BASIC HUMAN

ANATOMY
AND
PHYSIOLOGY

EMMANUEL Z. PAGALA M.D.

 “KNOWING THE
BODY’S STRUCTURE AND
FUNCTIONS PROVIDES
GREATER
UNDERSTANDING OF
WHAT HAPPENS WHEN
THE BODY DOES NOT
FUNCTION NORMALLY “
 ANATOMY

This is a branch of biology

concerned with the study of the
structure of organisms and their parts

The scientific study of

the body and how its
parts are arranged
 PHYSIOLOGY

This is the scientific study

of functions and mechanisms in
a living system
This is the study of
how
the human body works.
• It describes the chemistry and
physics behind basic body
functions, from how molecules
behave in cells to how systems of
organs work together.
 PATHOLOGY

This term comes from the Greek

words "pathos" meaning "disease"
and "logos" meaning "a treatise“

This is the study of the causes

and effects of disease or injury
• This is the study of
the causes and effects
of disease or injury
 Anatomical Terms of Direction
Term of direction Definition Example
Anterior or ventral Front or belly side The trachea is anterior to
the esophagus
Posterior or dorsal side Back side The esophagus is posterior
to the diaphragm
Superior Closer to the top of the The lungs are superior to
head(use for head, neck the diaphragm
and trunk
Inferior Farther from the top of The stomach is inferior to
head ( used for head, the diaphragm
neck and trunk

Medial Towards the midline of The heart is medial to the

the body lungs
Lateral Away from the midline The lungs are lateral to
the heart
Bilateral Relating or affecting She had bilateral
two sides ovarian tumors
Proximal Closer to the connection The elbow is proximal to
to the body the wrist
Distal Farther from the Fingernails are the
connection of the body distal end of the fingers
Superficial Closer to the surface The epidermis is
superficial to dermis of
the skin
Deep Farther from the surface The hypodermis is deep
to the dermis
Right On the body’s right side The liver is on the right
side of the body
Left On the body’s left side(
on the viewers left side
 ANATOMICAL REGIONS
REGION DEFINITION EXAMPLE

Axial Head , neck and trunk The ribs are in the axial
region

Abdominal Belly She had measles rash on

her abdomen

Axillary Armpit Many people apply

deodorant in the axillary
region

Cephalic or cranial Head The brain is located in the

cranial region

Cervical Neck He wore a cervical collar

after the accident

Facial Face The maxilla is a facial bone

Inguinal Groin He had an inguinal hernia

Pelvic

Thoracic Chest The breast is in the thoracic region

Umbilical Navel She developed an umbilical hernia

during pregnancy
Appendicular Arms and legs The is in the appendicular region

Brachial Arm The nurse administered the vaccine in

the brachial region
Carpal Wrist She had pain in the carpal region from a
wrist sprain
Cubital Elbow The phlebotomist drew blood from the
anterior cubital region
Femoral Thigh He had a bruise on the femoral region

Palmar Palms of the hand He had blisters on his palmar surface

Patellar Knee She was ticklish in her patellar region

Plantar Soles of the feet She had her planter warts removed

Tarsal Ankle He had a sprain in his ankle

Abdominal Quadrants and regions
1. Right upper 1. Right hypochondriac
quadrant 2. Epigastric region
2. Left upper quadrant 3. Left hypochondriac
3. Right lower 4. Epigastric region
quadrant 5. Right lumbar region
6. Umbilical region
4. Left lower quadrant
7. Right inguinal region
8. Hypogastric region
9. Left inguinal region
 Anatomical Planes

Sagittal Separates Right from left. If the plan is

exactly down the midline of
the body , It is mid sagittal

Transverse or Horizontal Separates top from bottom; commonly

it is called Cross section

Frontal or Coronal Separates anterior from

posterior ( front from back
 HOMOESTASIS
This refers to the body’s ability to maintain a
stable internal environment
This is facilitated by :
1. Regulating hormones
2. Body temperature
3. Acid-base balance
4. Fluid and electrolytes
 Feedback Loop
• A process by which the body condition and
function is continually checked and rechecked
to maintain an optimum level
• This is basically regulated by the neural
channels in the brain
Two types of FEEDBACK LOOP
1. Negative feedback
2. Positive feedback
Positive Feedback
• A deviation from the normal range
results in more change and the system
moves farther away from the normal
range.
• There is an intense change in the
body’s physiological condition rather
than reversing
• This is normal only when there is a
definite end point.
Negative Feedback
• Negative feedback mechanism is the body’s
most common mechanisms used to maintain
homeostasis.
• This mechanism effects the response to the
stimulus is to shut off the original stimulus or
reduce its intensity
• In order to set the system in motion, a
stimulus changes the internal environment
beyond the normal range
 DISEASE

