PHYSIOLOGY

Dr. MOHAMMED AL-NOAEMI

 Syllabus ‫المنهج‬
• Introduction
• Blood Physiology
• Physiology of the cardiovascular system
• Physiology of the respiratory system
• Physiology of the nervous system
• Physiology of the endocrine & reproductive system
• Physiology of the digestive system [GIT]
• Physiology of the renal system
• Text book: Physiology in the Library ‫الكتاب في المكتبة‬
 Introduction
Physiology: is the science that studies the functions
of body organs. ‫علم وظائف االعضاء‬
• Biology is the science that studies life and living
organisms. (Human, Animal, Plants). ‫علم االحياء‬
• Pathophysiology: is the science that studies
changes in physiology [changes in function ‫تغيرات في‬
‫الوظائف‬
• Anatomy is the science that studies body
structures.
• Pharmacology science that studies drugs
 Heart (Physiology & Pathophysiology)
• Physiology: It Pumps 5 liters/minute (Normal Function).

• Changes in the normal: Pathophysiology…causing Disease

• Ex: If the heart pumps 2 liters/minute…. Heart failure.
 Introduction
• Autonomic Nervous System (ANS)
• (Sympathetic & Parasympathetic NS)
 Nervous System (NS) consists of:
Central Nervous system (CNS) Peripheral Nervous System (PNS)
Brain & Cranial nerves &
Spinal Cord Spinal nerves &
Autonomic nerves
Peripheral Nervous system

• PNS consists of:

1. Cranial Nerves
2. Spinal Nerves
3. Autonomic Nerves
Sympathetic &
Parasympathetic
 Autonomic Nervous system
(Sympathetic & Parasympathetic Nerves)
• The autonomic nervous system is a component
of the peripheral nervous system
• that regulates involuntary
• physiologic processes including
• heart rate, blood pressure,
• respiration, digestion, and sexual
• arousal.
Pre & Post Ganglionic Nerve fibers
 Sympathetic Nervous System
• Anatomically, the preganglionic sympathetic nerve fibers
originate from the spinal cord segments (T1- L2). They
synapse with the sympathetic-chain ganglia which are
present on both sides of the spinal cord. Then post
sympathetic nerve fibers originate from these ganglia to
supply the target organs. The cervical ganglia (superior,
middle, and inferior) does not receive preganglionic nerve
fibers from the cervical segments, but from the thoracic
segments, which passes through the upper thoracic
ganglia. Postganglionic nerve fibers from the cervical
ganglia will the supply head and neck. While the
postganglionic fibers from the thoracic ganglia will supply
the thoracic, abdominal, and pelvic viscera.
• The preganglionic nerve fibers are short, while the
postganglionic nerve fibers are longer. The preganglionic
sympathetic nerve fibers secretes acetylcholine while the
postganglionic fibers secrets noradrenalin.
• Help us deal with emergencies.
• For instance, if the temperature of a room is hot,
the sympathetic system will encourage the body to
sweat in response to this change.
• The most noticeable function of the sympathetic
branch is during the fight-or-flight response. During
conditions that are considered threatening or
stressful, the sympathetic system activates,
providing an automatic response.
• For example, when walking home alone down a
dark street, this can be a scary situation for many
people. Whilst walking, your pupils may dilate, your
heart rate may increase, and you may be sweating.
• The purpose of stimulating these bodily responses
is to prepare the individual to either escape or fight
in dangerous situations.
Pre & Post Ganglionic Sympathetic Nerve Fibers
 Spinal Nerve Carry Symp. n.f.

