HUMAN ANATOMY AND

PHYSIOLOGY

UNIT 1: BASIC CONCEPTS

LECTURER:
HABUMUGISHA Emmanuel, RN, BScN, PGCLTHE, MSN
Assistant Lecturer
EACC/ Health Science Faculty
 Learning Objectives
At the end of this unit, the students will be able to:
• Define Anatomy and Physiology
• Discuss directional terms, anatomical position, planes and
sections used in anatomy.
• Differentiate body cavities,
• Explain Homeostasis,
• Describe levels of structural organization of the human
body.
• Explain the cell, tissue and membranes.
 INTRODUCTION
DEFINITIONS:
• The word anatomy is derived from a Greek word “Anatome” meaning to
cut up.
• Anatomy is the study of the structure of the body parts and their
relationships to one another. Subdivisions:
– Gross or macroscopic
– Microscopic
– Developmental
– Embryology
• Physiology is the study of how the body and its part/structure. Functions
include digestion, respiration, circulation, and reproduction.
• Hence, Anatomy and physiology are studied together to give the students
a full appreciation and understanding of human body.
 KINDS OF ANATOMICAL STUDIES
Gross Anatomy:
Is the study of human structures that can be seen with naked
eye such as the respiratory system or the digestive system,
the trunk, upper member, or lower member.
❖ Regional – all structures in one part of the body (such as
the abdomen or leg).
❖ Systemic – gross anatomy of the body studied by system.
❖ Surface – study of internal structures as they relate to the
overlying skin
 Microscopic Anatomy
• is the study of structures that cannot be seen
with the unaided eye. You need a
microscope.
❖Cytology – study of the cell
❖Histology – study of tissues

• Neuroanatomy studies the nervous system.

• Functional anatomy is the study of
relationships between functions and
structures.
 Developmental Anatomy

• Traces structural changes throughout life

(The study of structural changes of an
individual from fertilization to adulthood).

• Embryology – study of developmental

changes of the body before birth
 Specialized Branches of Anatomy

• Pathological anatomy: the study of

structural changes caused by disease.

• Radiographic anatomy: the study of internal

structures visualized by X ray.

• Molecular biology: the study of anatomical

structures at a sub-cellular level
 Physiology
• Considers the operation of specific organ systems
✓ Renal: kidney function
✓ Neurophysiology: workings of the nervous system
✓ Cardiovascular: operation of the heart and blood vessels
• Focuses on the functions of the body, often at the
cellular or molecular level
• Understanding physiology also requires a knowledge of
physics, which explains electrical currents, blood pressure,
and the way muscle uses bone for movement
ORGANIZATION OF THE HUMAN BODY
The human body is organized into cells, tissues, organs, organ
systems, and the total organism.
• Cells are the smallest living unit of body construction.
• A tissue is a grouping of cells working together like muscle
tissue, nervous tissue, etc.
• An organ is a structure composed of several different tissues
performing a particular function like the lungs, heart, etc.
• Organ systems are groups of organs which together perform
an overall function like the respiratory system, digestive
system, etc.
• The total organism is the individual human being.
 Con’t
• Tissue: tissue is made up of many similar cells that perform a specific
function. The various tissues of the body are divided in to four groups.
• These are epithelial, connective, nervous and muscle tissue.
• Epithelial tissue: Found in the outer layer of skin, lining of organs,
blood and lymph vessels and body cavities.
• Connective tissue: Connects and supports most part of the body.
They constitute most part of skin, bone and tendons.
• Muscle tissue: Produces movement through its ability to contract.
This constitutes skeletal, smooth and cardiac muscles.
• Nerve tissue: Found in the brain, spinal cord and nerves.
It responds to various types of stimuli and transmits nerve impulses.
 Principle of Complementarity

• Function always reflects structure

• What a structure can do depends on its

specific form
 Concept of Anatomical Position
• The anatomical position is an
artificial posture of the human body.
• This position is used as a standard
reference throughout the medical
profession.
• Body standing erect and facing the
observer,
• Feet are together
• Palms are facing forward and the
arms are hanging at the sides,
• Thumbs point away from body.

Figure 1.7a
 Reclining Position

• If the body is lying face down, it is in the prone position.

• If the body is lying face up, it is in the supine position.

 DIRECTIONAL TERMS
• Superior and inferior: Superior means above. Inferior
means below.
• Anterior and posterior: Anterior refers to the front of the
body. A commonly-used substitute word is Ventral.
Posterior refers to the back of the body. A commonly-used
substitute word is Dorsal.
• Medial means toward or nearer the midline of the body.
• Lateral means away from the midline or toward the side of
the body.
• Superficial means closer to the surface of the body.
• Deep means toward the center of the body or body part.
 Directional Terms
• Proximal and distal are terms applied specifically to
the limbs.
• Proximal and distal: closer to and farther from the
origin of the body. Example: Proximal means
nearer to
the shoulder joint or the hip joint.
• Superficial and deep: toward and away from the
body surface. Example: Distal means further away
from the shoulder joint or the hip joint.
Directional Terms Table 1.1
Directional Terms Table 1.1
 Body parts Regions
• The body can generally be described to
have areas of:
Axial body part: - It is the part of the body
near the axis of the body. This includes
head, neck, thorax (chest), abdomen,
and pelvis.
• Appendicular body part: - It is the part of
the body out of the axis line. This includes
the upper and lower extremities.
 Regional Terms: Anterior View

• Axial: head,
neck, and
trunk.
• Appendicula:
appendages or
limbs.

Figure 1.7a
Regional Terms: Posterior View

Figure 1.7b
 BODY PLANES
• Planes are imaginary flat surfaces that
pass through the body parts.
• Sagittal planes: divide the body or organ
into right and left sides/parts. They are
vertical planes that pass through the body
from front to back.
• Midsagittal or medial: sagittal plane that
lies on the midline. It passes through the
midline of the body or organ and divides it
into equal right and left sides.
 Body Planes
If the sagittal plane does not pass through the midline
instead divides the body or organ into two unequal
right and left sides is called parasagittal plane.
• Frontal or coronal planes: divide the body or
organ into anterior and posterior parts and they are
vertical planes which pass through the body from
side to
side.
• Transverse or horizontal planes (cross section):
divide the body or organ into superior and inferior
parts and are parallel to the floor.
• Oblique section: cuts made diagonally.
Body Planes Figure 1.8
 Basic body
planes or
sections
These terms are used for
planes or sections that cut
the body, organs, tissues, or
cells
Example of how planes
would cut the brain
 Anatomical Variability
• Humans vary slightly in both external and
internal anatomy
• Over 90% of all anatomical structures match
textbook descriptions, but:
– Nerves or blood vessels may be somewhat
out of place
– Small muscles may be missing
• Extreme anatomical variations are
seldom/rarely seen
 BODY CAVITIES
• Are spaces within the body that help
protect, separate and support internal
organs.
• Dorsal cavity: located near the dorsal
(posterior) surface of the vertebral canal.
It protects the nervous system, and is
divided into two subdivisions:
 Body Cavities
– Cranial cavity is within the skull and
contains the brain
– Vertebral cavity runs within the vertebral
column and contains the spinal cord.
The layers of protective tissue called
meninges , line the dorsal body cavity.
 Body Cavities
• Ventral cavity is located on the ventral (anterior) aspect of
the body.
• It houses the internal organs (viscera), and is divided into
two subdivisions:
-Thoracic: superior portion of the ventral body cavity. The
Thoracic cavity houses lung and heart. It is protected by the rib
cage & associated musculature and the sternum anteriorly. It
consists of the right and left pleural cavities and mediastinum
(the portion of tissues and organs that separates the left and
right lung).
-Abdominopelvic: inferior portion of the ventral body cavity
which extends from the diaphragm to the groin and is encircled
by the abdominal wall and bones and muscles of the pelvis.
 Con’t
• Abdomino-pelvic cavity: extends from the
diaphragm inferior to the floor of the pelvis.
• It is divided into superior abdominal and
inferior pelvic cavity by imaginary line
passing at upper pelvis.
• Abdominal cavity: contains the stomach,
intestine, liver, spleen and gallbladder.
• The pelvic cavity: contains urinary bladder,
rectum, and portions of the reproductive
organs.
 Body Cavities
• Thoracic cavity is subdivided into pleural
cavities, the mediastinum, and the
pericardial cavity
– Pleural cavities: each houses a lung
– Mediastinum: contains the pericardial
cavity, and surrounds the remaining
thoracic organs
– Pericardial cavity: encloses the heart
 Body Cavities
• The abdominopelvic cavity is separated
from the superior thoracic cavity by the
dome-shaped diaphragm
• It is composed of two subdivisions
– Abdominal cavity – contains the
stomach, intestines, spleen, liver, and
other organs
– Pelvic cavity – lies within the pelvis and
contains the bladder, reproductive
organs, and rectum
Body Cavities

Figure 1.9a
Body Cavities Figure 1.9b
 Membranes
Membranes are sheets of tissue that cover or
line surfaces or that separate organs or parts
(lobes) of organs from one another.
• Mucous membranes line the body tracts
(systems) that have openings to the
environment.eg: digestive tract
• Serous membranes line some closed body
cavities and cover the organs in these
cavities. The pleural membranes are the
serous membranes of the thoracic cavity.
Ventral Body Cavity Membranes
• Parietal serosa lines internal body walls

• Visceral serosa covers the internal

organs

• Serous fluid separates the serosae

Ventral Body Cavity Membranes

Figure 1.10a
Ventral Body Cavity Membranes

Figure 1.10b
 Other Body Cavities
• Oral and digestive: mouth and cavities of
the digestive organs
• Nasal: located within and posterior to the
nose
• Orbital: house the eyes
• Middle ear: contain bones (ossicles) that
transmit sound vibrations
• Synovial: joint cavities
 Abdominopelvic Regions

• Umbilical
• Epigastric
• Hypogastric
• Right and left iliac
or inguinal
• Right and left
lumbar
• Right and left
hypochondriac
Figure 1.11a
Organs of the Abdominopelvic Regions

Figure 1.11b
 Abdominopelvic Quadrants

• Right upper (RUQ)

• Left upper (LUQ)
• Right lower (RLQ)
• Left lower (LLQ)

Figure 1.12
 Homeostasis
• When the structure and function of the body are coordinated, the body
achieves a relative stability of its internal environment called
homeostasis / staying the same.
• Although the external environmental changes constantly, the internal
environment of a healthy body remains the same with in normal limits.
• Equilibrium of the body’s internal environment produced by the
interaction of organ systems and regulatory processes (feedback
systems).
• Some of the functions controlled by homeostasis mechanisms are blood
pressure, body temperature, breathing and heart rate.
• Homeostasis is a dynamic condition in response to changing conditions.
The two body systems that largely control the body’s homeostatic state:
1. Nervous system
2. Endocrine system
 Control of Homeostasis

• Homeostasis is continually being disrupted by

– External stimuli: intense heat, cold , and lack of
oxygen
– Internal stimuli: psychological stresses and
exercise
• Disruptions are usually mild & temporary
• If homeostasis is not maintained, death may result.
 Con’t
• Homeostatic imbalances occur because of disruptions
from the external or internal environments.
– Homeostasis is regulated by the nervous system and
endocrine system, acting together or independently.
– The nervous system detects changes and sends
nerve impulses to counteract the disruption.
– The endocrine system regulates homeostasis by
secreting hormones.
• Whereas nerve impulses cause rapid changes,
hormones usually work more slowly.
• Examples: CO2, O2, temperature, pH, blood pressure,
…
 Example of Homeostasis
Fluid balance in the Body
• Compartments for
Body Fluids
1. Intracellular
2. Extracellular
a. Interstitial
b. Plasma
Components of Feedback Loop
• Receptor
– monitors a controlled
condition
• Control center
– determines next action
• Effector
– receives directions
from the control center
– produces a response
that changes the
controlled condition
Basic Components of a
Negative Feedback
System
Basic Components of a Positive Feedback System
 Homeostatic Imbalances

• Disruption of homeostasis can lead to disease and

death.
• Disorder is a general term for any change or
abnormality of function.
• Disease is a more specific term for an illness
characterized by a recognizable set of signs and
symptoms.
– A local disease is one that affects one part or a
limited region of the body.
– A systemic disease affects either the entire body or
several parts.
 Con’t
• Disease is a more specific term for an illness characterized
by a recognizable set of signs and symptoms.
– Signs are objective changes that a clinician can observe
and measure; e.g., fever or rash.
– Symptoms are subjective changes in body functions that
are not apparent to an observer; e.g., headache or
nausea.
• Diagnosis is the art of distinguishing one disease from
another or determining the nature of a disease; a diagnosis
is generally arrived at after the taking of a medical history,
conduction of physical examination and performing of some
complementary exams.
Cells, Tissues, and Membranes
CELL INTRODUCTION
• Cells, the smallest structures capable of maintaining life and
reproducing, compose all living things,

• The human body, which is made up of numerous cells, begins as a

single, newly fertilized cell.

• Average-sized adult body, according to one estimate, consists of 100

trillion cells!
• A cell is the microscopic unit of body organization.
• A typical animal cell includes a cell membrane, a nucleus, a nuclear
membrane, cytoplasm, ribosomes, endoplasmic reticulum, mitochondria,
Golgi apparatus, centrioles, and lysosomes.
Types of Cells

• Based on cellular structure, there are two

types of cells:
• Prokaryotes
• Eukaryotes
 Difference between Prokaryotes and Eukaryotes cells

• Eukaryotic Cells:
• Eukaryotic cells have a true nucleus. • Prokaryotic Cells:
• The size of the cells ranges between • Prokaryotic cells have no nucleus.
10–100 µm in diameter. • They all are single-celled
• This broad category involves plants, microorganisms. Examples include
fungi, protozoans, and animals. archaea, bacteria, and cyanobacteria.
• The plasma membrane is responsible • The cell size ranges from 0.1 to 0.5 µm
for monitoring the transport of in diameter.
nutrients and electrolytes in and out of • Prokaryotic cells are smaller than
the cells. It is also responsible for cell Eukaryotic cells.
to cell communication. • The hereditary material can either be
• They reproduce sexually as well as DNA or RNA.
asexually. • Prokaryotes generally reproduce by
• Contrasting features: Plant cell binary fission, a form of asexual
contains chloroplast, central vacuoles, reproduction.
and other plastids, whereas the
animal cells do not.
Cell Structure
• There are many different types, sizes, and shapes of
cells in the body.
• It includes features from all cell types.
• A cell consists of three parts: the cell membrane, the
nucleus, and between the two, the cytoplasm.
• Within the cytoplasm lie intricate arrangements of fine
fibers and hundreds or even thousands of miniscule but
distinct structures called organelles.
Structure of
Animal Cells
Animal cell
 Cell Structure
• Cell membrane:
• Every cell in the body is enclosed by a cell (Plasma) membrane.
• Role:
✓ The cell membrane separates the material outside the cell, extracellular,
from the material inside the cell, intracellular.
✓ It maintains the integrity of a cell and controls passage of materials into
and out of the cell.
✓ Adhesion molecules
• Structure:
✓ The cell membrane is a double layer of phospholipids molecules.
✓ Proteins in the cell membrane provide structural support, form channels
for passage of materials, act as receptor sites, function as carrier
molecules, and provide identification markers.
Nucleus and Nucleolus
• Structure:
✓ The nucleus, formed by a nuclear membrane around a fluid nucleoplasm,
✓ The nucleolus is a dense region of ribonucleic acid (RNA) in the nucleus
• Function:
✓ The Nucleus is the control center of the cell. Threads of chromatin in the nucleus
contain deoxyribonucleic acid (DNA), the genetic material of the cell.
✓ The nucleus determines how the cell will function, as well as the basic structure
of that cell.
✓ The nucleolus is the site of ribosome formation..
• Two types of structures found in the nucleus are chromosomes and nucleoli.
• Chromosomes can be seen clearly only during cell divisions.
• Chromosomes are composed of both nucleic acid and protein.
• Chromosomes contain genes.
• Genes are the basic units of heredity which are passed from parents to their
children.
• Genes guide the activities of each individual cell.
Cytoplasm:
• The semifluid found inside the cell, but outside the nucleus,
is called the cytoplasm.
• Structure: The cytoplasm is the gel-like fluid inside the cell.
➢ Function:
• It is the medium for chemical reaction.
• It provides a platform upon which other organelles can
operate within the cell.
• All of the functions for cell expansion, growth and replication
are carried out in the cytoplasm of a cell.
• Within the cytoplasm, materials move by diffusion, a physical
process that can work only.
Cytoplasmic organelles:
• Cytoplasmic organelles are "little organs" that are
suspended in the cytoplasm of the cell. Each type of
organelle has a definite structure and a specific role in the
function of the cell.
• Examples of cytoplasmic organelles are mitochondrion,
ribosomes, endoplasmic reticulum, golgi apparatus, and
lysosomes.
Golgi Apparatus
– Receives and modifies
– Directs new materials
– Site of final processing of proteins to be secreted out of
cell
Mitochondria:
• Mitochondria are the "powerhouses" of the cell.
• The mitochondria provide the energy wherever it is needed
for carrying on the cellular functions.
• Food converted into energy in the form of Adenosine
triphosphate (ATP).
• Consumes Oxygen, produces CO2.
Endoplasmic Reticulum:
• The endoplasmic reticulum is a network of membranes,
cavities, and canals.
• The endoplasmic reticulum helps in the transfer of materials
from one part of the cell to the other.
Ribosomes:
• Ribosomes are "protein factories" in the cell.
• They are composed mainly of nucleic acids which help make proteins
according to instructions provided by the genes.
Centrioles:
• Centrioles help in the process of cell division.
Lysosomes:
– Lysosomes are membrane bound spheres which contain enzymes
that can digest intracellular structures or bacteria.
– Intracellular digestion
– Catalyze and breakdown proteins, lipids, nucleic acids, and
carbohydrates.
– Releases nutrients
– Breakdown of waste
• Cytoskeleton:
– “Bones and muscles” of the cell
– Maintains the cell’s shape and internal organization
– Permits movement of substances within the cell and
movement of external projections
– Microtubules
• Centrioles
– Microfilaments
 Organic Molecules of Cells
• Proteins
• Carbohydrates
• Lipids
• Nucleic acids
 Proteins
• Most diverse and complex macromolecules
in the cell.
• Used for structure, function and information.
• Made of linearly arranged amino acid
residues.
 Types of Proteins
1) Enzymes: catalyzes covalent bond breakage or formation
2) Structural: collagen, elastin, keratin, etc.
3) Motility: actin, myosin, tubulin, etc.
4) Regulatory: bind to DNA to switch genes on or off
5) Storage: ovalbumin, casein, etc.
6) Hormonal: insulin, nerve growth factor (NGF), etc.
7) Receptors: hormone and neurotransmitter receptors
8) Transport: carries small molecules or irons
9) Special purpose proteins: green fluorescent protein, etc.
Lipids
• Hydrophobic molecule:
– Energy storage, membrane components, signal
molecules
– Triglycerides (fat), phospholipids, waxes, sterols
Carbohydrates:
• Sugars, storage (glycogen, starch), Structural
polymers (cellulose and chitin)
• Major substrates of energy metabolism
Nucleic Acids
• DNA (deoxyribonucleic acid) and RNA
encode genetic information for synthesis
of all proteins
 Cell Function
• Movement
• Conductivity
• Metabolic absorption
• Secretion
• Excretion
• Respiration
• Communication
• The generalized cell functions include movement of
substances across the cell membrane, cell division to
make new cells, and protein synthesis.
 Con’t
❖Movement of substances across the cell membrane
 The survival of the cell depends on maintaining the difference between
extracellular and intracellular material.

 Mechanisms of movement across the cell membrane include simple

diffusion, osmosis, filtration, active transport, endocytosis, and
exocytosis.

 Simple diffusion: is the movement of particles (solutes) from a region

of higher solute concentration to a region of lower solute
concentration.

 Osmosis is the diffusion of solvent or water molecules through a

selectively permeable membrane.

 Filtration utilizes pressure to push substances through a membrane.

 Con’t

 Active transport moves substances against a

concentration gradient from a region of lower concentration

to a region of higher concentration. It requires a carrier

molecule and uses energy.

 Endocytosis refers to the formation of vesicles to transfer

particles and droplets from outside to inside the cell.

 Exocytosis process by which of Secretary vesicles move

from the inside to the outside of the cell by.

 Cell division
 Cell division is the process by which new cells are formed for
growth, repair, and replacement in the body.
 This process includes division of the nuclear material and
division of the cytoplasm.
 All cells in the body (somatic cells), except those that give
rise to the eggs and sperm (gametes), reproduce by mitosis.
 Gametes are produced by a special type of nuclear division
called meiosis in which the number of chromosomes is
halved.
 Division of the cytoplasm is called cytokinesis.
 Cell division: – mitosis – Prophase – metaphase – anaphase
– telophase – interphase and this is called Cell cycle.
 Cell division
Mitosis:
 results in two cells identical to
the one parent cell.
 Interphase is the period
between successive cell
divisions. It is the longest part of
the cell cycle.
 The successive stages of
mitosis are prophase,
metaphase, anaphase, and
telophase.
 Cytokinesis, division of the
cytoplasm, occurs during
telophase.
Different stages of the M phase during cell division (mitosis)
 Con’t

Meiosis :
• is a special type of cell division that occurs in the
production of the gametes.
• These cells have only 23 chromosomes, one-
half the number found in somatic cells, so that
when fertilization takes place the resulting cell
will again have 46 chromosomes, 23 from the
egg and 23 from the sperm.
 Con’t

 DNA replication and protein synthesis

 Proteins that are synthesized in the cytoplasm function as
structural materials, enzymes that regulate chemical
reactions, hormones, and other vital substances.
 DNA in the nucleus directs protein synthesis in the
cytoplasm.
 A gene is the portion of a DNA molecule that controls the
synthesis of one specific protein molecule.
 Messenger RNA carries the genetic information from the
DNA in the nucleus to the sites of protein synthesis in the
cytoplasm.
 Gametogenesis: meiosis (specialized form of cell division giving
rise to sperm and egg cells)

Meiosis I
Meiosis I (continued) Meiosis II

Cell division without DNA replication

 Haploid cell
 Body Tissues
• Tissue is a group of cells that have similar structure and that function
together as a unit.
• A nonliving material, called the intercellular matrix, fills the spaces
between the cells.

• This may be abundant in some tissues and minimal in others.

• The intercellular matrix may contain special substances such as salts
and fibers that are unique to a specific tissue and gives that tissue
distinctive characteristics.

• There are four main tissue types in the body: epithelial, connective,
muscle, and nervous.

• Each is designed for specific functions

 Epithelial Tissues
 Epithelial tissues are widespread throughout the body.
 They form the covering of all body surfaces, line body cavities and hollow
organs, and are the major tissue in glands.
Functions: protection, secretion, absorption, excretion, filtration, diffusion,
and sensory reception.
• The cells in epithelial tissue are tightly packed together with very little
intercellular matrix.
• Because the tissues form coverings and linings, the cells have one free
surface that is not in contact with other cells.
• Opposite the free surface, the cells are attached to underlying connective
tissue by a non-cellular basement membrane.
• This membrane is a mixture of carbohydrates and proteins secreted by
the epithelial and connective tissue cells.
• Epithelial cells may be squamous, cuboidal, or columnar in shape and
may be arranged in single or multiple layers
 Types of epithelial tissues:
 Simple cuboidal epithelium: found in glandular tissue and in the kidney
tubules.
 Simple columnar epithelium: lines the stomach and intestines.
 Pseudostratified columnar epithelium: lines portions of the respiratory
tract and some of the tubes of the male reproductive tract.
 Transitional epithelium can be distended or stretched.
 Glandular epithelium is specialized to produce and secrete substances.
Types of Tissue

• Epithelial tissue: • Connective tissue:

– Simple vs. stratified – Ground substance
– Squamous – Fibers
– Cuboidal – Loose and dense
– Columnar connective tissue
– Pseudostratified – Elastic and reticular
– Structures connective
• Cilia and microvilli – Cartilage, bone, vascular,
and adipose
 Connective Tissues
• Connective tissues bind structures together,
• Form a framework and support for organs and the body as a whole,
• store fat,
• Transport substances,
• Protect against disease,
• and help repair tissue damage.
• They occur throughout the body.
• Connective tissues are characterized by an abundance of intercellular
matrix with relatively few cells.
• Connective tissue cells are able to reproduce but not as rapidly as
epithelial cells.
• Most connective tissues have a good blood supply but some do not.
 Connective Tissues

 Numerous cell types are found in

connective tissue.
 Three of the most common are
the fibroblast, macrophage, and
mast cell.
The types of connective tissue
include:
 loose connective tissue,
 adipose tissue,
 dense fibrous connective tissue,
 elastic connective tissue,
 cartilage,
 osseous tissue (bone),
 and blood.
 Muscle Tissue

• is composed of cells that have the special ability to shorten or contract

in order to produce movement of the body parts.

 is highly cellular and is well supplied with blood vessels.

 The cells are long and slender so they are sometimes called muscle

fibers, and these are usually arranged in bundles or layers that are

surrounded by connective tissue.

 Actin and myosin are contractile proteins in muscle tissue.

 Muscle tissue can be categorized into skeletal muscle tissue, smooth

muscle tissue, and cardiac muscle tissue.

 Skeletal muscle fibers: are cylindrical, multinucleated,
striated, under voluntary control.
 Smooth muscle cells: are spindle shaped, have a single,
centrally located nucleus, and lack striations.
 involuntary muscles.
 Cardiac muscle: has branching fibers, one nucleus per cell,
striations, and intercalated disks.
 Its contraction is not under voluntary control.
Skeletal muscle fibers
Smooth muscle cells:
Cardiac muscle
 NervousTissue
 found in the brain, spinal cord, and nerves.

 responsible for coordinating and controlling of many body

activities.

 stimulates muscle contraction,

 creates an awareness of the environment,

 and plays a major role in emotions, memory, and reasoning.

 Con’t

• To do all these things, cells in nervous tissue need to be able to

communicate with each other by way of electrical nerve impulses.

• The cells in nervous tissue that generate and conduct impulses are called

neurons or nerve cells.

• These cells have three principal parts: the dendrites, the cell body, and

one axon.

• The main part of the cell, the part that carries on the general functions, is

the cell body.

• Dendrites are extensions, or processes, of the cytoplasm that carry

impulses to the cell body.

Neuroglia  Nervous tissue also includes cells that
do not transmit impulses, but instead
support the activities of the neurons.
 These are the glial cells (neuroglial
cells), together termed the neuroglia.
 Supporting, or glia, cells bind neurons
together and insulate the neurons.
 Some are phagocytic and protect
against bacterial invasion,
 while others provide nutrients by
binding blood vessels to the neurons.
 Body Membranes
 Thin sheets of tissue that cover the body, line body cavities, and cover
organs within the cavities in hollow organs.
 They can be categorized into epithelial and connective tissue
membrane.
❖ EPITHELIAL MEMBRANES
 consist of epithelia: the mucous membranes and serous membranes
❑ Mucous Membranes:
 epithelial membranes that consist of epithelial tissue that is attached to an
underlying loose connective tissue.
 These membranes, sometimes called mucosae, line the body cavities that
open to the outside.
 The entire digestive tract is lined with mucous membranes.
 Other examples include the respiratory, excretory, and reproductive tracts.
 Con’t

❑ Serous Membranes:
 Serous membranes line body cavities that do not open directly to the
outside, and they cover the organs located in those cavities.
 Serous membranes are covered by a thin layer of serous fluid that is
secreted by the epithelium.
 Serous fluid lubricates the membrane and reduces friction and abrasion
when organs in the thoracic or abdominopelvic cavity move against each
other or the cavity wall.
 Serous membranes have special names given according to their location.
 For example, the serous membrane that lines the thoracic cavity and
covers the lungs is called pleura.
 CONNECTIVE TISSUE MEMBRANES
 contain only connective tissue.
 Synovial membranes and meninges belong to this category.
❑ Synovial Membranes:
 Synovial membranes are connective tissue membranes that line the
cavities of the freely movable joints such as the shoulder, elbow, and
knee.
 Like serous membranes, they line cavities that do not open to the outside.
 Unlike serous membranes, they do not have a layer of epithelium.
 Synovial membranes secrete synovial fluid into the joint cavity, and this
lubricates the cartilage on the ends of the bones so that they can move
freely and without friction.
❑ Meninges:
 The connective tissue covering on the brain and spinal cord, within the
cranial and dorsal cavities, are called meninges.
 They provide protection for these vital structures.
References

• https://www.cliffsnotes.com/study-
guides/anatomy-and-physiology.
• https://www.cartercenter.org/resources/pdf
s/health/ephti/library/lecture_notes/nursing
_students/ln_human_anat_final.pdf
• https://ncert.nic.in/textbook/pdf/kebo110.p
df
 ANATOMY AND PHYSIOLOGY

UNIT 2: INTEGUMENTARY SYSTEM

Prepared by:
HABUMUGISHA Emmanuel, RN, BScN, PGCLTHE, MSN
EACC/ Health Science Faculty
2022
 Learning objectives
At the end of this unit, the students should be able to:
- Describe skin of the human body
- Discuss glands of the skin
- Explain the structure and function of hair
- Discuss about nails.
 Introduction
• Integumentary system is composed of following
organs:
– Skin and
– Its accessory structures such as
• Hair
• Nails
• Glands
• Blood vessles, muscles and nerves
• Specialized receptors.
Integumentary system
• Skin (cutaneous membrane):
– Covers the external surface of body
– It is the largest organ of the body by surface area and
weight
– It is about 2 square meters (22 square feet)
– It weights 4.5-5 kg about 16% of total body weight
– It is 0.5-4 mm thick
• Thinnest on the eyelids,
• Thickest on the heels
• Average thickness is 1-2 mm
• The skin has 3 main parts which are the epidermis,
dermis and hypodermis.
Layers of skin
• Skin has three layers:
– Epidermis
– Dermis
– Subcutaneous tissue (Hypodermis) found beneath
dermis attaches the skin to the underlying tissues
and organs like muscle and bones.
 Con’t
• The superficial: The thinner portion which is
composed of epithelial tissue, is the epidermis.
• The deeper: The thicker connective tissue portion
is the dermis.
• Deep to the dermis is the subcutaneous layer.
Also called the hypodermis and it consists of
adipose tissues.
• Fibers that extend from the dermis attach the
skin to the subcutaneous layer, which in turn
attaches to the connective tissue around muscles
and bones.
 Cont….
• The subcutaneous layer serves as a storage
depot for fat that supply the skin.
• This region (and sometimes the dermis) also
contains nerve endings called pacinian
(lamellated) corpuscles that are sensitive to
pressure.
 Types of skin
• 2 types of skin
– Thin skin
• Covers all body regions except palms, palmar surfaces of
digits and soles
– Thick skin
• Covers the palms, palmar surfaces of digits and soles
 Functions of skin
• Protection against:
– Physical injury
– Foreign material
– Environmental impacts e.g UV lights from sun rays
– Temperature such as heat or cold by body temperature
regulations (Storage of water and fats)
• Defense:
– From chemicals and microbes such as bacteria
• Blood reservoir
• Sensory reception/Cutaneous sensation: it contains sensory
receptors of heat, cold, touch, pressure, and pain.
• Regulation of body temperature
• Excretion and absorption
• Synthesis of vitamin D: By the action of Ultra Violet rays/ sunrays. The
Vitamin D (calcitriol) is synthesized in the skin. Vitamin D is necessary
for absorption calcium from intestine.
• Social function: makeup, piercing, tattoos, keloid scars.
 Structures of the skin

Epidermis:
– The top most
– Composed of stratified squamous epithelium
– It has 4 major types of cells
• Keratinocytes
• Melanocytes
• Langerhans cells
• Merkel cells
• Epidermis is not vascularized and the nutrients
reach epidermal cells by diffusion.
 Keratinocytes

• About 90% of epidermal cells are keratinocytes,

which are arranged in four or five layers and
produce the protein keratin, tough, fibrous protein
that helps protect the skin and underlying tissues
from heat, microbes, and chemicals.
• Keratinocytes also produce lamellar granules, which
release a water-repellent sealant that decreases
water entry and loss and inhibits the entry of
foreign materials.
 Melanocytes
• About 8% of the epidermal cells are melanocytes
(melano- black), which develop from the ectoderm
of a developing embryo and produce the pigment
melanin that protects against damage by ultraviolet
radiation.
• Their long, slender projections extend between the
keratinocytes and transfer melanin granules to
them.
• Melanin is a yellow-red or brown-black pigment that
contributes to skin color and absorbs damaging
ultraviolet (UV) light.
 Cont…
• Once inside keratinocytes, the melanin
granules cluster to form a protective covering
over the nucleus, on the side toward the skin
surface. In this way, they protect the nuclear
DNA from damage by Ultra Violet radiation.
• Although their melanin granules effectively
protect keratinocytes, melanocytes
themselves are particularly susceptible to
damage by UV light.
 Langerhans cells
• Langerhans cells arise from red bone marrow and
migrate to the epidermis where they constitute a
small fraction of the epidermal cells.
• Dendrocytes (Langerhans cells & granstein cells).
• They participate in immune responses mounted
against microbes that invade the skin, and are
easily damaged by UV light.
• Their role in the immune response is to help
other cells of the immune system recognize an
invading microbe and destroy it.
 Merkel cells
• Merkel cells are the least numerous of the
epidermal cells.
• They are located in the deepest layer of the
epidermis, where they contact the flattened
process of a sensory neuron (nerve cell), a
structure called a Merkel (tactile) disc.
• Merkel cells and their associated Merkel discs
detect touch sensations.
 LAYERS OF THE EPIDERMIS
• Several distinct layers of keratinocytes in various
stages of development form the epidermis.
• In most regions of the body, the epidermis has four
strata or layers: stratum basale, stratum spinosum,
stratum granulosum, and a thin stratum corneum.
This is called thin skin.
• Where exposure to friction is greatest, such as in
the fingertips, palms, and soles, the epidermis has
five layers: stratum basale, stratum spinosum,
stratum granulosum, stratum lucidum, and a thick
stratum corneum. This is called thick skin.
 Stratum Basale
• The deepest layer of the epidermis composed of
a single row of cuboidal or columnar
keratinocytes. Some cells in this layer are stem
cells that undergo cell division to continually
produce new keratinocytes.
• The nuclei of keratinocytes in the stratum basale
are large, and their cytoplasm contains many
ribosomes, a small Golgi complex, a few
mitochondria, and some rough endoplasmic
reticulum.
 Cont…..
• The cytoskeleton within keratinocytes of the stratum
basale includes scattered intermediate filaments,
called tonofilaments.
• The tonofilaments are composed of a protein that will
form keratin in more superficial epidermal layers.
• Tonofilaments attach to desmosomes, which bind cells
of the stratum basale to each other and to the cells of
the adjacent stratum spinosum, and to
hemidesmosomes, which bind the keratinocytes to the
basement membrane positioned between the
epidermis and the dermis.
 Cont….
• Melanocytes and Merkel cells with their
associated Merkel discs are scattered among
the keratinocytes of the basal layer.
• The stratum basale is also known as the
stratum germinativum (germ- sprout) to
indicate its role in forming new cells.
 Stratum Spinosum
• Superficial to the stratum basale (spinos-
thornlike), arranged in 8 to 10 layers of many-
sided keratinocytes fitting closely together.
• These keratinocytes have the same organelles as
cells of the stratum basale.
• When cells of the stratum spinosum are prepared
for microscopic examination, they shrink and pull
apart so that they seem to be covered with
thornlike spines although they appear rounded
and larger in living tissue.
 Cont….
• Each spiny projection in a prepared tissue
section is a point where bundles of
tonofilaments are inserting into a
desmosome, tightly joining the cells to one
another.
• This arrangement provides both strength and
flexibility to the skin.
• Langerhans cells and projections of
melanocytes are also present in this layer.
 Stratum Granulosum
• At about the middle of the epidermis
(granulos- little grains) consists of three to
five layers of flattened keratinocytes that are
undergoing apoptosis, an orderly, genetically
programmed cell death in which the nucleus
fragments before the cells die.
• The nuclei and other organelles of these cells
begin to degenerate, and tonofilaments
become more apparent.
 Cont….
• A distinctive feature of cells in this layer is the
presence of darkly staining granules of a protein
called keratohyalin which converts the
tonofilaments into keratin.
• Also present in the keratinocytes are membrane
enclosed lamellar granules, which release a lipid-
rich secretion. This secretion fills the spaces
between cells of the stratum granulosum,
stratum lucidum, and stratum corneum.
 Con’t…..
• The lipid rich secretion acts as a water-repellent
sealant, retarding loss and entry of water and
entry of foreign materials.
• As the nuclei break down during apoptosis, the
keratinocytes of the stratum granulosum can no
longer carry on vital metabolic reactions, and
they die.
• Thus, the stratum granulosum marks the
transition between the deeper, metabolically
active strata and the dead cells of the more
superficial strata.
 Stratum Lucidum
• The stratum lucidum (lucid- clear) is present
only in the thick skin of areas such as the
fingertips, palms, and soles. It consists of three
to five layers of flattened clear, dead
keratinocytes that contain large amounts of
keratin and thickened plasma membranes.
 Stratum Corneum
• The stratum corneum (corne- horn or horny)
consists on average of 25 to 30 layers of flattened
dead keratinocytes. These cells are continuously
shed and replaced by cells from the deeper
strata. The interior of the cells contains mostly
keratin. Between the cells are lipids from lamellar
granules that help make this layer an effective
water-repellent barrier.
• Its multiple layers of dead cells also help to
protect deeper layers from injury and microbial
invasion. Constant exposure of skin to friction
stimulates the formation of a callus, an abnormal
thickening of the stratum corneum.
Dermis:
• It is composed of fibrous connective tissue containing
collagen and elastic fibres and exocrine glands.
• Contains two layers
• Outer papillary region
– Consists of areolar connective tissue containing
» thin collagen and elastic fibers,
» dermal papillae,
» special nerve endings that serve as touch receptors (meissner’s
corpuscles).
» is next to stratum basale of the epidermis.
• Deeper reticular region
– Consists of dense irregular connective tissue containing
» Collagen and elastic fibers
» Adipose cells
» Hair follicles
» Nerves
» Sebaceous glands
» Sudoriferous glands-sweat glands
 Con’t
• Reticular layer: next to papillary layer.
• It is made of dense connective tissue with course of
collagenous fiber bundles that crisscross to form a
storma of elastic network.
• In the reticular layer, many blood and lymphatic
vessels, nerves, fat cell, sebaceous (oil) glands and hair
roots are embedded.
• Receptors of deep pressure (pacinian corpuscles) are
distributed through out the dermis.
• Papillary dermal layer has folds and ridges called papillae
that push up into epidermal layer.
• Contains capillaries, lymphatics that supply skin and
sensory neurons.
• Papillae contain capillary loop and light touch receptors –
Meissner’s corpuscles.
• Dermal ridges – fingerprints Reticular dermal layer (deep
to papillary layer) 80% of thickness of dermis.
• Contain Pacinian corpuscles sensitive to deep pressure.
• Interlacing collagen fibres arranged in parallel bundles, give
skin strength & resilience. (lines of cleavage).
• Elastin fibres provide the stretch/recoil properties of skin.
• Flexure lines (at joints).
• Glands of the dermis:
Sebaceous (oil) glands found all over the body
(except palms & soles).
• Secrete sebum into a hair follicle, keeps skin &
hair from drying out.
• Contains triacylglycerides, cholesterol, proteins,
electrolytes & cell fragments.
• Sebum inhibits growth of bacteria. Blocked ducts
– whiteheads, blackheads
 Subcutaneous layer
• Subcutaneous layer:
– Also know as hypodermis (under the skin).
– This is not part of skin
– It attaches the skin to the underlying tissues and
organs.
– This layer contains pacinian corpuscles (Lamellated
corpuscles) that detect external pressure
– Pacinian corpuscles are found also in the dermis.
– With in it coils of ducts of sudoriferous (sweat) glands,
and the base of hair follicles.
 Skin color:
• Variation of skin color is due to the amounts of the three
pigments; melanin, carotene and hemoglobin.
• Melanin:
– Yellow-red or brown-black pigmentation produced by melanocytes in
the epidermis
– It absorbs UV radiation
– Amount of melanin causes the skin’s color to vary from pale yellow
to red to tan to black
– Amount of melanocytes are the same to all people; difference in skin
color is due to amount of melanin pigment produced.
– All races have some melanin in their skins although the
darker races have slightly more melanocyte.
• Carotene: is a yellow-orange pigment found in the stratum
corneum, dermis and subcutaneous layers
• Hemoglobin: red color from erythrocytes flowing through
dermal capillaries
• Clinical significance:
– Overgrowth of melanocytes that is benign localized:
Nevus or mole
– Albinism is inherited inability to produce melanin
– Vitiligo is a condition in which there is partial or
complete loss of melanocytes (Autoimmune disease).
Accessory structures of skin
• Accessory structures of skin includes
– Hairs
– Skin glands
– Nails
• Hairs
– Functions
• Protection
• Reduction of heat loss
• Sensing light touch
– Hair is composed of dead, keratinized epidermal cells
Hairs
– Consists of
• Shaft which projects above the skin surface
• Root which penetrates into the dermis
• Hair follicle
• Epithelial root sheath
• Dermal root sheath
 con’t
• Hair consists of keratinised cells which develop
from the epidermis and have protective function.
• Because it arises from the skin, it is considered as
an appendage of the skin.
• It covers the entire body except the palms, soles,
lips, tip of penis, inner lips of vulva and nipples.
 Structure of Hair
• Hair has two parts, the shaft the part above skin and
the root embedded in the skin.
• Hair consist epithelial cell arranged in
• The lower portion of the root, located in the
hypodermis enlarges to form the bulbs.
• The bulb is composed of the matrix of epithelial cells.
• The bulb pushes in ward along its bottom to form a
papilla of blood rich connective tissue.
• Part of the hair follicle is attached with the bundle of
smooth muscle about halfway down the follicle.
 Con’t
• These are arrecter pili muscles.
• When it contracts, it pulls the follicles and its hair to an
erect position producing goose bump.
• Hair grows and when it finishes its growth sheds.
• The growth rate of hair depends on its position.
• The fastest growth rate occurs over the scalp of women
aged 16 to 24 years.
• Scalp hair grows 0.4 m.m per day (an average scalp contain
125.000 hairs).
• Hair sheds when its growth is complete.
• Just before a hair is to be shed, the matrix cell gradually
become inactive and eventually dies.
 Function of Hair
• Insulation against cold in scalp
• Against glare in eye brows
• Screen against foreign particles (eye lashes)
• In the nostrils trap dust particles in the
inhaled air
• Protect openings from foreign particles.
Hairs:
– There are different types of hairs
• Lanugo
• Vellus
• Terminalis
– Hair color is determined by the amount and type of
melanin
– Sebaceous (oil) glands are connected to hair follicle
Skin glands
– Sebaceous glands
• Secrete oily substance “sebum”
• Sebum prevents dehydration of hair and skin
• Inhibits growth of certain bacteria
– Sudoriferous (Sweat) glands
• Eccrine sweat glands
– Most numerous in the body
• Appocrine sweat glands
– Located in the axilla, groin, areolae and beardedh facial regions of
adult males
• Eccrine sweet glands helps to cool the body by evaporating
and also eliminates small amount of wastes
• Appocrine sweat glands secret sweat during emotional
stress and sexual excitement
 Sudoriferous /sweat glands
• Types: Eccrine and Apocrine glands

