The Human Respiratory System

The Pathway
Air enters the nostrils

passes through the nasopharynx,

the oral pharynx

through the glottis

into the trachea

into the right and left bronchi, which branches and rebranches into

bronchioles, each of which terminates in a cluster of

alveoli

Breathing

In mammals, the diaphragm divides the body cavity into the

abdominal cavity, which contains the viscera (e.g., stomach and intestines) and the

thoracic cavity, which contains the heart and lungs.

The inner surface of the thoracic cavity and the outer surface of the lungs are lined with pleural
membranes which adhere to each other. If air is introduced between them, the adhesion is broken and
the natural elasticity of the lung causes it to collapse. This can occur from trauma. And it is sometimes
induced deliberately to allow the lung to rest. In either case, reinflation occurs as the air is gradually
absorbed by the tissues.

Because of this adhesion, any action that increases the volume of the thoracic cavity causes the lungs to
expand, drawing air into them.

During inspiration (inhaling),

The external intercostal muscles contract, lifting the ribs up and out.
 The diaphragm contracts, drawing it down .

During expiration (exhaling), these processes are reversed and the natural elasticity of the lungs
returns them to their normal volume. At rest, we breath 15–18 times a minute exchanging about 500 ml
of air.

In more vigorous expiration,

The internal intercostal muscles draw the ribs down and inward

The wall of the abdomen contracts pushing the stomach and liver upward.

Under these conditions, an average adult male can flush his lungs with about 4 liters of air at each
breath. This is called the vital capacity. Even with maximum expiration, about 1200 ml of residual air
remain.

Diseases of the Lungs

Pneumonia

Pneumonia is an infection of the alveoli. It can be caused by many kinds of both bacteria (e.g.,
Streptococcus pneumoniae) and viruses. Tissue fluids accumulate in the alveoli reducing the surface area
exposed to air. If enough alveoli are affected, the patient may need supplemental oxygen.

Asthma

In asthma, periodic constriction of the bronchi and bronchioles makes it more difficult to breathe in and,
especially, out. Attacks of asthma can be

triggered by airborne irritants such as chemical fumes and cigarette smoke

airborne particles to which the patient is allergic.

Link to discussion of allergic asthma.

Emphysema

In this disorder, the delicate walls of the alveoli break down, reducing the gas-exchange area of the
lungs. The condition develops slowly and is seldom a direct cause of death. However, the gradual loss of
gas-exchange area forces the heart to pump ever-larger volumes of blood to the lungs in order to satisfy
the body's needs. The added strain can lead to heart failure.
The immediate cause of emphysema seems to be the release of proteolytic enzymes as part of the
inflammatory process that follows irritation of the lungs. Most people avoid this kind of damage during
infections, etc. by producing an enzyme inhibitor (a serpin) called alpha-1 antitrypsin. Those rare people
who inherit two defective genes for alpha-1 antitrypsin are particularly susceptible to developing
emphysema.

Chronic Bronchitis

Any irritant reaching the bronchi and bronchioles will stimulate an increased secretion of mucus. In
chronic bronchitis the air passages become clogged with mucus, and this leads to a persistent cough.
Chronic bronchitis is usually associated with cigarette smoking.

Chronic Obstructive Pulmonary Disease (COPD)

Irritation of the lungs can lead to asthma, emphysema, and chronic bronchitis. And, in fact, many people
develop two or three of these together. This constellation is known as chronic obstructive pulmonary
disease (COPD).

Among the causes of COPD are

cigarette smoke (often)

cystic fibrosis (rare)

Cystic fibrosis is a genetic disorder caused by inheriting two defective genes for the cystic fibrosis
transmembrane conductance regulator (CFTR), a transmembrane protein needed for the transport of Cl−
and HCO3− ions through the plasma membrane of epithelial cells. Defective ion transport in the lung
reduces the water content of the fluid in the lungs making it more viscous and difficult for the ciliated
cells to move it up out of the lungs. Precisely how defective CFTR function produces this effect is still
under investigation. In any case, the accumulation of mucus plugs the airways and provides a fertile
breeding ground for pathogenic fungi and bacteria. All of this damages the airways — interfering with
breathing and causing a persistent cough. Cystic fibrosis is the most common inherited disease in the
U.S. white population.

Lung Cancer

Lung cancer is the most common cancer and the most common cause of cancer deaths in U.S. males.
Although more women develop breast cancer than lung cancer, since 1987 U.S. women have been dying
in larger numbers from lung cancer than from breast cancer.
Link to lung cancer data.

Lung cancer, like all cancer, is an uncontrolled proliferation of cells. There are several forms of lung
cancer, but the most common (and most rapidly increasing) types are those involving the epithelial cells
lining the bronchi and bronchioles.