• Spinal
Nerve
 The Sympathetic Plexuses
Usually mixed plexuses with parasympathetic fibres
The internal & external carotid, receive fibres from the carotid
nerve & are distributed with the branches
Cardiac & pulmonary plexuses receive cervical & thoracic cardiac
branches
The oesophageal receives fibres from the thoracic SN
The coeliac, renal, superior & inferior mesenteric receive fibres
from the thoracic splanchnic through the prevertebral ganglia
(same names)
The aortic & superior hypogastric are extensions of the coeliac &
mesenteric
The inferior hypogastric receive from the lumbar SN
• The parasympathetic nervous system that relaxes
the individual once the emergency has passed (eg.
slows the heart rate down and reduces blood
pressure) and conserves the body’s natural
activity by decreasing activity/maintaining it.
• The parasympathetic nervous system is associated
with returning the body to resting state functions.
This makes the parasympathetic nervous system
important in supporting homeostasis.
• Therefore, it is important for ensuring we return
to normal after a stressful situation.
• Parasympathetic nerve fibers from the brain will pass to the
target organs along with the cranial nerves (III, VII, IX, and
X) (1973), but the main parasympathetic cranial nerve is
the vagus nerve(X), which carries about70-80% of the
parasympathetic activity. The vagus nerve will supply the
thoracic, abdominal viscera, while the terminal part of the
large intestine and the pelvic sex organs will be supplied by
the sacral parasympathetic fibers. The oculomotor (III),
facial (VII), and glossopharyngeal (IX) will supply the head
and neck by parasympathetic nerve fibers.
 Parasympathetic Nervous System
• Anatomically, the preganglionic parasympathetic
nerve fibers originate mainly from the brain, few
fibers originate from the terminal part of the spinal
cord (S2-S4). These fibers synapse with the
parasympathetic ganglia which are present near the
target organs. Therefore, the preganglionic fibers
will be long and the postganglionic fibers will be
short. The pre and post parasympathetic nerve
fibers secrete acetylcholine.
 Parasympathetic Cranial Outflow (brain stem)
• Preganglionic fibers run via
– Oculomotor nerve (III).
– Facial nerve (VII)
– Vagus nerve (X)
– Glossopharyngeal nerve (IX)
Outflow via the Oculomotor Nerve (III)

• Parasympathetic fibers innervate smooth

cilary muscles in the eye,
– Cause pupil constriction.
 Outflow via the Facial Nerve (VII)

• Parasympathetic fibers stimulate secretion of

glands in the head as lacrimal, sub-mandibular
and sub-lingual glands.
 Outflow via the Glossopharyngeal Nerve (IX)

• Parasympathetic fibers
– Stimulate secretion of glands in the head
 Outflow via the Vagus Nerve (X)
• Fibers innervate visceral organs of the thorax and
most of the abdomen
• Stimulates
– Digestion, reduction in heart rate and reduction in blood
pressure
 Sacral Outflow

Emerges from S2–S4

• Innervates organs of the pelvis and lower abdomen
 The Parasympathetic
Preganglionic neurons are in the brain stem & the spinal cord
(3rd & 4th & may be 2nd sacral)
In the brain stem they are in the nucleii of cranial nerves III, VII,
IX, & X

Namely the Edinger-Westphal, Superior salivatory, inferior

salivatory & dorsal vagal

The preganglionic fibres pass with these cranial nerves to

parasympathetic ganglia in the head

Sacral preganglionic fibres (sacral or pelvic splanchnic nerves or

nervi eregentis) pass through plexuses without synapsing
 Parasympathetic Ganglia
There are four parasymp. ganglia in the head

The ciliary receives PGFs from the occulomotor & the postg. pass
to the constrictor pupilae & the ciliary muscles

Pterygopalatine receives PGFs (of the nervus intermedius) through

the greater petrosal (of the facial) & then nerve of pterygoid canal

The submandibular receives PGFs through the chorda typani of

the facial-NI through the lingual

The otic receives PGFs of IX through the lesser petrosal, postg.

supply parotid through auriculot.
Pre & Post Autonomic ganglionic Nerve fibers
 Chemical Neurotransmitters
• Pre and postganglionic parasympathetic nerve
fibers secretes Acetylcholine.
• Preganglionic sympathetic nerve fibers secret
acetylcholine. While post ganglionic sympathetic
nerve fibers secret noradrenaline.
Synapse

• The release of the chemical neurotransmitter

 MCQ

• The following supply the head and neck with

parasympathetic nerve fibers except.
• A. Oculomotor (III).
• B. Facial (VII).
• C. Glossopharyngeal (IX).
• D. Vagus (X).
 Parasympathetic cranial nerves
• Oculomotor nerve [III] (3)
• Facial nerve [VII] (7)
• Glossopharyngeal nerve [IX] (9)
• Vagus nerve [X] (10)
• Which of the following cranial nerve that carries parasympathetic nerve
fibers
• A. I
• B. II
• C. III
• D. V
• E. VIII
• The Autonomic Nervous System
 Anatomical differences between
Sympathetic & Parasympathetic NS
Sympathetic N.S. Parasympathetic N.S.

