart
block) and mostly placed in one side of the upper chest.
In practice
Electrical treatments would be contraindicated
in a client with a pacemaker. Seek the GP’s advice
before offering any other form of treatment.
The site of the pacemaker is likely to be tender
and should be avoided, if any suitable treatment
is given.
Phlebitis
This condition is an inflammation of the wall of a vein and is most
In practice commonly seen in the legs as a complication of varicose veins. A
The site of phlebitis can be segment of the vein becomes tender and painful, and the surrounding
tender and careful handling is skin may feel hot and appear red.
essential. Thrombosis may develop as a result of phlebitis (thrombophlebitis) with
Massage should be avoided so subsequent deep vein thrombosis (DVT). Clots may dislodge and travel
as not to dislodge clots. to the lungs or other organs with serious consequences.
Pulmonary embolism
This occurs when a blood clot is carried into the lungs, where it blocks
In practice the flow of blood to the pulmonary tissue. It is a very serious condition
Clients on warfarin (an and can be life threatening, requiring hospitalisation and measures to
anticoagulant medication) have thin the blood, such as use of warfarin. This condition presents with chest
an increased risk of bleeding pain, cough and shortness of breath.
and you should be aware of
this with reference to any skin- Raynaud’s syndrome
piercing treatments such as This is a disorder of the peripheral arterioles, characterised by spasm in
epilation or ear piercing. the smooth muscle of the fingers and toes. It is generally brought on by
cold or emotional upset. The effect is a pallor or discolouration of the
skin due to the presence of poorly oxygenated haemoglobin. Affected
extremities can become painful and uncomfortable, and this is usually
followed by redness and stiffness of the toes and fingers.
Stress
Stress can be defined as any factor which affects physical or emotional
health. When the body is under stress, the heart beats faster, increasing
the circulation of blood. Excessive or prolonged stress can lead to high
blood pressure, coronary thrombosis and heart attack.
Stroke
This occurs when blood flow to the brain is blocked by an embolus
(clot) in a cerebral blood vessel. A stroke can result in a sudden
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attack of weakness on one side of the body, due Varicose veins may be due to several factors:
to the interruption to the flow of blood on the ● hereditary tendencies
corresponding side of the brain.
● ageing
A stroke can vary in severity from a passing
● obesity (excess weight), which puts pressure on
weakness or tingling in a limb, to a profound
the walls of the veins
paralysis and coma.
● pregnancy
Sometimes the term stroke is used to describe
● sitting or standing still for long periods of time,
cerebral haemorrhage when an artery or congenital
causing pressure to build up in the vein.
cyst of blood vessels in the brain bursts, resulting in
damage to the brain and causing similar signs to an
embolism. Haemorrhage is usually associated with
severe headaches and can cause neck stiffness.
Thrombosis
This is a condition in which the blood produces a blood
clot. Thrombosis in the wall of an artery obstructs the
blood flow to the tissue it supplies. In the brain, this is
one of the causes of stroke, and in the heart it results Deformed
in a heart attack (coronary thrombosis). valve
Thin wall of vein
Thrombosis may also occur in a vein (DVT). The
Abnormal blood flow
thrombus (blood clot) may be detached from its
site of formation and can be carried in the blood to Skin bulging
lodge in another part of the body (see pulmonary
embolism).
Varicose veins
Veins become varicose when the valves within
them lose their strength. As a result of this, blood
flow may reverse or become static (valves normally
prevent the backflow of blood). When their function p Varicose veins
is impaired, veins are unable to prevent the blood
from flowing downwards, causing the walls of the In practice
affected veins to swell and bulge out, becoming As varicose veins can be extremely painful,
visible through the skin. treatment is contraindicated in the affected area.
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Interrelationships with other

systems
The cardiovascular system
The cardiovascular system links to the following body systems.
Skin
The circulatory system transports blood rich in nutrients and oxygen to
the skin, hair and nails.
Skeletal
Red bone marrow is responsible for the development of blood cells.
Muscular
The heart is a muscular organ and contracts rhythmically and
continuously to pump blood around the body.
Lymphatic
The lymphatic system assists the circulatory system in transporting
additional waste products away from the tissues in order to maintain
blood volume and pressure and to prevent oedema.
Respiratory
The respiratory system oxygenates and deoxygenates blood in the
lungs.
Digestive
Nutrients broken down by digestive processeses are transported by
blood to the liver to be assimilated by the body.
Nervous
Blood pressure is regulated by sympathetic nerves in the arterioles.
Endocrine
Hormones are carried by blood to their target organs.
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Key words Heart: hollow muscular organ which lies in the

thorax above the diaphragm and between the lungs,
Agranulocyte: one of the two main categories of acts as a pump to provide a constant circulation of
leucocytes blood throughout the body
Antigen: a substance that can trigger an immune Hypertension (high blood pressure): when the
response if foreign to the body force of blood pushing against the walls of blood
Aorta: the main artery of the body, supplying vessels is consistently too high
oxygenated blood to the circulatory system Hypotension (low blood pressure): when the force
Arteriole: a small branch of an artery leading into of blood pushing against the walls of blood vessels
capillaries is consistently too low
Artery: a type of blood vessel that carries Inferior vena cava: a large vein carrying
oxygenated blood away from the heart deoxygenated blood into the heart
Atrium: one of two upper cavities of the heart from Leucocyte: white blood cell, which protects the
which blood is passed to the ventricles body against infection and disease
Basophil: a type of granulocyte Lumen: a void inside a blood vessel through which
blood flows
Blood: the fluid circulating through the heart, arteries,
veins and capillaries of the circulatory system Lymphocyte: a specialised type of white blood cell
Blood pressure: the amount of pressure exerted by Macrophage: a large white blood cell that ingests
blood on an arterial wall due to the contraction of foreign particles and infectious micro-organisms by
the left ventricle phagocytosis
B-lymphocyte: a type of white blood cell that Monocyte: a large phagocytic white blood cell
makes antibodies Myocardium: a strong layer of cardiac muscle,
Capillary: the smallest blood vessel, which unites which makes up the bulk of the heart
arterioles and venules Neutrophil: a type of granulocyte
Cardiac cycle: the sequence of events between one Pericardium: the membrane enclosing the heart,
heartbeat and the next consisting of an outer fibrous layer and an inner
Clotting: the process in which blood changes from double layer of serous membrane
liquid into a solid state to form a thick lump Phagocytosis: the process by which a white blood
Clotting factors: proteins in the blood that control cell ingests micro-organisms
bleeding Plasma: the colourless, liquid part of blood
Diastolic: the minimum blood pressure when the Portal circulation: circulation of blood to the liver
heart muscle relaxes and blood flows into the heart from the small intestine, the right half of the colon
from the veins and the spleen through the portal vein
Endocardium: the lining of the heart’s cavities Pulmonary artery: an artery carrying blood from
Eosinophil: a type of granulocyte the right ventricle of the heart to the lungs for
Erythrocyte: red blood cell, which transports the oxygenation
gases of respiration Pulmonary circulation: the circulatory system
Fibrin: an insoluble protein that forms a fibrous between the heart and the lungs
mesh during blood clotting Pulmonary vein: a vein carrying oxygenated blood
Fibrinogen: a soluble protein present in blood from the lungs to the left atrium of the heart
plasma, from which fibrin is produced Pulse: a pressure wave that can be felt in the
Granulocyte: one of the two main categories of arteries and which corresponds to the beating
leucocytes of the heart
Haemoglobin: a red iron–protein complex Septum: a partition separating the two chambers of
responsible for transporting oxygen in the blood the heart
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Stethoscope: a medical instrument for listening to T-lymphocyte: a type of white blood cell that
the action of the heart or breathing circulates around the body, scanning for cellular
Sphygmomanometer: an instrument for measuring abnormalities and infections
blood pressure Tunica externa (tunica adventitia): the outermost
Sinoatrial (SA) node: a specialised piece of heart layer or tunic of a vessel (except capillaries)
tissue that generates the electrical impulses to Tunica intima: the innermost lining or tunic of a
control the heartbeat vessel
Superior vena cava: a large vein carrying Tunica media: the middle layer or tunic of a vessel
deoxygenated blood into the heart (except capillaries)
Systemic circulation: part of the cardiovascular Vasoconstriction: constriction of the smooth
system that carries oxygenated blood away from the muscle of a blood vessel, resulting in a decreased
heart to the body and returns deoxygenated blood vascular diameter
back to the heart Vasodilation: relaxation of the smooth muscle in
Systolic: maximum pressure of the heartbeat, which the wall of a blood vessel, resulting in an increased
represents the pressure exerted on the arterial wall vascular diameter
during active ventricular contraction Vein: a type of blood vessel that carries
Thrombin: an enzyme in blood plasma which causes deoxygenated blood towards the heart
the clotting of blood by converting fibrinogen to Ventricle: one of the two lower chambers of the
fibrin heart
Thrombocyte (platelet): a small fragment of a cell Venule: a very small blood vessel in the
involved in blood clotting microcirculation that allows blood to return from
Thromboplastin: a plasma protein that helps with the capillary beds to drain into the veins
blood coagulation
Revision summary ● Leucocytes are designed to protect the body

against infection.
The cardiovascular system ● Thrombocytes are involved in the clotting process.
● Blood is a type of liquid connective tissue. ● Blood clotting or coagulation is a biological

● Blood transports substances between the body process that stops bleeding.
cells and the external environment to help ● Haemostasis is the physiological process by
maintain a stable cellular environment. which bleeding ceases. It involves three basic
● There are four major blood groups: A, B, AB and O. steps: vascular spasm, the formation of a platelet
plug, and coagulation, in which clotting factors
● Blood groups are determined by the presence
promote the formation of a fibrin clot.
or absence of two antigens – A and B – on the
surface of red blood cells. ● There are 12 clotting factors in human blood
and tissues.
● The universal red cell donor has type O negative
blood. ● Clotting factors are proteins in the blood that
control bleeding.
● The universal plasma donor has type AB blood.
● Examples of clotting factors include fibrinogen
● The percentage composition of blood is 55%
(clotting factor I), prothrombin (clotting factor II)
fluid (plasma) and 45% blood cells.
and thromboplastin (clotting factor III).
● There are three main types of blood cells –
● There are four main functions of blood – transport,
erythrocytes, leucocytes and thrombocytes.
defence, regulation of heat and clotting.
● The function of an erythrocyte is transporting
● Blood is carried around the body in vessels called
oxygen to the cells and carrying carbon dioxide
arteries, veins and capillaries.
away.
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● Arteries carry oxygenated blood away from ● The ventricles contract strongly and
the heart. They have thick, muscular walls in push blood out through the aorta and the
order to withstand the high pressure of blood. pulmonary artery.
● Veins carry deoxygenated blood towards the ● As the ventricles contract the atria relax and
heart. They have thinner walls and blood is fill up with blood.
carried under lower pressure. ● Blood is transported as part of a double circuit.
● Capillaries are the smallest vessels in the
● The pulmonary circulation is the circulatory
circulatory system. They unite arterioles and
system between the heart and the lungs. It consists
venules. Their walls are sufficiently thin to
of the circulation of deoxygenated blood from
allow dissolved substances in and out of them.
the right ventricle of the heart to the lungs via
● The heart lies in the thorax above the diaphragm the pulmonary arteries to become oxygenated.
and between the lungs. Oxygenated blood is then returned to the left
● The heart is composed of three layers of tissue – atrium by the pulmonary veins.
an outer pericardium, a middle myocardium and ● The systemic circulation is the largest
an inner endocardium. circulatory system and carries oxygenated blood
● The heart is divided into a right and left side by from the left ventricle of the heart to the aorta
a partition called a septum. Each side is divided and around the body.
into a thin-walled top chamber called an atrium ● Blood pressure is defined as the amount of
and a thick-walled bottom layer called a ventricle. pressure exterted by blood on an arterial wall
● The atria (top chambers) take in blood from due to the contraction of the left ventricle.
the large veins and pump it to the bottom
● The maximum pressure is called the systolic
chambers.
pressure and respresents the pressure exerted
● The ventricles (bottom chambers) pump blood
on the arterial walls during ventricular
to the body’s organs and tissues.
contraction.
● Blood flows through the heart in four stages.
● The lowest pressure is called the diastolic
● Stage 1 – deoxygenated blood flows into the
pressure and is when the heart muscle relaxes
right atrium. When the right atrium is full, it
(ventricular relaxation) and blood flows into the
empties into the right ventricle.
heart from the veins.
● Stage 2 – when the right ventricle is full, it
● A normal blood pressure reading is between
pushes blood into the pulmonary artery to the
100 and 140 mm Hg systolic and between
lungs, where the blood becomes oxygenated.
60 and 90 mm Hg diastolic.
● Stage 3 (taking place at the same time as
● High blood pressure is when the resting
stage 1) – oxygen-rich blood fills the left atrium.
blood pressure is above normal and when
When full, the blood passes to the left ventricle.
consistenly exceeding 160 mm Hg systolic
● Stage 4 (taking place at the same time as
and 95 mm Hg diastolic.
stage 2) – when the left ventricle is full it forces
● Low blood pressure is defined as a systolic
blood into the aorta and to all parts of the body.
pressure of 99 mm Hg or less and diastolic
● The cardiac cycle is the sequence of events of 59 mm Hg.
between one heartbeat and the next.
● The pulse is a pressure wave that can be felt in
● The duration of the cardiac cycle is less than a arteries, such as the carotid or brachial arteries,
second. and corresponds to the beating of the heart and
● During a cardiac cycle, the atria contract the contraction of the left ventricle.
simultaneosuly and force blood into the
● An average pulse is between 60 and 80 beats per
relaxed ventricles.
minute.
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Test your knowledge 8 Which of the following has branches that carry
oxygenated blood around the body?
questions a left ventricle
b left pulmonary vein
Multiple choice questions c aorta
1 Which of the following accounts for 55% of the d superior vena cava
composition of blood? 9 Which of the following best describes the flow of
a hormones blood through the heart?
b haemoglobin a Blood flows from the capillaries to the veins,
c fluid or plasma to the arteries and then to the aorta.
d erythrocytes, leucocytes and thrombocytes b Blood flows into the right atrium, then into the
2 Which blood cell protects the body against right ventricle, then into the pulmonary artery.
infection? The blood returns from the lungs and enters
a thrombocyte the left atrium, then flows into the left ventricle
b leucocyte and into the aorta to all parts of the body.
c erythrocyte c Blood flows into the sinoatrial nodes, then to
d platelet the right ventricle, aorta and coronary arteries.
d Blood flows from the brachial artery, to the
3 Which of the following is not a function of blood?
left ventricle, the pulmonary arteries and
a transport of oxygen, carbon dioxide, nutrients
onto the right atrium.
and hormones
b protection and defence 10 Where does the blood supply to the arm start?
c synthesis of vitamins A, D and E a at the brachial artery
d clotting b at the radial artery
c at the ulnar artery
4 What is the function of an artery?
d at the subclavian artery
a to carry oxygenated blood
b to carry blood under high pressure Exam-style questions
c to carry blood away from the heart
d all of the above 11 State two functions of the cardiovascular
system. 2 marks
5 Which of the following statements is false?
a Veins carry deoxygenated blood. 12 List the four main functions of blood.
b Veins are generally superficial. 4 marks
c Veins do not have valves. 13 Describe one characteristic and one function
d Veins carry blood towards the heart. of each of the following types of blood cells:
6 What is the function of a capillary? a erythrocyte 2 marks
a to carry only deoxygenated blood b leucocyte 2 marks
b to carry only oxygenated blood c thrombocyte or platelet. 2 marks
c to prevent backflow of blood 14 Name the type of blood cell that is crucial
d to supply cells and tissues with nutrients to our immune system. 1 mark
7 What is the name of the blood vessel that 15 Briefly describe each of the following parts
carries deoxygenated blood from the heart of the circulation system:
to the lungs? a pulmonary circulation 2 marks
a pulmonary vein b systemic circulation 2 marks
b aorta
c pulmonary artery
d inferior vena cava
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7 The lymphatic
system and
immunity
Introduction
The lymphatic system is a unidirectional
drainage system for the tissues. It helps to
provide a circulatory pathway for tissue fluid.
This is transported as lymph from the tissue
spaces of the body into the venous system,
where it becomes part of the blood circulation.
Through the filtering action of the lymphatic
nodes, along with the actions of specific organs
such as the spleen, the lymphatic system also
helps to provide immunity against disease.
The human body is equipped with a variety
of defence mechanisms that prevent the entry
of foreign agents known as pathogens. This
defence is called immunity. When working
effectively, the immune system protects the
body from most infectious micro-organisms. It
does this both directly through cells that attack
micro-organisms and indirectly by releasing
chemicals and protective antibodies.
OBJECTIVES
● the functions of the lymphatic system
● the definition of lymph and how it is formed
● the connection between blood and lymph
● the circulatory pathway of lymph
● the lymphatic organs
● the names, positions and drainage of the

main lymphatic nodes of the head, neck
and the body
● lymphatic organs such as the spleen, tonsils
and thymus
● the immune system and response
● common pathologies of the lymphatic system

lymphatic and other body systems.
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In practice Functions of the lymphatic

It is essential for therapists to
have a working knowledge of
system
the lymphatic system in order
to understand the effects of
Drainage of excess fluid from the
lymphatic drainage on the tissues
tissues. Muscle tension can The lymphatic system is important for the distribution of fluid and
put pressure on the lymphatic nutrients in the body because it drains excess fluid from the tissues and
vessels and interfere with returns to the blood protein molecules which are unable to pass back
efficient drainage. Any through the blood capillary walls because of their size.
treatment which relaxes the soft
tissue, such as massage, can Fighting infection
help acclerate lymph drainage.
The lymphatic system plays an important part in the body’s immune
system.The lymphatic nodes help to fight infection by filtering lymph
and destroying invading micro-organisms. Lymphocytes are reproduced
in the lymph nodes and, following infection, they generate antibodies
to protect the body against subsequent infection.
Absorbtion of products of fat

digestion
The lymphatic system also plays an important part in absorbing the
products of fat digestion from the villi of the small intestine. While
the products of carbohydrate and protein digestion pass directly
into the bloodstream, fats pass directly into the intestinal lymphatic
vessels, known as lacteals.
What is lymph?
Lymph is a transparent, colourless, watery liquid which is derived from
intersitial (tissue) fluid and is contained within lymphatic vessels. It
resembles blood plasma in composition, except that it has a lower
concentration of plasma proteins. This is because some large protein
molecules are unable to filter through the cells forming the capillary
walls, so they remain in blood plasma. Lymph contains only one type
of cell and these are called lymphocytes.
How is lymph formed?

As blood is distributed under pressure to the tissues, some of the plasma
escapes from the capillaries and flows around the tissue cells, delivering
oxygen, water and nutrients to the cells and picking up cellular waste
such as urea and carbon dioxide. Once the plasma is outside the capillary
and is bathing the tissue cells, it becomes interstitial (or tissue) fluid.
Some of the interstitial fluid passes back into the capillary walls to return
to the bloodstream via the veins and some is collected by lymphatic
vessels, where it becomes lymph. Lymph is taken through its circulatory
pathway and is ultimately returned to the bloodstream.
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7 The lymphatic system and immunity
Arteriole Venule
Capillary
Plasma escapes capillary

to bathe tissue cells
Waste products pass
out of cell into
capillary
Nutrients pass into cells
Interstitial
tissue fluid
Excess fluid drains into lymph vessels
Filtered lymph
re-enters
bloodstream
Lymphatic vessel
(blind-ended tube)
Lymph node
p The connection between blood and lymph
The connection between blood

and lymph
Lung
Artery carrying blood
from heart to lungs
Vein carrying blood

from lungs to heart
Lymph capillary
Lymphatic vessels
Arteries carrying blood

Lymph node from heart to body tissues
Veins carrying blood from

body tissues to heart
Tissues around the body
p How the lymphatic system works
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The lymphatic system is often referred to as a ‘secondary circulatory system’ as it consists of a network of vessels
that assist the blood in returning fluid from the tissues back to the heart. In this way, the lymphatic system is
complementary to the circulatory system. After draining the tissues of excess fluid, the lymphatic system returns
this fluid to the cardiovascular system. This helps to maintain blood volume and blood pressure and prevent oedema.
The circulatory pathway of lymph

Structures of the lymphatic system
The lymphatic system contains the following structures which are discussed in more detail in Table 7.1.
● lymphatic capillaries
● lymphatic vessels
● lymphatic nodes
● lymphatic collecting ducts.
Overview of the structures of the lymphatic system

Table 7.1 The structures of the lymphatic system
Structure Description Function

Lymphatic Very small blind-ended tubes, similar in structure to Drain away excess fluid and waste
capillaries blood capillaries products from the tissue spaces of the
body
Lymphatic Similar in structure to veins; have one-way valves and Carry the lymph towards the heart
vessels thin collapsible walls
Lymphatic Oval or bean-shaped structures made of lymphatic Filter lymph, removing micro-organisms,
nodes tissue and covered by a capsule of connective tissue cell debris and other harmful substances
Lymphatic ducts The thoracic duct is the largest lymphatic vessel in the Collect lymph from the whole body and
(thoracic and body and extends from the second lumbar vertebra up return it to the blood via the subclavian
right lymphatic) through the thorax to the root of the neck veins
The right lymphatic duct, at the root of the neck, is
very short in length
Lymphatic capillaries
Tissue spaces
Tissue fluid
Arteriole
Venule
Lymph
capillary
Tissue cells
Lymphatic
vessel
p Lymph capillaries in tissue spaces
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The lymphatic system is a one-way circulatory Networks or plexuses of lymphatic channels exist
pathway. Lymphatic vessels commence as lymphatic throughout the body. These intertwined channels are
capillaries (very small blind-ended tubes) in the found in the following areas:
tissue spaces of the body. The walls of the lymphatic ● mammary plexus – lymphatic vessels around
capillaries are like those of the blood capillaries in the breasts
that they are a one cell thick, making it possible for
● palmar plexus – lymphatic vessels in the palm
tissue fluid to enter. However, they are permeable
of the hand
to substances of larger molecular size than those
● plantar plexus – lymphatic vessels in the sole
of the blood capillaries.
of the foot.
The lymphatic capillaries mirror the blood
The lymphatic vessels carry the lymph towards the
capillaries and form a network in the tissues,
heart under steady pressure; about two to four litres
draining away excess fluid and waste products
of lymph pass into the venous system every day.
from the tissue spaces of the body. Once the
Once lymph has passed through the lymph vessels,
tissue fluid enters a lymphatic capillary it becomes
it drains into at least one lymphatic node before
lymph and is then collected into larger lymphatic
returning to the blood circulatory system.
vessels.
KEY FACT
KEY FACT As the lymphatic system lacks a pump,
The term oedema refers to an excess of fluid lymphatic vessels make use of contracting
within the tissue spaces that causes the tissues muscles to assist the movement of lymph.
to become swollen. Therefore, lymphatic flow is at its greatest
during exercise when there is increased
contraction of muscle.
Lymphatic vessels
Lymphatic Lymphatic nodes
vessel Afferent
lymphatic vessel
Endothelial
cell
Capsule
Closed Inner medulla

valve
Efferent
lymphatic
vessels
Vascular supply
for lymph node
p A lymphatic vessel
Outer cortex
Lymphatic vessels are similar to veins in that they
Afferent
have thin, collapsible walls and their role is to
lymphatic
transport lymph through its circulatory pathway. vessels
They have a considerable number of valves, which
p A lymphatic node
help to keep the lymph flowing in the right direction
by preventing backflow. Superficial lymphatic vessels Lymphatic nodes occur at intervals along the lymphatic
tend to follow the course of veins by draining the vessels. A lymphatic node is an oval or bean-shaped
skin, whereas the deeper lymphatic vessels tend to structure covered by a capsule of connective tissue.
follow the course of arteries, draining the internal It consists of lymphatic tissue and is divided into two
structures of the body. regions: an outer cortex and an inner medulla.
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There are more than 100 lymphatic nodes in specific

KEY FACT
locations along the course of the lymphatic vessels.
If an area of the body becomes inflamed or
They vary in size from 1 to 25 mm in length and are otherwise diseased, the nearby lymph nodes
massed in groups. Some are superficial and lie just swell up and become tender, indicating that
under the skin, whereas others are deeply seated and they are actively fighting the infection.
are found near arteries and veins.
Each lymphatic node receives lymph from several Once filtered, the lymph leaves the node by one
afferent lymphatic vessels and blood from small or two efferent vessels which open away from the
arterioles and capillaries. The valves of the afferent node. Lymphatic nodes occur in chains so that the
lymphatic vessels open towards the node, so that efferent vessel of one node becomes the afferent
lymph in these vessels can only move towards the vessel of the next node in the pathway. Lymph
node. Lymph flows slowly through the node, moving drains through at least one lymphatic node before
from the cortex to the medulla, and leaves through it passes into two main collecting ducts and is
an efferent vessel which opens away from the node. returned to the blood.
The function of a lymphatic node is to act as a filter
of lymph – to remove or trap any micro-organisms,
Cisterna chyli
cell debris or harmful substances which may cause The cisterna chyli is a large lymphatic vessel situated
infection, so that when lymph enters the blood at the lower end of the thoracic duct. It is part of
it has been cleared of any foreign matter. When the lymphatic drainage for the abdomen, as it drains
lymph enters a node, it comes into contact with two lymph laden with digested fats (chyle) from the small
specialised types of leucocytes: intestine. It also acts like a reservoir as it receives and
temporarily stores the chyle before it is collected by
● macrophages – phagocytic in action, these engulf
the thoracic duct.
and destroy dead cells, bacteria and foreign
material in the lymph
● lymphocytes – reproduced within the lymphatic
nodes, these neutralise invading bacteria and
produce chemicals and antibodies to fight disease.
Right lymphatic duct
Thoracic duct
Left subclavian vein
Right subclavian vein
Key
Drained by thoracic duct
Drained by right lymphatic duct
216 p Lymphatic ducts
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Lymphatic ducts
Activity
From each chain of lymphatic nodes, the efferent lymph vessels combine
Produce index cards with the
to form lymphatic trunks which empty into two main ducts:
name of a structure in the
● the thoracic duct lymphatic system on each
● the right lymphatic duct. one. Include a description and
These ducts collect lymph from the whole body and return it to the the functions of each system.
blood via the subclavian veins. Divide into groups and put the
cards in order of their structures
The thoracic duct is the main collecting duct of the lymphatic system. It in the circulatory pathway.
is the largest lymphatic vessel in the body and extends from the second
lumbar vertebra up through the thorax to the root of the neck. The
thoracic duct collects lymph from the left side of the head and neck, left
arm, lower limbs and abdomen and drains into the left subclavian vein to
return it to the bloodstream.
The right lymphatic duct is very short in length. It lies in the root of the
neck and collects lymph from the right side of the head and neck and
the right arm and drains into the right subclavian vein to be returned to
the bloodstream.
Lymphatic drainage
Movement of lymph throughout the lymphatic system is known as
lymphatic drainage and it begins in the lymphatic capillaries. The
movement of lymph out of the tissue spaces and into the lymphatic
capillaries is assisted by:
● the pressure exerted by the skeletal muscles against the vessels during
movement
● changes in internal pressure during respiration
● the compression of lymph vessels from the pull of the skin and fascia
during movement.
Lymphatic drainage of the head and KEY FACT

neck Factors such as muscle tension
put pressure on the lymphatic
The main groups of lymphatic nodes in the head and neck are as vessels and may block them,
follows: interfering with efficient
● buccal nodes drainage. Taking slow deep
breaths can help to stimulate
● cervical nodes (deep)
lymphatic flow.
● cervical nodes (superficial)
● mastoid nodes (post auricular)
● occipital nodes
● parotid nodes (anterior auricular)
● submandibular nodes
● submental nodes.
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Mastoid nodes
Parotid nodes
Buccal nodes
Occipital nodes
Submental nodes
Superficial cervical
nodes
Deep cervical nodes
Submandibular
nodes
p Lymphatic nodes of the head and neck
Table 7.2 Lymphatic node groups of the head and neck
Name of
lymphatic nodes Position Areas from which lymph is drained
Buccal nodes Located superficially to the buccinator muscle Lower eyelid and anterior of the cheek
in the cheek
Cervical nodes Deep within the neck, located along the path Larynx, oesophagus, posterior of the scalp
(deep) of the larger blood vessels (carotid artery and and neck, superficial part of the chest and arm
internal jugular vein)
Cervical nodes Located at the side of the neck, over the Lower part of the ear and the cheek region
(superficial) sternomastoid muscle
Mastoid nodes Behind the ear in the region of the mastoid Skin of the ear and the temporal region of the
(post auricular) process scalp
Occipital nodes At the base of the skull Back of scalp and the upper part of the neck
(ox-sip-it-tal)
Parotid nodes At the angle of the jaw Nose, eyelids and ear
(anterior
auricular)
Submandibular Underside of the jaw on either side Chin, lips, nose, cheeks (submaxillary salivary
nodes gland), tongue, mucous membrane that covers
the eyeball and under surface of the eyelid
Submental Middle of the neck under the chin Central lower lip, the floor of the mouth and
nodes the apex of the tongue
KEY FACT
Swollen submandibular nodes usually indicate an active viral or
bacterial infection and are commonly associated with infections of
the sinuses, eyes and ears.
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Lymphatic drainage of the body
Right lymphactic duct
Cervical nodes
Axillary nodes
Thoracic duct
Thoracic nodes
Abdominal nodes
Cubital/suptratrochlear
nodes
Cisterna chyli
Pelvic nodes
Inguinal nodes
Popliteal nodes
p Lymphatic nodes of the body
Lymph nodes are mainly clustered at joints, which The main groups of lymphatic nodes relating to the
assist in pumping lymph through the nodes when the body are as follows:
joint moves. The superficial lymph nodes are most ● cervical nodes (deep)
numerous in the groin, axillae and neck. Most of the
● cervical nodes (superficial)
deep lymph nodes are found alongside blood vessels
● axillary nodes
of the pelvic, abdominal and thoracic cavities.
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● supratrochlear/cubital nodes ● pelvic nodes

● thoracic nodes ● inguinal (in-gwine-nal) nodes
● abdominal nodes ● popliteal (pop-lit-tee-al) nodes.
Table 7.3 Lymphatic node groups of the body
Name of lymphatic nodes Position Area from which lymph is drained

Cervical nodes (deep) Deep within the neck, located along Larynx, oesophagus, posterior of the scalp and
the path of the larger blood vessels neck, superficial part of the chest and arm
Cervical nodes (superficial) Located at the side of the neck over Lower part of the ear and cheek region
the sternomastoid muscle
Axillary nodes In the underarm region Upper limbs, wall of the thorax, breasts,
upper wall of the abdomen
Supratrochlear In the elbow region (medial side) Upper limbs, passing through the axillary
(soo-pa- trok-lee-er) nodes
or cubital nodes
Thoracic nodes Within the thoracic cavity and along Organs of the thoracic cavity and from the
the trachea and bronchi internal wall of the thorax
Abdominal nodes Within the abdominal cavity along Organs within the abdominal cavity
the branches of the abdominal aorta
Pelvic nodes Within the pelvic cavity, along the Organs within the pelvic cavity
paths of the iliac blood vessels
Inguinal (in-gwine-nal) In the groin Lower limbs, external genitalia and lower
node abdominal wall
Popliteal (pop-lit-tee-al) Behind the knee The lower limbs through deep and
node superficial nodes
KEY FACT
Thoracic lymph nodes are separated into two types:
● parietal lymph nodes – located in the thoracic wall
● visceral lymph nodes – associated with the internal organs.
Due to their location, abnormalities of the lymph nodes in the thorax, or chest, are not easily detected.
Study tip
It is helpful to think of the lymphatic system as a unidirectional (one-way) drainage system. Although the lymphatic
system works alongside the blood circulation, lymph is carried one way, back towards the heart, whereas blood is
carried to and from the heart.
When thinking of the circulatory pathway, remember the following key functions:
1 Drainage – the lymphatic capillaries drain the tissues spaces of excess fluid.
2 Transport – the lymphatic vessels transport lymph back towards the heart.
3 Filter – the lymphatic nodes filter the lymph of impurities.
4 Collect – the lymphatic ducts collect the lymph before it enters the venous system via the subclavian veins.
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Summary of the circulatory The spleen is the largest of the lymphatic organs
and is located in the left-hand side of the abdominal
pathway of lymph cavity between the diaphragm and the stomach. As
● Plasma escapes the blood capillaries and bathes the spleen is largely a mass of lymphatic tissue, it
the tissue cells. contains lymph nodes, which produce lymphocytes
and macrophages.
● Excess fluid flows through a network of lymphatic
capillaries. The spleen:
● Tissue fluid enters lymph vessels, where it ● is a major site for filtering out worn-out red blood
becomes lymph. cells and destroying micro-organisms that are
circulating in the blood
● Larger lymphatic vessels lead to lymph nodes.
● is concerned with protection from disease and
● Lymph passes through at least one lymphatic
the manufacture of antibodies. It functions
node, where it is filtered.
with the lymphatic system by storing lymphocytes
● Filtered lymph is collected into lymphatic ducts. and releasing them as part of the immune
● Collected lymph is drained into the venous system response
via the subclavian veins. ● serves as a blood reservoir and can release small
amounts of blood into the circulation during times
Lymphatic organs of emergency or blood loss.
Lymphatic organs, whose functions are closely related
to those of the lymph nodes, are the spleen, tonsils
and thymus.
Tonsils
Spleen
p The tonsils
The tonsils are composed of lymphatic tissue, and
are located in the oral cavity and the pharynx. There
are three different sets of tonsils, all of which provide
defence against micro-organisms that enter the
mouth and nose:
● the palatine tonsils – commonly identified as the
tonsils and are located at the back of the throat,
one on each side
● the pharyngeal tonsils – known as the
adenoids, and lie on the wall of the nasal part of
the pharynx
p The spleen ● the lingual tonsils – found below the tongue.
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Thymus The human body has a variety of different defence

mechanisms. Some are non-specific in that they do
not differentiate between one threat and another.
Others are specific as the body mounts its defence
against a particular kind of threat.
Non-specific immunity
Non-specific immunity is programmed genetically
in the human body from birth. The non-specific
defences that are present from birth include:
● mechanical barriers
● chemicals
● inflammation
● phagocytosis
● fever.
Mechanical barriers
These are barriers such as the skin and mucous
membranes that line the tubes of the respiratory,
digestive, renal and reproductive systems. As long as
these barriers remain unbroken, many pathogens are
p The thymus
unable to penetrate them.
The thymus gland is a triangular-shaped gland The respiratory system is lined with mucus-secreting
composed of lymphatic tissue. It is located in cells to help remove micro-organisms from the
the upper chest above the superior vena cava respiratory tract. The highly acidic environment in the
and below the thyroid, where it lies against the stomach can help to kill pathogens; saliva also has an
trachea. The function of the thymus is important antimicrobial effect. Urine helps to deter the growth
in newborn babies in promoting the development of micro-organisms in the genito-urinary tract.The pH
and maturation of certain lymphocytes and in of the vagina protects against the multiplication and
programming them to become T-cells (specialised growth of microbes.
types of lymphocytes of the immune system,
page 177). The thymus gland begins to atrophy Chemicals
after puberty and becomes only a small remnant of Chemicals are released by different cells that play an
lymphatic tissue in adulthood. important role in immunity. There are many different
types of chemicals that are involved in immunity
The immune system including interferons, complements and histamine.
The immune system is not a specific structural Interferons
organ system but more of a functional system. These proteins are produced by cells that are
It draws on the structures and processes of each infected by viruses. Interferons form antiviral
of the organs, tissues and cells of the body and proteins to help protect uninfected cells and
the chemicals produced in them to eliminate any inhibit viral growth. There are three types of
pathogen, foreign substance or toxic material human interferon:
that can be damaging to the body. Immunity can, ● alpha (from white blood cells)
therefore, be defined as the ability of the body to
● beta (from fibroblasts)
resist infection and disease by the activiation of
specific defence mechanisms. ● gamma (from lymphocytes).
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Complements Macrophage detects bacteria
Complements are blood proteins that combine to

create substances which stimulate phagocytes
Bacteria
to ingest bacteria.
Histamine
This chemical is released by a variety of tissue cells, Macrophage
surrounds bacteria
including mast cells, basophils (a type of white blood
cell) and platelets. The release of histamine causes
vasodilation to bring more blood to an area of injury or
infection. It also increases vascular permeability to allow
fluid to enter the damaged area and dilute any toxins.
Inflammation Macrophage engulfs

Inflammation is a sequence of events involving bacteria and digests
chemical and cellular activation that destroys them
pathogens and aids in the repair of tissues. It is a tissue

p Phagocytosis
response and symptoms include localised redness,
swelling, heat and pain. The major actions that occur
during an inflammation response include the following. Fever
● Blood vessels dilate, resulting in an increase in blood An individual is said to have a fever if their body
volume (hyperaemia) to the affected area. temperature is maintained above 37.28 °C (99 °F).
The increase in temperature during a fever tends to
● Capillary permeability increases, causing tissues
inhibit some viruses and bacteria. It also speeds up
to become red, swollen, warm and painful.
the body’s metabolism and, thereby, increases the
● White blood cells invade the area and help to activity of defence cells.
control pathogens by phagocytosis.
● In the case of bacterial infections, pus may form. Specific immunity
● Body fluids collect in the inflamed tissues. These
fluids contain fibrinogen and other blood factors
that promote clotting. Antibody
● Fibroblasts may appear and a connective tissue sac
may be formed around the injured tissues.
● Phagocytic cells remove dead cells and other
debris from the site of inflammation. Antigen
● New cells are formed by cellular reproduction

to replace dead or injured ones.
Phagocytosis Antibody attaches to antigen and destroys bacteria
Neutrophils and monocytes are the most active

phagocytic cells of the blood. Neutrophils are
able to engulf and ingest smaller particles, while
monocytes can phagocytise larger ones. Monocytes
give rise to macrophages (large scavenger cells),
which become fixed in various tissues and may
be attached at the inner walls of the blood and p The antibody defence system
lymphatic vessels.
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Immunity involves interaction between two types ● cell-mediated immunity – effected by helper
of molecule: T-cells, suppressor T-cells and natural killer (NK)
● an antigen – any substance that the body regards cells that recognise and respond to certain
as foreign or potentially dangerous and against antigens to protect the body against their effects.
which elicits antibody production Lymphocytes develop in the following three ways:
● an antibody – a specific protein produced to 1 T-cells develop in the bone marrow and
destroy or suppress an antigen. grow in the thymus gland. They are able to
Antibodies circulate in the blood and tissue fluid, killing recognise antigens and respond by releasing
bacteria or making them harmless. Antibodies can also inflammatory and toxic materials. Specialised
neutralise poisonous bacterial chemicals called toxins. T-cells also regulate the immune response, either
Specific immunity is the ability to recognise certain by amplifying the response (T4 cells) or by
antigens and destroy them. It involves responses suppressing the body’s response (T8 cells). Some
that are particular to each identified foreign body or T-cells develop into memory cells and handle the
unusual substance and calls on special memory cells secondary response on re-exposure to antigens
to help if the foreign body or substance reappears. that have already produced a primary response.
The body must be able to identify which foreign 2 B-cells grow and develop in the bone marrow.
bodies and substances cause a threat before any B-cells contain immunoglobulin, an antibody
type of response can be initiated. that responds to specific antigens. Some B-cells
modify and become non-antigen specific, which
How antibodies work means that they have a greater ability to respond
Antibodies work in many different ways. to bacterial and viral pathogens. Some B-cells
become memory cells and are able to deal with
● Some neutralise antigens by combining with
re-exposure to antigens.
them and preventing them from carrying out
their usual effects. 3 A type of lymphocyte that does not develop the
same structural or functional characteristics as
● Others may lyse (destroy) the cell on which the
the T-cells or B-cells are the NK cells. They also
antigen is present.
develop in the bone marrow and when mature
● When some antibodies bind to antigens on
can attack and kill tumour cells and virus-infected
the surface of bacteria, they attract other white
cells during their initial developmental stage,
blood cells like macrophages to engulf the
before the immune system is activated.
bacteria.
The key cells of specific immunity are a specialised Primary and secondary
group of white blood cells called lymphocytes. They responses of the immune
are capable, not only of recognising foreign agents,
but also of ‘remembering’ the agents they have
system
encountered before. They are able to react more The initial response of the body on first exposure to
rapidly and with greater force if they encounter antigens is called the primary response. It normally
the agent again. takes about two weeks after exposure to the antigen
for antibody levels to peak. This is due to the fact
The immune response that B-cells have to become converted to plasma
cells that secrete antibodies specifically against
There are two types of immune response produced the antigen.
by different types of lymphocytes:
If the individual is exposed to the antigen for a second
● humoural immunity – involves the B-cells, which time, the presence of memory cells stimulates rapid
produce free antibodies that circulate in the production of antibodies (known as the secondary
bloodstream response). Antibody levels are much higher than
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in the primary response and remain elevated for a swelling (oedema), constriction of the bronchioles,
very long time. Secondary response can occur even heart failure and circulatory collapse and may even
if many years have elapsed since the first exposure result in death.
to the antigen.
Immunisation
Common pathologies
The body may be artificially stimulated into
of the lymphatic
producing antibodies (known as immunisation). This
prepares the body in advance to ward off infection.
system
It is carried out by inoculating an individual with a Acquired immune deficiency syndrome
vaccine (a liquid containing antigens powerful enough (AIDS)
to stimulate antibody formation without causing This condition results from infection with the human
disease or harm). immunodeficiency virus (HIV), which progressively
destroys the immunity of the individual. The HIV
KEY FACT virus suppressses the body’s immune response,
Vaccines have been developed against many allowing opportunist infections to take hold, and
diseases, including diphtheria, polio, tetanus, results in AIDS.
whooping cough and measles.
AIDS patients are more vulnerable to infections than
those without the condition. Infections that usually
Allergy produce mild symptoms in healthy individuals may
Under certain circumstances allergic reactions produce severe symptoms in AIDS patients. Sufferers
(abnormal responses) may occur when a foreign have an increased risk of developing Kaposi sarcoma,
substance, or antigen, enters the body. An allergic non-Hodgkin lymphoma and cancer of the cervix.
reaction can only occur if the person has already AIDs is caused by contact with infected blood or
been exposed to the antigen at least once and has body fluids. It can be passed on via unprotected sex
developed an antibody to it. or through the sharing of unsterilised needles.
The type and severity of an allergic reaction depends Hodgkin’s disease
on the strength and persistence of the antibody
This is a malignant disease of the lymphatic tissues,
evoked by previous exposure to the antigen.
usually characterised by painless enlargement of one
These antibodies are located on the cells in the
or more groups of lymph nodes in the neck, armpit,
skin or mucous membranes of the respiratory and
groin, chest or abdomen. The spleen, liver, bone
gastrointestinal tracts.
marrow and bones may also be involved. Apart from
the enlarged nodes, there may also be weight loss,
In practice fever, profuse sweating at night and itching.
Typical antigens include pollen, dust, feathers,
wool, fur, certain foods and drugs. Be aware of In practice
products that can trigger allergic reactions.
Advice from the client’s consultant physician
is necessary before undertaking any form of
Allergic reactions may cause symptoms of hayfever, treatment. It is inadvisable to treat if a client is
asthma, eczema, urticaria and contact dermatitis. If debilitated; otherwise, clients may benefit from
there is much cellular damage, excessive amounts a gentle and relaxing treatment.
of histamine may be released causing circulatory
Note that clients are vulnerable to infection due
failure (anaphylaxis). Anaphylactic shock is an
to reduced immunity and that there is a risk
extreme and generalised form of allergic reaction,
of spreading the disease through lymphatic drainage.
whereby widespread release of histamine causes
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Lupus erythematosus Oedema