A disease is a particular abnormal

condition that negatively affects the
structure or function of all or part of
an organism
 TWO CATEGORIES OF DISEASE
A. Acute Disease:
These are conditions which generally
develop suddenly and last a short time
only a few days or weeks.
B. Chronic Disease:
These are conditions that develop slowly
and may worsen over an extended period
of time
 Risk Factors
1. Age
Infections, congenital disorders, genetic
disorders , developmental disorders
2. Gender
3. Lifestyle
Habits that contribute to well being
4. Environment
5. Heredity
 Signals of Disease
Sign
This is a manifestation of disease that the
physician perceive
The sign is objective evidence of disease
Symptom
This is a manifestation of disease apparent
to the patient himself
This represent the subjective complaints
of the patient
PAIN
-This is a symptom indicating physical
suffering or distress
-It is a form of defense mechanism
and protective mechanism that alerts
the body
INFLAMATION
-This is the body’s normal response to
injury
 Classification of Disease
1. Infectious diseases
2. Cancers
3. Immune disorders
4. Genetic disorders
5. Mental Disorders
6. Trauma
 DIAGNOSIS

A process by which a disease

condition is identified by means of its
signs and symptoms
• This is done by a systemic history
and physical examination
• Aided by the use of diagnostic
tools like radiography, sonology
and a battery of laboratory
examination and other imaging
techniques
 TREATMENT PLAN
A. Palliative
This form of treatment is designed to
relieve symptoms, and improve your
quality of life
It can also be used to reduce or
control the side effects of cancer
treatment
B. Curative
• These pertains to treatment and
therapies that provide a patient with
the main intent of fully resolving an
illness and the goal of bringing the
patient back to health
• The purpose of curative care is to cure a
disease or promote recovery from an
illness injury or impairment.
Preventive
This is a proactive approach in the
treatment or prevention of disease
Preventive healthcare, or prophylaxis,
consists of measures taken for
disease prevention
This task is carried by a worldwide
approach, whole government approach,
local government approach or an individual
or familial approach
 Common conditions screened

Blood pressure, diabetes and cholesterol tests

Cancer screenings
Counselling for depression
Sexually transmitted infections
Routine vaccinations against diseases such as measles
or meningitis
Counselling, screening and vaccines for healthy
pregnancies
Influenza vaccine
 Epidemiology

• This is a scientific study witch

deals with how disease affects
the overall health and well being
of a certain population
Incidence
This is a measure of the probability of
occurrence of a given medical condition in a
population within a specified period of time
Prevalence
The proportion of individuals in a
population having a disease or characteristic.
Prevalence is a statistical concept referring to
the number of cases of a disease that are
present in a particular population at a given
time
 Predisposing Factors

• These are risk factors or activities

that people participate in that play a
large role in a persons overall health
• These are uncontrolled and
controlled factors
 LEVELS OF
ORGANIZATION OF THE
HUMAN BODY