Eccrine glands: are small, simple coiled tubular glands

distributed over nearly the entire body, and they are
absent over nail beds, margins of lips of vulva, tips of
penis.
• Eccrine glands: are numerous over the palms and soles.
Their secretary portion is embedded in the hypodermis.
• The sweat, they secret is colorless, aqueous fluid
containing neutral fats, albumin, urea, lactic acid and
sodium chloride.
• Its excretion helps body temperature to be regulated.
Apocrine glands: are odiferous, found at the armpits,
in the dark region around nipples, the outer lips of
the vulva, and the anal and genital regions.
• They are larger and deeply situate than eccrine
sweet glands.
• An apocrine sweet gland becomes active at puberty.
• They respond to stress including sexual activity.
• The female breasts are apocrine glands that have
become adapted to secret and release milk instead
of sweat.
• The ceruminous glands in the outer ear canal are
also apocrine skin glands.
Sebaceous (Oil) glands
• Sebaceous glands are simple branched alveolar glands found
in the dermis.
• Their main functions are lubrication and protection.
• They are connected to hair follicles and secret oily secretion called
sebum.
• It is a semi fluid substance composed of entirely lipids.
• It functions as a permeability barrier, an emollient (skin softening)
and a protective a gent against bacteria and fungi.
• This type of gland found all over the body except in the palms and
soles.
• Acne vulgaris is a condition when there is over secretion of sebum,
which may enlarge the gland and plug the pore.
Ceruminous glands:
• Modified sweat glands located in the ear canal
• They are involved in producing a waxy secretion called
“Cerumen (earwax)” together with nearby sebaceous glands
• Cerumen provides sticky barrier that prevents entry of
foreign bodies into the ear canal
• Nails:
– Nails are composed of hard, keratinized epidermal
cells located over the dorsal surfaces of the ends of
finger and toes
– Each nails consist of
• Free edge
• Transparent nail body (plate) with whitish lunula at its base
• Nail root embedded in a fold of skin
 con’t
• Nails, modified epidermis consisting of keratin,
useful for scratching, picking things up.
• Rich bed of capillaries underlie nails (in dermis).
• The proximal part of nail is lunula, which is white
in its color because of the capillaries underneath
are covered by thick epithelium.
• Nail has body and root.
• The body is the exposed part and the root is
hidden under the skin.
 Con’t
• Epithelial layer covering underneath of the fore-hang
nail is hyponychyem.
• The nail rests on an epithelial layer of skin called nail bed.
• The thicker layer of skin beneath the nail root is the matrix,
where new cells are generated.
• Nail grows 0.5 m.m a week.
• Thin layers of epidermis called eponychium originally cover
the growing nail.
• Our nail protects our fingers and toes.
• It also allows picking up and grasping objects as
well we use them to scratch.
 Burns
• 1st degree: only epidermis is damaged (sunburn).
• Heals 2-3 days.
• 2nd degree: injures epidermis & upper dermis, blisters appear
(partial thickness burns). Skin regenerates (1-2 wks) with little or no
scarring.
• 3rd degree: full thickness burns, involve whole thickness of skin.
Nerve endings are destroyed.
• Extensive burns cannot heal themselves.
• Skin grafting is required to avoid fluid loss & infection.
• If > 10% of skin area is full thickness burnt, it is critical.
If > 20% of skin area burnt, it is life threatening.
 Ageing of skin
• Newborn skin is thin.
• During infancy & childhood skin thickens & subcutaneous fat
deposited.
• During adolescence skin & hair become oilier, acne may appear.
• After 30 years skin begins to show effects of “environmental
assault”.
• With old age rate of epidermal cell replacement slows, skin
thins, glands secrete less.
• Elastin fibres clump, degenerate, collagen fibres become fewer
& stiffer, hypodermal fat layer diminishes and this is wrinkling.
• Number of active hair follicles diminishes and this is hair
thinning.
 Aging and the Integumentary System
Effects of aging on the integumentary system:
• Wrinkling
• decrease of skin’s immune responsiveness
• dehydration and cracking of the skin
• decreased sweat production
• decreased numbers of functional melanocytes resulting
in gray hair and atypical skin pigmentation
• loss of subcutaneous fat
• a general decrease in skin thickness
• an increased susceptibility to pathological conditions
• Growth of hair and nails decreases; nails may also
become more brittle with age.
 Sensory receptors in skin
Tactile receptors:
• Merkel cells monitored by sensory terminals called tactile
discs: in basal layer of hairless skin detect fine touch.
• Meissner’s corpuscles: for fine touch in dermal papillae.
• Pacinian (lamellated) corpuscles: for deep pressure in reticular
layer.
• Ruffini corpuscles: for pressure and distortion in skin (in
reticular layer).
• Root hair plexus: to detect movement/distortion of hair follicle.
• Free nerve endings between epidermal cells. Have small
receptive fields for touch
sensation
Thermoreceptors:
• free nerve endings for heat: detect heat,
• free nerve endings for cold: detect cold.
Nociceptors: Pain receptors are free nerve
endings with large receptive fields (3 types:
extremes of temp, mechanical damage, dissolved
chemicals – strong stimuli excite all 3 and it is
“burning sensation” excited by many stimuli).
 Assignment
• Describe epidermal layer of the skin.
• Describe the burn and its classification
References
• Principles of Anatomy and Physiology Chapter
5 by John Wiley and Sons incl. 2009.
• file:///C:/Users/user/Documents/Downloads/
burns-definition-classification-
pathophysiology-and-initial-approach-2327-
5146-1000298.pdf
• https://dghs.gov.in/WriteReadData/userfiles/f
ile/Practical_handbook-revised_Karoon.pdf
 HUMAN ANATOMY AND
PHYSIOLOGY

UNIT 3: MUSCULOSKELETAL SYSTEM

LECTURER:
HABUMUGISHA Emmanuel, RN, BScN, PGCLTHE, MSN
Assistant Lecturer
EACC/ Health Science Faculty
SKELETAL SYSTEM
Introduction
 The human skeletal system consists of bones, cartilage,
ligaments and tendons and accounts for about 20 percent of
the body weight.
 The living bones in our bodies use oxygen and give off waste
products in metabolism.
 They contain active tissues that consume nutrients, require
a blood supply and change shape or remodel in response to
variations in mechanical stress.
 Learning objectives:
At the end of this lesson, the students should be able to:
• Define skeleton.
• Name the functions of the human skeleton.
• Name the layers and describe the basic structure of an individual bone,
• Describe the development of an individual bone.
• Name four types of bones by shape.
• Describe major categories used in classification of joints.
• Name the major parts of a "typical" synovial joint.
• Name and describe classifications of synovial joints according to the kind of
motion and number of axes.
• Name and define the two major subdivisions of the skeleton.
• Describe a typical vertebra. Name the regions of the vertebral column and
give the number of vertebrae in each region. Describe the intervertebral
discs and ligaments that hold vertebrae together.
• Describe the thoracic cage.
• Describe the skull.
• Describe the general pattern of the bones of the upper and lower
members.
❖Function of the Skeletal System
 Supports and protects the soft organs of the body.
 Supports the body against the pull of gravity.
 Involved in Ca²⁺ metabolism
 Hematopoiesis takes place in the bone marrow
 Facilitate the movement.
 Provides surface for muscle attachment
❖Structure of Bone Tissue
 Types of bone tissue: compact and spongy.

 The names imply that the two types differ in density, or how tightly the
tissue is packed together.

 There are three types of cells that contribute to bone homeostasis:

1. Osteoblasts are bone-forming cell,

2. osteoclasts break down bone,

3. osteocytes are mature bone cells.

 An equilibrium between osteoblasts and osteoclasts maintains bone tissue.

❖Compact Bone
 Consists of closely packed osteons or haversian systems.
 The osteon consists of a central canal the osteonic
(haversian) canal, surrounded by concentric rings
(lamellae) of matrix.
 Between the rings of matrix, the bone cells (osteocytes)
are located in spaces called lacunae.
 Small channels (canaliculi) radiate from the lacunae to the
osteonic (haversian) canal to provide passageways through
the hard matrix.
 In compact bone, the haversian systems are packed tightly
together to form what appears to be a solid mass.
 The osteonic canals contain blood vessels that are parallel
to the long axis of the bone.
 These blood vessels interconnect, by way of perforating
canals, with vessels on the surface of the bone.
❖ Spongy (Cancellous) Bone
 Spongy (cancellous) bone is lighter and less dense than compact bone.

 Spongy bone consists of plates (trabeculae) and bars of bone adjacent

to small, irregular cavities that contain red bone marrow.

 The canaliculi connect to the adjacent cavities,

 instead of a central haversian canal, to receive their blood supply. It may

appear that the trabeculae are arranged in a haphazard manner, but
they are organized to provide maximum strength similar to braces that
are used to support a building.

 The trabeculae of spongy bone follow the lines of stress and can realign
if the direction of stress changes.
 Bone Development and Growth
 The terms osteogenesis and ossification are often used synonymously to
indicate the process of bone formation.

 Parts of the skeleton form during the first few weeks after conception.

 By the end of the eighth week after conception, the skeletal pattern is formed
in cartilage and connective tissue membranes and ossification begins.

 Bone development continues throughout adulthood.

 Even after adult stature is attained, bone development continues for repair of
fractures and for remodeling to meet changing lifestyles.

 Osteoblasts, osteocytes and osteoclasts are the three cell types involved in
the development, growth and remodeling of bones.
❖Bone Development
 There are two types of ossification: intramembranous and endochondral

❑ Intramembranous

 Intramembranous ossification involves the replacement of sheet-like

connective tissue membranes with bony tissue.

 Bones formed in this manner are called intramembranous bones.

 They include certain flat bones of the skull and some of the irregular bones.

 The future bones are first formed as connective tissue membranes.

 Osteoblasts migrate to the membranes and deposit bony matrix around

themselves.

 When the osteoblasts are surrounded by matrix they are called osteocytes.
 Bone Growth
 Even though bones stop growing in length in early adulthood, they can
continue to increase in thickness or diameter throughout life in response to
stress from increased muscle activity or to weight.

 The increase in diameter is called appositional growth.

 Osteoblasts in the periosteum form compact bone around the external

bone surface.

 At the same time, osteoclasts in the endosteum break down bone on the
internal bone surface, around the medullary cavity.

 These two processes together increase the diameter of the bone and, at the
same time, keep the bone from becoming excessively heavy and bulky.
❖ Classification of Bones

❑ Long Bones

• Bones that are longer than they are wide are called long
bones.

• They consist of a long shaft with two bulky ends or

extremities.

• They are primarily compact bone but may have a large

amount of spongy bone at the ends or extremities.
❑ Short Bones

• Short bones are roughly cube shaped with vertical and horizontal dimensions
approximately equal.

• They consist primarily of spongy bone, which is covered by a thin layer of compact
bone

❑ Flat Bones

• Flat bones are thin, flattened, and usually curved. Most of the bones of the
cranium are flat bones.

❑ Irregular Bones

• Bones that are not in any of the above three categories are classified as irregular
bones.

• They are primarily spongy bone that is covered with a thin layer of compact bone.

• The vertebrae and some of the bones in the skull are irregular bones.
 Divisions of the Skeleton
 The adult human skeleton usually consists of 206 named bones.

 It is grouped in two divisions: axial skeleton and appendicular skeleton.

 The 80 bones of the axial skeleton form the vertical axis of the body.

 They include the bones of the head, vertebral column, ribs and
sternum.

 The appendicular skeleton consists of 126 bones and includes the free
appendages and their attachments to the axial skeleton.

 free appendages are the upper and lower extremities, or limbs, and
their attachments which are called girdles.
Axial Skeleton (80 bones)
Skull (8)

➢Cranial Bones (8 )
Parietal (2)
Temporal (2)
Frontal (1)
Occipital (1)
Ethmoid (1)
Sphenoid (1)
➢ Auditory Ossicles (6)
• Malleus (2)
• Incus (2)
• Stapes (2)
Con’t

❑Vetebral Column
• Cervical vertebrae (7)
• Thoracic vertebrae (12)
• Lumbar vertebrae (5)
• Sacrum (1)
• Coccyx (1)
❑Thoracic Cage
• Sternum (1)
• Ribs (24)
 Appendicular skeleton (126 bones)
• Pectoral girdles
• Clavicle (2)
• Scapula (2)
• Upper Extremity
• Humerus (2)
• Radius (2)
• Ulna (2)
• Carpals (16)
• Metacarpals (10)
• Phalanges (28)
• Pelvic Girdle
• Coxal, innominate, or
hip bones (2)
• Sacrum
• Coccyx
• Lower Extremity
• Femur (2)
• Tibia (2)
• Fibula (2)
• Patella (2)
• Tarsals (14)
• Metatarsals (10)
• Phalanges (28)
 ARTICULATIONS:
 An articulation, or joint, is where two bones come together.

 In terms of the amount of movement they allow, there are three types of joints:
immovable, slightly movable and freely movable.

❑ SYNARTHROSES :

 are immovable joints.

 The singular form is synarthrosis.

 In these joints, the bones come in very close contact and are separated only by a

thin layer of fibrous connective tissue.

 The sutures in the skull are examples of immovable joints

 Amphiarthroses (sing: amphiarthrosis}
 Slightly movable joints

 The bones are connected by hyaline cartilage or

fibrocartilage.

 The ribs connected to the sternum by costal cartilages are

slightly movable joints connected by hyaline cartilage.

 The symphysis pubis is a slightly movable joint in which

there is a fibrocartilage pad between the two bones.

 The joints between the vertebrae and the intervertebral

disks are also of this type.
 DIARTHROSES ( sing: diarthrosis)
 Most joints in the adult body are diarthroses,
or freely movable joints.
 the ends of the opposing bones are covered
with hyaline cartilage, the articular cartilage,
 are separated by a space called the joint
cavity.
 The components of the joints are enclosed in
a dense fibrous joint (articular) capsule.
 The outer layer of the capsule consists of the
ligaments that hold the bones together.
 The inner layer is the synovial membrane that
secretes synovial fluid into the joint cavity for
lubrication.
 Because all of these joints have a synovial
membrane, they are sometimes called
synovial joints.
 MUSCULAR SYSTEM
 The muscular system is composed of specialized cells called muscle
fibers.

 Their predominant function is contractibility.

 Muscles, where attached to bones or internal organs and blood

vessels, are responsible for movement.

 Nearly all movement in the body is the result of muscle contraction.

 Exceptions to this are the action of cilia, the flagellum on sperm

cells, and amoeboid movement of some white blood cells.
 Learning objectives:
At the end of this lesson, the students will be able to:
• Describe the general features of the skeletal
muscles.
• Describe the general arrangement of the trunk and
limb musculature.
• Give a sample drawing, identify the class of lever.
• Name the components of a skeleton-muscular unit.
 FUNCTIONS:
❑Production of mouvements:

 integrated action of joints, bones, and skeletal muscles produces

obvious movements such as walking and running.

 Skeletal muscles also produce more subtle movements that result in

various facial expressions, eye movements, and respiration.

❑Posture: such as sitting and standing, is maintained as a result of

muscle contraction

 The skeletal muscles are continually making fine adjustments that

hold the body in stationary positions.

 Con’t

❑Joint stability: The tendons of many muscles extend over

joints and in this way contribute to joint stability

❑ Heat production: is an important by-product of muscle

metabolism.

 Maintain body temperature,

 Nearly 85 percent of the heat produced in the body is the

result of muscle contraction.
 Structure of Skeletal Muscle
 A whole skeletal muscle is considered an organ of the muscular
system.
 Each organ or muscle consists of skeletal muscle tissue,
connective tissue, nerve tissue, and blood or vascular tissue.
 Skeletal muscles vary considerably in size, shape, and
arrangement of fibers.
 They range from extremely tiny strands such as the stapedium
muscle of the middle ear to large masses such as the muscles of
the thigh.
 Some skeletal muscles are broad in shape and some narrow.
 In some muscles the fibers are parallel to the long axis of the
muscle, in some they converge to a narrow attachment, and in
some they are oblique.
• Each skeletal muscle fiber is a single cylindrical muscle cell.
• Each muscle is surrounded by a connective tissue sheath
called the epimysium.
• Fascia: connective tissue outside the epimysium, surrounds
and separates the muscles.
• Portions of the epimysium project inward to divide the muscle
into compartments.
• Each compartment contains a bundle of muscle fibers.
• Each bundle of muscle fiber is called a fasciculus
• and is surrounded by a layer of connective tissue called the
perimysium.
• Within the fasciculus, each individual muscle cell, called a
muscle fiber, is surrounded by connective tissue called the
endomysium.
Structure of Skeletal Muscle
❖STRUCTURE OF SKELETAL MUSCLE
 The connective tissue covering furnish support and protection for the delicate cells
and allow them to withstand the forces of contraction.

 The coverings also provide pathways for the passage of blood vessels and nerves.

 Commonly, the epimysium, perimysium, and endomysium extend beyond the fleshy
part of the muscle, the belly or gaster, to form a thick ropelike tendon or a broad,
flat sheet-like aponeurosis.
 The tendon and aponeurosis form indirect attachments from muscles to the
periosteum of bones or to the connective tissue of other muscles.
 Typically a muscle spans a joint and is attached to bones by tendons at both ends.

 One of the bones remains relatively fixed or stable while the other end moves as a
result of muscle contraction.
 Con’t

 Skeletal muscles have an abundant supply of blood vessels and nerves.

 This is directly related to the primary function of skeletal muscle,

contraction.

 Before a skeletal muscle fiber can contract, it has to receive an impulse

from a nerve cell.

 Generally, an artery and at least one vein accompany each nerve that
penetrates the epimysium of a skeletal muscle.

 Branches of the nerve and blood vessels follow the connective tissue
components of the muscle
 Muscle Types:
• In the body, there are three types of muscle: skeletal
(striated), smooth, and cardiac.
➢ Skeletal Muscle
• attached to bones, is responsible for skeletal
movements.
• The peripheral portion of the central nervous system
(CNS) controls the skeletal muscles. →under
conscious, or voluntary, control.
• The basic unit is the muscle fiber with many nuclei.
• muscle fibers are striated (having transverse streaks)
and each acts independently of neighboring muscle
fibers.
➢Smooth Muscle
 found in the walls of the hollow internal organs such as blood
vessels, the gastrointestinal tract, bladder, and uterus,
 under control of the autonomic nervous system→cannot be
controlled consciously and thus acts involuntarily.
 The non-striated (smooth) muscle cell is spindle-shaped and
has one central nucleus.
 Smooth muscle contracts slowly and rhythmically.
➢Cardiac Muscle
 found in the walls of the heart,
 under control of the autonomic nervous system.
 has one central nucleus, like smooth muscle, but it also is
striated, like skeletal muscle.
 The cardiac muscle cell is rectangular in shape.
 The contraction of cardiac muscle is involuntary, strong, and
rhythmical.
❖Skeletal Muscle Groups
• ≥ 600 muscles in the body,
• ≈ 40% of a person's weight.
• Most skeletal muscles have names that describe
some features of the muscle.
• Often several criteria are combined into one
name.
 SOME NAMING TERMS:

 Size: vastus (huge); maximus (large); longus (long); minimus

(small); brevis (short).

 Shape: deltoid (triangular); rhomboid (like a rhombus with

equal and parallel sides); latissimus (wide); teres (round);
trapezius (like a trapezoid, a four-sided figure with two sides
parallel).

 Direction of fibers: rectus (straight); transverse (across); oblique

(diagonally); orbicularis (circular).
 Con’t

 Location: pectoralis (chest); gluteus (buttock or rump); brachii (arm);

supra- (above); infra- (below); sub- (under or beneath); lateralis (lateral).

 Number of origins: biceps (two heads); triceps (three heads);

quadriceps (four heads).

 Origin and insertion: sternocleidomastoideus (origin on the sternum

and clavicle, insertion on the mastoid process); brachioradialis (origin on
the brachium or arm, insertion on the radius).

 Action: abductor (to abduct a structure); adductor (to adduct a

structure); flexor (to flex a structure); extensor (to extend a structure);
levator (to lift or elevate a structure); masseter (a chewer).
 Muscles of the Head and Neck
 Humans have well-developed muscles in the face that
permit a large variety of facial expressions.

 Because the muscles are used to show surprise, disgust,

anger, fear, and other emotions, they are an important
means of nonverbal communication.

 Muscles of facial expression include frontalis, orbicularis

oris, orbicularis oculi, buccinator, and zygomaticus
 Muscles of the Trunk
• The muscles of the trunk include those that move the vertebral column,
the muscles that form the thoracic and abdominal walls, and those that
cover the pelvic outlet.

• The erector spinae group of muscles on each side of the vertebral

column is a large muscle mass that extends from the sacrum to the skull.

• These muscles are primarily responsible for extending the vertebral

column to maintain erect posture.

• The deep back muscles occupy the space between the spinous and
transverse processes of adjacent vertebrae.
 Con’t
• The muscles of the thoracic wall are involved primarily in the process of breathing.

• The intercostal muscles are located in spaces between the ribs.

• They contract during forced expiration.

• External intercostal muscles contract to elevate the ribs during the inspiration phase of
breathing.

• The diaphragm is a dome-shaped muscle that forms a partition between the thorax and
the abdomen. It has three openings in it for structures that have to pass from the thorax
to the abdomen.

• The abdomen, unlike the thorax and pelvis, has no bony reinforcements or protection.

• The wall consists entirely of four muscle pairs, arranged in layers, and the fascia that
envelops them.

• The pelvic outlet is formed by two muscular sheets and their associated fascia.
 Muscles of the Upper Extremity
 Include those that attach the scapula to the thorax and generally move the scapula,
 those that attach the humerus to the scapula and generally move the arm,
 and those that are located in the arm or forearm that move the forearm, wrist, and
hand.
 Muscles that move the shoulder and arm include the trapezius and serratus
anterior.
 The pectoralis major, latissimus dorsi, deltoid, and rotator cuff muscles connect to
the humerus and move the arm.

 The muscles that move the forearm are located along the humerus, which include
the triceps brachii, biceps brachii, brachialis, and brachioradialis.

 The 20 or more muscles that cause most wrist, hand, and finger movements are
located along the forearm.
 Muscles of the Lower Extremity
 The muscles that move the thigh have their origins on some
part of the pelvic girdle and their insertions on the femur.

 The largest muscle mass belongs to the posterior group, the

gluteal muscles, which, as a group, abduct the thigh.

 The iliopsoas, an anterior muscle, flexes the thigh.

 The muscles in the medial compartment adduct the thigh.

 Con’t

 Muscles that move the leg are located in the thigh region.

 The quadriceps femoris muscle group straightens the leg at the knee.

 The hamstrings are antagonists to the quadriceps femoris muscle

group, which are used to flex the leg at the knee.

 The muscles located in the leg that move the ankle and foot are
divided into anterior, posterior, and lateral compartments.

 The tibialis anterior, which dorsiflexes the foot, is antagonistic to the

gastrocnemius and soleus muscles, which plantar flex the foot.
Types of Muscle Fibre
• White Muscle Fibre
– Predominantly takes part in fast action
– Requires more Oxygen
– Heart & Lungs have to work more
• Red Muscle Fibre
– Predominantly takes part in Slow action
– Requires less Oxygen
– Heart & Lungs have to work less
– Presence of Myoglobin
 Con’t

• Strieted Muscle (Voluntary Muscle, Skeletal Muscle)

– Movement controlled by will
– Attached to bones, ligaments, cartilage & skin
• Unstrieted Muscle (Involuntary Muscle, Smooth Muscle)
– Movements cannot be controlled by will
– Glands, Blood Vessels, Organs & Tubular structures
are made of unstrieted muscle
• Cardiac Muscle
– Involuntary Control
– Interconnected fibres (forming a web)
Properties of Muscles
• Contraction & Relaxation
• Elasticity
• Muscle tone
• Fatigue
• Work of Muscle depends on
– Speed of contraction and relaxation
– Co-ordination of joints and muscle
Type of Work
• Isotonic
– Tone remains constant
– Length changes
– Requires more Oxygen
– Taking initial state requires more time
• Isometric
– Length remains constant
– Tone changes
– Requires less Oxygen
– Taking initial state requires less time
MUSCULOSKELETAL SYSTEM

By Emmanuel HABUMUGISHA
BONES OF THE SKULL
 The skull is the an assembling of bones
 Some of them are protecting the brain:
 frontal, parietal, temporal, occipital bones
 Others hosts different organs of senses:
 Eyes, ears, nose…
 Others are involved in mastication which is an
important function in feeding
 maxilla and mandible
 They are 22 in all
BONES OF THE SKULL- FRONTAL
VIEW
Facial bones
•13 sutured bones
•1 mandible

Cranium:
•8 sutured bones
•Encases brain
•Muscle attachment
Sinuses
BONES OF THE SKULL-
LATERAL VIEW
BONES OF THE SKULL-INFERIOR
VIEW
SUPERIOR VIEW OF THE FLOOR OF
CRANIAL CAVITY
 THE FETAL SKULL: SUPERIOR
VIEW
•Anterior fontanel
remains soft until 1.5-
2yrs of age
•Others are replaced
by bone by the end of
the first year
THE FETAL SKULL: SUPERIOR VIEW

• Skull bones are still incomplete

• Fontanels (“little fountain”):
• Unossified remnants of fibrous membranes
• Pulse can be felt surging in these “soft spots”
• Allow infants head to be compressed slightly
during birth
• Accommodate brain growth in fetus & infant
FETAL SKULL: LATERAL VIEW
 PARANASAL SINUSES
• Mucus lined, hollow, air-filled portions of
bones surrounding the nasal cavity
• Mucus membrane of sinus help to warm
and humidify inspired air
 THE HYOID BONE
• The only bone that does
not articulate with
another bone

• Anchored by narrow
stylohyoid ligaments to
syloid process of
temporal bone.

• Serves as a moveable
base for the tongue

Figure 5.12
MUSCLES ON THE SKULL
Muscles acting on the skull can be divided into:
 Muscles of expression
 Muscles of mastication
 Intrinsic muscles of the eyes
 Muscles of the tongue
 Muscles of the pharynx
 Muscles of the anterior neck
 MUSCLES OF FACIAL EXPRESSION
▪ Origin - surface of the skull
▪ Insertion - superficial fascia and dermis
▪ Innervation – VII C.N.
▪ Action – Movements of facial structures
▪ Paralysis causes face to sag: Facial palsy
MUSCLES OF FACIAL EXPRESSION
 Include the
1. Orbicularis oculi
2. Buccinator
3. Orbicularis oris
4. Mentalis
5. Depressor labii inferioris
6. Levator labii superioris
7. Rizorius
8. Zygomatic
9. Frontalis
10. Platysma
11. Corrugator supercilii
 MUSCLES IN FACIAL EXPRESSION
• Frontalis: elevates eyebrow, wrinkles forehead
• Corrugator supercilii: wrinkles eyebrow
• Orbicularis oculi: closes eyelids
• Zygomaticus: elevates corner of mouth, upper lip
(smile)
• Rizorius: draws corner of mouth to side (smile)
• Buccinator: compresses cheek, whistling muscle
• Orbicularis oris: closes lips (purses lips)
• Platysma: tightens neck, depresses mandible
• We blink every 2 to 10 seconds. Each blink lasts for 0.3 to 0.4 seconds.
Different facial expressions and responsible muscles
MUSCLES OF MASTICATION
 Arise from skull and insert on
mandible
 Masseter and Temporalis elevate
the mandible
 Medial and Lateral Pterygoids help
elevate, but produce lateral excursion
of jaw (side to side grinding)
 V CN innervation
EXTRINSIC EYE MUSCLES
 a. Superior rectus b. Inferior rectus c. Medial rectus
d. Lateral rectus e. Inferior oblique f. Superior oblique
 Actions- eye movements; CN innervations- III, IV, & VI
 Superior rectus: to look up;
 Inferior rectus: to look down
 Medial rectus: to look medially;
 Lateral rectus: to look laterally
 Inferior oblique: to look down and laterally;
 Superior oblique: to look up and laterally
EXTRINSIC EYE MUSCLES
MUSCLES OF THE TONGUE
 Shifts food onto teeth and pushes it into pharynx; speech
 Intrinsic muscle gives shape to the tongue
 Extrinsic muscles are responsible of the movements
 Palatoglossus: elevate the tongue, innervated by XI CN
 Styloglossus: elevate & retract the tongue (same innervation)
 Hyoglossus: down & retract
XII CN
 Genioglossus: down & protract
 Action: Elevate, retract, & protract tongue
MUSCLES OF THE TONGUE
MUSCLES OF THE PHARYNX
 Action-Initiating the swallowing process
 Pharyngeal constrictors (superior, middle, inferior)
 Laryngeal elevators
 Palatal muscles:
 tensor veli palatini
 levator veli palatini
Muscles of the pharynx
Muscles of the pharynx
ANTERIOR MUSCLES OF NECK

 Digastric and geniohyoid depress the mandible or

elevates larynx
 Mylohyoid provides muscular floor to the mouth
 Stylohyoid elevates larynx
 Omohyoid and sternohyoid depress hyoid bone and
larynx
 Sternocleidomastoid – from clavicle and manubrium to
mastoid
 Action: contralateral rotation
 Innervation= XI CN
Anterior muscles of the neck
Thank you!
ANATOMY AND PHYSIOLOGY OF
THE TRUNK
By Emmanuel HABUMUGISHA
 COURSE STRUCTURE

 Chapter I: Osteology of the trunk

 Chapter II: Arthrology of the trunk
 Chapter III: Myology of the trunk
 Chapter IV: Spinal nerves
Introduction
 The trunk, together with the head form the axial skeleton
of the body.
 The skeleton of the trunk is made of the vertebral column
and the ribs.
 The trunk comprises three distinct cavities which are,
from proximal to distal:
 The neck
 The thoracic cage
 The abdomen
The skeleton of the
trunk
The vertebral column
 THE VERTEBRAL COLUMN/THE SPINE

In total there are

32/33 bones
which form the
spinal column
which are split
into 5 sections:
Typical vertebra of the cervical spine
Cervical spine

 This section forms the neck and consists of 7

vertebrae.
 These are the smallest of the vertebrae as they do not
have to carry as much weight.
 The top two cervical vertebrae are called the Axis
and Atlas and allow the head to rotate on the neck.
 The cervical vertebrae allow the movements of
flexion, extension, rotation and lateral flexion (side-
bending).
Cont’d

 Atlas
Cont’d

 It is the first vertebra

 Named after an ancient Greek story, of a man who
according to the myth, carried the entire world on
his shoulders.
 It has no body
 It has large superior articular surfaces for the skull
(occipital condyles)
 It has got a large inferior articular surfaces for C2
 It has no spinous process
Cont’d

 It has very small transverse processes

 The neural canal is very large and separated by the alar ligament
 Anterior of the alar ligament is the canal for the odontoid
process.
 If the alar ligament was not present the odontoid process could
move into the neural canal and damage it.
Cont’d
 The axis
 Cont’d

 The most special thing about axis is the odontoid process.

 This is a bone sticking up from the body also called the dens
(tooth) of axis.
 It has large superior articular surfaces for C1
 It has very small Transverse processes
 It has a small neural canal.
 Thoracic spine

 The thoracic spine runs from shoulder level down to the level
of the lowest ribs and includes 12 vertebrae which increase in
size the lower down the spine they are positioned.
 Each vertebra also forms a joint with the adjacent rib (known
as a costovertebral joint).
 The thoracic spine does not move as freely as the cervical or
lumbar sections as its main purpose is to provide stability
for the rib cage and protection for the organs within the
thoracic cavity.
Cont’d
 Made of vertebrae and intervertebral discs.
 There are 12 thoracic vertebrae unified in cartilaginous joint
and present the following characteristics:
A heart shaped body which increases progressively in size
from above downward.
 Each body presents on its lateral aspects, costal facets with
which the ribs of both sides articulate
 The head of most ribs articulate with the junction of two
vertebrae, so there are inferior and superior facets on each
side of most of the thoracic vertebral bodies.
Cont’d
 The first rib articulate only with T1. it has a complete upper
facet and one lower semi facet for the second rib.
 The 10th, 11th and 12th vertebrae have only one facet for the
corresponding ribs.
 Transverse processes with an anterior-facing facet for
articulation with the tubercle of the rib.
 These facets are absent on T11 and T12
 Articularprocesses ( superior & inferior) for the adjacent
vertebra oriented in a near vertical plane.
 The facet on the lower end of T12 is like an interlocking
lumbar facet.
Cont’d
 Long spinous processes directed downward.
 Pedicles and laminae which together form a neural
arches that create the posterior wall of the vertebral
canal.
 Intervertebral discs are fibro-cartilaginous tissues
between two adjacent vertebral bodies which at allow
and limit movements of the spine.
 Between two articular processes there is a synovial joint
and allow rotation and lateral flexion of the thoracic
spine.
Typical vertebra of the thoracic spine
Lumbar spine

 Contains 5 vertebrae and forms the lower back.

 These are the largest vertebrae due to the additional
weight they must carry.
 The lumbar region also allows a lot of movement, into
flexion, extension, rotation and lateral flexion which
means that it is the most frequently injured section of the
back.
Sacral spine:
 The sacral spine (or sacrum) consists of 4 fused vertebrae
which cannot move independently of each other.
 This part of the spine is shaped like a triangle and bridges
the gap between the two sides of the pelvis, connecting the
spine to the lower body.
 The joints with the ilium (pelvis), either side of the sacrum
are known as Sacroiliac (SI) joints.
Sacrum and coccyx
Coccyx:

 Contains 4 small fused bones known as the tail bone.

 These have no real function, although can occasionally be
the source of pain known as coccydynia.
Thoracic cage/RIB CAGE
 Made of:
 Thoracic spine made of thoracic vertebrae named of T 1 to T12
 12 pairs of ribs
 Costal cartilages
 The sternum
 It is a conical shaped cavity which encloses some viscera mainly the
heart and the lungs.
 At the top, it is separated from the neck by the supra-pleural
membrane
 At the basis, it is separated from the abdomen by the diaphragm.
RIBS
Typical rib Costal angle Neck

Head

Costal groove

Articular parts of the

tubercle

Body

Intercostalis externus

Intercostalis internus
Similarities in ribs

 Each rib has a head, neck and body.