This is a chronic inflammatory disease of connective This is an abnormal swelling of body tissues due
tissue affecting the skin and various internal organs. It to an accummulation of tissue fluid. It can be the
is an autoimmune disease and can be diagnosed by the result of heart failure, liver or kidney disease or
presence of abnormal antibodies in the bloodstream. chronic varicose veins. The swelling of tissues may
Typical signs are a red, scaly rash on the face, arthritis be localised, if the oedema is caused by injury or
and progressive damage to the kidneys. Often the inflammation, or may be more generalised, if it is
heart, lungs and brain are affected by progressive caused by heart or kidney failure.
attacks of inflammation, followed by the formation Subcutaneous oedema commonly occurs in the legs
of scar tissue. It can also cause psychiatric illness due and ankles due to the influence of gravity, and is a
to direct brain involvement. common problem in women before menstruation and
in the last trimester of pregnancy.
In practice
Care is required when treating patients with lupus In practice
erythematosus as skin lesions might be tender, and
joint pain and tenderness may be present. Remember that oedema is symptomatic of many
disease processes (particularly cardiovascular
Avoid contact if you are suffering from any infectious disease). Therefore, seek advice from the client’s
illness, as medication for this condition can suppress GP before offering any form of treatment.
immunity and clients can be prone to infection.
Interrelationships with Muscular

other systems The action of skeletal muscles aids lymphatic drainage.
Circulatory
The lymphatic system The lymphatic system aids the circulatory system in
The lymphatic system links to the following body that it assists the blood in returning fluid from the
systems. tissues back to the heart.
Cells and tissues Respiratory

Lymphatic tissue is a specialised type of tissue Low pressure in the thorax created by breathing
found in lymph nodes, spleen, tonsils, the adenoids, movements aids the movement of lymph.
walls of the large intestine and glands in the small
intestine.
Digestive
The lymphatic system plays an important part
Skin in absorbing the products of fat digestion from
Lymph vessels are numerous in the dermis of the the villi of the small intestine.
skin. They form a network allowing the removal
of waste from the skin’s tissues.
Skeletal
Red bone marrow is responsible for the development
of cells found in both blood and lymph.
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Key words Non-specific immunity: a type of immunity

programmed genetically from birth
Abdominal node: a type of lymphatic node within Occipital nodes: a type of lymphatic node located
the abdominal cavity along the branches of the at the base of the skull
abdominal aorta
Oedema: abnormal swelling of the body’s tissues
Allergic reaction: when the immune system due to an accumulation of tissue fluid
overreacts to a harmless allergen
Parotid nodes: a type of lymphatic node located at
Antibody: a specific protein produced to destroy or the angle of the jaw
suppress antigens
Popliteal nodes: a type of lymphatic node located
Antigen: any substance that the body regards as at the back of the knee
foreign or potentially dangerous and against which
it produces an antibody Right lymphatic duct: the lymphatic duct that
collects lymph from the right side of the head and
Axillary nodes: a type of lymphatic node located neck and the right arm and drains into the right
under the arm subclavian vein
Buccal nodes: a type of lymphatic node located in Specific immunity: the production of antibodies
the cheek against a particular antigen
Cisterna chyli – a large lymphatic vessel situated Spleen: the largest of the lymphatic organs,
at the lower end of the thoracic duct concerned with protection from disease and the
Deep cervical nodes: a type of lymphatic node manufacture of antibodies
located deep within the neck, along the path of Subclavian veins: a type of vein in the arm into
the larger blood vessels which lymph drains
Immunisation: artificial stimulation of the body to Submandibular nodes: a type of lymphatic node
produce antibodies located under the chin
Immunity: the body’s ability to resist infection Superficial cervical nodes: a type of lymphatic
Inguinal nodes: a type of lymphatic node located node located at the side of the neck over the
in the groin sternomastoid muscle
Lacteals: intestinal lymphatic vessels Suptratrochlear nodes: a type of lymphatic node
Lymph: a transparent, colourless, watery liquid in the elbow region (medial side)
derived from tissue fluid Thoracic duct: the main collecting duct of the
Lymphatic capillaries: very small blind-ended lymphatic system
tubes that arise in the tissue spaces of the body Thoracic nodes: a type of lymphatic node within
Lymphatic ducts: one of two lymphatic vessels the thoracic cavity and along the trachea and
(right lymphatic and thoracic ducts) that collect bronchi
and empty lymph into the circulatory system via Thymus: a gland composed of lymphatic tissue
the subclavian veins located in the upper chest; important in promoting
Lymphatic nodes: oval or bean-shaped structures the development and maturation of the lymphatic
that filter lymph system in newborn babies
Lymphatic vessels: thin-walled, valved structures Tissue (interstitial) fluid: intercellular fluid located
that carry lymph between the cells of the body tissues
Mastoid nodes: lymphatic nodes found behind Tonsils: a type of lymphatic tissue located in the
the ear oral cavity and the pharynx; there are three pairs
(palatine, pharyngeal, lingual)
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Revision summary collects lymph from the left side of the head and
neck, left arm, lower limbs and abdomen, and the
The lymphatic system right lymphatic duct, which collects lymph from the
right side of the head and neck and the right arm.
● The lymphatic system is closely associated with
the cardiovascular system. ● The collected lymph is then drained into the venous
system via the right and left subclavian veins.
● The lymphatic system assists the circulatory system
by draining the tissues of excess fluid and returning ● Other lymphatic organs include the spleen,
the fluid from the tissues back to the heart. This tonsils and thymus gland.
helps to maintain blood volume and blood pressure ● Immunity is the ability of the body to resist
and to prevent oedema (swelling of the tissues). infection and disease by the activation of defence
● The lymphatic system also plays an important mechanisms.
role in the body’s immune system, as the lymph ● There are two types of immunity – specific and
nodes fight infection and generate antibodies. non-specific.
● Non-specific immunity is programmed
● The lymphatic system also absorbs the products
of fat digestion through intestinal lymph vessels genetically from birth and includes mechanical
called the lacteals. barriers (skin and mucous membrane), chemicals,
inflammation, phagocytosis and fever.
● Lymph is a clear, colourless, watery fluid derived
● Specific immunity involves interaction
from tissue fluid and contained within lymph
between an antigen and an antibody.
vessels.
● An antigen is any substance that the
● Lymph is similar in composition to blood plasma body regards as foreign or potentially
except that it has a lower concentration of dangerous, and against which it produces
plasma proteins. an antibody.
● The circulatory pathway of lymph begins with ● An antibody is a specific protein produced
lymphatic capillaries, which lie in the tissue to destroy or suppress an antigen.
spaces between the cells. ● There are two types of immune response
● Tissue (interstitial) fluid drains into lymphatic produced by different types of lymphocytes –
capillaries, and this fluid becomes lymph. humoural immunity involving B-cells, which
● Lymphatic capillaries merge to form larger produce free antibodies that circulate in the
vessels called lymphatic vessels, which convey bloodstream, and cell-mediated immunity
lymph into and out of structures called lymph effected by helper T-cells, suppressor T-cells and
nodes. NK cells that recognise and respond to certain
● The main groups of lymph nodes relating to the antigens to protect the body against their effects.
head and neck include deep cervical, superficial ● Immunisation is the artificial stimulation of the
cervical, submandibular, occipital, mastoid and body to produce antibodies.
parotid nodes. ● An allergic reaction may occur when a foreign
● The main group of lymph nodes relating to the substance, or antigen, enters the body.
body include superficial cervical, deep cervical, ● An allergic reaction can only occur if the person
axillary, supratrochlear, thoracic, abdominal, has already been exposed to the antigen
pelvic, inguinal and popliteal nodes. at least once before and has developed an
● All lymph passes through at least one node, antibody to it.
● Antibodies are located on the cells in the skin
where it is filtered of cell debris, micro-organisms
and harmful substances. or mucous membranes of the respiratory and
gastrointestinal tracts.
● Once filtered, the lymph is collected into two main
● Typical antigens include pollen, dust, feathers,
ducts – the thoracic duct (the largest duct), which
wool, fur, certain foods and drugs.
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Test your knowledge 8 Which of the following drains lymph from the
lower limbs?
Multiple choice questions a cervical nodes
b axillary nodes
1 From which of these is lymph derived? c popliteal nodes
a plasma proteins d supratrochlear nodes
b tissue fluid
9 Which of the following nodes drain lymph
c blood plasma
from the back of the scalp and the upper part
d lymphocytes
of the neck?
2 Lymph is similar in composition to blood except a occipital
it has lower concentration of: b parotid
a water c deep cervical
b protein d superficial cervical
c waste
10 Where are axillary nodes situated?
d hormones.
a neck
3 Which of the following is not a function of the b groin
lymphatic system? c underarm
a production of lymphocytes d elbow
b prevention of oedema
c production of heat Exam-style questions
d absorption of fat 11 State two functions of the lymphatic system.
4 Which of the following cleanse lymph of foreign 2 marks
matter? 12 Name the type of cell that produces antibodies.
a lymphatic vessel 1 mark
b lymphatic node
13 Name the lymph nodes that drain lymph from
c lymphatic capillary
the lower limbs, external genitalia and lower
d lymphatic duct
abdominal wall. 1 mark
5 From which type of tissue are lymph nodes made?
14 Name the lymph nodes located in the elbow
a areolar tissue
region. 1 mark
b adipose tissue
15 a Name the type of vessel that enters a lymph
c lymphatic tissue
node. 1 mark
d yellow elastic tissue
b Name the type of vessel that exits a lymph
6 Which of the following statements best describes node. 1 mark
the structure of a lymph vessel?
16 State two structural features of lymphatic vessels.
a thick muscular tubes with no valves
2 marks
b thin muscular tubes with no valves
c thick collapsible walls with valves
d thin collapsible walls with valves
7 Which of these promote lymph flow?
a pressure exerted by skeletal muscles
during movement
b compression of lymph vessels from the pull
of the skin and fascia during movement
c changes in internal pressure during
respiration
d all of the above
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8 The respiratory
system
Introduction
The respiratory system consists of the nose,
nasopharynx, pharynx, larynx, trachea,
bronchi and lungs, which together provide
the passageway for air, in and out of the body.
Oxygen is needed for survival by every cell of
the body. Respiration is the process by which
the living cells of the body receive a constant
supply of oxygen and by which carbon dioxide
is removed. Our respiratory system serves us
in many ways, exchanging oxygen and carbon
dioxide, detecting smell, producing speech and
regulating pH.
OBJECTIVES
● the functions of the respiratory system
● the structure and functions of the main

parts of the respiratory system
● the process of the interchange of gases
in the lungs
● the mechanisms of external and internal
respiration
● the theory of olfaction
● the importance of correct breathing
● pathologies of the respiratory system

respiratory and other body systems.
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8 The respiratory system
Functions of the respiratory In practice

system It is important for therapists
to have a good knowledge of
The primary role of the respiratory system is to provide oxygen to the respiratory system in order
the body’s cells while also removing carbon dioxide; other functions to understand how breathing
include providing a sense of smell, speech and helping to maintain may be affected during a
homeostasis. treatment. A massage, for
● Exchange of gases – oxygen and carbon dioxide exchange is the instance, deepens respiration
primary function of the respiratory system and is necessary in order and improves lung capacity by
to sustain life. relaxing any tightness in the
● Olfaction – specialised nerve endings embedded in the nasal cavity respiratory muscles.
send impulses for the sense of smell to the brain. Understanding the mechanism
● Speech – the vocal cords in the larynx aid in producing speech. of breathing helps therapists
when teaching clients deep
● Homeostasis – the respiratory system has homeostastic functions in
breathing exercises as part
that it maintains the oxygen and carbon dioxide levels in the blood
of a stress management or
and it also dissipates heat.
relaxation programme.
The structures of the

respiratory system
Naso-pharynx
(nasal cavity) Pharynx
Epiglottis
Larynx Oesophagus
Trachea
Right lung Left lung
Bronchioles
Ribs
Bronchus
Pleural cavity
Intercostal muscles
Pleural membrane
p Structures of the respiratory system
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Overview of the structures Study tip

of the respiratory system When studying structures of the respiratory system
it helps to think of a tree with branches.
The respiratory system contains the following
● Air is breathed in through the nose and travels
structures, as discussed in Table 8.1.
down the pharynx and larynx.
● nose ● It travels from the larynx to the trachea, which is
● nasopharynx the trunk of the tree.
● pharynx ● The trachea then divides into two branches
(right and left bronchi), which then subdivide
● larynx
into bronchioles (imagine these as smaller
● trachea branches and twigs) inside the lungs.
● bronchi ● At the end of the bronchioles are the tiny air
● lungs. sacs. The alveoli are where the lungs and the
bloodstream exchange carbon dioxide and
oxygen. Alveoli are like the leaves of the tree.
Table 8.1 The structures of the respiratory system
Structure Description Function

Nose Lined with cilia and mucous membrane Inhales air
Moistens, warms and filters the air
Senses smell
Nasopharynx Upper part of the nasal cavity behind the nose, Continues to filter, warm and moisten the
lined with mucous membrane incoming air
Pharynx Large, muscular tube lined with mucous membrane Acts as a passageway for air, food and drink
(far-rink-s) Lies behind the mouth and between the nasal Resonating chamber for sound
cavity and the larynx
Larynx Short passage connecting the pharynx to the Provides a passageway for air between the
(lar-rink-s) trachea pharynx and the trachea
Produces sound
Trachea Tube anterior to the oesophagus, extends from the Transports air from the larynx into the
(trak-kee-a) larynx to the upper chest bronchi
Composed of smooth muscle and up to 20
c-shaped rings of cartilage
Bronchi Two short tubes (similar in structure to the trachea) Carry air into the lungs
which lead to each lung
Lungs Cone-shaped spongy organs situated in the Facilitate the exchange of the gases oxygen
thoracic cavity on either side of the heart and carbon dioxide
The nose The nasopharynx

The nose is divided into the right and left cavities. The nasopharynx is the upper part of the nasal cavity
It is lined with tiny hairs called cilia, which begin behind the nose and is lined with mucous membrane.
to filter the incoming air, and mucous membrane, The Eustachian tubes from the middle ears open into
which secretes a sticky fluid called mucus to prevent the nasopharynx so that air pressure inside the ear
dust and bacteria from entering the lungs. The nose can be adjusted to prevent damage to the eardrum. At
moistens, warms and filters the air and is an organ the back of the nasopharynx there is lymphoid tissue,
which senses smell. including the adenoids. Due to the close proximity of
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the Eustachian tubes to the throat, throat infections cavity with rigid walls. It contains the vocal cords and
can easily spread to the ear. stiff pieces of cartilage, such as the Adam’s apple,
which prevent collapse and obstruction of the airway.
KEY FACT The vocal cords are bands of elastic ligaments that
The sinuses are air-filled spaces located within are attached to the rigid cartilage of the larynx by
the maxillary, frontal, ethmoid and sphenoid skeletal muscle. When air passes over the vocal cords
bones of the skull. These spaces open into
they vibrate and produce sound. The opening into the
the nasal cavity and are lined with mucous
membrane, which is continuous with the lining larynx from the pharynx is called the glottis. During
of the nasal cavity. Consequently, mucous the process of swallowing, the glottis is covered by
secretions can drain from the sinuses into a flap of tissue called the epiglottis which prevents
the nasal cavity. If this drainage is blocked by food from ‘going down the wrong way’. The larynx
membranes that are inflamed and swollen provides a passageway for air between the pharynx
because of nasal infections or allergic reactions,
and the trachea.
the pressure of the accumulating fluids may
cause a painful sinus headache.
The trachea
The nasopharynx continues to filter, warm and moisten The trachea, or windpipe, is a tube anterior to the
the incoming air. oesophagus that extends from the larynx to the
upper chest. It is composed of smooth muscle and up
The pharynx to 20 c-shaped rings of cartilage, which serve a dual
The pharynx or throat is a large muscular tube lined purpose. The incomplete section of the ring allows
with mucous membrane that lies behind the mouth the oesophagus to expand into the trachea when a
and between the nasal cavity and the larynx. The food bolus is swallowed and the rings help to keep
tonsils are found at the back of the pharynx. The the trachea permanently open. The trachea passes
pharynx serves as an air and food passage but down into the thorax and connects the larynx with
cannot be used for both purposes at the same the bronchi, which pass into the lungs.
time, otherwise choking results. Air is warmed and
moistened further as it passes through the pharynx. The bronchi
The bronchi are two short tubes similar in structure
The larynx to the trachea that carry air into each lung. They are
The larynx (voice box) is a short passage connecting lined with mucous membrane and ciliated cells and,
the pharynx to the trachea. The larynx is a box-like like the trachea, contain cartilage to hold them open.
anterior view lateral view
1 Frontal sinuses
2 Ethmoidal sinuses
3 Sphenoidal sinuses
4 Maxillary sinuses
p The paranasal sinuses
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The mucus traps solid particles and cilia move them upwards, preventing
dirt from entering the delicate lung tissue. The bronchi subdivide into
bronchioles in the lungs. These subdivide yet again and finally end in very
small air-filled sacs called alveoli.
The lungs
The lungs are paired, cone-shaped spongy organs situated in the thoracic
cavity on either side of the heart. The left lung has two lobes and the
right lung has three lobes. The right lung is thicker and broader than the
left and is also slightly shorter than the left, as the diaphragm is higher
on the right side to accommodate the liver which lies below it. Internally,
the lungs consist of millions of tiny air sacs called alveoli which are
arranged in lobules and resemble bunches of grapes. The function of
the lungs is to facilitate the exchange of the gases oxygen and carbon
dioxide. In order to carry out this function efficiently, the lungs have
several important features:
● a very large surface area (about 100 m2), provided by approximately
300 million alveoli
● a thin, permeable membrane surrounding the walls of the alveoli
● a thin film of water lining the alveoli, which is essential for dissolving
oxygen from the incoming air
● thin-walled blood capillaries forming a network around the alveoli,
which absorb oxygen from the air breathed into the lungs and release
carbon dioxide into the air breathed out of the lungs.
The structures enclosed within the lungs are bound together by
elastic and connective tissue. On the outside, the lungs have two
layers of a serous membrane called pleura, an outer parietal layer
that lines the thoracic cavity and an inner visceral layer that is
attached to the surface of the lungs. Between the visceral and
parietal pleurae is the pleural cavity, which contains a lubricating
fluid secreted by the membranes that reduces friction between the
lungs and the chest wall.
The diaphragm (di-a-fram)

The diaphragm is the chief muscle of respiration and is a dome-shaped
muscular partition that separates the thoracic cavity from the abdominal
cavity. During contraction, the diaphragm is pulled down, decreasing the
pressure in the chest cavity, which sucks air into the lungs. Relaxation of
the diaphragm causes it to rise, pressure in the lungs increases and air is
pushed out of the lungs.
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Air is taken into the body

through the mouth and
nasal cavity. In the nostrils,
the air is filtered by tiny
Air passes through the larynx, hairs (cilia), warmed, and
which is sometimes known as moistened by mucus
the voice box. Sound is produced
by passing air over the vocal
chords in the larynx
At the top of the throat is a
flap of skin, the epiglottis,
The trachea is a large which prevents food or other
flexible but strong tube particles entering the lungs
also known as the windpipe.
Rings of cartilage maintain
The trachea branches
its shape
into two to enter the
lungs as bronchi
Lung
The bronchus in each

lung divides into
bronchioles
Artery
Bronchioles sub-divide into small

air sacs, alveoli. Most of the lung
Vein
tissue is made up of millions of
alveoli, which is where the exchange
of oxygen into the blood and carbon
dioxide out of the blood occurs
Venule
The alveoli are covered with very

small capillaries, which allow oxygen
and carbon dioxide to pass into and
out of the blood stream
Alveoli
Arteriole
Artery
p The respiratory system
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The interchange of of the circulatory system. Carbon dioxide, a waste

product of cell metabolism, is produced by every cell
gases in the lungs in the body and is removed by the circulatory system.
The interchange of gases in the lungs involves the
Oxygen and carbon dioxide exchange is the primary
absorption of oxygen from the air into the blood and
function of the respiratory system. Oxygen is needed
release of carbon dioxide from the blood into the
by every cell of the body and is delivered by way
alveolar air, from where it is expelled from the body.
Inhaled and exhaled air
Capilliaries
Trachea
Left lung
Right lung Pulmonary artery

Pulmonary vein
Aorta
Superior
vena cava
Heart
Red blood
Key cells
Oxygen (O2)
Carbon dioxide (CO2)
p The interchange of gases
External respiration 3 Carbon dioxide is transported by the blood from

the cells of the body to the capillaries attached
This refers to gas exchange in the lungs between to the alveoli.
the blood and air in the alveoli that came from the
4 The carbon dioxide then diffuses from the blood
external environment. The respiration process is as
across the alveolar walls into the air inside the
follows:
alveoli, which is exhaled through the nose and
1 During inhalation, air is taken in through the mouth.
nose and mouth. It flows along the trachea and
5 Oxygen and carbon dioxide exchange across the
bronchial tubes to the alveoli of the lungs, where
walls of the alveoli at the same time.
oxygen diffuses through the thin film of moisture
lining the alveoli.
2 Oxygen diffuses from the air inside the alveoli,
Internal/tissue respiration
across the alveolar walls and into the blood This is the gas exchange between the blood and the
capillaries. The oxygen binds to the haemoglobin tissues throughout the body. Oxygen diffuses from
inside erythrocytes and is transported to the cells the blood into the cells and carbon dioxide diffuses
throughout the body. from the cells into the bloodstream.
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The mechanism of respiration

Rib movements in breathing
Rib movements
Inhalingin breathing Exhaling
lungs
Inhaling Exhaling
lungs
chest chest
back back
chest chest
back back
first rib
first rib
Inhaling. The diaphragm and Exhaling. The contracted muscles
intercostal muscles contract, relax, the ribs fall slightly and decrease
pulling the ribs upward. This the volume of the chest. Air is forced
increases the
Inhaling. Thevolume of the
diaphragm chest
and out of the lungs.
Exhaling. The contracted muscles
cavity, drawing
intercostal air into
muscles the lungs.
contract, relax, the ribs fall slightly and decrease
pulling the ribs upward. This the volume of the chest. Air is forced
increases the volume of the chest out of the lungs.
cavity, drawing air into the lungs.
How the diaphragm works
Inhaling
How the diaphragm works Exhaling
Inhaling Exhaling
diaphragm diaphragm
Inhaling. As the rib cage expands

diaphragm Exhaling. The diaphragm
diaphragmrelaxes and
(arrows, above), the diaphragm is pressed up by the abdominal organs,
contracts and flattens downwards, returning to its dome shape. The chest
enlarging the
Inhaling. chest
As the ribcavity.
cage expands narrows,
Exhaling.driving air out of relaxes
The diaphragm the lungs.
and
(arrows, above), the diaphragm is pressed up by the abdominal organs,
p The mechanism of respiration
contracts and flattens downwards, returning to its dome shape. The chest
enlarging the chest cavity. narrows, driving air out of the lungs.
The mechanism of respiration is the means by which The major muscle of respiration is the diaphragm. Air
air is drawn in and out of the lungs (breathing). It is is moved in and out of the lungs by the combined
an active process in which the muscles of respiration action of the diaphragm and the intercostal muscles.
contract to increase the volume of the thoracic cavity.
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Inspiration Regulation of breathing

During inspiration, the dome-shaped diaphragm Breathing, like the beating of the heart, occurs
contracts and flattens, increasing the volume of the continuously and rhythmically without conscious
thoracic cavity. The diaphragm is responsible for thought. The basic pattern of breathing can be
bringing approximately 75% of the volume of air modified by voluntary intervention but the underlying
into the lungs. mechanism is essentially automatic; it continues when
The external intercostal muscles are also involved we are asleep and even when we are unconscious.
in respiration and on contraction they increase
the depth of the thoracic cavity by pulling the ribs Nervous control
upwards and outwards. The external intercostal Breathing is controlled by a group of neurones in
muscles are responsible for bringing approximately the parts of the brain called the medulla oblongata
25% of the volume of air into the lungs. and the pons, also known as the respiratory centre.
The combined contraction of the diaphragm and the Nerve cells, called chemoreceptors, which are found
external intercostals increases the thoracic cavity, in the aorta and the carotid arteries send impulses
which decreases the pressure inside the thorax so to the respiratory centre in the medulla oblongata
that air from outside of the body enters the lungs. of the brain with messages about the levels of
oxygen and carbon dioxide in the blood. When the
Expiration levels of carbon dioxide and oxygen need adjusting,
a nerve impulse is sent to the respiratory muscles
During normal respiration, the process of expiration
and breathing rate and depth changes accordingly.
is passive (without conscious effort) and is brought
The medulla oblongata controls the rate and depth
about by the relaxation of the diaphragm and the
of respiration and the pons moderates the rhythm of
external intercostal muscles, along with the elastic
the switch from inspiration to expiration.
recoil of the lungs. This increases the internal pressure
inside the thorax so that air is pushed out of the lungs.
KEY FACT
KEY FACT Breathing is a relatively passive process.
However, when more air must be exhaled,
Other accessory muscles which assist in
such as when coughing or playing a wind
inspiration include the sternomastoid, serratus
instrument, the process of expiration becomes
anterior, pectoralis minor, pectoralis major and
active. This is assisted by muscles such as the
the scalene muscles in the neck.
internal intercostals, which help to depress the
ribs. Abdominal muscles, such as the external
and internal obliques, rectus abdominus and
Activity transversus abdominus, help to compress the
Breathe in slowly for a count of three. During abdomen and force the diaphragm upwards,
inspiration, focus on the changing volume of thus assisting expiration and squeezing more air
your rib cage. Hold for a count of one and then out of the lungs.
breathe out slowly for a count of three. Focus on
what happens to the rib cage on expiration.
Modified respiratory
movements
Breathing rate
The normal breathing rate is 12 to 15 breaths per Speech/talking
minute, although this may increase during exercise Speech is achieved when air flows from the lungs,
and stress, and decrease during sleep. Breathing takes causing the vocal cords to vibrate. The sound is
place rhythmically, with inspiration lasting for about then reverberated in the vocal spaces created by
two seconds and expiration for approximately three the tongue, soft palate, lips and jaw. During speech,
seconds. forced inspiration and forced expiration are needed
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to create sound. In forced inspiration, the rib cage efforts together with the facial expressions typically
is elevated and the thoracic cavity enlarged by the associated with laughter.
accessory muscles. During forced expiration, the trunk
and abdomen muscles pull the rib cage down and the KEY FACT
thoracic cavity volume is reduced, forcing air out of Laughter helps to reduce stress hormones and
the lungs. triggers the release of the feel-good hormones,
endorphins, leading to a sense of wellbeing and
Singing happiness.
During singing, there is a need to inhale quickly and
deeply, then exhale slowly and steadily. Therefore, Sighing
singing requires a higher rate of breathing than Sighing is a long, slow inspiration, quickly followed by
speaking does, as well as elongation of the breath cycle. a long slow expiration.
Singers need to learn how to extend the normal
breath cycle by remaining in the inspiratory position Sneezing
for as long as possible, maintaining a raised sternum Sneezing is purely a reflex act as it is impossible
(but not raised shoulders or clavicle), no (or minimal) to produce a sneeze voluntarily. It is caused by a
chest displacement, allowing the muscles of the stimulus to the nose or eyes which triggers impulses
lateral abdominal wall to stay close to the position to the respiratory centre from the nasal and other
of inhalation and delaying rib cage collapse. branches of the fifth nerve.
A sneeze consists of a deep inspiration and closure of
Coughing the glottis, followed by a single explosive expiration
Coughing is caused by a stimulus in the air passages, and sudden opening of the glottis and nostrils.
particularly the larynx. A cough involves a deep
inspiration, then closure of the glottis, followed by Yawning
a violent expiratory effort. This is accompanied by Yawning involves a very long, deep inspiration which
two, three, or more sudden openings and closures completely fills the chest, accompanied by wide
of the glottis, so that rapidly repeated blasts of air opening of the mouth.
pass through the upper air passages and out of the
(generally open) mouth. Olfaction
KEY FACT Olfaction is the sense that detects different smells.
The sense of smell can evoke emotional responses
The glottis is the part of the larynx that includes
the vocal cords and the slit-like opening due to its close link with the endocrine system.
between them. It affects voice modulation The process of olfaction involves the nervous
through expansion and contraction. system as smells received as stimuli at the nose are
transmitted by nerve impulses to be perceived by the
Crying brain.
Crying (sobbing) is a series of short, sudden
expirations and rapid convulsive inspirations.
The structures of the
olfactory system
Hiccup
The features of the olfactory system are:
A hiccup is an unexpected inspiratory spasm, usually
of the diaphragm, with the entrance of the air being ● Nose – this is the organ of olfaction (smell).
checked by the sudden closure of the glottis. ● Mucous membrane – this lines the nose, moistens
the air passing over it and helps to dissolve the
Laughing odorous gas particles passing through the nasal
Laughing consists of a full inspiration, followed cavity. The mucous membrane has a very rich
by a long series of very short and rapid expiratory blood supply and warmth from the blood flowing
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through the tiny capillaries raises the temperature transmitted information directly to the brain. The
of the air as it passes through the nose. process of olfaction involves reception, transmission
● Cilia – these are the tiny, mucous-covered hairs and preception. Consider, for example, how we detect
inside the nose. They are highly sensitive protrusions the smell of an essential oil.
of the olfactory cells and are covered in receptors.
Reception
● Olfactory cells – these lie embedded in the
1 The volatile particles of an essential oil evaporate
mucous membrane in the upper part of the nasal
on contact with air.
cavity. These sensory nerve cells are specially
adapted for detecting smell. Each olfactory cell 2 The volatile molecules disperse through the air
has a long nerve fibre called an axon leading out and some enter the nose.
of the main body of the cell. This transmits any 3 The odiferous particles of the essential oil dissolve
information received at the receptor to the brain. in the mucus that lines the inner nasal cavity.
● Olfactory bulb – this is the area of the brain, Transmission
situated in the cerebral cortex, which perceives
1 The dissolved aromatic molecules join to the
smell.
receptors in the cilia which protrude from the
olfactory receptor cells.
2 The olfactory receptor cells have a long nerve fibre
called an axon, and an electrochemical message
of the aroma is transmitted along the axons of
receptor cells to join the olfactory nerves.
Gas 3 The fibres of the olfactory nerves pass through the
(smell) cribriform plate of the ethmoid bone in the roof of
the nose to reach the olfactory bulb, from where the
odorant signal is relayed to other parts of the brain.
Mucous membrane
covering entire
Olfactory
area
Olfactory area
of cerebral cortex Perception
nasal cavity 1 Once the message reaches the olfactory bulb, the
olfactory impulses pass into the olfactory tract
and then directly to the cerebral cortex, where
Olfactory bulb Olfactory nerve Olfactory tract the smell is perceived.
2 The temporal lobe of the brain contains the
primary olfactory area, which is directly connected
to the limbic area – this is concerned with
emotions, memory and sex drive.
Ethmoidal
bone 3 The olfactory bulb also connects closely with the
hypothalamus, the nerve centre which governs
Olfactory cell the endocrine system.
(sensory
receptors)
Olfactory cilia Epithelial cells KEY FACT
Most nerves in the body transmit nerve
p Olfaction impulses to the spinal cord and then on to the
brain. However, in the case of the olfactory
The theory of olfaction cells, the nerve fibres connect directly with
the olfactory bulb of the brain and, therefore,
Olfaction is categoried as a ‘special sense’ as have a powerful and immediate effect on the
odour perception uses specialised structures that emotions.
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The importance of smokers and may lead to emphysema (which is

caused by damage to the lung’s alveolar structure).
correct breathing Acute bronchitis can result from recent cold or flu.
During exercise, the demand for oxygen in muscle Cancer of the lung
cells goes up, so the rate and depth of breathing This may be caused by chronic inhalation of
increases. The breathing rate can more than double pollutants, such as cigarette smoke and asbestos
during vigorous exercise. Correct breathing is very fibres. Usually, there are no symptoms in the initial
important as it ensures that all the body’s cells stages and it is often detected only in the advanced
receive an adequate amount of oxygen and dispose stages. Late symptoms include chronic cough,
of enough carbon dioxide to enable them to function hoarseness, difficulty in breathing, chest pain, blood
efficiently. It is important to note that breathing in sputum, weight loss and weakness.
affects both our physiological and psychological
Emphysema
state. Deep breathing exercises can help to increase
the vital capacity and function of the lungs. This is a chronic obstructive pulmonary disease
(COPD) in which the alveoli of the lungs break down,
Common pathologies reducing the surface area for the exchange of oxygen
and carbon dioxide. Severe emphysema causes
of the respiratory breathlessness which is made worse by infection.
It is commonly associated with chronic bronchitis,
system smoking and advancing age.
Asthma Hayfever
This condition presents as attacks in which the patient This is an allergic reaction involving the mucous
experiences shortness of breath and difficulty in passages of the upper respiratory tract and the
breathing due to spasm or swelling of the bronchial conjunctiva of the eyes, caused by pollen or other
tubes. This is caused by hypersensitivity to allergens allergens. It causes blocked or streaming nose,
such as pollens of various plants, pet hair, dust mites sneezing and itchy, watery eyes.
and various proteins in foodstuffs such as shellfish, Pleurisy
eggs and milk. Asthma may be made worse by exercise,
This is an inflammation of the pleura of the lung. It
anxiety, stress or smoking. It can run in families and
presents on breathing deeply as an intense stabbing
may also be associated with hayfever and eczema.
pain over the chest. The patient has difficulty breathing,
so respiration is shallow and rapid, and fever is present.
In practice Pleurisy may develop as a complication of pneumonia,
Always obtain a detailed history during the tuberculosis or trauma to the chest.
consultation stage, specifically the triggers that
bring on an asthma attack. If the client has a history
Pneumonia
of allergies, ensure they are not allergic to any Pneumonia is a bacterial infection of the lung in
preparations you are proposing to use. which the alveoli become filled with inflammatory
cells and the lung becomes solid. Symptoms include
Position the clients according to their individual
fever, malaise and headache, together with a cough
comfort, usually in a semi-reclined position. The
and chest pain.
client should have their medications to hand, in
case of an attack. Rhinitis
This condition is the inflammation of the mucous
Bronchitis membrane of the nose, causing a blocked or runny
This is a chronic or acute inflammation of the nose. It may be caused by a virus infection, such as
bronchial tubes. Chronic bronchitis is common in a cold, or by an allergic reaction.
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Sinusitis Tuberculosis (TB)

This condition involves inflammation of the paranasal This infectious disease is caused by the bacteria
sinuses. It is usually caused by a virus, such as a cold, (bacillus) Mycobacterium tuberculosis. Transmission
or can result from bacterial infection or allergy. Nasal of tuberculosis is usually via droplet infection, and
congestion blocks the opening of the sinus into hence the most common site of initial infection
the nasal cavity, causing build-up of pressure in the is the lungs. Infection can also result from
sinus. The condition presents with nasal congestion drinking unpasteurised milk from infected cows.
followed by a mucous discharge from the nose. The TB is characterised by the formation of nodules
pain is located in a specific area, depending on the in the body tissues. Symptoms include coughing,
sinuses affected. If the frontal sinuses are affected, sneezing, night sweats, fever, weight loss and blood
the major symptom is a headache over one or both in the sputum. Enlarged lymph nodes can also be
eyes. If the maxillary sinuses are affected, one or both an indication of TB. Immunisation against TB is
cheeks hurt and the patient may experience a feeling possible, using the BCG (Bacillus Calmette-Guérin)
like toothache in the upper jaw. vaccine.
Stress
Stress can be defined as any factor which affects
physical or emotional health. Examples of excessive
respiratory stress include exacerbation of asthma
and frequent colds.
Interrelationships Circulatory
with other systems Blood transports oxygen that is breathed into the
lungs around the body to the cells and transports
The respiratory system carbon dioxide from the cells to the lungs to be
exhaled.
The respiratory system links to the following body
systems. Nervous
Breathing is an involuntary response that results
Cells and tissues from the stimulation of the respiratory centre in the
Squamous and ciliated are types of simple medulla and the pons of the brain.
epithelium that line the respiratory system.
Endocrine
Skin The hormone adrenaline, produced by the adrenal
Oxygen that is absorbed through the respiratory glands, is released into the bloodstream to change
process is carried to the skin via capillaries to the rate of the breathing when the body is under
facilitate cell renewal. stress.
Skeletal Digestive
The bones of the thorax (sternum, ribs and 12 The mouth and the pharynx link the respiratory and
thoracic vertebrae) provide vital protection for the digestive systems.
organs of respiration (heart and lungs).
Muscular
The mechanism of respiration uses the combined
action of the diaphragm and the intercostal muscles.
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Key words Inspiration: the act of drawing air into the lungs
Intercostal muscles: muscle groups situated
Adenoids: lymphoid tissue at the back of the between the ribs and that contribute to the
nasopharynx respiration
Alveoli: tiny air sacs of the lungs which allow for Internal respiration: gas exchange between the
rapid gaseous exchange blood and the tissues throughout the body
Bronchi: two short tubes which lead to and carry Larynx: a tube-shaped organ in the neck that
air into each lung contains the vocal cords
Bronchioles: small branches into which a bronchus Lungs: paired, cone-shaped, spongy organs situated
divides in the thoracic cavity on either side of the heart that
Chemoreceptors: nerve cells found in the aorta facilitate gas exchange
and the carotid arteries that send impulses to the Mucous membrane: a sheet of tissue (or
respiratory centre in the medulla oblongata of the epithelium) lining all body channels that
brain about the levels of oxygen and carbon dioxide communicate with the air
in the blood
Nasopharynx: the upper part of the pharynx,
Cilia: tiny hairs that protect the nasal passageways connecting with the nasal cavity above the soft
and other parts of the respiratory tract by filtering palate
out dust
Nose: the organ of smell
Diaphragm: the chief muscle of respiration; a
dome-shaped muscular partition that separates the Olfaction: sense of smell
thoracic cavity from the abdominal cavity Olfactory bulb: area of the brain that perceives
Diffusion: the movement of a fluid from an olfaction
area of higher concentration to an area of lower Olfactory cells: sensory nerve cells that are adapted
concentration (gas exchange in the lungs) for sensing smell
Epiglottis: a flap of tissue covering the glottis that Pharynx: a membrane-lined cavity behind the nose
prevents food from ‘going down the wrong way’ and mouth, connecting them to the oesophagus
Expiration: the act of expelling air out of the lungs Pleura: a pair of serous membranes lining the thorax
External respiration: the process by which external and enveloping the lungs
air is drawn into the body in order to provide the Sinuses: air-filled spaces located within the
lungs with oxygen, and used carbon dioxide is maxillary, frontal, ethmoid and sphenoid bones
expelled from the body of the skull
Glottis: part of the larynx consisting of the vocal Trachea: the windpipe
cords and the slit-like opening between them
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Revision summary ● The interchange of gases occurs as a result of

simple diffusion.
The respiratory system ● During inhalation, oxygen is taken in through
the nose and mouth, along the trachea and

● The respiratory organs include the nose,
bronchi to the lungs, where it diffuses through
nasopharynx, pharynx, larynx, trachea,
a thin film of moisture that lines the alveoli.
bronchi, bronchioles and lungs.
● Oxygen then diffuses across the permeable
● The respiratory organs act with the membrane surrounding the alveoli to be
cardiovascular system to supply oxygen taken up by the red blood cells. Oxygen-rich
and remove carbon dioxide from the blood. blood is carried to the heart and pumped to
● The nose is lined with cilia and mucous the cells of the body.
membrane, and is adapted for warming, ● Carbon dioxide, collected from respiring
moistening and filtering air, and detecting smells. cells, diffuses from the capillary walls into
● Smell is perceived by specialised olfactory cells the alveoli, passes through the bronchi and
which connect directly with the olfactory bulb trachea, and is exhaled through the nose and
in the brain. mouth.
● The pharynx or throat connects the nasal cavity ● Air is moved in and out of the lungs by the
to the larynx. combined action of the diaphragm and
● As well as providing an air passage between the the intercostal muscles.
● During inspiration, the combined contraction
nasal cavity and larynx, the pharynx also serves
as a food passage for the digestive system. of the diaphragm and the external
intercostals increases the volume of the
● The larynx is a short passage that connects
thoracic cavity, which decreases the pressure
the pharynx with the trachea and contains the
inside the thorax so that air enters the lungs.
vocal cords.
● The process of expiration is passive and
● The trachea (windpipe) is made up mainly of is brought about by the relaxation of the
cartilage and passes down into the thorax to diaphragm and the external intercostals, and
connect the larynx with the bronchi, which the elastic recoil of the lungs.
pass into the lungs.
● Modified respiratory movements are needed
● The lungs are situated in the thoracic cavity on for talking (speech), singing, sighing, laughing,
either side of the heart. coughing, crying, hiccups, sneezing and
● Internally, the lungs consist of tiny air sacs yawning.
called alveoli which provide a very large surface
area for the exchange of the gases oxygen and
carbon dioxide.
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Test your knowledge 7 The trachea is made up of mainly:

a spongy tissue
questions b mucous membrane
c cartilage
Multiple choice questions d cilia.
1 Which of the following is a function of the 8 Which of the following respiratory structures
respiratory system? produces sound?
a produces speech a pharynx
b detects smell b larynx
c exchanges oxygen and carbon dioxide c nasopharynx
d all of the above d trachea
2 Which of the following statements is false? 9 What is a typical normal breathing rate?
a The pharynx serves as a food and air passage. a 12 to 15 breaths per minute
b The larynx contains the vocal cords. b 10 to 12 breaths per minute
c The pharynx provides a passageway between c 15 to 20 breaths per minute
the larynx and the bronchi. d 20 to 25 breaths per minute
d The bronchi subdivide into bronchioles in 10 Which of the following brings about inspiration?
the lungs. a the combined relaxation of the diaphragm
3 Which of the following opens into the and the internal intercostal muscles
nasopharynx so that air pressure inside the ear b the combined contraction of the diaphragm
can be adjusted? and the external intercostal muscles
a glottis c the combined relaxation of the diaphragm
b Eustachian tube and the external intercostal muscles
c adenoids d the combined contraction of the diaphragm
d sinuses and the internal intercostal muscles
4 What is another name for the throat?
a larynx
b pharynx 11 Name the sticky fluid that prevents dust
c epiglottis and bacteria from entering the lungs. 1 mark
d trachea 12 State two factors that may cause the
5 The windpipe is the common name for which breathing rate to increase. 2 marks
of these structures? 13 State two muscles that become active
a pharynx when more air needs to be expelled from
b epiglottis the lungs. 2 marks
c larynx
14 Define these terms:
d trachea
a external respiration 2 marks
6 What is the name of the tiny air sacs in the lungs b internal respiration. 2 marks
which provide a large surface area for diffusion?
15 Name the two parts of the brain that
a surfactants
control breathing. 2 marks
b alveoli
c pleura 16 Describe the mechanism of respiration.
d bronchioles 4 marks
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9 The ner vous
system
Introduction
The anatomical structures of the nervous system
include the brain, spinal cord and nerves, which
together form the main communication system
for the body. The nervous system is the body’s
control centre and is, therefore, responsible for
receiving and interpreting information from
inside and outside the body.
The nervous system receives, interprets and
integrates all stimuli to effect an appropriate
response. It is also responsible for all mental
processes and emotional responses, and works
intimately with the endocrine system to help
regulate body processes.
OBJECTIVES
● the functions of the nervous system
● the organisation of the nervous system
● the characteristics of nervous tissue
● the structure and function of different

types of neurones
● the transmission of nerve impulses
● an outline of the principal parts of the

nervous system
● the sense organs
● common pathologies of the nervous system
● the interrelationships between the nervous

9781510435179.indb 246 04/10/18 4:51 PM

9 The nervous system
In practice
Therapists need to have a comprehensive knowledge of the nervous
system in order to understand the effects of treatments. Some
treatments stimulate nerves, others have the ability to relax the client.
Having knowledge of the nervous system can also help therapists to
understand the effects of stress on the body.
Therapists communicate with their clients through their respective
nervous systems.
Functions of the nervous

system
Neurology is the science of nerves and the nervous system, and
especially of the diseases that affect them.
The nervous system has three main functions:
1 It detects changes both within the body (the internal environment)
and outside the body (the external environment).
2 It analyses sensory information, stores some data and makes
decisions about how to respond. This is called integration.
3 It may respond to stimuli by initiating muscular contractions
or glandular secretions.
Organisation of the nervous

system
The nervous system has two main parts which possess unique structural
and functional characteristics:
1 The central nervous system (CNS) – this is the main control system
and it consists of the brain and the spinal cord.
2 The peripheral (pur-rif-fur-ral) nervous system (PNS) – this system
can be subdivided into:
● the somatic nervous system
● the autonomic (aw-toe-nom-ik) nervous system.
Peripheral nervous system (PNS)