Ordinarily, the lining of these airways consists of two layers of cells. Chronic exposure to irritants

causes the number of layers to increase. This is especially apt to happen at forks where the
bronchioles branch.

The ciliated and mucus-secreting cells disappear and are replaced by a disorganized mass of cells with
abnormal nuclei.

If the process continues, the growing mass penetrates the underlying basement membrane.

Link to illustrations of the cellular changes in developing lung cancer.

At this point, malignant cells can break away and be carried in lymph and blood to other parts of the
body where they may lodge and continue to proliferate.

It is this metastasis of the primary tumor that eventually kills the patient.

cardiovascular systm

Functions of the Cardiovascular System

Knowing the functions of the cardiovascular system and the parts of the body that are part of it are
critical in understanding the physiology of the human body. The cardiovascular system is the system that
keeps life pumping through you with its complex pathways of veins, arteries, and capillaries. The heart,
blood vessels, and blood help to transport vital nutrients throughout the body as well as remove
metabolic waste. They help to protect the body and regulate body temperature.

The cardiovascular system consists of the heart, blood vessels, and blood. This system has three main
functions:

Transport of nutrients, oxygen, and hormones to cells throughout the body and removal of metabolic
wastes (carbon dioxide, nitrogenous wastes, and heat).
 Protection of the body by white blood cells, antibodies, and complement proteins that circulate in the
blood and defend the body against foreign microbes and toxins. Clotting mechanisms are also present
that protect the body from blood loss after injuries.

Regulation of body temperature, fluid pH, and water content of cells.

The Heart

The heart is located in the mediastinum, the cavity between the lungs. The heart is tilted so that its
pointed end, the apex, points downward toward the left hip, while the broad end, the base, faces
upward toward the right shoulder. The heart is surrounded by the pericardium, a sac characterized by
the following two layers:

The outer fibrous pericardium anchors the heart to the surrounding structures.

The inner serous pericardium consists of an outer parietal layer and an inner visceral layer. A thick layer
of serous fluid, the pericardial fluid, lies between these two layers to provide a slippery surface for the
movements of the heart.

The wall of the heart consists of three layers:

The epicardium is the visceral layer of the serous pericardium.

The myocardium is the muscular part of the heart that consists of contracting cardiac muscle and
noncontracting Purkinje fibers that conduct nerve impulses.

The endocardium is the thin, smooth, endothelial, inner lining of the heart, which is continuous with the
inner lining of the blood vessels.

As blood travels through the heart, it enters a total of four chambers and passes through four valves. The
two upper chambers, the right and left atria, are separated longitudinally by the interatrial septum. The
two lower chambers, the right and left ventricles, are the pumping machines of the heart and are
separated longitudinally by the interventricular septum. A valve follows each chamber and prevents the
blood from flowing backward into the chamber from which the blood originated. Two prominent
grooves are visible on the surface of the heart:

The coronary sulcus (artioventricular groove) marks the junction of the atria and ventricles.

The anterior interventricular sulcus and posterior interventricular sulcus mark the junction of the
ventricles on the front and back of the heart, respectively.

The pathway of blood through the chambers and valves of the heart is described as follows (see Figure
1 ):

The right atrium, located in the upper right side of the heart, and a small appendage, the right auricle,
 act as a temporary storage chamber so that blood will be readily available for the right ventricle.
Deoxygenated blood from the systemic circulation enters the right atrium through three veins, the
superior vena cava, the inferior vena cava, and the coronary sinus. During the interval when the
ventricles are not contracting, blood passes down through the right atrioventricular (AV) valve into the
next chamber, the right ventricle. The AV valve is also called the tricuspid valve because it consists of
three flexible cusps (flaps).

The right ventricle is the pumping chamber for the pulmonary circulation. The ventricle, with walls
thicker and more muscular than those of the atrium, contracts and pumps deoxygenated blood through
the three-cusped pulmonary semilunar valve and into a large artery, the pulmonary trunk. The
pulmonary trunk immediately divides into two pulmonary arteries, which lead to the left and right lungs,
respectively. The following events occur in the right ventricle.

When the right ventricle contracts, the right AV valve closes and prevents blood from moving back into
the right atrium. Small tendonlike cords, the chordae tendineae, are attached to papillary muscles at the
opposite, bottom side of the ventricle. These cords limit the extent to which the AV valve can be forced
closed, preventing it from being pushed through and into the atrium.

When the right ventricle relaxes, the initial backflow of blood in the pulmonary artery closes the
pulmonary semilunar valve and prevents the return of blood to the right ventricle.

The left atrium and its auricle appendage receive oxygenated blood from the lungs though four
pulmonary veins (two from each lung). The left atrium, like the right atrium, is a holding chamber for
blood in readiness for its flow into the left ventricle. When the ventricles relax, blood leaves the left
atrium and passes through the left AV valve into the left ventricle. The left AV valve is also called the
mitral or bicuspid valve, the only heart valve with two cusps.