 The head most ribs has two hemi-facets for articulation with
the corresponding vertebra and the one above.
 The narrow head connects the head to the body.
 At the junction there is the tubercle which articulates with
the transverse process of its own vertebra and also has a
roughed area ligamentous attachment to the transverse
process
Cont’d
 Shortly in front of the tubercle the rib is bent at the angle.
 The inner aspect of the inferior part of most rib is hollowed to
form a costal groove in which the intercostal nerve and vessels
are located.
 At the sternal end each rib is continuous with a costal cartilage.
 All the ribs slope down from the spine to their costal cartilage
 The costal cartilage slope upward towards their attachment
direct or indirect to the sternum.
Cont’d
Ribs can be divided into three groups:
 Ribs from 1 to 7
Articulate with the sternum: vertebrosternal ribs
Are sometimes called “true ribs” and ribs from 8-12 “false ribs”
but this is nonsensical.
 The first rib is atypical.
 Ithas a wide, horizontally flattened body which slopes
downwards from its articulation with the first thoracic
vertebra.
 Cont’d
 Itmoves little during breathing. Thus it acts as the fixed
point of suspension from in relation to which other ribs
move.
 On its postero-lateral surface is a roughened area where
the to which scalenus medius is attched.
 More anteriorly is the scalene tubercle to which is attached
the scalene anterior muscle.
 Both muscles act to prevent the depression of the of the
first rib
 Behind the scalene tubercle is a smooth groove in which
lies the subclavian artery and the T1 root of the brachial
plexus as it passes out of the thorax to enter the axilla
Cont’d
 Ribs 2-7
 Articulate anteriorly eithe with manubriosternal
junction or the body of the sternum (synovial joint).
 Posteriorly, the head of each one articulate via a
synovial joint with the body of the numerically
corresponding vertebra and the vertebra above.
 Within the joint a ligament attaches the head of the
rib to the intervertebral disc.
Cont’d

 Vertebrocostal ribs:
 These are from 8-10 ribs.
 Are attached to costal cartilages which do not articulate
with the sternum.
 They are attached to the costal cartilage of the rib above
 Posteriorly the vertebrocostal joint is like in the previous
joints but the facets of the costotransverse joints of these
lower ribs are flat allowing glinding movement to take
place.
Cont’d

 Flotting ribs:
 11 and 12 ribs are called floating ribs because they are
not directly attached to the interiorly to the thoracic
cage.
 11 and 12 articulate with one vertebra only.
The sternum

The manubrium

The body

The xyphoid process

Cont’d
• The anterior midline of the rib cage is made of a
bony part which is known as sternum
• It has three parts:
o A manubrium which is the proximal part of the sternum
o A body: the middle part of the sternum
o A xiphoid process: the distal part of the sternum
• The manubrium has a concave shape upper border
which forms the suprasternal notch.
• Its lateral border articulates with the clavicle
(sternoclavicular joint) with the first costal cartilage
and with the upper facet of the second costal
cartilage.
Cont’d
 The manubriosternal joint is between the lower border of
manubrium and the upper border of the body of the sternum
is also a cartilaginous joint.
 This joint may ossify in later life. It forms the sternal angle.
 The body laterally articulates with the second to the seventh
costal cartilages.
 The xiphoid is a cartilaginous flange attached to the lower
end of the body of the sternum between the apex of the
costal margins
 It may also ossify in later life.
Lumbar spine as part of the rib cage

 The distinguished things for the lumbar vertebras are:

 A very large body
 Spinous process straight, short and horizontal. Almost
square
 Transverse process short and thin
 Superior articular process faces postero-medial
 Inferior articular process faces antero-lateral
Typical vertebra of the lumbar spine
Arthrology of the trunk
Joint of the trunk

 Atlanto-ocipital joint
 Atlanto-axial joint
 Intervertebral joint
 Costovertebral joint
 Costomanubrial joint
 Sternoclavicular joint
 Sacroiliac joint
 The atlanto-occipital joint
 Joint made by the top cervical vertebra, the atlas, at the points where it articulates
with the two occipital condyles at the base of the skull.
 It is a synovial joint.
 The articular structure connecting the two bones
 two articular capsules
 posterior atlanto-occipital membrane
 anterior atlanto-occipital membrane
 cruciform ligament
 alar ligament
 Ligamentum nuchae
Atlanto-occipital joint
The atlanto-axial joint

 The atlanto-axial joint occurs between the atlas and the axis
bones
 These are the first two cervical vertebrae of the spine.
 It is a compound synovial joint.
 A layer of cartilage, as well as lubricating synovial fluid,
facilitates this movement.
 Two joint in one:
 Median Atlanto-Axial Joint
 Lateral Atlanto-Axial Joints
Cont’d

 Median Atlanto-Axial Joint

 It involves two bony parts of two bones: the odontoid process of
the Axis and the arch of the Atlas
 The position of the dens is maintained by the transverse ligaments
of the axis.
 Another pair of alar ligaments attach the dens to the occipital
condyle of the back skull
 This prevents over-rotation within the atlanto-axial joint.
Cont’d

 Lateral Atlanto-Axial Joints

 Two lateral atlanto-axial joints complement the median atlanto-axial
joint.
 On each of these, the inferior articulate facet of atlas pivots on the
superior articulate facet of axis.
 The concave shape of the atlas perfectly cups the convex axis, and
loose, capsular ligaments allow back and forth gliding during the
rotation of the atlas.
 Additionally, the lateral atlanto-axial joints help to transfer the weight
of the skull from the atlanto-occipital joint.
Atlanto-axial joint
Picture showing the atlanto-axial joint with
the transverse and alar ligament
Intervertebral joint

 The spine is made of the overlapping vertebrae and

intervertebral discs.
 The joint between two adjacent vertebrae comprises the
following structure:
 Two adjacent vertebrae
 The intervertebral disc
 Ligaments
Intervertebral joint and associated structures
Vertebral disc

 The components of the disc are

 The annulus fibrosus (outer part)
 The nucleus pulposus (inner part)
 The cartilage end plates (top and bottom)
Cont’d

The annulus fibrosus

 Its function is to control movement and protect nucleus pulposus
 The annulus fibrosus consists of the fibers that run in all directions, mostly
oblique, and some around.
 The fibers are very strong under tension and not very elastic.
Cont’d

The end plate cartilage

 Its is to protect the vertebra from high forces, which can cause bone
destruction and protect the nucleus pulposus.
Cont’d

The nucleus pulposus

 Its function is to accommodate movement, and transfer weight from
one vertebra to another (shock absorber).
 The nucleus pulposus is a gel fluid.
 Being a gel, the nucleus can deform under pressure without a
reduction in volume.
 It is elastic.
 The structure of the intervertebral disc
Ligaments
 The main functions of the ligaments surrounding the spinal
vertebras are
 To connect the vertebrae to each other in order to create a mechanic
unit.
 To stabilize the spine and the rib cage.
 To control movement at each joint of the trunk.
 The six main ligaments are
 Anterior longitudinal ligament
 Posterior longitudinal ligament
 Ligamentum Flavum
 Supraspinous ligament
 Interspinous ligament
 Ligamentum Nuchae
Cont’d
 Anterior longitudinal ligament
 Supports the anterior aspect of the vertebral column
 Action is to stop extension of the spine
 Posterior longitudinal ligament
 Support posterior side of the vertebral bodies
 Attach to the intervertebral discs and the adjacent margins of the vertebral
bodies
 Action is to stop flexion of the spine.
Cont’d

 Ligamentum Flavum
 Attach to the laminae of the vertebra (therefore there are right
and left sides), passes from one adjacent vertebra to the next
adjacent vertebra
 It is yellow in appearance, due to a high content of elastic fibers.
 Action appears to be to restrict the amount of flexion and to help
return the spine to upright after movement
Cont’d

 Supraspinous ligament
 Runs from the tip of the spinous processes of the vertebrae.
 The action is to limit the amount of flexion and to control some
rotation.
 Interspinous ligament
 Runs between the spinous processes of adjacent vertebrae.
Cont’d

 Ligamentum Nuchae
 Only at the cervical part of the spine
 Runs from the occipital protuberance of the skull to
 Each spinous process of the cervical vertebrae and finishes on the
spinous process of C7.
 Its action is to limit the amount of flexion of the head and neck,
and mostly to help hold the head upright on the neck.
 Ligamentum nuchae
The sternoclavicular joint

 The sternoclavicular articulation is a synovial double-plane

joint.
 Two portions separated by an articular disc which is made from
fibrocartilage.
 It has got the following structures:
 Anterior sternoclavicular ligament
 Articular capsule
 Articular disk
 Costoclavicular ligament
 Interclavicular ligament
 Posterior sternoclavicular ligament
 Sternoclavicular joint
The costomanubrial joint

 The costomanubrial joint is the joint between the first rib

and the manubrial part of the sternum.
 It is much involved in the sternoclavicular joint by the
costomanubrial ligament. (see the above image)
 It count also among the costosternal joints
The costosternal joint

 The sternocostal articulations (costosternal

articulations), articulations of the cartilages of the
true ribs with the sternum
 They are arthrodial joints, with the exception of the first, in
which the cartilage is directly united with the sternum
 This is therefore, a synarthrodial articulation.
 The ligaments connecting them are:
 Articular capsules
 Interarticular sternocostal ligament
 Radiate sternocostal ligaments
 Costoxiphoid ligaments
 Costosternal ligament
Costovertebral joints

 The costovertebral joints are the articulations that

connect the heads of the ribs with the bodies of
the thoracic vertebrae.
 Joining of ribs to the vertebrae occurs at two places, the
head and the tubercle of the rib.
 Two convex facets from the head attach to two adjacent
vertebrae.
 This forms a synovial planar (gliding) joint, which is
strengthened by the ligament of the head and the
intercapital ligament.
Cont’d

 Articulation of the tubercle is to the transverse process of

the adjacent vertebrae. This articulation is reinforced by
the dorsal costotransverse ligament.
 Other ligaments involved are:
 Radiate ligaments
 Accessory ligaments
 Intra-articular ligaments
 Costovertebral ligament
Movements of the trunk

 Movements of the spine

 Atlanto-occipital movements
 Atlanto axial movements
 Cervical region movements
 Thoracic region movements
 Lumbar region movements
 Flexion
 Extension
 Lateral Flexion
 Rotation
Myology of the trunk
Neck Muscles

 The cervical part of the spine has got powerful muscles.

 It is the most mobile part
 It balances the head on the rest of the body.
 4 main muscle groups according to their function:
 Extensors of the neck and head
 Flexors of the neck and head
 Lateral flexors of the neck and head
 Rotators of the neck and head
Cont’d
 Muscles extending the neck
 Levator scapulae
 Splenius cervicis
 Muscles extending the neck and head;
 Erector spinae
 Splenius capitis
 Trapezius
 Extensors of the neck &
head
Cont’d
 Muscles rotating the neck:
 Semispinalis
 Multifidus
 Scalenus anterior
 Splenius cervicis

 Muscles rotating the neck and head;

 Sternocleidomastoid
 Splenius capitis
Cont’d
 Muscles flexing the neck and head;
 Sternocleidomastoid
 Longus capitis
 Muscles lateral flexing the neck;
 Scaleneus anterior
 Scalenues medius
 Scaleneus posterior
 Splenius cervicis -
 Levator scapulae Sternocleidomastoid
 Flexors of the neck & head
Cont’d

 Lateral flexor muscles of the neck

 Trpezius muscle
 Anterior middle and posterior scalenus muscle
 Sternocleidomasoid muscle
 Splenius capitis
 Splenius cervicis
 Lateral flexors of the neck
Back MUSCLES
 The upper limb is attached to the back of the trunk by
five muscles, the trapezius and the latissimus dorsi, which
are attached to the scapula and to the humerus, and
cover nearly all the back from the occiput to the ilium.
 Underneath the trapezius are the two rhomboid muscles,
and the levator anguli scapulae.
 The latissimus dorsi, with the teres major, form the
posterior fold of the axilla.
 Cont’d
 There are five layers of muscles on the back.
 The first two, as above mentioned, are connected with and act
on the upper limb.
 Of the third layer, two are muscles of respiration. The third
keeps the head erect.
 The fourth layer is composed of the erector spinae and its
continuations, the long extensors of the back, extending from
sacrum to occiput. They keep the back erect.
 The fifth layer is composed of many small muscles, lying in the
groove between the lateral and spinous processes, the entire
length of the column.
Muscle of the back
Thoracic muscles

 Pectoral muscles
 Costal muscles
 Breathing muscles
 Main muscle
 Accessory muscles
Pectoral muscles

 The pectoralis major, which extends from the anterior

aspect of the sternum to the pectoral ridge of the
bicipital groove of the humerus, forms, with the lower
border of the pectoralis minor, the anterior fold of the
axilla.
 These two muscles and the subclavius and serratus
magnus attach the upper limb to the front of the trunk.
 The lower limb is attached to the trunk by psoas, iliacus,
pyriformis, and gluteus maximus muscles.
Cont’d

Pectoralis major Pectoralis minor

Breathing muscles

 Main muscle is only one

 The thoracic diaphragm muscle

 Accessory muscles
 All the costal muscles
 All the abdominal muscles
  Thoracic diaphragm

Diaphragm(Inferior view) Diaphragm (latero-anterior view)

Costal muscles
 They are muscles that attache the ribs to one
another and are responsible of movements
between the ribs.
 They are also accessory muscles of breathing.
These are:
 Internal intercostal muscles
 External intercostal muscles
 Levatores costarum muscles
 Transverus thoracis muscles
 Subcostales muscles
 Costal muscles

Subcostales muscles Levatores costarum

 Costal muscles

Transversus thoracis
Abdominal muscles
 The front of the trunk (the abdomen) is closed in by
five pairs of muscles ; in the middle are two recti,
which are parallel to the middle line, with the two
pyramidales at their lower end.
 At the sides are the external oblique, the fibres of
which run downward and forward ; the internal oblique
immediately under the external—its fibres run upward
and forward ; and the transversalis under the internal
oblique—its fibres run across.
 This arrangement of the fibres gives strength to the
abdominal walls.
Cont’d
 These three muscles become tendinous towards the
middle, and unite with their fellows of the opposite
side, forming an incomplete sheath for the recti
muscles.
 A fibrous band is formed in the middle line by their
union, reaching down from the ansiform cartilage
(xiphoid process of the sternum) to the pubis ; it is
called the linea alba.
Cont’d

 The thickened lower border of the external oblique

muscle is folded back on itself, and forms Poupart's
ligament.
 It is attached to the anterior superior spine of the ilium
and to the pubis. The lower border joins the fascia lata of
the thigh.
Muscles of the Abdomen
 Muscles of the abdomen
 Rectus abdominus
 External oblique
 Internal oblique
 Transversus abdominis
 Quadratus lumborum
Rectus abdominis muscle
 Quadratus lumborum muscle
 Obliquus internus muscle
 Obliquus externus muscle
 Transversus abdominis
Back muscles

 They are grouped into 5 layers (6 in some literatures.

 For organizational reasons we group them into 3:
 Deep back muscles
 Intermediate back muscles
 Superficial back muscles
 Deep muscles of the back
 This layer count many muscles, some very small.
 Some of these muscles extend up to the cervical region.
 Others are only confined to the thoracic and lumbar region.
 These are:
 Splenius capitis
 Splenius cervicis
 Sacrospinalis (part of erector spinae muscle)
 Semispinalis
 Iliocostalis lumborum
 Iliocostalis dorsi
Cont’d

 Iliocostalis cervicis  Spinalis capitis

 Longissimus dorsi  Semispinalis capitis
 Longissimus cervisis  Semispinalis cervicis
 Longissimus capitis  Semispinalis thoracis
 Spinalis cervicis  Multifidus
 Spinalis thoracis
 Deep muscles of the back
 Deep muscles of the back (Cont’d)
Intermediate muscles of the back

 This layer is made of 5 muscles including

 Splenius capitis
 Splenius cervicis
 Serratus posterior superior
 Serratus posterior inferior
Intermediate muscle of the back
Serratus posterior superior Serratus posterior inferior
Splenius capitis and cervicis
Superficial muscles of the back

 It is made of 5 muscles including

 Latissimus dorsi
 Trapezius
 Romboid minor
 Romboid major
 Levator scapulae
Superficial muscles of the back

Rhomboid minor and major

  Superficial muscles of the back (cont’d)

Trapezius muscle Latissimus dorsi

Pelvic floor muscles
 We have 3 layers of muscles that prevent the organs from falling
down.
 Colloquially we call this the diaphragm!
 Note that the “perineum” is the diamond shaped area defined by
these four landmarks:
 Pubic symphysis
 Coccyx
 2 Ischial tuberosities
 The perineum includes all structures inferior to, or external to
the pubic diaphragm
 Cont’d
Superior Pelvic Diaphragm
 The superior pelvic diaphragm is the inner, deepest layer.
 The superior pelvic diaphragm is made of two layers called the
Coccygeus and the Levator Ani.
 The Coccygeus
 originates from the ischial spine and inserts into the coccyx (and
lower sacral margin).
 The Levator Ani
 layer is actually a pair of muscles
called…
 pubococcygeus (pubis to coccyx)
 iliococcygeus (very bottom of iliac bone to coccyx).
 These muscles flatten out when it contracts to allow the lungs to expand
and take in air.
 Cont’d
The urogenital diaphragm
 This is the second layer that is made of 2 muscles called the
external urethral sphincter and deep transverse perineal muscle.
EXTERNAL URETHRAL SPHINCTER
 This surrounds the urethra and voluntarily constricts to prevent you from
peeing.
 Since it is a sphincter muscle, it is round, but not only is it round; it is a
skeletal muscle, which means we have voluntary control over this.
DEEP TRANSVERSE PERINEAL
 This runs from the ischial rami to the central tendon of the
perineum, which is located at the exact center of the perineum.
 This helps support the pelvic organs.
Cont’d
Muscles of the superficial perineal space

 The superficial layer is the layer most inferior when the pelvis
is upright (as opposed to the superior pelvic diaphragm).
 It contains 4 muscles:
The superficial transverse perineal muscle
 Most bottom, it strengthens the central tendon and runs from ischial
tuberosities to central tendon.
Cont’d

The ischiocavernosus
 It runs alongside the ischium
The bulbospongiosus
 It is a kind of surrounding/supporting the base of penis or either side
of the vagina. It maintains erections for the penis or clitoris.
The external anal sphincter
 This is again, a skeletal muscle, which is voluntary, and that’s why
we have to learn to poop. It prevents defecation.
Nerve supply to the
trunk
Intro
Three distinct parts of the nervous system
 Central nervous system
 The encephalus
 Cerebrum
 Cerebellum
 Medulla oblongata
 Spinal cord
 Peripheral nervous system
 Sensory
 Motor components
 Autonomic nervous system
 Sympathetic
 parasympathetic
Spinal nerves

 There are thirty-one pairs of spinal nerves.

 These nerves are mixed, having both sensory and motor
components.
 Their motor fibers begin on the ventral part of the spinal
cord at the anterior horns of the gray matter.
 The sensory ones on the posterior horn of the grey matter
(posterior root ganglia)
Cont’d

 8 pairs cervical
 12 pairs thoracic
 5 pairs lumbar
 5 pairs sacral
 1 pair coccygeal
Functions of spinal nerves

 These second order lower motor neurons

 Final common pathway for information traveling from the
central nervous system to the periphery.
 Provide innervation to the body areas below the neck.
 The sensory part of the spinal nerve is conveying the
peripheral information to the central nervous system
(afferent fibers).
 Reflex Arc
 Within the spinal cord the sensory and motor fibers of the
spinal nerves form a reflex arc.
 This type of reflexive behavior occurs when a message
from afferent fibers causes a motor reaction before going
to the brain.
 The info travels along spinal nerves to your spinal cord
and are carried directly to their motor nuclei by
interneurons.
 The motor command goes out along the axons of the
lower motor neuron and the reaction mediated by this
reflex arc can occur very rapidly.
Plexuses
 Brachial plexus
Cont’d
 Lumbar plexus
Blood supply to the
trunk
Intro
 Two main network of blood circulation are found in the
human body.
 Pulmonary circulation
 Systemic circulation.
 The trunk is supplied in blood by the systemic circulation
made of
 Aorta
 Inferior vena cava
 Superior vena cava
Cont’d
Cardiovascular system
Anatomy and Physiology
Prepared by Emmanuel HABUMUGISHA
Course Objectives

 To get the knowledge on the anatomy and physiology of

the lower limb or lower extremity

 Specific areas:
 Osteology (bones) of lower limb (LL)
 Arthrology (joints) of LL
 Myology (muscles) of LL
 Innervation of the LL
 Vasculature of LL
Segments of the Lower Limb

4 SEGMENTS/ REGIONS
 Pelvic girdle (gluteal)
 Free limb

- Thigh
- Leg
- Foot
Movements of the lower limbs
Osteology of the lower limbs
Function of lower limb bones

• Locomotion
• Support (frame)
• Provides attachment and insertion for muscles
• Carry weight of entire erect body
Bones of the Lower Limb
Gluteal/pelvic region
◼ Hip/pelvic bone
Thigh
◼ Femur
Knee
◼ Patella
Leg
◼ Tibia (medial)
◼ Fibula (lateral)
Foot
◼ Tarsals (7)
◼ Metatarsals (5)
◼ Phalanges (14)
Pelvic and leg bones
Pelvis (Also known as innominate bone)
Pelvic bone
Bones of thigh
Thigh

 Femur
 Largest,longest,
strongest bone in the
body
 Stress bearer
Femur
Head of Femur
Pelvis
Greater Trochanter

Lesser Trochanter Shaft of Femur

Linea Aspera

Lateral Condyle
Medial Condyle

Tibia
Fibula

Right, Posterior View

Bones of the leg
 Leg: Anterior Patella (knee cap)
Femur
Medial condyle of femur
Lateral condyle of femur
Medial condyle of tibia

Lateral condyle of tibia

Tibial tuberosity

Fibula
Tibia

Lateral malleolus Medial malleolus

Talus (tarsal bone)

Right Leg, Anterior View

◼ TIBIA
◼ Receives the weight
of body from femur
and transmits to foot
◼ Second to femur in
size and weight

◼ FIBULA
◼ Does NOT bear
weight
◼ NOT a part of knee
joint
◼ Stabilizes ankle joint
Patella

 Triangular sesamoid
bone
 Protects knee joint
 Improves leverage of
thigh muscles acting
across the knee
 Contained within
patellar ligament
The foot (dorsum)
The foot (plantar)
The foot

Function:
◼ Supports weight

◼ Acts as lever when

walking
The foot
Tarsals
✓ Talus => ankle
 Between tibia + fibula
✓ Calcaneus => heel
 Carries talus
✓ Navicular
✓ Cuboid
✓ Medial, lateral and intermediate
cuneiforms
 Metatarsals:
✓ Named from 1st to 5th
✓ 1st => the hallux
✓ 5th the little toe
 Phalanges: two rows:
✓ Distal and proximal
Myology of the lower limbs
Muscles of Hip and Thigh
◼ Gluteal
◼ Posterior pelvis
◼ Extend thigh
◼ Rotate thigh
◼ Abducts thigh
◼ Anterior Compartment Thigh
◼ Flexes thigh at hip
◼ Extends leg at knee
◼ Medial/Adductor Compartment
◼ Adducts thigh
◼ Medially rotates thigh
◼ Posterior Compartment Thigh
◼ Extends thigh
◼ Flexes leg
Muscle groups acting at hip
 Flexors: Iliopsoas
 Extensors: Gluteus Maximus
 Abductors: Gluteus Medius & minimus
 Adductors: Groin muscles: adductor magnus, adductor longus, adductor brevis
 Compartments of the thigh

 Anterior (quadriceps, extensors of knee)

 Innervated by femoral nerve

 Posterior (hamstrings, flexors of knee)

 Innervated by sciatic nerve

 Medial (hip adductors)

 Innervated by obturator nerve
Anterior Compartment of the thigh- Extensors of knee

◼ Quadriceps femoris
◼ Rectus femoris
◼ Vastus lateralis
◼ Vastus medialis
◼ Vastus intermedius
◼ Sartorius
◼ Iliopsoas

All above innervated by the femoral nerve

Iliopsoas Muscle
• Psoas Major, Psoas Minor,
Iliacus muscle

• Psoas major: brings leg

up frontally (flexion of
the LL to the chest)

• Psoas minor: Bends thigh

(flexion of the pelvis to
over the LL)
Iliopsoas Muscle

Iliacus muscle: bends

the thigh

Origin: Iliac Fossa

Insertion: Lesser
Trochanter
Gluteus Minimus

Assists in abducting
thigh (lifting it
outwards)

Keeps torso upright

during walking and
standing with one
foot
Gluteus Medius Thicker than
minimus

Abducts thigh
(lifting it outwards)

Keeps torso upright

during walking and
standing with one
foot
Gluteus Maximus Largest, thickest
most superficial of
gluteal muscles

Extension of the
hip: brings leg
back to a straight
position after you
lift it forward

Helps in walking,
climbing stairs and
lifting leg side
ways
Quadriceps
4 in one:
Vastus lateralis, vastus
medialis, vastus
intermedius, rectus
femoris

Muscles act together to

straighten the leg by
extending the knee
Quadriceps
Vastus lateralis

Origin: greater
trochanter

Insertion: Patella
Quadriceps

Vastus medialis

Origin: Femur

Insertion: Patella
Quadriceps

Vastus intermedius

Origin: Femur

Insertion: Patellar
ligament
Quadriceps
Rectus Femoris:
Fourth muscle in
quadriceps

Origin: anterior
inferior iliac spine

Insertion: patellar
tendon
Sartorius

Origin: anterior superior

iliac spine

Insertion: Tibia
Sartorius Helps to flex the knee and
thigh

Plays a role in moving leg

outward (abduction) and
outward rotation

Assists in motion needed to

cross one leg over the other
and helps us climb stairs

Plays a small part in walking

Medial Compartment of Thigh- Adductors of hip
◼ Adductor longus
◼ Adductor brevis
◼ Adductor magnus
◼ Pectineus
◼ Gracilis

Innervation – Obturator nerve

Adductors
Adduction means to bring towards the center

“ADD to the body”

Adductors assist in maintaining posture and

rotating the thigh inwards
Adductor Magnus

Origin: Pubis

Insertion: Posterior
Femor
Adductor Longus

Origin: Pubis

Insertion: Posterior
femur
Adductor Brevis

Origin: Pubis

Insertion: posterior
femur
Pectineus Muscle
An adductor muscle that
works with the adductor
magnus, longus and
brevis.

Origin: pectineal line

Insertion: Linea aspira

Helps to flex thigh

Gracilis Muscle
Flat and narrow muscle

Origin: Pubis

Insertion: Tibia

Helps to bend the knee

(flexion) and turn it
inward (medial rotation)
Posterior Compartment of the thigh – Hamstrings

 Biceps femoris
 Semitendinosus
 Semimembranosus

Sciatic nerve innervates all of the above muscles!!!

 Hamstrings (extensors of hip and flexors of knee)

Muscles of the hamstring: bicep

femoris, semitendinosus,
semimembranous act as knee
flexors

Assist in moving the upper leg

backwards (extension of the
thigh)
rotate the knee, maintain a
stance with the knees slightly
bent
Hamstring: Bicep femoris

2 heads:

Long head
Origin: Ischial tuberosity
Insertion: Head of fibula

Short head
Origin: Midway down shaft of femur
Insertion: Head of fibula
Hamstring: Semitendinosus

Origin: Ischial tuberosity

Insertion: Proximal Tibia

Flex thigh, flex and extend knee

joint
Hamstring:Semimembranosus

Origin: Ischial tuberosity

Insertion: Proximal Tibia

Flex and extend knee joint

Muscles of the Lower Leg and
Foot
Muscle Compartments of the leg
◼ Posterior
Superficial and deep layers
Action: Plantarflex foot, flex toes
Innervation: Tibial nerve

◼ Anterior
Action: Dorsiflex ankle, invert foot, extend toes
Innervation: Deep fibular nerve

◼ Lateral
Action: Plantarflex, evert foot
Innervation: Superficial Fibular nerve
Muscle
Compartments
of the leg
Anterior Compartment
Dorsiflex ankle, invert
foot, extend toes

 Tibialis anterior

 Extensor digitorum longus

 Extensor hallucis longus

All innervated by deep fibular nerve

 Tibialis anterior

Dorsiflexor of the foot

Origin: Tibia

Insertion: base of 1st metatarsal

 Tibialis Anterior
Helps to lift and invert the foot
or turn the sole of the foot
medially

Minimal role in standing but

plays a role in walking and
running by helping lift the toes
off the ground
 Extensor Digitorium Longus

Origin: Shaft of fibula

Insertion: Base of middle

and distal phalanges
 Extensor Digitorium Longus

•When you bend your toes and

foot up, extensor digitorium is at
work

•It works with extensor digitorium

brevis
 Extensor Hallucis longus

Origin: Tibia

Insertion: Base of distal phalanx of

big toe
 Extensor hallucis longus

•Hallucis – latin word for big toe

•Lifts the big toe and helps lift the whole

foot by flexing the ankle

•When you bend your big toe or lift your

foot up without moving your legs, you
can feel this muscle tighten in the mid
lower leg
 Lateral
Compartment
◼ Fibularis (peroneus) longus

◼ Fibularis (peroneus) brevis

All innervated by the superficial fibular nerve

 Peroneus brevis

Origin: Fibula

Base: Base of 5th metatarsal

Peroneus Longus

Origin: Fibula

Base: Base of 1st metatarsal

 Peroneus Brevis and Longus
Peroneus brevis is a stabilizer:

• Restricts foot’s inversion, thus

easing the strain on the ligaments
of tibialis anterior

• Keeps you steady when you stand

• Peroneus Longus everts the foot

(lifting the outside edge of the
foot)
 Peroneus Brevis and Longus

•Peroneus Longus acts as a natural

arch supporter

•Both muscles are active when you tip

toe and lift your foot
Superficial
Posterior
Compartment
 Triceps surae
 Gastrocnemius (2 heads)
 Soleus

 Plantaris (variable)

All innervated by the tibial nerve

 Soleus

Plantar flexors: bend the foot back

Origin: upper fibular head

Insertion: posterior aspect of

calcaneus
 Soleus

•Soleus acts to hold leg firmly on

your foot when you are standing.

•Soleus: Latin for sole

 Gastrocnemius Muscle

Has two heads

Origin: lateral femoral condyle

Insertion: posterior aspect of

calcaneus
 Gastrocnemius Muscle

•Less powerful than soleus muscle

•Knee flexor, helps to bend the knee

and provide propulsion when you
walk, run and jump
 Plantaris

Origin: distal lateral end of femur

Insertion: posterior surface of

calcaneus
 Plantaris

•Helps flex the ankle and the

knee

•Lies between soleus and

gastrocnemius muscle.
Deep Posterior
Compartment

 Popliteus
 Flexor digitorum longus
 Flexor hallucis longus
 Tibialis posterior

All innervated by the tibial nerve

 Popliteus

Causes medial rotation of either the

femur or tibia

Origin: lateral condyle of femur

Insertion: posterior side of tibia

 Popliteus

•Locks the knee joint when the leg is

fully extended and beginning to bend.

•Aids in keeping femur from pushing

forward when you crouch.
 Flexor Digitorum Longus

Origin: middle posterior aspect of

tibia

Insertion: distal phalanges of

lateral four toes

Works with flexor hallucis longus to

bend the foot down and back
 Flexor Hallucis Longus

•Works with flexor digitorum longus

Origin: lower 2/3 of fibula

Insertion: base of distal phalanx of

big toe

•Involved in toe flexion

 Tibialis Posterior

Deepest muscle in posterior group

Origin: interosseous membrane of tibia &

fibula

Insertion: tuberosity of navicular

 Tibialis Posterior

•Major flexor of the foot, helping the

sole of the foot to bend back.

•Also participates in supporting arch and

maintaining balance when you walk or
stand.
 ASSIGNMENT:
Going for a run,
identifying muscles used
 ASSIGNMENT:
Stretching, identifying
muscles used
Joints of Lower Limb
Joints of Lower Limb
◼ Hip (articular surfaces: femur + acetabulum)
◼ Ball + socket
◼ Multiaxial
◼ Synovial

◼ Knee (femur + tibia)

◼ Hinge (modified)
◼ Biaxial
◼ Synovial
◼ Contains menisci, bursa, many ligaments

◼ Knee (femur + patella)

◼ Plane
◼ Gliding of patella
◼ Synovial
Joints of Lower Limb
 Proximal Tibia + Fibula
 Plane, Gliding
 Synovial

 Distal Tibia + Fibula

 Slight “give” (synarthrosis)
 Fibrous (syndesmosis)

 Ankle (Tibia/Fibula + Talus)

 Hinge, Uniaxial
 Synovial

 Intertarsal & Tarsal-metatarsal

 Plane, synovial

 Metatarsal-phalanges
 Condyloid, synovial

 Interphalangeal: Hinge, uniaxial

 Hip Joint
 Largest joint in the body

 Capsule of hip is attached proximally to margins of acetabulum

and to the transverse acetabular ligament.
 Distally it is attached along trochanteric line, bases of greater
and lesser trochanters.

 Three ligaments reinforce capsule:

 Iliofemoral
 Pubofemoral

 Ischiofemoral (strongest)
Hip Joint
Hip Joint
 Synovium of hip covers non-articular surfaces

 Hip is capable of flexion, extension, abduction,

adduction, medial and lateral rotation and
circumduction
Knee Joint
 Synovial hinge joint made up of articulations
between femoral and tibial condyles and between
patella and patellar surfaces of femur

 Capsule is attached to margins of articular

surfaces

 Capsule is reinforced on each side by medial and

lateral collateral ligaments
Knee Joint
Knee Joint
 Principal knee movements – flexion and extension
 Some rotation is possible when knee is in flexed
position
 Principal muscles acting on knee:
 Extensor – quadriceps femoris
 Flexors – hamstrings assisted by gracilis,
gastrocnemius and sartorius
 Medial rotator – popliteal (‘unscrews’ the knee)
 Ankle Joint

 Simple hinge joint between lower end of the tibia and the talus

 Capsule of joint fits closely around articular surfaces

 Weak anterior and posteriorly but reinforced laterally and

medially by collateral ligaments
Ankle Joint
Ankle Joint

 Capable of flexion and extension (plantar- and

dorsiflexion)

 Principle muscles acting on ankles:

 Dorsiflexors– tibialis anterior assisted by extensor
digitorum longus, extensor hallucis longus and peroneus
tertius
Ankle Joint

 Tarsus: forms ankle joint

 Calcaneus: forms heel

ARCHES OF FOOT
Arches of Foot
 Bones of foot are arranged in form of two longitudinal arches
 1)Medial arch:
 Made of calcaneus, talus, navicular, the three cuneiforms
and three medial metatarsals
 Apex of arch is the talus
 2) Lateral arch
 Lower than medial arch
 Composed of calcaneus, cuboid and two lateral metatarsals
 Foot functions as rigid support and as mobile springboard
Arches of foot

Medial Arch

Lateral Arch
Arches

 Arches are maintained by:

 Shape of interlocking bones
 Ligaments of foot
 Muscle action
Arches
 Whenone stands, arches sink under the body’s
weight and individual bones lock together.

 Ligamentslinking them are at maximum tension

and foot becomes immobile.

 When one walks, weight is released from arches,

which unlock and become a mobile lever system in
spring-like actions of locomotion.
Lower limb nerves
NERVES

 Nerves that enter the lower limb from the

abdomen and pelvis are terminal branches of
the lumbosacral plexus
Plexuses of the Lower Limb
 “Lumbosacral plexus”

 Lumbar Plexus
 Arises from L1-L4
 Lies within the psoas
major muscle
 Mostly anterior structures

 Sacral Plexus
 Arises from spinal nerve
L4-S4
 Lies caudal to the lumbar
plexus
 Mostly posterior
structures
 Major nerves that originate from the
lumbosacral plexus to enter the lower limb
include:
1. the femoral nerve,
2. obturator nerve,
3. sciatic nerve,
4. superior gluteal nerve, and
5. inferior gluteal nerve.
Femoral nerve

 Originates from
anterior rami of
L2 to L4
Obturator nerve

 Originates from
L2 to L4
Sciatic nerve

 It is the largest nerve

of the body
 Originates from L4 to
S3
 It divides into two
major branches when
it enters the posterior
compartment of the
thigh
1. The common
fibular nerve
2. The tibial nerve
Gluteal nerves

Major motor nerves of the

gluteal region

Superior gluteal nerve:

Originates from anterior
rami of L4 to S1
Inferior gluteal nerve:
 Originates from L5 to S2
 Other nerves that also originate from the plexus
and enter the lower limb to supply skin or muscle
include:
1. the lateral cutaneous nerve of the thigh,
2. nerve to obturator internus,
3. nerve to quadratus femoris,
4. posterior cutaneous nerve of thigh,
5. perforating cutaneous nerve, and
6. branches of the ilio-inguinal and genitofemoral
nerves.
Ilio-inguinal and
genitofemoral
nerves
Lateral
cutaneous nerve
of thigh
Nerve to quadratus femoris and nerve
to obturator internus
Posterior cutaneous nerve of
thigh
Perforating cutaneous nerve
Blood supply to lower limbs
 Arteries
◼ Common iliac (from
aorta) branches into:

◼ Internal iliac
◼ Supplies pelvic
organs

◼ External iliac
◼ Supplies lower
limb
ARTERIES
The major artery supplying the lower limb is the
femoral artery which is the continuation of
external iliac artery in the abdomen.

Other arteries supplying parts of the lower limb

include: superior and inferior gluteal arteries
& obturator artery

All three of them are branches of internal iliac

artery
Arteries  Internal iliac branches
into:
 Cranial and Caudal
Gluteals
(Superior and
Inferior)
Gluteals
 Internal Pudendal
Perineum, external
genitalia
 Obturator
Adductor muscles
 Other branches supply
rectum, bladder, uterus,
 External iliac becomes…….
 Femoral
Once passes the inguinal
ligament
Lower limb
Branches into Deep
femoral
Adductors, hamstrings,
quadriceps
Branches into
Medial/lateral femoral
circumflex
Head and neck of
femur
 Femoral becomes……
 Popliteal (continuation of
femoral)
Branches into:
Geniculars
Knee
Splits
into:
Anterior Tibial
Anterior leg
muscles,
branches to feet
PosteriorTibial
Flexor muscles,
plantar arch,
branches to toes
 VEINS

Deep veins:
 Femoral vein, proximal end is called the
external iliac vein.
Superficial veins:
 They form two major channels
1. Great saphenous vein
2. Small saphenous vein
 Superficial veins are interconnected with
and ultimately drain into the deep veins
Veins
Deep Veins: Mostly share names of
arteries
◼ Ultimately empty into Inferior
Vena Cava
◼ Plantar
◼ Tibial
◼ Fibular
◼ Popliteal
◼ Femoral
◼ External/internal iliac
◼ Common iliac
 Veins
◼ Superficial Veins
◼ Dorsal venous arch (foot)
◼ Great saphenous (empties into
femoral)
◼ Small saphenous (empties into
popliteal)
DEEP FASCIA AND THE
SAPHENOUS OPENING
 Fascia lata is the
outer layer of deep
fascia in the lower
limb that forms a
thick “stocking-
like” membrane,
which covers the
limb and lies
beneath the
superficial fascia.
DEEP FASCIA AND THE
SAPHENOUS OPENING
 Saphenous
opening is one
prominent aperture
on the anterior
aspect of fascia
lata of thigh, which
allows the great
saphenous vein to
pass through
DEEP FASCIA AND THE
SAPHENOUS OPENING
 Iliotibial tract is a
longitudinal band of
thickened fascia lata,
which descends along
the lateral margin of limb

 Along with tensor fascia

lata and gluteus
maximus muscles it
holds the leg in
extension once the other
muscles have extended
the leg at the knee joint.
FEMORAL TRIANGLE
 A wedge-shaped
depression formed by
muscles in the upper thigh
at the junction between the
anterior abdominal wall and
the lower limb.
 The inferior continuation is
called adductor canal
 In the femoral triangle, the
femoral artery and vein and
the associated lymphatic
vessels are surrounded by
a funnel shaped sleeve of
fascia called the femoral
sheath
SUMMARY
Anterior and Lateral Muscles of Leg
Muscle Origin Insertion Nerve Action Blood
Supply
Tibialis Tibia base of 1st Deep Fibular Dorsiflexes Anterior
anterior metatarsal and inverts Tibial
foot Artery
Extensor Tibia/Interosseous Base of Deep Fibular Extends big Anterior
hallucis membrane distal toe Tibial
longus phalanx of Artery
big toe
Extensor Shaft of fibula Base of Deep Fibular Extends toes
digitorum middle and
longus distal
phalanges
Fibularis Distal 1/3 of Base of 5th Deep Fibular Dorsiflexes Anterior
Tertius fibula; interossous metatarsal and everts Tibial
membrane foot Artery

Lateral
Fibularis Base 1st Superficial Everts and
longus metatarsal fibular plantar
flexes foot
Fibularis Base 5th Superficial Everts and
brevis metatarsal fibular plantar
flexes foot
Anterior Muscles of Thigh/Extensor Compartment
Anterior Muscles of Thigh/Extensors Compartment

Muscle Origin Insertion Nerve Action Blood Supply

Iliacus Iliac fossa Lesser Femoral Flexes thigh
trochanter with psoas
major
Sartorius ASIS Tibia Femoral Flexes and Femoral
laterally
rotates hip
Flexion of
knee
Rectus femoris ASIS Femoral Flexes hip and
extends leg
Vastus medialis Femur Tibial tuberosity Femoral Extend
leg/knee
Vastus lateralis Femur Femoral Extend Femoral/Lateral
leg/knee descending
branch of
profunda
brachi
Vastus Femur Femoral Extends Femoral/Lateral
intermedius leg/knee descending
branch of
profunda
brachi
 Medial Muscles of Thigh
Muscle Origin Insertion Nerve Action Blood
Supply
Adductor Pubis Posterior Obturator Adducts Femoral
longus femor hip joint- artery
Adducts
and flexes
thigh
Adductor Pubis Posterior Obturator/Anterior/Posterior Adducts Femoral
brevis femor Branches and flexes
thigh
Adductor Pubis Posterior Obturator Adducts, Femoral
magnus femor flexes, and
extends
thigh
Pectineus Pectineal Linea Obturator/Femoral Adducts Femoral
line aspira and flexes
thigh
Gracilis Pubis tibia Femoral
Obturator Pubis Obturator Lateral
Externus rotator of
thigh
Muscle Origin Insertion Nerve Action
Gastrocnemius Lateral femoral Posterior aspect Tibial Flexes knee;
condyle of calcaneus plantar flexes

Medial femoral
condyle
Soleus Upper fibular Posterior aspect Tibial Plantar flexes
head, soleal line of calcaneus
on tibia does not
cross knee joint
Plantaris Distal lateral Posterior Tibial Flexes leg;
end of femur, surface of plantar flexes
crosses knee calcaneus
joint
Tibial

Deep Group
Popliteus Lateral condyle Posterior side of Tibial Flexes by
of femur tibia unlocking knee
Flexor hallucis Lower 2/3 of Base of distal Tibial Plantar flexes,
longus fibula, phalanx of big flexes distal
MOST LATERAL intermusclar toe phalanx of big
septa toe
Flexor digitorum Middle posterior Distal phalanges Tibial Flexes lateral
longus aspect of tibia of lateral four four toes
MOST MEDIAL toes

Tibialis posterior Interosseous Tuberosity of Tibial Plantar flexes

MIDDLE membrane navicular,
sustentacular
tali
 ANATOMY OF THE
UPPER LIMB
By Emmanuel HABUMUGISHA
ANATOMY OF THE UPPER
LIMB

1- Bones of the upper limb.

2- Muscles of the upper limb.
5- Joints of the upper limb.
 ANATOMY OF THE UPPER
LIMB
Surface anatomy of the upper limb.
The upper limb is divided into 4
regions
1- The Shoulder girdle
2- The arm
3- The forearm
4- The hand
Anterior
view
Posterior
view
 GENERAL CONCEPTS
 The upper limb is part of the appendicular
skeleton =>The upper appendicular skeleton
 It is attached to the trunk via the scapular and
the clavicle.
 The two bones make the shoulder/pectoral
girdle
 The scapular doesn’t attach to any bone of the
trunk while the clavicle articulates medially
with the manubrium of the sternum
THE SHOULDER GIRDLE
It comprises THE SCAPULA
& THE CLAVICLE which
articulate with the STERNUM
medially & the humerus laterally.
 THE SCAPULA
 It is a flat bone
◦ with 2 surfaces (ventral&
dorsal)
◦ 3 angles (superior, lateral&
inferior)
◦ 3 borders (medial, lateral
& superior)
 It has got laterally
◦ a spine (posterior aspect)
◦ acromion process (lateral
angle)
◦ coracoid process (lateral
angle).
 THE SCAPULA
The ventral (costal) surface is concave &
forms the subscapular fossa.
The dorsal surface is convex & divided
by the spine of the scapula to 2 fossae:
1- a small supraspinous fossa.
2-a large infraspinous fossa.
THE SCAPULA
 The spine of the scapula starts medially
to extend laterally where it becomes
wider to form acromion process which
articulate with the lateral end of the
clavicle.
 At the lateral end of the superior border
is the coracoid process.
 The superior angle lies opposite the
second rib while the inferior angle lies
opposite the seventh rib.
 The lateral angle forms the glenoid
cavity.
Articulation of the scapula

 There are 2 synovial & 2 fibrous joints.