Somatic nervous system
This contains 31 pairs of spinal nerves and 12 pairs of cranial nerves,
and governs the impulses from the CNS to the skeletal muscles.
Automatic nervous system

This supplies impulses to smooth muscles, cardiac muscle, skin,
special senses, proprioceptors (sensory nerve endings located in
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muscles and tendons that transmit information to coordinate

muscular activity), organs and glands. The autonomic nervous system
consists of:
● the sympathetic system
● the parasympathetic system.
CNS (brain and spinal cord) PNS (cranial and spinal

nerves)
Processes and integrates Carries impulses between
information the CNS and the rest of
the body
Autonomic (involuntary)
Somatic (voluntary)
Controls all automatic processes
Allows control of skeletal muscles of smooth and cardiac muscle
and glands
Study tip
Although the nervous system is
a complicated system, it helps Sympathetic Parasympathetic
if you think of it as the body’s Stimulates activity, for Inhibits activity, for
communication network – example increases the example decreases the
heart rate heart rate
nerves are the body’s way of
transmitting messages from one
part of the body to another. p Organisation of the nervous system
Nervous tissue
There are two types of nervous tissue – neuroglia and neurones.
KEY FACT Neuroglia or glial cells are a special type of connective tissue of the
Over 50% of the brain is made CNS that is designed to support, nourish and protect the neurones.
up of glial cells and most Glial cells are smaller and more numerous than neurones. They are
brain tumours are, therefore, unable to transmit impulses and never lose their ability to divide by
made up of glial cells.
mitosis.
The functional unit of the nervous system is the neurone, a specialised
nerve cell that is designed to receive stimuli and conduct impulses. The
nervous system contains billions of interconnecting, impulse-conducting
neurones. Neurones have two major properties:
1 excitability – the ability to respond to a stimulus and convert it to an
KEY FACT
electrical impulse
Nerve cells have the highest
metabolic rate in the body 2 conductibility – the ability to transmit the impulses to other
and are easily damaged and neurones, muscles and glands.
destroyed by toxins and lack Neurones also occur in groups called ganglia outside the CNS and as
of oxygen.
single cells, known as a ganglion, in the walls of organs.
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Parts of a neurone KEY FACT

Thick myelinated nerve fibres allow nervous
Dendrites signals to be transmitted very quickly, for
example pain fibres. In contrast, hot and cold
receptor fibres are non-myelinated and their
Nerve signals are transmitted more slowly.
cell
Neurilemma
Nucleus This is a delicate membrane that surrounds the axon
and consists of a layer of one or more Schwann
cells. The neurilemma plays an important role in
Axon
Nodes of the regeneration of PNS nerve fibres.
Ranvier
Nucleus Myelin sheath

Nodes of Ranvier
in myelin The nodes of Ranvier are gaps in the myelin sheath
sheath Neurilemma
situated at intervals of 2–3 mm along the length of
the axon. During neural activity, impulses jump from
Synaptic one node to the next, resulting in a faster rate of
end bulb
conduction.
p The structure of a nerve cell Synapse

Although neurones vary in their shape and size, they This is the tiny gap between one neurone and the
all have three basic parts: next, across which nerve impulses have to pass. When
a nerve impulse reaches a synapse, a chemical called
1 Cell body – this has a central nucleus that is
a neurotransmitter is released. This diffuses across
surrounded by cytoplasm and contains standard
the gap and triggers an electrical impulse in the
organelles such as mitochondria and a Golgi
next neurone.
body.
2 Dendrites – these are highly branched extensions Synaptic cleft
of the nerve cell. These neural extensions receive This is the name of the space between neurones at
and transmit stimuli towards the cell body. a synapse, also called a synaptic gap.
3 Axon – this is long, single nerve fibre extending
from the cell body. The function of the axon is Axon terminals
to transmit impulses away from the cell body. These are also called synaptic ends, bulbs, or feet.
Other parts of a neurone’s structure are discussed The ends of the axons have bulb-like structures
below. containing sacs (synaptic vesicles) that store
neurotransmitters. These are chemicals that facilitate
Myelin (my-a-lyn) sheath the transmission of impulses between neurones
across synapses.
This is a fatty, insulating sheath that covers the
axon. Its function is to insulate the nerve and Neurotransmitters
accelerate the conduction of nerve impulses
The two most common neurotransmitters released
along the length of the axon. The myelin sheath
by neurones of the autonomic nervous system are:
is produced by Schwann cells (large flat cells
containing a nucleus and cytoplasm) which wrap ● Acetylcholine – a neurotransmitter which causes
themselves around the axon in a spiral fashion, muscles to contract, activates pain responses and
layer after layer. regulates endocrine and rapid eye movement
(REM) sleep functions.
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● Norepinephrine (noradrenaline) – a neurotransmitter designed to

mobilise the brain and body for action. Norepinephrine release is
lowest during sleep, rises during wakefulness, and reaches a higher
level during situations of stress or danger, such as in the so-called
fight-or-flight response.
Types of neurones
There are three types of neurones, as shown in Table 9.1.
Table 9.1 Types of neurones
Sensory/ Receive stimuli from sensory organs and receptors, and

afferent transmit the impulse to the spinal cord and brain
neurones Sensations transmitted by the sensory neurones include
heat, cold, pain, taste, smell, sight and hearing
Motor/efferent Conduct impulses away from the brain and the spinal
neurones cord to muscles and glands in order to stimulate them
into carrying out actions
Association Link sensory and motor neurones, helping to form the
(mixed) complex pathways that enable the brain to interpret
neurones incoming sensory messages, decide on what should be
done and send out instructions along motor pathways to
keep the body functioning properly
Cell body
Axon
terminal Sensor
receptor
Sensory neurone
Association
neurone
Motor
and plate
Motor neurone
Cell body
Schwann
cell Muscle
p A simple nerve pathway
The transmission of nerve

impulses
Neurones are responsible for neurotransmission; the conduction of
electrochemical impulses throughout the nervous system. Neurone
activity is triggered by:
● mechanical stimuli – touch and pressure
● thermal stimuli – heat and cold
● chemical stimuli – from external chemicals or from chemicals released
by the body, such as histamine.
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Nerve impulses are transmitted electrochemically, A particular kind of synapse occurs at the junction
by the movement of charged chemicals called ions between a nerve and a muscle – this is known as
into and out of the cell. At rest, positive potassium a motor point and is the point at which the nerve
ions are located inside the nerve cell body and supply enters the muscle.
positive sodium ions are located outside the cell
membrane. Other ions within the cell cause the inside How a motor impulse
of the cell to be negatively charged in comparison causes contraction
to the outside. The cell is said to be polarised due to
the charge difference across the membrane. of skeletal muscle
When a nerve is stimulated, the membrane becomes 1 A motor impulse is initiated in the brain.
permeable to sodium and the positively charged ions 2 The motor stimulus travels along the length
flow in, depolarising the cell. Eventually, the inside of the of the axon to the effector muscle.
cell becomes positive and the outside of the membrane 3 The motor impulse reaches the motor point of the
is negative. Then, potassium ions flow out of the cell muscle fibres.
to reverse the depolarisation until the outside of the 4 The nerve impulse is passed across the
membrane is slightly more positively charged than at neuromuscular junction by a chemical transmitter
rest. After this, the balance of potassium and sodium substance that diffuses across the synapse.
ions inside and outside the cell returns to normal.
5 The muscle fibres contract and effect the desired
This wave of polarisation and depolarisation movement.
conducts the nerve impulse along the neurone
from dendrite to axon.
The neurones are not physically joined together.
The principal parts of
The junction where nerve impulses are transmitted the nervous system
from one neurone to another (or from a neurone to
a muscle cell or gland) is called a synapse. The central nervous
Axon terminal system
Myelin sheath The CNS consists of the brain and spinal cord and
Mitochondrion
is covered by a special type of connective tissue
Synaptic knob Synaptic membrane called the meninges. The meninges
vesicle have three layers:
1 dura mater – this is the outer, protective, fibrous
Presynaptic
membrane
connective tissue sheath that covers the brain
Synaptic
cleft of first and spinal cord
neuron
2 pia mater – this is the innermost layer which is
Movement attached to the surface of organs and is richly
of transmitter
Postsynaptic membrane
substance
supplied with blood vessels to nourish the
of dendrite of next neuron
underlying tissues
p The conduction of a nerve impulse across a synapse 3 arachnoid mater – this provides a space for the
blood vessels and circulation of cerebrospinal fluid.
Nerve impulses are relayed from one neurone to
another by a chemical transmitter substance. The Cerebrospinal fluid
transmitter is released by the first neurone and it This is a clear fluid derived from the blood and secreted
diffuses across the synapse to stimulate the next into the inner cavities of the brain. It carries some
neurone. Synapses can pass nerve impulses in one nutrients to the nerve tissue and takes waste away, but
direction only and are important in co-ordinating its main function is to protect the CNS by acting as a
the actions of neurones. shock absorber for the delicate nervous tissue.
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The brain
The brain is an extremely complex mass of nervous tissue that lies within
the skull. It is the main communication centre of the nervous system
and its function is to analyse the nerve stimuli received and co-ordinate
the correct responses. The main parts of the brain include the cerebrum,
thalamus, cerebellum and brainstem.
Like the spinal cord, the brain is mainly made of grey matter and white
matter arranged in distinct layers.
Grey matter and white matter

The differences between grey and white matter are outlined in Table 9.2.
Table 9.2 Grey matter and white matter
Grey matter White matter

Primarily associated with processing Acts as a relay to co-ordinate
and cognition communication between different
brain regions
In the cortex of the brain, the In the brain, connects the various parts
place where all the higher mental of the cortex so that information can
processing takes place be transported for further processing
and integration
Occupies 40% of the brain Fills 60% of the brain
Composed of nerve cell bodies Composed of myelinated nerve fibre
Study tip tracts
When trying to understand Has no myelin sheath Myelinated
the relationship between grey
Has a grey colour because of the Appears white due to the presence
matter and white matter, it
grey nuclei in the cells of myelin
can be helpful to think of a
computer network: the grey Does not have extended axons Has axons connecting different parts
matter equates to the actual of grey matter
computers, whereas the white Processing is concluded in the grey Allows communication to and from
matter is represented by the matter grey matter areas, and between
network cables that connect the the grey matter and the other parts
computers together. of the body
p Grey matter and white matter
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The principal parts of the brain

Thalamus
Hypothalamus
Cerebrum
Pineal gland
Mid-brain
Brain stem
Pons
Cerebellum
Medulla
oblongata
Spinal cord
p Principal parts of the brain
Table 9.3 Overview of the principal parts of the brain
Part of brain Location Function

Cerebrum Largest part of the brain Intelligence
Makes up the front and top part of the brain Emotions
Thalamus Lies to either side of the forebrain Relays sensory impulses to the cerebral cortex
Hypothalamus Small structure lying beneath the thalamus Governs many important homeostatic
functions (hunger, thirst, temperature
regulation, anger, aggression, hormones, sexual
behaviour, sleep patterns and consciousness)
Pineal gland Pea-sized mass of nervous tissue attached by a Secretes melatonin
stalk to the central part of the brain Regulates circadian rhythms
Attached to the upper portion of the thalamus
Cerebellum Cauliflower-shaped structure located at the Co-ordinates skeletal muscles, posture and
posterior of the cranium, below the cerebrum balance
Brainstem Enlarged continuation of the spinal cord Connects the brain with the spinal cord
Contains control centres for heart, lungs and
intestines
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Cerebrum
This is the largest portion of the brain and makes up the front and top
part of the brain. It is divided into two large cerebral hemispheres. Each
cerebral hemisphere is divided into four lobes – frontal, temporal,
parietal and occipital, named according to the skull bones that lie over
them.
A mass of nerve fibres known as the corpus callosum bridges the
hemispheres, allowing communication between corresponding centres
in each hemisphere. The surface of the cerebrum is made up of
convolutions called gyri and creases called sulci.
The outer layer, the cerebral cortex, is made of grey matter and the inner
layer is made of white matter.
The cerebral cortex is the region where the main functions of the
cerebrum are carried out. It is concerned with all forms of conscious
activity such as vision, touch, hearing, taste and smell, as well as control
of voluntary movements, reasoning, emotion and memory. The cortex of
each cerebral hemisphere has a number of functional areas:
● Sensory areas receive impulses from sensory organs all over the body.
There are separate sensory areas for vision, hearing, touch, taste and
smell.
● Motor areas have motor connections (through motor nerve fibres)
with voluntary muscles all over the body.
● Association areas where links are made between information from
the sensory areas and remembered information from past experiences.
Conscious thought then analyses these links and decisions are made,
which often result in conscious motor activity controlled by motor
areas.
Speech area Motor area
Sensory area
Intellect, learning
and personality area
Vision area
Taste area
Hearing area
Language area
Balance area
General interpretation area
Spinal cord
p Functional areas of the brain
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KEY FACT Brainstem

The brain requires a continuous supply of The brainstem contains three main structures:
glucose and oxygen as it is unable to store 1 Midbrain – this contains the main nerve pathways
glycogen, unlike the liver and muscles.
connecting the cerebrum and the lower nervous
system. It also mediates certain visual and
Thalamus auditory reflexes that co-ordinate head and eye
Lying deep in the cerebral hemispheres in each side movements with vision and hearing.
of the forebrain are one of two egg-shaped masses of 2 Pons – this is below the midbrain and relays
grey matter called the thalami. The thalami are relay messages from the cerebral cortex to the spinal
and interpretation stations for the sensory messages cord and helps regulate breathing.
(except olfaction) that enter the brain before they are 3 Medulla oblongata – this vital part of the brain
transmitted to the cortex. is an enlarged continuation of the spinal cord
and connects the brain with the spinal cord.
Hypothalamus Control centres within the medulla oblongata
This small structure lies beneath the thalamus and include those for the heart, lungs and intestines.
governs many important homeostatic functions. The medulla also controls gastric secretions and
It regulates the autonomic nervous and endocrine reflexes such as sweating, sneezing, swallowing
systems by governing the pituitary gland. It controls and vomiting.
hunger, thirst, temperature regulation, anger,
aggression, hormones, sexual behaviour, sleep Blood–brain barrier
patterns and consciousness.
The blood–brain barrier is a selective, semipermeable
Pineal gland (allowing some substances to pass through) wall of
blood capillaries with a thick basement membrane. It
This is a pea-sized mass of nerve tissue attached by
prevents, or slows down, the passage of some drugs
a stalk to the central part of the brain. It is located
and other chemicals, and keeps disease-causing
deep between the cerebral hemispheres, where it is
organisms such as viruses from travelling into the
attached to the upper portion of the thalamus. The
central nervous system via the bloodstream.
pineal gland secretes a hormone called melatonin,
which is produced from serotonin. The pineal gland is Spinal cord
involved in the regulation of circadian rhythms. These
are patterns of repeated activity that are associated The spinal cord provides the nervous tissue link
with the environmental cycles of day and night, between the brain and other organs of the body and
such as sleep–wake rhythms. The pineal gland is also is the centre for reflex actions which provide fast
thought to influence mood. responses to external or internal stimuli.
The spinal cord is an extension of the brainstem,
Cerebellum which extends from an opening at the base of the
The cerebellum is a cauliflower-shaped structure skull down to the second lumbar vertebra.
located at the posterior of the cranium, below the It forms a two-way information pathway between
cerebrum. It is the brain’s second largest region. Like the brain and the rest of the body via the spinal
the cerebrum, it has two hemispheres with an outer nerves. It is protected by three layers of tissue called
cortex of grey matter and an inner core of white the meninges and by cerebrospinal fluid. Its function
matter. The cerebellum is concerned with muscle is to relay impulses to and from the brain. Sensory
tone, the co-ordination of skeletal muscles and tracts conduct impulses to the brain and motor tracts
balance. conduct impulses from the brain.
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Grey matter is located in the centre of the spinal Cranial nerves – 12 pairs
cord. In cross section it is shaped like a butterfly, and
consists of cell bodies of interneurons and motor
neurons, as well as neuroglia cells and unmyelinated
axons. The projections that give the grey matter its
characteristic H-shape (the butterfly wings) in cross
section are called horns. Cervical
nerves
White matter surrounds the grey matter in the
spinal cord, acting as a relay and co-ordinating
communication between different brain regions. Spinal
cord
Thoracic
KEY FACT nerves
Damage to the grey matter may lead to tingling
and muscle weakness. Spinal
nerves – 31 pairs
Reflex action Lumbar

nerves
A reflex action is a rapid and automatic response

Sacral
to a stimulus without any conscious input from the nerves
brain. Coccygeal
nerves
p The spinal cord
Motor centre Sensory area
Thalamus
Commands movement Communicates sensation of pain
Elbow tapped
Tendon reflex occurs
Sensory
nerve
Pain applied Motor
Muscle contracts nerve
p A reflex action
Reflexes are essentially designed to protect the immediately removed. The stimulus triggers a
body. A reflex action, sometimes called a reflex arc, sensory impulse which travels along the dorsal
is a neural relay cycle for a quick motor response to root to the spinal cord and a motor impulse that
a harmful sensory stimulus. It is mediated through travels back again.
the spinal cord by a sensory (afferent) neurone and Two synaptic transmissions occur at the same time.
a motor (efferent) neuron. One synapse continues the impulse along a sensory
A reflex arc allows a quicker response than a situation neurone to the brain, the other immediately relays
in which a sensory impulse would have to go all the impulse to an interneuron which transmits it to
the way to the brain to be analysed and the correct a motor neurone.
response selected, followed by transmission of a The motor neurone delivers the impulse to
motor impulse all the way back from the brain. a muscle (or gland) producing an immediate
A typical example of a reflex action is illustrated response, in this example withdrawing the hand
by a hand that touches a hot object and is from the hot object.
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The peripheral nervous

system
The PNS contains all the nerves outside of the CNS. It consists of cable-
like nerves that link the CNS to the rest of the body. The PNS can be
subdivided into:
● the somatic nervous system
● the autonomic nervous system.
The somatic nervous system contains:
● 31 pairs of spinal nerves (nerves originating from the spinal cord)
● 12 pairs of cranial nerves (nerves originating from the brain).
Somatic nervous system

Pairs of spinal nerves (31)
These nerves pass out of the spinal cord and each has two thin branches
that link it with the autonomic nervous system. Spinal nerves receive
sensory impulses from the body and transmit motor signals to specific
regions of the body, thereby providing two-way communication between
the CNS and the body.
Each of the spinal nerves are numbered and named according to the level
of the spinal column from which they emerge. There are:
● 8 cervical nerves
● 12 thoracic nerves
● 5 lumbar nerves
● 5 sacral nerves
● 1 coccygeal spinal nerve.
Each spinal nerve is divided into several branches, forming a network of
nerves or plexuses which supply different parts of the body (Table 9.4).
Table 9.4 Types of nerve plexuses
Nerve plexus Location Area(s) of the body it supplies

Cervical Neck Skin and muscles of the head, neck and
upper region of the shoulders
Brachial Top of the Skin and muscles of the arm, shoulder
shoulder and upper chest
Lumbar Between the Front and sides of the abdominal wall
waist and hip and part of the thigh
Sacral Base of the Skin and muscles and organs of the
abdomen pelvis
Coccygeal Base of the Skin in the area of the coccyx and the
(cox-e-gee-al) spine muscles of the pelvic floor
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Pairs of cranial nerves (12)

These nerves connect directly to the brain. Between them they provide
a nerve supply to sensory organs, muscles and skin of the head and
neck. Some of the nerves are mixed, containing both motor and sensory
neurones, while others are either sensory or motor.
Olfactory
Olfactory bulb
Optic
Olfactory tract Oculomotor
Optic tract Trochlear
Trigeminal
Vestibulocochlear Abducens
Glossopharyngeal
Vagus Facial
Hypoglossal
Accessory
p The cranial nerves
Table 9.5 Types of cranial nerves
Cranial nerve Type of nerve Description

Olfactory Sensory Nerve of olfaction
Optic Sensory Nerve of vision
Oculomotor Mixed nerve Innervates both internal and external muscles of the eye and a muscle of the
upper eyelid
Trochlear Motor nerve Smallest of the cranial nerves
Innervates the superior oblique muscle of the eyeball, which helps you look
upwards
Abducens Mixed nerve Innervates only the lateral rectus muscle of the eye, which helps you look to
the side
Facial Mixed nerve Conducts impulses to and from several areas in the face and neck
The sensory branches are associated with the taste receptors on the tongue
and the motor fibres transmit impulses to the muscles of facial expression
Vestibulocochlear Sensory nerve Transmits impulses generated by auditory stimuli and stimuli related to
equilibrium, balance and movement
Glossopharyngeal Mixed nerve Supplies motor fibres to part of the pharynx and to the parotid salivary
glands, and sensory fibres to the posterior third of the tongue and the
soft palate
Vagus Mixed Has branches to numerous organs in the thorax and abdomen, as well as to
the neck
Supplies motor nerve fibres to the muscles for swallowing, and to the heart
and organs of the chest cavity
Sensory fibres carry impulses from the organs of the abdominal cavity and
the sensation of taste from the mouth
➜
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Cranial nerve Type of nerve Description

Accessory Motor Innervates muscles in the neck and upper back, such as the trapezius and
the sternomastoid, as well as muscles of the palate, pharynx and larynx
Hypoglossal Motor Innervates the muscles of the tongue
Trigeminal Mixed Containing motor and sensory nerves that conduct impulses to and from
several areas in the face and neck
Controls the muscles of mastication (the masseter, temporalis and
pterygoids)
Has three main branches:
● the ophthalmic branch carries sensations from the eye, nasal cavity and
skin of the forehead, upper eyelid, eyebrow and part of the nose
● the maxillary branch carries sensations from the lower eyelid, upper lip,
gums, teeth, cheek, nose, palate and part of the pharynx
● the mandibular branch carries sensations from the lower gums, teeth, lips,
palate and part of the tongue
The autonomic nervous system

This is the part of the nervous system that controls the automatic
actions of smooth and cardiac muscle and the activities, of glands. It
is divided into the sympathetic and parasympathetic divisions, which
have complementary (balancing) responses.
PARASYMPATHETIC SYMPATHETIC
Brain
Eye Eye
Constricts Pupil Dilate Pupil
Salivary & Parotid Glands Salivary & Parotid Glands

Stimulates Saliva Production Inhibits Saliva Production
Blood Vessels Blood Vessels

Constricts in Skeletal Muscles Dilates in Skeletal Muscles
Sweat Gland Sweat Gland
Inhibits Sweat Secretion Stimulates Sweat Secretion
Lungs Lungs
Constricts Bronchi Dilates Bronchi
Heart Heart
Slows Heart Beat Accelerates Heart Beat

Spinal Cord
Liver Liver
Inhibits Glucose Release Stimulates Glucose Release
Gallbladder Gallbladder
Stimulates Bite Inhibits Bile
Pancreas Pancreas
Stimulates Pancreas Inhibits Pancreas
Stomach Stomach
Stimulates Stomach Motility & Secretions Inhibits Stomach Motility & Secretions
Intestines Intestines
Stimulates Intestinal Motility Inhibits Intestinal Motility
Rectum Rectum
Relaxes Rectum Contracts Rectum
Kidneys Kidneys
Stimulates Adrenal Gland Inhibits Adrenal Gland
Decrease Renin Secretion Increase Renin Secretion
Bladder Bladder
Stimulate Urination Inhabits Urination
Vagina Vagina
Promotes Vaginal Lubrication Promotes Vaginal Contraction & Orgasm
Penis Penis
Promotes Erection of Genitals Promotes Ejaculation
p The autonomic nervous system
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Effects of the sympathetic and

parasympathetic nervous systems
Table 9.6
Effects of sympathetic Effects of parasympathetic

Part of body stimulation stimulation
Heart Increases heart rate Slows down heart rate
Lungs Dilates bronchi to increase Slows down breathing rate
respiration
Blood vessels Dilates blood vessels Constricts blood vessels
Adrenal Stimulates release of
glands adrenaline
Sweat glands Stimulates/increases the
Study tip secretion of sweat
When comparing the
Digestive Reduces peristalsis Increases peristalsis
sympathetic and parasympathetic
nervous systems, think of the Liver Increases conversion of Increases conversion of
sympathetic nervous system glycogen to glucose by liver glucose to glycogen
as the ‘day nerve’ that makes us
Bladder Relaxes bladder Contracts bladder
active and allows us to work, and
the parasympathetic system as Skin Constricts arterioles so
the ‘night nerve’, which permits less blood flows near skin
us to rest, sleep and renew our surface (skin looks pale)
strength for the next working day. Eyes Dilates pupils Constricts pupils
The sympathetic system

The sympathetic system prepares the body for expending energy
and dealing with emergency situations.
Table 9.7 Effects of sympathetic stimulation on parts of the body
Effects of sympathetic
Part of body stimulation Body response
Heart Increases rate of contraction Heart rate increases
of cardiac muscle
Lungs Dilates bronchi Breathing rate increases
Blood vessels Dilates blood vessels Increases blood flow
to muscles and so the
body’s ability to move
Adrenal glands Stimulates release Body prepared for fight-
of adrenaline and or-flight response
noradrenaline
Sweat glands Stimulates/increases the Sweaty palms and
secretion of sweat nervousness
Salivary glands Decreased secretion of saliva Dry mouth
Digestive Reduces peristalsis May feel constipated
➜
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Effects of sympathetic
Liver Increases conversion of Provides extra glucose
glycogen to glucose by liver for tissues (may get
‘sugar high’)
Bladder Relaxes bladder and closes Body can go long
sphincter muscles periods without
urinating
Skin Constricts arterioles Less blood flows near
skin surface (skin looks
pale)
Eyes Dilates pupils Improves vision
The parasympathetic system KEY FACT

This balances the action of the sympathetic division by working The sympathetic stimulation of
to conserve energy and create the conditions needed for rest and the autonomic nervous system
sleep. It slows down the body processes, except digestion and the is increased by the release of
the hormone adrenaline from
functions of the genito-urinary system. In general, the actions of
the adrenal medulla. This is an
the parasympathetic system contrast with those of the sympathetic example of the nervous and
system and the two systems work in opposition to regulate the internal endocrine system working
workings of the body. synergistically (together).
Table 9.8 Effects of parasympathetic stimulation on parts of the body
Effects of parasympathetic
Heart Slows down the rate of Heart rate slows down,
contraction of the cardiac blood pressure reduces Activity
muscle Imagine you are feeling
stressed – perhaps due to an
Lungs Constricts bronchi Breathing rate slows
down and becomes
exam. Identify the systems of
deeper the body and describe how
they are affected by stress.
Blood vessels Constricts blood vessels Increased ability to sit still
Adrenal glands No effect
Sweat glands No effect KEY FACT
Salivary glands Increases secretion of saliva Stimulates digestion The sympathetic and
parasympathetic nervous
Digestive Increases peristalsis May digest food better systems are finely balanced
Liver No effect to ensure the optimum
functioning of organs of the
Bladder Contracts bladder and More frequent urination body.
relaxes sphincter muscles
Skin No effect
Eyes Constricts pupils
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Sense organs Nose (olfaction)

The specialised chemoreceptors of the olfactory
nerve cells in the nose pick up information about an
incoming odour and pass it to the olfactory bulb in
the brain to be analysed.
Tongue (taste)
Chemosensitive receptors are concentrated on
the papillae (projections of the tongue). Within
the papillae are tiny taste buds, which are round
in structure. These are formed from bundles of cell
bodies and nerve endings of the seventh, ninth and
tenth cranial nerves. The taste hairs are stimulated by
food and drink that is placed in the mouth, sending
messages in the form of electrical impulses to the
taste area in the cerebrum for interpretation.
Eyes (sight)
p The sense organs The human eyes are the organs of vision and are
responsible for around 80% of all the information
The special senses are: our brain receives. The human eye is the organ which
● touch – mediated through the skin gives us the sense of sight, allowing us to learn more
● olfaction – using the nose about the surrounding world than we can with any
● taste – using the tongue of the other four senses.
● sight – through the eyes Functions of the eye
● hearing – using the ears. The functions of the eyes are to:
The special senses are all linked to the nervous 1 provide vision
system. For instance, olfactory receptors in the nose 2 provide depth perception
connect directly with the olfactory bulb in the brain;
3 help with balance
nerve receptors in the eye send messages to the
visual cortex in the brain to enable images to be 4 produce tears.
interpreted. Structure of the eye
Skin (touch) The eye consists of three layers:
1 an outer fibrous layer
There are numerous sensory nerve endings in the
skin that are sensitive to touch, pain and changes in 2 a middle vascular layer
temperature (see Chapter 2). 3 an inner nervous layer.
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Sclera
Choroid
Conjunctiva
Retina
Fovea (centre Cornea

of the macula)
Optic disc
(blind spot) Pupil
Central artery
and vein Iris
Optic nerve
Lens
Ciliary body
Vitreous chamber
p The structure of the eye
The outer fibrous layer

This consists of the:
● conjunctiva (con-junk-ti-vaa) – the mucous membrane that covers
the front of the eye and lines the inside of the eyelids
● cornea (corr-nee-a) – the outer, transparent structure at the front of
the eye that covers the iris, pupil and anterior chamber; it is the eye’s
primary light-focusing structure
● sclera (sk-ler-raa) – the sclera is the white of the eye; it is made up
of a tough outer coat that protects the entire eyeball, giving it shape
and rigidity
● trabecular meshwork – this is spongy tissue located near the cornea,
KEY FACT
through which aqueous humour flows out of the eye.
The main purpose of the
The middle vascular layer cornea is to help focus light
The middle vascular layer consists of the following parts: as it enters the eye.
● Iris – the coloured ring of tissue behind the cornea that regulates the
amount of light entering the eye by adjusting the size of the pupil. In practice
The iris is pigmented, and this determines the colour of the eyes. It is important that contact
● Pupil – the adjustable opening at the centre of the iris through which lenses are removed for eye
light enters the eye. The pupil regulates the amount of light entering treatments. Since lenses rest
the eyeball. on the cornea, they could cause
● Choroid (cor-roy-d) – the layer of the eye behind the retina irritation during treatment.
containing blood vessels that nourish the retina by providing There is also a risk of damage
nutrients. It also absorbs scattered light. to the lenses.
● Ciliary body – part of the eye, above the lens, that contains processes
that secrete aqueous humour. It also contains muscles that alter the
shape of the lens for near or far vision. The ciliary body is closely
associated with the lens and the trabecular meshwork.
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● The aqueous (a-qui-us) humour is a liquid which

KEY FACT sits in a chamber behind the cornea. Aqueous
Aqueous humour is a watery fluid that nourishes humour is continuously produced by the ciliary
the lens and cornea, and helps to produce
body. The aqueous humour nourishes the cornea and
intraocular pressure (the pressure inside the
eyeball that helps to maintain its shape). the lens, and helps maintain the shape of the eye.
● The vitreous (vitt-tree-us) cavity is located
● The lens – the transparent structure suspended behind the lens and in front of the retina. It is
behind the iris that helps to focus light on filled with a gel-like fluid, called the vitreous
the retina; it primarily provides a fine-tuning humour that fills the eye from the lens to the
adjustment to the primary focusing structure of retina at the back of the eye.
the eye, which is the cornea. ● The vitreous (vitt-tree-us) humour is a jelly-like
The inner nervous layer of the eyes substance that helps to produce the intraocular
pressure which maintains the shape of the eyeball
The inner nervous layer of the eyes consists of the
and keeps the retina in place.
following parts:
● The optic nerve is the bundle of nerve fibres at
● The retina is the light-sensitive layer of tissue that
the back of the eye that carries visual messages
lines the back of the eye and is located near the
from the retina to the brain.
optic nerve. The purpose of the retina is to:
● receive light that the lens has focused
● convert the light into neural signals
KEY FACT
● send these signals to the brain for visual
As people age, the vitreous humour liquefies
and shrinks, and collagen and proteins become
recognition.
stringy. These stringy entities float around,
● The retina has two types of cells that initiate these casting shadows on the retina. These are called
nerve impulses; the rods and cones, which are ‘floaters’ and they may appear as specks, strings
classed as photoreceptors (light-sensitive nerve cells). or other shapes, visible just out of the corner of
the eye.
Rods and cones convert the light from our retinas
into electrical impulses, which are sent by the optic
nerve to the brain, where an image is produced. How the eyes work
● Cones are the cells that are responsible for
Study tip
daylight vision, allowing us to see images in
colour and in detail. There are three kinds, each The human eye functions a bit like a digital camera,
as shown in these steps.
responding to a different wavelength of light:
red, green and blue. In darkness, the cones do
1 Light enters the eye through the cornea, the
not function at all.
clear front surface of the eye, which acts like
● Rods are responsible for night vision, peripheral
a camera lens.
(side) vision and detecting motion. They are
more sensitive to light; therefore, they allow us 2 The iris works like the diaphragm of a camera,
to see in low light situations, but they do not controlling how much light reaches the back of
allow us to see colour. the eye. It does this by automatically adjusting the
size of the pupil which, in this scenario, functions
● The macula is the portion of the eye at the centre
like a camera’s aperture.
of the retina that processes clear straight-ahead
vision. It’s how we see form, colour, and detail in 3 The eye’s crystalline lens sits just behind the pupil
our direct line of sight. and acts like an autofocus camera lens, focusing
on close and approaching objects.
● The fovea is the pit or depression at the centre
of the macula that provides the greatest visual 4 Focused by the cornea and the crystalline lens, the
acuity. light makes its way to the retina. This is the light-
sensitive lining in the back of the eye. Think of the
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retina as the electronic image sensor of a digital Balance

camera. The retina’s job is to convert images into As well as providing hearing, our ears help keep us
electronic signals and send them to the optic nerve. balanced.
5 The optic nerve then transmits these signals to Inside the inner ear, there are three small, hollow
the visual cortex of the brain, which creates our loops called the semicircular canals. These loops
sense of sight. This is like viewing camera images are filled with liquid and have thousands of
on a screen. microscopic hairs.
When you move your head, the liquid in the
Ears (hearing) semicircular canals moves, too. In turn, the liquid
The ear is a multifaceted organ that connects the moves the tiny hairs, which send nerve messages
CNS to the external head and neck. The ear structure to your brain about the position of your head.
as a whole is divided into three parts: In less than a second, your brain sends messages
● outer ear to the right muscles so that you keep your
balance.
● middle ear
● inner ear.
Study tip
All three parts of the ear’s structure have different,
Sometimes the liquid in the semicircular
but important, features that work collectively to
canals keeps moving after the body has stopped
facilitate hearing and balance. moving. Consider the effects of a roller coaster
All three parts of the ear are important for detecting ride. When you stop spinning and step off the
sound. They work together to move sound waves ride, the fluid in your semicircular canals is
from the outer part through the middle part and into still moving. The hairs inside the canals sense
the inner ear. The ears collect sounds, process them movement, even though you are actually
and send electrical signals about sound to your brain. standing still. This can produce a feeling
of dizziness, because your brain is getting
Functions of the ear conflicting messages from your eyes and ears
and, therefore, is confused about the position
The two functions of the ears are: of your head. Once the fluid in the semicircular
● hearing canals stops moving, your brain gets a message
● balance. that supports what you are seeing, and you
regain your balance.
Hearing
● Sound waves are collected by the outer ear and travel
into the ear canal until they reach the eardrum. Structure of the ear
● The eardrum passes the vibrations through the The outer ear
middle ear bones (ossicles) into the inner ear. The outer ear is made up of:
Inside part of the inner ear (the cochlea), there ● the auricle or pinna
are thousands of tiny hair cells.
● the ear canal (external auditory canal or meatus)
● The hair cells change the vibrations into electrical
● the tympanic membrane (eardrum).
signals that are sent to the brain through the
hearing nerve. The function of the outer part of the ear is to collect
sound. Sound waves travel through the auricle and
● The brain experiences this as hearing and may
the auditory canal, a short tube that ends at the
process knowledge about what sound has been
eardrum.
detected.
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Malleus Incus Stapes Oval window Semicircular canals Vestibular

Helix Fossa
apparatus
Scapha Concha Pinna
Antihelical
foid
Extemal
auditory
meatus Nerves
Anthihelix
Tragus
Lobule
Labyrinth
Antitragus
Ear
canal
ANATOMY OF THE AURICLE Round
window
Oval window Cochlea
(behind stirrup)
Anvil Stirrup
Hammer Auditory
Auditory nerve
canal
Eardrum To
pharynx
Roud Cochlea
window Tympanic membrane Internal jugular vein Eustachian tube
THE EARDRUM AND MIDDLE EAR BONES ANATOMY OF THE EAR
p The structure of the ear