The left ventricle is the pumping chamber for the systemic circulation. Because a greater blood pressure
is required to pump blood through the much more extensive systemic circulation than through the
pulmonary circulation, the left ventricle is larger and its walls are thicker than those of the right ventricle.
When the left ventricle contracts, it pumps oxygenated blood through the aortic semilunar valve, into a
large artery, the aorta, and throughout the body. The following events occur in the left ventricle,
simultaneously and analogously with those of the right ventricle.

When the left ventricle contracts, the left AV valve closes and prevents blood from moving back into the
right atrium. As in the right AV valve, the chordae tendineae prevent overextension of the left AV valve.

When the left ventricle relaxes, the initial backflow of blood in the aorta closes the aortic semilunar valve
and prevents the return of blood to the left ventr

Two additional passageways are present in the fetal heart:

The foramen ovale is an opening across the interatrial septum. It allows blood to bypass the right
ventricle and the pulmonary circuit, while the nonfunctional fetal lungs are still developing. The opening,
which closes at birth, leaves a shallow depression called the fossa ovalis in the adult heart.
The ductus arteriosus is a connection between the pulmonary trunk and the aorta. Blood that enters the
right ventricle is pumped out through the pulmonary trunk. Although some blood enters the pulmonary
arteries (to provide oxygen and nutrients to the fetal lungs), most of the blood moves directly into the
aorta through the ductus arteriosus.

The coronary circulation consists of blood vessels that supply oxygen and nutrients to the tissues of the
heart. Blood entering the chambers of the heart cannot provide this service because the endocardium is
too thick for effective diffusion (and only the left side of the heart contains oxygenated blood). Instead,
the following two arteries that arise from the aorta and encircle the heart in the artioventricular groove
provide this function:

The left coronary artery has the following two branches: The anterior interventricular artery (left anterior
descending, or LAD, artery) and the circumflex artery.

The right coronary artery has the following two branches: The posterior interventricular artery and the
marginal artery.

Blood from the coronary circulation returns to the right atrium by way of an enlarged blood vessel, the
coronary sinus. Three veins, the great cardiac vein, the middle cardiac vein, and the small cardiac vein,
feed the coronary sinus.

Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels, and is
one of the principal vital signs. During each heartbeat, BP varies between a maximum (systolic) and a
minimum (diastolic) pressure.[1] The mean BP, due to pumping by the heart and resistance to flow in
blood vessels, decreases as the circulating blood moves away from the heart through arteries. Blood
pressure drops most rapidly along the small arteries and arterioles, and continues to decrease as the
blood moves through the capillaries and back to the heart through veins.[2] Gravity, valves in veins, and
pumping from contraction of skeletal muscles, are some other influences on BP at various places in the
body.

What Is Sudden Cardiac Arrest?

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating. If
this happens, blood stops flowing to the brain and other vital organs.

SCA usually causes death if it's not treated within minutes.

Overview

To understand SCA, it helps to understand how the heart works. The heart has an electrical system that
controls the rate and rhythm of the heartbeat. Problems with the heart's electrical system can cause
irregular heartbeats called arrhythmias (ah-RITH-me-ahs).
 There are many types of arrhythmias. During an arrhythmia, the heart can beat too fast, too slow, or
with an irregular rhythm. Some arrhythmias can cause the heart to stop pumping blood to the body—
these arrhythmias cause SCA.

SCA is not the same as a heart attack. A heart attack occurs if blood flow to part of the heart muscle is
blocked. During a heart attack, the heart usually doesn't suddenly stop beating. SCA, however, may
happen after or during recovery from a heart attack.

People who have heart disease are at higher risk for SCA. However, SCA can happen in people who
appear healthy and have no known heart disease or other risk factors for SCA.

Outlook

Most people who have SCA die from it—often within minutes. Rapid treatment of SCA with a
defibrillator can be lifesaving. A defibrillator is a device that sends an electric shock to the heart to try to
restore its normal rhythm.

Automated external defibrillators (AEDs) can be used by bystanders to save the lives of people who are
having SCA. These portable devices often are found in public places, such as shopping malls, golf courses,
businesses, airports, airplanes, casinos, convention centers, hotels, sports venues, and schools.

peripheral system

The nervous system consists of the brain, spinal cord, and a complex network of neurons. This system is
responsible for sending, receiving, and interpreting information from all parts of the body. The nervous
system monitors and coordinates internal organ function and responds to changes in the external
environment. This system can be divided into two parts: the central nervous system and the peripheral
nervous system.