 The synovial joints :
1. The glenoid cavity with the head of the
humerus to form the shoulder joint
2. Acromio-clavicular joint
 The fibrous joints :
1. Coraco- clavicular joint (strong joint
covered with strong ligament)
2. Coraco- acromial joint (strong joint
covered with strong ligament)
 THE CLAVICLE

 It lies horizontally in the root of the neck.

 It has 2 important functions:

1. To transmit forces from the upper limb to the

bones of the axial skeleton (sternum)

2. To act as support holding the arm free from the

trunk.
THE CLAVICLE
 It is a long bone with a body & 2 ends:
◦ The sternal end articulate with the
manubrium of the sternum forming the
sterno- clavicular joint.
◦ The acromial end articulate with the
acromial process of the scapula forming the
acromio- clavicular joint.
 Thebody is convex in medial 2/3
concave in lateral 1/3.
THE CLAVICLE
Important relations of the clavicle
✓ The subclavian artery & vein & the trunk
of the brachial plexus pass behind the
middle1/3 of the clavicle.
✓ The common carotid artery lies behind
the left sternoclavicular joint.
✓ The brachio-cephalic artery is divided
into 2 branches behind the right
sternoclavicular joint.
✓ The internal jugular vein lies a little
laterally on either side.
THE HUMERUS
 It is a tubular long bone composed of upper
end, body (shaft) & lower end.
 The upper end formed by
1. the head
2. the necks (anatomical & surgical)
3. the tubercles (greater & lesser)
The head
 Which is less than ½ sphere directed medially,
upward & posteriorly.
 It is separated from the greater & lesser
tubercles by a shallow groove called the
anatomical neck.
THE HUMERUS
 The greater tubercle is a prominence
which projects posteriorly in resting
position.
 The lesser tubercle is a small prominence
which project anteriorly.
 The greater & lesser tubercles & the head
are separated from the shaft by the
surgical neck.
 There is small groove below them called
the bicipital groove .
THE HUMERUS
 The body (shaft ): the upper ½ of the
shaft is cylindrical while the lower ½ is
like a prism.
 The lateral & medial borders of the
lower shaft are continued below to
form the lateral & medial
supracondylar ridges (crests) which
end with the lateral & medial
epicondyles.
In the middle of the shaft there is
deltoid tuberosity & the radial groove.
THE HUMERUS
The lower end is formed by (from medial
to lateral) :
 the anterior aspect :medial epicondyle ,
trochlea, capitulum & lateral epicondyle .
With 2 fossae (coronoid & radial)
 the posterior aspect: medial epicondyle ,
trochlea & lateral epicondyle with one
fossa (olecranon) .
 The medial epicondyle is larger , more
prominent & extend downward more
than the lateral .It carries a shallow
groove in the posterior surface for the
ulna nerve.
3 Snell\Upper limb\473.jpg
THE HUMERUS

Ligaments attached to the humerus

1- The capsule of the shoulder joint is
attached to the anatomical neck except
inferiorly where it extends for about 1cm to
attach to the surgical neck.
2- The capsule of the elbow joint is
attached to the upper margins of the
fossae
3- The lateral & medial supracondylar ridges
give attachments to the lateral & medial
intermuscular septum.
THE HUMERUS
Nerves related to the humerus :
 The circumflex (axillary) N. may be
injured in fracture of surgical neck .
 The radial N. (which lies in the spiral
groove ) may be injured in fracture
of the middle of the shaft .
 The ulnar N. may be injured in
fracture of the lower end (the
medial epicondyle)
THE RADIUS
 It is a long bone, consists of thin narrow
upper end, body & thick expanded lower
end.
 The upper end consist of :
◦ The head is disc like with 2 articular surfaces:
 the upper surface with the capitulum of the
humerus.
 the lateral surface with the radial notch of the
ulna
 The neck constricted part below the
head.
 The radial tuberosity: below the medial
part of the neck .
THE RADIUS
 The body of the radius which has 3
surfaces & 3 borders & pronator
tuberosity.
 The lower end which is the styloid
process placed laterally & ulnar notch
medially .
 THE RADIUS
The joints of the radius:
Proximally:
 the upper surface of the head receives
the capitulum of the humerus to form
part of the elbow joint.
 the circumference of the head
articulates with radial notch of the ulna
to form the superior radio-ulnar joint.
Distally:
 the ulnar notch receives the head of the
ulna to form the inferior radio-ulnar
joint.
 the inferior surface of the lower end
articulate with 2 carpal bones to
form the wrist joint (radio-carpal)
THE ULNA
 Itis along bone with upper end, body
(shaft ) & lower end.
 The upper end consist of :
◦ The olecranon process: the upper part of
the trochlear notch.
◦ The coronoid process: the lower part of
the trochlear fossa.
◦ The ulnar tuberosity: below the coronoid
process on the anterior surface .
THE ULNA
 The trochlear notch : is a large deeply
concave articular surface which lies
between the olecranon & coronoid
processes.
 The radial notch is a concave surface
in the upper part of the lateral side
of the coronoid process. It articulates
with the circumference of the head
of the radius to form the superior
radio-ulnar joint.
THE ULNA
The body (shaft) of the ulna is triangular
in the upper ¾ & cylindrical in the
lower ¼ .
The lower extremity of it consist of :
 The head: small rounded articulating
with the medial side of the lower end
of the radius forming the inferior radio
-ulnar joint.
 The styloid process: projects medially
& below the head .
The interosseous membrane

 In addition to the sup. & inf. radio-ulnar

joints, the radius & ulna are also joined by a
fibrous membrane which stretches between
the interosseous borders of the 2 bones.
 It runs obliquely downwards & medially
from radius to ulna.
 It is pierced by the ant. interosseous vein.
Its function is to
◦ increase the area of origin of forearm muscles.
◦ transmits forces received by the lower end of
radius to ulna.
The bones of the hand
 They consist of: carpus, metacarpus
& phalanges
 The carpal bones are 8 arrange in 2
rows ( proximal & distal ).
From lateral to medial:
 the proximal row: scaphoid ,lunate ,
triquetral & pisiform .
 the distal row : trapezium ,
trapezoid , capitate & hamate .
The bones of the hand
 The Metacarpal bones are 5: One for
each finger.
 Each metacarpal bone has: base, shaft
& head.
 The phalanges: all the fingers have 3
phalanges (proximal, middle & distal)
except the thumb has only 2 (proximal
& distal).
 Each phalanx has base, shaft & head.
The articulation of the carpal bones

 The proximal row is convex toward the

lower end of radius & ulna.
 The scaphoid & lunate articulate with the
lower end of the radius .
 The triquetral articulates with the lower
end of the ulna .
 The bones of the proximal row articulate
with the bones of the distal row in mid-
carpal joint (transverse carpal joint).
 The bones of the distal row articulate
with the base of the metacarpals by
1. the trapezium articulate with the 1 st
metacarpal bone.
2. the trapazoid articulate with the 2 nd
metacarpal.
3. the capitate articulate with the 3 rd
metacarpal.
4. the hamate articulate with the 4 th &
5th metacarpals.
THE MUSCLES OF THE UPPER LIMB
In general they divided into

•Mm that attaches the upper limb to

axial skeleton.

•Mm of the upper limb proper.

Mm attaching the upper limb to the
axial skeleton
The front Mm
Pectoralis major, Pectoralis minor &
subclavius Mms.
The side Mm : serratus ant Mm.
The back Mm: Latissimus dorsi, trapezius,
levator scapulae , rhomboid minor &
rhomboid major Mms.

Only the pectolaris major & latissimus dorsi are

inserted in the humerus while all the others
are inserted in the shoulder girdle (scapula &
clavicle).
Pectolaris major and minor
Subclavius muscle
Serratus anterior muscle
Latissimus dorsi and two Rhomboid
muscles
Trapezius and levator scapulae muscles
MOVEMENTS OF THE SHOULDER GIRDLE
1- ELEVATION: by upper fibers of trapezius &
levator scapulae Mm.
2-DEPRESSION: by pectolaris major, pectolaris
minor & latissmus dorsi Mm.
3- RETRACTION: by middle fibers of trapezius,
rhomboid major & minor Mm.
4- PROTRACTION: by serratus anterior,
levator scapulae & pectolaris Minor.
5- ROTATION UP : by upper & lower fibers of
trapezius & serratus anterior Mm.
6-ROTATION DOWN : levator scapulae,
rhomboid major & rhomboid minor Mm.
MUSCLES OF THE SHOULDER REGION
 They are 6 Mm: deltoid, teres major, teres
minor, supraspinatus, infraspinatus &
subscapularis Mm.
 The last 4 called The Rotator cuff Mm.
 All of them arise from the scapula (all from
the dorsal surface except subscapularis Mm
from the anterior surface) & all inserted in
the tuberosities of humerus. They rotate the
arm(medially or laterally) & adduct the arm
(except the deltoid &supraspinatus Mm) all
supplied by C5, C6 Nn.
Deltoid muscle
Teres major muscle
Teres minor muscle
Infraspinatus, supraspinatus
Subscapularis muscle
4 Rotator cuff muscles
MUSCLES OF THE FRONT OF THE ARM
They are:
 Biceps, Brachialis & coraco-brachialis Mm.
 All are supplied by musculo-cutaneous N.
1. The biceps act on the shoulder jt. & on elbow
jt. as flexor & supinator as it inserted in the
post. part of tuberosity of the radius.
2. The brachialis Mm: Originate from the shaft of
humerus to the tuberosity of ulna, act as flexor
to the elbow.
3. The coracobrachialis act as flexor & adductor
to the arm.
Biceps brachii
Brachialis
Coracobrachialis
MUSCLES OF THE BACK OF THE ARM

It is the Triceps Mm:

 Has got the long ,medial & lateral
heads
 Inserted in the upper post. Part of
olecranon process & supplied by
the radial N.
 Acts as extensor of the elbow &
stabilize the elbow jt.
Triceps brachii
Triceps brachii
THE FOREARM MUSCLES
They divided into 2 groups:
1. The flexor-pronator group
2. The extensor-supinator group

The flexor –pronator group

 They flex the wrist, fingers & pronate the
forearm.
 They are divided into superficial & deep groups.
 The superficial group arise from the front of
medial epicondyle of humerus, pass in front of
the forearm & the wrist to inserted on
bones of the hand .
THE FLEXOR –PRONATOR GROUP
 Made of Pronator teres, Flexor Carpi-
radialis, Flexor Carpi-ulnaris, Flexor
Digitorum superficialis & Palmaris longus
Mm.
 The deep group arise from the front of
interosseous membrane, radius & ulna.
 They are: Flexor digitorum profundus, Flexor
pollicis longus & pronator quadratus Mm.
Flexor carpi radialis
Flexor digitorum superficialis
Palmaris longus
THE FLEXOR –PRONATOR GROUP
 The pronators are Pronator teres &
Pronator quadratus Mm. which inserts on
the radius & pronate the forearm .
 The flexors of the wrist are Flexor carpi-
radialis ,Flexor carpi-ulnaris & Palmaris
longus where inserted in the metacarpal
bones .
 The flexor of the fingers are Flexor
digitorum superficialis & Flexor digitorum
profundus where inserted in the
phalanges.
 The flexor of the thumb is Flexor Pollicis
longus & inserted in phalanges of the
thumb .
Flexor pollicis longus and
digitorum profundus
Pronator teres and quadratus
THE EXTENSOR - SUPINATOR GROUP
 They extend the wrist & the fingers &
supinate the forearm .
 They divided to superficial & deep groups:
 The superficial group arise from the back of the
lateral epicondyle of humerus to pass on the
back of the forearm & inserted in the bones of
the hand .
 The are 7; Brachio-radialis, extensor carpi-
radialis longus, extensor calpi-radialis brevis,
extensor digitorum, extensor digiti-minimi, ext.
carpi-ulnaris & anconeus Mm.
Brachioradialis
Extensor carpi radialis longus and
brevis
Extensor digiti minimi
Ext. carpi ulnaris and Ext. digitorum
Anconeus muscle
THE EXTENSOR - SUPINATOR GROUP

The deep group is 5 Mm : supinator

;abductor pollicis longus ; ext. pollicis
brevis ; ext. pollicis longus & ext.
indicis Mm.
Supinator
Abductor pollicis
Extensor pollicis brevis
Extensor pollicis longus
Extensor pollicis brevis
THE EXTENSOR - SUPINATOR GROUP
 The supinators are :Supinator ,Brachio
radialis & the anconeus Mm. where
inserted in the bones of the forearm.
 The extensor of the wrist are : Ext.carpi-
radialis longus , Ext. carpi-radialis brevis &
ext. carpi-ulnaris Mm. where inserted in
the metacarpal bones& extend the wrist.
 The extensors of the fingers are :Ext.
digitorum ; Ext. digiti- minimi & Ext.
indicis where inserted in the fingers &
extend the metacarpo-phalangeal joints
THE EXTENSOR - SUPINATOR GROUP.

 The muscles of the thumb are :

◦ Abductor pollicis longus
◦ Ext. pollicis brevis
◦ Ext. pollicis longus
 Mms are inserted on the thumb
bones.
THE FLEXOR RETINACULUM
 It is a thick band made of dense white fibrous
tissue which stretch across the anterior
surface of the carpus bones which are concave
in shape ( carpus arch ) changing the arch to
carpus tunnel .
 In the tunnel pass the median nerve &
tendons of Mm.
THE EXTENSOR RETINACULUM
 It is a thickening of deep fascia between the
lower ends of radius & ulna .
 THE MUSCLES OF THE HAND
 They are divided into thenar & hypothenar
Mm.
 The thenar Mm: Abductor pollicis brevis ,
flexor pollicis brevis & opponens pollicis Mm.
 The hypothenar Mm : abductor digiti minimi,
flexor digiti minimi & opponens digiti minimi
Mm.
 There are also 4 lumbrical Mm & 7
Interosseous Mm. in the fingers .
 All these Mm are responsible for fine
movements of fingers.
Thank you
ANATOMY AND PHYSIOLOGY

UNIT 7: UROGENITAL SYSTEM

Prepared by:
HABUMUGISHA Emmanuel, RN, BScN, PGCLTHE, MSN
EACC/ Health Science Faculty
2022
DEFINITION
• The human urogenital systems are made up of the urinary organs,
which produce the fluid called urine, and the genital, or reproductive,
organs of male and female humans, which together can produce a
new human being.
• Urogenital system covers both urinary system and genital system.
 Learning objectives:
At the end of this presentation, the students will be able to:
• Define urogenital systems.
• Identify the function and major parts of the human urinary system.
• Describe the kidney, including its gross internal structure and the structure
of the nephron.
• Describe the ureters, the urinary bladder, and the urethra.
• Identify general characteristics of both the male and female genital
systems.
• Describe the ovaries, the uterine tubes, the uterus, the vagina, the external
genitalia, and secondary sexual characteristics of human females.
• Describe the testes, the epididymis, the ductus deferens, the seminal
vesicles, the ejaculatory duct, the prostate gland, the penis, and the
secondary sexual characteristics of human males.
Urinary system
• Components:
• 2 kidneys
• 2 ureter
• 1 urinary bladder
• 1 urethra
• Kidney functions:
• Maintains blood volume and blood pressure
• Removes nitrogenous waste products from blood
• Regulates electrolytes, acid-base and water balance
THE KIDNEY
• The kidneys have the same shape and color as kidney beans, but are
about 8-10 centimeters (3-3 1/2 inches) in length.
• Each kidney has a fibrous capsule. On the concave, medial side of each
kidney, there is a notch called the hilus. Through this hilus pass the ureter
and the NAVL (nerve, artery, vein, and lymphatic) which service the kidney.
• Each kidney is attached to the posterior wall of the abdominal cavity,
just above the waistline level. Each is held in place by special fascia and fat.
 Con’t

• Kidney has 3 regions:

• Cortex
• Medulla
• Pelvis
• Medulla is divided into cone shaped renal pyramids separated by
renal columns
• The base of the pyramids face the cortex and the apex point towards
the pelvis
Kidney
• Located posterior to the peritoneal cavity (retroperitoneal)
• Surrounded by 3 layers:
• Renal capsule
• Adipose tissue
• Renal fascia
The Nephron
• Nephrons are the functional units of the human kidney.
• Each kidney has about 1 million nephrons that filter blood to produce
urine
• Nephrons are located in the cortex and medulla
• The minor calyces drains collect urine as it drains from the papillae of
each renal pyramids
• From minor calyces the urine goes into major calyces and to the renal
pelvis before going into the ureter and to be stored in urinary bladder
before evacuation outside through urethra
• Their primary function is to remove the wastes of protein usage from
the blood. In addition, they serve to conserve water and other
materials for continued use by the body.
• The end result of nephron function is a more or less concentrated
fluid called urine.
• In addition, they serve to conserve water and other materials for
continued use by the body.
• The Bowmans capsule opens into the 1st part of the tubule called
proximal convoluted tubule located in the cortex
• Next is the descending limb of Henle which narrows as it enters the
medulla
• The tubule then bends in a U shaped structure called loop of Henle
• It ascends and widen going back to the cortex (ascending limb of
Henle)
• When it reaches the cortex it becomes convoluted again (distal
convoluted tubule) which ends in a large straight collecting duct
• 2 types:
• Juxtamedullary nephrons: (loop of Henle reach into the medulla)
• Cortical nephrons: (loop of Henle does not enter the medulla)
The main subdivisions of a nephron are the renal corpuscle and a tubular
system:
• Renal corpuscle:
• Small rounded structures
• Their action consist of filtration from plasma
• Afferent arteriole: very small artery leading into the capsule.
• Efferent arteriole: drains the blood away from the capsule.
• They are formed by
• Glomerulus (capillary vessels network)
• Bowmans glomerular capsule enclosing the glomerulus
• Renal tubules:
• Another component of the nephron with acts in selective resorption from filtrate to
form urine
• The renal tubules ends into collecting ducts which pass through the renal pyramids
and opens into the calyces.
• Each renal capsule is drained by a renal tubule.
• The first part of this tubule runs quite a distance in a coiled formation
and is called the proximal convoluted tubule.
• A long loop, the renal loop (of Henle), extends down into the medulla
with two straight parts and a sharp bend at the bottom.
• As the tube returns to the cortex layer, it once again becomes coiled
and here is known as the distal convoluted tubule.
• Filtration/reabsorption.
• Except for the blood cells and the larger proteins, the fluid portion of
the blood passes through the walls of the glomerulus into the cavity
between the two layers of the renal capsule.
• This fluid is called the glomerular filtrate.
• By a process of taking back (resorption), the majority of the fluid is
removed from the tubules and the concentrated fluid is called the
urine.
The collecting Tubule

• The distal convoluted tubules of several nephrons empty into a

collecting tubule.
• The urine is then passed from the collecting tubule at the papilla of
the medullary pyramid. Several collecting tubules are present in each
pyramid.
Renal Pelvis: The renal pelvis is a hollow sac within the sinus of the
kidney.
• Urine from the pyramids collects into the funnel-shaped renal pelvis.
• The ureter then drains the urine from the renal pelvis.
• Nephrons has 3 main functions:
• Filtration (glomerulus)
• Tubular reabsorption (proximal convoluted tubule)
• Secretion (distal tubule)
 URETERS
• The ureters are tubes which connect the kidneys to the urinary bladder.
• The smooth muscle walls of the ureters produce a peristalsis (wave-like
movement) that moves the urine along drop by drop.
URINARY BLADDER

• The urinary bladder is a muscular organ for storing the urine.

• Near the inferior posterior corners of the urinary bladder are
openings where the ureters empty into the bladder.
• Also at the inferior aspect of the urinary bladder is the exit, the
beginning of the urethra.
• The triangular area, between the openings of the ureters and the
urethra, is called the trigone, or base of the urinary bladder.
• The urinary bladder wall is stretchable to accommodate varying volumes
of urine.
• Nerve endings called stretch receptors are found in the wall of the urinary
bladder.
• Usually, the pressure within the urinary bladder is low.
• However, as the volume of the enclosed urine approaches the bladder's
capacity, stretching of the wall stimulates the stretch receptors.
• The cycle of events controlling urination (voiding or emptying of the
urinary bladder) is known as the voiding reflex.
URETHRA
• The urethra is a tube which conducts the urine from the urinary
bladder to the outside of the body.
• It begins at the anterior base of the urinary bladder.
Urethral Sphincters: The urethral sphincters are circular muscle masses
which control the passage of the urine through the urethra.
There are two urethral sphincters, an internal urethral sphincter and an
external urethral sphincter.
• The internal urethral sphincter is located in the floor of the urinary
bladder.
• It is made of smooth muscle tissue.
• It is controlled by nerves of the autonomic nervous system.
• The external urethral sphincter is more inferior around the urethra in
the area of the pelvic floor.
• It is made up of striated muscle tissue.
• It is controlled by the peripheral nervous system
Male-Female Differences.
• The female urethra is short and direct.
• The male urethra is much longer and has two curvatures.
• Whereas the female urethra serves only as urinary function, the male
urethra serves both the urinary and reproductive functions.
Kidney blood supply
• Renal artery from abdominal aorta divides into small arteries into the kidneys
(segmental, interlobar, arcuate and interlobular arteries).
• These lead to afferent arteriores which end in the glomerulus ( contained in the
Bowmans capsule).
• The glomerulus drains into efferent arterioles.
• The efferent arterioles divide to form a complex system of peritubular capillaries
that eventually reunite to form interlobular vein.
• interlobular veins into arcuate veins then into interlobal vein.
• Interlobal veins run between pyramids in renal columns and unit to form right
and left renal vein and into the inferior vena cava (IVC).
INTRODUCTION TO HUMAN GENITAL SYSTEMS

• The human male and human female each has a system of organs
specifically designed for the production of new humans.
• These systems are known as reproductive or genital systems.
• Since there are different systems for males and females.
• The existence of two parents for each child means that genetic
materials are recombined to produce a new type.
• This new type may be an improvement over previous generations.
MAJOR COMPONENT CATEGORIES OF THE GENITAL SYSTEMS

• Components of the genital systems may be considered in the

following categories:
• Primary Sex Organs (Gonads):
• Primary sex organs produce sex cells (gametes).
• A male gamete and a female gamete may be united to form the one-
cell beginning of an embryo (the process of fertilization).
• Primary sex organs also produce sex hormones.
• Secondary Sex Organs. Secondary sex organs care for the product of
the primary sex organ.
• Secondary Sexual Characteristics:
• Secondary sexual characteristics are those traits that tend to make
males and females more attractive to each other.
• Secondary sexual characteristics help to ensure mating.
• These characteristics first appear during puberty (10-15 years of age).
Male reproductive system
• The male reproductive system consist of
• Gonads (testes)
• Spermatic cord
• Sex accessory gland
• External genitaria
• Testes:
• Ovoid organs that produce sperm and testosterone
• Suspended in the scrotum by spermatic cord
• The left testes is usually lower than the right testes
• They are enclosed in a tough capsule of 3 layers:
• Tunica vasculosa
• Tunica albuginea
• Tunica vaginalis
• The tunica albuginea extends inside the testes and divides it into
small compartments called lobules
• Each lobule has 1-3 tubules called seminiferous tubules which
produce sperm by spermatogenesis
• In these lobules between seminiferous tubules lies clusters of
interstitial cells of Leydig producing testosterone
• Testosterone is responsible for development and maintenance of
male sex organs and stimulates maturation of sperm cells
• Accessory glands:
1. Seminal vesicles:
• Located posterior the base of urinary bladder in front of the rectum
• Produce 60% of the semen volume, an alkaline viscous rich in fructose that serves as nutrients for
the sperm cells
2. Prostate gland:
• Produce an alkaline fluid that account for about 13-33% of semen
• This fluid activates sperm cells for swimming
3. Bulbourethral (Cowper) gland:
• Located beneath the prostate
• Secrete a thick, alkaline mucus that serves as lubricant during sexual intercourse and also clean
the urethral of traces of acidic urine
• Penis
• Shaft (body)
• Gland
• Prepuce (foreskin)
Location
• The paired testes lie within the scrotum.
• The scrotum is a sac of loose skin attached in the pubic area of the
lower abdomen.
• The scrotum provides a site cooler than body temperature to
maintain the viability of the spermatozoa.
• However, when the air is too cold, muscles and muscular fibers draw
the testes and scrotum closer to the body to maintain warmth.
Otherwise, the scrotum hangs loosely.
• The tunica vaginalis is a serous cavity surrounding each testis.
Functions
• The testis produces the male sex cells called spermatozoa
(spermatozoon, singular).
• The spermatozoa are continuously produced by the millions.
• One such cell may eventually fertilize an ovum of a human female.
• The testes also produce male sex hormones called androgens.
 Epididymis
• The epididymis is a coiled tube whose function is to aid in the
maturation of spermatozoa.
• Its coiled length is only about one and one-half inches.
• Its uncoiled length is about 16 feet.
• When coiled, it extends downward along the posterior side of each testis.
• Its lining secretes a nutritive medium for spermatozoa.
• It receives spermatozoa from the testes in an immature state.
• As the spermatozoa pass through the nutrient, they mature.
Ductus Deferens
• The ductus deferens is a transporting tube which carries the mature
sperm from the epididymis to the prostate.
• Each tube enters the abdomen through the inguinal canal.
• Each passes over a ureter to reach the back of the urinary bladder
and then down to the prostate gland.
Seminal Vesicles
• Lying alongside each ductus deferens as it crosses the back of the
bladder is a tubular structure called the seminal vesicle.
• The seminal vesicle produces a fluid which becomes part of the
ejaculate.
Ejaculatory Duct
• Each ductus deferens and its corresponding seminal vesicle converge
to form a short tube called the ejaculatory duct.
• The ejaculatory duct opens into the urethra within the prostate gland.
The ejaculatory duct carries both spermatozoa and seminal vesicle
fluid.
Prostate Gland
• As the urethra leaves the urinary bladder, its first inch is surrounded
by a chestnut-size gland called the prostate gland.
• The prostate gland provides an additional fluid to be added to the
spermatozoa and seminal vesicle fluid.
Penis
• As the urethra leaves the abdomen, it passes through the penis, the
male organ of copulation.
• Surrounding the urethra is a central cylinder of erectile tissue called
the corpus spongiosum.
• This cylinder is bulb-shaped at each end.
• The posterior end is attached to the base of the pelvis. The sensitive
anterior end is known as the glans.
• Overlying the corpus spongiosum is a pair of cylinders of erectile tissue
called the corpora cavernosa.
• These two cylinders are separate in their proximal fourth and joined in
their distal three-fourths.
• They are attached to the pubic bones.
• Together, the corpus spongiosum and the corpora cavernosa combine to
form the shaft of the penis.
• The prepuce, or foreskin, is a covering of skin for the glans. It may be
removed in a surgical procedure called circumcision.
Female reproductive system
• The primary sex organs of female reproductive system are ovaries
(gonads).
• They produce eggs(ova) and hormones (estrogen, progesterone)
• The ovaries are located to the sides of the upper end of the uterus.
• Accessory organs
• Fallopian tube
• Uterus
• Vagina
• External genitalia
• Some accessory gland do produce mucus for lubrication during sexual
intercourse
• They are anchored to the posterior surface of the broad ligaments. (The
broad ligaments are sheets or folds of peritoneum enclosing the uterus and
uterine tubes and extending to the sides of the pelvis.)
• The ovary produces the egg cell or ovum (ova, plural).
• The ovary produces female sex hormones (estrogens and progesterone).
• The production of ova is cyclic.
• One ovum is released in each menstrual period, about 28 days.
• Ovaries
• 2 ovaries, located in the upper pelvic cavity
• Held by ligaments (suspensory and ovarian)
• Contain ovarian follicle in different stages of development
Uterine Tubes (Fallopian Tubes, Oviducts).

• Extending to either side of the uterus are two muscular tubes which
open at the outer ends like fringed trumpets.
• The fringe-like appendages encircle the ovaries.
• At their medial ends, the uterine tubes open into the uterus.
• The function of the uterine tubes is to pick up the ovum when
released from the ovary and hold it UNTIL one of the following
happens:
• It is fertilized.
• After fertilization, the initial stages of embryo development take place.
• The developing embryo is eventually moved into the uterus.
• The nutrient stored within the ovum is used up and the ovum dies.
• This may take three to five days.
 Uterus.
• The uterus is the site where all but the first few days of embryo
development takes place.
• After eight weeks of embryonic development, it is known as the fetus.
• Main subdivisions:
• The uterus is shaped like a pear, with the stem (cervix) facing downward and
toward the rear.
• The fundus is the portion of the uterus above the openings of the uterine tubes.
• The main part, or body, is the portion between the cervix and the fundus.
• The uterus usually leans forward with the body slightly curved as it passes over the
top of the urinary bladder.
• The cervix opens into the upper end of the vagina.
 Wall structure of uterus
• The inner lining of the uterus is called the endometrium.
• Made up of epithelium, it is well supplied with blood vessels and glands.
• The muscular wall of the uterus is called the myometrium.
• In the body of the uterus, the muscular tissue is in a double spiral
arrangement.
• In the cervix, it is in a circular arrangement.
Age differences
• The uterus of an infant female is undeveloped.
• During puberty, the uterus develops.
• The uterus of an adult is fully developed.
• The uterus of an old woman is reduced in size and nonfunctional.
Vagina.
• The vagina is a tubular canal connecting the cervix of the uterus with
the outside.
• It serves as a birth canal and as an organ of copulation.
• It is capable of stretching during childbirth.
• The lower opening of the vagina may be partially closed by a thin
membrane known as the hymen.
External Genitalia
• Other terms for the external genitals of the human female are vulva
and pudendum.
• Included are the:
• Mons pubis:
• The mons pubis is a mound of fat tissue covered with skinand hair in
front of the symphysis pubis (the joint of the pubic bones).
Labia majora
• Extending back from the mons pubis and encircling the vestibule
(discussed below) are two folds known as the labia majora.
• Their construction is similar to the mons pubis, including fatty tissue
and skin.
• The outer surfaces are covered with hair. The inner surfaces are moist
and smooth.
• The corresponding structure in the male is the scrotum.
Labia minora
• The labia minora are two folds of skin lying within the labia
majora and also enclosing the vestibule.
• In front, each labium minus (minus = singular of minora) divides into
two folds.
• The fold above the clitoris is called the prepuce of the clitoris.
• The fold below is the frenulum.
Clitoris
• The clitoris is a small projection of sensitive erectile tissue which
corresponds to the male penis.
• However, the female urethra does not pass through the clitoris.
• Vestibule:
• The cleft between the labia minora and behind the clitoris is called
the vestibule.
• It includes the urethral opening in front and the vaginal opening
slightly to the rear.
Pregnancy and Delivery
• When an embryo forms an attachment to the endometrium, a
pregnancy exists.
• The attachment eventually forms a placenta, an organ joining mother
and offspring for such purposes as nutrition of the offspring.
• The fetal membranes surround the developing individual (fetus) and
are filled with amniotic fluid.
• During the first eight weeks, the developing organism is known as an
embryo. During this time, the major systems and parts of the body
develop.
• During the remainder of the pregnancy, the developing organism is
known as the fetus.
• During this time, growth and refinement of the body parts occur.
• Parturition is the actual delivery of the fetus into a free- living state.
• The delivery of the fetus is followed by a second delivery and it is that
of the placenta and fetal membranes.
Menstruation and Menopause
• About two weeks after an ovum is released, if it is not fertilized,
menstruation occurs.
• Menstruation involves the loss of all but the basal layer of the
endometrium.
• This process includes bleeding.
• It first occurs at puberty and lasts until menopause (45 to 55 years of
age).
• After menopause, pregnancy is no longer possible.
Menstrual
cycle
SECONDARY SEXUAL CHARACTERISTICS

• The secondary sexual characteristics of females include growth of

pubic hair, development of mammary glands, development of the
pelvic girdle, and deposition of fat in the mons pubis and labia
majora.
Female external genitalia
MAMMARY GLANDS

• The mammary glands begins to secret the milk after parturition.

• Stimulation from suckling helps to maintain the normal
rate of milk secretion.
• At the time of menopause, breast tissue becomes less prominent.
ANATOMY AND PHYSIOLOGY

THE DIGESTIVE SYSTEM

EACC 2022
Learning objectives

➢At the end of this chapter, students will be able to:

✓Identify the organs of the alimentary canal from

proximal to distal, and briefly state their function
✓Identify the accessory digestive organs and briefly
state their function
✓Describe the interaction between digestive system and
other body system
✓Explain the process of digestion
✓Describe the structure and function of alimentary and
accessory organs of the digestive system along with
their functions
✓Differentiate mechanical and chemical digestion
Introduction

GI Tract
The digestive system is the collective name used to
describe the alimentary canal, some accessory organs
and a variety of digestive process that takes place at
different levels in the canal to prepare food eaten in the
diet for absorption.
 INTRODUCTION:

The function of the digestive system is to break

down the foods, release their nutrients, and absorb
those nutrients into the body. Although the small
intestine is the workhorse of the system, where the
majority of digestion occurs, and where most of
the released nutrients are absorbed into the blood
or lymph, each of the digestive system organs
makes a vital contribution to this process.
 DIGESTIVE SYSTEM AND OTHER BODY SYSTEMS
Table 1. Contribution of Other Body Systems to the Digestive System

Body
Benefits received by the digestive system
system

Cardiovascul Blood supplies digestive organs with oxygen and processed

ar nutrients

Endocrine hormones help regulate secretion in digestive glands

Endocrine
and accessory organs

Integumenta Skin helps protect digestive organs and synthesizes vitamin D

ry for calcium absorption
 DIGESTIVE SYSTEM AND OTHER BODY SYSTEMS
Mucosa-associated lymphoid tissue and other lymphatic tissue
Lymphatic defend against entry of pathogens; lacteals absorb lipids; and
lymphatic vessels transport lipids to bloodstream
Muscular Skeletal muscles support and protect abdominal organs

Sensory and motor neurons help regulate secretions and

Nervous
muscle contractions in the digestive tract

Respiratory organs provide oxygen and remove carbon

Respiratory
dioxide

Skeletal Bones help protect and support digestive organs

Kidneys convert vitamin D into its active form, allowing

Urinary
calcium absorption in the small intestine
THE DIGESTIVESYSTEM
 The digestive tract is more than 10 meters (30
feet) long from one end to the other.
 It is continuous starting at the mouth, passing
through the pharynx, oesophagus (25 cm long) ,
the stomach, the small and large intestine and
ending in the rectum (12.5-15 cm long) & finally
into the anus.
HUMAN DIGESTIVE SYSTEM
 DIGESTION
SYSTEM: PROCESS AND REGULATION

The digestive system uses mechanical and chemical

activities to break food down into absorbable
substances during its journey through the digestive
system.
Table 1 provides an overview of the basic functions of
the digestive organs.
 DIGESTION

 INGESTION

 DIGESTION

 ABSORPTION

 ELIMINATION
The digestive processes
 INGESTION
It involves
 Placing the food into the mouth.

 Chewing the food into smaller pieces

(mastication).
 Moistening of the food with salivary secretion.

 Swallowing the food (deglutition).

 DIGESTION
 During digestion, food is broken down into small
particles by the grinding action of the gastro-
intestinal tract (GIT) and then degraded by the
digestive enzyme into usable nutrients.
ABSORPTION
 During
absorption,
nutrients,
water and
electrolytes
are
transported
from the
GIT to the
circulation.
ELIMINATION

 Food substances that

have been eaten but
cannot be digested and
absorbed are excreted
from the alimentary
canal as feces by the
process of defecation.
Summary of digestive organs function

Table 1. Functions of the Digestive Organs

Other
Organ Major functions
functions
Moistens and
dissolves food,
Ingests food allowing one
Chews and mixes food to taste it
Begins chemical breakdown of Cleans and
Mouth carbohydrates lubricates the
Moves food into the pharynx teeth and oral
Begins breakdown of lipids via cavity
lingual lipase Has some
antimicrobial
activity
Summary of digestive organs function

Organ Major Activities Other activities

Lubricates food
Pharyn Propels food from the oral cavity to
and
x the esophagus
passageways
Lubricates food
Esopha
Propels food to the stomach and
gus
passageways
Summary of digestive organs function

Mixes and churns food with gastric

Stimulates
juices to form chyme
protein-
Begins chemical breakdown of
digesting
proteins
enzymesSecrete
Releases food into the duodenum as
Stomach s intrinsic factor
chyme
required for
Absorbs some fat-soluble
vitamin B12
substances (for example, alcohol,
absorption in
aspirin)
small intestine
Possesses antimicrobial functions
Summary of digestive organs function

Mixes chyme with digestive juices

Propels food at a rate slow enough for
digestion and absorption
Absorbs breakdown products of Provides optimal
Small
carbohydrates, proteins, lipids, and nucleic medium for
intestine
acids, along with vitamins, minerals, and enzymatic activity
water
Performs physical digestion via
segmentation

Bicarbonate-rich
Liver: produces bile salts, which emulsify
pancreatic juices
lipids, aiding their digestion and absorption
help neutralize
Accessory Gallbladder: stores, concentrates, and
acidic chyme and
organs releases bile
provide optimal
Pancreas: produces digestive enzymes and
environment for
bicarbonate
enzymatic activity
Summary of digestive organs function

Food residue is
concentrated and
Further breaks down food residuesAbsorbs
temporarily stored
most residual water, electrolytes, and
Large prior to
vitamins produced by enteric
intestine defecationMucus
bacteriaPropels feces toward
eases passage of
rectumEliminates feces
feces through
colon
ORGANS OF DIGESTIVESYSTEM
A LIMENTARY TRACT
 Mouth

 Pharynx

 Esophagus

 Stomach

 Small intestine
 Large intestine

 Rectum and anal

canal
ACCESSORY ORGANS
OF DIGESTIVE SYSTEM
 Three pairs of
salivary gland
 The pancreas
 The liver &
biliary tract.
STRUCTURE OF ALIMENTAYCANAL
The walls of the alimentary tract are formed by
4 layers of tissues.
 1) ADVENTITIA OR SEROSA
 Thisis the outer most layer and in the thorax it
consists of losse fibrous tissue and in the
abdomen the organs are covered by a serous
membrane (serose) called peritoneum.
PERITONEUM
 It is the largest
serous membrane of
the body. It has two
layers
 Parietal layer- which
lines the abdominal
valve
 Visceral layer- it
cover the organs
within the
abdominal and
pelvic cavities.
 2. MUSCLELAYER
 It consist of two layer of
smooth (voluntary)muscle
 Contraction and relaxation of
these muscle layers occur in
waves, which push the
contents of the tract onwards.
 This type of contraction of
smooth muscle is called
“peristalsis”.
 Onward movement of the
content of the tract is
controlled at various points by
sphincters, which are
thickened rings of circular
muscle contraction of
sphincter regulates forward
movement and prevent the
backflow in the tract.
3. Sub mucosa:
This layer consists of loose connective tissue,
blood vessels and lymphatics.
4. MUCOSAL LAYER:
It consists of three layers of tissues.
 Mucus membrane

 Lamina propria

 Muscularis mucosa

o Mucus membrane:
It has three main function- protection, secretion,
and absorption.
MUCOSAL LAYER:
 Lamina propria: it
consisting of loose connective
tissue, which supports the blood vessels that
nourish the inner epithelial layer, and varying
amounts of lymphoid tissue that has a protective
function.

 Muscularis mucosa: it
is a thin outer layer of
smooth muscles that provides involutions of the
mucosa layer, gastric glands, and villi.
THE WALLS OF THE ALIMENTARY TRACT
MOUTH (ORALCAVITY)
 The mouth or oral cavity is lined by mucous
membrane, consisting of stratified squamous
epithelium containing mucus secreting glands.
 BOUNDARIES OF ORALCAVITY
 Anteriorly : by lips
 Posteriorly : it is
continuous with
oropharynx
 Laterally: by muscles of
the cheeks
 Superiorly: by bony
hard palate & muscles of
soft palate
 Inferiorly: by soft tissue
of floor, mouth &
tongue.
 TOUNGUE

 It is a voluntary muscular structure.