The auricle or pinna is made up of fibroelastic Cerumen (ear wax) is a yellow waxy secretion that
cartilage and skin. It has three different parts: is produced inside the ear canal. Cerumen has an
1 the tragus – the prominence over and in front of important function in that it assists in cleaning and
the external auditory canal or auditory meatus lubricating the ear canal, as well as protecting against
bacteria, fungi and the penetration of insects.
2 the helix – a fold surrounding the auricle
3 the lobe (or lobule) – the fleshy part at the base KEY FACT
of the ear.
Excessive or impacted cerumen can obstruct the
The auricle is the only visible part of the ear, the external auditory canal and press against the
rest of which is housed within the temporal bone eardrum, causing conductive hearing loss.
of the skull. It is the first part of the ear to come
into contact with sound. The auricle of the external The middle ear
ear helps collect sound waves travelling through The middle ear is a small air-filled cavity found
the air and directs them into the external auditory between the outer ear and the inner ear. Its function is
canal. to transmit sound from the outer ear to the inner ear.
The external auditory canal (also called the ear It is partitioned from the outer ear by the eardrum and
canal or external auditory meatus is a passageway from the inner ear by a bony partition containing two
that leads from the outside of the head to the windows: the oval window and the round window.
tympanic membrane (eardrum) of each ear. After The middle ear contains three tiny auditory bones
entering the canal, the sound waves pass to the called ossicles (oss-ik-culls):
end of the tube and cause pressure changes on ● the hammer or malleus (mall-ee-us)
the eardrum. The eardrum moves back and forth
● the anvil or incus
in response and thus reproduces the vibrations of the
sound wave source. ● the stirrup or stapes (stay-pees).
The tympanic (tim-pan-ik) membrane or eardrum The bones of the middle ear are surrounded by a
is a thin layer of cone-shaped tissue that separates small cavity called the tympanic (tim-pan-ik) cavity.
the auditory canal from the middle ear. It facilitates The handle of the hammer is attached to the inner
hearing by transmitting sound vibrations from the air surface of the eardrum and, when the eardrum vibrates,
to the bones in the middle ear. it causes the hammer to move. The hammer hits the
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anvil, which in turn hits the stapes, which is attached to 6 These impulses are processed in the auditory
the oval window, a membrane covered opening. The oval cortex located in the temporal lobes of the
window then transmits the sound wave into the inner ear. cerebral cortex in brain, which are situated above
The Eustachian (yoo-stay-shun) tube, also known as the the ears, and we experience hearing.
auditory tube, is part of the middle ear and links to the The eyes and ears are such important sense organs,
nasopharynx. It controls the pressure within the middle constantly collecting information for the brain
ear, making it equal with the air pressure outside the body. to interpret, that their malfunction can have a
significant effect on health and wellbeing.
The inner ear
The inner ear (labyrinth) is entirely enclosed within
the temporal bone. The parts of the inner ear include: In practice
● The cochlea (cock-lee-er) – the portion of the For client comfort and wellbeing the eyes should
inner ear that results in the final detection of be closed during some treatments. Treatments
sounds within the CNS, transforming sounds into around the eyes could cause stinging and irritation
signals that get sent to the brain where the signals if the eyes are not protected.
are interpreted as hearing. Care should be taken if a client wears a hearing
● The semicircular canals – three tiny, fluid-filled tubes aid to prevent product entering the ears, where it
that help with balance. When the head moves around, could cause the equipment to malfunction.
the liquid inside the semicircular canals sloshes about
and moves the tiny hairs that line each canal.
Activity
● The vestibule – a bony chamber, located between
Research the following disorders that affect the
the cochlea and the semicircular canals, which
eyes and ears. Discuss the effects these disorders
contains membranous structures that serve both
may have on sight and hearing, and on the overall
hearing and balance. The vestibule’s main function is wellbeing of the person (consider, for example,
to detect changes in gravity and linear acceleration. the complete loss of vision and hearing).
Disorders of the eye
KEY FACT
The semicircular canals are lined with tiny
● Blepharitis
hairs called cilia. The fluid contained in the ● Cataract
membranous labyrinth of the inner ear is called ● Conjunctivitis
endolymph. ● Glaucoma
When the head moves, it causes the endolymph Disorders of the ear
to move the cilia. The actions of the cilia are
relayed to the brain, which senses this as motion. ● Glue ear
● Labyrinthitis
Meniere’s disease
How the ear works ●
● Tinnitus
The process of hearing sounds happens like this:
● Vertigo
1 Sound waves enter the ear canal and cause the
eardrum to vibrate.
2 Vibrations pass through three connected bones Common pathologies
(malleus, incus, stapes) in the middle ear.
3 These vibrations set fluid in motion in the inner ear.
of the nervous system
4 Moving fluid bends thousands of delicate Anxiety
hair-like cells, which convert the vibrations Anxiety involves experiencing feelings of fear and worry.
into nerve impulses. As an illness, it can vary from mild to severe stress and
5 Nerve impulses are carried to the brain by the can include panic attacks and severe phobias that can
auditory nerve. be socially, psychologically and physically disabling.
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It presents with feelings of dread and is associated of the brain that is affected, but may include some or
with palpitations, rapid breathing, sweaty hands, all of the following:
tremor (shakiness), dry mouth, indigestion, ● speech impairment and difficulty swallowing
sensations of butterflies in the stomach, occasional
● learning difficulties
diarrhoea and generalised aches and pains in the
● spastic muscle tone, making co-ordinated
muscles. Some of these signs are similar to features
movements difficult
of mild-to-moderate agitated depression.
● hyperexcitable muscles; small movements,
The causes of anxiety include genetic and
touch and emotional stress can increase muscle
behavioural predisposition, a traumatic experience
spasticity
or physical illness such as hyperthyroidism.
● abnormal posture and gait due to muscle spasticity
Bell’s palsy
● abnormal involuntary movements of the
This is a disorder of the seventh cranial nerve limbs that may be exaggerated on voluntarily
(facial nerve) that results in paralysis on one side of performing a task
the face. The disorder usually comes on suddenly and
● general muscle weakness
is commonly caused by inflammation around the
facial nerve as it travels from the brain to the exterior. ● seizures
It may be caused by pressure on the nerve due to a ● hearing and visual impairment.
tumour, injury to the nerve, infection of the meninges Depression
or inner ear, or dental surgery. Diabetes, pregnancy
Symptoms include lowered mood, changes in
and hypertension are other causes.
appetite and sleep pattern, lack of concentration,
The condition may present with a drooping of the interest and enjoyment, constipation and loss of
mouth on the affected side, due to flaccid paralysis libido. There may also be suicidal thinking, death
of the facial muscles. There may also be difficulty in wish or active suicide attempts.
puckering the lips due to paralysis of the orbicularis
Depression can be the result of chemical imbalance,
oris muscle. Other symptoms include:
usually related to serotonin and noradrenalin. The
● diminished or complete loss of sense of taste, causes of depression can be endogenous (no apparent
if the nerve has been affected proximal to the external cause but thought to be linked to genetic
branch which carries taste sensations predisposition), physical illness or disability, or
● difficulty tightly closing the eye and creasing the emotional trauma, such as bereavement or loss
forehead of relationship.
● inability to puff out the cheeks and problems People who are depressed may present in a wide
with food getting caught between the teeth and variety of sometimes opposing ways. Behaviours
cheeks, if the buccinator muscle is affected may include:
● excessive tearing from the affected eye ● being tearful, or restless, or irritable
● pain near the angle of the jaw and behind the ear. ● slowness in speech, thinking and remembering
Between 80–90% of individuals recover ● comfort eating or loss of appetite
spontaneously and completely in around one to eight ● difficulty maintaining eye contact and social
weeks. Corticosteroids may be used to reduce the withdrawal
inflammation of the nerve.
● difficulty sleeping or sleeping a lot
Cerebral palsy ● excessive use of drugs or alcohol
This condition is caused by damage to the CNS of ● self-harm.
the baby during pregnancy, delivery or soon after
The severity of depression can vary from mild to
birth. The damage to the brain could be due to
psychotic, manifested by hallucinations, delusions,
bleeding, lack of oxygen or other injuries. The signs
paranoia and other thought disorders.
and symptoms of this condition depend on the area
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Epilepsy
In practice
This is a neurological disorder which makes the
individual susceptible to recurrent and temporary Always refer to the client’s GP regarding their type
seizures. Epilepsy is a complex condition and of epilepsy and nature of seizures. If they are on
classifications of types of epilepsy are not definitive. controlled medication, the chances of a seizure are
Types of epilepsy are: minimal; however, caution is advised due to the
complexity of this condition. Avoid any form of
● Generalised – this may take the form of major
electrotherapy.
tonic–clonic seizures (formerly known as grand
mal). At the onset, the patient falls to the ground Headache
unconscious with their muscles in a state of
This is a pain affecting the head, excluding facial pain.
spasm (tonic phase). This is followed by convulsive
It can result from diseases of the ear, nose and throat,
movements (clonic phase). The patient may bite
such as sinusitis. Eye problems, which can often be
their tongue and urinary incontinence may occur.
corrected by glasses, may also cause headache. Types
Movements gradually cease and the patient may
of headaches include:
rouse in a state of confusion, complaining of a
headache or may fall asleep. ● Simple headache – this may occur at times of
stress, during menstruation, the day after heavy
● Partial – this may be idiopathic (of unknown
alcohol consumption and as a symptom of a cold
cause) or a symptom of structural damage to
or flu. These are transient and normally settle
the brain. In one type of partial idiopathic epilepsy,
spontaneously, or after simple analgesia.
often affecting children, seizures may take the
form of absences (formerly known as petit mal), ● Chronic headaches – these are daily headaches,
in which there are brief spells of unconsciousness often caused by tension. The pain can be severe
lasting for a few seconds. The eyes stare blankly and disabling. Pain can affect the front of the head,
and there may be fluttering movements of the be located behind the eyes or may be felt in the
lids and momentary twitching of the fingers and whole head. The client sometimes describes the
mouth. This form of epilepsy seldom appears pain as being like a tight band around the head.
before the age of three or after adolescence. It ● Cervical spine headache (cervicalgia) – this is
often subsides spontaneously in adult life but may normally in the back and sides of the head and
be followed by the onset of generalised or partial can present with neck pain.
epilepsy. ● Migraine headache – this is a specific form of
● Focal – this is partial epilepsy due to brain headache, usually unilateral (affecting one side of
damage (either local or from a stroke). The the head), associated with nausea or vomiting, and
nature of the seizure depends on the location of may be accompanied by visual disturbances such
the damage in the brain. In a Jacksonian motor as scintillating light waves or zigzag lines.
seizure the convulsive movements may spread ● Intracranial (inside brain) disease headaches –
from the thumb to the hand, arm and face. these are headaches caused by diseases such as
● Psychomotor – this type of epilepsy is caused brain tumours. They can present with nausea and
by a dysfunction of the cortex of the temporal vomiting, and may cause other neurological signs
lobe of the brain. Symptoms may include and symptoms.
hallucinations of smell, taste, sight and hearing. Herpes zoster (shingles)
Throughout an attack the patient is in a state of
This is an infection by the chicken pox virus of the
clouded awareness and afterwards may have no
sensory nerves. Lesions resemble herpes simplex, with
recollection of the event.
erythema and blisters along the lines of the nerves.
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The most commonly affected areas are the back and Depending on severity, migraines can be treated
upper chest wall. This condition is very painful due to with simple analgesia (pain medication) or more
acute inflammation of one or more of the peripheral specialised anti-migraine medication.
nerves. Severe pain may persist at the site of shingles
for months or even years after apparent healing of In practice
the skin. Stress and tension can increase the frequency of
Meningitis migraines. Women are more likely to have migraines
This is an inflammation of the meninges due to during premenstrual periods, when they are taking
infection by viruses or bacteria. Meningitis presents the contraceptive pill, during the menopause or
with an intense headache, fever, loss of appetite, when starting hormone replacement therapy (HRT).
intolerance to light and sound, and rigidity of Clients should avoid treatments during acute
muscles, especially those in the neck. In severe cases migraine attacks.
there may be convulsions, vomiting and delirium,
leading to death. The different types of meningitis are: Motor neurone disease (MND)
● Bacterial meningitis – bacterial infection of the This is a progressive degenerative disease of the motor
meninges is treated with large doses of antibiotics. neurones of the nervous system. It tends to occur in
middle age and causes muscle weakness and wasting.
● Meningococcal meningitis – this specific form
of bacterial meningitis is caused by a bacterium Multiple sclerosis (MS)
called Neisseria meningitidis and is characterised This is a disease of the CNS in which the
by a non-blanching haemorrhagic rash that may myelin (fatty) sheath covering the nerve fibres
occur anywhere on the body. The symptoms is destroyed and various functions become
appear suddenly and the infection may very impaired, including movement and sensations.
quickly culminate in life-threatening septicaemia. Multiple sclerosis is characterised by relapses and
● Viral meningitis – this does not respond to drugs remissions. It can present with blindness or reduced
but normally has a relatively benign prognosis. vision, and can lead to severe disability within a
short period. It can also cause incontinence, loss of
Migraine
balance, tremor and speech problems. Depression
This is a specific form of headache, usually unilateral and mania can occur.
(affecting one side of the head), associated with
nausea or vomiting, and visual disturbances such as Myalgic encephalomyelitis
scintillating light waves or zigzag lines. The client Myalgic encephalomyelitis (ME, or chronic fatigue
may experience a visual aura (visual disturbance) syndrome) is characterised by extreme disabling
before an attack actually happens. This is usually fatigue that has lasted for at least six months and
called a classical migraine. There are other types of is made worse by physical or mental exertion and is
migraine: not resolved by bed rest. The symptom of fatigue is
● ophthalmoplegic migraine – this causes painful, often accompanied by some of the following: muscle
red and watery eyes pain or weakness, poor co-ordination, joint pain, slight
fever, sore throat, painful lymph nodes in the neck
● neuropathic migraine – causes one-sided
and armpits, depression, inability to concentrate and
paralysis and weakness of the face and body
general malaise.
● abdominal migraine – this can affect children
People in any age group can contract ME, but recently
with recurring attacks of abdominal pain,
a higher incidence has been reported in children and
sometimes accompanied by nausea and vomiting.
adolescents.
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Sciatica
In practice
This is lower back pain which can also affect the
Relaxation treatments may help clients to cope buttock and thigh. On occasions, it radiates to the
with ME, but since they tire easily it is best to keep leg and foot. In severe cases, it can cause numbness
treatments short and light. and weakness of the lower limb. It can result from
Be aware that people with ME often experience prolapse of the discs between the spinal vertebrae,
tenderness in the muscles and joints. tumour or blood clot (thrombosis). Diabetes or heavy
alcohol intake can also produce symptoms of sciatica.
Neuralgia This condition tends to recur and may require strong
Neuralgia presents as attacks of pain along the analgesia or surgery in severe cases.
entire course or branch of a peripheral sensory nerve.
A common example is trigeminal neuralgia, which In practice
affects the trigeminal nerve in the face. In the case of a client with sciatica, arrange the couch
Neuritis for comfort and avoid unnecessary manipulation. Be
aware that climbing onto or lying on the couch be
This is inflammation or disease of a single nerve or
painful. If possible, lower the treatment table to help
several nerves. There are different causes, such as
the client climb up and avoid having the client lie in
infection, injury or poison. Neuritis causes pain along
one position for too long.
the length of the nerve and/or loss of the use of
structures supplied by the nerve. Relaxation and massage can be helpful and the
aim in treatments should be to relax muscles and
Parkinson’s disease prevent spasms.
This disease is caused by damage to the grey
matter of the brain, known as basal ganglia. It Stress
causes involuntary tremors of limbs with stiffness Stress can be defined as any factor that affects
and a shuffling gait. The face lacks expression and physical or emotional wellbeing. Signs of stress in the
movements are slow. Clients may suffer from nervous system include anxiety, depression, irritability,
depression, confusion and anxiety. headache, back pain and excessive tiredness.
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Interrelationships with centre for the heart. The sympathetic nervous

system prepares the body for activity by increasing
other systems the heart rate. The parasympathetic nervous system
activates the resting heart rate.
The nervous system
Respiratory
The nervous system links to the following body
systems. Oxygen that is inhaled into the body is carried to
nerve cells to enable them to function properly.
Cells and tissues Without oxygen, nerve cells become damaged and
Nervous tissue is a specialised type of tissue which die, causing irreversible damage. The sympathetic
can detect stimuli and transmit them as electrical nervous system prepares the body for activity by
nerve impulses. increasing the respiration rate. The parasympathetic
nervous system activates the resting respiratory rate.
Skin
The skin is a highly sensitive organ with many Endocrine
sensory nerve endings which respond to touch, The endocrine system works closely with the
temperature and pressure. nervous system in order to maintain homeostasis in
the body.
Skeletal
The skeleton provides protection for the spinal cord Digestive
and the brain. The nervous system influences the actions
of the digestive system. The effects of the
Muscular sympathetic nervous system include increased
The brain sends impulses to muscles via motor conversion of glycogen to glucose by the liver and
nerves in order to effect movement. decreased secretion of saliva. The effects of the
parasympathetic nervous system include increased
Circulatory
gastrointestinal activity and stimulated salivation.
Blood transports vital oxygen to the nerve cells.
The medulla oblongata in the brain is the control
Key words Brainstem: the portion of the brain that is

continuous with the spinal cord and comprises the
Anvil (incus): one of the three small auditory bones medulla oblongata, pons, midbrain, and parts of
located in the middle ear the hypothalamus
Aqueous humour: watery fluid that nourishes Central nervous system (CNS): part of the nervous
the lens and cornea of the eye, and helps produce system consisting of the brain and spinal cord
intraocular pressure Cerebrospinal fluid: the fluid that flows in and
Auditory nerve: a bundle of nerve fibres that carries around the brain and spinal cord, to help cushion
information about sound between the cochlea and them from injury and provide nutrients
the brain Cerebellum: the portion of the brain that is in the
Autonomic nervous system: part of the nervous back of the head, between the cerebrum and the
system responsible for control of the bodily brainstem
functions that are not consciously directed, such as Cerebral cortex: the outer layer of the cerebrum
breathing, heartbeat and digestive processes that is concerned with all forms of conscious activity,
Axon: a long, single nerve fibre extending from the such as vision, touch, hearing, taste and smell, as
cell body, whose function is to transmit impulses well as control of voluntary movements, reasoning,
away from the cell body emotion and memory
Brain: the central organ of the nervous system
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Cerebrum: the largest and anterior part of the brain, Incus (anvil): one of the three small auditory bones
divided into two hemispheres located in the middle ear
Cerumen: a yellowish, waxy substance secreted into Iris: the coloured ring of tissue behind the cornea
the ear canals that regulates the amount of light entering the eye
Choroid: a layer of the eye behind the retina that by adjusting the size of the pupil
provides nutrients to the retina Labyrinth: the rigid, bony outer wall of the inner ear
Ciliary body: a circular structure located above in the temporal bone, consisting of three parts: the
the lens that secretes aqueous humour and also vestibule, semicircular canals, and cochlea
contains (ciliary) muscles that alter the shape of the Lens: the transparent structure suspended behind
lens for near or far vision the iris that helps to focus light on the retina
Cochlea: part of the inner ear responsible for Macula: the functional centre of the retina that
transforming sounds into signals that get sent to the provides the best colour vision
brain, where they are experienced as hearing Malleus (hammer): one of the three small auditory
Conjunctiva: the mucous membrane that covers the bones located in the middle ear
front of the eye and lines the inside of the eyelid Medulla oblongata: the continuation of the spinal
Cornea: the outer, transparent structure at the front cord within the skull, forming the lowest part of the
of the eye that help focus light as it enters the eye brainstem and containing control centres for the
heart and lungs
Cranial nerves: the nerves of the brain which
emerge from or enter the skull (the cranium); Meninges: three membranes (the dura mater,
there are 12 pairs (accessory, abducens, facial, arachnoid, and pia mater) that line the skull and
glossopharyngeal, hypoglossal, olfactory, optic, vertebral canal and enclose the brain and spinal cord
oculomotor, trochlear, trigeminal, vestibulocochlear Mixed neurone: a nerve containing both sensory
and vagus) and motor fibres
Dendrites: short branched extensions of a nerve Motor neurone: a nerve cell which passes impulses
cell, along which impulses received from other cells from the brain or spinal cord to a muscle or gland
at synapses are transmitted to the cell body Myelin sheath: a fatty insulating sheath that covers
Endolymph: watery fluid contained within the the axon of a neurone
labyrinth of the inner ear Neurilemma: the fine delicate membrane that
Eustachian tube (auditory tube): a tube that links surrounds the axon of a neurone
the nasopharynx to the middle ear, and controls the Neuroglia: a type of connective tissue of the CNS
pressure within the middle ear that is designed to support, nourish and protect the
External auditory canal: also called the ear canal; a neurones
passageway that leads from the outside of the head Neurone: nerve cell
to the tympanic membrane (eardrum) of each ear
Neurotransmitter: a chemical that is released from
Fovea: a depression at the centre of the macula that a nerve cell to transmit an impulse across a synapse
provides the greatest visual acuity to another nerve, muscle, tissue or organ
Ganglia/ganglion: a mass of nerve tissue existing Optic nerve: a bundle of nerve fibres at the back of
outside the CNS the eye that transmits visual information from the
Grey matter: darker tissue of the brain and spinal retina to the brain
cord, consisting mainly of nerve cell bodies and Parasympathetic nervous system: part of the
branching dendrites autonomic nervous system that controls the body
Hammer (malleus): one of the three small auditory at rest
bones located in the middle ear Peripheral nervous system (PNS): the part of the
Hypothalamus: a region of the forebrain below the nervous system outside of the brain and spinal cord
thalamus which co-ordinates both the autonomic Photoreceptors: light-sensitive nerve cells (rods
nervous system and the activity of the pituitary and cones)
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Pineal gland: a small endocrine gland located on Spinal nerves: mixed nerves, which carry motor,
the back portion of the third cerebral ventricle of sensory, and autonomic signals between the spinal
the brain; secretes melatonin cord and the body; there are 31 pairs, one on each
Pinna: the only visible part of the ear; collects sound side of the vertebral column (8 cervical, 12 thoracic,
waves 5 lumbar, 5 sacral and 1 coccygeal)
Plexuses: a network of nerves Stapes (stirrup): one of the three small auditory
bones located in the middle ear
Pons: part of the brainstem that links the medulla
oblongata and the thalamus Sympathetic nervous system: part of the
autonomic nervous system that prepares the body
Pupil: an adjustable opening at the centre of the iris for intense physical activity, and mediates the fight-
through which light enters the eye or-flight response
Reflex action: an automatic response to a stimulus Synapse: a junction between two nerve cells
that does need any conscious thought
Thalamus: a structure in the middle of the
Retina: a thin layer of tissue that lines the back of brain, located between the cerebral cortex and
the eye on the inside; its role is to receive light that the midbrain, that works to co-ordinate several
the lens has focused, convert the light into neural important processes, including consciousness, sleep,
signals, and send these signals on to the brain for and sensory interpretation
visual recognition
Tympanic membrane (eardrum): a membrane that
Sclera: the white of the eye transfers sound vibrations from the outer ear to the
Semicircular canals: three tiny, fluid-filled tubes in middle ear
the inner ear that help with sense of balance Vestibule: a bony chamber, located between the
Sensory neurone: a neurone that transmits nerve cochlea and the semicircular canals
impulses from a sense organ towards the CNS Vitreous membrane: a transparent jelly-like fluid
Somatic nervous system: part of the PNS filling the eyeball behind the lens
associated with the voluntary control of body White matter: the paler tissue of the brain and
movements via skeletal muscles spinal cord, consisting mainly of nerve fibres with
Spinal cord: an extension of the brainstem which their myelin sheaths
extends from an opening at the base of the skull
down to the second lumbar vertebra
Revision summary ● Neuroglia – this is a specialised type of

connective tissue that supports, nourishes
The nervous system and protects neurones.
● Neurones have two major properties – excitability
● The nervous system helps regulate homeostasis
and conductibility.
and integrate all body activities by sensing
changes, interpreting them and reacting to them. ● Most nerve cells, or neurones, consist of a cell
body, many dendrites and usually a single axon.
● The central nervous system (CNS) consists of the
● There are three main types of neurones – sensory,
brain and the spinal cord.
motor and mixed.
● The peripheral nervous system (PNS) consists ● Sensory neurones conduct impulses from
of the somatic nervous system, consisting of the receptors to the CNS.
cranial and spinal nerves, and the autonomic ● Motor neurones conduct impulses to effectors
(involuntary) nervous system. (muscles and glands).
● There are two types of nervous tissue: ● Mixed neurones conduct impulses to other
● Neurone – this is a functional unit of the neurones.

nervous system. The neurone is designed to ● The junction where nerve impulses are transmitted
receive stimuli and conduct impulses. from one neurone to another is called a synapse.
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● Impulses are relayed from one neurone to ● A reflex action is a rapid and automatic
another by a chemical transmitter substance response to a stimulus without any conscious
which is released by the neurone to carry impulses action of the brain.
across the synapse to stimulate the next neurone. ● The PNS contains all the nerves outside of the CNS
● The central nervous system (brain and and can be subdivided into the somatic nervous
spinal cord) is covered by a protective type system and the autonomic nervous system.
of connective tissue in three layers called the ● The somatic nervous system contains
meninges. 31 pairs of spinal nerves (nerves originating

● The parts of the brain include the cerebrum, from the spinal cord) and 12 pairs of cranial
thalamus, hypothalamus, pituitary gland, nerves (nerves originating from the brain).
pineal gland, cerebellum and brainstem. ● The 31 pairs of spinal nerves are 8 cervical,
● The cerebrum is the largest part of the brain

12 thoracic, 5 lumbar, 5 sacral and
and is concerned with all forms of conscious 1 coccygeal.
● Each spinal nerve is divided into several
activity. It has sensory areas which control
vision, touch, hearing, taste and smell, as branches, forming a network of nerves or
well as motor areas which control voluntary plexuses which supply different parts of
movements and association areas which the body.
● The 12 pairs of cranial nerves connect directly
control reasoning, memory and emotions.
● The thalamus is a relay and interpretation
to the brain. They are olfactory, optic,
centre for all sensory impulses, except olfaction. oculomotor, trochlear, trigeminal, abducens,
● The hypothalamus controls hunger, thirst,
facial, vestibulocochlear, glossopharyngeal,
temperature regulation, anger, aggression, vagus, accessory and hypoglossal.
hormones, sexual behaviour, sleep patterns ● The autonomic nervous system is the part of
and consciousness. the nervous system that controls the automatic
● The pituitary gland is a lobed structure actions of smooth and cardiac muscle and
attached by a stalk to the hypothalamus. the activities of glands. It is divided into the
● The pineal gland is involved in the regulation sympathetic and parasympathetic divisions.
of circadian rhythms and is thought to ● The function of the sympathetic system is to
influence mood. prepare the body for expending energy and

● The cerebellum is concerned with the co- dealing with emergency situations.
ordination of skeletal muscles, muscle tone and ● The parasympathetic system balances the
balance. action of the sympathetic division by working

● The brainstem contains the midbrain, pons to conserve energy and create the conditions
and medulla oblongata. needed for rest and sleep. It slows down the
● The midbrain contains certain visual body processes, except digestion and the
and auditory reflexes that co-ordinate functions of the genito-urinary system.
head and eye movements with vision and ● The sense organs include the nose (olfaction),
hearing. tongue (taste), eyes (sight), ears (hearing) and
● The pons relays messages from the skin (touch).
cerebral cortex to the spinal cord and ● The human eye is the organ of vision.
helps regulate breathing. ● Its main function is to convert light into
● The medulla oblongata contains electrical nerve impulses, which then travel to
control centres for the heart, lungs the visual cortex in the brain where they are
and intestines. interpreted.
● The spinal cord is an extension of the brainstem ● The eye is divided into three layers: an outer
and its function is to relay impulses to and from fibrous layer, a middle vascular layer and an
the brain. inner nervous layer.
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● The eye produces two types of gel-like fluids: anvil (incus) and the stirrup (stapes) and is
aqueous humour and vitreous humour. connected to the throat via the Eustachian
● The human eye functions much like a digital tube.
camera. ● The Eustachian tube links the nasopharynx to
● Focused by the cornea and the crystalline the middle ear. It controls the pressure within
lens, the light makes its way to the retina, the middle ear, making it equal with the air
which is the light-sensitive lining in the back pressure outside the body.
of the eye. ● The handle of the hammer is attached to the
● The retina acts like the electronic image inner surface of the eardrum and when the
sensor of a digital camera, converting images eardrum vibrates it causes the hammer to
into electrical signals and sending them to move. The hammer hits the anvil, which in turn
the optic nerve. hits the stapes, which then transmits the sound
● The optic nerve then transmits these signals to wave into the inner ear.
the visual cortex of the brain, which creates our ● The inner ear (labyrinth) is entirely enclosed
sense of sight. within the temporal bone.
● The human ear is the organ of hearing. ● The parts of the inner ear include:
● The ear is structured in three parts (outer, ● the cochlea – responsible for transforming
middle and inner ear), that work collectively sounds into signals that get sent to the brain
to co-ordinate hearing and balance. for hearing
● The outer ear is made up of fibroelastic ● the semicircular canals – three tiny, fluid-
cartilage and skin, and has three different filled tubes in the inner ear that help with
parts; the tragus, helix and lobule. balance
● The auricle or pinna is the only visible part of ● the vestibule – a bony chamber, located
the ear; it helps collect sound waves travelling between the cochlea and the semicircular
through the air and directs them into the canals, whose function is to detect changes
external auditory canal or meatus. in gravity and linear acceleration.
● The tympanic membrane, otherwise ● The sequence of hearing a sound is:
known as the eardrum, facilitates hearing ● Sound waves enter the ear canal and cause
by transmitting sound vibrations from the the eardrum to vibrate.

air in the auditory canal to the bones in ● Vibrations pass through three connected
the middle ear. bones (malleus, incus and stapes) in the

● Earwax, also known as cerumen, is a middle ear; this sets fluid in motion in
yellowish, waxy substance secreted in the ear the inner ear.
canals. It assists in cleaning and lubrication of ● Moving fluid bends thousands of cilia
the ear canal. which convert the vibrations into nerve

● The middle ear is a small air-filled cavity found impulses, which are carried to the brain by
between the outer ear and the inner ear. Its the auditory nerve.
function is to transmit sound from the outer ● In part of the brain’s cerebral cortex, the
ear to the inner ear. auditory cortex, these impulses are

● The middle ear contains three tiny auditory interpreted as hearing.
bones (ossicles): the hammer (malleus), the
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Test your knowledge 7 Which part of the brain contains vital control
centres for the heart, lungs and intestines?
questions a hypothalamus
b mid brain
Multiple choice questions c medulla oblongata
1 What are the two major divisions of the nervous d cerebellum
system? 8 What is the name of the junction where nerve
a the central nervous system and peripheral impulses are transmitted from one neurone to
nervous system another?
b the central nervous system and autonomic a neurotransmitter
nervous system b synapse
c the brain and the spinal cord c dendrite
d the peripheral nervous system and the brain d axon
2 What are the three basic parts of a neurone? 9 The point where the nerve supply enters the
a cell body, sensory and afferent nerves muscle is the:
b cell body, nucleus and axon a motor impulse
c cell body, axon and dendrites b motor transmitter
d cell body, motor and efferent nerves c motor point
3 Where do sensory nerves send messages? d muscle fibre.
a from the brain and spinal cord 10 What type of neurone stimulates muscles to
b to and from the brain and spinal cord produce movement?
c to the brain and spinal cord a sensory
d none of the above b motor
4 What is the name of the part of the brain that c afferent
houses the thalamus and hypothalamus? d efferent
a cerebrum
b brainstem
c cerebellum 11 Name the two parts of the central nervous
d medulla oblongata system (CNS). 2 marks
5 Which part of the brain is concerned with all 12 What is the somatic nervous system and
forms of conscious activity? what does it consist of? 2 marks
a cerebrum 13 What is meant by the autonomic nervous
b thalamus system, and what parts does it consist of?2 marks
c hypothalamus 14 Describe the functions of these parts of a
d medulla oblongata neurone:
6 What are the connective tissue membranes that a myelin sheath
envelop the central nervous system called? b axon. 2 marks
a cerebrospinal membranes 15 Name the two most common neurotransmitters
b meninges released by neurons of the autonomic
c myelin sheaths nervous system. 2 marks
d synapses
16 State two differences between sensory and
motor nerves. 4 marks
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10 The endocrine
system
Introduction
The endocrine system comprises a series
of internal secretions called hormones and
the glands that secrete them. Hormones are
chemical messengers that help to regulate
body processes to provide a constant internal
environment. The endocrine system works
closely with the nervous system. Nerves enable
the body to respond rapidly to stimuli, whereas
the endocrine system causes slower and longer-
lasting effects.
OBJECTIVES
● the functions of the endocrine system
● the definition of a hormone
● the location of the main endocrine glands

of the body
● the principal hormone secretions from the
main endocrine glands and their effects on
the body
● the natural glandular changes that occur
in the body during puberty, menstruation,
pregnancy and menopause
● common pathologies of the endocrine
system
endocrine and other body systems.
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10 The endocrine system
Functions of the endocrine In practice

system It is important for therapists
to have a comprehensive
The functions of the endocrine system are to: knowledge of the endocrine
● produce and secrete hormones, which regulate body activities such system in order to understand
as growth, development and metabolism the actions of hormones
● maintain the body during times of stress and their roles in the healthy
functioning of the body. Over-
● contribute to the reproductive process.
or under-secretion of particular
Hormones hormones results in disorders
and diseases. For instance,
A hormone is a chemical messenger or regulator that is secreted by an hypersecretion of the hormone
endocrine gland and which travels via the bloodstream to influence the testosterone in women can
activity of a destination organ. Some hormones have a slow action over a lead to hair growth in the male
period of years, such as growth hormone from the anterior pituitary, while sexual pattern.
others have a quick action, such as adrenaline from the adrenal medulla.
The endocrine glands are ductless glands and the hormones they secrete
pass directly into the bloodstream to influence the activity of another
organ or gland. The main endocrine glands are as follows:
● pituitary gland ● islets of Langerhans
● thyroid gland ● ovaries in the female
● parathyroid glands ● testes in the male.
● adrenal glands
Overview of the endocrine glands

Table 10.1 Location of endocrine glands
Endocrine gland Location

Thymus gland Behind the sternum, between the lungs
Pituitary (pit-tu-it-tur-ree) gland Attached by a stalk to the hypothalamus
of the brain
Thyroid gland In the neck on either side of the trachea
Parathyroid glands Four small glands situated on the posterior
of the thyroid gland
Adrenal glands Two triangular-shaped glands which lie
on top of each kidney
Pancreas (islets of Langerhans) Situated behind the stomach between
the duodenum and the spleen
Ovaries Situated in the lower abdomen below
the kidneys
Testes Situated in the groin in a sac called the
scrotum
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Anterior
lobe
Posterior
lobe
Pineal Pituitary
Parathyroid
glands
Thyroid Pancreas
Medulla
Cortex
Adrenal gland Ovary
Testis
p The endocrine glands
The thymus gland Thymosin is the hormone of the thymus, and it

stimulates the development of T-cells, which defend
The thymus gland, despite containing glandular
the body from potentially deadly pathogens such as
tissue and producing several hormones, is much
bacteria, viruses and fungi.
more closely associated with the immune system
than with the endocrine system. It serves a vital role The thymus gland, located behind the sternum
in the training and development of disease-fighting and between the lungs, is only active until puberty.
T-cells or T-lymphocytes, an extremely important type After puberty, the thymus starts to shrink and is
of white blood cell. replaced by fat.
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The immune system fights disease and infection via The hypothalamus
T-cells that migrate to the different lymph nodes The hypothalamus is a small region of the brain that
throughout the body. The T-cells start migrating to is the major integrating link between the nervous
the lymph nodes once they reach full maturity in the and endocrine systems. Hormones of the pituitary
thymus. are controlled by releasing or inhibiting hormones
Lymphomas such as Hodgkin and non-Hodgkin occur produced by the hypothalamus.
when lymphocytes (small white blood cells) develop The hypothalamus produces releasing or inhibiting
into cancers. hormones as a result of stimulation in the brain.
Though the thymus gland is only active until This has a cascading effect on the pituitary, which
puberty, its double-duty function as an endocrine in turn produces its own hormones that stimulate
and lymphatic gland means that it plays a significant other glands. For example, thyrotrophin (a releasing
role in long-term health. hormone) is produced by the hypothalamus, which
signals the pituitary gland to secrete thyroid-
The pituitary gland stimulating hormone, which controls the growth
This is a lobed structure attached by a stalk to and activity of the thyroid gland.
the hypothalamus of the brain. For many years
The pituitary gland consists of two main parts:
the pituitary gland was referred to as the ‘master’
endocrine gland because it secretes several hormones 1 an anterior lobe
that control other endocrine glands. However, the 2 a posterior lobe.
pituitary itself has a master – the hypothalamus.
Bone and muscle growth The pituitary gland

Growth hormone (GH)
and its master control
Kidney tubules
Antidiuretic
hormone (ADH)
Adrenal cortex
Adrenocorticotrophic hormone (ACTH)
Thyroid gland Anterior Posterior

Thyroid-stimulating hormone (TSH) pituitary pituitary
Uterus smooth
muscle
Oxytocin (OT)
Testis and ovary
Follicle-stimulating hormone (FSH)
and Luteinising hormone (LH)
Mammary
Mammary glands
glands
Prolactin (PRL)
Oxytocin (OT)
Skin
Melanocyte-stimulating hormone (MSH)
p The pituitary and its master control
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Anterior lobe
The principal hormones secreted by the anterior lobe of the pituitary are
shown in Table 10.2.
Table 10.2 Hormones secreted by the anterior lobe
Hormone Effects
Thyroid-stimulating hormone (TSH) Controls the growth and activity of the thyroid gland
Adrenocorticotrophic Stimulates and controls the growth and hormonal output of the
(add-dree-no-corr-tick-co tro-fik) adrenal cortex
hormone (ACTH)
Gonadotrophic Control the development and growth of the ovaries and testes
(go-nad-oo-tro-fik) In women FSH stimulates the development of the Graafian follicle in
hormones the ovary, which secretes the hormone oestrogen
The gonadotrophic hormones include: In men FSH stimulates the testes to produce sperm
a) Follicle-stimulating hormone (FHS) In women LH helps to prepare the uterus for the fertilised ovum
b) Luteinising hormone (LH) In men LH acts on the testes to produce testosterone
Prolactin Stimulates the secretion of milk from the breasts following birth
Melanocyte-stimulating hormone (MSH) Stimulates the production of melanin in the basal cell layer of the skin
KEY FACT Posterior lobe

Endocrine glands in the body The posterior lobe of the pituitary secretes two hormones which are
have a feedback mechanism manufactured in the hypothalamus but are stored in the posterior lobe
which is co-ordinated by (Table 10.3).
the pituitary gland. This
gland is influenced by Table 10.3 hormones secreted by the posterior lobe
the hypothalamus, which
increases its output of Hormone Function
releasing factors if a hormone Antidiuretic hormone (ADH) Increases water reabsorption in the renal
level falls and decreases its tubules of the kidneys
output if a hormone level in
the bloodstream starts to rise. Oxytocin Stimulates the uterus during labour and
stimulates the breasts to produce milk
Pineal gland
This is a pea-sized mass of nerve tissue attached by a stalk to the central
part of the brain. It is located deep between the cerebral hemispheres,
where it is attached to the upper portion of the thalamus.
The pineal gland secretes a hormone called melatonin, which it
synthesises from serotonin. This gland is involved in the regulation of
circadian rhythms (patterns of repeated activity that are associated
with the environmental cycles of day and night), such as sleep and wake
cycles. It is also thought to influence mood.
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Thyroid gland The thyroid gland is controlled by a feedback

mechanism. It will increase production to meet the
The thyroid gland is found in the neck, situated on
demand for more thyroid hormones at various times,
either side of the trachea and is controlled by the
such as during the menstrual cycle, pregnancy and
anterior lobe of the pituitary.
puberty.
The principal secretions of the thyroid gland are
shown in Table 10.4.
Study tip
Table 10.4 Hormones secreted by the thyroid gland The endocrine system is complex. Try and think of
Hormone Effects it as a series of different systems working together
to relay messages to keep the body in harmony.
Triiodothyronine The active form of thyroxine,
Consider the regulation of body heat. In this case
(T3) the thyroid hormone, is
think of:
triiodothyronine (T3)
T3 performs essential roles ● the thyroid gland as a furnace that produces heat
in the functioning of the ● the pituitary gland as the thermostat that
heart, the metabolic rate, regulates the furnace
brain development, digestive ● the hypothalamus as the controller – the person
functions, the upkeep of the who sets the thermostat.
bones and muscle control
In this model, when excess heat (thyroid hormones)
Thyroxine (T4) Thyroxine (T4) is a hormone the from the furnace is detected at the thermostat
thyroid gland secretes into the (the pituitary gland), it turns the thermostat off
bloodstream and production of heat at the furnace stops. As the
Along with T3 it plays a crucial role room cools (the thyroid hormone level drops), the
in heart and digestive function, thermostat turns back on (TSH increases) and the
metabolism, brain development,
furnace (the thyroid) produces more heat (thyroid
bone health, and muscle control
hormones).
It affects almost all of the body’s
systems, which means correct
thyroxine level is vital for health THYROID AND PARATHROID
Both T3 and T4 regulate growth
and development, and also Thyroid gland Thyroid gland
(front view) (back view)
influence mental, physical and
metabolic activities
Calcitonin Controls the level of calcium
in the blood
The functions of the thyroid gland are to:

● control the metabolic rate by stimulating
metabolism
Parathyroid
● influence growth and cell division glands
● influence mental development p Thyroid and parathyroid glands
● be responsible for the maintenance of healthy
skin and hair Parathyroid glands
● store the mineral iodine, which it needs to These are four small glands situated on the posterior
manufacture thyroxin of the thyroid gland. Their principal secretion is the
● stimulate the involuntary nervous system and hormone parathormone, which helps to regulate
control irritability. calcium metabolism by controlling the amount
of calcium in blood and bones.
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Adrenal glands
These are two triangular-shaped glands which lie on top of each kidney.
They consist of two parts – an outer cortex and an inner medulla.
p Adrenal glands
Adrenal cortex
The principal hormones secreted by the adrenal cortex are shown in
Table 10.5.
Table 10.5 Effects of hormones secreted by adrenal cortex
Hormone Effects
Glucocorticoids Influence the metabolism of protein and
(cortisone and carbohydrates, and utilisation of fats
hydrocortisone) Important in maintaining the level of glucose
in the blood so that blood glucose level is
increased at times of stress
Mineral corticoids Acts on the kidney tubules, retaining salts
(aldosterone) in the body, excreting excess potassium and
maintaining the water and electrolyte balance
Sex corticoids Control the development of the secondary
(testosterone, oestrogen sex characteristics and the function of the
and progesterone) reproductive organs
KEY FACT
The production of sex corticoids in the adrenal
cortex is important up to puberty. When the
ovaries and testes mature, they produce the sex
hormones themselves.
Adrenal medulla
The principal hormones secreted by the adrenal medulla are adrenaline
and noradrenaline. They are under the control of the sympathetic
nervous system and are released at times of stress. Since the release of
these hormones is under nervous control, it can happen very quickly.
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The effects of adrenaline can be summarised: Islets of Langerhans

1 dilates the arteries, increasing blood circulation The islets of Langerhans are the groups of endocrine
and heart rate cells in the pancreas which contain alpha, beta and
2 dilates the bronchial tubes and increases the gamma cells that produce glucagon, insulin and
rate and depth of breathing, thereby increasing somatostatin, respectively.
oxygen uptake ● Approximately 22% of the cells in the pancreas
3 raises the metabolic rate are alpha cells and secrete glucagon, a hormone
4 constricts the blood vessels to the skin and that plays an active role in regulation of glucose
intestines, diverting blood from these regions and fat use in the body. The hormone glucagon
to the muscles and brain to effect action. is released from the alpha cells in response to a
low blood glucose level, when the body requires
The effects of noradrenaline are similar to those of
additional glucose, for instance when exercising.
adrenaline and include:
Glucagon promotes the conversion of glycogen to
1 vasoconstriction of small blood vessels leading glucose.
to an increase in blood pressure
● Beta cells produce insulin, which assists with
2 increase in the rate and depth of breathing metabolism in several ways. It helps to regulate
3 relaxation of the smooth muscle of the the storage of fat and glucose within the
intestinal wall. body and it stimulates the removal of glucose
So, the effects of these stress hormones are similar from the blood. It promotes the conversion of
except that: glucose to glycogen.
● adrenaline has a primary influence on the heart, ● The gamma cells in the pancreas secrete
causing an increase in heart rate somatostatin (som-at-o-staa-tin), also
● noradrenaline has a greater effect on blood known as growth hormone inhibiting hormone
vessels, causing peripheral vasoconstriction which (GHIH).
raises blood pressure. Insulin and blood glucose level
The control of glucose level in the blood is aided by
KEY FACT insulin, which initiates the absorption of glucose from
The effects described above can be felt when the the blood by the liver, fat and muscles cells when
body is under stress: a pounding heart, increased blood glucose level is high. The glucose is converted
ventilation rate, dry mouth and ‘butterflies’ in to glycogen and later used for energy. Approximately
the stomach. Stress hormones are broken down
5% of the liver’s overall mass can be used to store
slowly, so the effects on the sympathetic nervous
system are long-lasting. Over the long term, glycogen.
if levels of these hormones remain elevated, Glucagon and blood sugar level
stress-related disorders may result.
Glucagon has the opposite effects to insulin; in
order to maintain the correct balances within the
Pancreas body, glucagon and insulin have to work together.
The pancreas is known as a dual organ as it has an When the body needs additional glucose to meet
exocrine and an endocrine function: its energy demands, for example when exercising,
● exocrine function – the secretion of pancreatic glucagon is released.
juice to assist with digestion Glucagon serves to keep the blood glucose level
● endocrine function – secretion of hormones high enough for the body to function well. When
by the islets of Langerhans, which are irregular- blood glucose level is low, glucagon is released
shaped patches of endocrine tissue located within and signals the liver to release glucose into the
the pancreas. blood.
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Somatostatin ● Relaxin – this hormone dilates the cervix and

Somatostatin affects several areas of the body: promotes widening of the pelvis during childbirth.
● In the hypothalamus, it regulates the secretion
of hormones coming from the pituitary gland, Activity
including growth hormone and TSH. Write the following hormones on pieces of card
or paper and place face down in a pile.
● In the pancreas, it restricts the secretion of
● antidiuretic hormone (ADH)
pancreatic hormones, such as glucagon and insulin.
● oxytocin
● It is also secreted by the pancreas in response to ● FSH (gonadotrophic hormone)
many factors related to food intake, such as a high ● luteinising hormone (gonadotrophic hormone)
level of blood glucose and amino acids. ● testosterone
The sex glands ● oestrogen
● progesterone
Testes ● insulin
● calcitonin
The testes are situated in the groin in a sac called
● melatonin
the scrotum. They have two functions:
● glucagon
1 the secretion of the hormone testosterone, ● parathormone
which controls the development of the secondary ● adrenaline
sex characteristics in the male at puberty ● noradrenaline
(influenced by LH) ● glucocorticoids
2 the production of sperm (influenced by FSH ● mineral corticoids
from the anterior pituitary). ● sex corticoids
● triiodothyronine (T3)
Ovaries ● thyroxine (T4)
The ovaries are situated in the lower abdomen below ● growth hormone
the kidneys, and each ovary is attached to the upper ● thyroid-stimulating hormone (TSH)
part of the uterus by broad ligaments. The two ovaries ● melanocyte-stimulating hormone (MSH)
are the sex glands in the female and have two distinct ● adrenocorticotrophic hormone
functions: ● prolactin
1 production of ova at ovulation Now write down the names of the endocrine
2 production of the female sex hormones, oestrogen glands on similar pieces of card or paper and also
and progesterone. place face down in a separate pile.
● anterior pituitary gland
Oestrogen is concerned with the development and
● posterior pituitary gland
maintenance of the female reproductive system and
● thyroid gland
the development of the secondary sex characteristics.
● parathyroid glands
Progesterone is produced by the ovaries after
● pineal gland
ovulation. It helps to prepare the uterus for the
● islets of Langerhans
implantation of the fertilised ovum, develops the
● ovaries
placenta if implantation occurs and prepares the
● testes
breasts for milk secretion.
● adrenal cortex (adrenal gland)
The ovaries also secrete the following hormones in ● adrenal medulla (adrenal gland)
addition to oestrogen and progesterone:
Working either in groups or individually, match
● Inhibin – this hormone inhibits the secretion of the each hormone to its correct point of secretion.
FSH towards the end of the menstrual cycle.
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Natural glandular
● the onset of ovulation and the menstrual cycle
● the female reproductive organs becoming functional
changes ● the growth of pubic and axillary hair
● development of breast tissue
Puberty ● increase in the amount of subcutaneous fat.
This is the time at which the onset of sexual In boys, the same gonadotrophic hormones (FSH
maturity occurs and the reproductive organs become and LH) stimulate the testes to produce testosterone.
functional. Changes in both sexes occur, with the The effects of puberty in boys include:
appearance of the secondary sexual characteristics ● voice breaking and larynx enlarging
such as the deepening of the voice in a boy and
● the growth of muscle and bone
growth of breasts in girls. These changes are brought
about by an increase in sex hormone activity, due to ● noticeable height increase
stimulation of the ovaries and testes by the pituitary ● the development of sexual organs
gonadotrophic hormones. ● the growth of pubic, facial, axillary, abdominal
The average age for girls to reach puberty is and chest hair
between 10 and 14, although it can occur as early ● the onset of sperm production.
as eight or nine years of age. In boys, the average
age is 13 to 16. The menstrual cycle
In girls, the ovaries are stimulated by the gonadotrophic Starting at puberty, the female reproductive system
hormones, FSH and LH. The effects of puberty in girls undergoes a regular sequence of monthly events,
include: known as the menstrual cycle. The ovaries undergo
Ovum
Ovary
Uterus
Fallopian tube
Endometrium
Menstrual fluid
Days 1–6
Ovum Menstruation
Ovary
Days 15–28 Days 7–13

Secretory Proliferative
phase phase
Ovum
Ovary
Day 14
Ovulation
p The menstrual cycle
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cyclical changes in which a certain number of until the fourth month of pregnancy, by which time
ovarian follicles develop. When one ovum completes the placenta has taken over this function.
the development process, it is released into one
of the fallopian tubes. If fertilisation does not occur, Menstrual phase
the developed ovum disintegrates and a new cycle If the ovum is not fertilised, the cycle continues and
begins. the corpus luteum shrinks and the endometrium is
The menstrual cycle lasts approximately 28 days, shed. This is called menstruation. Over a period of
although it can be longer or shorter than this. There about five days, the muscles of the wall of the uterus
are three stages of the menstrual cycle: contract to expel the unfertilised egg, pieces of
endometrial tissue and some tissue fluid.
1 proliferative (first) phase – days 7 to 14 of the cycle
As soon as the level of progesterone drops, due
2 secretory (second) phase – days 14 to 28 of to the breakdown of the endometrium and the
the cycle corpus luteum, the pituitary gland starts producing
3 menstrual (third) phase – days 1 to 7 of the progesterone again and, hence, stimulates the ovaries
cycle. to produce another follicle and a new ovum. The
cycle then begins again.
Proliferative phase
At the beginning of the cycle an ovum develops In practice
within an ovarian follicle in the ovary. This is in
Due to increased sensitivity, some treatments may
response to a hormone that is released by the
be best avoided during menstruation (for instance,
anterior lobe of the pituitary gland called FSH, which
waxing, epilation or laser/IPL).
stimulates the follicles of the ovaries to produce
the hormone oestrogen.
Oestrogen stimulates the endometrium (lining of the Pregnancy
uterus) to promote the growth of new blood vessels Pregnancy takes approximately nine calendar months
and mucus-producing cells. and is divided into three trimesters:
When mature, the ovum bursts from the follicle and 1 The first trimester – this is a time of radical
travels along the fallopian tube to the uterus. This hormonal change. During this phase, all of the
occurs about 14 days after the start of the cycle baby’s body systems develop.
and is known as ovulation. 2 The second trimester – characterised by rapid
fetal growth and the completion of systemic
Secretory phase development. Blood volume in the mother
A temporary endocrine gland, the corpus luteum, increases as additional workload is placed on all
develops in the ruptured follicle in response to physiological functions. Cardiac output, breathing
stimulation from LH secreted by the anterior lobe rate and urine production increase in response to
of the pituitary gland. The corpus luteum secretes fetal demands. The uterus enlarges greatly during
the hormone progesterone, which together with pregnancy, along with the size of the breasts.
oestrogen causes the lining of the uterus to become Appetite increases in response to the fetal need
thicker and more richly supplied with blood in for increasing amounts of nutrients.
preparation for pregnancy. 3 The third trimester – mostly a weight-gaining
After ovulation, the ovum can only be fertilised and maturing phase, preparing the baby for life
during the next eight to 24 hours. If fertilisation does outside of the uterus. Posture changes are evident
occur, the fertilised ovum becomes attached to the at this stage as the mother gains more weight
endometrium and the corpus luteum continues to and internal organs are compressed. The body’s
secrete progesterone. Pregnancy then begins. The connective tissue structure alters by softening,
corpus luteum continues to secrete progesterone to allow for the expansion needed for the birth.
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First trimester Second trimester Third trimester Birth
p Pregnancy
stimulate development of the mammary glands

Hormonal changes that occur ●
inhibit uterine contractions until birth

during pregnancy ●
● cause enlargement of the reproductive organs.