EMMANUEL Z. PAGALA
 TABLE OF MAJOR ELEMENT

Oxygen O 65.00%

Carbon C 18

Hydrogen H 10

Nitrogen N 3.00

Calcium Ca 1.50

Phosphorus P 1.00

Sulfur S 0.25

Potassium K 0.20
 CELL
Basic knowledge of the cell is
essential to an understanding of the
organ system in the body and the way
they function
It is the basic unit structure of a
living organism
 STRUCTURE OF THE CELL
CELL MEMBANE
o Limiting structure of the cell
o It is semi–permeable
NUCLEUS
The nucleus contains nearly all of the cell's
DNA, surrounded by a network of
fibrous intermediate filaments and enveloped
in a double membrane called the "nuclear
envelope
CHROMOSOMES
It contains the basic genetic material DNA
which is responsible to provide hereditary
characteristics and genetic information to the
various cell
NUCLEOLI
oResponsible for the genetic material in the cell
oContain the DNA-RNA COMPLEX
oResponsible for cellular reproduction
CYTOPLASM
Cytoplasmic organelles
Endoplasmic Reticulum –
This is a network of channels which span the whole span
of the structure of the cell
2 TYPES:
• Rough Endoplasmic Reticulum
o Ribosomes - which are important in Protein Synthesis
o Lysosomes - known as the suicide bags of the cell
• Smooth Endoplasmic Reticulum
o Ribosomes Protein Synthesis
▪ Golgi Apparatus - site of production of
substances to be secreted by the cell
▪ Mitochondria - known as the ‘power
house’ of the cell
▪ Lysosomes - contain proteolytic enzymes
and is responsible for phagocytosis
▪ Centrioles - aids in cell division
▪ Cytoplasmic Inclusions - aggregate
materials found in the cell which are
products of digestion
 Cellular Function

Cell membrane
• Also known as plasma membrane
• The structure is made up of
phospholipids and protein
• The most important quality is its semi
permeability
• The very basic function of the plasma
me membrane is to limit the boundary of
the cell
Factors that regulate permeability:
1. Size of molecules
2. Solubility in lipids
3. Charge on ions
4. presence of carrier molecule
 Molecular transfer
1. Diffusion
The process by which molecules
migrate from an area of greater
concentration to a region of lower
concentration
2. Osmosis
This is defined as the migration of water
molecule from an area of high water
concentration to an area of low
concentration
3. Active transport
The process by which substances usually
ions, are transported across a plasma
membrane typically from an area of lower
concentration to an area of higher
concentration
4. Phagocytosis
A process by which cells , take in
substances across the plasma membrane
5. Pinocytosis
The cells engulf liquid or water than solid
 CELL DIVISION
A process by which cells replicate the main aim
is the propagation of species
Mitosis : Cell division by ordinary somatic cells
or ordinary cells of the body
– Eukaryotic cell
– Prokaryotic cells

Meiosis : Cell division undergone by sex cells

like gonads ( ovary and testes)
 Protein synthesis
Production of amino acids which is the
building blocks of proteins
Essential
• These are amino acids which are those
which are not produced by the body but
essential in body functions
Non - essential amino acid
• Amino acids produced by the body
 DNA
• Deoxyribonucleic acid
• This was discovered in 1953 by Watson and
Creek
• DNA codes genetic information for the
transmission of inherited traits
• It codes genetic information for the
transmission of inherited traits
• This is a double helical structure made up of
nucleotides
 RNA
This is a complex compound f
high molecular weight hat functions in
cellular protein synthesis and replaces DNA
RNA consists of
ribose nucleotides attached by phospholipid
bonds, forming strands of varying lengths.
The nitrogenous bases in RNA
are adenine, guanine, cytosine, and uracil
 Types of RNA
1. Messenger RNA
This is The type of RNA that reflects
the exact nucleoside sequence of the
genetically active DNA.
MRNA carries the "message" of the
DNA to the cytoplasm of cells where
protein is made in amino acid sequences
specified by the mRNA.
2. Transfer RNA
Transfer RNA (tRNA)
• This is a short-chain type of RNA
present in cells.
• There are 20 varieties of tRNA.
• Each variety combines with a
specific amino acid and carries it along
(transfers it), leading to the formation
of protein with a specific amino acid
arrangement dictated by DNA.
 Ribosomal RNA
• Ribosomal RNA (rRNA) is a
component of ribosomes.
• Ribosomal RNA functions as a
nonspecific site for making
polypeptide
 Two types of cell in the body
Prokaryotic cells
• Prokaryotes are made up of a single cell
• They are normally smaller than the
eukaryotic cells
• Their genetic material isn’t stored within
a membrane-bound nucleus it is stored
in a nucleoid that floats in the cell’s
cytoplasm
Eukaryotic cells
• These are cells that possesses a
clearly defined nucleus
• It has a nuclear membrane that
surrounds the nucleus, which
contain chromosomes containing
hereditary materials
• Eukaryotic cells also
contain organelles
including mitochondria , a Golgi
apparatus and an endoplasmic
reticulum and lysosomes
CELL REPRODUCTION