Peripheral Nervous System

There are two types of cells in the peripheral nervous system. These cells carry information to (sensory
nervous cells) and from (motor nervous cells) the central nervous system (CNS). Cells of the sensory
nervous system send information to the CNS from internal organs or from external stimuli.
 Motor nervous system cells carry information from the CNS to organs, muscles, and glands. The motor
nervous system is divided into the somatic nervous system and the autonomic nervous system. The
somatic nervous system controls skeletal muscle as well as external sensory organs such as the skin. This
system is said to be voluntary because the responses can be controlled consciously. Reflex reactions of
skeletal muscle however are an exception. These are involuntary reactions to external stimuli.

The autonomic nervous system controls involuntary muscles, such as smooth and cardiac muscle. This
system is also called the involuntary nervous system. The autonomic nervous system can further be
divided into the parasympathetic and sympathetic divisions.

The parasympathetic division controls various functions which include inhibiting heart rate, constricting
pupils, and contracting the bladder. The nerves of the sympathetic division often have an opposite effect
when they are located within the same organs as parasympathetic nerves. Nerves of the sympathetic
division speed up heart rate, dilate pupils, and relax the bladder. The sympathetic system is also involved
in the flight or fight response. This is a response to potential danger that results in accelerated heart rate
and an increase in metabolic rate.

Peripheral Nervous System Divisions

The peripheral nervous system is divided into the following sections:

Peripheral Nervous System

Sensory Nervous System - sends information to the CNS from internal organs or from external stimuli.

Motor Nervous System - carries information from the CNS to organs, muscles, and glands.

Somatic Nervous System - controls skeletal muscle as well as external sensory organs.

Autonomic Nervous System - controls involuntary muscles, such as smooth and cardiac muscle.

Sympathetic - controls activities that increase energy expenditures.

Peripheral Nerve Disorders

Many of us have experienced severe burning, numbness, and tingling after hitting our "funny bone." This
is caused by trauma to the ulnar nerve at the elbow. Similar discomfort may be brought on by sleeping
on an arm or leg in a funny position.

The brain and spinal cord are considered the Central Nervous System. Incoming and outgoing
information travel in the nerves of the arm similar to a telephone wire. These nerves are considered the
Peripheral Nervous System. Information regarding the environment such as hot, cold, and the position of
our pen are carried on sensory nerves. Motor nerves carry bioelectrical information to muscle, resulting
in contraction and movement. The other components of this peripheral system are the neuromuscular
junction where the nerve meets the muscle and the muscle itself.

Neuropathy is a disorder that prevents nerves from functioning properly. It can cause paralysis if a nerve
is completely lacerated, although total paralysis is rare in people with neuropathy. Rather, the disease
causes varying degrees of weakness, depending on the type and severity of the neuropathy.

Peripheral neuropathy involves damage to the peripheral nerves that transmit pain and temperature
sensations, and can prevent people from sensing that they have been injured from a cut or that a wound
is becoming infected. Pain receptors in the skin can also become over-sensitized, so that people may feel
severe pain from stimuli that are normally painless (for example, some may experience pain from bed
sheets draped lightly over the body).

Examples of peripheral nerve disorders include:

Guillain-Barre´ Strohl Syndrome: Since the polio vaccine came into widespread use, GBS has become the
most common remaining cause of acute neuromuscular paralysis. An acute, ascending, and progressive
neuropathy characterized by weakness, paresthesias, and hyporeflexia. In the early 1900s, Guillain, Barre
´, and Strohl first described the syndrome in 2 patients who spontaneously recovered from a progressive
ascending motor weakness with areflexia, paresthesias, sensory loss, and an elevated level of
cerebrospinal fluid (CSF) protein.

Chronic Inflammatory Demyelinating Polyneuropathy (CIPD)

Polyneuropathies

Diabetic Neuropathies: Tingling in the feet may be caused by a peripheral neuropathy. Early evaluation
with laboratory studies may uncover potentially treatable disease such as diabetes and vitamin B12
 deficiency.

Mononeuropathies: Isolated numbness of the hands brought on by excessive keyboard work may be
identified as Carpal Tunnel Syndrome, also a treatable problem. Ulnar neuropathies are also included as
a type of mononeuropathy.

Peripheral Nerve Injuries

Amyotrophic Lateral Sclerosis (ALS): Gehrig's disease, a disorder of the motor nerves resulting in
progressive weakness of the limbs, facial and respiratory muscles, is the most serious of the
neuromuscular disorders.

Radiculopathies

Small Fiber Neuropathies

Occupational Neuropathies: Industrial and athletic injuries to nerves such as the stinger in football result
in arm weakness and tingling.