Origin (Location) From spinal cord Brain & few from sacrum
(thoracolumbar) (craniosacral)
Nerves Spinal nerves Cranial nerves

Ganglion Far from target organ Near target organ

Preganglionic nerve fiber Short Long

Postganglionic nerve fibers long Short

Secretion Pregang n.f. secret Acetylcholin Acetylcholin (pre & post

Postgang n.f. secrete Adrenalin ganglionic n.f.)
 Functions (Effects) of the SNS and PSNS
Target organ Sympathetic NS [Stress] Parasympathetic NS[Relax]
Heart increase heart rate decrease heart rate
increase stroke volume decrease stroke volume
Coronary arteries Vasodilatation Vasoconstriction
increase cardiac output decrease cardiac output
Lungs bronchodilation bronchoconstriction
Eye pupillary dilation pupillary constriction
Saliva Decrease secretion Increase secretion
GIT secretion Decreased Increased
GIT motility Decreased Increased
Sweat Glands Increase secretion (Ach) No innervation
Glands (nasal, Inhibits secretory activity Stimulates secretory activity
lacrimal, gastric ,
pancreas)
 Functions (Effects) of the SNS and PSNS
Target organ Sympathetic NS [Stress] Parasympathetic NS[Relax]
Adipose tissue Stimulates lipolysis No innervation
(breakdown of lipid)

Liver Stimulates glucose release to No effects

the blood
Gallbladder Inhibits bile secretion Stimulates bile secretion
Adrenal medulla Stimulates secretion No innervation
(Adrenaline, noradrenaline)
Mental activity Increase alertness No innervation
(CNS stimulation)
 Functions (Effects) of the SNS and PSNS
Target organ Sympathetic NS [Stress] Parasympathetic NS[Relax]
Urinary Bladder Relaxation of bladder & Contraction of bladder
contraction of sphincters Relaxation of sphincters
Inhibits voiding (urination) Stimulates voiding (urination)
Penis Causes ejaculation Causes erection (vasodilation)
Vagina & Clitoris Contraction of vagina Erection of clitoris
(vasodilation)
Blood vessels Constrict most of abdominal Little or no effects
and skin vessels to divert blood
to the brain, heart and muscle.
But Dilates skeletal muscle
vessels during exercise
(cholinergic effect)
•
 Central Control
The autonomic system is influenced by centres in the reticular
fomation of the brain stem (vasopressor, vasodilator,
cardioaccelerator, cardiodecelerator & respiratory)

These are under the modulatory effect of the anterior

(parasympathetic) & posterior (sympathetic) hypothalamic nucleii

They exert their effects through the descending tracts of the

reticular formation
The hypothalamic function is influenced by the cortex, the limbic
system (emotions), olfactory inputs & direct thermoreception &
osmoreception
Disorders that affect the autonomic
nervous system?
• Autonomic neuropathy:
• Uncontrolled Type 2 diabetes can damage your
autonomic nervous system over time (autonomic
neuropathy). An example of this is orthostatic
(postural) hypotension, where your blood pressure
drops when you stand up (dizziness).
•
 MCQ
• Which of the following is the function of sympathetic
nervous system?
• A. Bronchoconstriction.
• B. Pupillary dilation
• C. Increase cardiac out put.
• D. Contraction of the bladder
Which of the following is the function of parasympathetic
nervous system?
A. Relaxation of bladder.
B. Pupillary dilation.
C. Bronchoconstriction.
D. Decrease salivary secretion.
 MCQ
• Acetylcholine is secreted from the following except.
• A. Preganglionic sympathetic
• B. Post ganglionic parasympathetic
• C. Post ganglionic sympathetic.
• D. Pre ganglionic parasympathetic.

• Which of the following secretes noradrenaline?

