RBE NOTES (Block 3)

HES 034 - 035 | REHABSCI | SEM 1

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I. THE
➢ The enteric nervous system contains
both sensory and motor neurons,
which can function independently of

NERVOUS the CNS.

SYSTEM CELLS OF THE

NERVOUS SYSTEM
FUNCTIONS OF THE
NERVOUS SYSTEM Neurons
● Neurons receive stimuli and conduct
action potentials. A neuron consists of
The functions of the nervous system include
a cell body, dendrites, and an axon.
receiving sensory input, integrating
● Neurons are multipolar, bipolar, or
information, controlling muscles and glands,
pseudo-unipolar.
maintaining homeostasis, and serving as the
center of mental activity.
Glial Cells
Glial cells are the support cells of the nervous
system. They include astrocytes, ependymal
DIVISIONS OF THE cells, microglia, oligodendrocytes, and Schwann
NERVOUS SYSTEM cells.
Myelin Sheaths
Axons are either unmyelinated or myelinated.
➢ The central nervous system (CNS)
Organization of Nervous Tissue Nervous tissue
consists of the brain and spinal cord,
consists of white matter and gray matter. Gray
whereas the peripheral nervous
matter forms the cortex and nuclei in the brain
system (PNS) consists of all the
and ganglia in the PNS. White matter forms
nervous tissue outside the CNS.
nerve tracts in the CNS and nerves in the PNS.
➢ The sensory division of the PNS
transmits action potentials to the CNS;
the motor division carries action ELECTRICAL SIGNALS AND
potentials away from the CNS. NEURAL PATHWAYS
➢ The motor division is divided into
somatic and autonomic systems. The
somatic nervous system innervates Resting Membrane Potential
skeletal muscle and is mostly under ● A resting membrane potential results
voluntary control. The autonomic from the charge difference across the
nervous system innervates cardiac membrane of cells.
muscle, smooth muscle, and glands ● The resting membrane potential is set
and is mostly under involuntary by leak ion channels and the sodium-
control. potassium pump.
➢ The autonomic nervous system is Action Potentials
divided into sympathetic and
parasympathetic divisions.
 ● An action potential occurs when the
charge across the cell membrane is ➢ The spinal cord extends from the
briefly reversed. foramen magnum to the second lumbar
● Chemically gated and voltage-gated vertebra; below that is the cauda
ion channels generate the action equina.
potential. ➢ The spinal cord has a central gray part
The Synapse organized into horns and a peripheral
● A synapse is a point of contact between white part forming nerve tracts.
two neurons or between a neuron and ➢ Roots of spinal nerves extend out of
another cell, such as a muscle or gland the cord.
cell. Spinal Cord Reflexes
● An action potential arriving at the ● The knee-jerk reflex occurs when the
synapse causes the release of a quadriceps femoris muscle is stretched.
neurotransmitter from the presynaptic ● The withdrawal reflex removes a body
terminal, which diffuses across the part from a painful stimulus.
synaptic cleft and binds to the
receptors of the postsynaptic
SPINAL NERVES
membrane.
Reflexes
● Reflex arcs are the functional units of ➢ The spinal nerves exit the vertebral
the nervous system. column at the cervical, thoracic,
● A complex reflex arc consists of a lumbar, and sacral regions.
sensory receptor, a sensory neuron, ➢ The nerves are grouped into plexuses.
interneurons, a motor neuron, and an ➢ The phrenic nerve, which supplies the
effector organ; the simplest reflex arcs diaphragm, is the most important
do not involve interneurons. branch of the cervical plexus.
➢ The brachial plexus supplies nerves to
Neuronal Pathways
the upper limb.
● Neuronal pathways are either
➢ The lumbosacral plexus supplies nerves
converging or diverging.
to the lower limb.
● Spatial and temporal summation occur
in neuronal pathways.
BRAIN
CENTRAL and PERIPHERAL
NERVOUS SYSTEMS Brainstem
● The brainstem contains several nuclei.
● The medulla oblongata contains nuclei
The CNS consists of the brain and spinal cord.
that control activities such as heart
The PNS consists of nerves and ganglia outside
rate, breathing, swallowing, and
the CNS.
balance.
● The pons contain relay nuclei between
SPINAL CORD the cerebrum and cerebellum.

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 ● The midbrain is involved in hearing and
SOMATIC MOTOR FUNCTIONS
in visual reflexes.
● The reticular formation is scattered
throughout the brainstem and is ➢ Somatic motor functions include
important in regulating cyclical motor involuntary and voluntary movements.
functions. It is also involved in ➢ Upper motor neurons in the cerebral
maintaining consciousness and in the cortex connect to lower motor neurons
sleep-wake cycle. in the spinal cord or cranial nerve
Cerebellum nuclei.
The cerebellum is attached to the brainstem. Motor Areas of the Cerebral Cortex
Diencephalon ● Upper motor neurons are located in the
The diencephalon consists of the thalamus primary motor cortex.
(main sensory relay center), the epithalamus ● The premotor and prefrontal areas
(the pineal gland may play a role in sexual regulate movements.
maturation), and the hypothalamus (important Descending Tracts
in maintaining homeostasis). Descending tracts project directly from upper
Cerebrum motor neurons in the cerebral cortex to lower
The cerebrum has two hemispheres, each motor neurons in the spinal cord and brainstem;
divided into lobes: the frontal, parietal, occipital, indirectly, they project from basal nuclei, the
and temporal lobes. cerebellum, or the cerebral cortex through the
brainstem to lower motor neurons in the spinal
cord.
SENSORY FUNCTIONS Basal Nuclei
● Basal nuclei help plan, organize, and
➢ The CNS constantly receives sensory coordinate motor movements and
input. posture.
➢ We are unaware of much of the input, ● People with basal nuclei disorders
but it is vital to our survival. exhibit increased muscle tone and
➢ Some sensory input results in exaggerated, uncontrolled movements
sensation. when at rest.
Ascending Tracts Cerebellum
● Ascending tracts transmit action ● The cerebellum is involved in balance,
potentials from the periphery to the muscle tone, and muscle coordination.
brain. ● Through its comparator function, the
● Each tract carries a specific type of cerebellum compares the intended
sensory information. action to what is occurring and
Sensory Areas of the Cerebral Cortex modifies the action to eliminate
● Ascending tracts project to primary differences.
sensory areas of the cerebral cortex. ● If the cerebellum is damaged, muscle
● Association areas are involved in tone decreases and fine motor
recognizing the sensory input. movements become very clumsy.