1. MEIOSIS

2. MITOSIS
CELL REPLICATION

1. PROPHASE
2. METAPHASE
3. ANAPHASE
4. TELOPHASE
5. INTERPHASE
MUTATION
–This is a change that occurs in our DNA
sequence
– Maybe due to mistakes when the DNA
is copied
–Due to an environmental factors such
as UV light and cigarette smoke etc
• AGING CELLS
– TELOMERES
 TISSUE LEVEL

HISTOLOGY
• The study of tissues and cells under a
microscope.
FOUR BASIC CLASSIFICATION OF TISSUES
1. Epithelial
2. Connective
3. Muscular
4. Nervous
 EPITHELIAL TISSUES

• They technically all surfaces of the

different organs of the body
• Epithelial tissues line the outer
surfaces of organs and blood vessels
throughout the body, as well as the
inner surfaces of cavities in many
internal organs.
• They allow materials to pass through
by simple diffusion and filtration
• Capable of absorption and secretion
thus are seen in glandular tissues
• Secretion may be in the form of
mucous or chemical substances like
enzymes
• Some of specialized cells poses cilia
• These cells are named their shape and
how the are layered
Three principal shapes :
1. Squamous cells
-These cells that are wider than their
height
-They are flat and scale like
-They are found as the lining of the
mouth, esophagus, blood vessels and in
the alveoli of the lungs.
 Cuboidal
-These cells are those whose height
and width are approximately the same
(cube shaped)
• Columnar
-They are cells that are taller than
they are wide (column-shaped)
-They are secretory cells with
protective capacity
 MUSCULAR TISSUES
• These are specialized tissue found in
animals, the function of which is to
produce motion
• Movement is the intricate cooperation of
muscle and nerve fibers
• The innervation of muscle cell permits
an animal to move and hunt for food
 Types of muscles
1. Cardiac
- They are located in the walls of the
heart appear striated
- These have fibers with one to two
nuclei and are physically and
electrically connected to each other
so that the entire heart contracts as
one unit.
-These are under involuntary control.
Skeletal
- These are muscles attached to the
bones and ligaments important in
movement
- The fibers are multinucleated
structures
3. Smooth
- They are located in walls of hollow
visceral organs
- They are spindle-shaped are also
under involuntary control.
 NERVOUS TISSUES
• These are found in the brain, spinal cord, and
nerves.
• It is responsible for coordinating and
controlling many body activities
• The cells in nervous tissue that generate and
conduct impulses are called
• These cells have three principal parts:
the dendrites and one axon
 CONNECTIVE TISSUE

• It develops from the mesoderm

• They have cells and fibers in a
matrix
• These may include structures like
fibroblast macrophages mast cells
and leucocytes
 3 main components of connective
1. Elastic fibers
2. Collagen fibers
3. Ground substance and cells
Types of connective tissues
a. Areolar
-Areolar connective tissue is made of cells
and extracellular matrix
-The fibers are irregularly arrange
-These are found in collagen fibers
 Types of connective tissues

a. Areolar connective tissue

-Areolar connective tissue is made
of cells and extracellular matrix
-The fibers are irregularly arrange
-These are found in collagen fibers
b. Adipose
- This connective tissue consist mainly of
fat cell
-It is found mainly under the skin but
also in deposits between the muscles,
in the intestines and in their
membrane folds, around the heart
c. Hyaline
-This is the most widespread and
is the type that makes up the
embryonic skeleton.
-It persists in human adults at the
ends of bones in free-moving
joints as articular cartilage, at the
ends of the ribs, and in the nose,
larynx, trachea
d. Fibrous
- Fibrous connective tissue is
composed of parallel bundles of
collagen fibers.
- It is found in the dermis,
tendons, and ligaments and can
also be referred to as dense
connective tissue.
Osseous
- This is a connective tissue that
has a large amount of two
different types of matrix material.
- The organic matrix is similar to
the matrix material found in other
connective tissues, including some
amount of collagen and elastic
fibers.
–This gives strength and flexibility
to the tissue
-The inorganic matrix consists of
calcium mineral salts—
mostly salts—that give the tissue
hardness.
INTEGUMENTARY SYSTEM

DR. EMMANUEL Z. PAGALA

 INTRODUCTION

This is the outer covering of the

human body

This is the largest organ of the

body
It extends over the entire surface
of the body and is continuous
with internal mucous membranes
at various openings of the body
 Structure of skin