Causes

Returning to the example of hitting your elbow, tingling in your hands is caused by injury to the sensory
nerve. If the blow is severe, we may also experience weakness, implying injury to the motor portion of
the nerve. In spite of the discomfort, we take solace in the fact that the symptoms are transient and we
will soon be back to normal. In some individuals, their motor and sensory problems persist and even
progress.

Peripheral neuropathy can result from

diabetes

Nerve compression or entrapment

Trauma

Penetrating injuries

Fracture or dislocated bones

Tumor

Intraneural hemorrhage

Exposure to cold or radiation

Rarely, certain medicines or toxic substances

Vascular or collagen disorders such as atherosclerosis, lupus, scleroderma, sarcoidosis, and rheumatoid
arthritis.

In some cases, neuropathy is caused by heredity, vitamin deficiency, infection, and kidney disease.
 Symptoms

Peripheral neuropathy produces symptoms such as weakness, muscle cramps, twitching, pain,
numbness, burning, and tingling (often in the feet and hands). Symptoms are related to the type of
affected nerve and may be seen over a period of days, weeks, or years. Neuropathic pain is difficult to
control and can seriously affect emotional well-being and overall quality of life. Neuropathic pain is often
worse at night, seriously disrupting sleep and adding to the emotional burden of sensory nerve damage.

Motor nerve damage causes muscle weakness, and symptoms may include painful cramps and muscle
twitching, muscle loss, bone degeneration, and changes in the skin, hair, and nails.

Sensory nerve damage may result in a general sense of numbness, especially in the hands and feet.
People may feel as if they are wearing gloves and stockings even when they are not. Damage to these
fibers may cause people to become insensitive to injury from a cut or that a wound is becoming infected.
Others may not detect pains that warn of impending heart attack or other acute conditions. Pain
receptors in the skin can also become oversensitized, so that people may feel severe pain from stimuli
that are normally painless (for example, some may experience pain from bed sheets draped lightly over
the body).

breast

1 Chest wall 2 Pectoralis muscles

3 Lobules 4 Nipple surface 5 Areola 6 Lactiferous duct7

8 Skin

The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female
contains the mammary gland that secretes milk used to feed infants. Both men and women develop
breasts from the same embryological tissues. However, at puberty, female sex hormones, mainly
estrogen, promote breast development which does not occur in men as a result of the higher level of
testosterone. As a result, women's breasts become far more prominent than those of men.

Anatomically, breasts are modified sudoriferous (sweat) glands which produce milk in women, and in
some rare cases, in men.[4] Each breast has one nipple surrounded by the areola. The color of the areola
varies from pink to dark brown and has several sebaceous glands. In women, the larger mammary glands
within the breast produce the milk. They are distributed throughout the breast, with two-thirds of the
tissue found within 30 mm of the base of the nipple.[5] These are drained to the nipple by between 4
and 18 lactiferous ducts, where each duct has its own opening. The network formed by these ducts is
complex, like the tangled roots of a tree. It is not always arranged radially, and branches close to the
nipple. The ducts near the nipple do not act as milk reservoirs; Ramsay et al. have shown that
conventionally described lactiferous sinuses do not, in fact, exist. Instead, most milk is actually in the
back of the breast, and when suckling occurs, the smooth muscles of the gland push more milk forward.

The remainder of the breast is composed of connective tissue (collagen and elastin), adipose tissue (fat),
 and Cooper's ligaments. The ratio of glands to adipose tissues rises from 1:1 in nonlactating women to
2:1 in lactating women.[5]

The breasts sit over the pectoralis major muscle and usually extend from the level of the 2nd rib to the
level of the 6th rib anteriorly. The superior lateral quadrant of the breast extends diagonally upwards
towards the axillae and is known as the tail of Spence. A thin layer of mammary tissue extends from the
clavicle above to the seventh or eighth ribs below and from the midline to the edge of the latissimus
dorsi posteriorly. (For further explanation, see anatomical terms of location.)

The arterial blood supply to the breasts is derived from the internal thoracic artery (formerly called the
internal mammary artery), lateral thoracic artery, thoracoacromial artery, and posterior intercostal
arteries. The venous drainage of the breast is mainly to the axillary vein, but there is some drainage to
the internal thoracic vein and the intercostal veins. Both sexes have a large concentration of blood
vessels and nerves in their nipples. The nipples of both women and men can become erect in response
to sexual stimuli,[6] to touch, and to cold.

The breast is innervated by the anterior and lateral cutaneous branches of the fourth through sixth
intercostal nerves. The nipple is supplied by the T4 dermatome.

Breast cancer (malignant breast neoplasm) is cancer originating from breast tissue, most commonly from
the inner lining of milk ducts or the lobules that supply the ducts with milk.[1] Cancers originating from
ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas.