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 OTHER BRAIN FUNCTIONS
CEREBROSPINAL FLUID
Communication Between the Right
and Left Hemispheres Meninges
● Each hemisphere controls the opposite Three connective tissue meninges cover the
half of the body. CNS: the dura mater, arachnoid mater, and pia
● Commissures connect the two mater.
hemispheres. Ventricles
● The left hemisphere is thought to be ● The brain and spinal cord contain fluid-
the dominant analytical hemisphere, filled cavities: the lateral ventricles in
and the right hemisphere is thought to the cerebral hemispheres, a third
be dominant for spatial perception and ventricle in the diencephalon, a
musical ability. cerebral aqueduct in the midbrain, a
Speech fourth ventricle at the base of the
Speech involves the sensory speech area, the cerebellum, and a central canal in the
motor speech area, and the interactions spinal cord.
between them and other cortical areas. ● The fourth ventricle has openings into
the subarachnoid space.
Brain Waves and Consciousness Cerebrospinal Fluid
An EEG monitors brain waves, which are a Cerebrospinal fluid is formed in the choroid
summation of the electrical activity of the brain. plexuses in the ventricles. It exits through the
fourth ventricle and reenters the blood through
Memory
arachnoid granulations in the superior sagittal
● The types of memory are working
sinus.
(lasting a few seconds to minutes),
short-term (lasting a few minutes), and
long-term (permanent) memory. CRANIAL NERVES
● Long-term memory includes
declarative and procedural memories.
There are two general categories of cranial
Limbic System and Emotions nerve function: sensory and motor. Sensory
● The limbic system includes the functions can be divided into the special senses,
olfactory cortex, deep cortical regions, such as vision, and the more general senses,
and nuclei. such as touch and pain in the face. Motor
● The limbic system is involved with functions are subdivided into somatic motor and
memory, motivation, mood, and other parasympathetic. Somatic motor cranial nerves
visceral functions. Olfactory innervate skeletal muscles in the head and neck.
stimulation is a major influence. Parasympathetic cranial nerves innervate
glands, smooth muscle throughout the body,
and cardiac muscle of the heart.

MENINGES, VENTRICLES, and

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 of tongue;
motor to
Cranial Nerve and Their Functions pharyngeal
muscles;
NUMBER NAME GENERAL SPECIFIC parasympath
FUNCTION FUNCTION etic to
salivary
I Olfactory S Smell glands

II Optic S Vision X Vagus S, M, P Sensory to

pharynx,
III Oculomotor M, P Motor to four larynx, and
of six viscera;
extrinsic eye motor to
muscles and palate,
upper eyelid; pharynx, and
parasympath larynx;
etic: parasympath
constricts etic to
pupil, viscera of
thickens lens thorax and
abdomen
IV Trochlear M Motor to one
extrinsic eyes XI Accessory M Motor to two
muscle neck and
upper back
V Trigeminal S, M Sensory to muscles
face and
teeth; motor XII Hypoglossal M Motor to
to muscles of tongue
mastication muscles
(chewing)
*S - sensory; M - somatic motor; P - parasympathetic
VI Abducens M Motor to one
extrinsic eye
muscle

VII Facial S, M, P Sensory:

taste; motor
to muscles of
facial
expression;
parasympath
etic to
salivary and
tear glands

VIII Vestibuloco S Hearing and

chlear balance

IX Glossophar S, M, P Sensory:
yngeal taste and
touch to back

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 rest, such as the digestion of food,
AUTONOMIC NERVOUS SYSTEM
defecation, and urination.

➢ The autonomic nervous system

Sympathetic and Parasympathetic
contains preganglionic and
postganglionic neurons. Divisions of the
➢ The autonomic nervous system has Autonomic Nervous System
sympathetic and parasympathetic
divisions.

Division Location of Location of General

Anatomy of the Sympathetic Division Preganglio Postgangli Fuction
● Preganglionic cell bodies of the nic Cell onic Cell
sympathetic division lie in the thoracic Body Body

and upper lumbar regions of the spinal

Sympathe T1–L2 Sympathet “Fight-or-
cord. tic ic chain flight”;
● Postganglionic cell bodies are located ganglia or prepares
collateral the body
in the sympathetic chain ganglia or in
ganglia for
collateral ganglia. physical
Anatomy of the Parasympathetic activity

Division Parasymp Cranial Terminal “Rest-and-

● Preganglionic cell bodies of the athetic nerves III, ganglia digest”;
parasympathetic division are VII, IX, X; near or stimulates
embedded involuntary
associated with some of the cranial and S2–S4
in the walls activities
sacral nerves. spinal of target of the body
nerves organs at rest
● Postganglionic cell bodies are located
in terminal ganglia, either near or
within target organs.
EFFECTS OF THE ANS on
Autonomic Neurotransmitters
● All autonomic preganglionic and
VARIOUS TISSUES
parasympathetic postganglionic
neurons secrete acetylcholine.
● Most sympathetic postganglionic
Target Sympathetic Parasympathe
neurons secrete norepinephrine.
Effects tic
Functions of the Autonomic Nervous Effects
System
Heart Increases rate Decreases rate
● The sympathetic division prepares a
and force of
person for action by increasing heart contraction
rate, blood pressure, respiration, and
release of glucose for energy. Blood Constricts and None
● The parasympathetic division is vessels dilates
involved in involuntary activities at

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Lungs Dilates Constricts
bronchioles bronchioles ➢ The enteric nervous system forms
plexuses in the digestive tract wall.
Eyes Dilates pupil, Constricts ➢ Enteric neurons are sensory, motor, or
relaxes ciliary pupil, interneurons; they receive CNS input
muscle to contracts but can also function independently.
adjust lens for ciliary muscle
far vision to adjust lens
for near vision EFFECTS OF AGING ON THE
Intestinal Decreases Increases
NERVOUS SYSTEM
and stomach motility, motility,
walls contracts relaxes
➢ In general, sensory and motor functions
sphincters sphincters
decline with age.
Liver Breaks down Synthesizes ➢ Mental functions, including memory,
glycogen, glycogen may decline with age, but this varies
releases from person to person.
glucose