 It is attached by its base to the hyoid bone & by
frenulum to the floor of the mouth.
 Its superior surface consists of stratified squamous
epithelium, with little projection called as papillae,
containing taste buds.
 FUNCTIONS OF TOUNGE

The term plays an important role in

 chewing ( mastication),
 swallowing( deglutition),
 speech &
 taste.
 TEETH
The teeth are embedded in sockets of the mandible and maxilla.
Each person has two sets of teeth, the temporary &
permanent teeth.
 TEMPORARY (DECIDUOUS) - They are 20 in number,
10 in each jaw. They begin to erupt at the age of six months
& all are present by the age of 24 months.
Shapes- molars 2/2, premolars, canine 1/1, incisors 2/2.
 TEETH
 PERMANENT TEETH- They are 32 in
number & begin to replace the temporary teeth
in the sixth year of age. It is usually completed
by the 24th year.
 Shapes- molars 3/3, premolars 2/2, canine 1/1,
incisors 2/2.
FUNCTIONS OF TEETH:
 Incisor and canine teeth
have cutting surface & are
used for biting off pieces
of foods.
 Whereas the premolar &
molar have broad & flat
surfaces & are used for
chewing food.
STRUCTURE OF TOOTH
 The shape of the
different teeth vary,
the structure is the
same & consists of
 The crown- the part
that protrudes from the
gum.
 The root- the part
embedded in the bone.
 The neck- slightly
narrowed region
where the crown
merges with the root.
 SALIVARYGLAND
Salivary gland releases their secretion into ducts that lead
into the mouth.
There are 3 main pairs
 Parotid gland

 The submandibular glands

 Sublingual glands
a) PAROTIDGLAND
 These are situated one on each side of the face just below
the external acoustic meatus. Each gland has a parotid
duct opening into the mouth at the level of the second
upper molar tooth.
B) SUBMANDIBULAR GLAND
 These lie one on each side of the face under the angle of
the jaw. The two submandibular ducts open on the floor
of the mouth, one on each side of the frenulum of the
tongue.
C) SUBLINGUALGLANDS:
 These glands lie under the mucous membrane of the
floor of the mouth in front of the sub-mandibular glands.
These have numerous small ducts that open into the floor
of the mouth.
 STRUCTURE OF THE SALIVARYGLANDS:
 The glands are all surrounded
by the fibrous capsule.
 They consist of a number of
lobules made up of small acini
lined with secretory cell.
 The secretion are poured into
ductiles that join upto form
larger ducts leading into the
mouth.
BLOOD SUPPLY:
Arterial supply is by various
branches from the external
carotid artery and venous
drainage is into the external
jugular veins.
COMPOSITON OF SALIVA:
It about 1.5 liters of saliva is produced daily and it
consist of
 Water

 mineral salts

 An enzyme- salivary amylase

 Mucous

 Lysozyme

 Immunoglobulins

 Blood clotting factors

 FUNCTIONS OF SALIVA:
 Chemical digestion of polysaccharides:
Saliva contains the enzyme amylase that begins
the breakdown of complex sugar, including
starch, reducing them to the disaccharides
maltose. The optimum pH for the action of
salivary amylase is 6.8.
 salivary pH ranges from 5.8 -7.4 depending

upon the rate of flow.

 Lubrication of food: Dry food entering the
mouth is moistened and lubricated by saliva
before it can be made into a bolus ready for
swallowing.
 FUNCTIONS OF SALIVA:

 Cleaning and lubricating: an adequate flow of saliva is

necessary to clean the mouth and to keep it soft, moist
and pliable. It help to prevent damage to the mucous
memvrane by rough or abrasive food.
 Taste: The taste buds are stimulated only by chemical
substances in solution & therefore dry fruits only
stimulated the sense of taste after through mixing with
saliva.
 PHARYNX:
 Pharynx is divided for descriptive purpose into three
parts, the nasopharynx, oropharynx and laryngopharynx.
The nasopharynx is important in respiration.
 The oropharynx & laryngopharynx are passage common
to both the respiratory and the digestive system. Food
passes from the oral cavity into the pharynx then to the
esophagus below, with which it is continuous.
BLOOD SUPPLY OF PHARYNX
 The blood supply to the pharynx is by several
branches of the facial arteries. The venous
drainage is into the facial veins and internal
jugular veins.
NERVE SUPPLY:
 This is from the pharyngeal plexus and consist of
parasympathetic and sympathetic nerve.
Parasympathetic supply is mainly by the
glossopharyngeal and vagous nerves and
sympathetic from the cervical ganglia.
 OESOPHAGUS:

 The oesophagus is about 25 cm long and about 2cm in

diameter and lies in the median plane in the thorax in
front of the vertebral column behind the trachea and the
heart
 STRUCTURE OF OESOPHAGUS:
 There are four layers of tissue .As the
oesophagus is almost entirely in the thorax the
outer covering ,the adventitia ,consist of elastic
fibrous tissue that attaches the oesophagus to the
surrounding structure .

 Theproximal third is lined by stratified

squamous epithelium and distal third by
columnar epithelium .the middle third is lined by
a mixture of the two.
 BLOOD SUPPLY

Arterial- The thoracic region is supplied

mainly by the paired oesophagus arteries
,branches from the thoracic aorta. The abdominal
region is supplied by branches from the inferior
phrenic arteries and the left gastric branches of
the celiac artery.
 VENOUS DRAINAGE
 From the thoracic region venous drainages is in
to the azygos and hemiazygos vein. There is a
venous plexus at the distal end that links the
upward and downward venous drainages, the
general and portal circulation.
 STOMACH
 Thestomach is J- shaped dilated portion of the
alimentary tract situated in the epigastric
,umbilical and left hypochondriac regions of the
abdominal cavity.
STRUCTURE OF THE STOMACH
 The stomach is
continuous with the
oesophagus at the
cardiac sphincter and
with the duodenum at
the pyloric sphincter .
 It has two curvatures
,the lesser curvature is
short
 Just before the pyloric
sphincter it curve
upwards to complete
the J- shape .
 STRUCTURE OF THE STOMACH
 Where the oesophagus join the stomach the
anterior region angles acutely upwards ,curves
downwards forming the greater curvature and
then slightly upwards the pyloric sphincters.
 The stomach is divided in to three regions :the
fundus ,the body and the antrum. At the distal
end of the pyloric antrum is the pyloric
sphincter, is relaxed and open ,and when the
stomach contains food the sphincter is closed.
 ORGANS ASSOCIATED WITH THE STOMACH

 Anteriorly - left lobe of liver and anterior

abdominal wall.
 Posteriorly – abdominal aorta, pancreas
,spleen,left kidney and adrenal glands.
ORGANS ASSOCIATED WITH THE STOMACH
 Superiorly- diaphragm, oesophagus and left lobe of
liver.
 Inferiorly- transverse colon and small intestine

 To the left- diaphragm and spleen.

 To the right- liver and duodenum.

 WALLS OF THE STOMACH
The four layers of tissue that comprise the basic
structure of the alimentary canal are found in the
stomach but with some modifications.
 MUSCLES LAYER-
This consists of
three layers of
smooth muscles
fibers
 An outer layer of
longitudinal fibers
 A middle layer of
circular fibers.
 An inner layer of

oblique fibers.
 BLOOD SUPPLY

Arterial supply to the stomach is by the left

gastric artery , and branch of the coeliac artery
,the rights gastric artery and the gastroepiploic
arteries. Venous drainages is through veins of
corresponding names into the portal veins .
FUNCTIONS OF THE STOMACH
These includes
 Temporary storage allowing time for the digestive
enzyme, pepsin, to act.
 Enzyme digestion- pepsin convert protein to peptides .

 Mechanical breakdown- the three smooth muscle layer

able the stomach to act as a churn, gastric juice is added
and the contents are liquefied to chyme. Motility &
secretion are increased by parasympathetic nerve
stimulation.
 FUNCTIONS OF THE STOMACH
 Limited absorption of water, alcohol & some
lipid soluble drugs.
 Known, specific defense against microbes-
provided by hydrochloride acid into gastric
juice.
 Production & secretion for intrinsic factor
needed for absorption of vitamin b12 in the
terminal ileum.
 Regulation of the passage of gastric contents into
the duodenum.
 Secretion of the gastric hormones .
 SMALLINTESTINE
 The small intestine can be divided into 3 major regions:
 The duodenum is the first section of intestine that
connects to the pyloric sphincter of the stomach. It is the
shortest region of the small intestine, measuring only
about 10 inches in length.
 SMALLINTESTINE
 The jejunum is the middle section of the small
intestine that serves as the primary site of
nutrient absorption. It measures around 3 feet in
length.
 The ileum is the final section of the small
intestine that empties into the large intestine via
the ileocecal sphincter. The ileum is about 6 feet
long and completes the absorption of nutrients
that were missed in the jejunum.
 SMALLINTESTINE
 The small intestine (or small bowel) is the part
of the gastrointestinal tract.
 The small intestine is a long, highly convoluted
tube in the digestive system that absorbs about
90% of the nutrients from the food eaten.
 It is given the name “small intestine” because it

is only 1 inch in diameter, making it less than

half the diameter of the large intestine.
 The small intestine is, however, about twice the
length of the large intestine and usually measures
about 10 feet in length.
 THE SMALL INTESTINE
It is made up of four layers of tissue

 Mucosa -The mucosa forms the inner layer of

epithelial tissue and is specialized for the
absorption of nutrients from chyme.
 Sub mucosa layer -Deep to the mucosa is
the sub mucosa layer that provides blood
vessels, lymphatic vessels, and nerves to
support the mucosa on the surface.
LAYERS OF SMALL INTESTINE
 Muscularis layer -Several layers of smooth
muscle tissue form the muscularis layer that
contracts and moves the small intestines.

 Serosa- it forms the outermost layer of

epithelial tissue that is continuous with the
mesentery and surrounds the intestines.
FUNCION OF SMALLINTESTINE
1.Onward movement of its contents by
peristalsis, which is increased by
parasympathetic stimulation.
2.A secretion of intestinal juice, also increase
by parasympathetic stimulation.
3.Completion of chemical digestion of
carbohydrate, protein and fat in the
electrolytes of the villi.
4.Secretion of the hormones cholesystokinin
(CCK) .
5. Absorption of nutrients.
LARGEINTSTINE
It consists of the
following parts:
 1. Caecum

 2. The ascending
colon
 3. The transverse
colon
 4. The descending
colon
 5. The pelvic or
sigmoid colon
 6. The Rectum
 7. The anal canal
 LARGE INTSTINE
 Large intestine, posterior section of the intestine,
consisting typically of four regions:
the cecum, colon, rectum, and anus.
 The large intestine is wider and shorter than
the small intestine(approximately 1.5 meters, or
5 feet it begins in the right iliac region of
the pelvis, just at or below the waist, where it is
joined to the end of the small intestine.
 It then continues up the abdomen, across the
width of the abdominal cavity, and then down to
its endpoint at the anus.
 LARGEINTSTINE

 The caecum is the first part of the colon and is a

dilated portion which has a blind lower end and
is continuous above with the ascending colon.
Just below the junction of the two, the ileocaecal
valve opens. This valve is a sphincter and
prevents the caecal contents passing back into
the ileum.
 LARGEINTSTINE
 The Vermiform appendix is a fine tube closed at
one end, which opens out of the caecum, about 2 cm
below the ileo-caecal valve. It is usually about 13
cm (5 inches) long and has the same structure as the
walls of the colon but contains more lymphoid
tissues.
 LARGEINTSTINE
The ascending colon passes upwards from the
caecum to the level of the liver where it bends
acutely to the left of at the right colic flexure to
become the transverse colon.
The transverse colon is about 50 cm in length
and passes across the abdomen to the under
surface of the spleen. Where it forms the left
colic flexure, by bending acutely downwards to
become the descending colon.
 LARGEINTSTINE
 The descending colon is about 25 cm in length
and passes down the left side of the abdomen to
the inlet of the lesser pelvis, where it becomes
the sigmoid colon.
 The pelvic or sigmoid colon has an S-shaped
curve in the pelvis and it continues downwards
to become the rectum.
 The Rectum is about 12 cm long and is a
slightly dilated part of the colon. It leads from
the pelvic colon and terminates in the anal canal.
 THE ANAL CANAL
It is a short canal about 3.8 cm (11/2 inches) long in
adults and leads from the rectum to the exterior.

 There are two sphincter muscles which controls the

anus- The internal sphincter surrounds the upper
the three quarters of the canal and consists of
smooth muscle fibers.
 The external spinster and consists of striated
muscle. It is the tone of these sphincters which
keep the anal canal and the anus Closed.
 STRUCTURE
In structure, the large intestine consists of the same four
layers of the alimentary canal as described above with a
few modifications.
 The arrangement of the longitudinal muscle fiber is
modified in the colon. They do not form a smooth
continuous layer of tissues, but are collected into three
bands called taenia coli situated at regular intervals
round the colon.
 STRUCTURE
 These bands are shorter than the other layers of
the large intestine and so produce a typical
puckered or sacculated appearance.
 In the sub mucous layer, there are more
lymphoid tissues than in any other part of the
alimentary canal.
 The mucus lining of the colon and the upper
part of the rectum contains large number of
goblet cells, which secrets mucus.
 FUNCTIONS OF LARGEINTESTINE
Functions are:
1. Absorption:
 In the colon, water, mineral, salts and some
drugs are absorbed into the blood capillaries.
2. Secretion:
 Colon has only one secretion, mucin which
lubricates the feces and facilitates their passage
through the rectum and anus.
 FUNCTIONS OF LARGEINTESTINE
3. Digestion:
 Many bacteria are present here which act on
various food residues which have not been
digested or absorbed in the small intestine.
4. Excretion:
 Excess of calcium, iron and drugs of heavy
metals, such as bismuth, are excreted from the
walls of the large intestine and mix with the
feces.
 FUNCTIONS OF LARGEINTESTINE
 Defecation:

Defecation is the process of emptying the rectum

or the passage of feces out of the body. This is
achieved by the gastro-colic reflex, which occurs
by reflex action with the infant whereas in
adults, is under the control of the will and is
carried out in response to the desire to empty the
bowel produced by distension of the rectum with
feces.
 PANCREAS
 The pancreas is a pale grey gland waiting about 60gms.
It is about 12-15 cm long & is situated in the epigastric
& left hypochondriac region of the abdominal cavity. It
consist of a broad head , a body & a narrow tale. The
head lies in the curve of the duodenum, the body behind
the stomach & the tale lies in the front of the left kidney
& just reaches the spleen.
 PANCREAS
 The pancreas is both an endocrine and exocrine gland.
Exocrine Endocrine

Description Large number of Groups of specialised

lobes, each drained by cells (pancreatic islets/
a tiny duct islets of Langerhans)
Ducts eventually unite with no ducts
to form the pancreatic Hormones diffuse
duct, which opens into directly into the blood
the duodenum as glands have no
ducts

Function Production of Secretes hormones,

pancreatic juice insulin and glucagon
containing enzymes which are principally
that digest concerned with the
carbohydrates, regulation of blood
proteins and fats glucose levels
 LIVER
 Liveris the largest gland in the body, weighing
between 1 and 2.3 kg. It is situated in the upper
part of the abdominal cavity.
ORGANS ASSOCIATED WITH THELIVER
 Superiorly & anteriorly- diaphragm and anterior
abdominal wall.
 Inferiorly- stomach, bile ducts, duodenum,
hepatic flexure of the colon, right kidney &
adrenal gland
 Posteriorly- oesophagus, inferior vanacava,
aorta, gall bladder, vertebral column &
diaphragm.
 Laterally- lower ribs & diaphragm.
ORGANS ASSOCIATED WITH THELIVER
 LIVER
 Liver has four lobes. The two most obvious are
the large right lobe & the smaller, wedge shaped
left lobe. The other two, caudate and quadrate
lobe, are area on the posterior surface.

 BLOOD SUPPLY
The hepatic artery & the portal vein take blood to
the liver. Venous return is by a variable number
of the hepatic veins that leave the posterior
surface & immediately enter the inferior vena
cava just below the diaphragm.
 STRUCTURE
 The lobes of the liver are made up of tiny
functional units called lobules, which are just
visible to the naked eye. Liver lobules are
formed by cubicle- shaped cells, the hepatocytes.
 Between two pairs of columns of cells are
sinusoids which containing a mixture of blood
from the tiny branches of the portal vein and
hepatic artery.
 This arrangement allows the arterial blood and

portal venous blood to mix and close contact

with the liver cells.
 FUNCTIONS OF LIVER
 Carbohydrate metabolism
 Fat metabolism

 Protein metabolism

 Breakdown of erythrocytes and defense against

microbes.
 Detoxification of drug & noxious substance-
e.g., alcohol & toxin produced by microbes.
 Intoxification of hormones.
 FUNCTIONS OF LIVER
 Production of heat
 Secretion of bile.

 Storage- the substances include

 Glycogen

 Fat soluble vitamins- A, D, E, K.

 Iron, copper

 Some water soluble vitamins- vitamin B12.

 BILIARYTRACT

BILE DUCTS

 The right & left hepatic ducts join to form the

common hepatic duct just outside the portal
fissure.
 The hepatic ducts passage downwards for about
3 cm where it is joined at an acute angle by the
cystic duct from the gall bladder.
 The common bile duct is around 7.5 cm long and
has a diameter of about 6mm.
 STRUCTURE
 The walls of the bile ducts have the same layers of tissue
as those described in the basic structure of the alimentary
canal. In the cystic duct the mucous membrane lining is
arranged in irregular circular folds, which have the effect
of a spiral bulb.
 GALLBLADDER
 The gall bladder is a pear-shaped sac attached to
the posterior surface of the liver by connective
tissue. It has a fundus or expended and, a body
or main part and a neck, which is continues with
the cystic duct.
 STRUCTURE OF GALLBLADDER
 The gall bladder has the same layer of tissue as those
described in the basic structure of the alimentary canal,
with some modifications. There are three layers
 Peritoneum

 Cover only the inferior surface

 Muscle layer

 This is an additional layer of oblique muscle fiber.

 Mucus membrane

 Displays small rugae, when the gall bladder is empty that

disappears when it is distended with bile.
 FUNCTION OF GALLBLADDER
 Reservoir for bile.
 Concentration of the bile by upto 10- or 15- fold,
by absorption of water through the walls of the
gall bladder.
 Release of stored bile.
THE MAJOR DIGESTIVE ENZYMES AND
SECRETION
 Enzymes that digest carbohydrates
ENZYME ENZYME SOURCE DIGESTIVE ACTION
SECRETION

Ptyalin Salivary glands Starch to dextrin,

maltose,glucose

Amylase Pancreas and intestinal Starch to dextrin,

mucosa maltose, gluccose

Maltase Intestinal mucosa Dextrin to maltose and

glucose

Sucrase Intestinal mucosa Sucrose to glucose and

fructose

Lactase Intestinal mucosa Lactose to glucose and

galactose
ENZYMES THAT DIGEST PROTEINS
ENZYME ENZYME SOURCE DIGESTIVE ACTION
SECRETION
Pepsin Gastric mucosa Protein to polypeptides

Trypsin Pancreas Proteins and

polypeptides to
dipeptides and amino
acids
Aminopeptidase Intestinal mucosa Polypeptides to
dipeptides and amino
acids
Dipeptidase Intestinal mucosa Dipeptides and amino
acids
Hydrochloric acid Gastric mucosa Protein to polypeptidase
and amino acids
ENZYMES THAT DIGEST FATS
ENZYME ENZYME SOURCE DIGESTIVE ACTION
SECRETION

Pharyngeal lipase Pharynx mucosa Triglycerides to fatty

acids , diglycerides and
monoglycerides
Steapsin Gastric mucosa Triglycerides to fatty
acids , diglycerides and
monoglycerides

Pancreatic lipase Pancreas Triglycerides to fatty

acids , diglycerides and
monoglycerides

Bile liver Fat emulsification

 Assignment one
1. Describe briefery the three phases of gastric
secretion.

2. Explain how the stomach is protected from self-

digestion and why this is necessary.

3. Describe the unique anatomical features that

enable the stomach to perform digestive functions.

4. Explain how nutrients absorbed in the small

intestine pass into the general circulation.

5. Discuss different the cells found in the small

intestinal mucosa and explain how they involve in
digestion
 Review
The digestive system includes the organs of the
alimentary canal and accessory structures. The
alimentary canal forms a continuous tube that is open
to the outside environment at both ends. The organs
of the alimentary canal are the mouth, pharynx,
esophagus, stomach, small intestine, and large
intestine. The accessory digestive structures include
the teeth, tongue, salivary glands, liver, pancreas, and
gallbladder.
 Review

The wall of the alimentary canal is composed of four

basic tissue layers: mucosa, submucosa, muscularis,
and serosa. The enteric nervous system provides
intrinsic innervation, and the autonomic nervous
system provides extrinsic innervation.
 Review

The digestive system ingests and digests food, absorbs

released nutrients, and excretes food components that
are indigestible. The six activities involved in this
process are ingestion, motility, mechanical digestion,
chemical digestion, absorption, and defecation. These
processes are regulated by neural and hormonal
mechanisms.
 Review
In the mouth, the tongue and the teeth begin mechanical
digestion, and saliva begins chemical digestion. The
pharynx, which plays roles in breathing and vocalization
as well as digestion, runs from the nasal and oral cavities
superiorly to the esophagus inferiorly (for digestion) and
to the larynx anteriorly (for respiration). During
deglutition (swallowing), the soft palate rises to close off
the nasopharynx, the larynx elevates, and the epiglottis
folds over the glottis.
 Review
The esophagus includes an upper esophageal sphincter
made of skeletal muscle, which regulates the movement
of food from the pharynx to the esophagus. It also has a
lower esophageal sphincter, made of smooth muscle,
which controls the passage of food from the esophagus
to the stomach. Cells in the esophageal wall secrete
mucus that eases the passage of the food bolus.
 Review
The stomach participates in all digestive activities
except ingestion and defecation. It vigorously churns
food. It secretes gastric juices that break down food and
absorbs certain drugs, including aspirin and some
alcohol. The stomach begins the digestion of protein and
continues the digestion of carbohydrates and fats. It
stores food as an acidic liquid called chyme, and
releases it gradually into the small intestine through the
pyloric sphincter.
 Review

The three main regions of the small intestine are the

duodenum, the jejunum, and the ileum. The small intestine
is where digestion is completed and virtually all absorption
occurs. These two activities are facilitated by structural
adaptations that increase the mucosal surface area by 600-
fold, including circular folds, villi, and microvilli. There are
around 200 million microvilli per square millimeter of small
intestine, which contain brush border enzymes that
complete the digestion of carbohydrates and proteins.
 Review

Combined with pancreatic juice, intestinal juice

provides the liquid medium needed to further digest and
absorb substances from chyme. The small intestine is
also the site of unique mechanical digestive movements.
Segmentation moves the chyme back and forth,
increasing mixing and opportunities for absorption.
Migrating motility complexes propel the residual chyme
toward the large intestine.
 Review
The main regions of the large intestine are the cecum, the
colon, and the rectum. The large intestine absorbs water
and forms feces, and is responsible for defecation.
Bacterial flora break down additional carbohydrate residue,
and synthesize certain vitamins. The mucosa of the large
intestinal wall is generously endowed with goblet cells,
which secrete mucus that eases the passage of feces. The
entry of feces into the rectum activates the defecation
reflex.
 Review

Chemical digestion in the small intestine cannot occur

without the help of the liver and pancreas. The liver
produces bile and delivers it to the common hepatic
duct. Bile contains bile salts and phospholipids, which
emulsify large lipid globules into tiny lipid droplets, a
necessary step in lipid digestion and absorption. The
gallbladder stores and concentrates bile, releasing it
when it is needed by the small intestine.
 Review

The pancreas produces the enzyme- and bicarbonate-

rich pancreatic juice and delivers it to the small
intestine through ducts. Pancreatic juice buffers the
acidic gastric juice in chyme, inactivates pepsin from
the stomach, and enables the optimal functioning of
digestive enzymes in the small intestine.
 Review
The small intestine is the site of most chemical digestion
and almost all absorption. Chemical digestion breaks
large food molecules down into their chemical building
blocks, which can then be absorbed through the intestinal
wall and into the general circulation. Intestinal brush
border enzymes and pancreatic enzymes are responsible
for the majority of chemical digestion. The breakdown of
fat also requires bile.
 Review

With the help of bile salts and lecithin, the dietary fats
are emulsified to form micelles, which can carry the
fat particles to the surface of the enterocytes. There,
the micelles release their fats to diffuse across the cell
membrane. The fats are then reassembled into
triglycerides and mixed with other lipids and proteins
into chylomicrons that can pass into lacteals. Other
absorbed monomers travel from blood capillaries in
the villus to the hepatic portal vein and then to the
liver.
QUESTIONS??
ANATOMY AND PHYSIOLOGY

UNIT 13: SENSORY SYSTEM

LECTURER:
HABUMUGISHA Emmanuel, RN, BScN, PGCLTHE, MSN
Assistant Lecturer
EACC/ Health Science Faculty
 INTRODUCTION
 The sensory system is the body's way of receiving
information about its surroundings.
 Sensory systems include organs, tissues, and cells that
receive stimuli from the environment and send this
information to the brain for processing.
 Sensory receptors are specialized neurons in the skin,
eyes, ears, nose, tongue and other parts of the body that
convert external stimuli (sight, sound, smell, taste and
touch) into signals that are sent to the brain via nerve
pathways.
CON’T

 The sensory system protects a person by detecting changes in

the environment.
 An environmental change becomes a stimulus when it initiates a
nerve impulse, which then travels to the central nervous system
(CNS) by way of a sensory (afferent) neuron.
 A stimulus becomes a sensation of something we experience only
when a specialized area of the cerebral cortex interprets the
nerve impulse it generates.
 Many stimuli arrive from the external environment and are
detected at or near the body surface.
 Others, such as stimuli from the viscera, originate internally
and help to maintain homeostasis.
SPECIAL SENSES ANATOMY AND PHYSIOLOGY
The functions of the five special senses include:
 Vision: Sight or vision is the capability of the eye(s) to focus and
detect images of visible light on photoreceptors in the retina of each
eye that generates electrical nerve impulses for varying colors, hues,
and brightness.
 Hearing: Hearing or audition is the sense of sound perception.

 Taste: Taste refers to the capability to detect the taste of substances

such as food, certain minerals, and poisons, etc.
 Smell: Smell or olfaction is the other “chemical” sense; odor
molecules possess a variety of features and, thus, excite specific
receptors more or less strongly; this combination of excitatory
signals from different receptors makes up what we perceive as the
molecule’s smell.
 Touch: Touch or somatosensory, also called tactition or
mechanoreception, is a perception resulting from activation of
neural receptors, generally in the skin including hair follicles, but
also in the tongue, throat, and mucosa.
SENSORY SYSTEMS

 Vision
 Hearing

 Taste

 Smell

 Equilibrium

 Somatic Senses
SENSES
 Somatic sensory
 General: transmit impulses from skin, skeletal muscles,
and joints
 Special senses: hearing, balance, vision
 Visceral sensory
 Transmit impulses from visceral organs
 Special senses: olfaction (smell), gustation (taste).
PROPERTIES OF SENSORY SYSTEMS
 Stimulus: energy source
 Internal
 External
 Receptors
 Sense organs: structures specialized to respond to stimuli
 Transducers: stimulus energy converted into action potentials
 Conduction
 Afferent pathway
 Nerve impulses to the CNS
 Translation
 CNS integration and information processing
 Sensation and perception; your reality
SENSORY PATHWAYS
 Stimulus as physical energy → sensory receptor acts as a
transducer
 Stimulus > threshold → action potential to CNS
 Integration in CNS → cerebral cortex or acted on subconsciously.
 SENSORY RECEPTORS
 The part of the nervous system that detects a stimulus is the sensory
receptor.
 In structure, a sensory receptor may be one of the following:
◗ The free dendrite of a sensory neuron, such as the receptors for
pain.
◗ A modified ending, or end-organ, on the dendrite of an afferent
neuron, such as those for touch and temperature
◗ A specialized cell associated with an afferent neuron, such as the
rods and cones of the retina of the eye and the receptors in the other
special sense organs.
 CLASSIFICATION BY FUNCTION (STIMULI)

 Mechanoreceptors: respond to touch, pressure, vibration, stretch,

and itch.
 Thermoreceptors: sensitive to changes in temperature
 Photoreceptors: respond to light energy (e.g., retina)
 Chemoreceptors: respond to chemicals (e.g., smell, taste, changes in
blood chemistry)
 Nociceptors: sensitive to pain-causing stimuli
 Osmoreceptors: detect changes in concentration of solutes, osmotic
activity
 Baroreceptors: detect changes in fluid pressure.
SOMATIC SENSES
 General somatic: includes touch,
pain, vibration, pressure,
temperature
 Proprioceptive: detects the
stretch in tendons and muscle
provide information on body
position, orientation and
movement of body in space.
 SOMATIC RECEPTORS
 Divided into two groups:
 Free or Unencapsulated nerve endings,
 Encapsulated nerve endings: consist of one or more neural end
fibers enclosed in connective tissue.
FREE NERVE ENDINGS
 Abundant in epithelia and underlying connective tissue
 Nociceptors: respond to pain
 Thermoreceptors : respond to temperature
 Two specialized types of free nerve endings
 Merkel discs : lie in the epidermis, slowly adapting receptors for light touch
 Hair follicle receptors: Rapidly adapting receptors that wrap around hair follicles.
ENCAPSULATED NERVE ENDINGS
 Meissner’s corpuscles
 Spiraling nerve ending surrounded by Schwann cells

 Occur in the dermal papillae of hairless areas of the skin

 Rapidly adapting receptors for discriminative touch

 Pacinian corpuscles
 Single nerve ending surrounded by layers of flattened Schwann cells

 Occur in the hypodermis

 Sensitive to deep pressure : rapidly adapting receptors

 Ruffini’s corpuscles
 Located in the dermis and respond to pressure

 Monitor continuous pressure on the skin: adapt slowly.

 ENCAPSULATED NERVE ENDINGS: PROPRIOCEPTORS
 Monitor stretch in locomotory organs
 Three types of proprioceptors:
 Muscle spindles: monitor the changing length of a muscle, imbedded in the
perimysium between muscle fascicles.
 Golgi tendon organs: located near the muscle-tendon junction, monitor tension
within tendons.
 Joint kinesthetic receptors: sensory nerve endings within the joint capsules,
sense pressure and position
MUSCLE SPINDLE & GOLGI TENDON ORGAN
THE SPECIAL SENSES
 5 SPECIAL SENSES

1. Olfaction/ Smell from receptors in the upper nasal

cavities
2. Gustation/ Taste from the tongue receptors
3. Hearing from receptors in the internal ear
4. Equilibrium from receptors in the internal ear
5. Vision from receptors in the eye
General senses
 Pressure, temperature, pain, and touch from
receptors in the skin and internal organs
 Sense of position from receptors in the muscles,
tendons, and joints.
OLFACTORY ORGANS

 Located in nasal
cavity on either side
of nasal septum

Figure 17–1a
 CON’T

 Contains:
 Olfactory receptors
 Supporting cells
 Basal (stem) cells
 The receptors for
taste and olfaction
are classified as
chemoreceptors
because they
respond to
chemicals in
solution.
OLFACTORY RECEPTORS
 Highly modified neurons
 Involves detecting dissolved chemicals as they
interact with odorant-binding proteins

Figure 17–1b
 CON’T

 Olfactory receptors: The thousands of olfactory receptors,

receptors for the sense of smell, occupy a postage stamp-sized area
in the roof of each nasal cavity.
 Olfactory receptor cells: The olfactory receptor cells are neurons
equipped with olfactory hairs, long cilia that protrude from the
nasal epithelium and are continuously bathed by a layer of mucus
secreted by underlying glands.
 Olfactory filaments: When the olfactory receptors located on the
cilia are stimulated by chemicals dissolved in the mucus, they
transmit impulses along the olfactory filaments, which are bundled
axons of olfactory neurons that collectively make up the olfactory
nerve.
 Olfactory nerve: The olfactory nerve conducts the impulses to the
olfactory cortex of the brain.
TASTE BUDS AND THE SENSE OF TASTE
 The word taste comes from the Latin word taxare,
which means “to touch, estimate, or judge”.
 TASTE (GUSTATORY) RECEPTORS
 Clustered in taste
buds:
 Associated with
epithelial
projections (lingual
papillae) on dorsal
surface of tongue
 Each taste bud
contains:
 basal (stem) cells
 gustatory cells:

 Extend taste

hairs through
taste pore.
 Survive only 10

days before
replacement.
 PRIMARY TASTE SENSATIONS

 Sweet
 Salty

 Sour

 Bitter

 Umami

 Taste vs
Flavor
 CON’T
 Taste buds: The taste buds, or specific receptors for the sense of taste, are
widely scattered in the oral cavity; of the 10, 000 or so taste buds we have,
most are on the tongue.
 Papillae: The dorsal tongue surface is covered with small peg-like
projections, or papillae.
 Circumvallate and fungiform papillae: The taste buds are found on the
sides of the large round circumvallate papillae and on the tops of the more
numerous fungiform papillae.
 Gustatory cells: The specific cells that respond to chemicals dissolved in
the saliva are epithelial cells called gustatory cells.
 Gustatory hairs: Their long microvilli- the gustatory hairs- protrude
through the taste pore, and when they are stimulated, they depolarize and
impulses are transmitted to the brain.
 Facial nerve: The facial nerve (VII) serves the anterior part of the tongue.
 Glossopharyngeal and vagus nerves: The other two cranial nerves- the
glossopharyngeal and vagus- serve the other taste bud-containing areas.
 Basal cells: Taste bud cells are among the most dynamic cells in the body,
and they are replaced every seven to ten days by basal cells found in the
deeper regions of the taste buds.
 THE EAR: HEARING AND BALANCE
 Anatomically, the ear is divided into three major areas:
the external, or outer ear; the middle ear, and the
internal, or inner ear.
THE EAR

Figure 17–20
EXTERNAL EAR
 Auricle:
 Surrounds entrance to external acoustic/ auditory canal
 Protects opening of canal
 Provides directional sensitivity
 External acoustic/ auditory canal
 Canal that runs from auricle to tympanic membrane.
 Tympanic membrane (Eardrum)
 Is a thin, semitransparent sheet,
 Separates external ear from middle ear
 EXTERNAL (OUTER) EAR
 The external, or outer, ear is composed of the auricle and the
external acoustic meatus.
 Auricle: The auricle, or pinna, is what most people call the “ear”-
the shell-shaped structure surrounding the auditory canal
opening.
 External acoustic meatus: The external acoustic meatus is a
short, narrow chamber carved into the temporal bone of the skull;
in its skin-lined walls are the ceruminous glands, which secrete
waxy, yellow cerumen or earwax, which provides a sticky trap
for foreign bodies and repels insects.
 Tympanic membrane: Sound waves entering the auditory canal
eventually hit the tympanic membrane, or eardrum, and cause it
to vibrate; the canal ends at the ear drum, which separates the
external from the middle ear.
EXTERNAL EAR

Figure 17–20
 CERUMINOUS GLANDS
 Integumentary glands along external acoustic canal
 Secrete waxy material (cerumen):
 Keeps foreign objects out of tympanic membrane
 Slows growth of microorganisms in external acoustic canal.
 MIDDLE EAR
 The middle ear, or tympanic cavity, is a small, air-filled, mucosa-
lined cavity within the temporal bone.
 Openings: The tympanic cavity is flanked laterally by the
eardrum and medially by a bony wall with two openings, the oval
window and the inferior, membrane-covered round window.
 Pharyngotympanic (Auditory) tube: The pharyngotympanic
tube runs obliquely downward to link the middle ear cavity with
the throat, and the mucosae lining the two regions are continuous.
 Ossicles: The tympanic cavity is spanned by the three smallest
bones in the body, the ossicles, which transmit the vibratory motion
of the eardrum to the fluids of the inner ear; these bones, named
for their shape, are the hammer, or malleus, the anvil, or incus,
and the stirrup, or stapes.
3 AUDITORY OSSICLES

1. Malleus (hammer)
2. Incus (anvil)
3. Stapes (stirrup)
 VIBRATION OF TYMPANIC MEMBRANE
 Converts arriving sound waves into mechanical
movements.
 Auditory ossicles conduct vibrations to inner ear.
INNER EAR

Figure 17–20
INNER EAR
 Contains fluid
 Subdivided into:
 Vestibule
 Semicircular canals
 Cochlea
 INTERNAL (INNER) EAR
 The internal ear is a maze of bony chambers, called the bony, or
osseous, labyrinth, located deep within the temporal bone
behind the eye socket.
 Subdivisions: The three subdivisions of the bony labyrinth are
the spiraling, pea-sized cochlea, the vestibule, and the
semicircular canals.
 Perilymph: The bony labyrinth is filled with a plasma-like fluid
called perilymph.
 Membranous labyrinth: Suspended in the perilymph is a
membranous labyrinth, a system of membrane sacs that more or
less follows the shape of the bony labyrinth.
 Endolymph: The membranous labyrinth itself contains a
thicker fluid called endolymph.
 PARTS TO INNER EAR
 Vestibular Complex
 Combination of vestibule and semicircular canals
 Vestibule
 Receptors provide sensations of gravity and linear acceleration
 Semicircular Canals
 Contain semicircular ducts
 Receptors stimulated by rotation of head

 Cochlea
 Contains cochlear duct
 Receptors provide sense of hearing
PARTS TO INNER EAR
 EQUILIBRIUM
 Sensations provided by receptors of vestibular
complex.
 A state of physical balance, or a calm state of mind.

 https://www.youtube.com/watch?v=KuiNueVxdec

Mechanisms of Equilibrium
 The equilibrium receptors of the inner ear,
collectively called the vestibular apparatus, can be
divided into two functional arms:
o One arm responsible for monitoring static
equilibrium and,
o The other involved with dynamic equilibrium.
 STATIC EQUILIBRIUM
 Within the membrane sacs of the vestibule are receptors called
maculae that are essential to our sense of static equilibrium.
 Maculae: The maculae report on changes in the position of the head
in space with respect to the pull of gravity when the body is not
moving. Maculae are the sensory cells from the otoliths organ.
 Otolithic hair membrane: Each macula is a patch of receptor (hair)
cells with their “hairs” embedded in the otolithic hair membrane, a
jelly-like mass studded with otoliths, tiny stones made of calcium
salts.
 Otoliths: As the head moves, the otoliths roll in response to changes
in the pull of gravity; this movement creates a pull on the gel, which
in turn slides like a greased plate over the hair cells, bending their
hairs. Otolith: Each of three oval calcareous bodies in the inner ear of
vertebral responsible for sensing the gravity and movement.
 Vestibular nerve: This event activates the hair cells, which send
impulses along the vestibular nerve (a division of cranial nerve VIII)
to the cerebellum of the brain, informing it of the position of the head
in space.
 DYNAMIC EQUILIBRIUM
 The dynamic equilibrium receptors, found in the semicircular canals,
respond to angular or rotatory movements of the head rather than to
straight-line movements.
 Semicircular canals: The semicircular canals are oriented in the
three planes of space; thus regardless of which plane one moves in,
there will be receptors to detect the movement.
 Crista ampullaris: Within the ampulla, a swollen region at the base
of each membranous semicircular canal is a receptor region called
crista ampullaris, or simply crista, which consists of a tuft of hair
cells covered with a gelatinous cap called the cupula.
 Head movements: When the head moves in an arclike or angular
direction, the endolymph in the canal lags behind.
 Bending of the cupula: Then, as the cupula drags against the
stationary endolymph, the cupula bends- like a swinging door- with
the body’s motion.
 Vestibular nerve: This stimulates the hair cells, and impulses are
transmitted up the vestibular nerve to the cerebellum.
SOUND
 Consists of waves of pressure through air or water.
PITCH
 Our sensory response to frequency
 Increased frequency results in a higher pitch
 Decreased frequency results in a lower pitch
 HOW DO WE HEAR?
1. Sound waves enter external acoustic canal
2. Soundwaves vibrate the tympanic membrane
3. Vibrations are transferred to and through the
auditory ossicles.
4. Vibrations are transferred to fluid in cochlea,
5. Nerve endings pick up vibrations and send signal
to brain.
 MECHANISM OF HEARING
 The following is the route of sound waves through the ear and activation of
the cochlear hair cells.
 Vibrations. To excite the hair cells in the organ of Corti in the inner ear,
sound wave vibrations must pass through air, membranes, bone and fluid.
 Sound transmission. The cochlea is drawn as though it were uncoiled to
make the events of sound transmission occurring there easier to follow.
 Low frequency sound waves. Sound waves of low frequency that are
below the level of hearing travel entirely around the cochlear duct without
exciting hair cells.
 High frequency sound waves. But sounds of higher frequency result in
pressure waves that penetrate through the cochlear duct and basilar
membrane to reach the scala tympani; this causes the basilar membrane to
vibrate maximally in certain areas in response to certain frequencies of
sound, stimulating particular hair cells and sensory neurons.
 Length of fibers. The length of the fibers spanning the basilar membrane
tune specific regions to vibrate at specific frequencies; the higher Hertz
(Hz) are detected by shorter hair cells along the base of the basilar
membrane.
HOW DO WE HEAR?
 THE EYE AND VISION
 Vision is the sense that requires the most “learning”, and the eye
appears to delight in being fooled; the old expression “You see what
you expect to see” is often very true.
 It is a delicate organ, protected by a number of structures:
 The skull bones form the walls of the eye orbit (cavity) and protect
more than half of the posterior part of the eyeball.
 The upper and lower eyelids aid in protecting the eye’s anterior
portion.
 The eyelids can be closed to keep harmful materials out of the eye,
and blinking helps to lubricate the eye.
 A muscle, the levator palpebrae, is attached to the upper eyelid.
 When this muscle contracts, it keeps the eye open.
 If the muscle becomes weaker with age, the eyelids may droop and
interfere with vision, acondition called ptosis.
 CON’T
 The eyelashes and eyebrow help to keep foreign matter out of the eye.
 A thin membrane, the conjunctiva, lines the inner surface of the
eyelids and covers the visible portion of the white of the eye (sclera).
 Cells within the conjunctiva produce mucus that aids in lubricating
the eye.
 Where the conjunctiva folds back from the eyelid to the anterior of the
eye, a sac is formed.
 The lower portion of the conjunctival sac can be used to instill drops
of medication.
 With age, the conjunctiva often thins and dries, resulting in
inflammation and enlarged blood vessels.
EYE
EXTERNAL ACCESSORY STRUCTURES OF
THE EYE

1. Eyelids
2. Superficial epithelium of eye/ conjunctiva
3. Extrinsic eye muscles,
4. Structures associated with production,
secretion, and removal of tears.
 EYELIDS (PALPEBRAE)
 Continuation of skin,
 Anteriorly, the eyes are protected by the eyelids, which
meet at the medial and lateral corners of the eye, the
medial and lateral commissure (canthus),
respectively.
 Blinking keeps surface of eye lubricated, free of dust,
and debris.
 EYELASHES
 Projecting from the border of each eyelid are the
eyelashes.
 Robust hairs that prevent foreign matter from reaching
surface of eye.
 TARSAL GLANDS
 Associated with eyelashes,
 Modified sebaceous glands associated with the eyelid
edges are the tarsal glands; these glands produce an
oily secretion that lubricates the eye and helps keep
eyelids from sticking together.; ciliary glands,
modified sweat glands, lie between the eyelashes.
 Contribute to gritty deposits that appear after good
night’s sleep.
 CONJUNCTIVA
 Epithelium covering inner surfaces of eyelids and outer
surface of eye.
 A delicate membrane, the conjunctiva, lines the eyelids
and covers part of the outer surface of the eyeball; it
ends at the edge of the cornea by fusing with the
corneal epithelium.
 Conjunctivitis;
 Results from damage to conjunctiva surface.