The size, stage, rate of growth, and other characteristics of the tumor determine the kinds of treatment.
Treatment may include surgery, drugs (hormonal therapy and chemotherapy), radiation and/or
immunotherapy.[2] Surgical removal of the tumor provides the single largest benefit, with surgery alone
being capable of producing a cure in many cases. To somewhat increase the likelihood of long-term
disease-free survival, several chemotherapy regimens are commonly given in addition to surgery. Most
forms of chemotherapy kill cells that are dividing rapidly anywhere in the body, and as a result cause
temporary hair loss and digestive disturbances. Radiation may be added to kill any cancer cells in the
breast that were missed by the surgery, which usually extends survival somewhat, although radiation
exposure to the heart may cause heart failure in the future.[3] Some breast cancers are sensitive to
hormones such as estrogen and/or progesterone, which makes it possible to treat them by blocking the
effects of these hormones.

Prognosis and survival rate varies greatly depending on cancer type and staging. With best treatment
and dependent on staging, 5-year relative survival varies from 98% to 23, with an overall survival rate of
85%.

Worldwide, breast cancer comprises 22.9% of all non-melanoma skin cancers in women. In 2008, breast
cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women).Breast cancer is more than
100 times more common in women than breast cancer in men, although males tend to have poorer
outcomes due to delays in diagnosis.

axilla

Known commonly as the armpit, a pyramid-shaped space between the upper part of the arm and the
side of the chest. It forms an important passage for nerves, blood, and lymph vessels as they travel from
the root of the neck to the upper limb.
 The upper end of the axilla, or apex, is directed into the root of the neck and is bounded in front by the
clavicle, behind by the upper border of the scapula, and medially by the outer border of the first rib. The
lower end, or base, is bounded in front by the anterior axillary fold (formed by the lower border of the
pectoralis major muscle), behind by the posterior axillary fold (formed by the tendon of latissimus dorsi
and the teres major muscle), and medially by the chest wall.

The walls of the axilla are made up as follows:

Anterior wall, by the pectoralis major, subclavius, and pectoralis minor muscles, the clavipectoral
fascia, and the suspensory ligament of the axilla.

Posterior wall, by the subscapularius, latissimus dorsi, and teres major muscles from above down.

Medial wall, by the upper four or five ribs and the intercostal spaces covered by the serratus anterior
muscle.

Lateral wall, by the coracobrachialis and biceps muscles in the bicipital groove of the humerus,

The base is formed by the skin stretching between the anterior and posterior walls.

Diseases of Lymph Glands

Lymphadenitis.—Inflammation of lymph glands results from the advent of an irritant, usually bacterial or
toxic, brought to the glands by the afferent lymph vessels. These vessels may share in the inflammation
and be the seat of lymphangitis, or they may show no evidence of the passage of the noxa. It is
exceptional for the irritant to reach the gland through the blood-stream.

A strain or other form of trauma is sometimes blamed for the onset of lymphadenitis, especially in the
glands of the groin (bubo), but it is usually possible to discover some source of pyogenic infection which
is responsible for the mischief, or to obtain a history of some antecedent infection such as gonorrhœa. It
is possible for gonococci to lie latent in the inguinal glands for long periods, and only give rise to
lymphadenitis if the glands be subsequently subjected to injury. The glands most frequently affected are
those in the neck, axilla, and groin.

The characters of the lymphadenitis vary with the nature of the irritant. Sometimes it is mild and
evanescent, as in the glandular enlargement in the neck which attends tonsillitis and other forms of sore
throat. Sometimes it is more persistent, as in the enlargement that is associated with adenoids,
hypertrophied tonsils, carious teeth, eczema of the scalp, and otorrhœa; and it is possible that this
indolent enlargement predisposes to tuberculous infection. A similar enlargement is met with in the
axilla in cases of chronic interstitial mastitis, and in the groin as a result of chronic irritation about the
external genitals, such as balanitis.

Sometimes the lymphadenitis is of an acute character, and the tendency is towards the formation of an
abscess. This is illustrated in the axillary glands as a result of infected wounds of the fingers; in the
femoral glands in infected wounds or purulent blisters on the foot; in the inguinal glands in gonorrhœa
and soft sore; and in the cervical glands in the severer forms of sore throat associated with diphtheria
and scarlet fever. The most acute suppurations result from infection with streptococci.

Superficial glands, when inflamed and suppurating, become enlarged, tender, fixed, and matted to one
another. In the glands of the groin the suppurative process is often remarkably sluggish; purulent foci
form in the interior of individual glands, and some time may elapse before the pus erupts through their
respective capsules. In the deeply placed cervical glands, especially in cases of streptococcal throat
infections, the suppuration rapidly involves the surrounding cellular tissue, and the clinical features are
those of an acute cellulitis and deeply seated abscess. When this is incised the necrosed glands may be
found lying in the pus, and on bacteriological examination are found to be swarming with streptococci. In
suppuration of the axillary glands the abscess may be quite superficial, or it may be deeply placed
beneath the strong fascia and pectoral muscles, according to the group of glands involved.