Adipose Breaks down None

tissue lipids

Adrenal Secretes None

gland epinephrine,
norepinephrin
e

Sweat glands Secretes None

Salivary
sweat

Secretes thick Secretes

II. SENSES
glands saliva watery saliva
SENSATION
Urinary Relaxes Contracts
bladder muscle, muscle, Perception of sensations results only from
constricts relaxes
those stimuli that reach the cerebral cortex and
sphincter sphincter
are consciously perceived. Senses can be
Pancreas Decreases Increases defined as general or special.
secretion of secretion of
digestive digestive
enzymes and enzymes and SENSORY RECEPTORS
insulin insulin
Sensory receptors are sensory nerve endings or
specialized cells capable of responding to
stimuli by developing action potentials.
ENTERIC NERVOUS SYSTEM

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 TASTE
GENERAL SENSES
➢ Taste buds contain taste cells with
Receptors for general senses, such as pain, hairs that extend into taste pores.
temperature, touch, pressure, and Receptors on the hairs detect
proprioception, are scattered throughout the dissolved substances.
body. ➢ There are five basic types of taste:
Pain sour, salty, bitter, sweet, and umami.
● Pain is an unpleasant sensation that Neuronal Pathways for Taste
may be either localized or diffuse. The facial nerve carries taste from the anterior
● Pain can be reduced or controlled by two-thirds of the tongue; the glossopharyngeal
“gating mechanisms” involving the nerve carries taste from the posterior one-third
gate control theory. of the tongue; and the vagus nerve carries taste
● Pain from deeper structures may be from the root of the tongue.
referred to more superficial structures,
such as the skin.
VISION

SPECIAL SENSES Accessory Structures of the Eye

● The eyebrows prevent perspiration
Smell and taste respond to chemical from entering the eyes.
stimulation, vision to light stimulation, and ● The eyelids protect the eyes from
hearing and balance to mechanical stimulation. foreign objects.
● The conjunctiva covers the inner
OLFACTION
eyelids and the anterior surface of the
eye.
➢ Olfactory neurons have enlarged distal ● Lacrimal glands produce tears that
ends with long cilia. The cilia have flow across the eye surface to
receptors that respond to dissolved lubricate and protect the eye. Excess
substances in the nasal mucus. tears pass through the nasolacrimal
➢ The wide range of detectable odors duct into the nasal cavity.
results from combinations of receptor ● The extrinsic eye muscles move the
responses. eyeball.
Neuronal Pathways for Olfaction Anatomy of the Eye
Axons of the olfactory neurons form the ● The fibrous tunic is the outer layer of
olfactory nerves, which enter the olfactory the eye. It consists of the sclera and
bulb. Olfactory tracts carry action potentials cornea.
from the ● The vascular tunic is the middle layer
olfactory bulbs to the olfactory cortex of the of the eye. It consists of the choroid,
brain. ciliary body, and iris.

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 ● The lens is held in place by the Axons from the nasal retina cross, and
suspensory ligaments, which are those from the temporal retina do not.
attached to the smooth muscles of the ● Optic tracts from the chiasm lead to
ciliary body. the thalamus.
● The nervous tunic (retina) is the inner ● Optic radiations extend from the
layer of the eye and contains neurons thalamus to the visual cortex in the
sensitive to light. occipital lobe.
● Rods are responsible for vision in low
illumination (night vision).
HEARING AND BALANCE
● Cones are responsible for color vision.
● Light causes retinal to change shape,
which causes opsin to change shape, Anatomy and Function of the Ear
leading eventually to cellular changes ● The external ear consists of the auricle
that result in vision. and the external auditory canal.
● The fovea centralis in the center of the ● The middle ear contains the three
macula has the highest concentration auditory ossicles.
of cones and is the area where images ● The tympanic membrane (eardrum) is
are detected most clearly. stretched across the external auditory
● The optic disc, or blind spot, is where canal.
the optic nerve exits the eye and blood ● The malleus, incus, and stapes connect
● The anterior and posterior chambers the tympanic membrane to the oval
of the eye are anterior to the lens and window of the inner ear.
are filled with aqueous humor. The ● The auditory, or eustachian, tube
vitreous chamber is filled with vitreous connects the middle ear to the
humor. The humors keep the eye pharynx and equalizes pressure. The
inflated, refract light, and provide middle ear is also connected to the
nutrients to the inner surface of the mastoid air cells.
eye. ● The inner ear has three parts: the
Functions of the Eye semicircular canals, the vestibule, and
● Light passing through a concave the cochlea.
surface diverges. Light passing ● The cochlea is a canal shaped like a
through a convex surface converges. snail’s shell.
● . Converging light rays cross at the ● The cochlea is divided into three
focal point and are said to be focused. compartments by the vestibular and
● The cornea, aqueous humor, lens, and basilar membranes.
vitreous humor all refract light. The ● The spiral organ consists of hair cells
cornea is responsible for most of the that attach to the basilar and tectorial
convergence, whereas the lens can membranes.
adjust the focus by changing shape Hearing
(accommodation). ● Sound waves are funneled through the
Neuronal Pathways for Vision auricle down the external auditory
● Axons pass through the optic nerves canal, causing the tympanic
to the optic chiasm, where some cross. membrane to vibrate.

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 ● The tympanic membrane vibrations
are passed along the ossicles to the Elderly people experience a general decline in
oval window of the inner ear. some general senses and in taste, vision,
● Movement of the stapes in the oval hearing, and balance.
window causes the perilymph to move

III. ENDOCRINE
the vestibular membrane, which
causes the endolymph to move the
basilar membrane. Movement of the
basilar membrane causes the hair cells
in the spiral organ to move and SYSTEM
generate action potentials, which
travel along the vestibulocochlear PRINCIPLES OF CHEMICAL
nerve. COMMUNICATION
Neuronal Pathways for Hearing
From the vestibulocochlear nerve, action The principal means by which this coordination
potentials travel to the cochlear nucleus and on occurs is through chemical messengers, some
to the cerebral cortex. produced by the nervous system and
Balance others produced by the endocrine system.
● Static equilibrium evaluates the Chemical messengers allow cells to
position of the head relative to gravity. communicate with each other to regulate body
● Maculae, located in the vestibule, activities.
consist of hair cells with the microvilli
embedded in a gelatinous mass that Therefore, the study of the endocrine system
contains otoliths. The gelatinous mass includes several of the following categories:
moves in response to gravity. 1. Autocrine chemical messengers -
● Dynamic equilibrium evaluates stimulates the cell that originally
movements of the head. secreted it, and sometimes nearby
● The inner ear contains three cells of the same type.
semicircular canals, arranged 2. Paracrine chemical messengers - are
perpendicular to each other. The local messengers and are secreted by
ampulla of each semicircular canal one cell type but affect neighboring
contains a crista ampullaris, which has cells of a different type.
hair cells with microvilli embedded in a 3. Neurotransmitters - secreted by
gelatinous mass, the cupula. neurons that activate an adjacent cell,
Neuronal Pathways for Balance whether it is another neuron, a muscle
Axons in the vestibular portion of the cell, or a glandular cell.
vestibulocochlear nerve project to the 4. Endocrine chemical messenger -
vestibular nucleus and on to the cerebral secreted into the bloodstream by
cortex. certain glands and cells, which
together constitute the endocrine
system.
EFFECTS OF AGING ON THE SENSES