During a typical menstrual cycle, the corpus luteum
degenerates about two weeks after ovulation. The ovaries and placenta produce inhibin, which
Consequently, the levels of oestrogen and progesterone inhibits the secretion of the FSH from the
decline rapidly and the lining of the uterus is not anterior lobe of the pituitary, thus preventing the
maintained but is cast off as menstrual flow. development of ova during pregnancy.
If this occurs after implantation, the embryo is At the end of the gestation period, the level of
spontaneously aborted (miscarried). The mechanism progesterone falls. Labour cannot begin until the
that usually prevents this occurring involves a hormone level of progesterone falls, as it inhibits uterine
called human chorionic gonadotrophic hormone contractions. Oxytocin, secreted by the posterior
(HCG), which is secreted by a layer of embryonic cells lobe of the pituitary, stimulates uterine contractions
that surround the developing embryo. HCG causes the and the ovaries and placenta secrete relaxin, which
corpus luteum to be maintained in order to establish helps to dilate the cervix and relaxes the ligaments
the pregnancy. and joints to assist labour.
The maintenance of the corpus luteum is important
KEY FACT
for the first three months, after which the placenta
Mood, sleep and energy levels are all affected
is usually well developed and is able to secrete during pregnancy due to the hormonal changes
sufficient oestrogen and progesterone to support that occur. Some women report extreme
the pregnancy. tiredness at the start of their pregnancy and
The secretion of the hormones oestrogen and experience a surge of energy towards the end.
Sleep patterns may be affected due to the
progesterone is important during pregnancy as they:
activity of the growing foetus and hormone
● maintain the uterine wall levels may cause emotional disturbances.
● inhibit the secretion of the gonadotrophic
hormones FSH and LH
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Menopause
After puberty, the menstrual cycle normally continues to occur at
regular intervals into a woman’s late forties or early fifties (most
commonly until between the ages of 45 and 55). At this time, there are
marked changes in which the cycle becomes increasingly irregular until
it ceases altogether. This period in a woman’s reproductive life is called
the menopause (female climacteric).
Younger older
Menopause
Estrogen
Hormone levels
Progesterone
Age
20 30 40 50 60 70
p The menopause
During the menopause, there is a change in the balance of the sex

hormones. The ovaries cease responding to FSH and this decline in
function results in lower levels of oestrogen and progesterone secretion.
As a result of reduced oestrogen concentration and lack of progesterone,
the female’s secondary sexual characteristics undergo varying degrees
of change, which may include a decrease in the size of the vagina, uterus
and uterine tubes, as well as atrophy of the breasts.
Other changes that occur commonly in response to low oestrogen
concentration include a loss of bone matrix leading to an increased
KEY FACT
risk of osteoporosis, thinning of the skin and dryness of the mucous
Many menopausal women
membrane lining the vagina.
take HRT in order to alleviate
some of the unpleasant Some women of menopausal age experience unpleasant vasomotor
effects of menopause. HRT symptoms including sensations of heat in the face, neck and upper
usually involves administering body, known as ‘hot flushes’. Menopausal women may also experience
oestrogens, along with varying degrees of headache, backache and fatigue, as well as emotional
progesterone.
disturbances.
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Stress and hormones Fröhlich’s syndrome

(adiposogenital dystrophy)
Whatever glandular stage of life we are experiencing, A rare childhood metabolic disorder characterised
one factor is clear: stress has a direct effect on the by obesity, and abnormal growth and development
synchronicity of our hormones. of the genital organs. It is commonly associated
When the stress level is constantly high, the production with tumours of the hypothalamus, causing an
of sex hormones is affected, thyroid function slows increase in appetite and reducing the secretion of the
down and blood sugar level becomes unbalanced. gonadotropin hormone.
Stress also makes it hard for the body to create
Gigantism
‘feel-good’ hormones such as serotonin.
Hypersecretion of the growth hormone secreted by
Examples of possible symptoms of excessive stress
the anterior pituitary leads to gigantism in children,
on the endocrine system include amenorrhea
a disease marked by the rapid growth of the body to
(absence of periods), loss of libido and infertility.
extremely large proportions (seven to eight feet in
height). If the overproduction occurs in adulthood,
KEY FACT this condition is known as acromegaly.
The first step in rebalancing hormones is to
minimise stress. Lorain-Levi syndrome
(pituitary dwarfism)
Common pathologies Under-secretion of growth hormone from the
pituitary gland in childhood results in smaller-than-
of the endocrine average stature.
system Simmonds’ disease

This is a chronic deficiency of the pituitary gland,
Pathologies of the pituitary a result of a progressive destruction of the anterior
lobe of the pituitary gland. It leads to atrophy of the
gland gonads, the thyroid and the adrenal cortex. It can also
Acromegaly result in loss of hair on the body.
During adulthood, if the pituitary gland produces an Pathologies of the thyroid

excess of growth hormone, the hormonal disorder
acromegaly develops. This causes an increase in the gland
size of the bones. As time passes, the hands and feet Congenital iodine deficiency syndrome
become abnormally large, facial features become
Hyposecretion of thyroxine leads to this condition
coarse and a range of other symptoms develop.
(previously known as cretinism) in children, which is
Diagnosis of the condition is usually between the
a congenital deficiency causing learning difficulties,
ages of 30 and 50, although it can affect people at
small stature, coarsening of the skin and hair, and
any age. This disorder is referred to as ‘gigantism’ if it
deposition of fat on the body.
develops prior to puberty.
Myxoedema
Diabetes insipidus
Hyposecretion of thyroxine in an adult leads to
Hyposecretion of ADH by the posterior lobe of the
myxoedema, which is characterised by the slowing
pituitary leads to the disease diabetes insipidus.
down of physical and mental activity resulting in
Symptoms include dehydration, increased thirst
lethargy, brittle hair, coarse and dry skin and a slow
and increased output of urine.
metabolism.
Dwarfism
Hyposecretion of the growth hormone during
childhood leads to stunted growth, a condition
known as dwarfism.
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Thyrotoxicosis (hyperthyroidism) Pathologies of the islets

Hypersecretion of thyroxine leads to a condition
known as thyrotoxicosis or Graves’ disease.
of Langerhans
Thyrotoxicosis results in an increased metabolic Diabetes mellitus
rate, weight loss, sweating, restlessness, increased Hyposecretion can lead to a condition called diabetes
appetite, sensitivity to heat, raised temperature, mellitus. This condition is due to a deficiency or
frequent bowel action, anxiety and nervousness. absence of insulin. The symptoms associated with
When the thyroid gland produces and secretes an diabetes include an increased thirst, increased output
excessive amount of thyroxine, it may produce a of urine, weight loss, thin skin with impaired healing
goitre (an enlargement of the thyroid gland). capacity, increased tendency to develop minor skin
infections and decreased pain threshold when insulin
In practice level is low. There are two types of diabetes mellitus:
It is helpful to remember that clients with ● Insulin-dependent diabetes (early onset) – this
hyperthyroidism are intolerant of heat and those occurs mainly in children and young adults and
with hypothyroidism are intolerant of cold. the onset is usually sudden. The deficiency or
Treatments such as laser hair removal or waxing, absence of insulin is due to the destruction of the
which involve increased temperature of the skin, islet cells in the pancreas. The causes are unknown
may need to be adapted. but there is a familial tendency, suggesting genetic
involvement.
Pathologies of the ● Non-insulin-dependent diabetes (late onset) –
parathyroid gland this type of diabetes occurs later in life and
its causes are also unknown. Insulin secretion
Addison’s disease may be below or above normal, and body cells
Under-secretion of corticosteroid hormones is may become resistant to the effects of insulin.
responsible for the condition known as Addison’s Deficiency of glucose inside the body cells may
disease. Symptoms include loss of appetite, weight occur where there is hyperglycaemia and a high
loss, brown pigmentation around joints, low blood insulin level. This may be due to changes in cell
sugar, low blood pressure, tiredness and muscular walls which block the insulin-assisted movement
weakness. This disease is treatable by replacement of glucose into cells. This type of diabetes can be
hormone therapy. controlled by diet alone, or diet and oral drugs.
Adrenal hyperplasia
In practice
Congenital adrenal hyperplasia (CAH) is a genetic
Always obtain a detailed history during the
disorder characterised by a deficiency in the hormones
consultation and liaise with the client’s GP
cortisol and aldosterone and an overproduction of the
regarding their type of diabetes. Always ensure
hormone androgen. CAH is present at birth and affects
that the client brings their glucose and other
the sexual development of the child.
medications when coming for treatment.
Cushing’s syndrome It is important for the therapist to be aware that
Hypersecretion of the glucocorticoids can lead to a feedback may be inadequate in those with decreased
condition known as Cushing’s syndrome. This condition sensation due to diabetes. Therefore, pressure should
results from an excess amount of corticosteroid be used in treatments only with great care.
hormones in the body. Symptoms include weight gain, Diabetic clients may have acute complications such
reddening of the face and neck, excess growth of facial as hypoglycaemia, resulting in dizziness, weakness,
and body hair, raised blood pressure, loss of mineral pallor, rapid heartbeat and excessive sweating.
from bone and sometimes mental disturbances.
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Pathologies of the ovaries Other endocrine

Polycystic ovary syndrome pathologies
(Stein-Leventhal syndrome) Seasonal affective disorder (SAD)
Hyposecretion of the hormones oestrogen and
Hyposecretion of the hormone melatonin is thought
progesterone in the female can lead to polycystic
to be associated with the condition SAD. Symptoms
ovary syndrome, which is characterised by cysts on
include depression (typically with the onset of
the ovaries, cessation of periods, obesity, atrophy of
winter), a general slowing down of mind and body,
the breasts, hirsutism and sterility.
excessive sleeping and overeating.
Pathologies of the sex Stress
hormones Stress can be defined as any factor which affects
physical or emotional health. Effects of short-term
Gynaecomastia physical stress are associated with the hormone
Hypersecretion of oestrogen and progesterone in adrenaline and include an increased heartbeat, rapid
the male can lead to muscle atrophy and breast breathing, increased sweating, tense muscles, dry
development. mouth, increased frequency of urination and a feeling
of nausea. Stress can become negative stress when
Hirsutism
excess adrenaline is left in the bloodstream following
This is hair growth in the male sexual pattern due a short-term stress signal. Examples of possible
to hypersecretion of the hormone testosterone in symptoms of excessive stress on the endocrine
women and an overproduction of androgens. system include amenorrhea (absence of periods), loss
Virilism of libido and infertility.
Hypersecretion of the hormone testosterone in
women can lead to virilism (masculinisation), causing
an overproduction of androgens.
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Interrelationships with Circulatory

other systems Hormones are secreted and carried in the
bloodstream to their target organs.
The endocrine system Respiratory
The endocrine system links to the following body The adrenal glands increase the breathing rate in
systems. times of stress to provide more oxygen as fuel for
the muscles.
Cells and tissues
Meiosis is the form of cell division involving the Nervous
formation of sperm in the male and ova in the female. The endocrine system works closely with the
nervous system in order to maintain homeostasis
Skin in the body. The endocrine system is linked to the
MSH produced by the central lobe of the pituitary nervous system by the hypothalamus and the
gland stimulates the production of melanin in the pituitary gland.
basal cell layer (stratum germinativum) of the skin.
Digestive
Skeletal The production of insulin and glucagon in the
The hormones calcitonin from the thyroid gland and pancreas helps to regulate blood sugar level.
parathormone from the parathyroid glands help
to maintain the calcium level in the blood for bone Renal
strength and flexibility. ADH helps to regulate fluid balance in the body
Muscular
Muscles receive additional blood flow in response to the
secretion of the hormone adrenaline at times of stress.
Key words Calcitonin: a hormone secreted by the thyroid that

has the effect of lowering blood calcium
Adrenal cortex: the outer part of the adrenal gland Follicle-stimulating hormone (FSH): a hormone
Adrenal glands: two triangular-shaped glands secreted by the anterior pituitary gland which
which lie on top of each kidney promotes the formation of ova or sperm
Adrenal medulla: the inner part of the adrenal gland Gamma cells: a type of cell in the pancreas which
Adrenaline: a hormone secreted by the adrenal secretes the hormone somatostatin
medulla that increases rates of blood circulation, Glucagon: a hormone formed in the pancreas
breathing and carbohydrate metabolism and which promotes the breakdown of glycogen to
prepares muscles for exertion glucose in the liver
Adrenocorticotrophic hormone (ACTH): a Glucocorticoids: hormones secreted by the adrenal
hormone secreted by the pituitary gland that cortex, involved in the metabolism of carbohydrates,
stimulates the adrenal cortex proteins and fats
Alpha cells: cells in the pancreas that secrete glucagon Gonadotrophic hormones: the sex hormones that
Antidiuretic hormone (ADH, vasopressin): a control the development and growth of the ovaries
hormone secreted by the posterior pituitary that and testes
plays an important role in water retention, thirst and Growth hormone: a hormone secreted by the
blood pressure anterior lobe of the pituitary that controls the
Beta cells: cells in the pancreas that secrete the growth of long bones and muscles
hormone insulin Hormone: a chemical messenger or regulator, secreted
by an endocrine gland and which travels via the
bloodstream to influence the activity of other organs
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Inhibin: a hormone secreted by the gonads that Pregnancy: the fetal development period from the
inhibits the production of FSH time of conception until birth
Insulin: a hormone produced in the pancreas by the Prolactin: a hormone secreted by the anterior lobe
islets of Langerhans that regulates the amount of of pituitary that stimulates the secretion of milk from
glucose in the blood the breasts following birth
Luteinising hormone (LH): a hormone secreted Proliferative phase: the second phase of the
by the anterior pituitary gland that stimulates menstrual cycle, when oestrogen causes the lining
ovulation in females and the synthesis of androgens of the uterus to grow
in males Puberty: the time at which the onset of sexual
Melanocyte-stimulating hormone (MSH): a maturity occurs and the reproductive organs
hormone secreted by the pituitary gland that is become functional
involved in pigmentation changes Relaxin: a hormone secreted by the placenta that
Melatonin: a hormone secreted by the pineal gland causes the cervix to dilate and prepares the uterus
that inhibits melanin formation and is thought to be for the action of oxytocin during labour
concerned with regulating the reproductive cycle Secretory phase: the second half of the menstrual
Menopause: permanent cessation of menstruation cycle after ovulation; the corpus luteum secretes
resulting from the loss of ovarian follicular activity progesterone, which prepares the endometrium for
Menstrual cycle: the cycle of physiological the implantation of an embryo; if fertilisation does
changes affecting the reproductive organs that not occur then menstrual flow begins
takes place typically over a month and includes Sex corticoids: hormones secreted by the adrenal
ovulation, thickening of the lining of the uterus cortex that control the development of the
and menstruation if fertilisation of the egg has not secondary sex characteristics and the function of
occurred the reproductive organs
Menstrual phase: the phase of the menstrual cycle Somatostatin (growth hormone inhibiting hormone,
during which the lining of the uterus is shed (the GHIH): a hormone secreted in the pancreas and
first day of menstrual flow is considered day 1 of the pituitary gland which inhibits gastric secretion
menstrual cycle) and somatotropin release
Mineral corticoids: corticosteroids involved with Testes: sex glands in the male
maintaining the salt balance in the body, such as Thymosin: one of the polypeptide hormones
aldosterone secreted by the thymus that control the maturation
Noradrenaline: a hormone which is released by of T-cells
the adrenal medulla and by the sympathetic nerves, Thymus: a ductless, butterfly-shaped gland lying
and which functions as a neurotransmitter at the base of the neck, formed mostly of lymphatic
Ovaries: sex glands in the female tissue and aiding in the production of T-cells of the
Ovulation: discharge of ova from the ovary immune system
Oxytocin: a hormone released by the pituitary Thyroid: a large ductless gland in the neck which
gland that causes increased contraction of the secretes hormones that regulate growth and
uterus during labour and stimulates the ejection of development through the rate of metabolism
milk into the ducts of the breasts Thyroid-stimulating hormone (TSH): a hormone
Parathormone: a hormone that is made by the controlling the growth and activity of the thyroid
parathyroid glands and is crucial to maintaining gland
calcium and phosphorus balance Thyroxine (T4): the main hormone produced by the
Pineal gland: a pea-sized mass of nerve tissue that thyroid gland, acting to increase metabolic rate and
is attached by a stalk to the central part of the brain so regulating growth and development
Pituitary gland: a lobed structure attached by a Triiodothyronine (T3): a thyroid hormone similar
stalk to the hypothalamus of the brain to thyroxine but having greater potency
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Revision summary ● The pineal gland is attached by a stalk in the

central part of the brain and secretes a hormone
The endocrine system called melatonin, which is thought to regulate
circadian rhythms and influence mood.
● The endocrine system consists of ductless glands
that secrete hormones into the bloodstream. ● The thyroid gland’s principal secretions are
triiodothyronine (T3) and thyroxine (T4), which
● Endocrine glands are concerned with the
regulate metabolism and influence growth and
regulation of metabolic processes.
development.
● A hormone is a chemical regulator secreted by an
● The thyroid gland also secretes calcitonin, which
endocrine gland into the bloodstream and has the
controls the level of calcium in the blood.
power to influence the activity of other organs.
● Hypersecretion of the thyroid hormones leads
● The main endocrine glands are the pituitary
to a condition called thyrotoxicosis, or Graves’
(attached to base of brain), thyroid (neck),
disease.
parathyroids (posterior to the thyroid glands),
● Hyposecretion of the thyroid hormones leads
adrenals (top of kidneys), islets of Langerhans
(in the pancreas), ovaries (in the female) and to congenital iodine deficiency syndrome in
testes (in the male). childhood and myxoedema in adulthood.
● The principal hormones secreted by the ● The parathyroid glands help regulate calcium
anterior lobe of the pituitary include growth metabolism.
hormone, thyroid-stimulating hormone (TSH), ● Hypersecretion of parathormone can lead
adrenocorticotrophic hormone (ACTH), to renal stones, kidney failure, softening of the
gonadotrophic hormones (FSH and LH), bones, and tumours.
prolactin and melanocyte-stimulating hormone ● Hyposecretion of parathormone can lead to a
(MSH). condition called tetany.
● Growth hormone controls the growth of long
● The thymus gland, located behind the sternum
bone and muscle. and between the lungs, is only active until
● TSH controls the growth and activity of the
puberty.
thyroid gland.
● The thymus gland produces the hormone
● ACTH controls the growth and hormonal
thymosin which stimulates the development of
output of the adrenal cortex.
T-cells, who aid the immune system in fighting
● FSH and LH control the development and
disease.
growth of the ovaries and testes.
● Prolactin stimulates the secretion of milk from
● The adrenal glands have two parts – an outer
the breasts following birth. cortex and an inner medulla.
● MSH stimulates the production of melanin in ● The principal hormones secreted by the adrenal
the basal cell layer of the skin. cortex include glucocorticoids, mineral
● Hypersecretion of the growth hormone from corticoids and sex corticoids.
● Glucocorticoids influence the metabolism of
the pituitary gland can lead to gigantism in
childhood and acromegaly in adulthood. protein, carbohydrates and utilisation of fats.
● Mineral corticoids are concerned with
● Hyposecretion of the growth hormone from
maintaining water and electrolyte balance.
the pituitary gland during childhood leads to
● Sex corticoids control the development of the
dwarfism.
secondary sex characteristics and the function
● The posterior lobe of the pituitary secretes ADH of the reproductive organs.
and oxytocin.
● Hypersecretion of the mineral corticoids can
● Hyposecretion of ADH by the posterior lobe of lead to kidney failure, high blood pressure and
the pituitary can lead to diabetes insipidus. an excess of potassium in the blood.
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● Hypersecretion of the glucocorticoids can lead ● Hypersecretion of oestrogen and progesterone

to a condition called Cushing’s syndrome. in the male can lead to gynaecomastia.
● Hypersecretion of the sex corticoids can lead ● Hyposecretion of oestrogen and progesterone
to hirsutism and amenorrhea in the female and in the female can lead to polycystic ovary
muscle atrophy and development of breasts in syndrome.
the male. ● Puberty is a natural glandular change due to
● Hyposecretion of the corticosteroid hormones stimulation of the ovaries and testes by the
can lead to a condition called Addison’s disease. pituitary gonadotrophic hormones.
● The principal hormones secreted by the adrenal ● Starting at puberty, the female reproductive
medulla include adrenaline and noradrenaline. system undergoes a regular sequence of monthly
events, known as the menstrual cycle.
● Adrenaline and noradrenaline are under the
control of the sympathetic nervous system and ● The ovaries undergo cyclical changes, in which
are released at times of stress. a certain number of ovarian follicles develop.
When one ovum completes the development
● The pancreas is an organ with dual functions –
process, it is released into one of the fallopian
exocrine and endocrine.
tubes. If fertilisation does not occur, the
● The exocrine function is the secretion of
developed ovum disintegrates and a new cycle
pancreatic juice to assist with digestion.
begins.
● The endocrine function is the secretion of
insulin from the islets of Langerhans cells, ● The menstrual cycle lasts approximately 28 days,
which helps regulate blood sugar level. although it can be longer or shorter than this.
● Hypersecretion can lead to ● Pregnancy takes approximately nine calendar
hypoglycaemia. months and is divided into three trimesters.
● Hyposecretion can lead to a condition ● During the first trimester, all of the body
called diabetes mellitus. systems develop.

● The testes (in the male) have two functions – the ● The second trimester consists of rapid fetal
secretion of testosterone and the production growth and the completion of systemic
of sperm. development.
● The third trimester is mostly a weight-gaining
● The ovaries (in the female) have two functions –
and maturing process, preparing the baby for
the production of ova and production of the
life outside of the uterus.
hormones oestrogen and progesterone.
● Hypersecretion of the hormone testosterone ● In the menopause, the ovaries cease responding
in women can lead to virilism, hirsutism and to FSH, resulting in lower levels of oestrogen and
amenorrhea. progesterone secretion.
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Test your knowledge 7 Which of the following hormones increases heart

and breathing rates during times of stress?
questions a insulin
b noradrenaline
Multiple choice questions c testosterone
1 What is the purpose of the endocrine system? d adrenaline
a to contribute to the reproductive process 8 Which hormone is responsible for increasing
b to produce and secrete the hormones that water reabsorption in the kidney tubules?
regulate body activities a luteinising hormone (LH)
c to maintain the body during times of stress b antidiuretic hormone (ADH)
d all of the above c follicle-stimulating hormone (FSH)
2 Which of the following statements is false? d oxytocin
a A hormone is a chemical messenger that 9 Where are the islets of Langerhans situated?
reaches its destination via the bloodstream. a in the liver
b Endocrine glands are ductless glands. b in the pancreas
c All hormones have a quick action. c in the ovaries
d Hormones regulate and co-ordinate various d in the kidneys
functions in the body. 10 Which hormone is concerned with the
3 Which of the following secretes the development of the placenta?
adrenocorticotrophic (ACTH) hormone? a prolactin
a posterior lobe of pituitary b progesterone
b anterior lobe of pituitary c follicle-stimulating hormone (FSH)
c adrenal medulla d oestrogen
d adrenal cortex
4 Which endocrine gland is responsible for Exam-style questions
secreting thyroid-stimulating hormone (TSH)?
11 State two functions of the endocrine
a thyroid gland
system. 2 marks
b anterior lobe of pituitary
c posterior lobe of pituitary 12 List the seven major endocrine glands
d parathyroid glands in the body. 7 marks
5 Which of the following hormones stimulates the 13 State two characteristics of a hormone. 2 marks
uterus during labour? 14 Describe the role of the hypothalamus
a prolactin in relation to the endocrine system. 2 marks
b oestrogen 15 Describe the position and function of the
c oxytocin thymus gland. 2 marks
d progesterone
6 The hormone parathormone regulates the
metabolism of
a protein
b calcium
c carbohydrates
d fats.
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11 The reproductive
system
Introduction
The reproductive systems are the only systems
that are very different, both in terms of
structure and function, for men and women.
The sex organs (testes in men and ovaries in
women) are also endocrine glands. Therefore,
there are also sexual differences in the
functioning of the endocrine system.
The reproductive system is also the only system
that undergoes particular changes at certain
times in an individual’s life, maturing at puberty,
and for women, ceasing to function in the same
way after the menopause.
These systems are unique in that they are not
vital to the survival of an individual, but they
are essential to the continuation of the human
species.
OBJECTIVES
● functions of the reproductive systems
● structure and functions of the parts of the

female reproductive system
● structure and functions of the parts of the
male reproductive system
● common pathologies of the reproductive
system
reproductive and other body systems.
9781510435179.indb 299 04/10/18 4:52 PM

● the crura – two legs of erectile tissue that fan

In practice out to support the exterior structures of the
It is important for therapists to have a clitoris and attach to the underlying tissues;
comprehensive knowledge of the reproductive these fill with blood allowing the clitoris to grow
systems in order to be able to understand the effects in size and harden during sexual stimulation
of the natural glandular changes in the body, which ● the body – the main cylindrical region of the
can impact the suitability of certain treatments. clitoris, which extends from the crura and which
contains two columns of the erectile tissue
Functions of the ● the glans – forms the pointed tip of the clitoris
extending outward from the body and beyond
reproductive systems the prepuce that covers the rest of the clitoris.
● the hymen – a thin layer of mucous membrane at
The male and female reproductive systems are
the entrance to the vagina
specialised to produce the sex hormones responsible
for the male and female characteristics and for ● the greater vestibular glands – the vulva is
producing the cells required for reproduction. lubricated by mucus which is secreted from these
glands, located in the labia majora, one on either
The female side near the opening of the vagina
reproductive system
● the vulval vestibule – this is the central area of
the labia minora where the urinary meatus and
The function of the female reproductive system is vaginal opening lie
the production of sex hormones and ova (egg cells) ● the urinary meatus – this is where the urethra
which, if fertilised, are supported and protected until opens and urine exits the body in females; in
birth. The female reproductive system consists of the males, both urine and semen exit through this
following internal organs lying in the pelvic cavity: opening. In females it is located in the vulval
● the ovaries vestibule approximately 25 mm behind the clitoris.
● the fallopian tubes The breasts are accessory glands to the female
reproductive system.
● the uterus
● the vagina. Fallopian Ovary
tube
The external genitalia

The external genitalia is known collectively as the Uterus
vulva and consists of:

● the mons pubis – the exterior of the vulva, a
rounded mass of fatty tissue found over the pubic
symphysis of the pubic bones Ovum
Vagina
● the labia majora and minora – lip-like folds at the Cervix
entrance of the vagina

● the clitoris – attached to the symphysis pubis by a
suspensory ligament and containing erectile tissue,
which can be divided into three major regions:
p Female reproductive organs
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11 The reproductive system
Overview of the female reproductive organs

Table 11.1 The position and functions of the female reproductive organs
Female
reproductive parts Position Function(s)
Ovaries Either side of uterus on lateral Production of ova
walls of the pelvis Secretion of oestrogen and progesterone
Fallopian tubes Extend from the sides of the Convey the ovum from the ovary to the uterus
uterus, passing upwards and
outwards to end near each ovary
Uterus Situated behind the bladder and Area in which an embryo grows
in front of the rectum
Cervix A tube of tissue that forms a Functions as a barrier for protection but softens and opens
passageway to connect the when required allowing sperm to pass through into the uterus
vagina to the uterus During childbirth, opens allowing passage of the baby
During ovulation, helps maintain the uterus in a healthy
condition to aid egg fertilisation
Vagina Leads from the cervix to the Provides a passageway for menstruation and for childbirth
vulva (connects internal sex
organs with external genitalia)
The ovaries Oestrogen and progesterone regulate the changes

in the uterus throughout the menstrual cycle
These are the female sex glands and they lie on the
and pregnancy. Oestrogen is responsible for the
lateral walls of the pelvis. They are almond-shaped
development of the female sexual characteristics,
organs which are held in place, one on each side of
while progesterone, produced in the second phase
the uterus, by several ligaments. The largest of the
of the menstrual cycle, supplements the action of
ligaments is the broad ligament, which holds the
oestrogen by thickening the lining of the uterus,
ovaries in close proximity to the fallopian tubes.
ready for the possible implantation of a fertilised egg.
The ovary contains numerous small masses of cells
called ovarian follicles, within which the ova (egg cells) The fallopian tubes
develop. At the time of birth, there are about two The two fallopian tubes are each about 5 cm long,
million immature ova in a female’s ovaries. Many of and extend from the sides of the uterus, passing
the ova degenerate, and at the time of puberty there upwards and outwards to end near each ovary. At the
are only about 400 000 left. end of each fallopian tube are finger-like projections
The immature ova (oocytes) lie dormant in the ovary called fimbriae which encircle the ovaries.
until they are stimulated by a sudden surge in the
Function of the fallopian tubes
hormone FSH at the time of puberty. Normally one
The function of the fallopian tubes is to convey the
egg (ovum) ripens and is released each month.
ovum from the ovary to the uterus. It is swept down
Functions of the ovaries the tube by peristaltic muscular contraction, assisted
The ovaries have two distinct functions: by the lining of ciliated epithelium.
1 the production of ova Fertilisation of the ovum takes place within the
2 the secretion of the female hormones oestrogen fallopian tubes and the fertilised egg then passes
and progesterone. to the uterus.
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The uterus
The uterus is a small, hollow, pear-shaped organ situated behind the
bladder and in front of the rectum. It has thick muscular walls and is
composed of three layers of tissue:
1 The perimetrium – an outer covering which is part of the peritoneum
(a serous membrane in the abdominal cavity). It covers the superior
(top) part of the uterus.
2 The myometrium – a middle layer of smooth muscle fibres. This layer
forms 90% of the uterine wall and is responsible for the powerful
contractions that occur at the time of labour.
3 The endometrium – a soft, spongy mucous membrane lining, the
surface of which is shed each month during menstruation.
The uterus can be divided into three parts:
1 The fundus is the dome-shaped part of the uterus above the openings
KEY FACT of the fallopian tubes.
The cervix of the uterus
dilates during childbirth and
2 The body is the largest and main part of the uterus and leads to the
the measurement of dilation cervix.
is used to decide how soon 3 The cervix of the uterus is a thick fibrous muscular structure at the
the baby will be born. neck of the uterus which opens into the vagina.
Functions of the uterus
The uterus is part of the female reproductive tract which is specialised
to receive an ovum, and serves as the area in which an embryo grows and
develops into a foetus. After puberty, the uterus goes through a regular
cycle of changes which prepares it to receive, nourish and protect a
fertilised ovum.
During pregnancy, the walls of the uterus relax to accommodate the
growing foetus. If the ovum is not fertilised, the menstrual cycle ends
with a short period of bleeding as the endometrium degenerates.
The vagina
The vagina is a 10–15 cm muscular and elastic tube, lined with
moist epithelium, which connects the internal organs of the female
reproductive system with the external genitalia.
It is made up of vascular and erectile tissue and extends internally
Study tip from the cervix of the uterus to the vulva on the outside of the body.
When learning parts of the During sexual stimulation, the erectile tissues become engorged with
female reproductive system, it blood.
may be helpful to remember the
following mnemonic. Functions of the vagina
Olivia Ovaries The function of the vagina is for the reception of the male sperm, and to
Feels Fallopian tubes provide a passageway for menstruation and for childbirth.
Unlucky Uterus The wall of the vagina is sufficiently elastic to allow for expansion during
Contracting Cervix
childbirth. Between the phases of puberty and the menopause, the vagina
also provides an acid environment, due to acid-secreting bacteria, in order
Vaginosis Vagina
to help prevent the growth of microbes that may infect the internal organs.
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Anatomy of the female The number of glands can vary greatly, usually from
about four to 28 per breast.
breast A considerable amount of fat or adipose tissue covers
The female breasts are accessory organs to the the surface of the gland and is found between the
female reproductive system, and their function is lobes. The skin on the breast is thinner and more
to produce and secrete milk after pregnancy. translucent than the body skin.
Position Support
The breasts lie on the pectoral region of the front of The breasts are supported by powerful suspensory
the chest. They are situated between the sternum and Cooper’s ligaments, which go around the breast, both
the axilla, extending from approximately the second ends being attached to the chest wall. The pectoralis
to the sixth rib. The breasts lie over the pectoralis major and serratus anterior muscles help to support
major and serratus anterior muscles, and are attached the ligaments.
to them by a layer of connective tissue. If the breast grows large in adolescence or pregnancy,
the Cooper’s ligaments may become irreparably
stretched and the breast will then sag. With age,
Pectoralis major the supporting ligaments, along with the skin and the
breast tissue, become thin and inelastic, and the
Adipose tissue
breasts lose their support.
Physiology of the breast

Lymphatic drainage
The breasts contain many lymphatic vessels, and the
lymph drainage, mainly into the axillary nodes under
Areola Copper’s the arms, is extensive.
ligaments
● About 75% of lymph of the breast drains into the
Nipple
axillary nodes.
● About 20% drains into the internal mammary
Lactiferous nodes.
duct
● The remaining 5% drains into the intercostal
nodes.
p The structure of the female breast
Blood supply
Structure The blood vessels supplying blood to the breast
include the internal thoracic artery, a branch of the
The breasts consist of glandular tissue arranged in
subclavian artery and the axillary arteries.
lobules, supported by connective, fibrous and adipose
tissue. The lobes are divided into lobules which open The veins of the breast correspond with the arteries,
up into lactiferous or milk ducts. draining into the axillary and internal thoracic veins.
The milk ducts open into the surface of the breast Nerve supply
at a projection called the nipple. Around each nipple, There are numerous sensory nerve endings in the
the skin is pigmented and forms the areola; this varies breast, especially around the nipple. In lactation,
in colour from a deep pink to a light or dark brown when these touch receptors are stimulated,
colour. the impulses pass to the hypothalamus, which
Glands of Montgomery are sebaceous glands in the stimulates the release of the hormone oxytocin from
areola area, which make oily secretions to keep the posterior lobe of the pituitary. This promotes the
the areola and the nipple lubricated and protected. flow of milk when required.
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Hormones The areola and the nipple enlarge and become more
The hormones responsible for the developing pigmented.
breast are: Menopause
● oestrogen – responsible for the growth and The reduction in female hormones during the
development of the secondary sex characteristics menopause causes the glandular tissue in the breast to
● progesterone – causes the mammary glands shrink and the supporting ligaments, along with the skin,
to increase in size if ovum fertilisation and to become thinner and lose their elasticity. Therefore,
subsequent pregnancy occurs. during the menopause the breasts begin to lose their
Other hormones involved in breast physiology include: support, although the degree of loss is dependent on
the original strength of the suspensory ligaments.
● prolactin – a hormone that is released from the
anterior pituitary gland and which stimulates milk Factors determining size
production after childbirth
and shape
● oxytocin (ox-ee-toe-sin) – a hormone that is
The size of the breast is largely determined by genetic
released from the posterior lobe of the pituitary
factors. Other factors include:
gland.
● the amount of adipose tissue present
The two main actions of oxytocin are contraction
of the uterus during childbirth and lactation. ● the degree of fluid retention
● the levels of ovarian hormones in the blood and the
KEY FACT sensitivity of the breasts to these hormones
The first secretion from the mammary glands ● the degree of ligamentary suspension
after giving birth is called colostrum. It is rich ● the amount of exercise undertaken.
in antibodies.
KEY FACT
Development of the breasts Exercise may help to strengthen the pectoral
Puberty muscles, which helps to support the ligaments
and increase the uplift of the breast. However, if
The breast starts out as a nipple which projects the wrong type of exercise is undertaken and/or
from the surrounding ring of pigmented skin called insufficient support is provided for the breasts
the areola. Approximately two or three years before during exercise, the ligaments may become
the onset of menstruation, the fat cells enlarge irreparably stretched.
in response to the sex hormones (oestrogen and
progesterone) that are released during adolescence.
Reproductive cycles
KEY FACT and hormones
The breasts change monthly in response to Hormones are body chemicals that bring about many
the menstrual cycle. The action of the female
changes in the reproductive system throughout life,
hormone progesterone increases blood flow to
the breast, which increases fluid retention, and including at puberty, during the menstrual cycle and
the breast may increase in size, causing it to feel ovulation, throughout pregnancy and at the menopause.
swollen and uncomfortable.
Hormones during puberty
Pregnancy The onset of puberty, which is triggered by the brain,
During pregnancy, the increased production of produces a number of changes in the reproductive
oestrogen and progesterone causes an increase in system of both boys and girls.
blood flow to the breast. This causes an enlargement ● Gonadotropin-releasing hormone (GnRH) is
of the ducts and lobules of the breast in preparation released by the hypothalamus, which initiates the
for lactation, and there is an increase in fluid retention. first stage of hormonal reactions.
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● The pituitary gland receives a signal from this During ovulation, the follicle releases the egg due
hormone and, in turn, releases FSH along with LH. to an increase in LH produced by the pituitary
The process of sexual development is initiated gland, which itself is triggered by the increase in
by these hormones, which work in different ways the oestrogen level. Progesterone and oestrogen are
for males and females. then secreted from the burst follicle as the uterus
The male sex hormone testosterone is produced in continues to get ready for pregnancy.
the testes. FSH and LH are the two hormones that Progesterone
are responsible for producing testosterone. During
This hormone is released by the ruptured follicle
puberty, the development of male secondary sexual
(the one that has released an egg). After the egg
characteristics, such as pubic hair, facial hair and
is released from the follicle, the follicle closes and
muscular development, are due to a surge in these
becomes a corpus luteum. The corpus luteum secretes
hormone levels.
increasing amounts of progesterone. This rise in the
In females, the ovaries produce oestrogen and level of progesterone typically causes a rise in body
progesterone when the brain releases FSH and LH. temperature. If no pregnancy occurs, the level of
The development of breasts and a curvier body shape progesterone falls and this, along with the decreasing
are the result of the female hormones. amount of oestrogen, helps the built-up lining of the
The growth spurt in puberty for both males and uterus to separate and menstruation begins.
females is caused by an increase in the secretion of
growth hormone. Stages of pregnancy
Pregnancy starts with fertilisation and ends with
Hormones during childbirth.
menstruation
The female hormones are responsible for the Fertilisation
menstrual cycle. The hormones that are most This is the fusion of a spermatozoon (sperm) with
involved in the process include oestrogen, FSH, an ovum (egg).
LH and progesterone.
Oestrogen
The endometrium builds up in response to the rising
Spermatazoon
level of oestrogen within the female body. This enables
the uterus to prepare to receive an egg that has been
fertilised. The level of oestrogen decreases if there are
no fertilised eggs and no subsequent pregnancy. The
decreasing level of oestrogen results in the loss of the
built-up uterine lining, leading to menstruation.
Follicle-stimulating hormone (FSH) Ovum
The pituitary gland produces this hormone, which Zona