1.Epidermis
The most superficial layer
made up of stratified squamous
epithelium
2. Dermis
This layer is composed of a
closely interwoven layer of
dense areolar connective tissue
• Some authors say that the dermis is
the true skin
• This layer of the skin changes from
loose areolar tissue to dense
irregular connective tissue
dependent on its depth of location
• Blood supply to the surface from the
stratum basale is through the
process of diffusion
Structure in skin that make it
supple
1. Elastin
–It contains glycine and proline
which makes the skin elastic
– These fibers also add to the overall
strength to the skin
2. Collagen
- This element in the skin
improves the process of wound
repair and healing in general
- It promotes healing by
promoting granulation tissue
formation
Epidermis
1. Stratatum basale\
Germinativum
• Single layer of cuboidal cells
• Deepest layer of cells
• Site of active cell growth
• This layer dips into the dermis to
form the hair follicle

• Location of granular structure

which contain keratohyalin
2.Stratum spinosum
This layer of the skin is only found
in humans
This is typically 5 to 10 layers of
cells
Found only on thick skin in human
skin
3. Stratum granulosum
–Made up of several payers of
cells
–They contain keratohyalin
fibers
–Responsible in making the skin
permeable
4. Stratum Lucidum
-This is a homogenous structure which
contain eleidin
5. Stratum Corneum
- Varying layers of thickness consisting
dead cornified \ scale like cells
• The skin makes up approximately
15% of the total body weight

• The epidermis is the most

superficial layer made up of
stratified squamous epithelium
• The outermost layer of the
epidermis and marks the final
stage of keratinocyte maturation
and development
• The hypodermis serves as the
insulating structure and energy
conserving layer
 Cells of the epidermis

1. Keratinocyte
- Makes up the majority of cells
and contain waterproof subs called
the keratin, as it age these cells
undergo cornification
2. Melanocytes
• During the embryonic life these cells
migrate from the neural crest
• These cells produce the skin
pigment called melanin
• They are found in the deepest layer
of the epidermis
DERMIS
• This is formed by dense areolar
connective tissue
• This is predominantly collagenous
fiber bundles with few elastic
fibers
• The margins adjacent to the
epidermis has a lot of papillary
structures
 FUNCTIONS OF THE SKIN

1. It acts as a guard or barrier between

the deeper structures of the body and
the external environment
2. The keratin renders this layer water
proof
3.This layer also prevents the escape
of fluid thus prevents dehydration

4. The pigments of the skin protects it

fro the hazards of ultraviolet light

5. It aids in the regulation of

temperature by the use sweat glands
6. It serves as an excretory
organ as it effectively eliminates
water and other waste
materials
7. Production of Vitamin D with
the aid of ultraviolet rays
 Sweat Glands
Merocrine sweat Most numerous Watery sweat Helps cool the body
gland type. They deliver composed of 99% through
sweat to the water, lactic acid evaporation
surface of the skin ,urea and salt
through a duct
called a pore.
Numerous on pals
and soles
Apocrine sweat This type of sweat Lipid rich sweat Serves as scent to
glands glands deliver their that bacteria can influence the
secretion through feed on. It is not behavior of others
the hair follicle. the sweat itself but
They are associated the waste from the
with axillary hair , bacteria that create
pubic hair and body odor
beard. They
become active
during puberty
Ceruminous Modified sweat Cerumen or ear Keeps the
gland glands which are wax eardrum flexible
found in the ear and water proof.
canal Protects the ear
canal from
foreign debris

Mammary gland Modified sweat Breast milk which Nourishes an

gland found on is composed of infant
the chest of water,
males and carbohydrates,
females. They lipids, proteins
begin to develop and minerals
at puberty. They
deliver their
secretion through
their ducts that
end in the nipple
 Hair
• This structure is made of a tough
protein called keratin.
• A hair follicle anchors each hair into
the scalp of the head or the skin
elsewhere in the body
• The hair bulb forms the base of the
hair follicle
• Living cells divide and grow to
build the hair shaft.
• Blood vessels nourish the cells in
the hair bulb, and deliver
hormones that modify hair
growth and structure at different
times of life.
Three types of hair
1. Lanugo hair
- Very fine unpigmented hair seen on the
fetus on the third trimester of pregnancy
2. Villous hair
- This type of hair replaces lanugo at the time
of birth
3. Terminal hair
- Coarse and heavily pigmented and seen in
adult life
 Nails
• A nail is a claw-like plate at the tip of
the fingers and toes in most primates
• Fingernails and toenails are made of
a tough protective protein
called alpha-keratin
• The nail bed is the skin beneath the
nail plate
 Blood supply of the skin