10
 and stimulates milk release from the
FUNCTIONS OF THE
breasts in lactating females.
ENDOCRINE SYSTEM 10. Immune system regulation. The
endocrine system helps control the
The main regulatory functions of the endocrine production and functions of immune
system are the following: cells.
1. Metabolism. The endocrine system
regulates the rate of metabolism, the CHARACTERISTICS OF THE
sum of the chemical changes that
ENDOCRINE SYSTEM
occur in tissues.
2. Control of food intake and digestion.
The endocrine system regulates the ➢ The endocrine system is composed of
level of satiety (fullness) and the endocrine glands and spe-cialized
breakdown of food into individual endocrine cells located throughout the
nutrients. body.
3. Tissue development. The endocrine ➢ Endocrine glands and cells secrete
system influences the development of minute amounts of chemical
tissues, such as those of the nervous messengers called hormones (hor
system. ′mōnz) into the bloodstream, rather
4. Ion regulation. The endocrine system than into a duct. Hormones then travel
regulates the solute concentration of through the general blood circulation
the blood. to target tissues or effectors. The
5. Water balance. The endocrine system target tissues are specific sites where
regulates water balance by controlling hormones produce a particular
solutes in the blood. response of the target tissues.
6. Heart rate and blood pressure ➢ Endocrine glands are not to be
regulation. The endocrine system confused with exocrine glands.
helps regulate the heart rate and blood Exocrine glands have ducts that carry
pressure and helps prepare the body their secretions to the outside of the
for physical activity. body, or into a hollow organ, such as
7. Control of blood glucose and other the stomach or intestines.
nutrients. The endocrine system The study of the endocrine system, known as
regulates the levels of blood glucose endocrinology.
and other nutrients in the blood.
8. Control of reproductive functions. The
HORMONES
endocrine system controls the
development and functions of the
reproductive systems in males and Chemical Nature of Hormones
females. 1. There are two chemical categories of
9. Uterine contractions and milk release. hormones: lipid-soluble and water-
The endocrine system regulates soluble.
uterine contractions during delivery

11
 2. Lipid-soluble hormones include Inhibition of Hormone Release
steroids, thyroid hormones, and some Although the stimulus of hormone secretion is
fatty acid derivatives. important, inhibition is equally important.
3. Water-soluble hormones include 1. Humoral substances can inhibit the
proteins, peptides, and amino acid secretion of hormones.
derivatives. 2. Neural stimuli can prevent hormone
a. Water-soluble hormones secretion.
circulate freely in the blood. 3. Inhibiting hormones prevent hormone
b. Proteases degrade protein release.
and peptide hormones in the
Regulation of Hormone Levels in the
circulation; the breakdown
Blood
products are then excreted in
the urine. However, some Two processes regulate the overall blood levels
water-soluble hormones have of hormones: negative feedback and positive
chemical modifications, such feedback.
as the addition of a ● Negative feedback prevents further
carbohydrate group, which hormone secretion once a set point is
prolongs their life span. achieved.
● Positive feedback is a self-promoting
system whereby the stimulation of
CONTROL OF HORMONE hormone secretion increases over
SECRETION time.

Stimulation of Hormone Release HORMONE RECEPTORS and

Three types of stimuli result in hormone MECHANISMS OF ACTION
secretion: humoral, neural, and hormonal.
● Humoral stimulation is exhibited by
Classes of Receptors
hormones that are sensitive to
circulating blood levels of certain Each of the two groups of hormones has its own
molecules, such as glucose or calcium. class of receptors.
● Neural stimuli cause hormone ● Lipid-soluble hormones bind to nuclear
secretion in direct response to action receptors located inside the nucleus of
potentials in neurons, as occurs during the target cell. Some lipid-soluble
stress or exercise. Hormones from the hormones have rapid actions that are
hypothalamus that cause the release most likely mediated via a membrane-
of other hormones are called releasing bound receptor.
hormones. ● Water-soluble hormones bind to
● Hormonal stimulation of other membrane-bound receptors, which are
hormone secretion is common in the integral membrane proteins.
endocrine system. Hormones from the Action of Nuclear Receptors
anterior pituitary that stimulate ● Nuclear receptors have portions that
hormones from other endocrine glands allow them to bind to the DNA in the
are called tropic hormones. nucleus once the hormone is bound.