is responsible for readying follicles for ovulation. pellucida
Between 3 and 30 follicles are matured for ovulation
each month, but usually only one follicle completes
the process and is released as an egg.
Luteinising hormone (LH)
This is the hormone that makes the egg release from
p Fertilisation
the follicle in the ovary. This is called ovulation – the
time in the menstrual cycle when the follicle ruptures The spermatozoon penetrates the inner membrane,
and releases the egg from the ovary. referred to as the zona pellucida, of the ovum.
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This initiates the ovum’s final meiotic division and The zygote then develops into a small mass of cells
makes the zona pellucida impenetrable to other called a morula, which reaches the uterus around the
spermatozoa. After the spermatozoon penetrates the third day after fertilisation. Fluid then masses in the
ovum, its nucleus is released into the ovum, the tail centre of the morula and forms a central cavity.
degenerates, and its head enlarges and fuses with The structure is then called a blastocyst.
the ovum’s nucleus. During the next phase, the blastocyst stays within
This fusion provides the fertilised ovum, now called the zona pellucida, unattached to the uterus. Next,
a zygote, with 46 chromosomes, 23 from the egg the zona pellucida degenerates and by the end of the
and 23 from the sperm. first week of fertilisation, the blastocyst attaches to
the endometrium.
Pre-embryonic development
The pre-embryonic phase starts with ovum Formation of the embryo
fertilisation and last for two weeks. By day 24, the blastocyst has formed an amniotic cavity
As the zygote passes through the fallopian tube, containing an embryo. The developing zygote starts to
it undergoes a series of mitotic divisions, forming take on a human shape. Each of the three germ layers
daughter cells, called blastomeres, that each (ectoderm, mesoderm and endoderm) forms specific
contain the same number of chromosomes. The tissues and organs in the developing embryo.
first cell division ends about 30 hours The endometrium and part of the blastocyst mesh
after fertilisation; subsequent divisions occur and development into the placenta, which allows for
rapidly. the passages of nutrients, oxygen and waste to and
from baby and mother.
4 8 12 16 20 24 28 32 36 40
p Foetal development
Foetal development as the eyes, ears, nose, lips, tongue and tooth buds
form. The arms and legs also take shape. Although
Significant growth and development takes place
the gender of the foetus is not yet visible, all external
within the first three months following conception.
genitalia are present.
Month 1 Cardiovascular function is complete and the umbilical
At the end of the first month, the embryo has a cord has a definite form.
definite form. The head, trunk, and the tiny buds From the eighth week, the embryo is called a foetus.
that will become the arms and legs are visible. The
cardiovascular system has begun to function and Month 3
the umbilical cord is visible in its most primitive form. During the third month, the foetus grows to 7.5 cm
in length. Teeth and bones begin to appear, and
Month 2
the kidneys start to function. The foetus opens its
During the second month the embryo grows to mouth to swallow, grasps with its fully developed
2.5 cm in length. The head and facial features develop hands, and prepares for breathing by inhaling and
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exhaling amniotic fluid (although its lungs are ● Human chorionic (cor-ri-on-ik) gonadotrophin
not functioning properly). At the end of the third (HCG) – this is only produced during pregnancy
month, or first trimester, the foetus’s gender is and almost exclusively in the placenta. This
distinguishable. hormone enters the maternal circulation,
preventing the mother’s immune system from
Months 4 to 9 rejecting the embryo and beginning to change
Over the remaining 6 months, the foetal growth her body to support a pregnancy. HCG hormone
continues, as internal and external structures levels found in maternal blood and urine increase
develop at a rapid rate. In the third trimester, the dramatically during the first trimester.
foetus stores the fats and minerals it will need to ● Human placental lactogen (HPL) – produced
live outside of the uterus. by the placenta, this helps in the process of
At birth, the average full-term foetus measures 51 cm providing nutrition for the foetus and plays a
and weights 7 to 7 ½ lbs (roughly 3 to 3.5 kg). role in stimulating milk glands in the breasts in
anticipation of breastfeeding.
Birth ● Oestrogen – responsible for the development
of the female sexual characteristics. Normally
Childbirth is divided into three stages; the duration
formed in the ovaries, oestrogen is also produced
of each stage varies according to the size of the
by the placenta during pregnancy to help maintain
uterus, the woman’s age and the number of previous
a healthy pregnancy.
pregnancies.
● Progesterone – produced by the ovaries and by
1 The first stage of labour is when the foetus
the placenta during pregnancy, progesterone
begins its descent and the cervix starts to dilate,
stimulates the thickening of the uterine lining in
preparing to allow the foetus to pass from the
anticipation of implantation of a fertilised egg.
uterus into the vagina.
During this stage, the amniotic sac ruptures as KEY FACT
the uterine contractions increase in frequency Human chorionic gonadotrophin can be detected
and intensity (the amniotic sac can also rupture in the urine as early as 7–9 days after fertilisation
before the onset of labour). and is used as an indicator of pregnancy in most
3 The second stage of labour begins with full over-the-counter pregnancy tests.
cervical dilation and ends with delivery of
the foetus. Hormones during labour
4 The third stage of labour starts immediately The hormone oxytocin has a key role during labour.
after childbirth and ends with expulsion of the It is associated with feelings of motherhood and
placenta. After the neonate is delivered, the uterus bonding. Prolactin is similarly linked to these feelings.
continues to contract intermittently and grows As labour commences, the regular contractions of
smaller. the uterus and abdominal muscles are initiated by an
increase in the level of oxytocin. These contractions
Hormones during pregnancy continue to increase in frequency as well as
The ovaries, and then later the placenta, are the strength, without the assistance of oestrogen and
main producers of the pregnancy-related hormones progesterone, which inhibit labour at elevated levels.
that are essential in creating and maintaining the
For a baby to pass through, the cervix must be dilated
conditions for a successful pregnancy.
to about 10 cm. Oxytocin is one of the hormones that
Many hormone levels change in the body during assists with the preparation of the cervix to enable
pregnancy, with several hormones playing major roles successful dilation during the birth.
during this time. These include:
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During labour, the level of relaxin rises very quickly, last even longer. Approximately 80% of women can
which assists the birth process. The increased level of experience several different symptoms during the
relaxin helps the cervix to soften and become longer, menopause; most common are sweating during the
as well as expanding and softening the lower pelvic night and hot flushes at varying intervals during the
region. day. These symptoms usually occur within the first
At the point where the arrival of the baby becomes year of the menopause and can sometimes be severe
imminent, increased quantities of the hormones enough to affect the quality of sleep, resulting in low
adrenaline and noradrenaline are released. This energy and a loss of strength.
results in a flood of energy that initiates very strong
contractions to help complete the birth process.
The role of hormones
in menopause
Hormones after labour Oestrogen is made up of the three reproductive
To reduce bleeding after labour, oxytocin contracts hormones:
the uterus, effectively restricting the blood flow. 1 oestradiol
This also aids with detachment and expulsion of 2 oestrone
the placenta. Prolactin, along with oxytocin, aids
3 oestriol.
mother-and-baby bonding by remaining elevated
at this stage. During her fertile years, a woman’s ability to produce
eggs each month is linked with the release of these
Progesterone and oestrogen fall once the placenta is
hormones. The main producer of oestrogen are the
expelled. This enables the mother to produce a high-
ovaries. However, the adrenal glands and, during
density milk that is more suitable for the newborn
pregnancy, the placenta also produce small amounts
baby, as opposed to on-going mature milk. This first
of oestrogen.
milk produced by the mother is known as colostrum
and contains a much richer content of minerals, Oestrogen works at puberty to stimulate the female
protein and vitamins for the baby’s first feed. characteristics. It governs the reproductive cycle
including ovulation and thickening of the uterus in
Oxytocin and prolactin from the pituitary are
preparation for implantation of a fertilised egg. If
released during breastfeeding and pass through the
there is no pregnancy, the monthly period occurs,
blood to the breast. The prolactin promotes the
and the lining of the uterus is expelled through
production of the milk and the oxytocin stimulates
the vaginal opening.
the delivery of the milk to the mothers’ nipples.
With age, a woman’s ability to become pregnant
Mature milk that continues to nourish baby and
lessens as the eggs, stored in the ovaries, decrease in
aids sleep starts to be produced usually around
number. The amount of oestrogen produced gradually
four days after the birth.
decreases over a number of years, causing changes in
The menopause the body and various symptoms to arise. This period
is known as the peri-menopause. The menopause
The menopause is the period at the end of a woman’s itself usually occurs around the age of 50 to 55. This
reproductive years when the menstrual cycle is when ovulation and the monthly period cycle stop,
stops. This is due to the loss of the egg-containing and a woman is no longer able to become pregnant.
follicles in her ovaries. Once the follicles are gone,
Ovarian follicles reduce during the menopause
progesterone and oestrogen, the hormones that
and the ovaries respond decreasingly to LH and
regulate the menstrual cycle, are no longer secreted
FSH, which are both involved in the process of
by the ovaries and menstruation ceases.
reproduction. With the release of fewer hormones
A change in the regular period cycle often indicates from the ovaries as age increases, LH and FSH lose
the start of the menopause. This stage usually lasts their ability to function correctly in order to regulate
for up to four years, but for some women it can oestrogen, progesterone and testosterone.
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Effects of hormone changes during The oestrogen-only medications are for woman
menopause who have had a hysterectomy, whereas for woman
The changes in these hormone levels during the who still have their uterus, both oestrogen and
menopause can result in decreased health for a progestogen are part of the medication.
number of years. A woman can experience a range
of different conditions such as fatigue, mood swings,
Female reproductive
memory loss, increased sweating during the night and changes with ageing
day, hot flushes, anxiety and depression. These can
Ovulation usually stops 1 to 2 years before the
be brought on by changes in the nervous system due
menopause. As the ovaries reach the end of their
to hormonal fluctuations caused by the reduction of
reproductive cycle, they become unresponsive to
oestrogen in the body.
gonadotrophic stimulation. With ageing, the ovaries
The reduction in oestrogen can cause poor muscle atrophy and become thicker and smaller.
tone and dryness in the vagina, often making sexual
The vulva also atrophies with age and the tissue
intercourse painful or uncomfortable. This is coupled
shrinks. Atrophy causes the vagina to shorten and the
with other changes in mood or sleep patterns, and can
mucous lining to become thin, dry and less elastic.
result in a reduced libido (little or no interest in sex).
After the menopause, the uterus shrinks rapidly to
It is not clear whether depression, anxiety or panic
half its premenstrual weight. The cervix atrophies
attacks are brought on by the menopause, but the
and no longer produces mucus for lubrication,
onset of these conditions can occur at this stage in
and the endometrium and myometrium become
a woman’s life.
thinner.
Diagnosis of the menopause can only be made
In the breasts, the glandular, supporting and fatty
accurately once a woman has stopped having periods
tissues atrophy and as the Cooper’s ligaments lose
for a year or more. It is, however, often the case that
their elasticity, the breasts become pendulous.
a woman knows she has started the menopause due
to symptoms she is experiencing.
Activity
KEY FACT Hormones play a major role in regulating body
To identify the menopause, a test can be processes. When the body is in balance it is like
performed to check for an elevated level of a finely tuned orchestra with all instruments
FSH. If a woman has not had her menstrual playing in synchrony.
period for a year or more and the test results Discuss with your colleagues what effects stress
show a consistently elevated FSH blood level of may have on the following glandular changes in
30 mIU/ml or higher, it is generally considered life: puberty, pregnancy and menopause.
that she has commenced the menopause.
Discuss the hormones involved and what effects
they may have on the body.
Hormone replacement
therapy (HRT)
A slight change in lifestyle, such as healthier eating The male reproductive
and better sleeping habits coupled with regular
exercise, is all that may be required for a significant
system
improvement in a woman’s comfort during the The male reproductive system consists of the:
menopause. However, for some women who ● testes
experience more unpleasant menopausal symptoms, ● epididymis
HRT can be used as treatment. HRT can be taken
● vas deferens
by pill, administered through skin gels and patches
or even implants. HRT medications all contain ● urethra
oestrogen, and some contain progesterone as well. ● penis.
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Ureter
Vas deferens Seminal vesicle

Prostate gland
Penis Vas deferens Penis

Urethra
Epididymis
Testis Testis
Urethra Prostate gland

Epididymis
p Male reproductive system
Table 11.2 The position and functions of the male reproductive organs
Male reproductive parts Position Function(s)

Testes In the scrotum Production of sperm
Epididymis Lies along the posterior border of each testis Stores sperm until maturation
(epp-pee-did-ee-mus)
Vas deferens Very long tubes leading from the seminiferous Tubes through which sperm is
(vass-def-fer-rens) tubules of the testes to the urethra released
Urethra Extends from neck of the bladder through the Provides a common pathway for
(you-reeth-ra) penis to outside of the body urine and semen
Penis Male external sex organ Excretes urine and ejaculates semen
The testes are specialised to produce and maintain

Study tip
sperm cells, and to produce male sex hormones known
When learning parts of the male reproductive
collectively as androgens. Testosterone is the most
system, it may be helpful to remember the
important androgen as it stimulates the development
following mnemonic.
of the male reproductive organs. It is also responsible
Tom Testes
for the development and maintenance of the male
Evades Epididymis secondary sexual characteristics.
Very Vas deferens
Unfortunate Urethra Epididymis
Pathologies Penis The epididymis (plural: epididimydes) is a coiled tube
leading from the seminiferous tubule of the testis to
Testes the vas deferens. They store and nourish immature
sperm cells and promote their maturation until
The testes are the reproductive glands of the male,
ejaculation.
and lie in the scrotal sac. Each testis consists of
approximately 200 to 300 lobules; these are separated
by connective tissue and filled with seminiferous
Vas deferens
tubules, in which sperm cells are formed. Between the The vas deferens (plural: vas deferentia) is a tube
tubules are a group of secretory cells known as the leading from the epididymis to the urethra, through
interstitial cells, which produce male sex hormones. which the sperm are released.
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KEY FACT Prostate gland

The vas deferentia are cut in the operation The prostate gland is a male accessory gland about
known as a vasectomy, which produces the size of a walnut. It lies in the pelvic cavity in
sterilisation in the male. front of the rectum and behind the symphysis pubis.
During ejaculation, it secretes a thin, milky fluid
Seminal vesicles that enhances the mobility of sperm and neutralises
semen and vaginal secretions.
The seminal vesicles are pouches lying on the posterior
aspect of the bladder attached to the vas deferens. KEY FACT
They secrete an alkaline fluid which contains nutrients The prostate gland commonly becomes
and is added to sperm cells during ejaculation. enlarged in older men, causing difficulty in
passing urine due to constriction of the urethra
Ejaculatory ducts
The two ejaculatory ducts are short tubes which join Male reproductive changes
the seminal vesicles to the urethra.
with ageing
Urethra Physiological changes in older men include reduced
testosterone production, with in turn may cause
The urethra provides a common pathway for the flow
decreased libido. A reduced testosterone level also
of urine and the secretion of semen. A sphincter muscle
causes the testes to atrophy and soften, and sperm
prevents both functions occurring at the same time.
production decreases by around 48–69% between the
Urinary meatus ages of 60–80. Normally, the prostate glands enlarge
with age and its secretions diminish. Seminal fluid also
The urinary meatus is located at the tip of the glans decreases in volume and becomes less viscous.
penis and is a sensitive part of the male reproductive
system. It resembles a vertical slit, which facilitates
the flow of urine. Sometimes, the opening may
Common pathologies
be naturally more rounded, or occur as a result of of the reproductive
excessive skin removal during circumcision.
system
Penis
The penis is the main external sex organ of the male. Female pathologies
It is composed of erectile tissue and is richly supplied Amenorrhoea
with blood vessels. When stimulated by sexual
Amenorrhea is the absence of menstrual periods.
activity the blood vessels become engorged with
Causes may include deficiency of ovarian, pituitary
blood and the penis becomes erect. Its function is
or thyroid hormones, mental disturbances, depression,
to convey urine and semen.
radical weight loss, stress, excessive exercise or a
Accessory sex glands major change in surroundings or circumstances.
in the male Cancer of the breast

Most breast cancers are detected when the patient
Cowper’s glands notices a breast or axillary lump; mammography
The Cowper’s glands are a pair of small glands that screening can confirm whether a lump is potentially
open into the urethra at the base of the penis. These cancerous.
glands produce further secretions to contribute to Breast cancer can present as redness and pain,
the seminal fluid, but less than that of the prostate puckering of the breast skin or change in breast
gland or seminal vesicles. shape, or discharge from or retraction of the nipple.
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Cancer can spread locally, or to the axilla and neck Hormone changes may result in abnormal vaginal
lymph nodes, causing oedema of the arm, or by blood bleeding.
to the lung, bone and liver.
Dysmenorrhea
The type of breast cancer can determine whether the
This condition is defined as painful and difficult
spread is rapid or very slow.
menstruation. It presents with spasms and congestion
of the uterus, resulting in cramping lower abdominal
In practice pains which start before or with the menstrual
Note that the spread of cancer is determined by the flow, and continue during menstruation. It is often
type of breast cancer (some spread rapidly while associated with nausea, vomiting, headache and
others are slow growing). a feeling of faintness.
Consult the client’s GP or consultant regarding the Ectopic pregnancy
extent and type of the cancer, and the treatment
This term is used to describe the development of a
regime.
foetus at a site other than in the uterus. An ectopic
Avoid areas that have been exposed to radiation, pregnancy may occur if the fertilised egg remains in
if a client is having radiotherapy, as these may be the ovary, or in the fallopian tube, or if it lodges in
sensitive and tender. the abdominal cavity.
Both radio and chemotherapy can reduce a client’s The most common type of ectopic pregnancy
immunity and, therefore, therapists should avoid occurs in the fallopian tube. There is a danger of
contact if they have an infection. haemorrhage as growth of the foetus may cause
Clients who have had surgery which involved the tube to rupture and bleed. Ectopic pregnancy
removal of the axillary nodes are likely to have can be life threatening.
oedema of the arm. Provided permission for
Endometriosis
treatment has been granted by the client’s GP or
consultant, elevating the oedematous arm above This is inflammation of the endometrium (the inner
heart level throughout a massage can be beneficial. lining of the uterus). It presents with abnormal
Gently massage the arm with strokes that are menstrual bleeding, lower abdominal pain and a
directed towards the axilla. Advise the client to foul-smelling discharge. Fever and malaise may
open and close their hand tightly six to eight times accompany this condition.
every few hours (the contraction of the muscles will Fibroid
help venous and lymphatic flow). A fibroid is an abnormal growth of fibrous and
muscular tissue in the muscular wall of the uterus.
Cancer of the cervix Fibroids can cause pain and excessive bleeding, and
Cervical cancer is asymptomatic in the early stages. may become extremely large. Although they do not
Later there may be foul-smelling, blood-stained threaten life, they make pregnancy unlikely.
discharge from the vagina. Lower back pain, loss Some fibroids may be removed surgically; in other
of weight, unexplained anaemia and pain during cases a hysterectomy may be necessary.
intercourse are other symptoms. Polycystic ovary syndrome
Cancer of the ovaries (as known as Stein-Leventhal
Ovarian cancer is asymptomatic. Diagnosis is usually syndrome)
made after the cancer has spread extensively. The This is a hormonal disorder in which there is
symptoms are vague and are usually associated with inadequate secretion of the female sex hormones.
gastrointestinal problems, such as bloating of the As a result, the ovarian follicles fail to ovulate and
abdomen, mild abdominal pain and excessive passage remain as multiple cysts, distending the ovary. Other
of gas. There may be fluid in the peritoneal cavity associated symptoms include obesity, hirsutism,
in late stages. acne and infertility.
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Premenstrual syndrome there may be a frequency of micturition, urgency,

Premenstrual syndrome is a term for the physical difficulty in voiding, blood in urine or blood in the
and psychological symptoms experienced 3–14 days ejaculate. Cancer of the prostate is often diagnosed
prior to the onset of menstruation. by rectal examination – the diseased prostate feels
nodular and hard. Prostate cancer may spread to the
The condition presents with varying symptoms:
bones, where it produces pain, or causes fractures
headache, bloatedness, water retention, backache,
after trivial injury.
changes in co-ordination, abdominal pain, swollen
and painful breasts, depression, irritability and In the advanced stage, as in all cancers, the person
craving for sweet foods. loses weight and is anaemic.
Infertility Prostatitis
Infertility is the inability in a woman to conceive or This is inflammation of the prostate gland, which is
in a man to induce conception. Female infertility may usually caused by bacteria. This condition presents
be due to a failure to ovulate, to obstruction of the with a frequent need to urinate and urgency on
fallopian tubes, or endometriosis. passing urine (urine may be cloudy). High fever
with chills, muscle and joint pain are common.
Male pathologies A dull ache may be present in the lower back
and pelvic area.
Cancer of the testis
Infertility
Slight enlargement of the testis is the first symptom
of testicular cancer. It may be accompanied by pain, Causes of male infertility can include decreased
discomfort and heaviness of the scrotum. Soon numbers or motility of sperm, or may be due to the
there is a rapid enlargement of the testis, which total absence of sperm. In both male and female
can become hot and red. infertility, the cause may also be associated with
stress.
Cancer of the prostate
Usually there are no initial symptoms of prostate
cancer. If the cancer is located close to the urethra,
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Interrelationships with contract rhythmically. During orgasm in the male,

motor impulses are transmitted to skeletal muscles
other systems at the base of the erectile penis causing them to
contract rhythmically.
The reproductive system
Circulatory
The reproductive system links to the following body
systems. During erection of the penis, the vascular spaces
within the erectile tissue become engorged with
Cells and tissues blood as arteries dilate and veins are compressed.
Ova are the reproductive cells in the female and During periods of sexual stimulation, the erectile
sperm cells are the reproductive cells in the male. tissues of the clitoris become engorged with blood.
Skeletal Nervous
The pelvis offers protection for the uterus. Orgasm is the culmination of sexual stimulation; the
movement of semen occurs because of sympathetic
Muscular
reflexes.
Smooth muscle is responsible for the passage of ova
from the ovaries to the vagina, and sperm from the Endocrine
testes to the urethra. The ovaries in women and the testes in the male are
During orgasm in the female, the muscles of the responsible for the development of the secondary
perineum, uterine wall and the uterine tubes sexual characteristics.
Key words Fertilisation: the fusion of a spermatozoon with

an ovum
Clitoris: a female sex organ; its visible button-like Genitalia: the collective term for male or female
portion is near the front junction of the labia minora, reproductive organs
above the opening of the urethra
Greater vestibular glands (known as Bartholin’s
Cooper’s ligament: connective tissue in the breast glands): glands that lie in the labia majora, one on
that helps to maintain structural integrity each side near the vaginal opening, and secrete
Corpus luteum: a hormone-secreting structure mucus which lubricates the vulva
that develops in an ovary after an ovum has been Human chorionic gonadotropin hormone
discharged but degenerates after a few days unless (HCG): a hormone produced by the placenta
pregnancy has begun after implantation
Cowper’s gland: either of a pair of small glands Human placental lactogen (HPL): a hormone,
which open into the urethra at the base of the penis produced by the placenta, which plays a role
and secrete a constituent of seminal fluid in stimulating milk glands in the breasts in
Ejaculation: the discharge of semen from the male anticipation of breastfeeding
reproductive organs Hymen: a membrane that surrounds or partially
Ejaculatory duct: a duct through which semen is covers the external vaginal opening
ejaculated Labia majora and labia minora: lip-like folds at
Endometrium: the mucous membrane that lines the entrance of the vagina
the inside of the uterus Mammary gland: the milk-producing gland in females
Epididymis: a highly convoluted duct behind Menopause: the ceasing of menstruation and the
the testis, along which sperm passes to the vas end of a woman’s reproductive life
deferens
Mons pubis: a rounded mass of fatty tissue found
Fallopian tube: one of a pair of tubes along which over the pubic symphysis of the pubic bones at the
ova travel from the ovaries to the uterus exterior of the vulva
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Myometrium: the middle layer of the uterine wall Seminiferous tubule: a coiled tubule of the testis
Oestrogen: a female hormone that causes in which spermatozoa are produced
development and change in the reproductive organs Spermatozoon/spermatozoa: sperm cell(s) that
Oocyte: an immature ovum combines with an ovum to form a zygote
Ovaries: female sex glands that lie on the lateral Testes: paired male reproductive glands that
walls of the pelvis produce sperm and secrete testosterone
Ovum/ova: an egg, or eggs within the ovary of the Testosterone: a hormone that stimulates
female development of male secondary sexual
characteristics, produced mainly in the testes
Penis: the organ of the male reproductive system
through which semen passes out of the body during Urethra: the duct by which urine is conveyed out
sexual intercourse; also an organ of urination of the body from the bladder, and which in men
also conveys semen
Perimetrium: the outer serous layer of the uterus,
equivalent to the peritoneum Urinary meatus: the opening of the urethra; the
point where urine exits the urethra in males and in
Pregnancy: the period from conception to birth females, and also where semen exits the urethra
Progesterone: a hormone released by the corpus in males
luteum that stimulates the uterus to prepare for Vagina: the muscular tube leading from the external
pregnancy genitals to the cervix of the uterus in women
Prostate: a gland surrounding the neck of the Vas deferens: the duct that conveys sperm from the
bladder in males; releases a fluid component testicle to the urethra
of semen
Vulva: part of the female reproductive system that
Scrotum: a pouch of skin containing the testicles contains the external female sex organs
Semen: the male reproductive fluid, containing Vulval vestibule: the area between the labia minora
spermatozoa in suspension where the vaginal opening and the urinary meatus
Seminal vesicle: one of a pair of glands which are located
opens into the vas deferens near to its junction with Zygote: an egg that has been fertilised by sperm,
the urethra and secretes many of the components and which could develop into an embryo
of semen
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Revision summary
The reproductive system
● The male and female reproductive systems function to produce:
● the sex hormones responsible for the male and female characteristics
● the cells required for reproduction.
● The structures of the female reproductive system include: ovaries, fallopian tubes, uterus, vagina and vulva.
● The breasts, or mammary glands, are also part of the female reproductive system.
● The ovaries lie on the lateral walls of the pelvis and have two distinct functions: the production of ova
and the secretion of the female hormones oestrogen and progesterone.

● The fallopian tubes transport ova from the ovaries to the uterus.
● The uterus is situated behind the bladder and in front of the rectum and is designed to receive, nourish
and protect a fertilised ovum.

● The vagina is a muscular and elastic tube designed for the reception of sperm and to provide a
passageway for menstruation and childbirth.

● The vulva is a collective term for the female genitalia.
● In older females, levels of oestrogen and progesterone decrease, causing the menopause. Ovaries atrophy
becoming thicker and smaller. The vulva atrophies and tissue shrinks. Atrophy causes the vagina to shorten
and the mucous lining to become thin, dry and less elastic.
● After the menopause, the uterus shrinks rapidly to half its premenstrual weight. The breasts atrophy and
lose their elasticity and support.
● Pregnancy starts with fertilisation and ends with childbirth, and consists of the following stages:
fertilisation, pre-embryonic development, formation of embryo, fetal development and birth.
● The structures of the male reproductive system include: testis, epididymis, vas deferens, ejaculatory
ducts, urethra, seminal vesicles, prostate, Cowper’s gland and penis.
● The testes lie in a scrotal sac; they produce and maintain sperm cells, and release the male sex hormone
testosterone.
● Each testis is filled with a seminiferous tubule in which sperm cells are formed.
● The epididymis is a coiled tube that leads from the seminiferous tubule of the testis to the vas deferens.
It stores and nourishes immature sperm cells and promotes their maturation until ejaculation.
● The vas deferens leads from the epididymis to the urethra and is a tube through which the sperm are
released.
● The seminal vesicles are pouches lying on the posterior aspect of the bladder, attached to the vas deferens.
They secrete an alkaline fluid which contains nutrients and is added to sperm cells during ejaculation.
● The two ejaculatory ducts are short tubes which join the seminal vesicles to the urethra.
● The Cowper’s glands are a pair of small glands that open into the urethra at the base of the penis.
These glands produce further secretions to contribute to the seminal fluid.

● The prostate gland lies in the pelvic cavity in front of the rectum and behind the symphysis pubis.
During ejaculation, it secretes a thin, milky fluid that enhances the mobility of sperm and neutralises
semen and vaginal secretions.
● The urethra provides a common pathway for the flow of urine and the secretion of semen.
● The penis is composed of erectile tissue and is richly supplied with blood vessels. Its function is to
convey urine and semen.

● In the male, a decreased level of testosterone decreases sexual desire and viable sperm; testes also
atrophy as muscle strength decreases.
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Test your knowledge 8 Where in the male reproductive system are

sperm cells stored to maturation?
Multiple choice questions a vas deferens
b penis
1 What is the main function of the ovaries? c epididymis
a to accommodate a growing foetus during d Cowper’s glands
pregnancy
9 Which part of the vulva protects the entrance
b to serve as a site for fertilisation
to the vagina?
c to produce mature ova
a labia majora
d to receive male sperm
b labia minora
2 What is a fertilised ovum known as? c clitoris
a a blastocyst d mon pubis
b a zygote
c an embryo Exam-style questions
d a foetus
10 Which of the following statements is true?
3 What is the function of the fallopian tubes? a The seminal vesicles secrete an alkaline fluid
a to convey ova from the ovary to the uterus which contains bacteria.
b to convey ova from the ovary to the vulva b Vas deferentia are the tubes through which
c to prepare for the implantation of a fertilised sperm is released.
ovum c The prostate gland lies in front of the
d to secrete mucus symphysis pubis and behind the rectum.
4 Where is the uterus situated? d The male urethra can only serve as a pathway
a in front of the bladder and behind the rectum for semen.
b behind the bladder and in front of the rectum 11 State two functions of the reproductive
c on the lateral walls of the pelvis system. 2 marks
d at the entrance of the vulva
12 State two functions of each of the following
5 What is the cervix? structures:
a a thick muscular structure that opens into a ovaries
the vagina b uterus
b an outer covering of the uterus c fallopian tubes. 6 marks
c the largest and main part of the uterus
13 Name the hormones responsible
d the dome-shaped part of the uterus
for developing the breast tissue. 2 marks
6 What is the inner mucous membrane lining of the
14 Name the hormone that is only produced
uterus called?
during pregnancy. 1 mark
a perimetrium
b perineum 15 List the parts of the male reproductive
c myometrium system. 5 marks
d endometrium
7 What is the primary function of the testes?
a to store seminal fluid
b to produce and maintain sperm cells
c development of the male secondary
characteristics
d to nourish immature sperm cells
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12 The digestive
system
Introduction
In the digestive system, food is broken down
and made soluble before it can be absorbed by
the body for nutrition. Food is taken in through
the mouth, mechanically broken into smaller
particles and chemically broken into subunits.
These are absorbed into the bloodstream, from
where they can be utilised by the body.
Waste materials that are not required by the
body are passed through to be eliminated.
Once food has been absorbed by the body,
it is converted into energy to fuel the body’s
activities and into components for growth and
renewal. This process is known as metabolism.
OBJECTIVES
● the functions of the digestive system
● the process of digestion; from the ingestion

of food to the elimination of waste
● the structure and functions of the organs
associated with digestion
● the absorption and utilisation of nutrients
in the body
● the sources and functions of the main food
groups required for good nutrition and
health
● common pathologies of the digestive system

digestive and other body systems.
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12 The digestive system
In practice
It is essential for therapists to have a good knowledge of the process
of digestion to understand how the body utilises nutrients for efficient
and healthy body function.
Understanding the structure of the digestive system and its links
with the parasympathetic nervous system can also help therapists to
understand the link between digestive disorders and stress.
Functions of the digestive

system
The digestive system serves two major functions:
1 It breaks down food and fluid into simple chemicals that can be
absorbed into the bloodstream and transported throughout the body.
2 It eliminates waste products through excretion of faeces via the anal
canal.
The structure and function

of digestive organs
Digestion occurs in the alimentary tract, which is a long, continuous
muscular tube extending from the mouth to the anus. The process of
breaking down food is called digestion. Digestion involves the following
processes: ingestion, absorption, assimilation and elimination (defaecation).
Ingestion
This is the act of taking food into the alimentary canal through the mouth.
Absorption
This is the movement of soluble materials out through the walls of the
small intestine. Nutrients are absorbed through the villi and pass out into
the network of blood and lymph vessels to be delivered to various parts
of the body.
Assimilation
This is the process by which digested food is used by the tissues after
absorption.
Elimination (defaecation)
This is the expulsion of the semi-solid waste called faeces through the
anal canal.
The process of digestion

The digestive system serves two major functions:
● Mechanical digestion – the breakdown of solid food into smaller
pieces by the chewing action of the teeth, known as mastication, and
the churning action of the stomach, assisted by peristalsis.
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● Chemical digestion – the breakdown of large ● oesophagus

molecules of carbohydrates, proteins and fats into ● stomach
smaller ones by the action of digestive enzymes.
● small intestine (consisting of the duodenum,
The structure of the jejunum and the ileum)
large intestine (consisting of the caecum,
digestive system
●
appendix, colon and rectum)
The digestive system consists of the following parts: ● anus.
● mouth The pancreas, gall bladder and the liver are
● pharynx accessory organs to digestion.
Mouth
Salivary
glands
Oesophagus
Liver
Stomach
Gall bladder
Pancreas
Pyloric
sphincter
Jejunum
Duodenum
Colon
IIeum
Caecum
Small
intestine
Rectum
Anal canal
IIeocaecal
Anal
valve
sphincter
Appendix
p The digestive organs
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Overview of the main The tongue contains many small ridges, known as
papillae, which help it to grip and move food around
digestive organs the mouth. Taste buds are hidden in and around some
Table 12.1 The function of the main digestive organs of the papillae and produce the sense of taste by
Digestive organ Function detecting chemicals in food.
Mastication renders the food into small enough
Mouth Commencement of digestion
Food is chewed and mixed with pieces to be swallowed and also allows saliva to be
saliva thoroughly mixed in.
Pharynx Swallowing projects food down The smell and sight of food triggers the reflex action
the oesophagus of saliva secretion in the mouth. Saliva enters the
mouth from three pairs of salivary glands. These
Oesophagus Pushes the food onwards to the
stomach are the:
● sublingual glands – located in the lower part
Stomach Mechanical breakdown of food
Commences digestion of protein
of the mouth on either side of the tongue
● submandibular glands – located inside the arch
Small intestine Chemical breakdown of food
Absorption of digested food
of the mandible
● parotid glands – located superficial to the
Large intestine Formation and storage of faeces
before defaecation
masseter muscle.
Saliva, containing the enzyme salivary amylase,
Anus Defaecation (expulsion of faeces)
or ptyalin, commences the digestion of starch,
or carbohydrates, in the mouth.
The following are accessory organs to digestion:
● The pancreas has two main functions – an
exocrine function that helps in digestion Parotid duct
(production of pancreatic juice) and an endocrine

Parotid
function that regulates blood sugar. gland
● The gall bladder stores bile, which is produced in
Opening of
the liver, until it is needed for digesting fatty foods sublingual
in the duodenum of the small intestine.
Sublingual
● The liver has many functions; the main ones gland
regarding digestion include bile production and
Submandibular
excretion, and the metabolism of fats, proteins, gland
and carbohydrates.
Submandibular duct
Activity
Take a blank body template and draw on the
digestive organs, add labels, and then number
Saliva
them in the correct order to reflect the progression
of digestion.
Mucus-
secreting
Mouth cells
The digestive system commences in the mouth. Food

is broken up into smaller pieces by the action of the p The salivary glands
jaws and the teeth, and shaped into a ball, or bolus,
by the tongue.
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KEY FACT Pharynx and oesophagus

An enzyme is a chemical The ball of food is projected to the back of the mouth. The muscles of
catalyst which activates and
the pharynx force the food down the oesophagus, which is a long, narrow
speeds up a chemical reaction
without being permanently tube linking the pharynx to the stomach. A lubricative substance called
changed itself. mucus, secreted from the lining of the oesophagus, makes the food
Enzymes are highly specific easier to swallow. The food is then conveyed by peristalsis down the
in that each enzyme catalyses oesophagus to the stomach.
only one type of metabolic
reaction. An example is KEY FACT
salivary amylase, which only
Peristalsis is the co-ordinated, rhythmical contractions of the
acts on starch.
circular and oblique muscles in the wall of the alimentary tract.
These muscles work in opposition to one another to break food
down and move it along the alimentary canal. Peristalsis is an
automatic action that is stimulated by the presence of food and
occurs in all sections of the alimentary tract.
Stomach
The stomach is a curved J-shaped muscular organ, positioned in the left-
hand side of the abdominal cavity below the diaphragm.
Cardiac sphincter
Circular muscle layer
Longitudinal muscle layer
Oblique muscle layer

Pyloric sphincter
Duodenum
p The stomach
Food enters the stomach via the cardiac sphincter, which is a strong
circular muscle at the junction of the stomach and the oesophagus. Its
function is to control the entry of food into the stomach.
The peritoneum serous membrane lines the abdominal cavity, supporting

the alimentary canal and secreting a serous fluid, which prevents friction
between different organs.
The stomach consists of four layers as shown in Table 12.2.
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Table 12.2 The layers of the stomach ● mucus, which is secreted by the neck cells in the
Stomach
stomach wall; it protects the stomach lining from
layer Description the damaging effects of the acidic gastric juice
● pepsinogen, an enzyme precursor that is
Muscular Consists of longitudinal, circular and
coat oblique muscle fibres which assist the converted into pepsin in the acidic environment
mechanical breakdown of food created by gastric juice.
Sub-mucous Made up of areolar tissue containing Enzymes in the stomach include:
coat blood vessels and lymphatics ● pepsin – the main gastric enzyme which starts
Mucous coat Secretes mucus to protect the stomach the digestion of proteins, breaking them up into
lining from the damaging effects of the polypeptides
acidic gastric juice ● rennin – an enzyme found in the gastric juices
Surface Infolded into numerous tubular gastric of infants that curdles milk protein.
epithelium glands which secrete gastric juice Food stays in the stomach for approximately five
hours until it has been churned to a liquid state called
Rugae chyme. Chyme is then released at intervals into the
Rugae are folds in the mucous lining of the stomach first part of the small intestine. The exit from the
that allow the stomach to expand when a bolus (ball) stomach is controlled by the pyloric sphincter, which
of food enters it. sits at the junction of the stomach and the duodenum.
Peritoneum The small intestine
The peritoneum is a serous membrane that lines the
The small intestine is approximately three metres
abdominal cavity, supporting the alimentary canal
long and consists of three parts:
and secreting a serous fluid which prevents friction.
1 the duodenum, the first and shortest part of the
Functions of the stomach small intestine
The functions of the stomach are to: 2 the jejunum, which lies between the duodenum
● churn and mechanically break up large particles
and the ileum
of food 3 the ileum, the longest segment of the small intestine
● mix food with gastric juice to begin its chemical
where the main absorption of food takes place.
breakdown Duodenum
● commence the digestion of protein
● absorb alcohol.
Chemical digestion in the Jejunum

stomach
In the presence of food, the endocrine cells in the
stomach walls secrete the hormone gastrin, which
stimulates the production of gastric juice.
Gastric juice
The main constituents of gastric juice, which is produced
and secreted by cells in the stomach wall, are:
● water, which helps to liquefy food Ileum
● hydrochloric acid, which provides the acidic
conditions needed for pepsin to become active,
kills any germs present in food and prepares it for
intestinal digestion p The small intestine
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The small intestine consists of the following four Chemical breakdown of food
layers:
in the small intestine
1 peritoneum
The muscles in the wall of the small intestine
2 muscular coat, excluding the oblique fibres continue the mechanical breakdown of food by
3 sub-mucous layer containing numerous blood peristaltic movements, while chemical digestion is
and lymph vessels, and nerves brought about by the following juices, which prepare
4 circular folds of mucosa, which protect the the food to be absorbed into the bloodstream.
intestine from bacteria. ● Bile is a green alkaline liquid consisting of water,
The special features of the small intestine are the mucus, bile pigments, bile salts and cholesterol.
thousands of minute projections called villi, each It is produced in the liver and stored in the gall
containing a lymph vessel called a lacteal. The villi bladder. Its function is to neutralise the chyme
have a network of capillaries into which the nutrients and break up any fat droplets in a process called
pass to be absorbed into the bloodstream. emulsification.
The epithelium of the villi is made up of tall columnar ● Pancreatic juice is produced by the pancreas and
intestinal absorptive cells called enterocytes and the enzymes contained within it continue the
goblet cells. Goblet cells secrete mucin for lubrication digestion of protein, carbohydrates and fats.
of the intestinal contents and protection of the ● Intestinal juice is released by the glands of
epithelium. the small intestine. It neutralises hydrochloric
acid coming from the stomach and contains
KEY FACT digestive enzymes that facilitate the digestion and
There are over 400 million villi on the lining absorption of food. It also stimulates the release of
of the small intestine, creating a surface area gastrointestinal hormones into the bloodstream.
of approximately 250 m2. This huge area is
necessary for the absorption of water and Hormones involved
nutrients.
in digestion
Cholecystokinin (CCK)
Cholecystokinin (coal-lee-cyst-ta-ky-nin) is a
Lymphocytes
hormone that is secreted by cells in the lining of
Capillaries
Microvilli
the duodenum of the small intestine in response
to chyme that has high fat or protein content.
Lymphatic CCK stimulates:
lacteal
Intestinal ● the gall bladder to contract and release bile into
epithelium the intestine
Vein
● the secretion of enzymes by the pancreas.
Artery
Secretin
This is a hormone that is released by cells in the
Lymphatic
nodule duodenum and its role is mainly in improving digestion,
Lymphatic
while protecting the stomach and intestines.
Inner circular layer vessel
Mucosa
of smooth muscle
The main role of secretin is to stimulate the
of small Nerves
intestine pancreas to secrete digestive juices that are rich in
Outer layer of
smooth muscle bicarbonates in order to neutralise the acid from the
stomach as it passes into the small intestine. Secretin
also stimulates the stomach to produce the enzyme
p The villi of the small intestine pepsin, which helps to break down proteins.
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● maltase – splits maltose into glucose

Enzymes in the small
● sucrase – splits sucrose into glucose and fructose
intestine
● lactase – splits lactose into glucose and galactose.
The enzymes made by the pancreas include:
● pancreatic proteases (pro-tea-ay-sis ), which help Mono, di and polysaccharides
to digest proteins ● Monosaccharides are the simplest form of
● pancreatic amylase, which helps to digest sugars carbohydrate (simple sugar). Monosaccharides
(carbohydrates) are used by the body’s cells to produce energy.
Examples of monosaccharides are glucose,
● pancreatic lipase, which helps to digest fat.
fructose and galactose.
Pancreatic proteases ● Disaccharides are formed by two
● Trypsin and chymotrypsin are both digestive monosaccharides joined together (double sugar).
enzymes that are produced and secreted by the Disaccharides are usually used to store energy.
pancreas. The function of these enzymes is to Examples include maltose, sucrose and lactose.
help break down the large protein molecules that ● Polysaccharides are large molecules – long-chain
are taken in as food. They are known as protease carbohydrates made up of multiple monosaccharides.
enzymes because their function is to break down Polysaccharides are used for energy storage
proteins. Without the action of these enzymes, our (examples include starch and glycogen) or structural
bodies would be unable to access the amino acids support (an example is cellulose).
that are essential for tissue building and repair.
● Enteropeptidase (also called enterokinase, enter- Protein digestion
roak-kin-nayys) is an enzyme that is produced Protein digestion is completed by peptidases
by the glands of Brunner in the membrane lining (pep-tied-days-es), which split short chain
of the duodenum and is involved in digestion. polypeptides into amino acids.
It converts trypsinogen into its active form Peptidase, also known as protease, is an enzyme with
trypsin, resulting in the subsequent activation a very important role in the hydrolysis of proteins.
of pancreatic digestive enzymes. Hydrolysis is the process of breaking down bigger
Pancreatic amylase molecules into smaller parts, in this case breaking
proteins into peptides and then into even smaller
Pancreatic amylase acts on more complex sugars
units called amino acids.
(carbohydrates), hydrolysing (breaking down) dietary
starch into disaccharides and trisaccharides, which Amino acids are joined together by peptide bonds to
are then converted by other enzymes to glucose to form proteins:
supply the body with energy. ● two amino acids join together to form a dipeptide
Pancreatic lipase ● three amino acids join together to form a tripeptide
Pancreatic lipase is the principal enzyme that breaks ● more than three amino acids join together to form
down fat molecules in the digestive system. It a polypeptide.
converts triglycerides (with three fatty acid chains) Pancreatic enzymes split polysaccharides into di- and
to monoglycerides (with one fatty acid chain). tripeptides:
● Monoglycerides consist of one fatty acid chain. ● pH rises to about neutral, enabling the next
● Diglycerides consist of two fatty acid chains. enzymes in the process to accomplish the final
breakdown of the polypeptide strands
● Triglycerides consist of three fatty acid chains.
● protein-digesting enzymes from the pancreas and
Carbohydrate digestion small intestine continue working until almost all
Carbohydrate digestion is completed by the pieces of protein are broken into strands of two
following enzymes, which split disaccharides or three amino acids, dipeptides and tripeptides, or
into monosaccharides: into single amino acids.
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Absorption of digested food

The absorption of the digested food takes place in the jejunum, but
mainly in the ileum. It occurs by diffusion from the intestinal tract,
through the walls of the villi, into the rich network of blood capillaries.
Each villus also contains a lymph vessel called a lacteal, into which
fatty acids and glycerol can pass.
Simple sugars from carbohydrate digestion and amino acids from protein
digestion pass into the bloodstream via the villi and are then carried
to the liver via the hepatic portal vein to be processed. Vitamins and
minerals also travel across to the blood capillaries of the villi and are
absorbed into the bloodstream to assist in normal body functioning and
cell metabolism. The products of fat digestion pass into the intestinal
lymphatics and are carried through the lymphatic system before they
eventually reach the blood circulation.
How the body’s nutrients are assimilated

Once all the nutrients have been absorbed into the bloodstream
they are transported to the body’s cells for metabolism as shown
in Table 12.3.
Table 12.3 The uses of nutrients in metabolism
Nutrient Origin Use in metabolism

Glucose End product of Used to provide energy for the cells to function
carbohydrate digestion
Amino acids End products of protein Used to produce new tissues, repair damaged cell
digestion parts and to formulate enzymes, plasma proteins and
hormones
Fatty acids End products of fat Used to provide energy, in addition to glucose
and glycerol digestion Those fats which are not required immediately by the
body are used to build cell membranes and some are
stored under the skin (where they provide insulation) or
around vital organs such as the kidneys and the heart
When the nutrients in food have been absorbed and assimilated by

the body, any undigested material that remains passes into the large
intestine, where it is eventually eliminated from the body.
Large intestine
The large intestine is formed of the caecum, appendix, colon and
rectum. It coils around the small intestine and is characterised by:
● three bands of longitudinal muscle
● deep, longitudinal folds of mucosa, which increase in the rectum
● numerous tubular glands, which secrete mucus from their goblet cells.
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Transverse colon
Descending
colon
Sigmoid
Ascending colon
colon
Appendix
Rectum
p The large intestine

The parts of the large intestine are:
● the caecum, a small pouch to which the appendix is attached and
into which the ileum opens through the ileocecal valve
● the appendix, which has no known function in humans
● the colon, the main part of the large intestine, which is divided into
four sections:
● the ascending colon, which is the part that passes upwards on
the right side of the abdomen from the caecum to the lower
edge of the liver
● the transverse colon, which is the longest and most mobile
part; it extends across the abdomen from right to left below the
stomach
● the descending colon, which is the part that passes downwards
along the left side of the abdominal cavity to the brim of the pelvis
● the sigmoid colon, which is the S-shaped part of the large
intestine between the descending colon and the rectum.
● the rectum, which is the last part of the large intestine, extending from
the sigmoid colon to the anal canal. It is firmly attached to the sacrum
and ends about 5 cm below the tip of the coccyx, where it becomes the
anal canal. Faeces are stored in the rectum before defaecation
● the anus is an opening at the lower end of the alimentary canal.
Faeces are discharged through the anal canal. The anus is guarded by
two sphincter muscles:
● the internal sphincter, which is composed of smooth muscle
under involuntary control
● the external sphincter, which this is composed of skeletal muscle
under voluntary control.
The anus remains closed through the action of these sphincters,
except during defecation.
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The functions of the large intestine