Figure 17–3b
 CORNEA
 Transparent part of outer fibrous layer of eye.
 The cornea is an anterior continuation of the sclera, but
it is transparent and colorless, whereas the rest of the
sclera is opaque and white.
 The cornea is referred to frequently as the window of the
eye.
 It bulges forward slightly and is the main refracting
structure of the eye.
 The cornea has no blood vessels; it is nourished
by the fluids that constantly wash over it.
 CON’T
 The aqueous humor, a watery fluid that fills much of the eyeball
anterior to the lens, helps maintain the slight forward curve of the
cornea.
 The aqueous humor is constantly produced and drained from the
eye.
 The lens, technically called the crystalline lens, is a
clear, circular structure made of a firm, elastic material.
 The lens has two bulging surfaces and is thus described as biconvex.
 The lens is important in light refraction because it is elastic and its
thickness can be adjusted to focus light for near or far vision.
 The vitreous body is a soft jellylike substance that fills the entire
space posterior to the lens (the adjective vitreous means “glasslike”).
 Like the aqueous humor, it is important in maintaining the
shape of the eyeball as well as in aiding in refraction.
EXTRINSIC EYE MUSCLE.
 Six extrinsic, or external, eye muscles are
attached to the outer surface of the eye;
 These muscles produce gross eye movements and
make it possible for the eyes to follow a moving
object;
 These are the lateral rectus, medial rectus,
superior rectus, inferior rectus, inferior
oblique, and superior oblique.
 THE INTRINSIC MUSCLES OF THE EYE
 The intrinsic muscles of the eye are muscles that control the
movements of the lens and pupil and thus participate in the
accommodation of vision.
 There are three smooth muscles that comprise this group; ciliary,
dilatator pupillae and sphincter pupillae muscles.
 The ciliary muscle occupies the biggest portion of the ciliary body,
which lies between the anterior border of the choroid and iris. It is
composed of smooth muscle fibers oriented in three different
directions; longitudinal, radial and circular. Together with the
sphincter pupillae, the ciliary muscle functions are mainly
instructed by the parasympathetic nerve fibers of oculomotor nerve
(CN III).
 The contraction of the ciliary muscle loosens the zonular fibers
increasing the convexity of the lens, which induces
accommodation for near vision.
 LACRIMAL GLAND (TEAR GLAND)
 The lacrimal apparatus consists of the lacrimal gland
and a number of ducts that drain the lacrimal secretions
into the nasal cavity.
 Secretions contain lysozyme, an antibacterial enzyme
that destroys bacteria; thus, it cleanses and protects the
eye surface as it moistens and lubricates it.
 The lacrimal glands are located above the lateral end of
each eye; they continually release a salt solution (tears)
onto the anterior surface of the eyeball through several
small ducts.
 Lacrimal canaliculi: The tears flush across the eyeball
into the lacrimal canaliculi medially, then into the
lacrimal sac, and finally into the nasolacrimal duct,
which empties into the nasal cavity.
ORBITAL FAT
 Cushions and insulates eye.

Figure 17–4c
 INTERNAL STRUCTURES OF THE EYE;
EYEBALL:
 Is hollow sphere
 Has three layers
 Is divided into 2 cavities:
 Large posterior cavity: filled with fluids called humors
that help to maintain its shape.
 Smaller anterior cavity.
LAYERS FORMING THE WALL OF THE EYEBALL
 Fibrous layer: The outermost layer, called the fibrous layer, consists of
the protective sclera and the transparent cornea.
 Sclera: The sclera, thick, shiny, white connective tissue, is seen anteriorly
as the “white of the eye”.
 Cornea: The central anterior portion of the fibrous layer is crystal clear;
this “window” is the cornea through which light enters the eye.
 Vascular layer: The middle eyeball of the layer, the vascular layer, has
three distinguishable regions: the choroid, the ciliary body, and the
iris.
 Choroid: Most posterior is the choroid, a blood-rich nutritive tunic that
contains a dark pigment; the pigment prevents light from scattering inside
the eye.
 Ciliary body: Moving anteriorly, the choroid is modified to form two
smooth muscle structures, the ciliary body, to which the lens is attached
by a suspensory ligament called ciliary zonule, and then the iris.
 Pupil: The pigmented iris has a rounded opening, the pupil, through
which light passes.
 CON’T

 Sensory layer: The innermost sensory layer of the eye is the delicate
two-layered retina, which extends anteriorly only to the ciliary body.
 Pigmented layer: The outer pigmented layer of the retina is
composed pigmented cells that, like those of the choroid, absorb light
and prevent light from scattering inside the eye.
 Neural layer: The transparent inner neural layer of the retina
contains millions of receptor cells, the rods and cones, which are
called photoreceptors because they respond to light.
 Two-neuron chain: Electrical signals pass from the photoreceptors
via a two-neuron chain-bipolar cells and then ganglion cells–
before leaving the retina via optic nerve as nerve impulses that are
transmitted to the optic cortex; the result is vision.
 Optic disc: The photoreceptor cells are distributed over the entire
retina, except where the optic nerve leaves the eyeball; this site is
called the optic disc, or blind spot.
 Fovea centralis: Lateral to each blind spot is the fovea centralis, a
tiny pit that contains only cones.
OUTER SURFACE OF EYE
1. Sclera (white of eye),
2. Cornea
 MIDDLE LAYER OF EYE
 Includes:
 Iris
 Ciliary body
 Iris:
 Contains muscle fibers
 Changes diameter of
pupil
 Ciliary body:
 Assist in changing shape
of lens for focusing
images.
MIDDLE LAYER OF EYE
 LENS
 Lies posterior to cornea,
 Forms anterior boundary of posterior cavity.
 Light entering the eye is focused on the retina by the lens, a flexible
biconvex, crystal-like structure.
 Chambers: The lens divides the eye into two segments or
chambers; the anterior (aqueous) segment, anterior to the lens,
contains a clear, watery fluid called aqueous humor; the
posterior (vitreous) segment posterior to the lens, is filled with a
gel-like substance called either vitreous humor, or the vitreous
body.
 Vitreous humor: Vitreous humor helps prevent the eyeball from
collapsing inward by reinforcing it internally.
 Aqueous humor: Aqueous humor is similar to blood plasma and is
continually secreted by a special of the choroid; it helps maintain
intraocular pressure, or the pressure inside the eye.
 Canal of Schlemm: Aqueous humor is reabsorbed into the venous
blood through the scleral venous sinus, or canal of Schlemm, which
is located at the junction of the sclera and cornea.
INNER LAYER OF EYE (RETINA)
1. Outer pigmented part,
2. Inner neural part:
 Contains visual receptors and associated neurons.
FUNCTION OF THE RETINA

 The retina has a complex structure with multiple

layers of cells.

Structure of the retina.

Rods and cones form a
deep layer of the retina,
near the choroid.
Connecting neurons carry
visual impulses toward the
optic nerve just anterior to
the choroid. Next are the
rods and cones,
the receptor cells of the
eye, named for their shape.
RETINA
 Rods and cones are types of photoreceptors.

Figure 17–6
RODS
 Do not discriminate
light colors
 Highly sensitive to
light intensity.
 CONES
 Provide color vision
 Densely clustered in
fovea.
 VISUAL AXIS
 Imaginary line from center of object, through center
of lens, to fovea.

Figure 17–4c
COLOR BLINDNESS
 Inability to detect certain colors.

Figure 17–17
 OPTIC DISC
 Circular region just medial to fovea.
 Origin of optic nerve.

 NO RODS OR CONES IN THIS REGION

 Creates a blind spot.

Figure 17–6b, c
CATARACT
 Condition in which lens has lost its transparency

 https://www.youtube.com/watch?v=rUCoQzui704
ERRORS OF REFRACTION AND OTHER EYE DISORDERS
 Hyperopia, or farsightedness usually results from an abnormally
short eyeball. In this situation, light rays focus behind the retina
because they cannot bend sharply enough to focus on the retina. If
the need for refraction exceeds this limit, a person must move an
object away from the eye to see it clearly. Glasses with convex lenses
that increase light refraction can correct for hyperopia.
 Myopia or nearsightedness, is another eye defect related to
development. In this case, the eyeball is too long or the cornea bends
the light rays too sharply, so that the focal point is in front of the
retina. Distant objects appear blurred and may appear clear only if
brought near the eye. A concave lens corrects for myopia by widening
the angle of refraction and moving the focal point backward.
 CON’T
 Strabismus Strabismus is a deviation of the eye that
results from lack of coordination of the eyeball muscles.
That is, the two eyes do not work together. In convergent
strabismus, the eye deviates toward the nasal side, or
medially. This disorder gives an appearance of being
cross-eyed. In divergent strabismus, the affected eye
deviates laterally.
 Infections: Inflammation of the conjunctiva is called
conjunctivitis. It may be acute or chronic and may be
caused by a variety of irritants and
pathogens.
 CON’T
 Injuries: The most common eye injury is a laceration or scratch of
the cornea caused by a foreign body. Injuries caused by foreign
objects or by infection may result in scar formation in the cornea,
leaving an area of opacity through which light rays cannot pass.
 Cataract: A cataract is an opacity (cloudiness) of the lens or the
outer covering of the lens. An early cataract causes a gradual loss of
visual acuity (sharpness). An untreated cataract leads to complete
loss of vision. Surgical removal of the lens followed by implantation
of an artificial lens is a highly successful procedure for restoring vi-
sion.
 Glaucoma: Glaucoma is a condition characterized by excess
pressure of the aqueous humor. This fluid is produced constantly
from the blood, and after circulation in the eye, it is reabsorbed into
the bloodstream. Interference with the normal reentry of this fluid
to the blood stream leads to an increase in pressure inside the
eyeball.
VISUAL PATHWAY

Figure 17–19
 EYE REFLEXES

 Both the external and internal eye muscles are necessary

for proper eye function.
 Photopupillary reflex. When the eyes are suddenly
exposed to bright light, the pupils immediately constrict;
this is the photopupillary reflex; this protective reflex
prevents excessively bright light from damaging the
delicate photoreceptors.
 Accommodation pupillary reflex. The pupils also
constrict reflexively when we view close objects; this
accommodation pupillary reflex provides for more acute
vision.
THE GENERAL SENSES
 Unlike the special sensory receptors, which are
localized within specific sense organs, limited to a
relatively small area, the general sensory
receptors are scattered throughout the body.
 These include receptors for touch, pressure, heat,
cold, position, and pain.
 SENSE OF TOUCH
 The touch receptors, tactile corpuscles, are found mostly
in the dermis of the skin and around hair follicles.
 Sensitivity to touch varies with the number of touch
receptors in different areas.
 They are especially numerous and close together in the
tips of the fingers and the toes.
 The lips and the tip of the tongue also contain many of
these receptors and are very sensitive to touch.
 Other areas, such as the back of the hand and the back
of the neck, have fewer receptors and are less sensitive to
touch.
SENSE OF PRESSURE
 Even when the skin is anesthetized, it can still
respond to pressure stimuli.
 These sensory end-organs for deep pressure are
located in the subcutaneous tissues beneath the
skin and also near joints, muscles, and other
deep tissues.
 They are sometimes referred to as receptors for
deep touch.
SENSE OF TEMPERATURE
 The temperature receptors are free nerve endings,
receptors that are not enclosed in capsules, but are merely
branching of nerve fibers.
 Temperature receptors are widely distributed in the skin,
and there are separate receptors for heat and cold.
 A warm object stimulates only the heat receptors, and a
cool object affects only the cold receptors.
 Internally, there are temperature receptors in the
hypothalamus of the brain, which help to adjust body
temperature according to the temperature of the
circulating blood.
 SENSE OF POSITION
 Receptors located in muscles, tendons, and joints relay
impulses that aid in judging one’s position and changes
in the locations of body parts in relation to each other.
 They also inform the brain of the amount of muscle
contraction and tendon tension.
 These rather widespread receptors, known as
proprioceptors, are aided in this function by the
equilibrium receptors of the internal ear.
 Information received by these receptors is needed for
the coordination of muscles and is important in such
activities as walking, running, and many more
complicated skills, such as playing a musical
instrument.
CON’T

 They help to provide a sense of body movement,

known as kinesthesia.
 Proprioceptors play an important part in
maintaining muscle tone and good posture.
 They also help to assess the weight of an object to
be lifted so that the right amount of muscle force
is used.
 The nerve fibers that carry impulses from these
receptors enter the spinal cord and ascend to the
brain in the posterior part of the cord.
 The cerebellum is a main coordinating center for
these impulses.
 SENSE OF PAIN
 Pain is the most important protective sense.
 The receptors for pain are widely distributed free nerve
endings.
 They are found in the skin, muscles, and joints and to a
lesser extent in most internal organs (including the blood
vessels and viscera).
 Two pathways transmit pain to the CNS.
 One is for acute, sharp pain, and the other is for slow, chronic
pain.
 Thus, a single strong stimulus produces the immediate sharp
pain, followed in a second or so by the slow, diffuse, burning
pain that increases in severity with the passage of time.
 CON’T
 Sometimes, the cause of pain cannot be remedied
quickly, and occasionally it cannot be remedied at all.
 In the latter case, it is desirable to lessen the pain as much as
possible.
 Some pain relief methods that have been found to be effective
include:
◗ Analgesic drugs: An analgesic is a drug that relieves pain.

There are two main categories of such agents:

 Nonnarcotic analgesics act locally to reduce inflammation and are
effective for mild to moderate pain.
Most of these drugs are commonly known as non-steroidal anti-
inflammatory drugs (NSAIDs) like ibuprofen.
 Narcotics act on the CNS to alter the perception and response to
pain.
 Effective for severe pain: narcotics are administered by varied
methods, including orally and by intramuscular injection.
 CON’T
 They are also effectively administered into the space surrounding the
spinal cord. An example of a narcotic drug is morphine.
 Anesthetics: Although most commonly used to prevent pain during
surgery, anesthetic injections are also used to relieve certain types of
chronic pain.
 Massage, acupressure, and electric stimulation are among the techniques
that are thought to activate this system of natural pain relief.
 Applications of heat or cold can be a simple but effective means of pain
relief, either alone or in combination with medications.
 Care must be taken to avoid injury caused by excessive heat or cold.
 Relaxation or distraction techniques include several methods that reduce
perception of pain in the CNS.
 Relaxation techniques counteract the fight-or-flight response to pain and
complement other pain-control methods.
 SENSORY ADAPTATION
 When sensory receptors are exposed to a continuous stimulus,
receptors often adjust themselves so that the sensation becomes
less acute.
 The term for this phenomenon is sensory adaptation.
 For example, if you immerse your hand in very warm water, it may
be uncomfortable; however, if you leave your hand there, soon the
water will feel less hot (even if it has not cooled appreciably).
 Receptors adapt at different rates.
 Those for warmth, cold, and light pressure adapt rapidly.
 In contrast, those for pain do not adapt.
 In fact, the sensations from the slow pain fibers tend to increase
over time.
 This variation in receptors allows us to save energy by not
responding to unimportant stimuli while always heeding the
warnings of pain.
 Anatomy & Physiology Of
Female Reproductive System

EACC/2022
 Learning Objectives
⚫ Define the terms listed.
⚫ Identify the female external reproductive organs.
⚫ Explain the structure of the bony pelvis.
⚫ Explain the functions and structures of pelvic floor.
Introduction
Definition

Reproduction (or procreation) is the ⚫

biological process by which new individual
organisms – "offspring" – are produced from
their "parents". Reproduction is a
fundamental feature of all known life; each
individual organism exists as the result of
reproduction.
Introduction

Female reproductive system definition ⚫

The female reproductive system is made up ⚫
of internal organs external structures. Its
function is to enable reproduction of the
species(new organism). Sexual maturation is
the process that this system undergoes in
order to carry out its role in the process of
pregnancy and birth.
Introduction

Due to its vital role in the survival of the ⚫

species, many scientists feel that the
reproductive system is among the most
important systems in the entire body.
Of the body’s major systems, the ⚫
reproductive system is the one that
differs most between sexes, and the only
system that does not function until
puberty.
 External Female Structures

⚫Collectively,
the external
female reproductive
organs are called the
Vulva.
figure
 External Female Structures
⚫ Mons Pubis.
⚫ Labia Majora & Minora.
⚫ Clitoris.
⚫ Urethral meatus and opening of the paraurethral (sken’s glands.
⚫ Vaginal vestibule( vaginal orifice, vulvo vaginal(baltholin
gland,hymen and fossa navicularis
⚫ Perineum body
Female Reproductive System

Anatomy ⚫
Pudendum (vulva): external genitalia –
 Mons Pubis
Also known as mons veneris ,Is rounded, soft fullness of
subcutaneous fatty tissue, prominence over the symphysis
pubis that forms the anterior border of the external
reproductive organs.
It is covered with varying amounts of pubic hair.
It protects the symphsis pubis, especially during coitus
Labia Majora & Minora
⚫ The labia Majora are two rounded,
fleshy folds of tissue that extended
from the mons pubis to the perineum.

⚫ It
is protect the labia minora, urinary
meatus and vaginal introitus.
 Labia Minora
⚫ It is located between the labia majora, are narrow.
⚫ The lateral and anterior aspects are usually pigmented.
⚫ The inner surfaces are similar to vaginal mucosa, pink and
mois.
⚫ Their rich vascularity.
⚫ They are rich in sebaceous gland , which lubricate and
waterproof the vulvar skin and provide bactericidal
secretions.
 Clitoris.
⚫ The term clitoris comes from a Greek word meaning key.
⚫ Located at the anterior junction of the labia minora ; highly
innervated by sensory neurons
Erectile organ.
⚫ It’s rich vascular, highly sensitive to temperature, touch,
and pressure sensation
⚫ The clitoris has rich blood and nerve suppliers and is
primary erogenous organ of the women
⚫ Important in sexual arousal

⚫
 Vestibule.
⚫ Is oval-shaped area formed
between the labia minora, clitoris,
and fourchette.
⚫ Vestibule contains the external
urethral meatus, vaginal introitus,
and Bartholins glands.
THE VULVA

6. Bartholin Glands: (Greater Vestibular Glands): ⚫

bilateral compound racemose glands –

secrete mucus during sexual excitement –
situated deep in the labia majora, at the junction of the –
posterior and the middle thirds
Its duct is 2 cm long and opens between the hymen and the
labium minus.
◆ 7. Vestibule:
◼ the area between the inner aspects of the labia minora and the
fourchette.
◼ Structures that open in the vestibule are:
 Urethra
 The Bartholin glands ducts.
 3. The vagina.
◆ 8. Vestibular bulbs:
◼ oblong masses of erectile tissue that lie on each side of the
vaginal introitus
◆ 9. External urethral meatus:
◼ a triangular slit in the anterior part of the vestibule below the clitoris
in which the urethra opens.
◆ 10. Skene’s duct:
◼ 2 blindly ending para-urethral tubules which open in the floor of the
urethra, few millimetres form the external urethral meatus.
 Perineum
⚫ Is the most posterior part of the external female
reproductive organs.
⚫ It extends from fourchette anteriorly to the anus
posteriorly.
⚫ And is composed of fibrous and muscular tissues that
support pelvic structures.
⚫ It has muscles mingle with elastics fibers and connective
tissues in an arrangement that allows a remarkable
amount of stretching during birth.
Hymen

Hymen: a thin membrane that surrounds or ⚫

partially covers the external vaginal opening,
It forms part of the vulva, or external
genitalia, and is similar in structure to the
vagina.
Hymen
]

The effects of sexual intercourse and childbirth on the hymen ⚫

are variable. If the hymen is sufficiently elastic, it may return to
nearly its original condition. In other cases, there may be
remnants myrtiformes), or it may appear completely absent
after repeated penetration. Additionally, the hymen may be
lacerated by disease, injury, medical examination, masturbation
or physical exercise. For these reasons, the state of the hymen
is not a conclusive indicator of virginity.
Hymen

Hymens can come in different shapes. The ⚫

most common hymen in young girls is
shaped like a half moon. This shape allows
menstrual blood to flow out of a girl’s vagina
FIGURES
Types of Hymen

Imperforate hymen: An imperforate hymen can be diagnosed at ⚫

birth. More often, the diagnosis is made during the teen years. An
imperforate hymen is a thin membrane that completely covers the
opening to the vagina. Menstrual blood cannot flow out of the vagina.
This usually causes the blood to back up into the vagina which often
develops into an abdominal mass and abdominal and/or back pain.
Some teens may also have pain with bowel movements and difficulty
passing urine.
The treatment for an imperforate hymen is minor surgery to remove ⚫
the extra hymenal tissue and create a normal sized vaginal opening so
that menstrual blood can flow out of the vagina.
Types of Hymen

Microperforate hymen: A microperforate hymen is a thin membrane ⚫

that almost completely covers the opening to a young women’s
vagina. Menstrual blood is usually able to flow out of the vagina but
the opening is very small. A teen with a microperforate hymen usually
will not be able to insert a tampon into her vagina and may not realize
that she has a very tiny opening. If she is able to place a tampon into
her vagina, she may not be able to remove it when it becomes filled
with blood. The treatment is minor surgery to remove the extra
hymenal tissue making a normal sized opening for menstrual blood to
flow out
Types of Hymen

Septate hymen: A septate hymen is when the thin ⚫

hymenal membrane has a band of extra tissue in the
middle that causes two small vaginal openings instead of
one. Teens with a septate hymen may have trouble getting
a tampon in or trouble getting a tampon out. The treatment
for a septate hymen is minor surgery to remove the extra
band of tissue and create a normal sized vaginal opening.
FIGURES
Internal Female Structures

⚫Vagina
⚫Uterus
⚫Fallopian tubes
⚫Ovaries
Fallopian tubes :

Overview ⚫
The uterine tubes, also known as oviducts ⚫
or fallopian tubes, are the female structures
that transport the ova from the ovary to the
uterus each month. In the presence of sperm
and fertilization, the uterine tubes transport
the fertilized egg to the uterus for
implantation
 Fallopian tubes
⚫ The two tubes extended from the
cornu of the uterus to the ovary.
⚫ It runs in the upper free border of
the broad ligament.
⚫ Length 8 to 14 cm average 10 cm
⚫ Its divided into 4 parts.
 1. Interstitial part
⚫ Which runs into uterine cavity,
passes through the myometrium
between the fundus and body of
the uterus. About 1-2cm in
length.
 2. Isthmus
⚫ Which is the narrow part of the tube adjacent to the uterus.
⚫ Straight and cord like , about 2 – 3 cm in length.
⚫ It is a site for tubal ligation, a surgical procedure to prevent
pregnancy
 3. Ampulla
⚫ Which is the wider part about 5 cm in length.

⚫ Fertilization of the second oocyte by a spermatozoa occurs in

the ampulla.
 4. Infundibulum or Fimbriae

⚫ It is funnel or trumpet shaped.

⚫ Fimbriae are fingerlike processes, one of these is longer than
the other and adherent to the ovary.
⚫ The fimbriae become swollen almost erectile at ovulation.
not directly attached to the ovary
It help “sweep” the egg into the uterine tube
3) takes 3 days for an egg to pass through
⚫
Functions of the fallopian
tube
⚫ Gamete transport (ovum pickup, ovum transport, sperm
transport).

⚫ It provide transport for the ovum from the ovary to the

uterus(transport time through the fallopian tubes varies
from 3 to 4 days
⚫ Fluid
environment for early
embryonic development.

⚫ Transport of fertilized and

unfertilized ovum to the uterus.
 Ovaries
⚫ Oval solid structure, 1.5 cm in thickness, 2.5 cm in width and
3.5 cm in length respectively. Each weights about 4–8 gm.
⚫ They are two almost shaped structure just below the pelvic
brim

⚫ Ovary is located on each side of the uterus, below and behind

the uterine tubes
⚫ The ovaries are maintained in their position by the broad
,ovarian and infundibulopelvic ligaments.
 Structure of the ovaries

⚫Cortex
⚫Medulla
⚫Hilum or tunica
albuginea
Structure of the ovaries

Cortex ⚫
it is main functional part, because it contain
ova,graffian follicles, corpora lutea, the
degenerated corpora lutea( corpora albicantia and
degenerated follicles
Structure of the ovaries

Medulla ⚫
It is completery surrounded by the cortex and ⚫
contains the nerves and the blood and
.lymphatics vessels
Structure of the ovaries

Hilum or tunica albuginea ⚫

it serve as protective layer, with a dull white ⚫
 Ovaries and Relationship
to Uterine Tube and Uterus

Figure 28–14
 Function of the ovary

⚫ Secrete estrogen & progesterone.

⚫ Production of ova
 Uterus
⚫ The uterus is a hollow, thick walled organ with pear
shaped muscular organ, shaped like an upside –down pear.
⚫ It lies in the center of the pelvic cavity between the base of
the bladder and the rectum, and above the vagina.
⚫ It is level with or slightly below the brim of the pelvis, with
external opening of the vaginal.

⚫ The uterus measures about 7.5 X 5 X 2.5 cm and weight

about 50 – 60 gm.
 Position

The uterus is kept in an ⚫

anteverted anteflexed position
(AVF), with the external os lying
at the level of the ischial spines,
by the support of the cervical
ligaments, endopelvic fascia and
pelvic floor muscles (levator ani).
Anteversion: The uterus is ⚫
inclined anteriorly to axis of the
vagina.
Anteflexion: The body of the ⚫
uterus is bent forwards upon the
cervix.
Relations of the Body of the
Uterus
Anteriorly:
The bladder and –
vesicouterine pouch.
Posteriorly: ⚫
The pouch of Douglas. –
Laterally: ⚫
The broad ligament on –
each side.
⚫ Its
normal position is anteverted
(rotated forward and slightly
antiflexed (flexed forward)

⚫ Theuterus divided into three

parts
 1. Body of the uterus
⚫ The upper part is the corpus, or body
of the uterus
⚫ The fundus is the part of the body or
corpus above the area where the
fallopian tubes enter the uterus.
⚫ Length about 5 cm.
 2. Isthmus
⚫A narrower transition zone.
⚫ Is between the corpus of the uterus
and cervix.
⚫ During late pregnancy, the isthmus
elongates and is known as the lower
uterine segment.
 3. Cervix

⚫ The lowermost position of the

uterus “neck”.
⚫ The length of the cervix is about
2.5 t0 3 cm.
⚫ The os, is the opening in the cervix
that runs between the uterus and
vagina.
⚫ The upper part of the cervix is marked
by internal os and the lower cervix is
marked by the external os.
Functions of the cervix mucous

To lubricate the vaginal canal ⚫

To act as bacteriostatic agent ⚫
To provide an alkaline environment to shelter ⚫
deposted sperm from the acidics vaginal
secretions

At ovulation , cervical mucus is clear ⚫

,thinner,more profuse , and more alkaline
than at other times.
 Layers of the uterus
⚫ Perimetrium.
⚫ Myometrium.
⚫ Endometrium.
Uterine layers
 1. Perimetrium

⚫ Isthe outer peritoneal layer of

serous membrane that covers
most of the uterus.
⚫ Laterally,the perimetrium is
continuous with the broad
ligaments on either side of the
uterus.
 2. Myometrium
⚫ Is the middle layer of thick
muscle.
⚫ Most of the muscle fibers are
concentrated in the upper uterus,
and their number diminishes
progressively toward the cervix.
 ⚫The myometrium
contains three types of
smooth muscle fiber
Longitudinal fibers (outer layer)

⚫ Which are found mostly in the

fundus and are designed to
expel the fetus efficiently
toward the pelvic outlet during
birth.
 Middle layer figure-8 fibers

⚫These fiber contract after

birth to compress the blood
vessels that pass between
them to limit blood loss.
 Inner layer circular fibers
⚫ Which form constrictions where the
fallopian tubes enter the uterus and
surround the internal os
⚫ Circular fibers prevent reflux of
menstrual blood and tissue into the
fallopian tubes.
⚫ Promote normal implantation of
the fertilized ovum by controlling
its entry into the uterus.
⚫ And retain the fetus until the
appropriate time of birth.
 3. Endometrium
⚫ Is the inner layer of the uterus.
⚫ It is responsive to the cyclic
variations of estrogen and
progesterone during the female
reproductive cycle every month.
⚫ The two or three layers of the
endometrium are:
*Compact layer
*The basal layer
*The functional or Sponge layer this
layer is shed during each menstrual period
and after child birth in the lochia
 Anatomical relation of the
uterus

⚫ Anterior------------Bladder
⚫ Posterior-----------The rectum and
Douglas pouch
⚫ Lateral------------- The broad ligaments
,F. T& ovaries
⚫ Superior-----------The intestines.
⚫ Inferior------------- The Vagina
 The Function of the uterus

⚫ Menstruation ----the uterus

sloughs off the endometrium.

⚫ Pregnancy ---the uterus support

fetus and allows the fetus to grow.
⚫ Labor and birth---the uterine
muscles contract and the cervix
dilates during labor to expel the
fetus
 Vagina
⚫ Itis an elastic fibro-muscular tube
and membranous tissue about 8 to
10 cm long.
⚫ Lying between the bladder
anteriorly and the rectum
posteriorly.
⚫ Thevagina connects the uterus
above with the vestibule below.

⚫ The upper end is blind and called

the vaginal vault.
⚫ The vaginal lining has multiple
folds, or rugae and muscle layer.
These folds allow the vagina to
stretch considerably during
childbirth.
Female Reproductive System

Vagina – receives sperm during copulation;

serves as birth canal
1) 3 tissue layers
a) mucosal layer – inner layer; non-
keratinized stratified squamous
b) muscular layer – middle layer;
smooth muscle
c) fibrous layer – outer layer; areolar
CT
Female Reproductive System

2) Fornix – clefts created where the vagina

surrounds the cervix
3) Vaginal orifice – opening between the
vaginal canal the outside the body is
usually partially covered by a thin mucus
membrane known as the hymen until the
time of first intercourse
⚫The reaction of the vagina
is acidic, the pH is 4.5 that
protects the vagina against
infection.
Anatomical relation of the vagina

⚫ Anterior------------Urethra and bladder

⚫ Posterior-----------Perineal body
&rectum and Douglas pouch
⚫ Lateral------------- Pelvic floor muscles
⚫ Superior-----------The cervix.
⚫ Inferior------------- The vulva
 Functions of the vagina

⚫ To allow discharge of the

menstrual flow.
⚫ As the female organs of coitus.
⚫ To allow passage of the fetus from
the uterus.
 3 Functions of the Vagina
Passageway for elimination of menstrual fluids .1
Receives spermatozoa during sexual intercourse .2
Forms inferior portion of birth canal .3

The Vaginal Wall

Contains a network of blood vessels: ⚫

and layers of smooth muscle –

Is moistened by: ⚫
secretions of cervical glands –
water movement across permeable epithelium –
 Support structures

⚫The bony pelvis support

and protects the lower
abdominal and internal
reproductive organs.
Pelvis
 Bony Pelvis
⚫ Bony Pelvis Is Composed of 4
Pelvic bones:
1. Two innominate or hips
bones.
2. Sacrum.
 1. Two hip bones.
⚫ Each or hip bone is composed
of three bones:
*Ilium
*Ischium
*Pubis
 *Ilium
⚫ Itis the flared out part.
⚫ The greater part of its inner
aspect is smooth and concave,
forming the iliac fossa.
⚫ The upper border of the ilium is
called iliac crest
 *Ischium
⚫ It is the thick lower part.
⚫ It has a large prominence
known as the ischial tuberosity
on which the body rests while
sitting.
⚫Behind and little above the
tuberosity is an inward
projection the ischial spine.
 2. Sacrum
⚫ Is a wedge shaped bone consisting of
five vertebrae.
⚫ The anterior surface of the sacrum is
concave
⚫ The upper border of the first sacral
vertebra known as the sacral
promontory
 3. Coccyx.

⚫ Consists of four
vertebrae forming a
small triangular bone.
⚫ Muscle, Joints and ligaments
provide added support for
internal organs of the pelvis
against the downward force of
gravity and the increases in
intra-abdominal pressure
 Pelvic Joints
⚫ There are four pelvic joints:
* One Symphysis pubis
* Two sacro-iliac joints
* One sacro-coccygeal joint
 Ligaments

⚫ The ligaments of the female reproductive tract are a

series of structures that support the internal female
genitalia in the pelvis.

⚫ A total of 10 ligaments stabilize the uterus within the

pelvic cavity.
Ligaments

The ligaments of the female reproductive ⚫

tract are a series of structures that support
the internal female genitalia in the pelvis.
The ligaments of the female reproductive ⚫
tract can be divided into three categories:
ligaments of the female reproductive tract. ⚫
 Broad ligament – a sheet of peritoneum, associated with both the ⚫
uterus and ovaries.
Uterine ligaments – ligaments primarily associated with the uterus. ⚫
Ovarian ligaments – ligaments primary associated with the ovaries. ⚫
Collectively, these ligaments are tough and non-extensible. They act to ⚫
support the female viscera and provide a conduit for neurovascular
structures.
⚫ Four paired ligaments
⚫ Broad, round, uterosacral, cardinal
⚫ Two single ligaments anterior
(pubocervical) and posterior
(rectovaginal)
The uterine ligaments supports and stabilise ⚫
the various reproductive organs .
The terine ligaments are as follow : ⚫
The broad ligaments

Keep the uterus centrally placed and ⚫

provides stability within the pelvic cavity, it
covers the uterus anteriorly and posteriorly
and extends outwards from the uterus to
enfold the fallopian tubes.
The round ligaments

It Help the broad ligaments keep the uterus in place. The ⚫

round ligaments arise from the side of the uterus near the
fallopian tube insertions. Made up of longitudinal muscle
, the round ligaments enlarge during
pregnancy.
During labor the round ligaments steady the uterus , pulling
downward and forward so that the presenting part of the
uterus is moved into the cervix
Ovarian ligaments

Ovarian ligaments anchor the lower pole of ⚫

the ovary to the cornua of the uterus .they
are surrounded by muscle fibers that allow
the ligaments to contract. This contractile
ability influences the position of the ovary to
some extent, thus helping the fimbriae of the
fallopian tube to catch the ovum as it is
released each month.
The cardinal ligaments

The cardinal ligaments are the chief uterine ⚫

support and suspend the uterus from side
walls of the true pelvis. these ligaments ,also
known as mackenrodt’s or transverse
cervical ligaments, arise from the sides of the
pelvic walls and attach to the cervix in the
upper vagina. these ligaments prevent
uterine prolapse and also the upper vagina.
The infundibulopelvic ligament

The infundibulopelvic ligament suspends and ⚫

supports the ovaries. Arising from the outer
third of the broad ligament, The
infundibulopelvic ligament contains the
.ovarian vessels and nerves
The uterosacral ligaments

The uterosacral ligaments provide support ⚫

for the uterusThe uterosacral ligaments and
cervix at the level of the ischial spines I
contain smooth muscles fibers, connective
tissue , blood limph vessels , and nerves.
They also contain sensory nerve fibers that ⚫
contribute to dysmenorrhea(paiful
menstruation)
PELVIC FLOOR MUSCLES

What are pelvic floor muscles? ⚫

Pelvic floor muscles are the layer of muscles ⚫
that support the pelvic organs and span the
bottom of the pelvis. The pelvic organs are
the bladder and bowel in men, and bladder,
bowel and uterus in women. The diagram
below shows the pelvic organs and pelvic
floor muscles in women (right) and men (left).
PELVIC FLOOR MUSCLES
/WOMEN/MEN
What do pelvic floor muscles do?

Pelvic floor muscles provide support to the organs ⚫

that lie on it. The sphincters give us conscious
control over the bladder and bowel so that we can
control the release of urine, faeces (poo) and allow
us to delay emptying until it is convenient. When the
pelvic floor muscles are contracted, the internal
organs are lifted and the sphincters tighten the
openings of the vagina, anus and urethra. Relaxing
the pelvic floor allows passage of urine and faeces.
What can make these muscles loose? ⚫
Pregnancy and childbirth for women ⚫
Straining on the toilet ⚫
Chronic coughing ⚫
Heavy lifting ⚫
High impact exercise ⚫
Age ⚫
Obesity ⚫
 Types of Pelvis
1. Gynecoid, or normal female
pelvis is round and adapted for
the function of childbirth. Its inlet,
cavity, and outlet are in better
proportion, the pubic arch is wide
and the coccyx is more movable
than android pelvis.
2. Android pelvis or male type pelvis
which has a heart-shaped outlet
3. anthropoid, which oval shaped.
4. platypelloid, which has a wide
transverse outlet, kidney shaped.
 Blood Supply
⚫ The uterine blood supply is carried by the uterine arteries,
which are branches of the internal iliac artery. These
vessels enter the uterus at the lower border of the broad
ligament, near the isthmus of the uterus.
References
QUESTIONS??
THANK YOU
MENSTRUAL CYCLE
 Definition

Menstruation is the periodic uterine

bleeding that begins approximately 14
days after ovulation.
It is controlled by a feed- back system of
three cycles: endometrial, hypothalamic-
pituitary, and ovarian.
The menstrual cycle has two phases: pre
ovulatory and post ovulatory
 Menstrual cycle

The average length of a menstrual cycle is

28 days, but variations are normal. The first
day of bleeding is des- ignated as day 1 of
the menstrual cycle, or menses
The average duration of menstrual flow is 5
days (with a range of 3 to 6 days) and the
average blood loss is 50 ml (with a range of
20 to 80 ml), but this duration of flow and
blood loss vary greatly.
 Menstrual cycle

 Uterine discharge includes mucus and

epithelial cells in addition to blood.
 The menstrual cycle is a complex interplay of
events that occur simultaneously in the
endometrium, the hypothalamus, the pitu- itary
glands, and the ovaries.
 The menstrual cycle prepares the uterus for
pregnancy.
 When pregnancy does not occur, menstru
ation follows. A woman’s age, physical and
emotional status, and environment influence
the regularity of her menstrual cycles.
Phases of the menstrual cycle
Pre-ovulatory phase
 The pre-ovulatory phase is a fertile period that
begins with the production of cervical mucus, which
indicates maturation of an ovarian follicle and is
also critical to the progression of spermatozoa. This
phase ends with ovulation.
Phases of the menstrual cycle
 ii. Ovulation
 Ovulation is the release of a reproductive cell
(also referred to as an oocyte, or an ovule),
which generally occurs around the 14th day
before the next menstruation (14th day in a
28-day cycle).
 The mature follicle grows out of the ovarian
surface and ruptures to release an ovule,
ovules will reach maturity; others
degenerate).
 The ovary releases a single ovule in every
cycle from puberty to menopause (only 400
to 500 )
 Each month, the ovary releases an egg cell. It travels
down the fallopian tube towards the uterus.
Graafian Folllicle
Post-ovulatory phase or luteal phase

After ovulation the post-ovulatory follicle

transforms itself under the action of LH into
the yellow body OR corpus luteum and
secretes progesterone and estrogen.
Under the influence of the two hormones,
the endometrium completes its
development and reaches the pre-
pregnancy stage
Post-ovulatory phase or luteal phase
CONT

 Through a negative feedback process from

the progesterone and estrogen the pituitary
gland produces less and less LH; the yellow
body consequently degenerates.
 There is decreased production of testosterone
and estrogen; the endometrium wall breaks
down, causing menstruation.
 The luteal phase is a relatively fixed period of
14 days.
Hypothalamic-Pituitary Cycle

Toward the end of the normal menstrual

cycle, blood levels of estrogen and
progesterone decrease.
Low blood levels of these ovarian
hormones stimulate the hypothalamus to
secrete gonadotropin-releasing hormone
(GnRH).
Hypothalamic-Pituitary Cycle

In turn, GnRH stimulates anterior pituitary

secretion of follicle-stimulating hormone
(FSH).
 FSH stimulates development of ovarian
graafian follicles and their production of
estrogen.
Hypothalamic-Pituitary Cycle

Estrogen levels begin to decrease, and

hypothalamic GnRH triggers the anterior
pituitary to release luteinizing hormone (LH).
A marked surge of LH and a smaller peak of
estrogen (day 12) precede the expulsion of
the ovum from the graafian follicle by
about 24 to 36 hours.