12
 ○ The hormone-receptor infundibulum. It is divided into anterior
complex activates genes, and posterior portions.
which in turn activate the ● Secretions from the anterior pituitary
DNA to produce mRNA. are controlled by hormones that pass
○ The mRNA increases the through the hypothalamic-pituitary
synthesis of certain proteins portal system from the hypothalamus.
that produce the target cell’s ● Hormones secreted from the posterior
response. pituitary are controlled by action
● Nuclear receptors cannot respond potentials carried by axons that pass
immediately because it takes time to from the hypothalamus to the
produce the mRNA and the protein. posterior pituitary.
Membrane-Bound Receptors and ● The hormones released from the
anterior pituitary are growth hormone
Signal Amplification
(GH), thyroid-stimulating hormone
● Membrane-bound receptors activate a
(TSH), adrenocorticotropic hormone
cascade of events once the hormone
(ACTH), luteinizing hormone (LH),
binds.
follicle-stimulating hormone (FSH),
● Some membrane-bound receptors are
prolactin, and melanocyte- stimulating
associated with membrane proteins
hormone (MSH).
called G proteins. When a hormone
● Hormones released from the posterior
binds to a membrane-bound receptor,
pituitary include antidiuretic hormone
G proteins are activated. The α subunit
(ADH) and oxytocin.
of the G protein can bind to ion
channels and cause them to open or Thyroid Gland
change the rate of synthesis of The thyroid gland secretes thyroid hormones,
intracellular mediators, such as cAMP. which control the metabolic rate of tissues, and
● Second-messenger systems act calcitonin, which helps regulate blood Ca2+
rapidly because they act on already levels.
existing enzymes and produce an Parathyroid Glands
amplification effect. The parathyroid glands secrete parathyroid
hormone, which helps regulate blood Ca2+
levels. Active vitamin D also helps regulate
ENDOCRINE GLANDS and
blood Ca2+ levels.
THEIR HORMONES Adrenal Glands
● The adrenal medulla secretes primarily
➢ The endocrine system consists of epinephrine and some norepinephrine.
ductless glands. These hormones help prepare the
➢ Some glands of the endocrine system body for physical activity.
perform more than one function. ● The adrenal cortex secretes three
Pituitary and Hypothalamus classes of hormones.
● The pituitary is connected to the a. Glucocorticoids (cortisol)
hypothalamus in the brain by the reduce inflammation and
break down proteins and

13
 lipids, making them available Thymus
as energy sources to other The thymus secretes thymosin, which enhances
tissues. the function of the immune system.
b. Mineralocorticoids
Pineal Gland
(aldosterone) help regulate
The pineal gland secretes melatonin, which may
blood Na+ and K+ levels and
help regulate the onset of puberty by acting on
water volume. Renin, secreted
the hypothalamus.
by the kidneys, helps regulate
blood pressure by increasing
angiotensin II and aldosterone OTHER HORMONES
production. These hormones
cause blood vessels to
➢ Hormones secreted by cells in the
constrict and enhance Na+
stomach and intestine help regulate
and water retention by the
stomach, pancreatic, and liver
kidney.
secretions.
c. Adrenal androgens increase
➢ The prostaglandins are hormones that
female sexual drive but
have a local effect, produce numerous
normally have little effect in
effects on the body, and play a role in
males.
inflammation
Pancreas, Insulin, and Diabetes ➢ ANH from the right atrium of the heart
● The pancreas secretes insulin in lowers blood pressure.
response to elevated levels of blood ➢ Erythropoietin from the kidney
glucose and amino acids. Insulin stimulates red blood cell production.
increases the rate at which many ➢ The placenta secretes human
tissues, including adipose tissue, the chorionic gonadotropin, estrogen, and
liver, and skeletal muscles, take up progesterone, which are essential to
glucose and amino acids. the maintenance of pregnancy.
● The pancreas secretes glucagon in
response to reduced blood glucose and
increases the rate at which the liver EFFECTS OF AGING ON THE
releases glucose into the blood. ENDOCRINE SYSTEM
● The pancreas secretes somatostatin in
response to food intake. Somatostatin
● Age-related changes include a gradual
inhibits insulin and glucagon secretion
decrease in:
and gastric tract activity.
a. GH in people who do not
Testes and Ovaries exercise
● The testes secrete testosterone, and b. melatonin
the ovaries secrete estrogen and c. thyroid hormones (slight
progesterone. These hormones help decrease)
control reproductive processes. d. reproductive hormones
● LH and FSH from the pituitary gland e. thymosin
control hormone secretion from the
ovaries and testes.

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 ● Parathyroid hormones increase if The formed elements are cells (red blood cells
vitamin D and Ca2+ levels decrease. and white blood cells) and cell fragments
● There is an increase in type 2 diabetes (platelets).
in people with a familial tendency. Production of Formed Elements
Formed elements arise (hematopoiesis) in red

IV. BLOOD bone marrow from stem cells.

Red Blood Cells
● Red blood cells are disk-shaped cells
FUNCTIONS OF BLOOD containing hemoglobin, which
transports oxygen and carbon dioxide.
➢ Blood transports gasses, nutrients, Red blood cells also contain carbonic
waste products, processed molecules, anhydrase, which is involved with
and regulatory molecules. carbon dioxide transport.
➢ Blood regulates pH as well as fluid and ● In response to low blood oxygen levels,
ion balance. the kidneys produce erythropoietin,
➢ Blood is involved with temperature which stimulates red blood cell
regulation and protects against production in red bone marrow.
foreign substances, such as ● Worn-out red blood cells are
microorganisms and toxins. phagocytized by macrophages in the
➢ Blood clotting prevents fluid and cell spleen or liver. Hemoglobin is broken
loss and is part of tissue repair. down, iron and amino acids are reused,
and heme becomes bilirubin that is
COMPOSITION OF BLOOD secreted in bile.
White Blood Cells
➢ Blood is a connective tissue consisting ● White blood cells protect the body
of plasma and formed elements. against microorganisms and remove
➢ Total blood volume in an average adult dead cells and debris.
is approximately 5 L. ● Granulocytes contain cytoplasmic
granules. The three types of
granulocytes are neutrophils, small
PLASMA
phagocytic cells; basophils, which
promote inflammation; and
➢ Plasma is 91% water and 9% eosinophils, which defend against
suspended or dissolved substances. parasitic worms and influence
➢ Plasma maintains osmotic pressure, is inflammation.
involved in immunity, prevents blood ● Agranulocytes have very small
loss, and transports molecules. granules and are of two types:
Lymphocytes are involved in antibody
production and other immune system
FORMED ELEMENTS
responses; monocytes become
macrophages that ingest
microorganisms and cellular debris.

15
Platelets ● Serum is plasma without clotting
Platelets are cell fragments involved with factors.
preventing blood loss. ● Fibrinolysis (clot breakdown) is
accomplished by plasmin.