MUSCULAR SYSTEM

All of the bones, cartilage, muscles, joints, tendons and ligaments in a person's body compose what is
known as the musculoskeletal system. The bones provide the body with a framework, giving it shape and
support; they also serve as protection for internal organs such as the lungs and liver. Muscles are fibers
that help to make deliberate movement of a body part or involuntary movement within an internal
organ possible. Some people view the musculoskeletal system as two body systems in one or two
systems that work very closely together, with one being the muscular system and the other being the
skeletal system.

The bones of the musculoskeletal system are categorized according to their appearance or shape —
short, long, flat and irregular. For example, the humerus, or bone of the upper arm, and the femur, or
thigh bone, are long. The vertebrae, which protect the spinal cord, are irregularly shaped.

Muscular Disorders
There are around 640 named muscles in the human body - in addition to thousands of smaller (un-
named) muscles.

Knowledge of muscle structure and familarisation with the major muscles of the body is an essential part
of training in many therapies - such as Massage, Aromatherapy, Shiatsu, and many others.

This page summarises basic information about some of the most common muscular diseases and
disorders.

The following table lists key terms in alphabetical order.

Atony-A state in which muscles are floppy, lacking their normal elasticity.

Atrophy-Generally, the wasting away of a normally developed organ or tissue due to degeneration of
cells. In the case of muscle tissue, the individual muscle fibers decrease in size due to a progressive loss
of myofibrils.

Cramp-Prolonged painful involuntary contraction of skeletal muscle.

It is sometimes caused by an imbalance of the salts in the body, but is more often a result of fatigue,
imperfect posture, or stress.

Fibrositis-Inflammation of fibrous connective tissues in muscles. It often affects the muscles of the trunk
and back

Muscle Fatigue-Tiredness following prolonged or intense activity.

Myositis-Inflammation of muscle fibers / Any of a group of muscle diseases in which inflammation and
degenerative changes occur.

Spasm-A sustained involuntary muscular contraction (which may occur either as part of a generalized
disorder such as spastic paralysis, or as a local response to an otherwise unconnected painful condition.)

= Muscular Hypertonicity (i.e. an increase in the state of readiness of muscle fibers to contract; an
increase in partial contraction) with an increased resistance to stretch. Moderate cases show movement
requiring great effort and a lack of normal coordination, while slight cases show exaggerated movements
that are coordinated.

Sprain-Injury to a ligament, caused by overstretching.

Overstretching of ligament.
Strain-Excessive stretching or working of a muscle, resulting in pain and swelling of the muscle.

Damage to muscle caused by overstretching.

genu varum-(also called bow-leggedness, bandiness, bandy-leg, and tibia vara), is a physical deformity
marked by (outward bowing) of the leg in relation to the thigh, giving the appearance of an archer's bow.
Usually medial angulation of both femur and tibia is involved.

genu valgum-commonly called "knock-knees", is a condition where the knees angle in and touch one
another when the legs are straightened.

Fig. 479. - Kyphosis or angular anteroposterior curvature, usually due to caries of the bodies of the
vertebras.

Fig. 480. - Lordosis or hollow-back, caused by congenital luxation of the hips.

Fig. 481. - Scoliosis or lateral curvature of the spine.

Flexion-Bending a joint; decreases

Hyperextension-moving past extension

Abduction-moving away from midline

Adduction-moving toward the midline

Int. rotation-rotating toward midline

Ext. rotation-rotating away from midline

Circumduction-rotating in complete circle

Human abdomen

Anatomy of the human abdomen.

Functionally, the human abdomen is where most of the alimentary tract is placed and so most of the
absorption and digestion of food occurs here. The alimentary tract in the abdomen consists of the lower
esophagus, the stomach, the duodenum, the jejunum, ileum, the cecum and the appendix, the
ascending, transverse and descending colons, the sigmoid colon and the rectum. Other vital organs
inside the abdomen include the liver, the kidneys, the pancreas and the spleen.

The abdominal wall is split into the posterior (back), lateral (sides), and anterioriet (front) walls

viscera

Viscera: The internal organs of the body, specifically those within the chest (as the heart or lungs) or
abdomen (as the liver, pancreas or intestines).