Hypothalamic-Pituitary Cycle
LH peaks at about day 13 or 14 of a 28-
day cycle. If fertilization and implantation
of the ovum have not occurred by this
time, regression of the corpus luteum
follows.
Levels of progesterone and estrogen
decline, menstruation occurs, and the
hypothalamus is once again stimulated to
secrete GnRH. This process is called the
hypothalamic-pituitary cycle.
Ovarian Cycle
The primitive graafian follicles contain
immature oocytes (primordial ova).

Before ovulation, from 1 to 30 follicles begin

to mature in each ovary under the
influence of FSH and estrogen.

The preovulatory surge of LH affects a

selected follicle.
 OVULATION
 The mature Graafian follicle moves toward the surface of
the ovary and ruptures releasing the egg(ovum) from the
follicle and the ovary.

 This process, ovulation occurs about the 14th day after

the beginning of the menstrual period.

 When the ovum is released it enters the oviduct and

passes along the oviduct to the uterus
 After ovulation, the pituitary gland secretes lutenizing
hormone (LH).

 LH changes the remains of the follicle into the corpus

luteum/yellow body.

 Corpus luteum produces the hormone progesterone.

 Progesterone further thickens the uterus lining and

increases blood supply
 If fertilization does occur the corpus luteum enlarges and
continues to produce progesterone.The lining of the
uterus thickens and blood supply increases.

 Progesterone also causes the breast to enlarge.

 These are pregnancy changes, progesterone is also known as

the ‘pregnancy hormone’.

 Both oestrogen and progesterone slow down FSH

production when their concentrations become high. Thus
no more eggs develop. *negative feedback *
 If fertilization does not occur the corpus luteum
degenerates to ordinary ovary tissue and the
progesterone level falls.

 The lining of the uterus breaks down and the egg dies.

 Lining along with blood passes out the vagina as the

menstrual period.

 Cycle continues with increased FSH production and egg

development.

 Cycle lasts approximately 28days

Ovarian Cycle

The oocyte matures, ovulation occurs, and

the empty follicle begins its transformation
into the corpus luteum or yellow body .
More than one follicle is selected and
more than one oocyte matures and
undergoes ovulation.
Ovarian Cycle
After ovulation, estrogen levels drop.
For 90% of women, only a small amount of
withdrawal bleeding occurs, and it goes
unnoticed.
In 10% of women, there is sufficient
bleeding for it to be visible, resulting in what
is termed midcycle bleeding.
Ovarian Cycle

The luteal phase begins immediately after

ovulation and ends with the start of
menstruation.
This postovulatory phase of the ovarian
cycle usually requires 14 days (range 13 to
15 days).
The corpus luteum reaches its peak of
functional activity 8 days after ovulation,
secreting the steroids estrogen and
progesterone
Ovarian Cycle

Coincident with this time of peak luteal

functioning, the fertilized ovum is implanted
in the endometrium.
If no implantation occurs, the corpus
luteum regresses and steroid levels drop.
Two weeks after ovulation, if fertilization
and implantation do not occur, the
functional layer of the uterine endometrium
is shed through menstruation.
Endometrial OR Uterine Cycle

The four phases of the endometrial cycle

are:
 (1) the menstrual phase,
(2) the proliferative phase,
(3) the secretory phase, and
(4) the ischemic phase
Endometrial OR Uterine Cycle
During the menstrual phase shedding of
the functional two thirds of the endome-
trium (the compact and spongy layers) is
initiated by periodic vasoconstriction in
the upper layers of the endometrium.
Two layered
Superficial layer that sheds during the
menstrual cycle
Basal layer that doesn’t take part, but
regenerates the superficial layer
Endometrial OR Uterine Cycle

The basal layer has straight arterioles where

as the superficial layers has spiral ones –
important in the process of shedding
Uterine Cycle – Proliferative Phase
 The proliferative phase is a period of rapid
growth lasting from about the fifth day to the
time of ovulation. The endometrial surface is
completely restored in approximately 4 days,
or slightly before bleeding ceases.
 The proliferative phase depends on estrogen
stimulation derived from ovarian follicles.
 Endometrium exposed to oestrogen
regeneration from the last menstrual cycle
Uterine Cycle – Secretory Phase

 The secretory phase extends from the day of

ovulation to about 3 days before the next
menstrual period.
 After ovulation, large amounts of
progesterone are produced.
 An edematous, vascular, functional
endometrium is now apparent.
 At the end of the secretory phase, the fully
matured secretory endometrium reaches the
thickness of heavy, soft velvet.
 It becomes luxuriant with blood and glandular
secretions, creating a suitable protective and
nutritive bed for a fertilized ovum.
Uterine Cycle – Menstrual Phase

Luteal phase lasts 14 days – then there is a

regression of corpus luteum
 decline in oestrogen and progesterone
This leads to an intense spasmodic
contraction of spiral section of endometrial
arterioles TO ischaemic necrosis TO shedding
of superficial layer TO bleeding.
These spasms are associated with
prostoglandin, which are also associated
with increased uterine contractions during
menstrual flow.
Cervical Mucus
Important to stop ascending infection
Changes during the menstrual cycle
Early follicular phase – viscid and
impermeable
Late follicular phase – increasing oestrogen
levels TO mucus becomes watery and easily
penetrated, allowing spermatozoa to get
through. Change is known as Spinnbarkheit
Post-ovulation – progesterone from corpus
luteum counteracts oestrogens effects TO
mucus becomes impermeable and the
cervical os contracts
Other Changes
Body temperature – Rise of 0.5°C after
ovulation till onset of menstruation. Due to
progesterone levels. If conception occurs –
this temperature is maintained throughout
pregnancy
Breast changes – breast swelling during
luteal phase due to increasing
progesterone levels
Psychological changes – change in mood
and an increase in emotional lability. Might
be due to falling progesterone levels.
 Normal Menstrual Cycle
What is the mean duration of the MC?
Mean 28 days (only 15% of ♀ )
Range 21-35

What is the average duration of menses?

3-8 days

What is the normal estimated blood loss?

Approximately 30 ml

When does ovulation occur?

Usually day 14
36 hrs after the onset of mid-cycle LH surge
Menses
 What is the mean duration of the MC?
 Mean 28 days (only 15% of ♀)
Range 21-35
 What is the average duration of menses?
 The average duration of menstrual flow is 5 days
(with a range of 3 to 6 days)
 What is the normal estimated blood loss?
 the average blood loss is 50 ml (with a range of 20
to 80 ml)

 When does ovulation occur?

 Usually day 14
 36 hrs after the onset of mid-cycle LH surge
 Menstrual Cramps
 Menstrual cramps are pains in the abdominal (belly) and
pelvic areas that are experienced by a woman as a result
of her menstrual period.

 Menstrual cramps can range from mild to quite severe.

Mild menstrual cramps may be barely noticeable and of
short duration - sometimes felt just as a sense of light
heaviness in the belly. Severe menstrual cramps can be so
painful that they interfere with a woman's regular
activities for several days.
What causes menstrual cramps
 When the old uterine lining begins to break down,
molecular compounds called prostaglandins are released.
These compounds cause the muscles of the uterus to
contract. When the uterine muscles contract, they
constrict the blood supply to the endometrium.
 This contraction blocks the delivery of oxygen to the
tissue of the endometrium which, in turn, breaks down
and dies. After the death of this tissue, the uterine
contractions literally squeeze the old endometrial tissue
through the cervix and out of the body by way of the
vagina.
 “NERVOUS
SYSTEM
LECTURER”
EACC
March ,2023.
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
 Course contents
• Introduction
• General organization of nervous system
• Peripheral Nerves
• Cranial Nerves and its classification
• Peripheral nerves and its classifications
• Sympathetic and parasympathetics nervous
system
2
 General Organization
• The nervous system integrates and regulates many
body activities, sometimes at discrete locations
(specific targets) and sometimes more globally.

• The nervous system usually acts quite rapidly and can

also modulate efects of the endocrine and immune
systems. The nervous system is separated into two
structural divisions ( 3
Chapter 8-Nervous System
 Functions
1. Sensory input:
sensory receptors respond to stimuli
2. Integration:
brain and spinal cord process stimuli
3. Control of muscles and glands
4. Mental activity:
brain

5
Main Divisions of Nervous System
1. Central Nervous System (CNS):
brain and spinal cord

2. Peripheral Nervous System (PNS):

all neurons outside CNS

6
 Neurons
• Nerve cells are called neurons, and their structure
reflects the functional characteristics of an
individual neuron .
• Information comes to the neuron largely through
treelike processes called axons, which terminate
on the neuron at specialized junctions called
synapses.
• Synapses can occur on neuronal processes called
dendrites or on the
neuronal cell body, called a soma or perikaryon 7
 Neurons
• Neurons convey eferent (motor or output)
information via action potentials that course
along a single axon arising from the soma
that then synapses on a selective target,
usually another neuron or target cell, such
as muscle cells.

8
 Neuron Characteristics
• Nerve cells

• Require oxygen and glucose

• Receive input, process input, produce a

response

9
 Neuron Structures
• Dendrite:
receives stimulus from other neurons or sensory
receptors
• Cell body:
- processes stimulus
- contains a nucleus
• Axon:
transmits stimulus to a gland, muscle, organ, or
other neuron
10
 Myelin Sheath
• What is it?
- fatty, protective wrapping around axons
- excellent insulator

• Nodes of Ranvier:
gaps in myelin sheath where action potentials
develop

• Saltatory conduction:
jumping of action potentials 12
15
Electrical Signals and Neural Pathways
Resting Membrane Potential
• Outside of cell is more + (Na+)
• Inside of cell is more – (K+)
• Leak ion channels:
- always open
- K+ channels
• Gated ion channels:
- closed until opened by specific signal
- Na+ channels 16
 Action Potentials
• “Electricity” that cause depolarization and
repolarization

• Change resting membrane potential by activating

gated ion channels

• Local Current:
movement of Na+ which causes inside of cell to be
more positive (depolarize)
19
• If enough Na+ enters then threshold is reached
and more Na+ channels open

• Once threshold is reached all or none law applies

• Action potentials continue until Na+ channels

close, K+ channels open, and repolarization
occurs

• Sodium/potassium pump restores

20
 Types of Neurons
• Multipolar:
- many dendrites and a single axon
- Ex. CNS and most motor neurons
• Bipolar:
- one dendrite and one axon
- Ex. Eye and nasal cavity
• Pseudo-unipolar:
- one axon and no dendrites
- Ex. Sensory neurons 23
Neuroglia Characteristics
• Supporting cells for neurons

• More numerous than neurons

• Can divide to produce more cells

• 5 types

25
 Types of Neuroglia

• Astrocytes:
- star-shaped
- most abundant
- form blood-brain barrier
• Ependymal Cells:
produce and circulate cerebrospinal fluid (CSF) 26
 Types of Neuroglia

• Microglia:
help remove bacteria and cell debris from CNS
• Oligodendrocytes:
produce myelin sheath in CNS
27
 Types of Neuroglia

• Schwann cells:
produce myelin
sheath in PNS

28
 Organization of Nervous Tissue
• Gray matter:
collection of dendrites and cell bodies

• White matter:
collection of axons and their myelin sheath

29
 Three functional types for neurones:

• Motor neurons: they convey efferent

impulses from the CNS or ganglia
(collections of neurons outside the CNS) to
target (effector) cells; somatic efferent
axons target skeletal muscle,and visceral
efferent axons target smooth muscle,cardiac
muscle, and glands.

30
 Three functional types for
neurones:
• Sensory neurons: they convey afferent impulses
from peripheral receptors to the CNS; somatic
afferent axons convey pain, temperature, touch,
pressure, and proprioception (nonconscious)
sensations; visceral afferent axons convey pain
and other sensations (e.g., nausea) from organs,
glands, and blood vessels to the CNS

31
• Interneurons: they convey impulses between
sensory and motor neurons in the CNS, thus
forming integrated networks between
cells;interneurons probably account for more than
99% of all neurons in the body.

32
• Neurons can vary considerably in size, ranging
from several micrometers to more than 100 μm in
diameter.
• Neurons may possess numerous branching
dendrites, studded with dendritic spines that
increase the receptive area of the neuron many-
fold.
The neuron’s axon may be quite short or over 1
meter long. he axonal diameter may vary.
• Axons that are larger than 1 to 2 μm in diameter
are insulated by myelin sheaths
33
• In the CNS, axons are myelinated by a
special glial cell called an oligodendrocyte,
whereas in the PNS they are surrounded by
a glial cell called a Schwann cell.
Schwann cells also myelinate many of the
PNS axons they surround.

34
 Glia
• Glia are the cells that support neurons, within both
the CNS (the neuroglia) and the PNS.
• Glial cells far outnumber the neurons in the
nervous system and contribute to most of the
postnatal growth, along with axonal myelination,
seen in the CNS.

35
 Function of glia:
• Provide structural isolation of neurons and their
synapses.
• Sequester ions in the extracellular compartment.
• Provide trophic support to the neurons and their
processes.
• Support growth and secrete growth factors.
• Support some of the signaling functions of
neurons.
• Myelinate axons.
• Phagocytize debris and participate in inlam-
36
matory responses.
• Play a dynamic role in pruning or
preserving
neuronal connections.
• Rid the brain of metabolites and dump
them
into the CSF.
• Participate in the formation of the blood-
brain
barrier. 37
 Types of glial cells
• Astrocytes: these are the most numerous of
the glial cells; provide physical and metabolic
support for CNS neurons, can become reactive
during CNS injury, release growth factors and
other bioactive molecules, and contribute to the
formation of the blood-brain barrier.
• Oligodendrocytes: these are smaller glial cells;
responsible for the formation and maintenance
of myelin in the CNS.
• Microglia: these are smallest and rarest of CNS
38
glia, although more numerous than neurons in
 Types of glial cells
• CNS; these phagocytic cells participate in
inflammatory reactions, remodel and
remove synapses, and respond to injury.
• • Ependymal cells: these cells line the
ventricles of the brain and the central canal
of the spinal cord, which contains
cerebrospinal Fluid.

39
• • Schwann cells: these are the glial cells of
the PNS;surround all axons (myelinating
many of them) and provide trophic support,
facilitate regrowth of PNS axons, and clean
away cellular debris.

40
 Synapse
• What is it?
- where an axon attaches to a muscle, gland,
organ, or other neuron
- involved with release of neurotransmitters
- Ex. Neuromuscular junction

41
 Neurotransmitters
• Neurotransmitters are chemical
messengers that your body can't
function without. Their job is to carry
chemical signals (“messages”) from
one neuron (nerve cell) to the next
target cell. The next target cell can be
another nerve cell, a muscle cell or a
gland.
42
Figure 8.13
 Reflexes
• What are they?
involuntary response to a stimulus

• Reflex arc:
path reflex travels

45
 Components of Reflex Arc
1. Sensory receptors:
- pick up stimulus
- in skin
2. Sensory (afferent) neurons:
send stimulus to interneurons in spinal cord

3. Interneurons (Association) neuron:

- located in CNS and connect to motor neurons
- process stimulus
46
4. Efferent (motor) neurons:
send response to effector

5. Effector:
muscle, gland, or organ

47
Figure 8.14
 Neuronal Pathways
• Converging:
- two or more neurons synapse same neuron
- allows info. to be transmitted in more than one
neuronal pathway to converge into a single
pathway
• Diverging:
- axon from one neuron divides and synapses with
more than one neuron
- allows info. to be transmitted in one neuronal
pathway to diverge into 2 or more pathways 49
 Peripheral Nerves

• The peripheral nerves observed grossly in

the human body are composed of bundles of
thousands of nerve fibers enclosed within a
connective tissue covering and supplied by
small blood vessels.

51
 Peripheral Nerves
• The nerve “fibers” consist of axons
(efferent and afferent) individually
separated from each other by the
cytoplasmic processes of Schwann cells or
myelinated by a multilayered wrapping of
continuous Schwann cell membrane (the
myelin sheath).

52
 Peripheral Nerves
• The peripheral nerve resembles an electrical cable of
axons that is further supported by three connective
tissue sleeves or coverings:
• Endoneurium: a thin connective tissue sleeve that
surrounds the axons and Schwann cells.
• Perineurium: a dense layer of connective tissue that
encircles a bundle (fascicle) of nerve Fibers.
• Epineurium: an outer thick connective tissue sheath
that encircles bundles of fascicles; this is the “nerve”
typically seen grossly coursing throughout the human
body.
53
 Peripheral Nerves
• Peripheral nerves include the 12 pairs of
cranial nerves arising from the brain or
brainstem and the 31 pairs of spinal nerves
arising from the spinal cord.

54
 Meninges
• The brain and spinal cord are surrounded by three
membranous connective tissue layers called the
meninges. These three layers include the
following:
• Dura mater: the thick, outermost meningeal
layer, richly innervated by sensory nerve Fibers.
• Arachnoid mater: the Fine, weblike avascular
membrane directly beneath the dural surface.
• Pia mater: the delicate membrane of connective
tissue that intimately envelops the brain and spinal
cord.
•
55
56
 Meninges
• The space between the arachnoid and the
underlying pia is called the subarachnoid
space and contains cerebrospinal luid
(CSF), which bathes and protects the CNS.

57
 Cranial Nerves

• Twelve pairs of cranial nerves arise from

the brain, and they are identiied both by
their names and by Roman numerals I to
XII .
• The cranial nerves are somewhat unique
and can contain multiple functional
components:

58
 Cranial Nerves
• 12 pair of cranial nerves

• Named by roman numerals

• 2 categories of functions: sensory and motor

60
 Cranial Nerves

• General: same general functions as spinal nerves.

• Special: functions found only in cranial nerves.
• Afferent and efferent: sensory and motor
• functions, respectively.
• Somatic and visceral: related to skin and skeletal
muscle (somatic) or to smooth muscle, cardiac
muscle, and glands (visceral).
therefore, each cranial nerve (CN) may possess
multiple functional components, such as the
following:
62
 Cranial Nerves

• In general, CN I and CN II arise from the

forebrain and are really tracts of the brain for the
special senses of smell and sight.
• The other cranial nerves arise from the brainstem.
Cranial nerves III, IV, and VI move the
extraocular skeletal muscles of the eyeball.
•
63
 Cranial Nerves

• CN V has three divisions: V1 and V2 are sensory, and

V3 is both motor to skeletal muscle and sensory.
• Cranial nerves VII, IX, and X are both motor and
sensory.
• CN VIII is the special sense of hearing and balance.
• CN XI and CN XII are motor to skeletal muscle.
• Cranial nerves III, VII, IX, and X also contain
parasympathetic Fibers of origin (visceral), although
many of the autonomic fibers will “jump” onto the
branches of CN V to reach their targets.
64
 Cranial Nerves
• What are the types of cranial nerves?
• Your 12 cranial nerves each have a specific function.
Experts categorize the cranial nerves based on number
and function:
• It play a role in controlling your sensations and motor
skills.
• Sensory nerves help you: Feel touch, Hear, See.,
Smell, Taste.
• Olfactory nerve: Sense of smell.
• Optic nerve: Ability to see.
• Oculomotor nerve: Ability to move and blink your
eyes.
65
 Cranial Nerves

• Trochlear nerve: Ability to move your eyes up

and down or back and forth.
• Trigeminal nerve: Sensations in your face and
cheeks, taste and jaw movements.
• Abducens nerve: Ability to move your eyes.
• Facial nerve: Facial expressions and sense of
taste.

66
 Cranial Nerves
• Auditory/vestibular nerve: Sense of hearing and
balance.
• Glossopharyngeal nerve: Ability to taste and
swallow.
• Vagus nerve: Digestion and heart rate.
• Accessory nerve (or spinal accessory nerve):
Shoulder and neck muscle movement.
• Hypoglossal nerve: Ability to move your tongue.

67
 Spinal Nerves
• The spinal cord gives rise to 31 pairs of spinal
nerves ,which then form two major branches
(rami):
• Posterior (dorsal) ramus: a small ramus that
courses dorsally to the back; it conveys motor and
sensory information to and from the skin and
intrinsic back skeletal muscles (erector spinae,
transversospinales).
• Anterior (ventral) ramus: a much larger ramus
that courses laterally and ventrally; it innervates
all the remaining skin and skeletal muscles of the
neck, limbs, and trunk. 69
71
 Spinal Nerves

• Once nerve Fibers (sensory or motor) are

beyond, or peripheral to, the spinal cord
proper, the Fibers (axons) then reside in
nerves of the PNS. Components of the PNS
include the following:

72
 Central Nervous System
Consists of brain and spinal cord Spinal cord in vertebral
Brain in brain case: column:

73
 Spinal Cord

• Extends from foramen

magnum to 2nd lumbar
vertebra
• Protected by vertebral
column
• Spinal nerves allow
movement
• If damaged paralysis can
occur

74
Gray and White Matter in Spinal Cord

• Gray Matter:
- center of spinal cord
- looks like letter H or a butterfly

• White Matter:
- outside of spinal cord
- contains myelinated fibers

75
 White Matter in Spinal Cord
• Contains 3 columns dorsal, ventral, lateral
columns

• Ascending tracts:
axons that conduct action potentials toward
brain

• Descending tracts:
axons that conduct action potentials away from
brain 76
 Gray Matter in Spinal Cord
• Posterior horns:
contain axons which synapse with interneurons
• Anterior horns:
contain somatic neurons
• Lateral horns:
contain autonomic neurons
• Central canal:
fluid filled space in center of cord
77
 Spinal Nerves
• Arise along spinal cord from union of dorsal
roots and ventral roots
• Contain axons sensory and somatic neurons
• Located between vertebra
• Categorized by region of vertebral column
from which it emerges (C for cervical)
• 31 pairs
• Organized in 3 plexuses
79
 Cervical Plexus
• Spinal nerves C1-4

• Innervates muscles attached to hyoid bone

and neck

• Contains phrenic nerve which innervates

diaphragm

80
 Brachial Plexus
• Originates from spinal nerves C5-T1

• Supply nerves to upper limb, shoulder, hand

81
 Lumbosacral Plexus
• Originates from spinal nerves L1 to S4

• Supply nerves lower limbs

82
 Cerebrospinal Fluid
• Fluid that bathes the brain and spinal cord

• Provides a protective cushion around the CNS

• Produced in choroid plexus of brain

84
 Components of the PNS
• Somatic nervous system: sensory and motor
Fibers to skin, skeletal muscle, and joints.
• Autonomic nervous system (ANS): sensory and
motor Fibers to all smooth muscle (viscera,
vasculature), cardiac muscle (heart), and glands.
• • Enteric nervous system: plexuses and ganglia
of the GI tract that regulate bowel secretion,
absorption, and motility (originally considered
part of ANS); they are linked to the ANS for
optimal regulation.
85
 Autonomic Nervous System

• The ANS is divided into sympathetic and

parasym- pathetic divisions. In contrast to the
somatic division of the PNS, the ANS is a two-
neuron system with a preganglionic neuron in
the CNS that sends its axon into a peripheral nerve
to synapse on a postganglionic neuron in a
peripheral autonomic ganglion (Fig. 1.25).

86
 Autonomic Nervous System

• The postganglionic neuron then sends its

axon to the target (smooth muscle, cardiac
muscle, and glands). the ANS is a visceral
system, since many of the body’s organs are
composed of smooth muscle walls or
contain secretory glandular tissue.

87
 Sympathetic Division

• The sympathetic division of the ANS is also

known as the thoracolumbar division because:
Its preganglionic neurons are found only in the
T1-L2 spinal cord levels.
• Its preganglionic neurons lie within the inter-
mediolateral gray matter of the spinal cord, in 14
spinal cord segments (T1-L2).

88
 Sympathetic Division

• The sympathetic system acts globally throughout

the body to mobilize it in “fright-light- light”
situations.
• sympathetic nervous system, division of the
nervous system that functions to produce localized
adjustments (such as sweating as a response to an
increase in temperature) and reflex adjustments of
the cardiovascular system.

89
 Sympathetic Division

• Under conditions of stress, the entire sympathetic

nervous system is activated, producing an immediate
widespread response called the fight-or-flight response.
• This response is characterized by the release of large
quantities of epinephrine from the adrenal gland, an
increase in heart rate, an increase in cardiac output,
skeletal muscle vasodilation, cutaneous and
gastrointestinal vasoconstriction, pupillary dilation,
bronchial dilation, and piloerection. The overall effect is
to prepare the individual for imminent danger. 90
91
92
 Parasympathetic Division

• The parasympathetic division of the ANS

also is a two-neuron system with its
preganglionic neuron in the CNS and
postganglionic neuron in a peripheral
ganglion.
• The parasympathetic division also is
known as the craniosacral division because:

93
 Parasympathetic Division

• parasympathetic nervous system, division

of the nervous system that primarily
modulates visceral organs such as glands.
The parasympathetic system is one of two
antagonistic sets of nerves of the autonomic
nervous system; the other set comprises the
sympathetic nervous system.

94
 Parasympathetic Division

• The nerve fibres of the parasympathetic

nervous system are the cranial nerves,
primarily the vagus nerve, and the lumbar
spinal nerves. When stimulated, these
nerves increase digestive secretions and
reduce the heartbeat.

95
 Parasympathetic Division

• The parasympathetic system is involved in

feeding and sexual arousal functions and
acts more slowly and focally than the
sympathetic system. For example, CN X
can slow the heart rate without affecting
input to the stomach.

96
 Parasympathetic Division
• The parasympathetic nervous system is organized
in a manner similar to the sympathetic nervous
system.
• Its motor component consists of preganglionic and
postganglionic neurons.
• The preganglionic neurons are located in specific
cell groups (also called nuclei) in the brainstem or
in the lateral horns of the spinal cord at sacral
levels.

97
 Parasympathetic Division

• Preganglionic axons emerging from the brainstem

project to parasympathetic ganglia that are located
in the head or near the heart, are embedded in the
end organ itself (e.g., the trachea, bronchi, and
gastrointestinal tract), or are situated a short
distance from the urinary bladder.
• Both pre- and postganglionic neurons secrete
acetylcholine as a neurotransmitter, but, like
sympathetic ganglion cells, they also contain other
neuroactive chemical agents that function as98
cotransmitters.
99
BRAIN STRUCTURE AND
ITS ROLES

100
 Brainstem

• Components:
– Medulla oblongata
– Pons
– Midbrain
101
 Brainstem Components
• Medulla oblongata
– Location:
continuous with spinal cord
– Function:
regulates heart rate, blood vessel diameter, breathing,
swallowing, vomiting, hiccupping, coughing, sneezing,
balance
– Other:
pyramids: involved in conscious control of skeletal
muscle

102
• Pons
– Location:
above medulla, bridge between cerebrum and cerebellum
– Function:
breathing, chewing, salivation, swallowing

• Midbrain
– Location:
above pons
– Function:
coordinated eye movement, pupil diameter, turning head
toward noise
103
• Reticular Formation
- Location:
scattered throughout brainstem
- Function:
regulates cyclical motor function, respiration,
walking, chewing, arousing and maintaining
consciousness, regulates sleep-wake cycle

104
 Diencephalon

• Located between the brainstem and cerebrum

• Components:
-Thalamus
-Hypothalamus
105
 Diencephalon Components
• Thalamus
- Characteristics:
largest portion of diencephalon
- Function:
influences moods and detects pain

• Epithalamus:
- Location:
above thalamus
- Function:
emotional and visceral response to odors
106
• Hypothalamus
- Location:
below thalamus
- Characteristics:
controls pituitary gland and is connected to it by
infundibulum
- Function:
controls homeostasis, body temp, thirst,
hunger, fear, rage, sexual emotions

107
Figure 8.24
Cerebrum Characteristics
• Largest portion of brain
• Divisions:
– Right Hemisphere
– Left Hemisphere
separated by
longitudinal fissure
• Lobes: frontal, parietal,
occipital, temporal

109
 Cerebrum Components
• Cerebral Cortex
- Location:
surface of cerebrum, composed of gray matter
- Function:
controls thinking, communicating,
remembering, understanding, and initiates
involuntary movements

110
• Left hemisphere:
- controls right side of body
- responsible for math, analytic, and speech

• Right hemisphere:
- controls left side of body
- responsible for music, art, abstract ideas

• Corpus callosum:
connection between 2 hemispheres
111
112
 Lobes of Brain
• Frontal lobe
- Location: front
- Function: controls voluntary motor functions, aggression,
moods, smell

• Parietal lobe
- Location: top
- Function: evaluates sensory input such as touch, pain,
pressure, temp., taste

113
• Occipital lobe
- Location: back
- Function: vision

• Temporal lobe
- Location: sides
- Function: hearing, smell, memory

114
115
Cerebellum
• Location:
below cerebrum
• Characteristics:
- means little brain
- cortex is composed of
gyri, sulci, gray matter
• Functions: controls
balance, muscle tone,
coordination of fine
motor movement
116
 Sensory Functions
• CNS constantly receives sensory input

• We are unaware of most sensory input

• Sensory input is vital of our survival and

normal functions

117
 Ascending Tracts
• What are they?
- pathways in brain and spinal cord
- transmit info. via action potentials from
periphery to brain
- each tract has limited type of sensory input
(temp, touch, pain, etc.)
- tracts are named that indicated origin and
termination
- made of 2-3 neurons in sequence 118
 Meninges
• What are they?
protective wrapping around brain and spinal
cord

• Meningitis:
infection of meninges (bacterial or viral)

121
 Types of Meninges
• Dura Mater:
- superficial
- thickest layer
• Arachnoid mater:
2nd layer
• Pia mater:
- 3rd layer
- surface of brain
• Subarachnoid space:
where cerebrospinal fluid sits 122
• Epidural space:
- in vertebral column between dura and vertebra
- injection site for epidural anesthesia

• Spinal block and spinal tap:

- in subarachnoid space where cerebrospinal
fluid can be removed or anesthetic inject
- numbs spinal nerves

123
 Ventricles
• What are they?
cavities in CNS that contain fluid

• Fourth ventricle:
- base of cerebellum
- continuous with central canal of spinal cord

125
 Peripheral Nervous System
• Consists of all neurons outside brain and
spinal cord

• Collects input from different sources, relays

input to CNS, and performs action

126
 Divisions of Peripheral Nervous System

1. Afferent (Sensory):
collects input from periphery and sends it to
CNS

2. Efferent (Motor):
carries processed input from CNS to effector

127
 Divisions of Efferent (Motor)
1. Autonomic:
- response is automatic (involuntary)
- controls smooth and cardiac muscles and glands

2. Somatic:
- response is voluntary
- controls skeletal muscles

128
 Divisions of Autonomic
1. Sympathetic:
– activated during times of stress
– part of fight or flight response
– prepares you for physical activity by:
- ↑ HR
- ↑ BP
- ↑ BR
- sending more blood to skeletal muscles
- inhibiting digestive tract
130
2. Parasympathetic:
– “housekeeper”
– activated under normal conditions
– involved in digestion, urine production, and
dilation/constriction of pupils, etc.

131
THANKS

THANKS

133
ANATOMY AND PHYSIOLOGY OF CARDIOVASCULAR
SYSTEM
( Unit Summary)

By
Adrien UWIZEYIMANA RN,MSN
WHAT IS CARDIOVASCULAR SYSTEM?
 The heart and blood vessels make up the circulatory system.
 The main function of the circulatory system is to provide
oxygen, nutrients and hormones to muscles, tissues and
organs throughout the body.
 Another part of the circulatory system is to remove waste
from cells and organs so your body can dispose of it.
CONT’D

 Theheart pumps blood to the body through a

network of arteries and veins (blood vessels).
 Thecirculatory system can also be defined as
your cardiovascular system.
 Cardio means heart, and vascular refers to
blood vessels.
Cardiac layers view
The four chambers of the
heart Valves
 1.left atrium: left upper  Atrioventricular (AV) Valves:
chamber Control blood flow between the
upper and lower chambers
 2.Right atrium: Right upper
chamber  Tricuspid valve: On the right
side between the atria and the
 3.left ventricle: Left lower ventricles
chamber
 Mitral valve: On the left side
 4.Right ventrical: Right lower between the atria and the
chamber ventricles
 The septal wall separates the  Pulmonic valve: Controls the
right lower chamber flow between the right
ventricle and pulmonary artery
 Aortic valve:Controls the flow
between the left ventricle and
the aorta
The circulatory system circuits
 The circulatory system has three circuits. Blood circulates through ythe heart
and through these circuits in a continuous pattern:
• The pulmonary circuit: This circuit carries blood without oxygen from the
heart to the lungs. The pulmonary veins return oxygenated blood to the heart.
• The systemic circuit: In this circuit, blood with oxygen, nutrients and
hormones travels from the heart to the rest of the body.
• In the veins, the blood picks up waste products as the body uses up the
oxygen, nutrients and hormones.
• The coronary circuit: Coronary refers to the heart’s arteries .
• This circuit provides the heart muscle with oxygenated blood.
• The coronary circuit then returns oxygen-poor blood to the heart’s right upper
chamber (atrium) to send to the lungs for oxygen.
Pulmonary and systemic circuit
Coronary circuit
Where coronary circulation begins
 The coronary arteries originate as the right and
left main coronary arteries which exit the
ascending aorta just above the aortic valve
(coronary ostia).
 These two branches subdivide and course over
the surface of the heart (epicardium) as they
traverse away from the aorta.
Blood flow
1. unoxygenated blood empties into the right atrium
from the systemic circulation via the inferior vena
cava and superior vena cava.
2. The right atrium contracts and the tricuspid valve
opens, allowing the blood to flow into the right
ventricle
3. The right ventricle contracts and the pulmonic valve
opens, allowing the unoxygenated blood to enter the
pulmonary artery to go to the lungs to pick up oxygen
Blood flow CONT'
4.Oxgenated blood returns from the lungs to the heart via the
pulmonary vein and enters the left atrium.
5.The left atrium contracts and the mitral valve opens,
allowing the blood to follow into the left ventricle
The left ventricle contracts and the aortic valve opens,
allowing the blood to flow into the aorta and systemic
circulation.
6. Blood returns to the heart from the lower body via the
inferior vena cava and from the upper body via the supper
vena cava.
4.Oxgenated blood returns from the lungs to the heart via
the pulmonary vein and enters the left atrium.
5.The left atrium contracts and the mitral valve opens,
allowing the blood to follow into the left ventricle
The left ventricle contracts and the aortic valve opens,
allowing the blood to flow into the aorta and systemic
circulation.
6. Blood returns to the heart from the lower body via the
inferior vena cava and from the upper body via the
supper vena cava.
Blood flow summary
Heart Sounds
 Heart sounds are primarily generated from vibrations of
cardiac structures caused by changes that create turbulent
flow Under normal conditions, blood flow is laminar.
 With structural or hemodynamic changes turbulent flow
results, which causes vibrational waves.
 These waves are transmitted through the chest wall and are
the sounds practitioners auscultate with their stethoscopes.
The sound transmits in the same direction as the blood flow.

Physiologic Heart Sounds
 Normal heart sounds are S1 and S2
 The first heart sound (S1) represents closure of the
atrioventricular (mitral and tricuspid) valves as the ventricular
pressures exceed atrial pressures at the beginning of systole .
 S1 is normally a single sound because mitral and tricuspid
valve closure occurs almost simultaneously. Clinically, S1
corresponds to the pulse.
 The second heart sound (S2) represents closure of the
semilunar (aortic and pulmonary) valves
 S2 is normally split because the aortic valve closes before the
pulmonary valve .
Electrical conduction summary
The heart's electrical system
 Going back to the analogy of the central heating system, the pumps, pipes and
radiators are of no use unless connected to a power supply.
 The pump needs electricity to work.
 The human heart has a similar need for a power source and also uses electricity.
 Thankfully we don’t need to plug ourselves in to the mains, the heart is able to create
it’s own electrical impulses and control the route the impulses take via a specialized
conduction pathway.
 This pathways is made up of 5 elements:
1.The sino-atrial (SA) node
2. The atrio-ventricular (AV) node
3. The bundle of his
4.The left and right bundle branches
5. The Purkinje fibers
Cont’d
 The SA node is the natural pacemaker of the heart.
 The SA node releases electrical stimuli at regular rate, the rate is
dictated by the needs of the body.
 The electrical stimulus from the SA node eventually reaches the AV node
and is delayed briefly so that the contracting atria have enough time to
pump all the blood into the ventricles.
 One the atria are empty of blood the valves between the atria and
ventricles close.
 At this point the atria begin to refill and the electrical stimulus passes
through the AV node and bundle of his into the bundle branches and
purkinje fibers.
Cont’d
 At this point the ventricles contract,(see blood
flow).
 After contraction the ventricles are empty the
atria are full and the valves between them are
closed.
 The SA node is about to release another electrical
stimulus and the process is about to repeat itself.
 PRELOAD and AFTERLOAD
 Preload, also known as the left ventricular end-diastolic pressure (LVEDP),
is the amount of ventricular stretch at the end of diastole.
 Think of it as the heart loading up for the next big squeeze of the
ventricles during systole.
 Some people remember this by using an analogy of a balloon – blow air
into the balloon and it stretches; the more air you blow in, the greater the
stretch.
 Afterload, also known as the systemic vascular resistance (SVR), is the
amount of resistance the heart must overcome to open the aortic valve
and push the blood volume out into the systemic circulation.
 If you think about the balloon analogy, afterload is represented by the
knot at the end of the balloon.
 To get the air out, the balloon must work against that knot.
Control of Blood Pressure

 Changes in blood pressure are routinely made in order to

direct appropriate amounts of oxygen and nutrients to
specific parts of the body.
 For example, when exercise demands additional supplies of
oxygen to skeletal muscles, blood delivery to these muscles
increases, while blood delivery to the digestive organs
decreases.
 Adjustments in blood pressure are also required when
forces are applied to your body, such as when starting or
stopping in an elevator.
Blood pressure can be adjusted by producing
changes in the following variables:
• Cardiac output can be altered by changing stroke
volume or heart rate.
• Resistance to blood flow in the blood vessels is
most often altered by changing the diameter of the
vessels (vasodilation or vasoconstriction).
• Changes in blood viscosity (its ability to flow) or in
the length of the blood vessels (which increases
with weight gain) can also alter resistance to blood
flow.
The following mechanisms help regulate blood
pressure:

 The cardiovascular center provides a rapid,

neural mechanism for the regulation of blood
pressure by managing cardiac output or by
adjusting blood vessel diameter.
 Located in the medulla oblongata of the brain
stem, it consists of three distinct regions:
Cont’d
• The cardiac center stimulates cardiac output by increasing
heart rate and contractility. These nerve impulses are
transmitted over sympathetic cardiac nerves.
• The cardiac center inhibits cardiac output by decreasing
heart rate. These nerve impulses are transmitted over
parasympathetic vagus nerves.
• The vasomotor center regulates blood vessel diameter.
Nerve impulses transmitted over sympathetic motor
neurons called vasomotor nerves innervate smooth
muscles in arterioles throughout the body to maintain
vasomotor tone, a steady state of vasoconstriction
appropriate to the region.
 The cardiovascular center receives information
about the state of the body through the
following sources:
• Baroreceptors are sensory neurons that monitor arterial blood pressure. Major
baroreceptors are located in the carotid sinus (an enlarged area of the carotid artery
just above its separation from the aorta), the aortic arch, and the right atrium.
• Chemoreceptors are sensory neurons that monitor levels of CO 2 and O 2.
• These neurons alert the cardiovascular center when levels of O 2 drop or levels of
CO 2 rise (which result in a drop in pH). Chemoreceptors are found in carotid bodies
and aortic bodies located near the carotid sinus and aortic arch.
• Higher brain regions, such as the cerebral cortex, hypothalamus, and limbic system,
signal the cardiovascular center when conditions (stress, fight‐or‐flight response, hot
or cold temperature) require adjustments to the blood pressure.