PREVENTING BLOOD LOSS

BLOOD GROUPING

Vascular Spasm
➢ Blood groups are determined by
Blood vessels constrict in response to injury,
antigens on the surface of red blood
resulting in decreased blood flow.
cells.
Platelet Plug Formation ➢ In transfusion reactions, antibodies
● Platelet plugs repair minor damage to can bind to red blood cell antigens,
blood vessels. resulting in agglutination or hemolysis
● Platelet plugs form when platelets of red blood cells.
adhere to collagen, release chemicals
ABO Blood Group
(ADP and thromboxanes) that activate
● Type A blood has A antigens, type B
other platelets, and connect to one
blood has B antigens, type AB blood
another with fibrinogen.
has A and B antigens, and type O blood
has neither A nor B antigens.
● Type A blood has anti-B antibodies,
Blood Clotting type B blood has anti-A antibodies,
● Blood clotting, or coagulation, is the type AB blood has neither anti-A nor
formation of a clot (a network of anti-B antibodies, and type O blood
protein fibers called fibrin). has both anti-A and anti-B antibodies.
● There are three steps in the clotting ● Mismatching the ABO blood group can
process: result in transfusion reactions.
○ (1) activation of clotting Rh Blood Group
factors by connective tissue ● Rh-positive blood has Rh antigens,
and chemicals, resulting in whereas Rh-negative blood does not.
the formation of ● Antibodies against the Rh antigen are
prothrombinase; produced when an Rh-negative person
○ (2) conversion of prothrombin is exposed to Rh-positive blood.
to thrombin by ● The Rh blood group is responsible for
prothrombinase; and hemolytic disease of the newborn,
○ (3) conversion of fibrinogen which can occur when the fetus is Rh-
to fibrin by thrombin. positive and the mother is Rh-
● Anticoagulants in the blood, such as negative.
antithrombin and heparin, prevent clot
formation.
● Clot retraction condenses the clot, DIAGNOSTIC BLOOD TEST
pulling the edges of damaged tissue
closer together.

16
Type and Crossmatch ➢ The heart helps regulate blood supply
● Blood typing determines the ABO and to tissues.
Rh blood groups of a blood sample.
● A crossmatch test for agglutination
SIZE AND LOCATION OF THE HEART
reactions between donor and recipient
blood.
Complete Blood Count The heart is approximately the size of a closed
fist and is located in the pericardial cavity.
The complete blood count consists of the red
blood count (million/μL), the hemoglobin
measurement (grams of hemoglobin per 100 ANATOMY OF THE HEART
mL of blood), the hematocrit measurement
(percent volume of red blood cells), and the
white blood count (million/μL). Pericardium
Differential White Blood Count ● The pericardium is a sac consisting of
The differential white blood count determines fibrous and serous pericardia. The
the percentage of each type of white blood cell. fibrous pericardium is lined by the
parietal pericardium.
● The outer surface of the heart is lined
by the visceral pericardium
(epicardium).
Clotting ● Between the visceral and parietal
Platelet count and prothrombin time pericardia is the pericardial cavity,
measurement determine the blood’s ability to which is filled with pericardial fluid.
clot. External Anatomy
Blood Chemistry ● The atria are separated externally
The composition of materials dissolved or from the ventricles by the coronary
suspended in plasma (e.g., glucose, urea sulcus. The right and left ventricles are
nitrogen, bilirubin, and cholesterol) can be used separated externally by the
to assess the functioning and status of the interventricular sulci.
body’s systems. ● The inferior and superior venae cavae
enter the right atrium. The four
pulmonary veins enter the left atrium.
V. HEART ● The pulmonary trunk exits the right
ventricle, and the aorta exits the left
ventricle.
FUNCTIONS OF THE HEART
Heart Chambers and Internal
Anatomy
➢ The heart generates blood pressure.
● There are four chambers in the heart.
➢ The heart routes blood through the
The left and right atria receive blood
systemic and pulmonary circulations.
from veins and function mainly as
➢ The heart’s pumping action and its
reservoirs. Contraction of the atria
valves ensure a one-way flow of blood
completes ventricular filling.
through the heart and blood vessels.

17
 ● The atria are separated internally from pulmonary veins to the left atrium, and
each other by the interatrial septum. from the left atrium, blood flows to the
● The ventricles are the main pumping left ventricle. From the left ventricle,
chambers of the heart. The right blood flows into the aorta and then
ventricle pumps blood into the through the systemic vessels.
pulmonary trunk, and the left Blood Supply to the Heart
ventricle, which has a thicker wall, ● The left and right coronary arteries
pumps blood into the aorta. originate from the base of the aorta
● The ventricles are separated internally and supply the heart.
by the interventricular septum. ● The left coronary artery has three
Heart Valves major branches: the anterior
● The heart valves ensure one-way flow interventricular, the circumflex, and
of blood. the left marginal arteries.
● The tricuspid valve (three cusps) ● The right coronary artery has two
separates the right atrium and the major branches: the posterior
right ventricle, and the bicuspid valve interventricular and the right marginal
(two cusps) separates the left atrium arteries.
and the left ventricle. ● Blood returns from heart tissue
● The papillary muscles attach by the through cardiac veins to the coronary
chordae tendineae to the cusps of the sinus and into the right atrium. Small
tricuspid and bicuspid valves and cardiac veins also return blood directly
adjust tension on the valves. to the right atrium.
● The aorta and pulmonary trunk are
separated from the ventricles by the
semilunar valves.
HISTOLOGY OF THE HEART
● The skeleton of the heart is a plate of
fibrous connective tissue that Heart Wall
separates the atria from the ventricles, The heart wall consists of the outer epicardium,
acts as an electrical barrier between the middle myocardium, and the inner
the atria and ventricles, and supports endocardium.
the heart valves.
Cardiac Muscle
Route of Blood Flow Through the ● Cardiac muscle is striated; it depends
Heart on ATP for energy and on aerobic
● The left and right sides of the heart metabolism.
can be considered separate pumps. ● Cardiac muscle cells are joined by
● Blood flows from the systemic vessels intercalated disks that allow action
to the right atrium and from the right potentials to be propagated
atrium to the right ventricle. From the throughout the heart.
right ventricle, blood flows to the
pulmonary trunk and from the
pulmonary trunk to the lungs. From ELECTRICAL ACTIVITY OF
the lungs, blood flows through the THE HEART