The functions of the large intestine are:
● absorption of most of the water from the faeces in order to conserve
moisture in the body
● formation and storage of faeces, which consist of undigested food,
dead cells and bacteria
● production of mucus to lubricate the passage of faeces
● the expulsion of faeces out of the body through the anus.
Overview of the accessory organs

to digestion
● The liver has many important functions in metabolism. One of these is
to regulate the nutrients that are absorbed from the small intestine to
make them suitable for use in the body’s tissues.
● The gall bladder stores bile and releases it when needed.
● The pancreas secretes pancreatic juice, which contains enzymes
to continue the digestion of protein, carbohydrates and fats. It also
secretes the hormone insulin, which is important in carbohydrate
metabolism.
The liver
Right lobe
Left lobe
Falciform ligament
Gall bladder
p The liver
The liver is the largest gland in the body and is situated in the upper
right-hand side of the abdominal cavity under the diaphragm. It has a
soft reddish-brown colour and four lobes. It is made up of cells called
hepatocytes. The liver receives oxygenated blood from the hepatic artery
and deoxygenated blood from the hepatic portal vein. Blood from the
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digestive tract, which is carried in the hepatic portal vein, brings newly
absorbed nutrients into the sinusoids and nourishes the liver cells. The
liver is a vital organ with many important functions in the metabolism
of food. One of these is to regulate the nutrients absorbed from the
small intestine to make them suitable for use in the body’s tissues.
Other functions are described in Table 12.4.
Functions of the liver
Table 12.4 Significance of the liver functions
Function Significance
Secretion of bile Bile is manufactured by the liver but is stored and
released by the gall bladder to assist the body in the
breakdown of fats.
Regulation of When the blood sugar level rises after a meal, the
blood sugar levels liver cells store excess glucose as glycogen. Some
glucose may also be stored in the muscle cells as
muscle glycogen. When both these stores are full
surplus glucose is converted into fat by the liver cells.
Regulation of As our bodies cannot store excess protein and
amino acid levels amino acids, they are processed by the liver. Some
are removed by the liver cells and are used to
make plasma proteins. Some are diverted for use
by the cells in the body’s tissues, while the rest are
deaminated and excreted as urea in the kidneys.
Regulation of the The liver is involved in the processing and
fat content of blood transporting of fats. Those absorbed in the diet
are used for energy and excess fats are stored in
the tissues.
Regulation of The liver is active in the breakdown of worn-out red
plasma proteins blood cells.
Detoxification The liver detoxifies harmful wastes (for example,
from the diet and drugs) and excretes them in bile
or through the kidneys.
Storage The liver stores vitamins A, D, E, K and B12 and the
minerals iron, potassium and copper. The liver can
also hold up to a litre of blood. During exercise, the
liver supplies extra blood and so increases oxygen
transport to the muscles.
The production Due to its many functions, the liver generates heat.
of heat This keeps the body warm.
The gall bladder

The gall bladder is a pear-shaped organ attached to the posterior
and inferior surface of the liver by the cystic and bile ducts.
The Sphincter of Oddi is the smooth muscle ring that surrounds the
common bile duct at the point at which it enters the duodenum.
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Cystic duct
Hepatic ducts
The pancreas
Common hepatic
ducts
Gall bladder
Gall bladder
Common
bile duct
Bile duct
Pancreatic
duct
Duodenum
Pancreas Pancreatic
duct
p The gall bladder p The pancreas

Functions of the gall bladder The pancreas is situated behind the stomach,
The gall bladder concentrates and stores bile that is between the duodenum and the spleen. It is
produced by the liver until it is needed. It releases divided into a head, body and tail. The head is
bile into the common bile duct for delivery to the the expanded portion that fits into the c-shaped
duodenum. curve of the duodenum. The pancreas is composed
of numerous lobules, each containing secretory
Bile
alveoli (small sac-like cavities) which contain
Bile is a thick alkaline liquid that is produced in the cells that produce pancreatic juice. The islets of
liver as a result of the breakdown of red blood cells. Langerhans, which produce insulin, are located
Bile is partially an excretory product and partially a between the alveoli.
digestive secretion. Bile salts (sodium and potassium)
play a role in emulsification and breakdown of large Functions of the pancreas
fat globules. The pancreas has two functions:
Bile is a slightly alkaline liquid, with a pH of 7–8. It 1 Exocrine function – the pancreas secretes
consists of water, bile acids, bile salts, cholesterol, pancreatic juice, which contains water, alkaline
phospholipids, electrolyte chemicals and bile pigments. salts, the enzymes lipase, pancreatic amylase,
The most important bile pigments are bilirubin and trypsinogen and chymotrypsinogen. The
biliverdin. Bilirubin is orange–yellow and is oxidised alkalinity of pancreatic juice helps to neutralise
from biliverdin, which is green. the acidity of chyme from the stomach and
allows the pancreatic and intestinal enzymes to
When worn-out red blood cells are broken down,
work.
substances such as iron and globin are recycled but
some haemoglobin is broken down to form bilirubin, 2 Endocrine function – the islets of Langerhans
which is excreted into the bile ducts. Bilirubin is are endocrine glands that secrete the hormone
eventually broken down in the intestines and one of insulin into the bloodstream. The insulin
its breakdown products gives the faeces their normal circulates around the body in the blood and is
brown colour. important in carbohydrate metabolism.
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KEY FACT
Without insulin, glycogen cannot be stored in the liver and
muscles, and glucose cannot be oxidised to produce energy.
Study tip
When studying the digestion, it is helpful to break down the process
into smaller sections that are easier to digest!
1 The mouth starts the process of mechanical breakdown of food.
2 The pharynx swallows the partially broken down food.
3 The oesophagus conveys food from pharynx to the stomach.
4 The stomach is concerned with the mechanical breakdown of food.
5 The small intestine is concerned with chemical breakdown of food.
(Bile is added from the gall bladder and pancreatic juice is added
from the pancreas.)
6 The large intestine is concerned with absorption of digested nutrients.
7 The anus is concerned with the absorption of water from the
remaining indigestible food matter and the formation, storage
and elimination of waste as faecal matter.
Nutrition
Nutrition is the utilisation of food to facilitate growth and to maintain the normal working of the body. Poor
nutrition can have a dramatic effect on our general health, energy level, sleep pattern and stress response.
Table 12.5 Sources and functions of nutrients
Food group Dietary sources Main functions

Carbohydrates Bread, cereals, potatoes, fruit Body’s main source of energy, required
(starches and sugars) and sugars for the metabolism of other nutrients
such as proteins and fats
Proteins First-class proteins are fish, Necessary for the growth and repair of
milk, egg and meat the body tissues and are used in the
Second-class proteins include production of hormones and enzymes
pulses, beans and peas
Fats Meat, milk, cheese, butter and Sources of stored energy
(classified as saturated or eggs Also offer support and protection
unsaturated, depending on whether for the body and are used to build cell
they are solid (saturated) or liquid structures
(unsaturated) at room temperature)
Water Fresh water, fruit and Aids digestion and elimination
(although not usually considered vegetables Essential in maintaining the body’s
as food, it is an essential nutrient fluid balance and in the transport of
needed by every part of the body) substances around the body
Fibre Pulses, peas, beans, brown Aids digestion and bowel functioning
(although fibre is not broken down rice, wholemeal bread, jacket Provides bulk in food to satisfy the
into nutrients, it is a component for potatoes and green leafy appetite
effective digestion) vegetables
➜
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Vitamins Essential for normal physiological and
(divided into two groups according metabolic functioning of the body
to whether they are soluble in water Regulate the body’s processes and
or fat) contribute to its resistance to disease
Vitamin A Carotene in carrots, liver, Essential for healthy vision, healthy skin
(fat soluble) kidney, eggs, dairy products, and mucous membrane
fish and liver oils
Vitamin D Fish liver oils, fatty fish, Essential for healthy teeth and bones,
(fat soluble) margarine and eggs it maintains the blood calcium level by
Also synthesised in the skin increasing calcium absorption from food
using ultraviolet light
Vitamin E Peanuts, wheatgerm, milk, Inhibits the oxidation of fatty acids that
(fat soluble) butter and eggs help form cell membranes
Vitamin K Green leafy vegetables, cereals, Essential for blood clotting
(fat soluble) liver and fruit
Vitamin B1 Egg yolk, liver, milk, wholegrain Necessary for the steady release of
(water soluble) cereals, vegetables and fruit energy from glucose
Vitamin B2 Milk, liver, eggs and yeast Essential for using energy released from
(water soluble) food
Vitamin B5 Wholegrain cereals, yeast Involved in the breakdown of glucose to
(water soluble) extract, liver, beans, nuts release energy
and meat
Vitamin B6 Wholegrain cereals, yeast Necessary for the metabolism of protein
(water soluble) extract, liver, meat, nuts, and fat
bananas, salmon and tomatoes
Vitamin B12 Liver, kidney, milk, eggs and Necessary for the formation of red blood
(water soluble) cheese cells in bone marrow
Also involved in protein metabolism
Folic acid Liver, kidney, fresh leafy Essential for the normal production of
(water soluble) vegetables, oranges and red and white blood cells
bananas
Vitamin C Citrus fruits and blackcurrants Assists in the formation of connective
(water soluble) tissue and collagen
Helps prevent bleeding and aids healing
Minerals Provide the body with materials for
growth and repair, and for the regulation
of body processes
Needed in trace amounts and used
to build bone, work muscles, support
various organs and transport oxygen
and carbon dioxide
Calcium Milk, egg yolk, cheese and Essential for the formation of healthy
green leafy vegetables bones and teeth, blood coagulation
and the normal function of muscles
and nerves
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Iron Liver, kidney, red meats, Essential for the production of
egg yolk, nuts and green haemoglobin in red blood cells
vegetables
Phosphorus Cheese, eggs, white fish, Important in the formation of bones
wholemeal bread, peanuts and teeth, muscle contraction and the
and yeast extract transmission of nerve impulses
Sulfur Egg yolk, fish, red meat and An important component of structural
liver proteins (those in the skin and hair)
Sodium and chlorine Table salt, bacon, kippers and Maintains fluid balance in the body
is found in all body fluids Necessary for the transmission of nerve
impulses and contraction of muscle
Magnesium Green vegetables and salad Important for the formation of bone and
is required for the normal functioning of
muscles and nerves
Common pathologies obstruction appear slowly, as tumours in this region

generally tend to spread along the walls of the gut
of the digestive without narrowing the lumen. If on the left side
(descending colon, sigmoid colon or rectum) the signs
system of obstruction appear earlier in the disease. There
is constipation or diarrhoea with passage of pencil-
Anorexia nervosa shaped or ribbon-like stools. The blood in the stools
This is a psychological illness in which clients starve may be red or dark in colour.
themselves, or use other techniques such as vomiting
Cancer of the gall bladder
or laxatives, to induce weight loss. They are motivated
by a false perception of their body image and a phobia Indigestion and colicky pain may be present,
of becoming fat. The result is a severe loss of weight especially after a fatty meal. The pain is located in
with amenorrhea. Starvation can be life threatening. the upper right quadrant of the abdomen and may
be referred to the back, right shoulder, right scapula
Appendicitis
or between the scapula.
This is an acute inflammation of the appendix. The
main symptom is abdominal pain located centrally Cancer of the liver
and in the right lower abdomen over the appendix. It The most common type of liver cancer is that
is usually treated by surgical removal (appendectomy). which has spread from other areas of the body – a
metastatic carcinoma. Spread usually occurs from
Bulimia
those areas which supply the liver with blood.
This is a psychological illness which is characterised Commonly, liver cancer is due to secondary spread
by overeating (bingeing), followed by self-induced from the stomach, intestine or pancreas.
vomiting.
Cancer can also arise from the liver tissue – primary
Cancer of the colon cancer. Liver cancer may be present as a swelling in
In the early stages, the signs and symptoms are the upper right quadrant, associated with jaundice
vague and related to the location of the cancer. A dull or fluid in the abdomen. Other general symptoms
abdominal pain may or may not be present. General may include weight loss, weakness and loss of
symptoms include loss of weight, fatigue, anaemia appetite. This type of cancer is often well advanced
and weakness. If the tumour is on the right side of the when diagnosed, whether arising from the liver or
abdomen (caecum or ascending colon) symptoms of secondary to cancer elsewhere in the body.
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Cancer – oral Colitis

This may be caused by chronic irritation of the This is an inflammation of the colon. The usual
mucosa of the oral cavity, as in tobacco chewing. symptoms are diarrhoea, sometimes with blood
A recurrence of chronic ulcers of the mouth can and mucus, and lower abdominal pain.
lead to this type of cancer. Oral cancer may appear
Constipation
as a non-healing, slow-growing red ulcer or as
This condition presents as a difficulty in passing stools
a growth. Usually it is painful and firm to the touch.
or infrequent evacuation of the bowels. The causes
Cancer of the pancreas may be dietary, due to reduced fibre and fluid intake,
The person presents with severe weight loss and or due to certain medications or intestinal obstruction.
pain in the lower back. The pain increases a few
Diabetes mellitus
hours after taking food and is worse when lying
This is a carbohydrate metabolism disorder in which
down. If the tumour is growing around the bile duct,
sugars are not oxidised to produce enough energy
obstruction may result in jaundice and diarrhoea.
due to lack of the pancreatic hormone insulin. The
The accumulation of bilirubin under the skin causes
accumulation of sugar leads to its appearance in
severe itching. The jaundice may be so severe that
the blood, then in the urine. Symptoms of diabetes
the skin may turn from yellow to green or black as
mellitus include thirst, loss of weight and excessive
the bilirubin changes in structure. The reduction in
production of urine.
bile slows down the absorption and digestion of
fat, causing clay-coloured, foul-smelling stools and Diabetes insipidus
diarrhoea. The cancer spreads directly and rapidly to This is a rare metabolic disorder in which a person
the surrounding tissues, including the lymph nodes produces large quantities of dilute urine and is constantly
and liver. The kidneys, spleen and blood vessels may thirsty. It is due to a deficiency of the hormone ADH
also be involved. The symptoms may vary according which regulates reabsorption of water in the kidneys. It is
to the tissues affected. treated by administration of the hormone.
Cancer of the stomach Diarrhoea
In the early stages, the person has chronic pain or This condition presents with frequent bowel
discomfort in the upper part of the abdomen. Since evacuation or the passage of abnormally soft or liquid
the symptoms are vague, this cancer is often not faeces. It may be caused by intestinal infections or
diagnosed until it has spread considerably. There is other forms of intestinal inflammation, such as colitis
weight loss, anaemia, loss of appetite and the person or irritable bowel syndrome.
will feel easily fatigued. Vomiting is common and
often the vomit contains blood. A mass may be felt Gall stone
in the upper abdomen. Indigestion and acidity is not This is a hard pebble-like mass which is formed
relieved by medication. within the gall bladder. The condition may be
asymptomatic, or indigestion and colicky pain may
Cirrhosis of the liver be present. Changes in the composition of bile cause
Cirrhosis refers to a distorted or scarred liver as cholesterol and/or the bile pigment bilirubin to form
a result of chronic inflammation. The functional stones. Stagnation of bile and inflammation of the
liver cells are replaced by fibrous or adipose gall bladder increase the concentration of bile and
connective tissue. The symptoms of cirrhosis promote stone formation.
include jaundice, oedema in the legs, uncontrolled
bleeding and sensitivity to drugs. Cirrhosis may be
In practice
caused by hepatitis, alcoholism, certain chemicals
that destroy the liver cells or parasites that infect In the case of a client with gall stones, avoid massage
the liver. to the upper right quadrant of the abdomen.
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Haemorrhoids chest. This may cause no symptoms at all, but it can

This condition presents with abnormal dilatation cause acid reflux when acid from the stomach passes
of veins in the rectum. It is caused by increased to the oesophagus, causing pain and heartburn.
pressure in the venous network of the rectum. If the Jaundice
haemorrhoids are chronic, they may be seen or felt This is a yellowing of the skin or whites of the eyes
as soft swellings in the anus. caused by excessive bilirubin (bile pigment) in the
Heartburn blood. It is caused by a malfunctioning gall bladder
This is a burning sensation felt behind the sternum or obstructed bile duct.
and often appearing to rise from the abdomen up the Irritable bowel syndrome (IBS)
oesophagus towards or into the throat. It is caused by This is a common condition in which there is
regurgitation of the acidic stomach contents. recurrent abdominal pain and bloating, with
Hepatitis constipation and/or diarrhoea. Clients with stressful
This is an inflammation of the liver caused by lifestyles are more vulnerable to this illness. They
viruses, toxic substances or immunological defaecate infrequently, usually in the morning, but
abnormalities. may feel that their bowel is not empty or they may
pass pellet-like stools.
● Hepatitis A: this infection is highly contagious
and is transmitted by the faecal–oral route, via
ingestion of contaminated food, water or milk.
In practice
The incubation period is 15 to 45 days. Remember that, in IBS, the lower abdomen can be
painful and tender.
● Hepatitis B: this is also known as serum hepatitis
and is more serious than hepatitis A. It lasts longer Clients with this condition may need quick access
and can lead to cirrhosis, cancer of the liver and to the toilet.
a carrier state. It has a long incubation period Advise clients to avoid wind-producing foods, e.g.
of 1.5–2 months. The symptoms may last from onion, beans.
weeks to months. The virus is usually transmitted Relaxation by any form of therapy is often helpful.
through infected blood, serum or plasma. However,
it can spread by oral or sexual contact as it is Stress
present in most body secretions. Stress can be defined as any factor that affects
● Hepatitis C: this form can cause acute or chronic physical or emotional wellbeing. Signs of stress in the
hepatitis and can also lead to a carrier state and digestive system include the development of ulcers,
liver cancer. It is transmitted through blood irritable bowel syndrome and indigestion.
transfusions or exposure to blood products. Most
Ulcer
clients with hepatitis are jaundiced but they can
appear to be entirely healthy. This is a break in the skin or a break in the lining
of the alimentary tract which fails to heal and is
Hepatitis as a side-effect of drugs and alcohol intake
accompanied by inflammation. Peptic, duodenal
is not infective.
and gastric ulcers can present with increased
Hernia acidity, epigastric pain (in the upper central region
This is an abnormal protrusion of an organ or part of the abdomen) and heartburn. This may be worse
of an organ through the wall of the body cavity in when hungry or after consumption of irritating
which it normally lies. foods, such as spicy or fatty foods, and alcohol.
It can present with similar symptoms to a hiatus
Hiatus hernia
hernia and reflux.
This is the most common type of hernia and occurs
when part of the stomach is protruding into the
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Interrelationships contraction of the smooth muscle in the alimentary

canal. Skeletal facial muscles, such as masseter and
with other systems buccinator, assist in chewing.
The digestive system Circulatory

The digestive system links to the following body Nutrients are carried in the body to nourish the cells
systems. and tissues, and waste products are carried away by
the blood to be eliminated.
Cells and tissues
Lymphatic
In areas of the digestive system, such as the small
intestine where absorption of nutrients is required, Lymphatic vessels called lacteals (in the villi of the
there is a thin lining of simple epithelium to allow for small intestine) assist digestion by absorbing the
speedy absorption. products of fat digestion.
Skin Respiratory
One of the skin’s functions is to produce vitamin D, Oxygen absorbed from the lungs activates glucose
which helps in the absorption of calcium in the from the digestive system to produce energy for cell
small intestine. metabolism.
Skeletal Nervous
The maxilla and mandible, the larger bones in All the organs of the digestive system are stimulated
the face, support the jaw and teeth when food by nerve impulses.
in ingested in the mouth. Endocrine
Muscular The pancreas secretes insulin from cells called the
The action of peristalsis, which propels the food islets of Langerhans to help control blood sugar level.
through the digestive tract, is due to the involuntary
Key words Caecum: a pouch connected to the junction of the

small and large intestines
Absorption: the movement of soluble materials out Cholecystokinin (CCK): a hormone that is secreted
through the walls of the small intestine and into the by cells in the duodenum and stimulates the
bloodstream release of bile into the intestine and the secretion of
Alimentary tract: a tube of the digestive system enzymes by the pancreas
that extends from the mouth to the anus Chyme: acidic fluid that passes from the stomach to
Amino acids: the building blocks of polypeptides the small intestine, consisting of gastric juices and
and proteins partly digested food churned together
Anus: the opening at the end of the alimentary canal Chymotrypsin: a digestive enzyme that helps to
through which solid waste matter leaves the body digest proteins in food
Appendix: a tube-shaped sac attached to and Chymotrypsinogen: a precursor of the digestive
opening into the lower end of the large intestine enzyme chymotrypsin
Ascending colon: the first main part of the large Colon: part of the large intestine and the final part
intestine, which passes upwards from the caecum of the digestive system; its function is to reabsorb
on the right side of the abdomen fluids and process waste products from the body to
Assimilation: the process by which digested prepare them for elimination
nutrients are used by the tissues after absorption Defaecation: the discharge of faeces from the body
Bile: a greenish-brown alkaline fluid that is secreted Digestion: the process of digesting food
by the liver and stored in the gall bladder
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Diglyceride: lipids with two fatty acid chains Intestinal juice: secretions by glands lining the walls
Dipeptide: a short protein consisting of only two of the intestines secretion
amino acids linked together by one peptide bond Jejunum: the part of the small intestine between
Disaccharide: (also called a double sugar) a sugar the duodenum and ileum
formed when two monosaccharides (simple sugars) Lacteals: the lymphatic vessels of the small intestine
are joined together which absorb digested fats
Duodenum: the first part of the small intestine Liver: a large, reddish-brown, glandular organ located
immediately beyond the stomach, leading to the in the upper right side of the abdominal cavity
jejunum Monoglyceride: lipid with one fatty acid chain
Elimination: the expulsion of the semi-solid waste Monosaccharides: a simple sugar, consisting of one
called faeces through the anal canal sugar unit that cannot be further broken down into
Emulsification: the process by which fat globules simpler sugars
are broken up into smaller droplets by the action Mucus: a sticky substance that is used as a digestive
of bile salts lubricant (for food passing down the alimentary
Enterocytes: absorptive cells in the small intestine canal); also lines the wall of the stomach to protect
Enteropeptidase (enterokinase): an enzyme against the acidic environment
produced by cells of the duodenum that converts Oesophagus: part of the alimentary canal which
trypsinogen into its active form trypsin, resulting in connects the throat to the stomach
the subsequent activation of pancreatic digestive Pancreas: a large gland behind the stomach that
enzymes secretes digestive enzymes into the duodenum, and
Enzyme: a protein catalyst that speeds up the rate secretes insulin and glucagon to help control blood
of a chemical reaction in a living organism sugar level
Faeces: waste matter remaining after food has been Pancreatic amylase: an enzyme secreted by
digested the pancreas into the small intestine to convert
Fatty acids: the building blocks of the fat in our starches into sugars
bodies and in the food we eat, usually joined Pancreatic juice: the clear alkaline digestive fluid
together in groups of three, forming a molecule secreted by the pancreas
called a triglyceride Pancreatic lipase: an enzyme that breaks down fats,
Gall bladder: the small sac-shaped organ beneath produced by the pancreas
the liver, in which bile is stored after secretion by the Papillae: small ridges in the tongue that help grip
liver and before release into the intestine and move food around the mouth
Gastric juice: a thin, watery, acid digestive fluid Pepsin: the chief digestive enzyme in the stomach,
secreted by glands in the mucous membrane of which breaks down proteins into polypeptides
the stomach
Peptide: a compound consisting of two or more
Glycerol: with fatty acids, part of a fat molecule amino acids linked in a chain
Hydrochloric acid: primary digestive acid that Peptidase: an enzyme that breaks down peptides
prevents harmful bacteria from entering the into amino acids
stomach, and helps in breakdown of proteins
Pharynx: serves as a pathway for the movement of
Hydrolysis: the process of breaking down bigger food from the mouth to the oesophagus
molecules into smaller parts
Polypeptides: a chain of amino acids
Ileum: third portion of the small intestine, between
the jejunum and the caecum Polysaccharide: long-chain carbohydrate made up
of smaller carbohydrates called monosaccharides,
Ingestion: the act of taking food into the alimentary typically used by our bodies for energy or to help
canal through the mouth with cellular structure
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Rectum: the final section of the large intestine, bladder at the point at which it enters the
terminating at the anus duodenum
Rugae: coiled sections of tissue in the mucosal and Transverse colon: the middle part of the large
submucosal layers of the stomach, that allow the intestine, passing across the abdomen from right
stomach to expand to left below the stomach
Saliva: watery liquid secreted into the mouth by Triglyceride: a lipid with three fatty acid chains
salivary glands, providing lubrication for chewing Tripeptide: a peptide consisting of three amino
and swallowing, and aiding digestion acids joined by peptide bonds
Salivary amylase: a digestive enzyme produced Trypsin: a digestive enzyme that breaks down
by the salivary glands that converts starches to sugars proteins in the small intestine, secreted by the
Secretin: a hormone released into the pancreas as trypsinogen
bloodstream by the duodenum (especially Trypsinogen: an inactive substance secreted by
in response to acidity) to stimulate secretion the pancreas, from which the digestive enzyme
by the liver and pancreas trypsin is formed in the duodenum
Sigmoid colon: the S-shaped last part of the large Villi: the tiny finger-shaped processes of the mucous
intestine, leading into the rectum membrane of the small intestine that serve in the
Sphincter of Oddi: smooth muscle ring that absorption of nutrients
surrounds the common bile duct of the gall
Revision summary breakdown of proteins; hydrochloric acid, to

kill germs present in food and to prepare it for
The digestive system intestinal digestion; and mucus, which protects
the stomach lining from the damaging effects of
● Digestion is the process of breaking down food.
the acidic gastric juice.
It involves ingestion, mechanical and chemical
digestion, absorption, assimilation and ● The functions of the stomach are the mechanical
elimination. breakdown of large particles of food and mixing
food with gastric juice by churning to begin the
● Digestion occurs in the alimentary tract, which
digestion of protein and to absorb alcohol.
extends from the mouth to the anus.
● Food stays in the stomach for approximately five
● Peristalsis is the co-ordinated, rhythmical
hours until it has been churned to a liquid state
contraction of the muscles in the wall of the
called chyme.
alimentary tract.
● Chyme is then released at intervals into the first
● The digestive system consists of the mouth,
part of the small intestine.
pharynx, oesophagus, stomach, small
intestine, large intestine and anus. ● The small intestine consists of three parts –
duodenum, jejunum and ileum (where
● The accessory organs to digestion are the
absorption of food mainly takes place).
pancreas, gall bladder and liver.
● Special features of the small intestine are the
● The digestive process commences in the mouth
thousands of tiny projections called villi, a
where food is broken down by mastication and
network of capillaries into which the nutrients
mixed with saliva.
pass to be absorbed into the bloodstream.
● Saliva contains the enzyme salivary amylase which
● The small intestine continues the mechanical
commences the digestion of starch in the mouth.
breakdown of food by peristalsis, while the
● The muscles of the pharynx force the food down chemical digestion is brought about by bile
the oesophagus to the stomach. (released by the gall bladder), enzymes in
● In the stomach, food is mixed with gastric juice pancreatic juice (released by the pancreas) and
containing the enzyme pepsin which starts the intestinal juice (released by the walls of the small
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intestine), all of which prepare the food to be ● Fats are used primarily to provide energy, in
absorbed into the bloodstream. addition to glucose. Those fats which are not
required immediately by the body are used to
● The function of bile is to neutralise the chyme
build cell membranes and some are stored under
and break up any fat droplets by emulsification.
the skin (where they insulate the body) or around
● The enzymes contained within pancreatic juice vital organs such as the kidneys and the heart.
continue the digestion of protein (trypsin),
● When the nutrients in food have been
carbohydrates (pancreatic amylase) and fats
assimilated by the body, undigested matter is
(pancreatic lipase).
passed into the large intestine and is eventually
● Intestinal juice is released by the glands of eliminated from the body.
the small intestine and completes the final
● The large intestine is made up of the caecum,
breakdown of nutrients, including of complex
appendix, colon and rectum.
sugars to glucose and of protein to polypeptides
and then amino acids. ● The colon is the main part of the large intestine
and is divided into ascending, transverse,
● Protein digestion is completed by peptidases which
descending and sigmoid colons.
split short chain polypeptides into amino acids.
● The rectum is the last part of the large intestine
● The absorption of digested nutrients takes place
where faeces are stored before defecation.
in the jejunum and mainly in the ileum.
● The functions of the large intestine are the
● Each villus contains a lymph vessel called a lacteal
absorption of most of the water from the faeces,
into which fatty acids and glycerol can pass.
formation and storage of faeces, production of
● Simple sugars from carbohydrate digestion and mucus to lubricate the passage of faeces and the
amino acids from protein digestion pass into the expulsion of faeces out of the body.
bloodstream via the villi and are then carried
● The anus is an opening at the lower end (anal
to the liver via the hepatic portal vein to be
canal) of the alimentary canal, through which
processed.
faeces are discharged.
● The lacteals (intestinal lymphatics) absorb
● The liver is the largest gland in the body and
products of fat digestion and carry them through
is an accessory organ to digestion with many
the lymphatic system before they reach the
metabolic functions.
blood circulation.
● The functions of the liver include the secretion
● Vitamins and minerals travel across to the blood
of bile, regulation of blood sugar level, regulation
capillaries of the villi and are absorbed into
of amino acids, regulation of the fat content
the bloodstream. They are important in cell
of blood, regulation of plasma proteins,
metabolism and normal body function.
detoxification, glycogen storage and the
● Glucose, the end product of carbohydrate production of heat.
digestion, is used to provide energy for cells to
● The pancreas is also an accessory organ to
function.
digestion. Its exocrine function is the secretion of
● Amino acids, the end products of protein pancreatic juice.
digestion, are used to produce new tissues, repair
● The gall bladder is attached to the posterior
damaged cell parts and formulate enzymes,
and inferior surface of the liver and its function is to
plasma proteins and hormones.
store bile produced by the liver until it is needed.
● Fatty acids and glycerol are the end products of
fat digestion.
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Test your knowledge 7 Which of the following is responsible for the

chemical reactions of digestion?
questions a homeostasis
b enzymes
Multiple choice questions c absorption
1 The alimentary tract is a long continuous d peristalsis
muscular tube extending from the: 8 Salivary amylase commences:
a mouth to anus a carbohydrate digestion
b stomach to anus b protein digestion
c small intestine to anus c fat digestion
d large intestine to anus. d vitamin and mineral digestion.
2 Which of the following structures completes 9 What are the main constituents of gastric juice?
digestion? a gastrin and pepsin
a stomach b gastrin and pepsinogen
b gall bladder c pepsin, hydrochloric acid and mucus
c small intestine d gastric amylase
d large intestine 10 Which structure produces the enzyme trypsin?
3 Which of the following statements is true? a duodenum
a The liver is situated in the upper left-hand side b liver
of the abdominal cavity. c pancreas
b The liver’s internal structure is made up of cells d gall bladder
called hepatocytes.
c Bile is stored in the liver and released by the Exam-style questions
pancreas. 11 State two functions of the digestive system.
d When blood sugar level is low, liver cells stores 2 marks
excess glucose. 12 a What is meant by the term enzyme? 1 mark
4 Which of the following is produced in the b Give an example of a digestive enzyme.
stomach? 1 mark
a bile 13 a Where in the digestive system does the
b pancreatic juice digestion of protein commence? 1 mark
c pepsin b Where in the digestive system does the
d maltase absorption of digested food take place?
5 Where does protein digestion start? 1 mark
a mouth 14 a Define the term peristalsis. 1 mark
b small intestine b Where in the digestive system does
c stomach peristalsis occur? 1 mark
d pancreas 15 a What is bile? 1 mark
6 Food stays in the stomach for approximately how b State two constituents of bile. 1 mark
long before it is churned to a liquid state? c Which part of the digestive system
a two hours produces bile? 1 mark
b five hours
c three hours
d one hour
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13 The renal system
Introduction
The kidneys and their associated structures
are all part of the excretory system, along with
the skin, lungs and the intestines, which also
contribute to the job of waste elimination from
the body.
The renal system, also referred to as the urinary
system, is made up the kidneys, ureters,
bladder and urethra, which are involved in the
processing and elimination of normal metabolic
waste from the body, sometimes likened to the
body’s ‘plumbing’.
OBJECTIVES
● the functions of the renal system
● the structure and functions of the individual

parts of the renal system (kidneys, ureters,
urinary bladder and urethra)
● common pathologies of the renal system
● the interrelationships between the renal

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In practice Functions of the renal

It is essential for therapists to
have a working knowledge of
system
the renal system in order to
understand how fluid balance
Maintaining homeostasis
is controlled in the body and to The prime function of the renal system is to help maintain homeostasis
have an appreciation of the role by controlling the composition, volume and pressure of blood. It does
of the kidneys in detoxification. this by removing and restoring selected amounts of water and dissolved
substances.
Regulation of the composition

and volume of body fluids
Waste products, such as urea and uric acid, along with excess
water and mineral salts must be removed from the body in order
to maintain good health. If these waste materials were allowed to
accumulate in the body they would cause ill health. The primary
function of the renal system is to regulate the composition and
the volume of body fluids in order to provide a constant internal
environment for the body.
Structures of the renal

system
The renal system parts are shown in Table 13.1.
Table 13.1 Location and function of parts of renal system
Part of renal system Location Function

Kidneys × 2 Posterior wall of the abdomen on either Main functional organs of the renal system
side of the spine (between twelfth thoracic Site where blood is filtered and urine is
vertebra and the third lumbar vertebra) processed
Ureters × 2 Long thin tubes that lead from each Transport urine from the kidneys to the bladder
kidney down to the bladder
Urinary bladder × 1 Lies in the pelvic cavity behind the Collects and temporarily stores urine
symphysis pubis
Urethra × 1 Extends from the neck of the bladder to Tube through which urine is discharged from
(you-reeth-ra} the outside of the body the bladder and out of the body
In men, also acts as conducting channel for semen
Kidneys
The kidneys are bean-shaped organs lying on the posterior wall of the
abdomen on either side of the spine between the level of the twelfth
thoracic vertebra and the third lumbar vertebra. Due to the position of
the liver, the kidney on the right side of the body is slightly higher than
the one on the left.
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13 The renal system
Structure of the kidney KEY FACT

A kidney has an outer fibrous renal capsule and is Each day, the kidneys process and filter gallons
of blood through more than 2 million nephrons.
supported by adipose tissue. It has two main parts:
Due to the filtering ability of a nephron, around
1 Outer cortex: this reddish-brown part is where 99% of blood is recycled by the body.
fluid is filtered from the blood.
2 Inner medulla: this part is paler in colour and is Urine production
made up of conical-shaped sections called renal
Urine is produced by three processes:
pyramids. The renal pyramids consist mainly of
tubules that transport urine from the cortex of the 1 filtration
kidney, where urine is produced, to the calyces, or 2 selective reabsorption
cup-shaped cavities in which urine collects before it 3 secretion and collection.
passes through the ureter to the bladder. The point of
each pyramid, called the papilla, projects into a calyx. 1 Filtration
The medulla is the area where some materials are Blood enters the medulla of the kidney from the
selectively reabsorbed back into the bloodstream. renal artery. Inside the kidney, the renal artery splits
into a network of capillaries called the glomeruli,
Renal capsule which filter the waste. Almost encasing each
glomerulus is a sac called the Bowman’s capsule.
The afferent arteriole brings blood to the
glomerulus and the efferent arteriole takes
Renal vein
blood away from the glomerulus.
Renal artery The blood pressure in the glomerulus is maintained
at a high level, assisted by the fact that the afferent
Renal pelvis arteriole that feeds into the glomerulus has a larger
Pyramid diameter than the efferent arteriole leaving it. This
Ureter
Medulla pressure forces fluid out through the walls of the
Cortex glomerulus, together with some of the substances
of small molecular size that are able to pass through
the capillary walls, into the Bowman’s capsule. This
Urine
process is called simple filtration.
p Structure of a kidney
Afferent Glomerulus
The renal pelvis is a large funnel-shaped cavity in arteriole
the centre of the kidney that collects urine from the Bowman’s
capsule
renal pyramids in the medulla and drains it into Efferent
the ureter. The medial border of the kidney is called arteriole Collecting
duct
the hilus and is the area where the renal blood
Proximal Distal
vessels enter and leave the kidney. convoluted convoluted
tubule tubule
Nephrons
The cortex and the medulla contain tiny blood
filtration units called nephrons (nef-frons). Nephrons Capillaries
are the functional units of the kidney and they

extend from the renal capsule through the cortex
and medulla to the cup-shaped renal pelvis. Nephrons
are approximately 2–4 cm long and a single kidney Loop of Urine
Henle collected
has more than a million nephrons.
p A nephron
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and urethra, from where it is excreted through a

KEY FACT
process known as micturition.
Urine is the body’s primary waste product and
so the release of urine is the final step of all
metabolism. Study tip
Remember, the processing of urine works like any
2 Selective reabsorption other filtration system. For example, if we imagine
the Bowman’s capsule to be a teapot and liquid
The filtered liquid continues through a series of (in this case hot water) is poured into the pot to
twisted tubes called the convoluted tubules, which brew tea.
are surrounded by capillaries. The tubules of the Inside the teapot, the tea brews. It is filtered as the
nephron that lead away from the Bowman’s capsule tea is poured through a tea strainer and into a cup.
are known as the proximal convoluted tubules Just like tea through a tea strainer, the composition
and they straighten out to form a long loop called of the urine alters as it flows through the
the loop of Henle. There are then another series convoluted tubules. Some substances contained
of twists called the distal convoluted tubules, within the waste, such as glucose, are reabsorbed
which lead to a straightened collecting duct, which back into the bloodstream (think of adding sugar
in turn leads to the pelvis of the kidney and then to the tea).
to the ureter. The tea in the cup equates to urine in the bladder.
The composition of the filtered liquid alters as it flows Urine is passed from the kidney via the ureter to
through the convoluted tubules. Some substances the urinary bladder where it is stored before being
contained within the waste, such as glucose, amino released via the urethra.
acids, mineral salts and vitamins, are reabsorbed back
into the bloodstream.
The composition of urine
This reabsorption process is selective as the
amounts of these substances that pass back in to Urine is the concentrated filtrate from the kidneys.
the blood depend on the level already present in the Its composition is approximately 96% water, 2%
bloodstream. The reabsorption of salts and water is urea and 2% other substances, such as chloride salts,
variable to achieve maintenance of a stable pH and sodium ions, potassium ions, creatinine (a waste
electrolyte (sodium and potassium) balance of body product from the normal breakdown of muscle tissue),
fluids. Excess water, salts and the waste product urea other dissolved ions, inorganic and organic compounds
are all filtered and processed through the kidneys. (such as proteins, hormones and metabolites).
Filtered blood leaves the kidney via the renal vein. Urine is a pale watery fluid varying in colour according
to its composition and quantity. It is usually acidic and
3 Secretion and collection its pH varies between 4.5 and 8, depending on blood
Some substances are not completely removed from pH. A typical average is around 6.0.
the blood in the glomerular filtrate, the residue of Much of the variation in the pH of urine occurs due to
medicinal drugs for example. These substances are diet. For example, a high protein diets result in more
passed from the blood into the distal convoluted acidic urine, but vegetarian diets generally result in
tubule by secretion in order that they may be more alkaline urine (but both within the typical pH
excreted in the urine. range of 4.5–8).
Secretion involves the transfer of water, hydrogen The salts, chiefly sodium chloride, must be removed
ions, creatinine, drugs, and urea from the blood from the body (or reabsorbed back into the body) in
into the collecting duct. sufficient quantities to keep the blood at its normal
The waste remaining in the distal convoluted tubule pH and to maintain the usual water and electrolyte
(now known as urine) then flows via a collecting balance. As maintenance of pH and salt concentration
tubule to the renal pelvis of the kidney. From here are both essential to the normal function of blood
it passes into the ureter to be passed to the bladder and cells, the kidneys are of paramount importance.
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13 The renal system
The amounts of certain substances in urine can be a vessels causes the blood pressure to rise, because
good indication of health status. Urine tests can be the same amount of blood has less space to
used to diagnose some disorders. If urine contains flow through.
glucose, this may indicate diabetes. Protein in the In order to regulate blood pressure, the kidney
urine may indicate kidney failure. Urine tests can be filters out some of the excess fluid from the
used to confirm pregnancy, since a fertilised ovum blood, to reduce its volume. As the bladder fills
releases a hormone which the mother excretes in up with the excess fluid, we feel the urge to
the urine. urinate. Relieving a full bladder causes heat loss,
so urinating sooner helps preserve your core
Factors that affect urine warmth.
production ● Hot weather – when the body temperature
rises during hot weather, the body responds by
The kidneys maintain our water balance by producing
producing sweat, which removes body heat when
urine of different concentrations.
it evaporates. The production of urine decreases
● When the level of water in our blood plasma because sweating causes dehydration.
is low, more water is reabsorbed back into
● High dietary salt intake – high salt intake can result
the bloodstream and the urine becomes more
in increased water reabsorption in the kideneys,
concentrated as a result.
which reduces the volume of urine produced.
● When the level of water in our blood plasma is high,
● Water consumption – the more we drink,
less water is reabsorbed back into the bloodstream
the more dilute our blood plasma becomes. The
and the urine becomes more dilute as a result.
kidneys respond by producing dilute urine to get
Factors affecting urine production include: rid of the excess water.
● Body temperature – if body temperature increases ● Tea, coffee and alcohol consumption – tea,
(due to exercise, fever or environmental factors), coffee and alcohol are diuretics which increase the
water is lost from the body in sweat. If you sweat, volume of urine produced. Alcohol, in particular,
the amount of water in your body decreases. The causes the kidneys to produce a greater volume of
kidneys compensate for this by producing a smaller more dilute urine. This can lead to dehydration.
volume of more highly concentrated urine.
● Stress and anxiety – these are common causes of
● Physical activity/exercise – during exercise, frequent urination.
blood flow to the kidneys is reduced due to
Part of the body’s stress response includes causing
an increase in the activity of the sympathetic
the body to eliminate waste as quickly as possible,
nervous system. The reduction in blood flow to
hence the need to go to the toilet more frequently
the kidneys is important in order to maintain
when anxious or stressed.
blood pressure, due to the fact blood vessels
● Medication (diuretics) – diuretic drugs help rid
dilate in the exercising muscles.
the body of excess water and sodium by increasing
Due to decreased blood flow in the kidneys, the a person’s urinary output. Some diuretics act on
volume of fluid filtered also decreases during the kidneys directly and others increase blood
exercise, resulting in a fall in urine production. flow to the kidneys; either way these drugs cause
In order to maintain equilibrium, the kidneys a person to urinate more frequently to lose water
respond by conserving sodium and reabsorbing from the body.
water, which in turn results in decreased urine
● Blood pressure – when the blood pressure inside
production.
the kidney tubules rises, less water is reabsorbed
● Cold weather – in cold weather, the body tries and the volume of urine increases. When the
to keep the core warm by constricting its blood blood pressure inside the kidney tubules falls,
vessels and reducing the flow of blood to the more water is reabsorbed into the blood and the
skin (vasoconstriction). Constriction of blood volume of urine decreases.
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● Some water is used up in the cells’ metabolic