The kidneys provide a hormonal mechanism
for the regulation of blood pressure by
managing blood volume
 The renin‐angiotensin‐aldosterone system of the
kidneys regulates blood volume.
 In response to rising blood pressure, the
juxtaglomerular cells in the kidneys secrete renin
into the blood.
 Renin converts the plasma protein angiotensinogen to
angiotensin I, which in turn is converted to angiotensin II by
enzymes from the lungs.
Angiotensin II activates two mechanisms
that raise blood pressure:

 Angiotensin II constricts blood vessels throughout the body (raising blood

pressure by increasing resistance to blood flow).
 Constricted blood vessels reduce the amount of blood delivered to the
kidneys, which decreases the kidneys' potential to excrete water (raising
blood pressure by increasing blood volume).
Cont’d
 Angiotensin II stimulates the adrenal cortex
to secrete aldosterone, a hormone that
reduces urine output by increasing retention
of H 2O and Na + by the kidneys (raising
blood pressure by increasing blood volume).
Various substances influence blood pressure.
Some important examples follow
• Epinephrine and norepinephrine, hormones secreted
by the adrenal medulla, raise blood pressure by
increasing heart rate and the contractility of the heart
muscles and by causing vasoconstriction of arteries
and veins. These hormones are secreted as part of the
fight‐or‐flight response.
• Antidiuretic hormone (ADH), a hormone produced by
the hypothalamus and released by the posterior
pituitary, raises blood pressure by stimulating the
kidneys to retain H 2O (raising blood pressure by
increasing blood volume).
Cont’d

 Atrial natriuretic peptide (ANP), a hormone

secreted by the atria of the heart, lowers blood
pressure by causing vasodilation and by
stimulating the kidneys to excrete more water and
Na +(lowering blood pressure by reducing blood
volume).
Cont’d

• Nitric oxide (NO), secreted by endothelial cells, causes vasodilation.

• Nicotine in tobacco raises blood pressure by stimulating sympathetic
neurons to increase vasoconstriction and by stimulating the adrenal
medulla to increase secretion of epinephrine and norepinephrine.
• Alcohol lowers blood pressure by inhibiting the vasomotor center
(causing vasodilation) and by inhibiting the release of ADH
(increasing H 2O output, which decreases blood volume).
THANK YOU!
 Anatomy of the Lymphatic and Immune Systems
 The immune system is the complex collection of cells and organs that
destroys or neutralizes pathogens that would otherwise cause disease or
death.
 The lymphatic system, for most people, is associated with the immune
system to such a degree that the two systems are virtually indistinguishable.
 The lymphatic system is the system of vessels, cells, and organs that carries
excess fluids to the bloodstream and filters pathogens from the blood.
 The swelling of lymph nodes during an infection and the transport of
lymphocytes via the lymphatic vessels are but two examples of the many
connections between these critical organ systems.
 Functions of the Lymphatic System
 A major function of the lymphatic system is to drain body fluids and return
them to the bloodstream.
 Blood pressure causes leakage of fluid from the capillaries, resulting in the
accumulation of fluid in the interstitial space—that is, spaces between
individual cells in the tissues.
 In humans, 20 liters of plasma is released into the interstitial space of the
tissues each day due to capillary filtration.
 Once this filtrate is out of the bloodstream and in the tissue spaces, it is
referred to as interstitial fluid.
 Of this, 17 liters is reabsorbed directly by the blood vessels. But what happens
to the remaining three liters? This is where the lymphatic system comes into
play.
 CONT’D
 It drains the excess fluid and empties it back into the bloodstream via a series of vessels,
trunks, and ducts.
 Lymph is the term used to describe interstitial fluid once it has entered the lymphatic
system.
 When the lymphatic system is damaged in some way, such as by being blocked by cancer
cells or destroyed by injury, protein-rich interstitial fluid accumulates (sometimes “backs
up” from the lymph vessels) in the tissue spaces.
 This inappropriate accumulation of fluid referred to as lymphedema may lead to serious
medical consequences.
 As the vertebrate immune system evolved, the network of lymphatic vessels became
convenient avenues for transporting the cells of the immune system. Additionally, the
transport of dietary lipids and fat-soluble vitamins absorbed in the gut uses this system.
CONT’D
 Cells of the immune system not only use lymphatic vessels to make their way from
interstitial spaces back into the circulation, but they also use lymph nodes as major
staging areas for the development of critical immune responses.
 A lymph node is one of the small, bean-shaped organs located throughout the
lymphatic system.
 Structure of the Lymphatic System
 The lymphatic vessels begin as open-ended capillaries, which feed into larger and
larger lymphatic vessels, and eventually empty into the bloodstream by a series of
ducts. Along the way, the lymph travels through the lymph nodes, which are
commonly found near the groin, armpits, neck, chest, and abdomen.
 Humans have about 500–600 lymph nodes throughout the body.
 Lymph flows from the lymphatic capillaries, through lymphatic vessels, and then is
dumped into the circulatory system via the lymphatic ducts located at the junction
of the jugular and subclavian veins in the neck.
 The lymphatic capillaries empty into larger lymphatic vessels, which are similar to
veins in terms of their three-tunic structure and the presence of valves. These one-
way valves are located fairly close to one another, and each one causes a bulge in
the lymphatic vessel, giving the vessels a beaded appearance.
CONT’D
 The superficial and deep lymphatics eventually merge to form larger
lymphatic vessels known as lymphatic trunks
 On the right side of the body, the right sides of the head, thorax, and
right upper limb drain lymph fluid into the right subclavian vein via the
right lymphatic duct.
 On the left side of the body, the remaining portions of the body drain into
the larger thoracic duct, which drains into the left subclavian vein.
 The thoracic duct itself begins just beneath the diaphragm in the cisterna
chyli, a sac-like chamber that receives lymph from the lower abdomen,
pelvis, and lower limbs by way of the left and right lumbar trunks and the
intestinal trunk.
 The Organization of Immune Function
 The immune system is a collection of barriers, cells, and soluble proteins that
interact and communicate with each other in extraordinarily complex ways.
 The modern model of immune function is organized into three phases based on the
timing of their effects. The three temporal phases consist of the following:
❑ Barrier defenses such as the skin and mucous membranes, which act
instantaneously to prevent pathogenic invasion into the body tissues
❑ The rapid but nonspecific innate immune response, which consists of a variety of
specialized cells and soluble factors
❑ The slower but more specific and effective adaptive immune response, which
involves many cell types and soluble factors, but is primarily controlled by white
blood cells (leukocytes) known as lymphocytes, which help control immune
responses
CONTD’
 The cells of the blood, including all those involved in the
immune response, arise in the bone marrow via various
differentiation pathways from hematopoietic stem cells.
 These cells can be divided into three classes based on
function:
• Phagocytic cells, which ingest pathogens to destroy them
• Lymphocytes, which specifically coordinate the activities of
adaptive immunity
• Cells containing cytoplasmic granules, which help mediate
immune responses against parasites and intracellular
pathogens such as viruses
 Lymphocytes
 lymphocytes are the primary cells of adaptive immune responses.
 The two basic types of lymphocytes, B cells and T cells, are identical morphologically
with a large central nucleus surrounded by a thin layer of cytoplasm.
 They are distinguished from each other by their surface protein markers as well as by the
molecules they secrete.
 While B cells mature in red bone marrow and T cells mature in the thymus, they both
initially develop from bone marrow.
 T cells migrate from bone marrow to the thymus gland where they further mature.
 B cells and T cells are found in many parts of the body, circulating in the bloodstream and
lymph, and residing in secondary lymphoid organs, including the spleen and lymph nodes.
 The human body contains approximately 1012 lymphocytes.
 B Cells
 B cells are immune cells that function primarily by producing antibodies.
 An antibody is any of the group of proteins that binds specifically to pathogen-
associated molecules known as antigens.
 An antigen is a chemical structure on the surface of a pathogen that binds to T or B
lymphocyte antigen receptors.
 Once activated by binding to antigen, B cells differentiate into cells that secrete a
soluble form of their surface antibodies.
 These activated B cells are known as plasma cells.
T Cells
 The T cell, on the other hand, does not secrete
antibody but performs a variety of functions in
the adaptive immune response.
 Different T cell types have the ability to either
secrete soluble factors that communicate with
other cells of the adaptive immune response or
destroy cells infected with intracellular
pathogens.
Plasma Cells
 Another type of lymphocyte of importance is the plasma cell.
 plasma cell is a B cell that has differentiated in response to antigen
binding, and has thereby gained the ability to secrete soluble
antibodies.
 These cells differ in morphology from standard B and T cells in that
they contain a large amount of cytoplasm packed with the protein-
synthesizing machinery known as rough endoplasmic reticulum.
Natural Killer Cells
 A fourth important lymphocyte is the natural killer cell, a participant in
the innate immune response.
 A natural killer cell (NK) is a circulating blood cell that contains
cytotoxic (cell-killing) granules in its extensive cytoplasm.
 It shares this mechanism with the cytotoxic T cells of the adaptive
immune response. NK cells are among the body’s first lines of defense
against viruses and certain types of cancer.
Lymphocytes summary
Primary Lymphoid Organs and Lymphocyte
Development
 The primary lymphoid organs are the bone
marrow, spleen, and thymus gland. The lymphoid
organs are where lymphocytes mature,
proliferate, and are selected, which enables them
to attack pathogens without harming the cells of
the body.
Lymph Nodes
 Lymph nodes function to remove debris and pathogens from the
lymph, and are thus sometimes referred to as the “filters of the
lymph”.
 Any bacteria that infect the interstitial fluid are taken up by the
lymphatic capillaries and transported to a regional lymph node.
 Dendritic cells and macrophages within this organ internalize and kill
many of the pathogens that pass through, thereby removing them from
the body.
RESPIRATORY SYSTEM
I.Parts of respiratory  Capillaries: a network of tiny
system blood vessels that cover the
alveoli. Capillaries connect to a
 Nasal cavities: Nose and linked
network of arteries and veins.
air passages
 Pulmonary artery: delivers blood
 Mouth
containing carbon dioxide to the
 Larynx capillaries of the alveoli.
 Trachea  Diaphragm: The main muscle for
breathing located below the
 Bronchi
lungs;it separates the chest
 Bronchioles: small, thin tube cavity from the abdominal cavity.
 Alveoli :air sac connected to the  Intercostal muscles: located
bronchioles between the ribs, intercostal
muscles assist in breathing
RESPIRATORY SYSTEM
 Abdominal muscles: used to
exhale when breathing fast II.RESPIRATORY SYSTEM FUNCTION
 Accessory muscles (neck and  Nose and mouth wet and warm
collarbone): used for breathing the air: cold and dry air irritate
when the patient is having the lungs.
difficulty breathing.
 Cilia in the nose and airway trap
germs and other foreign particles
in the air. Particles are
swallowed, coughed, or sneezed
out of the body
 The lungs exchange oxygen and
carbon dioxide from blood
vessels.
II.RESPIRATORY SYSTEM FUNCTION
 The pulmonary artery delivers ➢ inhalation muscles
blood containing carbon dioxide
to the capillaries of the alveoli.  Diaphragm contracts, moving
Gas exchange takes, replacing down increased space in the
carbon dioxide from hemoglobin chest cavity, and enabling lungs
in red blood cells with oxygen to expand. Intercostal muscles
pull the rib cage out and up,
❑ Respiration: enlarging the chest cavity
o Airway : carries oxygenated air to  Air sucked through the nose and
the lungs and removes carbon mouth as the lungs expand and
dioxide travels down the trachea and
o Muscle around the lungs expand bronchi, bronchioles and alveoli,
and contract to force the lungs where gas exchange occurs.
to exhale and inhale. These
muscles are:
II.RESPIRATORY SYSTEM FUNCTION
➢ exhalation muscles  These sensors signal when
respiration should increase or
 The diaphragm and intercostals
decrease. sensors in the airways
muscles contract, reducing space
detect irritants and trigger the
in the chest cavity and forcing air
brain to cause coughing or
out of the lungs.
sneezing by tightening smooth
❑ RESIRATORY CONTROL muscles around the airway,
 The medulla oblongata portion of increasing the air pressure on
the brain controls breathing. exhalation. Sensors in the alveoli
Sensors in the carotid artery and detect fluid buildup and signal
aorta detect carbon dioxide and the brain to trigger rapid, shallow
oxygen levels in the blood. breathing.
Breath Sounds
 Breath sounds come from the lungs when you breathe in and out. These sounds
can be heard using a stethoscope or simply when breathing.
 Breath sounds can be normal or abnormal. Abnormal breath sounds can
indicate a lung problem, such as:
 obstruction
 inflammation
 infection
 fluid in the lungs
 asthma
Types of breath sounds
 A normal breath sound is similar to the sound of air. However, abnormal
breath sounds may include:
 rhonchi (a low-pitched breath sound)
 crackles (a high-pitched breath sound)
 wheezing (a high-pitched whistling sound caused by narrowing of the
bronchial tubes. Heard during exhalation )
 stridor (a harsh, vibratory sound caused by narrowing of the upper airway,
heard during inhalation)
 What are the causes of abnormal breath
sounds?
 Abnormal breath sounds are usually indicators of problems in the lungs or airways.
The most common causes of abnormal breath sounds are:
 pneumonia
 heart failure
 chronic obstructive pulmonary disease (COPD), such as emphysema
 asthma
 bronchitis
 foreign body in the lungs or airways
Various factors cause the sounds
described above:
 Rhonchi occur when air tries to pass through bronchial tubes that contain
fluid or mucus.
 Crackles occur if the small air sacs in the lungs fill with fluid and there’s any
air movement in the sacs, such as when you’re breathing. The air sacs fill
with fluid when a person has pneumonia or heart failure.
CONT’
 Wheezing occurs when the bronchial tubes become
inflamed and narrowed.
 Stridor occurs when the upper airway narrows.
AUSCULTATION LAND MARKS
 https://accesssurgery.mhmedical.com/content.aspx?bookid=1317&sectionid=
72435493
Anatomy, Thorax, Lung Pleura And Mediastinum
https://www.ncbi.nlm.nih.gov/books/NBK519048/
 The Anatomy of the Pleura
 The pleura is a vital part of the respiratory tract whose role it is to
cushion the lungs and reduce any friction which may develop between
the lungs, rib cage, and chest cavity.

 The pleura consists of a two-layered membrane that covers each lung.

The layers are separated by a small amount of viscous lubricant
known as pleural fluid
 Pleural fluid
 Pleural fluid is a serous fluid produced by the serous membrane covering
normal pleurae
 Under normal conditions, pleural fluid is secreted by the parietal
pleural capillaries at a rate of 0.6 millilitre per kilogram weight per hour,
and is cleared by lymphatic absorption leaving behind only 5–15 millilitres
of fluid, which helps to maintain a functional vacuum between the parietal
and visceral.
 Excess fluid within the pleural space can impair inspiration by upsetting
the functional vacuum and hydrostatically increasing the resistance against
lung expansion, resulting in a fully or partially collapsed lung.
GAZ EXCHANGE
 The primary function of the respiratory system is to take in
oxygen and eliminate carbon dioxide.
 Inhaled oxygen enters the lungs and reaches the alveoli.
 The layers of cells lining the alveoli and the surrounding
capillaries are each only one cell thick and are in very close
contact with each other.
 This barrier between air and blood averages about 1 micron
(1/10,000 of a centimeter, or 0.000039 inch) in thickness.
 Oxygen passes quickly through this air-blood barrier into the
blood in the capillaries.
 Similarly, carbon dioxide passes from the blood into the alveoli
and is then exhaled.
 Blood–air barrier
 The blood–air barrier or air–blood barrier, (alveolar–capillary
barrier or membrane) exists in the gas exchanging region of the lungs.
 It exists to prevent air bubbles from forming in the blood , and from blood entering
the alveoli .
 It is formed by the types I pneumocytes of the alveolar wall, the endothelial cells
of the capillaries and the basement membrane between the two cells.
 The barrier is permeable to molecular oxygen , carbon dioxide, carbon
monoxide and many other gases.
GAZ EXCHANGE
Mechanics of Ventilation
 Ventilation, or breathing, is the movement of air through the
conducting passages between the atmosphere and the lungs.

 The air moves through the passages because of pressure gradients

that are produced by contraction of the diaphragm and thoracic
muscles.
Pulmonary ventilation
 Pulmonary ventilation is commonly referred to as
breathing. It is the process of air flowing into the
lungs during inspiration ( inhalation ) and out of the
lungs during expiration ( exhalation ).
 Air flows because of pressure differences between the
atmosphere and the gases inside the lungs.
 Air, like other gases, flows from a region with higher
pressure to a region with lower pressure.
 Muscular breathing movements and recoil of elastic
tissues create the changes in pressure that result in
ventilation.
Pulmonary ventilation involves three
different pressures:
• Atmospheric pressure
• Intraalveolar (intrapulmonary) pressure
• Intrapleural pressure
 Atmospheric pressure is the pressure of the air outside the
body. Intra alveolar pressure is the pressure inside the alveoli of
the lungs. Intrapleural pressure is the pressure within the
pleural Capacity . These three pressures are responsible for
pulmonary ventilation.
 Inspiration
 Inspiration (inhalation) is the process of taking air into the lungs. It is the active
phase of ventilation because it is the result of muscle contraction. During
inspiration, the diaphragm contracts and the thoracic cavity increases in
volume.
 This decreases the intraalveolar pressure so that air flows into the lungs.
Inspiration draws air into the lungs.
 Expiration
 Expiration (exhalation) is the process of letting air out of the lungs during the
breathing cycle.
 During expiration, the relaxation of the diaphragm and elastic recoil of tissue
decreases the thoracic volume and increases the intraalveolar pressure.
 Expiration pushes air out of the lungs.
 Lung Capacity
 Lung capacity or total lung capacity (TLC) is the volume of air in
the lungs upon the maximum effort of inspiration.
 Among healthy adults, the average lung capacity is about 6 liters.
 Age, gender, body composition, and ethnicity are factors affecting
the different ranges of lung capacity among individuals.
 TLC rapid increases from birth to adolescence and plateaus at
around 25 years old. Males tend to have a greater TLC than
females, while individuals with tall stature tend to have greater TLC
than those with short stature.
CONT’D

 Clinicians can measure lung capacity by plethysmography,

dilutional helium gas method, nitrogen gas washout method, or
radiographically by a relatively new technique using by computed
tomography (CT).
 Methodically, the TLC is calculated by measuring the lung
capacities: inspiratory capacity (IC), functional residual capacity
(FRC), and the vital capacity (VC).
 the lung capacities can be further divided into the following lung
volumes: tidal volume (TV), inspiratory reserve volume (IRV),
expiratory reserve volume (ERV), and the residual volume (RV).
Self reading
1.Describe following lung capacities;
 inspiratory capacity (IC),
 functional residual capacity (FRC),
 and the vital capacity (VC).
2. Describe following lung volumes
 tidal volume (TV),
 inspiratory reserve volume (IRV),
 expiratory reserve volume (ERV), and
 the residual volume (RV).
THANK YOU
BLOOD BASICS
Blood is a specialized body fluid. It has four main components: plasma,
red blood cells, white blood cells, and platelets. Blood has many
different functions, including:
• transporting oxygen and nutrients to the lungs and tissues
• forming blood clots to prevent excess blood loss
• carrying cells and antibodies that fight infection
• bringing waste products to the kidneys and liver, which filter and
clean the blood
• regulating body temperature
CONT’D
• The blood that runs through the veins, arteries, and capillaries is
known as whole blood, a mixture of about 55 percent plasma and 45
percent blood cells. About 7 to 8 percent of your total body weight is
blood.
The Components of Blood and Their Importance
• Plasma
• The liquid component of blood is called plasma, a mixture of water,
sugar, fat, protein, and salts.
• The main job of the plasma is to transport blood cells throughout
your body along with nutrients, waste products, antibodies, clotting
proteins, chemical messengers such as hormones, and proteins that
help maintain the body's fluid balance.
Blood cells
• Red Blood Cells (also called erythrocytes or RBCs)
• Known for their bright red color, red cells are the most abundant cell
in the blood, accounting for about 40 to 45 percent of its volume.
• The shape of a red blood cell is a biconcave disk with a flattened
center - in other words, both faces of the disc have shallow bowl-like
indentations (a red blood cell looks like a donut).
• Production of red blood cells is controlled by erythropoietin, a
hormone produced primarily by the kidneys. Red blood cells start as
immature cells in the bone marrow and after approximately seven
days of maturation are released into the bloodstream.
 Cont’d
• Unlike many other cells, red blood cells have no nucleus and can easily
change shape, helping them fit through the various blood vessels in your
body.
• However, while the lack of a nucleus makes a red blood cell more flexible,
it also limits the life of the cell as it travels through the smallest blood
vessels, damaging the cell's membranes and depleting its energy supplies.
• The red blood cell survives on average only 120 days.
Cont’
• Red cells contain a special protein called hemoglobin, which helps
carry oxygen from the lungs to the rest of the body and then returns
carbon dioxide from the body to the lungs so it can be exhaled.
• Blood appears red because of the large number of red blood cells,
which get their color from the hemoglobin.
• The percentage of whole blood volume that is made up of red blood
cells is called the hematocrit and is a common measure of red blood
cell levels.
White Blood Cells (also called leukocytes)
• White blood cells protect the body from infection. They are much
fewer in number than red blood cells, accounting for about 1 percent
of your blood.
• The most common type of white blood cell is the neutrophil, which is
the "immediate response" cell and accounts for 55 to 70 percent of
the total white blood cell count.
• Each neutrophil lives less than a day, so your bone marrow must
constantly make new neutrophils to maintain protection against
infection.
• Transfusion of neutrophils is generally not effective since they do not
remain in the body for very long.
•.
Cont’d
• The other major type of white blood cell is a lymphocyte.
• There are two main populations of these cells.
• T lymphocytes help regulate the function of other immune cells and
directly attack various infected cells and tumors.
• B lymphocytes make antibodies, which are proteins that specifically
target bacteria, viruses, and other foreign materials
 Platelets (also called thrombocytes)
• Unlike red and white blood cells, platelets are not actually cells but
rather small fragments of cells.
• Platelets help the blood clotting process (or coagulation) by gathering
at the site of an injury, sticking to the lining of the injured blood vessel,
and forming a platform on which blood coagulation can occur.
• This results in the formation of a fibrin clot, which covers the wound
and prevents blood from leaking out.
Cont’d
• Fibrin also forms the initial scaffolding upon which new tissue forms,
thus promoting healing.
• A higher than normal number of platelets can cause unnecessary
clotting, which can lead to strokes and heart attacks; however, thanks
to advances made in antiplatelet therapies, there are treatments
available to help prevent these potentially fatal events. Conversely,
lower than normal counts can lead to extensive bleeding.
Complete Blood Count (CBC)
• A complete blood count (CBC) test gives your doctor important
information about the types and numbers of cells in your blood,
especially the red blood cells and their percentage (hematocrit) or
protein content (hemoglobin), white blood cells, and platelets.
• The results of a CBC may diagnose conditions like anemia, infection,
and other disorders.
• The platelet count and plasma clotting tests (prothombin time, partial
thromboplastin time, and thrombin time) may be used to evaluate
bleeding and clotting disorders.
Where Do Blood Cells Come From?
• Blood cells develop from hematopoietic stem cells and are formed in
the bone marrow through the highly regulated process of
hematopoiesis.
• Hematopoietic stem cells are capable of transforming into red blood
cells, white blood cells, and platelets.
• These stem cells can be found circulating in the blood and bone
marrow in people of all ages, as well as in the umbilical cords of
newborn babies.
• Stem cells from all three sources may be used to treat a variety of
diseases, including leukemia, lymphoma, bone marrow failure, and
various immune disorders.
Blood groups
• There are 4 main blood groups (types of blood) – A, B, AB and O.
Your blood group is determined by the genes you inherit from your
parents.
• Each group can be either RhD positive or RhD negative, which means
in total there are 8 blood groups.
Antibodies and antigens
• Blood is made up of red blood cells, white blood cells and platelets in
a liquid called plasma. Your blood group is identified by antibodies
and antigens in the blood.
• Antibodies are proteins found in plasma. They're part of your body's
natural defences. They recognise foreign substances, such as germs,
and alert your immune system, which destroys them.
• Antigens are protein molecules found on the surface of red blood
cells.
The ABO system
• There are 4 main blood groups defined by the ABO system:
• blood group A – has A antigens on the red blood cells with anti-B
antibodies in the plasma
• blood group B – has B antigens with anti-A antibodies in the plasma
• blood group O – has no antigens, but both anti-A and anti-B
antibodies in the plasma
• blood group AB – has both A and B antigens, but no antibodies.
People who are AB+ are universal recipients, meaning
they can safely receive a blood transfusion using any
other blood type
CONT’D
• Receiving blood from the wrong ABO group can be life-threatening.
• For example, if someone with group B blood is given group A blood,
their anti-A antibodies will attack the group A cells.
• This is why group A blood must never be given to someone who has
group B blood and vice versa.
• As group O red blood cells do not have any A or B antigens, it can
safely be given to any other group.
The Rh system
• Red blood cells sometimes have another antigen, a protein known as
the RhD antigen. If this is present, your blood group is RhD positive. If
it's absent, your blood group is RhD negative.
• This means you can be 1 of 8 blood groups:
• A RhD positive (A+)
• A RhD negative (A-)
• B RhD positive (B+)
• B RhD negative (B-)
• O RhD positive (O+)
• O RhD negative (O-)
• AB RhD positive (AB+)
• AB RhD negative (AB-)
CONT’D
• In most cases, O RhD negative blood (O-) can safely be given to
anyone. It's often used in medical emergencies when the blood type
is not immediately known.
• It's safe for most recipients because it does not have any A, B or RhD
antigens on the surface of the cells, and is compatible with every
other ABO and RhD blood group.
Applied Anatomy and
Physiology
 Cardiovascular System
• The cardiovascular system is a circulatory system comprising the
heart, blood vessels and the cells and plasma that make up the blood.
• The blood vessels of the body represent a closed delivery system,
which transports blood around the body, circulating substances such
as oxygen, nutrients and hormones to the organs and tissues.
• The circulatory system also acts to remove metabolic wastes such as
carbon dioxide and other unwanted products.
• The heart is a specialised muscle, the principal function of which is to
act as a pump to maintain the circulation of blood within the blood
vessels.
• The three main types of blood vessel are arteries, veins and capillaries.
Arteries

The afferent blood vessels carrying blood away from the heart.
• The walls (outer structure) of arteries contain smooth muscle
fibres that contract and relax in response to the sympathetic
nervous system.
Veins
• The efferent blood vessels returning blood to the heart.
• The walls (outer structure) of veins consist of three layers of
tissues that are thinner and less elastic than the corresponding
layers of arteries.
• Veins include valves that aid the return of blood to the heart by
preventing blood from flowing in the reverse direction.
• The basic structure of the vessel wall is similar in all blood
vessels with the tunica intima or endothelium lining the vessel’s
lumen.
Cont’

• Externally is a connective tissue, the tunica adventitia which is

slightly thicker in arteries.
• The middle layer is a layer of smooth muscle, the tunica media,
which is much thicker in arteries and which is largely
responsible for the peripheral control of blood pressure.
• The endothelial lining of veins is enveloped to form valves
which, with external muscle influence, assist in propelling blood
back to the heart (valves are rarely taken into consideration
during venepuncture, but they can be used to benefit or to
hinder successful cannulation of a vein).
Capillaries
• These are narrow, thin‐walled blood vessels (approximately 5–
20 µm in diameter) that connect arteries to veins.
• Capillary networks exist in most of the tissues and organs of the
body, and the narrow cell walls allow exchange of material
between the contents of the capillary and the surrounding
tissue.
• The networks are the site of gas, nutrient and waste exchange
between the blood and the respiring tissues.
The Heart
• The heart is composed of cardiac muscle; involuntary muscle
tissue only is found within this organ.
• It is a small but complex organ. The left side of the heart
delivers oxygenated blood, via the aorta, to the systemic
circulation.
• The right side of the heart receives deoxygenated blood
Cardiac Cycle
• The cardiac cycle is defined as the sequence of pressure and volume
changes that take place during cardiac activity. The time of a cycle in a
healthy adult is approximately 0.9 seconds, although it varies
considerably, giving an average pulse rate of around 70 beats per
minute (bpm). There are two elements of the cardiac cycle:
• Systole: rapid contraction of heart, 0.3 sec
• Diastole: resting phase, 0.5 sec.
• Heart Rate (HR)
• The number of ventricular contractions occurring in one minute.
• Stroke Volume (SV)
• The volume of blood ejected in one ventricular contraction,
approximately 70 ml
Cardiac Output (CO)

• The amount of blood ejected from one ventricle during one minute
(i.e., stroke volume × heart rate). The cardiac output of the right
ventricle passes through the lungs, while the output from the left
ventricle passes into the aorta and is distributed to the organs and
tissues.
• The cardiac output is a product of stroke volume and heart rate
described by the following equation: CO = SV × HR and is directly
affected by three factors:
• Filling pressure of the right side of the heart
• Resistance to outflow (peripheral resistance)
• Functional state of the heart‐lung unit.
 Conduction System
• The aim of the conduction system is to enable atrial and ventricular
contraction to be coordinated efficiently.
• Contraction or depolarisation of the heart is initiated via impulses
generated in the sinoatrial node (SAN) and conducted through
adjacent atrial muscle cells, causing systole in both atria.
• The depolarisation continues on to the atrioventicular node (AVN).
• These two nodes have their own inherent rhythm of: SAN 80 bpm
and AVN 40 bpm. The AVN conducts the impulse on via the Bundle
of His to the ventricles.
• These nerves divide into Purkinje fibres throughout the ventricles,
and the result is to depolarise the whole ventricle
Description
• The SAN is considered to be the heart’s pacemaker and is under the influence of
the sympathetic and parasympathetic nervous systems.
• The parasympathetic system (via the Vagus nerve) acts to slow the heart while the
sympathetic system increases the heart rate and volume intensity.
• As well as the nervous and chemical stimulation, there are hormonal influences
on the cardiovascular system. The kidneys produce renin which converts to
angiotensin II, which is an extremely powerful vasoconstrictor.
• In addition, the adrenal medulla can produce central release of catecholamines,
which simulate the action of the β receptors and induce sympathetic stimulation
of the heart.
• Finally, there is a hormone released by the vessel endothelium known as
endothelium‐derived relaxing factor (EDRF) which causes vasodilatation.
• Thus, control of the cardiovascular system can be seen to consist of a highly
complex series of mechanisms that can easily be disturbed by external factors
such as sedation. In young and healthy individuals, the compensatory
mechanisms are more than adequate to deal with this, but in the frail and elderly
cardiovascular problems develop much more readily and allowance should always
be made for this. This may also be true for those recovering from serious illnesses
or who may be debilitated for any other reason.
Heart Rate
• The heart rate will vary depending on age, anxiety and the
presence of systemic pathology. Average heart rates are
illustrated in Table 2.1
Tachycardia

• Tachycardia refers to a rapid heart rate (>100 bpm in adults).

Tachycardia may be a perfectly normal physiological response to
stress or exercise.
• However, depending on the mechanism of the tachycardia and the
health status of the patient, tachycardia may be harmful and require
medical treatment.
• Tachycardia can be harmful in two ways. First, when the heart beats
too rapidly, it may pump blood less efficiently.
• Second, the faster the heart beats, the more oxygen and nutrients it
requires. As a result, the patient may feel out of breath or, in severe
cases, suffer chest pain. This can be especially problematic for
patients with ischaemic heart disease
Bradycardia
• Bradycardia is defined as a resting heart rate <60 bpm in adults. It is
rarely symptomatic until the rate drops below 50 bpm.
• It is quite common for trained athletes to have slow resting heart
rates, and this should not be considered abnormal if the individual
has no associated symptoms.
• Bradycardia can result from a number of causes which can be
classified as cardiac or non‐cardiac. Non‐cardiac causes are usually
secondary, and can involve drug use or misuse; metabolic or
endocrine issues (especially related to the thyroid), neurologic
factors, and situational factors such as prolonged bed rest.
• Cardiac causes include acute or chronic ischaemic heart disease,
vascular heart disease or valvular heart disease.
• The blood is driven through the vascular system by the pressure
produced on ejection of the blood from the ventricles followed by the
elastic response of the major arteries
 Blood Pressure
• Blood pressure refers to the force exerted by circulating blood on the walls of
blood vessels.
• It is a function of cardiac output and peripheral vascular resistance.
• Blood pressure is important as it maintains blood flow to and from the heart,
the brain, kidneys and other major organs and tissues.
• The systolic pressure is defined as the peak pressure in the arteries, which
occurs near the beginning of the cardiac cycle.
• The diastolic pressure is the lowest pressure (at the resting phase of the
cardiac cycle).
• Typical values for a resting, healthy adult human are approximately 100–
130 mmHg systolic and 60–85 mmHg diastolic (average 120/80 mmHg).
• These measures of blood pressure are not static but undergo natural
variations from one heartbeat to another and throughout the day.
• They also change in response to stress, nutritional factors, drugs or disease.
Hypertension refers to blood pressure being abnormally high; hypotension,
when it is abnormally low.
Control of Blood Pressure
• Blood pressure (BP) is affected by the peripheral vascular resistance (PR)
and the cardiac output (CO). Peripheral resistance results from the natural
elasticity of the arteries and is an essential feature of the circulatory
system. When the heart contracts, blood enters the arteries faster than it
can leave, resulting in the arteries stretching from the pressure. As the
reverse pressure begins to exceed the ejectory pressure, the aortic valve
closes and the atria refill.
• The factors affecting blood pressure are many and include:
• Baroreceptor mechanism
• Carbon dioxide
• Hypoxia and chemoreceptors
• Respiratory centre
• Sensory nerves
• Higher centres
• Drugs.
cont’
• Each of these will be briefly considered.
• Baroreceptor mechanism: Baroreceptors are pressure receptors found
in the aortic arch and carotid sinus. Increased baroreceptor activity
inhibits vasomotor centre (VMC) activity in the brain, leading to
arterial vasodilatation, a lowering in PR and a consequent fall in BP.
Similarly, decreased baroreceptor activity disinhibits VMC activity
leading to arterial vasoconstriction, a rise in PR, with a
corresponding rise in BP. Receptors can also be stimulated
artificially, for example external pressure on the neck by high shirt
collars.
• Carbon dioxide: Carbon dioxide (CO2) is essential for the functioning
of the VMC. A decrease in CO2 leads to decreased VMC activity and a
fall in BP, with an increase in CO2 having the opposite effect.
Cont’
• Sensory nerves: Pain modifies the activity of the VMC, with mild pain
increasing VMC activity, leading to an increase in BP.
• Severe pain decreases VMC activity and may lead to a drop in BP.
• In this situation, the body is acting in a protective way.
• The mechanisms by which this occurs are complex.
• Higher centres: Emotional stress or excitement often increases BP by
affecting the VMC and also increases cardiac output.
• In emotional shock there may be a fall in BP, e.g. at the sight of
blood.
• Drugs: The majority of anaesthetic and sedative drugs cause a drop in
BP by reducing the brain’s ability to respond to stimuli to change BP,
and the muscle relaxant effect therefore leads to a reduction in PR. It
is, therefore, essential to monitor blood pressure throughout
procedures involving general anaesthesia or sedation.
Irregularities in Blood Pressure
• Hypertension (High Blood Pressure)
• Hypertension exists when the blood pressure is chronically
elevated. It is defined as values > 140 mmHg Systolic Blood
Pressure (SBP) and/or > 90 mmHg Diastolic Blood Pressure
(DBP).
• Degrees of hypertension are recognised and classified as
in Table 2.2
Cont’
Predisposing factors include:

• Age (blood pressure rises with age)

• Obesity
• Excessive alcohol intake
• Genetic susceptibility.
Hypotension (Low Blood Pressure
• Hypotension results if the systolic blood pressure falls below
90 mmHg.
• It often presents with the features of shock, including tachycardia
and cold and clammy skin.
• The common symptoms of hypotension are light‐headedness and
dizziness and, if the blood pressure is sufficiently low, syncope
(fainting) often occurs.
• This situation is not uncommon in the dental surgery and is normally
easily managed.
• Low blood pressure in patients presenting at assessment may be due
to autonomic failure as a result of drugs that interfere with
autonomic function, for example tricyclic antidepressants, or drugs
that interfere with peripheral vasoconstriction including nitrates and
calcium antagonists.
Importance of Blood Pressure in the
Dental Patient
• Dental treatment is perceived as a stressful situation by many
patients and in this situation blood pressure may be elevated.
• This becomes an issue mainly in patients with underlying
cardiovascular disease and can predispose to cardiovascular
events such as myocardial infarction, and stroke.
Vascular Anatomy of Upper Limb Relevant
to Sedation
• An understanding of the anatomy of the arm is important since
the most commonly used veins for cannulation are the
superficial veins of the dorsum of the hand (Figure 2.5), and the
anticubital fossa (Figure 2.6).
• It is important to note that in the antecubital fossa (Figure 2.6)
there are three important structures that must be avoided:
• The brachial artery
• The median nerve
• Bicipital aponeurosis.
• Fortunately, all three are to be found on the medial aspect of the
fossa and so injections are placed lateral to the easily palpable
biceps tendon in order to avoid these structures.
 Route of Drug Transfer to the Brain
• On injecting the IV sedation drug it travels in the venous circulation to the
heart and is then distributed through the arterial system to the brain where
it has its principal effect.
• The actual route taken is as follows: After the drug is injected into the dorsal
veins it passes into the cephalic and basilic veins to the median vein,
brachial and axillary veins to reach the subclavian vein; from here it travels
through the brachiocephalic vein to the superior vena cava and into the right
atrium. The drug then passes through to the right ventricle and through the
pulmonary artery to the lungs.
• Following oxygenation of the blood in the lungs the drug will pass back
through the pulmonary veins to the left atrium and into the left ventricle.
Travelling through the aorta the sedation agent will reach the GABA
receptors in the brain via the carotid and cerebral arteries where it has its
effect.
Respiratory System
• The respiratory system facilitates oxygenation of the blood with
a concomitant removal from the circulation of carbon dioxide
and other gaseous metabolic waste.
• Anatomically, the respiratory system consists of the nose,
pharynx, larynx, trachea, bronchi and bronchioles.
• The bronchioles lead to the respiratory zone of the lungs which
consists of respiratory bronchioles, alveolar ducts and the
alveoli, the multi‐lobulated sacs in which most of the gas
exchange occurs.
Upper Airway
• The upper airway consists of the nose and pharynx. The pharynx
is divided into three sections: nasopharynx, oropharynx and
laryngopharynx (Figure 2.7).
Lower Airway
• The lower airway (Figure 2.8) consists of the:
• Larynx – The mucosa of the larynx (voice box) is very sensitive, and if irritated
the cough reflex is initiated by the strong muscles surrounding the structure.
This acts as a protective mechanism preventing the entry of foreign objects.
• Trachea – The trachea is a continuation of the larynx beginning at the level of
the sixth cervical vertebra. It is approximately 11 cm long with a diameter of
20 mm. The trachea bifurcates into the right and left bronchi.
• Bronchi – The left bronchus emerges at an angle of approximately 45 degrees
from the trachea. The right bronchus branches off at an angle of 25 degrees; it
is approximately 2.5 cm in length and, for this reason, inhaled foreign bodies
tend to be directed to the right lung. The main bronchi then divide into
smaller branches to supply the lobes of the lungs.
• Bronchioles – The bronchioles are a continued division of the bronchi which
themselves divide further into the alveolar ducts, alveolar sacs and alveoli. It
is within the capillary beds of the alveoli that exchange between air and
carbon dioxide in the blood occurs.
Respiration
• The process of respiration consists of external and internal
mechanisms.
• External respiration – where there is an exchange of gases
between lungs and blood
• Internal respiration – involving exchange of gases between blood
and cells.
• With an inhalation sedation agent, the gas must enter the lungs,
cross the alveolar membranes to be absorbed into the blood, be
pumped round the left side of the heart into the arterial blood
before reaching the tissues of the body. There are, therefore,
three aspects of this process: entry into the lungs; circulation to
the tissues; and excretion or removal from the body.
Control of Respiration
• Ventilation of the lungs is carried out by the muscles of
respiration and is under the control of the autonomic nervous
system from part of the brain stem, the medulla oblongata and
the pons. This area of the brain forms the respiration regulatory
centre (Figure 2.9).
Cont’
• This control centre receives information from a variety of
sources including other brain receptors, the lungs, the blood
vessels and the respiratory muscles.
• In addition, the respiratory centre receives information from
various chemoreceptors in the medulla which monitor the pH of
the cerebrospinal fluid.
• Changes in pH are largely influenced by the rise and fall of
carbon dioxide levels since increased carbon dioxide (CO 2)
availability leads to an increase in hydrogen ion availability (and
a lowering of pH) as carbonic acid forms.
References
• https://pocketdentistry.com/applied-anatomy-and-physiology/