• A. Preganglionic sympathetic.
• B. Post ganglionic parasympathetic
• C. Post ganglionic sympathetic.
• D. Pre ganglionic parasympathetic
 Parasympathetic cranial nerves
• Oculomotor nerve [III] (3)
• Facial nerve [VII] (7)
• Glossopharyngeal nerve [IX] (9)
• Vagus nerve [X] (10)
• Which of the following cranial nerve that carries parasympathetic nerve
fibers
• A. I
• B. II
• C. III
• D. V
• E. VIII
Which of the following is the main cranial nerve that
carries parasympathetic nerve fibers?
• A. Olfactory
• B. Optic
• C. Oculomotor
• D. Trochlear
• E. Abducens
• F. Vagus
 Receptors of the Autonomic NS

• 1. Sympathetic receptors:
• Alpha (α 1, α 2 ), & Beta receptors (β1, β2, β3)

• 2. Parasympathetic receptors:
• Muscarinic (M1, M2, M3)
• and Nicotinic Receptors
 Types of sympathetic receptors
They are called adrenoceptors: α1, α2, β1, β2, β3
• α1: present in blood vessels, sphincters of GI and
urinary tracts, penis and seminal vesicles, radial
muscle of the iris.
• α2: found in the intestine and pancreas (β-cells),
presynaptically to control release
• β1: in the heart and juxtaglumerulous apparatus
• β2: in the ciliary muscle in the eyes, bronchial
muscles, GI, skeletal muscles
• β3: fat cells
 α- adrenoceptors
There are 2 types of α receptors:
• α1: • α2 :
causes: causes:
1. Vasoconstriction 1. Decrease release of
Ach and NA (pre-
2. Relax GIT muscles
synaptic inhibition)
3. Increase salivary
2. Platelet aggregation
secretion
3. Vasoconstriction
4. Increases
4. Inhibit insulin release
glycogenolysis
 β- adrenoceptors
There are 3 types:
• β1: found in the heart
Cause:
1. + ve inotropic effect
2. Choronotropic effect by CAT
• β2: found in smooth muscles
Causes: relaxation
• β3: found in fat or adipose tissue
Causes: lipolysis
• Positive inotropes make your heart muscle
contractions stronger, raising your cardiac
output.
• Chronotropic effects are those that change the
heart rate.
 Beta (β) Receptors
• β1 Receptors have approximately equal affinities for
epinephrine and norepinephrine (mainly found in
the heart)
• β2 receptors have a higher affinity for epinephrine
than for norepinephrine (mainly found in the
bronchioles)
• β3 receptors are involved in lipolysis.
 Distribution of receptors
• Tissues such as the vasculature to skeletal
muscle have both β1 and β2 receptors, but the
β2 receptors predominate.
• The heart contains predominantly β1
receptors.
 Effects mediated by the
adrenoceptors
• Stimulation of β1 receptors characteristically
causes cardiac stimulation,
• Stimulation of β2 receptors produces
vasodilatation (in skeletal & vascular beds)
and bronchiolar relaxation.
Types of Parasympathetic receptors
1. Muscarinic
2. Nicotinic
 Synthesis of acetylcholine
• Choline acetyltransferase catalyzes the
reaction of choline with acetyl coenzyme A
(CoA) to form acetylcholine.

choline + acetyl coenzyme A (CoA)

↓ Choline acetyltransferase
acetylcholine
 Cholinergic Transmission
(Acetylcholine - Ach)
• Ach was discovered in 1900 after adrenaline.
• Dale 1914, discovered two different sites for the
action of Ach:
Muscarinic and Nicotinic Receptors
Muscarine is extracted from a mushroom called
amanita muscaria
 Location of cholinergic transmission
• Preganglionic fibers terminating in autonomic
ganglia (both parasympathetic and sympathetic),
• Voluntary muscles (neuromuscular junction).
cholinergic neurons that innervate the muscles of
the somatic nervous system
• Preganglionic fibers terminating in the adrenal
medulla. Adrenal medulla (secretion of adrenaline)
• Post ganglionic parasympathetic fibers.
• Post ganglionic sympathetic to sweat glands
• also found in the central nervous system (CNS).
 Cholinergic receptors
A- Nicotinic receptors:
• They fall into 3 main classes:
1. The muscle type NM (neuromuscular junction)
2. The ganglia type NN (sympathetic and
parasympathetic ganglia)
3. The CNS type ( wide spread in the CNS)
4. Pre-synaptic adrenal medulla (secrete
adrenaline)
 PS Nicotinic Receptors