18
 Electrocardiogram
Action Potentials in Cardiac Muscle ● An ECG is a record of electrical events
● Action potentials in cardiac muscle are within the heart.
prolonged compared to those in ● An ECG can be used to detect
skeletal muscle and have a abnormal heart rates or rhythms,
depolarization phase, a plateau phase, abnormal conduction pathways,
and a repolarization phase. hypertrophy or atrophy of the heart,
● The depolarization is due mainly to and the approximate location of
opening of the voltage- gated Na+ damaged cardiac muscle.
channels, and the plateau phase is due ● A normal ECG consists of a P wave
to opened voltage-gated Ca2+ (atrial depolarization), a QRS complex
channels. Repolarization at the end of (ventricular depolarization), and a T
the plateau phase is due to the wave (ventricular repolarization).
opening of K+ channels for a brief ● Atrial contraction occurs during the
period. PQ interval, and the ventricles
● The prolonged action potential in contract and relax during the QT
cardiac muscle ensures that interval.
contraction and relaxation occur and
prevents tetany.
● The SA node located in the upper wall
CARDIAC CYCLE
of the right atrium is the normal
pacemaker of the heart, and cells of ➔ Atrial systole is contraction of the
the SA node have more voltage-gated atria, and ventricular systole is
Ca2+ channels than do other areas of contraction of the ventricles. Atrial
the heart. diastole is relaxation of the atria, and
Conduction System of the Heart ventricular diastole is relaxation of the
● The conduction system of the heart is ventricles.
made up of specialized cardiac muscle ➔ During atrial systole, the atria contract
cells. and complete filling of the ventricles.
● The SA node produces action ➔ During ventricular systole, the AV
potentials that are propagated over valves close, pressure increases in the
the atria to the AV node. ventricles, the semilunar valves are
● The AV node and the atrioventricular forced open, and blood flows into the
bundle conduct action potentials to aorta and pulmonary trunk.
the ventricles. ➔ At the beginning of ventricular
● The right and left bundle branches diastole, pressure in the ventricles
conduct action potentials from the decreases. The semilunar valves close
atrioventricular bundle through to prevent backflow of blood from the
Purkinje fibers to the ventricular aorta and pulmonary trunk into the
muscle. ventricles.
● An ectopic beat results from an action ➔ When the pressure in the ventricles is
potential that originates in an area of low enough, the AV valves open, and
the heart other than the SA node.

19
 blood flows from the atria into the parasympathetic stimulation
ventricles. decreases heart rate.
● The baroreceptor reflex detects
changes in blood pressure. If blood
HEART SOUNDS pressure increases suddenly, the
reflex causes a decrease in heart rate
➢ The first heart sound results from and stroke volume; if blood pressure
closure of the AV valves. The second decreases suddenly, the reflex causes
heart sound results from closure of the an increase in heart rate and stroke
semilunar valves. volume.
➢ Abnormal heart sounds, called ● Emotions influence heart function by
murmurs, can result from incompetent increasing sympathetic stimulation of
(leaky) valves or stenosed (narrowed) the heart in response to exercise,
valves. excitement, anxiety, or anger and by
increasing parasympathetic
stimulation in response to depression.
REGULATION OF THE HEART ● Alterations in body fluid levels of CO2,
FUNCTION pH, and ion concentrations, as well as
changes in body temperature,
influence heart function.
Cardiac output (volume of blood pumped per
ventricle per minute) is equal to the stroke
volume (volume of blood ejected per beat) EFFECTS OF AGING ON THE HEART
times the heart rate (beats per minute).
Intrinsic Regulation of the Heart
The following age-related changes are
● Intrinsic regulation refers to regulation
common:
mechanisms contained within the
● By age 70, cardiac output has often
heart.
decreased by one-third.
● As venous return to the heart
● Hypertrophy of the left ventricle can
increases, the heart wall is stretched,
cause pulmonary edema.
and the increased stretch of the
● Decrease in the maximum heart rate of
ventricular walls is called preload.
30–60% by age 85 leads to decreased
● A greater preload causes the cardiac
cardiac output.
output to increase because stroke
● The aortic semilunar valve can become
volume increases (Starling’s law of the
stenotic or incompetent.
heart).
● Coronary artery disease and
● Afterload is the pressure against which
congestive heart failure can develop.
the ventricles must pump blood.
● Aerobic exercise improves the
Extrinsic Regulation of the Heart functional capacity of the heart at all
● Extrinsic regulation refers to nervous ages.
and chemical mechanisms.
● Sympathetic stimulation increases
stroke volume and heart rate;

20
VI. BLOOD Arteries
● Large, elastic arteries have many

VESSELS AND
elastic fibers but little smooth muscle
in their walls. They carry blood from
the heart to smaller arteries with little
CIRCULATION ●
decrease in pressure.
The walls of muscular arteries have
FUNCTIONS OF THE CIRCULATORY SYSTEM much smooth muscle and some elastic
fibers. They undergo vasodilation and
vasoconstriction to control blood flow
The circulatory system can be divided into the
to different regions of the body.
pulmonary vessels and the systemic vessels.
● Arterioles, the smallest arteries, have
The circulatory system and the heart maintain
smooth muscle cells and a few elastic
sufficient blood flow to tissues. The circulatory
fibers. They undergo vasodilation and
system carries blood; exchanges nutrients,
vasoconstriction to control blood flow
waste products, and gases; transports
to local areas.
hormones; regulates blood pressure; and
directs blood flow. Capillaries
● Capillaries consist of only endothelium
and are surrounded by a basement
EFFECTS OF AGING ON THE HEART membrane and loose connective
tissue.
● The heart pumps blood through elastic ● Nutrient and waste exchange is the
arteries, muscular arteries, and principal function of capillaries.
arterioles to the capillaries. ● Blood is supplied to capillaries by
● Blood returns to the heart from the arterioles. Precapillary sphincters
capillaries through venules, small regulate blood flow through capillary
veins, medium-sized veins, and large networks.
veins. Veins
● Except for capillaries and venules, ● Venules are composed of endothelium
blood vessels have three layers: surrounded by a basement membrane.
○ The tunica intima, the ● Small veins are venules covered with a
innermost layer, consists of layer of smooth muscle and a layer of
endothelium, a basement connective tissue.
membrane, and connective ● Medium-sized and large veins contain
tissue. less smooth muscle and fewer elastic
○ The tunica media, the middle fibers than arteries of the same size.
layer, contains circular ● Valves prevent the backflow of blood
smooth muscle and elastic in the veins.
fibers.
○ The outer tunica adventitia is
BLOOD VESSELS OF THE PULMONARY
composed of connective
CIRCULATION
tissue.

21
 Branches of the internal iliac arteries supply
The pulmonary circulation moves blood to and the pelvis.
from the lungs. The pulmonary trunk carries Arteries of the Lower Limbs
oxygen-poor blood from the heart to the lungs, The common iliac arteries give rise to the
and pulmonary veins carry oxygen-rich blood external iliac arteries, and the external iliac
from the lungs to the left atrium of the heart. artery continues as the femoral artery and then
as the popliteal artery in the leg. The popliteal
BLOOD VESSELS OF THE SYSTEMIC artery divides to form the anterior and
CIRCULATION: ARTERIES posterior tibial arteries.