Activity activities.
The amount of urine produced by the body varies ● Water output – water is lost from the body in the
greatly according to various internal and external following ways:
factors. Split into two groups. Write each of the
● through the kidneys as urine
following factors on a card and divide the cards
● through the alimentary tract in the faeces
between the two groups.
● through the skin as sweat
● High blood pressure
● through the lungs as saturated exhaled breath.
● Low blood pressure
● Medication (diuretics)
Hormones involved in water
● Stress and anxiety
● Cold weather
reabsorption
● Hot weather Antidiuretic hormone (ADH)
● High salt intake The kidneys are responsible for regulating the amount
● Alcohol of water contained within the blood. The amount of
● Body temperature water reabsorbed into the blood is controlled by ADH
● Exercise (also known as vasopressin), which is stored and
Now work with your group colleagues to decide released into the blood by the posterior lobe of the
which factors increase and which decrease urine pituitary gland.
production. Indicate this by placing an arrow in The release of ADH is triggered by dehydration.
the top right-hand corner of each card:
The hypothalamus in the brain detects when the
● an upwards arrow to denote an increase
water concentration of blood is low and triggers
in urine production
the release of ADH. An increase in the level of ADH
● a downwards arrow to denote a decrease.
increases the amount of water that is reabsorbed
Swap cards with the other group and check their from the nephron back into the blood.
assessment of each factor. Did you all agree?
The reabsorption of water from the nephron into
the blood decreases the volume of urine produced
Functions of the kidney and increases the hydration level of the blood. This
The functions of the kidney are to: mechanism brings the water in the blood back to
● filter impurities and metabolic waste from blood, an acceptable level.
preventing poisons from accumulating in the body When the blood hydration level is back to normal,
● regulate the water and salt balance in the body the hypothalamus moderates the secretion of ADH
by the pituitary.
● maintain the normal pH balance of blood
● form urine KEY FACT
● regulate blood pressure and blood volume. This important negative feedback mechanism
between the nervous and endocrine systems
Role of the kidneys in fluid maintains the blood water concentration within
balance normal limits and is the means by which fluid
balance is controlled in the body.
The amount of fluid taken into the body must equal
the amount of fluid excreted from it, in order for the
body to maintain a constant internal environment. Aldosterone
The balance between water intake and water output Aldosterone is a hormone that is secreted by the
is controlled by the kidneys. adrenal cortex of the adrenal glands. It regulates the
● Water intake – water is taken into the body as reabsorption of sodium and water in the kidneys.
liquid in food and drink. It is absorbed during It plays a vital role in regulating blood pressure
digestion. by acting on the kidney and the colon to increase
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13 The renal system
the amount of sodium that is reabsorbed into 1 It inhibits the activity of the cells that are
the bloodstream and to increase the amount of responsible for breaking down bone. (When bone
potassium that is excreted in the urine. is broken down, the calcium from the bone is
released into the bloodstream.) The calcitonin,
Calcitonin
by its inhibitory action, reduces the amount of
Calcitonin is a hormone that is secreted by the
calcium being released into the bloodstream.
thyroid gland. The main action of calcitonin is to
2 It also has a role in decreasing the reabsorption
reduce the calcium level in the blood and it does
of calcium in the kidneys, resulting in a lower
this in two ways:
level of calcium in the bloodstream.
Right kidney Left kidney
Renal artery Medulla
Cortex
Renal vein
Renal pelvis
Ureter
Bladder
Urethra
p The urinary organs
Ureters Urinary bladder

The ureters are two very fine muscular tubes which This is a pear-shaped sac which lies in the pelvic
transport urine from the renal pelvis of the kidney to the cavity behind the symphysis pubis. The size of the
urinary bladder. They consist of three layers of tissue: bladder varies according to the amount of urine it
1 an outer layer of fibrous tissue contains. The bladder is composed of four layers
of tissue:
2 a middle layer of smooth muscle
1 a serous membrane which covers the outer
3 an inner layer of mucous membrane.
surface
Function of the ureters 2 a layer of smooth muscular fibres
Ureters propel urine from the kidneys into the bladder 3 a layer of adipose tissue
by the peristaltic contraction of their muscular walls. 4 an inner lining of mucous membrane.
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Functions of the urinary symptoms may arise if the cancer has spread to the
lungs, liver, lymph nodes and neighbouring tissues.
bladder Cystitis
The urinary bladder stores urine. It expels urine out This is an inflammation of the urinary bladder,
of the body, assisted by the muscular wall of the usually caused by infection of the bladder lining.
bladder, the lowering of the diaphragm and the Common symptoms are pain just above the pubic
contraction of the abdominal cavity. bone, lower back or inner thigh, blood in the urine
The expulsion of urine from the bladder is called and frequent, urgent urination with a burning or
micturition and is a reflex over which there is painful sensation. This condition is very common
voluntary control. When the volume of urine in the in women due to the shorter length of the female
bladder causes it to expand, stretch receptors in the urethra.
bladder wall are stimulated to trigger urination.
The micturition reflex causes the detrusor muscle in
In practice
the wall of the bladder to contract and the internal
urethral sphincter to relax. It is the combination of Encourage a client with cystitis to increase their
both the micturition reflex and voluntary relaxation of intake of fluids (water and cranberry juice).
the urethral sphincter that allows urination to occur. If symptoms of persist, they may need GP
assessment and advice.
Urethra Massage over the lower abdomen should
be avoided, as this may be painful and risks
The urethra (you-reeth-ra) is a canal which extends
inducing spasm.
from the neck of the bladder to the outside of the
body. The length of the urethra differs in males and
females. The female urethra is approximately 4 cm Incontinence
in length, whereas the male urethra is longer at This is a condition in which the individual is unable
approximately 18–20 cm in length. The exit from the to control urination voluntarily. Loss of muscle tone
bladder is controlled by a round sphincter of muscles and problems with innervation are associated with
which must relax before urine can be expelled. this condition.
The urethra is composed of three layers of tissue: Kidney stones
1 a muscular coat which is continuous with that of These are insoluble deposits of substances in the
the bladder urine, which form solid stones in the renal pelvis
2 a thin spongy coat which contains a large number of the kidney, ureter or bladder. This condition can
of blood vessels be extremely painful. Stones are usually removed
3 a lining of mucous membrane. by surgery.
Function of the urethra Nephritis

The urethra serves as a tube through which urine This is a general, non-specific term used to describe
is discharged from the bladder to the exterior. The inflammation of the kidney. Glomerulonephritis
urethra is longer in a male and it also serves as a (also known as Bright’s disease) is an inflammation
conducting channel for semen. of the glomeruli in the kidneys. This condition is
characterised by blood in the urine, fluid retention
Common pathologies and hypertension.
of the renal system Pyelonephritis

This is a bacterial infection of the kidney. In acute
Cancer of the bladder pyelonephritis there is pain in the back, high
This usually presents with blood in the urine, temperature and shivering fits. Treatment is usually
and urgency and pain on passing urine. Secondary with antibiotics.
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13 The renal system
Urinary tract infection

In practice
This is a bacterial infection of one or more of the
structures of the renal system. Symptoms include In the case of a client with a urinary tract infection,
fever, lower back pain, frequency of urination, a all forms of therapeutic treatment should be
burning sensation on passing urine (urine may be avoided until the infection has cleared.
bloodstained and cloudy). If the infection is severe,
there may be pus as well as blood in the urine.
Interrelationships with Muscular

other systems: the renal Smooth muscle is responsible for the passage of
urine through the urinary tract.
system Circulatory
The renal system links to the following body systems.
The kidneys filter the blood to avoid accumulation
Cells and tissues of poisons in the body.
Transitional epithelium lines renal system organs, Nervous
such as the bladder, which changes shape when
The relaxation and contraction of the bladder,
stretched.
and closing and opening of the sphincter muscles
Skin is under the control of the autonomic nervous
Like the renal system, the skin is also an excretory system (sympathetic and parasympathetic nervous
organ. When the skin loses excess water through systems).
sweating, the kidneys release less water in the urine Digestive
to help maintain the body’s fluid balance.
Water is an essential nutrient which is needed
Skeletal by every part of the body to aid the metabolic
The kidneys and the bones of the skeleton help processes. It is ingested in the diet and absorbed
to control the amount of calcium in the blood by during the process of digestion. The colon absorbs
storing some in the bones and excreting some most of the water from the faeces in order to
from the body in urine. conserve moisture in the body.
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Key words Kidney: one of a pair of organs that lie on the

posterior of the abdominal cavity and produce
Aldosterone: a hormone that stimulates absorption urine
of sodium by the kidneys and so regulates water Loop of Henle: the portion of a nephron that leads
and salt balance from the proximal convoluted tubule to the distal
Antidiuretic hormone (ADH): a hormone that convoluted tubule
increases the amount of water absorbed by the Medulla: the innermost part of the kidney
kidney and so increases blood pressure
Micturition: the act of urinating
Bowman’s capsule: a cup-shaped structure around
the glomerulus of each nephron of the kidney; Nephron: the functional unit of the kidney that
acts as a filter to remove organic wastes, excess filters blood and forms urine
inorganic salts, and water Proximal convoluted tubule: the convoluted
Calcitonin: a hormone secreted by the thyroid portion of the nephron that lies between Bowman’s
gland to lower levels of calcium (and phosphorous) capsule and the loop of Henle
in the blood; it can also decrease the resorption Renal artery: the branch of the abdominal aorta
of calcium in the kidneys, again leading to lower that supplies oxygenated blood to the kidney
blood calcium level Renal pyramids: cone-shaped masses of tissue
Calyx (calyces): a cup-shaped cavity inside the that make up the medulla (inner part of a kidney's
medulla of the kidney in which urine collects before structure)
it passes through the ureter to the bladder Renal vein: a blood vessel that drains blood from
Creatinine: a chemical waste product from muscle the kidneys
metabolism that is filtered, along with other Ureter: a muscular tube by which urine passes from
waste products, from the blood and leaves the the kidney to the bladder
body via urine
Urethra: a tube through which urine is discharged
Detrusor: a muscle in the wall of the bladder from the bladder to the exterior
Distal convoluted tubule: a portion of kidney Urinary bladder: a pear-shaped sac which lies
nephron between the loop of Henle and the in the pelvic cavity behind the symphysis pubis;
collecting tubule stores urine
Glomerulus: a cluster of capillaries around the Urine: a watery, typically yellowish fluid stored in
end of a kidney tubule the bladder and discharged through the urethra
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13 The renal system
Revision summary
The renal system
● The organs that contribute to the elimination of wastes in the body are the kidneys, lungs, skin and the
digestive system.
● The organs of the renal system are the kidneys, ureters, urinary bladder and urethra.
● The kidneys are bean-shaped organs lying on the posterior wall of the abdomen.
● The kidney has two main parts – the outer cortex where fluid is filtered from blood and the inner
medulla, which is the area where some materials are selectively reabsorbed back into the bloodstream.
● The cortex and the medulla contain tiny blood filtration units called nephrons.
● Urine is produced by three processes – filtration, selective reabsorption and collection.
● Blood to be processed enters the kidneys via the renal artery.
● Filtration takes place inside a network of capillaries in the nephron called the glomerulus.
● The sac encasing the glomerulus is called the Bowman’s capsule.
● The filtered liquid then continues through a series of twisted tubes called the convoluted tubules,
to the loop of Henle and the distal convoluted tubule before passing to the collecting duct and to
the renal pelvis.
● The composition of the filtered liquid alters as it flows through the convoluted tubules.
● Some substances in the filtrate such as glucose, amino acids, mineral salts and vitamins are reabsorbed
back into the bloodstream via the renal vein.
● From the distal convoluted tubule the filtrate then flows into the collecting duct (as urine) and passes
to the pelvis of the kidney to be passed to the ureter and bladder.
● The composition of urine is 96% water, 2% urea and 2% other substances (uric acid, creatinine, sodium
ions, potassium ions, phosphates, chloride salts, sulfate salts, excess vitamins and drug residues).
● Functions of the kidneys include filtration of impurities and metabolic waste from blood, regulation of
water and salt balance, formation of urine and regulation of blood pressure and volume.
● The ureters are muscular tubes that transport urine from the pelvis of the kidney to the urinary bladder.
● The urinary bladder is a pear-shaped sac which lies in the pelvic cavity behind the symphysis pubis.
It functions as a storage organ for urine.
● The urethra is a canal which extends from the neck of the bladder to the outside of the body.
● The urethra serves as a tube through which urine is discharged from the bladder to the exterior and as
a conducting channel for semen in men.
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Test your knowledge 7 Which hormone is responsible for controlling

water reabsorption in the kidneys?
Multiple choice questions a insulin
b antidiuretic hormone (ADH)
1 What is the function of the kidneys? c oxytocin
a filtering of impurities from the blood d adrenocorticotrophic hormone
b regulation of water and salt balance
8 What is the function of the ureter?
c formation of urine
a to propel urine from the bladder to the exterior
d all of the above
b to store urine
2 Which of the following is not considered an c to filter impurities
excretory organ? d to propel urine from the kidneys to the bladder
a digestive system
9 Where is the bladder situated?
b skin
a in the abdominal cavity behind the intestines
c muscular system
b in the pelvic cavity behind the symphysis pubis
d respiratory system
c on the posterior of the abdominal cavity
3 Blood is filtered inside which section of the kidney? d behind the urethra
a glomerulus
10 Which of these occurs in micturition?
b Bowman’s capsule
a contraction of the detrusor muscle and
c loop of Henle
relaxation of the internal urethral muscle
d proximal convoluted tubule
b relaxation of the detrusor muscle and
4 What is the blood filtration unit inside a kidney contraction of the internal urethral muscle
is known as? c contraction of the anal sphincter and
a hilus relaxation of the bladder
b renal pyramid d relaxation of the anal sphincter and
c nephron contraction of the bladder
d medulla
5 Which of the following best describes the Exam-style questions
position of the kidneys? 11 State two functions of the renal system. 2 marks
a posterior of abdomen between the level of
12 What is the name given to the blood
twelfth thoracic and fifth lumbar vertebrae
filtration units inside a kidney? 1 mark
b posterior of thorax, between the level of
13 a In which part of the kidney does simple
twelfth thoracic and fifth lumbar vertebrae
filtration take place? 1 mark
c posterior of abdomen between the level of
b In which part of the kidney is the composition
twelfth thoracic and third lumbar vertebrae
of the filtered liquid altered? 1 mark
d posterior of thorax, between the level of
14 a Name the canal that extends from the neck
twelfth thoracic and third lumbar vertebrae
of the bladder to the outside of the body.
6 Which of the following statements is true? 1 mark
a Filtered blood leaves the kidney via the renal b State the difference in this structure
artery. between males and females. 2 marks
b Excess water, salts and urea are all filtered 15 a State three factors that may cause
and processed through the kidneys. urine production to increase. 3 marks
c Blood to be processed enters the medulla b State two factors that may cause
from the renal vein. urine production to decrease. 2 marks
d The renal artery splits into a network of
capillaries called the Bowman’s capsule.
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Index
abdominal cavity 7 anterior basal cell layer 40, 41, 43
abdominal wall anatomical term 2–3 basilar artery 189–90
arteries of 192–3 lobe 282 Beau’s lines 73
veins of 198–9 anterior tibial artery 193 Bell’s palsy 268
abdominopelvic cavity 7 antibodies 223–4 bile 330
abduction 117 antigens 223–4 birthmark 57, 86
absorption 38 antioxidants 53 biting nails 70, 75
acetylcholine 249 anxiety 267–8 blackheads 55
acid mantle 38, 42 aorta 187–92 bladder 347–8
acidosis 13 apocrine glands 50 cancer of 348
acne 81–2 appendicitis 333 bleeding 48–9
acquired immune deficiency appendicular skeleton 103, blepharitis 77
syndrome (AIDS) 225 107–11 blocked pores 55
acromegaly 291 areolar tissue 27 blood
Addison’s disease 292 arm cells 176–7
adduction 116 arteries of 190–2 clotting 175–6
bones of 109 composition 174
adipose tissue 27, 38
veins of 196–8 flow 181–3, 189–200
adrenal glands 279–80, 284–5
arrector pili muscle 38, 49 functions 174–6
adrenal hyperplasia 292 glucose level 285
arteries 40, 178–9, 187–93
Afro-Caribbean skin 61 liquid connective tissue
abdominal wall 192–3
ageing 54, 55, 58–60 aorta 187–92 28, 33
see also puberty; menopause arm and hand 190–2 pH level 13
albinism 84–5 carotid 189–90 pressure 200–2
alcohol head and neck 188–90 types 174
effect on nails 69 leg and foot 193 vessels 178–9
effect on skin 54 subclavian 189–92 see also heart
alkalosis 13 thoracic wall 192 blood–brain barrier 255
allergic reaction 54–5, 57–8, 225 arteriosclerosis 202 body
alopecia 65–6 arthritis 120 anatomical planes 4
alveoli 235 Asian skin 61 anatomical regions 5–6
amenorrhoea 311 asthma 241 cavities 7
chemical make-up 11, 12, 14
anabolism 14 athletes’ foot 80
homeostasis 13
anaemia 201 atoms 11
structural organisation
anatomical atony 167 11–12
planes 4 atrophy 167, 168 body lice 81
position 8 autoimmune disorders 90 body temperature, heat
regions 5–6 autonomic nervous system regulation 38
anatomy (definition) 1 247–8, 259–61 boil 77
aneurysm 201 axial skeleton 103–7 bone
angina 201–2 axillary artery 190–1 as connective tissue 28
ankylosing spondylitis 119–20 axon terminals 249 development 98–9
anonychia 71–2 bacterial infections 77–8 fracture 121
anorexia nervosa 333 balance 265 marrow 98
antagonist muscles 140 basal cell carcinoma 87 structure 97–9
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types of 100–3 cardiovascular system diffusion 22

see also skeletal system arteries 178–9, 187–93 division 19–22
brachial artery 190–1 abdominal wall 192–3 functions of 18–19
brain aorta 187–92 life cycle 19–22
blood–brain barrier 255 arm and hand 190–2 meiosis 21
functional areas of 254 carotid 189–90 mitosis 20–1
grey matter 252, 256 head and neck 188–90 nerve 248–50
principle parts of 253 organelles 15–18
leg and foot 193
white matter 252, 256 pathologies 31
subclavian 189–92
brainstem 253, 255 regeneration 43
thoracic wall 192 stem 44
breast 303 blood
cancer 311–12 structure 15–17
cells 176–7 study of 15
development 303–4 clotting 175–6 transport 22–3
breathing composition 174
correct 241 cellular level 11, 12
functions 174–6 cellular respiration 22
rate 238
pressure 200–1, 202 central nervous system 251–6
regulation 238
types 174 centrioles 16, 17
bronchi 232, 233–4, 235
vessels 178–9 ceramides 42
bronchitis 241
heart cerebellum 253, 255
bulimia 333
blood flow 181–3, cerebral arteries 189–90
bunion 120–1
189–200 cerebral palsy 268
bursitis 121
cardiac cycle 184–5 cerebrospinal fluid 251
calcium 332
composition 180–1 cerebrum 253–4
cancer
function 183–5 cervical cancer 312
abnormal cell division 31
bladder 348 sounds 185 chemical level 11, 12, 14
breast 311–12 interrelationships 206 chemical peel 43
cervical 312 pathologies 201–5
chemotherapy 66, 69, 312
colon 333 portal circulation 187
childbirth 307
gall bladder 333 pulmonary circulation 185–6
pulse 201 see also pregnancy
liver 333 chloasma 85
lung 241 systemic circulation 186–7
veins 194–200 chloride 333
metastasis 31
abdominal wall 198–9 cholesterol 203
oral 334
arm and hands 196–8 chromatin 16, 17
ovarian 312
pancreatic 334 face and head 195–6 chromosomes 15–16, 20–2, 32
prostate 313 leg and foot 199–200 chronic fatigue syndrome 270–1
skin 87–8 thoracic wall 198–9 circumduction 117
stomach 334 carotid arteries 189–90 cirrhosis of the liver 334
testicular 313 carpal tunnel syndrome 167 cisterna chyli 216
capillaries cartilage 28, 100 clavicle 108
blood 178–9 catabolism 14 clear layer (skin) 40, 42, 44
lymphatic 214–15 caudal 3 clotting 175–6
capillary network 40 celiac artery 192 cold receptor 40
carbohydrates 14, 19, 325, 331 cells 11, 15 cold sores 78
carbon dioxide 236 abnormal division 31 colitis 334
carcinomas 31 blood 176–7 collagen 45
cardiac cycle 184–5 chemical make-up 14 colon cancer 333
cardiac muscle 133–4 dead 40, 42 combination skin type 52
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Index
comedone 55 diarrhoea 334 enzymes 17

compounds 14 diastolic pressure 200 digestive 325
congenital heart disease 202–3 diet 54 ephelides 86
congenital iodine deficiency see also nutrition epidermis 40–4
syndrome 291 diffusion 22 epiglottis 235
congested skin 58 digestive system epilepsy 269
conjunctivitis 77–8 absorption 326 epithelial tissue 24–6, 33–4
connective tissue 26–9, 33 digestion 319–23 erector pili muscle 38, 40, 49
constipation 334 enzymes 325 erythema 56
contact dermatitis 88 functions of 319
erythrocytes 176–7
contralateral 3 gall bladder 329–30
eversion 118
hormones 324
corneocytes 40–2, 44 excretion 39
interrelationships 336
coronal plane 4 extension 116
large intestine 326–8
cortex 62 liver 328–9 external
coughing 239 pancreas 330–1 anatomical term 4
cramp 167 pathologies 333–5 respiration 236–8
cranial small intestine 323–6 eyes 262–5
anatomical term 3 stomach 322–3 functions of 262
cavity 7 structure of 12, 319–31 infections 77–8
nerves 258–9 digital arteries 191–2 structure of 262–4
cretinism 291 distal 2–3 face
crow’s feet 55 DNA 15–16, 19–21 bones of 105–6
crying 239 dorsal veins of 195–6
Cushing’s syndrome 292 anatomical term 2–3 fallopian tubes 301
cuticle cavity 7 fascia 139
hair 62 dorsiflexion 116 fast twitch muscle fibres 131
nail 67 dry skin type 51 fat cells 48
cyst 56 Dupuytren’s contracture 121 fats 14, 19, 331
sebaceous 83–4 dwarfism 291 female reproductive
cystitis 348 dysmenorrhea 312 system 300–9, 311–13
cytokinesis 21, 32 ears 265–7 femoral artery 193
cytology 15 eccrine glands 50 fertilisation 305–6
cytoplasm 15, 16, 17, 18 ectopic pregnancy 312 fever 223
dead cells 40, 42 eczema 88–9 fibre 331
deep elastin fibres 45 fibroblasts 45
anatomical term 2–3 elements 14
fascia 40 fibroid 312
emphysema 241 fibromyalgia 167
palmar arch 191–2
endocrine system fibrositis 167
dehydrated skin 58 functions of 279
demodex 80 filtration 23, 33
glands 279–86
depression 268 glandular changes 287–90 fine lines 55
dermatitis 88, 90 interrelationships 294 fingerprints 47
dermatosis papulosa negra pathologies 291–3 fissure 56
(DPN) 85 sex glands 286 fixator muscles 140
dermis 44–7 see also hormones flexion 116
desquamation 42 endometriosis 312 foetal development 306–7
diabetes insipidus 291, 334 endoplasmic reticulum (ER) 16, folic acid 332
diabetes mellitus 292, 334 17, 18, 19, 33 follicle-stimulating hormone
diaphragm 7, 234–8 enlarged pores 55 (FSH) 305
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folliculitis 78 types 63 breast development 304

foot hammer toe 121 childbirth 307–8
arteries of 193 hand digestion 324
bones of 110–11 arteries 190–1 effect on skin 53
veins of 199–200 bones of 109 follicle-stimulating hormone
fractures 121 muscles of 154 (FSH) 305
freckles 56, 86 veins of 196–8 hair growth and 64
free nerve endings 46–7 hang nail 74 kidneys 346
free radicals 53 hayfever 225, 241 menopause 290, 308–9
Fröhlich’s syndrome head menstruation 287–8, 305
anatomical regions 5, 6 nail growth and 68
(adiposogenital
arteries of 188–90 oestrogen 305
dystrophy) 291
blood flow to 189 pregnancy 288–9, 305, 307
frontal plane 4
cranial cavity 7 progesterone 305
frozen shoulder 121 puberty 287, 304–5
lymphatic nodes 217–18
fungal infections 79–80 stress and 291
muscles of 142–6
gall bladder 329–30 horny layer (skin) 40, 42, 44
veins of 195–6
cancer 333 human immunodeficiency virus
head lice 80
gall stone 334 (HIV) 225
headache 269
genetic code 15–16 human papilloma virus (HPV) 79
hearing 265
gigantism 291 humectants 45
see also ears
glands
heart hyaluronic acid 45, 46
endocrine 279–86
blood flow 181–3 hyperhidrosis 84
prostate 311
cardiac cycle 184–5 hyperkeratosis 86–7
salivary 321
composition 180–1 hyperpigmentation 59
sebaceous 50
disease 202–3 hyperthyroidism 292
sweat 50, 84
function 183–5 hypertrichosis 66
glycosaminoglycans
sounds 185 hypertrophic disorders,
(GAGs) 45–6
heart attack 203 skin 86–7
Golgi body 17, 18, 19, 33
heartburn 335
gout 120 hypodermis 47–8
heat receptor 40
granular layer 40, 41–2, 43 hypopigmentation 59
heat regulation 38
Graves’ disease 292 hypothalamus 13, 253, 255, 281
hepatic artery 192
grey matter 252, 256 hypotrichosis 66
hepatitis 203, 335
growth iliac artery 193
hernia 335
hair 64–5 immune system 222–5
herpes allergic reactions 225
role of cells 18
simplex 78 antibodies 223–4
haemophilia 203
zoster 269–70
haemorrhoids 203, 335 antigens 223–4
hiatus hernia 335 fever 223
haemostasis 48–9, 175
hiccups 239 histamine 223
hair 49
high blood pressure 202 immunisation 225
bulb 40
high cholesterol 203 inflammation 223
colour 62
cortex 62 hirsutism 293 interferons 222–3
cuticle 62 histamine 223 non-specific immunity 222
follicle 40, 49–50, 62–3 hives 57–8 phagocytosis 223
growth 64–5 Hodgkin’s disease 225 specific immunity 223
medulla 62 homeostasis 13, 33 immunisation 225
pathologies 65–6 hormones 279–91 impetigo 78
structure 62–3 androgens 64 incontinence 348
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Index
infection 212 leg lymphocytes 175, 177, 212,

inferior 2–3 arteries of 193 216, 222–4
infertility 313 veins of 199–200 nodes 215–20
infestations 80–1 lentigo 86 body 219–20
inflammation 48–9, 223 lesion 56 head and neck 217–18
inflammatory conditions leucocytes 177 organs 221–2
muscular 167 leukaemia 31, 203 pathologies 225–6
skin 88–90 leukonychia 74 skin 46
lice 80–1 spleen 221
ingrown nails 75
ligaments 100, 138–9 structures 214–17
insulin 285
limbs thymus 222
intercellular lipids 42 tonsils 221
interferons 222–3 anatomical regions 5, 6
lower vessels 215
internal see also immune system
anatomical term 4 anatomical regions 5, 6
bones of 109–10 lymphocytes 175, 177, 212, 216,
respiration 236–8
muscles of 155–9 222–4
interstitial fluid 22 lymphoid tissue 28
upper
inversion 118 lymphoma 31
anatomical regions 5, 6
ipsilateral 3 lysosome 17, 18, 33
bones of 108–9
iron 333 macule 56
muscles of 149–54
irritable bowel syndrome magnesium 333
lingual artery 189–90
(IBS) 335 male reproductive system
lipids 14
islets of Langerhans 279–80, 309–11, 313
liver 328–9
285, 292 cancer 333 malignant
isometric contraction 141 cirrhosis of 334 melanoma 87
isotonic contraction 141 liver spots 86 tumour 88
jaundice 335 longitudinal 4 mast cells 45
joints Lorain-Levi syndrome 291 mastication 321
movement 116–18 lordosis 119 maxillary artery 189–90
synovial 113–15 low blood pressure 202 mechanoreceptors 40, 46–7
types of 112–15 lower limbs medial 2–3
jugular veins 195–6 anatomical regions 5, 6 median plane 4
keloid 56 bones of 109–10 medication
keratinisation 41–3 muscles of 155–9 effect on hair 64
keratinocytes 41, 43 lungs 232, 234–40 effect on skin 53
kidney stones 348 cancer of 241 Mediterranean skin 61
kidneys 342–6 interchange of gases 236–8 medulla 62
filtration 23 respiratory movements meiosis 21
pH balance and 13 238–9
Meissner’s corpuscle 40, 46–7
koilonychia 74 lupus 90, 226
melanin 39, 43, 59, 61, 62
Krause corpuscle 40, 46–7 lymph 212–13
melanoma 31, 87
kyphosis 119 lymphatic system
membranes 29
capillaries 214–15
Langerhans cells 41 meningitis 270
cisterna chyli 216
lanugo hair 63 drainage 217–20 menopause 64, 290, 304, 308–9
large intestine 326–8 ducts 217 menstruation 287–8, 305
larynx 232, 233, 235 functions 212–14 Merkel disks 46–7
lateral 2–3 interrelationships 226 metabolic rate 14
laughing 239 lymph 212–13 metabolism 13–14
357
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migraine headache 269, 270 nail 66 neuroglia 248

milia 56 conditions 70–7 neurones 248, 250–1
minerals 332–3 functions 66 neurotransmission 250–1
mitochondria 17, 18, 19, 33 growth 68–9 neurotransmitters 249–50
mitosis 20–1 pathologies 71–3 nociceptors 40, 46–7
molecules 11 shapes 70 nodes 215–20
structure 66–8 body 219–20
moles 56
trauma 69 head and neck 217–18
motor nerve 40
nasal cavity 232–3, 235 nodes of Ranvier 249
motor nerve endings 47
nasopharynx 232–3 non-specific immunity 222
motor neurone disease
neck norepinephrine 250
(MND) 270
anatomical regions of 5, 6
mouth 321 normal skin type 50–1
arteries of 188–90
cancer 334 nose 232, 262
blood flow to 189
movement lymphatic nodes 217–18 see also olfaction
joints 116–18 muscles of 142–6 nuclear membrane 16–18, 20, 33
muscles 140–1 nephritis 348 nucleic acids 14
mucous membrane 29 nerve nucleolus 16, 17
multiple sclerosis (MS) 270 cells 248–50 nucleus 15–16, 17, 18
muscle tone 137–8 endings 40 nutrition 19, 331–3
muscular dystrophy 168 plexus 257 occipital artery 189–90
muscular system nervous system oedema 215, 226
cardiac muscle 133–4 autonomic 247–8, 259–61 oesophagus 322
fascia 139 brain oestrogen 305
functions of 129 functional areas of 254 oily skin type 51–2
hand 154 grey matter 252, 256 olfaction 231, 239–40
head and neck 142–6 principle parts of 253 oncology 31
interrelationships 169
white matter 252, 256 onychatrophia 72
ligaments 138–9
central 251–6 onychauxis 75
lower limbs 155–9
functions of 247 onychia 72
movement 140–1
interrelationships 272 onychocryptosis 75
muscle
nerve cells 248–50 onychocyanosis 74–5
contraction 134–7, 141 nervous tissue 248
fibres 131–3 onychogryphosis 72
neurotransmission 250–1
tissue 29, 129–34 onycholysis 72
parasympathetic 248, 259,
tone 137–8 onychomalacia 76
261
pathologies 167–8 pathologies 267–71 onychomycosis 72–3
pelvic floor 159 peripheral 257–61 onychophagy 75
pelvis 159, 164 reflex action 256 onychorrhexis 75
respiration and 161 sense organs 262–7 onychoschizia 76
shoulder 147–8 sensory nerves 46–7 oral cancer 334
tendons 138 skin 46–7 organs
trunk 160–4 somatic 247, 257–9 definition 11
upper limbs 149–54 spinal cord 255–6 digestive 321–31
myalgic encephalomyelitis structures of 247–8 of lymphatic system 221–2
(ME) 270–1 sympathetic 248, 259–61 reproductive 300–1, 309–10
myelin sheath 249 nervous tissue 29, 248 see also specific organs
myocardial infarction 203 neuralgia 271 osmosis 22–3, 33
myxoedema 291 neurilemma 249 ossification 99
naevus 57, 86 neuritis 271 osteoarthritis 120
358
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Index
osteoporosis 122 piles 203 pyelonephritis 348

ovaries 279–80, 286, 293, 301 pineal gland 253, 255, 282 radial artery 190–2
cancer of 312 pinocytosis 23, 33 radiotherapy 69
ovulation 305 pituitary gland 279–80, 281–2, Raynaud’s syndrome 204
oxygen 236 291 reflex action 256
pacemaker 204 plantar renal artery 192
Pacinian corpuscle 40, 46–7 anatomical term 3, 6 renal system
pain receptors 40, 46–7 arch 193 bladder 347–8
palmar flexion 116 functions of 342
anatomical term 3, 6 platelets 177 interrelationships 349
arches 192, 194–6 pleurisy 241 kidneys 23, 342–6
plexus 215 pneumonia 241 pathologies 348–9
pancreas 279–80, 285–6, 321, polycystic ovary syndrome 64, structures of 342
330–1 293, 312 ureters 347
cancer of 334 reproductive system
popliteal artery 193
papillary layer (skin) 44 breast 303–4
pores 55
cell division 19–22
papule 57 portal circulation 187 childbirth 307
parasympathetic nervous portwine stain 86 female 300–9, 311–13
system 248, 259, 261 posterior fertilisation 305–6
parathyroid gland 279–80, 238, anatomical term 2–3 foetal development 306–7
292 lobe 282 interrelationships 314
parietal 4 posterior tibial artery 193 male 309–11, 313
Parkinson’s disease 271 posture 118–19 menopause 64, 290, 304,
paronychia 73 pregnancy 305–7 308–9
pathologies 241–2 ectopic 312 menstruation 287–8, 305
pathology (definition) 1 hormones 288–9 ovaries 301
pediculosis 80–1 ovulation 305 pathologies 311–13
pelvic premenstrual syndrome 313 pregnancy 305–7
cavity 7 pressure receptor 40 role of cells 18
floor 159 prickle cell layer 40, 41, 43 uterus 302
girdle 111–12 progesterone 305 vagina 302
muscles 159, 164 pronation 117 respiratory system
penis 311 breathing
prone 3
correct 241
peripheral nervous system prostate
rate 238
257–61 cancer 313
gland 311 regulation 238
pH scale 13, 33
bronchi 232, 233–4, 235
pH value prostatitis 313
cellular respiration 18, 22
blood 13 protein 19, 325, 331
diaphragm 234–8
skin 39 proteins 14 external respiration 236–8
urine 344 proximal 2–3 functions of 231–3
phagocytic cells 45 psoriasis 89 internal respiration 236–8
phagocytosis 23, 33, 223 pterygium 76 interrelationships 242
pharynx 232, 233, 322 puberty 287, 304–5 larynx 232, 233, 235
phlebitis 204 pulmonary lungs 232, 234–40
phosphorus 333 circulation 185–6 interchange of gases 236–8
photoageing 54 embolism 204 respiratory movements
physiology (definition) 1 pulse 201 238–9
pigmentation 39, 59, 84–6 pustule 57 muscles of respiration 161
359
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nasopharynx 232–3 sight 262 birthmarks 86

nose 232 see also eyes black 85
olfaction 231, 239–40 Simmond’s disease 291 cancers 87–8
pathologies 241–2 singing 239 capillaries 46
pharynx 232, 233 sinuses 105–6, 232–3 clear layer 40, 42, 44
pulmonary circulation 185–6 sinusitis 242, 269 collagen 45
structures of 231–5 combination 52
skeletal system
trachea 232, 233, 235 conditions 58–60, 88–90
appendicular skeleton 103,
reticular layer 44–5 congested 58
107–11
rheumatoid arthritis 120 cutaneous receptors 40, 46
arm 109
rhinitis 241 dehydration 42, 45, 58
axial skeleton 103–7
ribonucleic acid (RNA) 16 dermis 44–7
bone
dry 42, 45, 51
ribosomes 16, 17, 18, 33 development 98–9
elastin fibres 45
ribs 107 fracture 121 epidermis 40–4
ringworm 79–80 marrow 98 excretion 39
rodent ulcer 88 structure 97–9 extracellular matrix (ECM) 45
root hair plexus 46–7 types of 100–3 factors affecting 53–4
rosacea 82–3 cartilage 100 functions of 38–9
rotation 117 clavicle 108 fungal infections 79–80
Ruffini endings 40, 46–7 foot 110–11 granular layer 40, 41–2, 43
sagittal plane 4 functions of 97 horny layer 40, 42, 44
hand 109 hypertrophic disorders 86–7
salivary glands 321
interrelationships 123 infestations 80–1
sarcoma 31
joints inflammatory conditions
scabies 81
movement 116–18 88–90
scapula 108
synovial 113–15 interrelationships 91
scars 57
types of 112–15 lymphatic vessels 46
sciatica 271 ligaments 100 male 53
scoliosis 119 lower leg 110 nervous system and 46–7
seasonal affective disorder lower limb 109–10 normal 50–1
(SAD) 293 pathologies 119–22 oily 51–2
sebaceous pelvic girdle 111–12 pain receptors 40, 46–7
cyst 83–4 ribs 107 papillary layer 44
gland 40, 50 scapula 108 pathologies 77–8
seborrhoea 84 shoulder girdle 107–8 pH value 39
sebum 38 skull 104–6 photoageing 54
sense organs 262–7 sternum 107 pigmentation 39, 59, 84–6
sensitive skin type 52–3 thigh 110 prickle cell layer 40, 43
thoracic cavity 107 problems 54–8
sensory nerves 46–7
upper limb 108–9 as protective organ 38–9
serous membrane 29
vertebral column 106–7 renewal 43
sex glands 286 wrist 109 reticular layer 44–5
see also reproductive system skin rosacea 82–3
shin splints 168 absorption 38 sensitive type 52–3
shingles 79, 269–70 acne 81–2 sensitivity 38, 59
shoulder ageing 54, 55, 58–60 stem cells 44
bones of 107–8 autoimmune disorders 90 structure 39–48
muscles of 147–8 bacterial infections 77–8 subcutaneous layer 39, 47–8
sighing 239 basal cell layer 40, 41, 43 touch 262
360
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Index
transepidermal water loss stratum lucidum 40, 42, 44 temporomandibular joint tension
(TEWL) 42, 45 stratum spinosum 40, 41, 43 (TMJ syndrome) 122
trauma 85 Streptococcus bacteria 78 tendinitis 168
type 50–3, 61 stress 64, 122, 204, 242, 271, tendons 138
viral infections 78–9 291, 293, 335 tennis elbow 168
wound repair process 48–9 stroke 204–5 terminal hair 63
wrinkles 54, 58 stye 78 terminology
skin care products 45–6 subclavian arteries 189–92 directional 2–4
skin tag 57 subcutaneous layer 39, 40, 47–8 movement 4, 116–18
skull 104–6 subdermal muscle layer 40 regions of the body 5–6
sleep sulfur 333 testes 279–80, 286, 310
breathing during 238 cancer of 313
sunburn 43
effect on skin 54 testosterone 53
sunlight exposure 54
hormones and 255, 282 thalamus 253, 255
nervous system and 249–50 superficial
anatomical term 2–3 thermoreceptors 40, 46–7
slow twitch muscle fibres 132
palmar arch 192 thoracic cavity 7, 107
small intestine 323–6
superficial temporal artery 189–90 thoracic wall 192
smell see olfaction arteries of 192
superior 2–3
smoking veins of 198–9
supination 117
effect on nails 69 thrombocytes 177
supine 3
effect on skin 53
sweat gland 40, 50, 84 thrombosis 205
sneezing 239
sympathetic nervous thymus gland 222, 279–81
sodium 333
system 248, 259–61 thyroid
somatic nervous system 247, artery 189–90
synapse 249, 251
257–9 gland 279–80, 283, 291–2
synaptic gap 249, 251
somatostatin 286 tinea capitas 80
synovial
spasticity 168 tinea corporis 79–80
joints 113–15
specific immunity 223 tinea pedis 80
membrane 29
speech 238–9 tissues
synovitis 122
spina bifida 122 systemic circulation 186–7 connective 26–9, 33
spinal systemic lupus erythematosus definition 11, 23–4
cavity 7 epithelial 24–6, 33–4
(SLE) 90
cord 255–6 membranes 29
systems of the body
spleen 221 muscle 29
definition 12
splenic artery 192 imbalance 13 nervous 29, 248
sprain 122, 168 interrelationships 12, 32, tongue 262
squamous cell carcinoma 88 91, 123, 169, 206, 226, tonsils 221
Staphylococcus bacteria 78 242, 272, 294, 314, 336, torticollis 168
Stein-Leventhal syndrome 293 349 touch receptor 40
stem cells, skin 44 overview 30 trachea 232, 233, 235
sternum 107 synergy 13 transepidermal water loss
stomach 322–3 see also specific systems (TEWL) 42, 45
cancer 334 systolic pressure 200 transverse plane 4, 8
structural organisation of 12 taste 262 trunk
stratum corneum 40, 42, 44 telangiectasia 57 anatomical regions 5, 6
stratum germinativum 40, 41, 43 temperature 137 muscles of 160–4
stratum granulosum 41–2, 43 see also heat regulation ventral cavity 7
361
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tuberculosis (TB) 242 vasodilation 179 vitamin D 39, 332

tumour 57, 88 veins 40, 178–9, 194–200 vitamin E 54, 332
ulcer 57, 335 abdominal wall 198–9 vitamin K 332
ulnar artery 190–2 arm and hands 196–8 vitiligo 86
ultraviolet (UV) radiation 39, 54 face and head 195–6 voice box 232, 233
leg and foot 199–200
upper limbs warts 58, 79
thoracic wall 198–9
anatomical regions 5, 6 water 331
varicose 205
bones of 108–9 consumption 54
vellus hair 63
muscles of 149–54 physiological role 14
ventral
ureters 347 states of 14
anatomical term 2–3
urethra 348 weal 58
cavity 7
urinary tract infection 349 verrucae 79 whiplash 122
urine vertebral white blood cells 177
composition 344–5 cavity 7 white fibrous tissue 28, 34
production 343–6 column 106–7 white matter 252, 256
urticaria 57 vesicles 58 whiteheads 55
uterus 302 viral infections, skin 78–9 wound repair process 48–9
vacuole 17, 33 virilism 293 wrinkles 58
vagina 302 visceral 4 wrist 109
varicose veins 205 vitamin A 54, 332 yawning 239
vasoconstriction 175 vitamin B 54, 332 yellow elastic tissue 28, 34
vasoconstriction 179 vitamin C 54, 332 zygote 22, 306
362
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Anatomy & Physiology - Helen McGuinness - Hodder Education (2018)

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How to use this book vi

1 An introduction to anatomy and physiology: how the body is organised 1

2 Cells and tissues 10

3 The skin, hair and nails 37

4 The skeletal system 96

5 The muscular system 128

6 The cardiovascular system 173

7 The lymphatic system and immunity 211

8 The respiratory system 230

9 The nervous system 246

10 The endocrine system 278

11 The reproductive system 299

12 The digestive system 318

13 The renal system 341

9781510435179.indb 3 04/10/18 4:48 PM

9781510435179.indb 4 04/10/18 4:48 PM

9781510435179.indb 5 04/10/18 4:48 PM

Answers are available online at www.hoddereducation.co.uk/Anatomy-and-

9781510435179.indb 6 04/10/18 4:48 PM

9781510435179.indb 1 04/10/18 4:48 PM

KEY FACT The body as a map

Superior Medial Proximal Superficial

Inferior Lateral Distal Deep

Anatomical directional terms

9781510435179.indb 2 04/10/18 4:48 PM

Table 1.1 Anatomical directional terms

9781510435179.indb 3 04/10/18 4:48 PM

Other directional terms

The anatomical planes of the

Sagittal plane Frontal/coronal plane Transverse plane

p Anatomical planes of the body

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The anatomical Table 1.4 Anatomical regions of the lower limbs

Anatomical term Area of the body

The head and neck The trunk

9781510435179.indb 5 04/10/18 4:48 PM

Crucial (leg) Lower limb

Hallux (big toe)

9781510435179.indb 6 04/10/18 4:48 PM

Body cavities It is separated from the abdominal cavity by

9781510435179.indb 7 04/10/18 4:48 PM

Key words Median or sagittal plane: vertical plane that divides

two cavities: the cranial and spinal cavity.

thoracic cavity and the abdominal and pelvic cavities.

9781510435179.indb 8 04/10/18 4:48 PM

Test your knowledge questions

9781510435179.indb 9 04/10/18 4:48 PM

9781510435179.indb 10 04/10/18 4:48 PM

How to use this book vi

1 An introduction to anatomy and physiology: how the body is organised 1

2 Cells and tissues 10

3 The skin, hair and nails 37

4 The skeletal system 96

5 The muscular system 128

6 The cardiovascular system 173

7 The lymphatic system and immunity 211

8 The respiratory system 230

9 The nervous system 246

10 The endocrine system 278

11 The reproductive system 299

12 The digestive system 318

13 The renal system 341