• Vascular supply of the skin is through

the process of diffusion from the rich
vascular beds in the dermis
• The drainage of the vascular system
function as a reverse to its vascular
supply
 Nerve supply of the skin
1. Dermatomes
- These comes from 8 cervical nerves, 12
thoracic nerves , 5 lumbar nerves and 5 sacral
2. Meissner corpucles detect light touch
3. Ruffini endings detect deep
pressure and stretching of the skin’s
collagen fibers
4. Merkel receptors associated with
the Merkel cells respond to
sustained light touch
5. Free nerve endings located in the
epidermis respond to pain, light touch,
and temperature variations.
 Derivatives of the skin

1. Hair
2. Nails
3. Sebaceous glands
4. Sweat glands
 Muscles
Arrector pili muscles

–These are smallest skeletal

muscles of the body, are found in
all areas of the skin that contain
hair follicles.
– These tiny muscular structure is
also related to the function of the
sympathetic nervous system
BURNS
 Definitions
• To undergo alteration or destruction
by the action of fire or heat

• A burn is a type of injury

to flesh or skin caused by heat,
electricity ,chemicals friction or
radiation
 Partial thickness

Superficial partial thickness or

Superficial Dermal
• Superficial part of dermis as
well as epidermis involved
• Nerve ending involvement
 Deep partial thickness or Deep
Dermal

• Deep partial thickness or Deep

Dermal
• Destruction of the dermal vascular
plexus
• May have some blistering
• Do not heal spontaneously
 Deep partial thickness or Deep
Dermal

• Deep partial thickness or Deep

Dermal
• Destruction of the dermal vascular
plexus
• May have some blistering
• Do not heal spontaneously
 Full thickness

• Destruction of epidermis and

dermis
• There is white waxy or charred
appearance
• There is capillary destruction
• Loss of sensation
• Children’s skin is much thinner and
therefore more susceptible to deep
burns
• They do not heal spontaneously

• May need surgical intervention and

skin grafting
Causes of Pediatric Burns
EPIDERMAL MALIGNANCY
Viral Skin infection
Bacterial skin infection
Fungal skin infection
Parasitic skin infection
• His reports referred to the lines as elongated
creases following singular ellipsoidal patterns
in different directions based on the specific
body areas.
• The relaxed tension lines used by surgeons
today have been adapted from Langer’s lines.
• Relaxed tension lines have a completely
different functional rationale and anatomical
etiology from dermatome lines and surface
wrinkles.
Clinical Significance
• The skin has many areas of clinical and cosmetic
significance, including anatomical variations,
congenital defects, signs of aging, skin cancers,
acne, infections, and numerous inflammatory
disorders.
• Lines and creases develop over the bony
articulations (joints) and high friction surface
areas, such as the knees and elbows. Contraction
of the skin causes wrinkles that lie perpendicular
to the skeletal muscles underneath the skin,
which act as vectors of physical tension or stress
points.
• The three most common skin cancers
encountered are basal cell carcinoma, squamous
cell carcinoma, and melanoma. Skin cancers are
associated with UV damage, sporadic mutations,
and genetic alterations.
• Acne is one of the most common skin disorders
and results from the plugging of hair follicles with
exfoliated keratinocytes and oil. It is common in
youth but can also affect adults. The extent and
severity vary, including comedones, papules,
pustules, nodules, cysts, and scars.
• Skin infections include cellulitis, erysipelas, and
impetigo caused by staphylococcal and
streptococcal bacteria.
Other Issues
• Dermatomes and Referred Pain
• In the human body, the sensory fibers carrying pain
stimuli are arranged into dermatomes, which are
segmentally distributed across the entire body surface
(illustration below). Dermatomes develop embryo
logically.
• A dermatome functionally represents how sensory
information (e.g., pain) travels from a particular skin
receptor type (e.g., nociceptor) to the corresponding
peripheral nerve then connects to a specific spinal
nerve (cervical; C1–C8, thoracic: T1–T12, lumbar: L1–L5
and sacral: S1–S5), reaching the spinal cord where the
signals ultimately ascend to the brain