• Nicotinic receptors are located in the CNS, adrenal

medulla, autonomic ganglia, and the
neuromuscular junction.
• The nicotinic receptors of autonomic ganglia (
called nicotinic neuronal ) differ from those of the
neuromuscular junction (which are called
nicotinic muscular) .
 Ach

N Post-
Sym.
Pre- NE α/β Effector
PSNS N organ
Ach
SNS
N
Ach
Autonomic ganglia
Effector
organ

Pre-sym Adrenal
SNS Ach N medulla
B- Muscarinic receptors
• It has 7 subtypes
• Only 4 have been distinguished functionally
and pharmacologically
1. M1
2. M2
3. M3
4. M4: under investigation
A. M1:
found in the CNS, PNS and gastric parietal
cells
Action:
-1- Ach binds to its receptors, increases
conduction, depolarization, excitation.
Deficiency will cause dementia.
-2- increase gastric parietal cell secretion HCL
following vagal stimulation
B. M2:
found in the: heart (atria), pre-synaptic
terminals of the CNS and PNS.
Action:
-1- They mediate pre-synaptic inhibition
in CNS and PNS.
-2-Vagal inhibition of the heart.
C. M3:
found in the: exocrine glands, smooth
muscles and blood vessels endothelium.
Action:
-1- stimulate glandular secretion of (salivary
and bronchial)
-2- contraction of smooth muscles in the
eyes (accommodation)
-3- Vasodilatation (VD) mediated by NO
(Nitrous oxide).
 Enteric Nervous System
A system that is independent anatomically & physiologically

The sympathetic & parasympathetic modulate but do no control its

function

Made up of <100 million neurons

Comprises intrinsic neural networks composed of sensory
neurons, interneurons & motor ns.

Motor neurons are postg. parasympathetic influenced by

preganglionic parasympathetic

They are also influenced by intrinsic sensory & interneurons

within the gut
 Made of a myenteric (Auerbach’s) between the muscle
layers & a submucosal (Meissner’s) plexuses

They receive afferent fibres from vagal & sacral fibres

Also influenced by inhibitory postganglionic sympathetic

fibres
The two plexuses are interconnected

The plexuses contain neuroglia (astrocytes)

The enteric nervous
system
• Dual Innervation
Innervation by both sympathetic &
parasympathetic fibers
Most visceral organs receive dual
innervation (physiological antagonism)
 The Role of the Adrenal Medulla in the
Sympathetic Division
• Major organ of the
sympathetic nervous system
• Secretes great quantities of
norepinephrine and
adrenaline
• Stimulated to secrete by
Preganglionic sympathetic
fibers
Cranial Nerves
Cranial Nerves (CN) =12 Pair
CN Number Name Function
I Olfactory Smell
II Optic Vision
III Oculomotor Eye movement

IV Trochlear Eye movement

V Trigeminal Sensory (face)
VI Abducens Eye movement

VII Facial Mixed (Sensory taste

Motor Expression Muscle
Cranial Nerves (CN) =12 Pair
CN Number Name Function
VIII Auditory (Vestibulocochlear) Hearing

IX Glossopharyngeal Taste sensation

X Vagus Sensory (taste) and
motor of smooth
muscle
XI Accessory Motor of shoulder
muscle
XII Hypoglossal Motor of Tongue
 Cell Structures and Functions
Cell Structure Function
Plasma membrane Protection
Nucleus Control cell functions
Mitochondria Energy production (ATP)
Ribosomes Protein production
Smooth endoplasmic reticulum Lipid production and Detoxification
Rough endoplasmic reticulum Protein production
Golgi apparatus Package of protein
Lysosomes Contain digestive enzymes
Cytoskeleton Movement of cell and Cilia
Shape of the cell
Chromosomes Contain DNA and Genetics
 Cells of the Nervous System
• Neurons: These cells send and relay signals, and
makeup parts of your brain, spinal cord and
nerves. They also convert signals between the
chemical and electrical forms.
• Glial cells: These cells don’t transmit or relay
nervous system signals. Instead, they’re helpers or
support cells for the neurons.They shield your
nervous system from infections, control the
chemical balance in your nervous system and coat
neurons’ axons with myelin. There are 10 times
more glial cells than neurons.