The singular of "viscera" is "viscus" meaning in Latin "an organ of the body."

solid viscera

The liver is usually included during radiation treatment to the stomach, pancreas, and thoracolumbar
spine. The tolerance of the whole liver is 30-35 Gy in conventional fractionation, but parts of the liver
can be treated with doses in excess of 70 Gy with 3D radiation therapy treatment planning. Radiation-
induced liver disease (RILD), or radiation hepatitis, is a clinical syndrome of anicteric ascites and
 hepatomegaly occurring 2 weeks to 4 months after hepatic irradiation as a result of venoocclusive
disease [1]. The irradiated liver appears hypodense on unenhanced CT scans. This CT finding can also be
seen in patients who receive more than 45 Gy to a portion of the liver, regardless of whether they
develop RILD. Patients are usually asymptomatic if the nonirradiated liver is healthy. The irradiated liver
is hypodense with well-defined linear margins that conform to radiation portals (Figs. 1A, 1B, 1C, and
1D). In a fatty liver, the CT density pattern may be reversed (Figs. 2A and 2B). The irradiated area can
enhance more than adjacent liver because of increased arterial flow or delayed clearance of contrast
material from radiation-induced venoocclusive disease. On MR images, increased water within the
irradiated liver causes T1-weighted hypointensity and T2-weighted hyperintensity (Figs. 3A, 3B, 3C, and
3D).

ascites

What is ascites?

Ascites is the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) in the
abdominal (peritoneal) cavity. The abdominal cavity is located below the chest cavity, separated from it
by the diaphragm. Ascitic fluid can have many sources such as liver disease, cancers, congestive heart
failure, or kidney failure.

What causes ascites?

The most common cause of ascites is advanced liver disease or cirrhosis. Approximately 80% of the
ascites cases are thought to be due to cirrhosis. Although the exact mechanism of ascites development is
not completely understood, most theories suggest portal hypertension (increased pressure in the liver
blood flow) as the main contributor. The basic principle is similar to the formation of edema elsewhere in
the body due to an imbalance of pressure between inside the circulation (high pressure system) and
outside, in this case, the abdominal cavity (low pressure space). The increase in portal blood pressure
and decrease in albumin (a protein that is carried in the blood) may be responsible in forming the
pressure gradient and resulting in abdominal ascites.

Other factors that may contribute to ascites are salt and water retention. The circulating blood volume
may be perceived low by the sensors in the kidneys as the formation of ascites may deplete some
volume from the blood. This signals the kidneys to reabsorb more salt and water to compensate for the
volume loss.
Some other causes of ascites related to increased pressure gradient are congestive heart failure and
advanced kidney failure due to generalized retention of fluid in the body.

In rare cases, increased pressure in the portal system can be caused by internal or external obstruction of
the portal vessel, resulting in portal hypertension without cirrhosis. Examples of this can be a mass (or
tumor) pressing on the portal vessels from inside the abdominal cavity or blood clot formation in the
portal vessel obstructing the normal flow and increasing the pressure in the vessel (for example, the
Budd-Chiari syndrome).

There is also ascites formation as a result of cancers, called malignant ascites. These types of ascites are
typically manifestations of advanced cancers of the organs in the abdominal cavity, such as, colon cancer,
pancreatic cancer, stomach cancer, breast cancer, lymphoma, lung cancer, or ovarian cancer.

Pancreatic ascites can be seen in people with chronic (long standing) pancreatitis or inflammation of
pancreas. The most common cause of chronic pancreatitis is prolonged alcohol abuse. Pancreatic ascites
can also be caused by acute pancreatitis as well as trauma to the pancreas.

What are the types of ascites?

Traditionally, ascites is divided into 2 types; transudative or exudative. This classification is based on the
amount of protein found in the fluid.

A more useful system has been developed based on the amount of albumin in the ascitic fluid compared
to the serum albumin (albumin measured in the blood). This is called the Serum Ascites Albumin
Gradient or SAAG.

Ascites related to portal hypertension (cirrhosis, congestive heart failure, Budd-Chiari) is generally
greater than 1.1.

Ascites caused by other reasons (malignant, pancreatitis) is lower than 1.1.

What are the risk factors for ascites?

The most common cause of ascites is cirrhosis of the liver. Many of the risk factors for developing ascites
and cirrhosis are similar. The most common risk factors include hepatitis B, hepatitis C, and long standing
alcohol abuse. Other potential risk factors are related to the other underlying conditions, such as
congestive heart failure, malignancy, and kidney disease.

What are the symptoms of ascites?

There may be no symptoms associated with ascites especially if it is mild (usually less than about 100 –
400 ml in adults). As more fluid accumulates, increased abdominal girth and size are commonly seen.
Abdominal pain, discomfort, and bloating are also frequently seen as ascites becomes larger. Shortness
of breath can also happen with large ascites due to increased pressure on the diaphragm and the
migration of the fluid across the diaphragm causing pleural effusions (fluid around the lungs). A
cosmetically disfiguring large belly, due to ascites, is also a common concern of some patients.
 neurologic system

Brudzinski's sign of meningitis:

Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is
flexed to 90 degrees.