BLOOD VESSELS OF THE SYSTEMIC

Aorta
CIRCULATION: VEINS
The aorta leaves the left ventricle to form the
ascending aorta, the aortic arch, and the
descending aorta, which consists of the ➢ The superior vena cava drains the
thoracic aorta and the abdominal aorta. head, neck, thorax, and upper limbs.
The inferior vena cava drains the
Arteries of the Head and Neck
abdomen, pelvis, and lower limbs.
● The brachiocephalic, left common
carotid, and left subclavian arteries Veins of the Head and Neck
branch from the aortic arch to supply ● The internal jugular veins drain the
the head and the upper limbs. brain, anterior head, and anterior neck.
● The common carotid arteries and the ● The external jugular veins drain the
vertebral arteries supply the head. The posterior head and posterior neck.
common carotid arteries divide to Veins of the Upper Limbs
form the external carotids (which The deep veins are the brachial, axillary, and
supply the face and mouth) and the subclavian; the superficial veins are the
internal carotids (which supply the cephalic, basilic, and median cubital.
brain). Veins of the Thorax
Arteries of the Upper Limbs The left and right brachiocephalic veins and the
The subclavian artery continues as the axillary azygos veins return blood to the superior vena
artery and then as the brachial artery, which cava.
branches to form the radial and ulnar arteries. Veins of the Abdomen and Pelvis
Thoracic Aorta and Its Branches ● Posterior abdominal wall veins join the
The thoracic aorta has visceral branches, which azygos veins.
supply the thoracic organs, and parietal ● Veins from the kidneys, adrenal
branches, which supply the thoracic wall. glands, and gonads directly enter the
Abdominal Aorta and Its Branches inferior vena cava.
The abdominal aorta has visceral branches, ● Veins from the stomach, intestines,
which supply the abdominal organs, and spleen, and pancreas connect with the
parietal branches, which supply the abdominal hepatic portal vein, which transports
wall. blood to the liver for processing. The
Arteries of the Pelvis

22
 hepatic veins from the liver join the blood into the tissues. The fluid gained
inferior vena cava. by the tissues is removed by the
Veins of the Lower Limbs lymphatic system.
● The deep veins course with the deep
arteries and have similar names.
● The superficial veins are the great and
CONTROL OF BLOOD FLOW IN TISSUES
small saphenous veins.

Local Control of Blood Flow

PHYSIOLOGY OF CIRCULATION
Blood flow through a tissue is usually
proportional to the metabolic needs of the
Blood Pressure tissue and is controlled by the precapillary
● Blood pressure is a measure of the sphincters.
force exerted by blood against the Nervous and Hormonal Control of
blood vessel walls. Blood Flow
● Blood pressure moves blood through ● The vasomotor center (sympathetic
vessels. division) controls blood vessel
● Blood pressure can be measured by diameter. Other brain areas can excite
listening for Korotkoff sounds or inhibit the vasomotor center.
produced as blood flows through ● Vasomotor tone is the state of partial
arteries partially constricted by a constriction of blood vessels.
blood pressure cuff. ● The nervous system is responsible for
Pressure and Resistance routing the flow of blood, except in the
In a normal adult, blood pressure fluctuates capillaries, and for maintaining blood
between 120 mm Hg (systolic) and 80 mm Hg pressure.
(diastolic) in the aorta. If blood vessels ● Epinephrine and norepinephrine
constrict, resistance to blood flow increases, released by the adrenal medulla alter
and blood flow decreases. blood vessel diameter.
Pulse Pressure
● Pulse pressure is the difference
REGULATION OF ARTERIAL PRESSURE
between systolic and diastolic
pressures. Pulse pressure increases
when stroke volume increases. Mean arterial pressure (MAP) is proportional to
● A pulse can be detected when large cardiac output times the peripheral resistance.
arteries are near the body surface. Baroreceptor Reflexes
Capillary Exchange ● Baroreceptors are sensitive to stretch.
● Most exchange across the wall of the ● Baroreceptors are located in the
capillary occurs by diffusion. carotid sinuses and the aortic arch.
● Blood pressure, capillary permeability, ● The baroreceptor reflex changes
and osmosis affect movement of fluid peripheral resistance, heart rate, and
across the wall of the capillaries. There stroke volume in response to changes
is a net movement of fluid from the in blood pressure.

23
Chemoreceptor Reflexes VESSELS
● Chemoreceptors are sensitive to
changes in blood O2, CO2, and pH.
➢ Reduced elasticity and thickening of
● Chemoreceptors are located in the
arterial walls result in hypertension
carotid bodies and the aortic bodies.
and decreased ability to respond to
3. The chemoreceptor reflex increases
changes in blood pressure.
peripheral resistance in response to low O2
➢ Atherosclerosis is an age-related
levels, high CO2 levels, and reduced blood pH.
condition.
Hormonal Mechanisms ➢ The efficiency of capillary exchange
➔ Epinephrine released from the adrenal decreases with age.
medulla as a result of sympathetic ➢ Walls of veins thicken in some areas
stimulation increases heart rate, and dilate in others. Thromboses,
stroke volume, and vasoconstriction. emboli, varicose veins, and
➔ The kidneys release renin in response hemorrhoids are age-related
to low blood pressure. Renin promotes conditions.
the production of angiotensin II, which
causes vasoconstriction and increased
secretion of aldosterone. Aldosterone
reduces urine output.
➔ ADH released from the posterior
pituitary causes vasoconstriction and
reduces urine output.
➔ The heart releases atrial natriuretic
hormone when atrial blood pressure
increases. Atrial natriuretic hormone
stimulates an increase in urine
production, causing a decrease in
blood volume and blood pressure.
Summary of Regulatory Mechanisms
➔ The baroreceptor, chemoreceptor, and
adrenal medullary reflex mechanisms
are most important in short-term
regulation of blood pressure.
➔ Hormonal mechanisms, such as the
renin-angiotensin-aldosterone system,
antidiuretic hormone, and atrial
natriuretic hormone, are more
important in long-term regulation of
blood pressure.

EFFECTS OF AGING ON THE BLOOD

24