Martin Caon

Lecture Notes,
Worksheets, and
Exercises for Basic
Anatomy and
Physiology
Lecture Notes, Worksheets, and Exercises
for Basic Anatomy and Physiology
Martin Caon

Lecture Notes, Worksheets,

and Exercises for Basic
Anatomy and Physiology
Martin Caon
[Retired from Flinders University of South Australia]
Clarence Park, SA, Australia

ISBN 978-3-031-56295-2    ISBN 978-3-031-56296-9 (eBook)

https://doi.org/10.1007/978-3-031-56296-9

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Switzerland AG 2024
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By the Same Author

Caon, M. (2020) Examination Questions and Answers in Basic Anatomy and Physiology: 3rd ed.
2900 multiple choice questions and 64 essay topics, Springer, 742p. ISBN: 978-3-030-47313-6,
ISBN 978-3-030-47314-3 (eBook) https://doi.org/10.1007/978-3-030-47314-3
Caon, M. and Hickman, R. (2003) Human Science: Matter and Energy in the Human Body 3rd ed.
Crawford Publishing House, Adelaide 472 p. ISBN 0 8633 3255 3

v
Abstract

A first-year university level course of introductory Human Anatomy and Physiology

is presented as student’s notes for 26 lectures that follow an organ-systems based
approach. Some required basic chemistry and physics is also included. Many lec-
tures have “additional material” which is provided for the student’s interest but is
excluded from the study course. Accompanying each lecture set are short-answer
type revision questions that cover the important points of the lecture presentations.
The answers may be constructed from the preceding lecture material. To ensure that
the important points are not missed, extensive suggested answers to each of these
212 questions are provided and appear after the lecture material. Most of these ques-
tions have been used in end-of-course examinations. Also used in these examina-
tions were the multiple-choice questions presented in a previous publication: Caon,
M. (2020) Examination Questions and Answers in Basic Anatomy and Physiology:
3rd ed., 2900 multiple choice questions and 64 essay topics, Springer.

vii
Contents

Lecture 1: Cells and Tissues����������������������������������������������������������������������������    1

Lecture 2: Review of Chemistry ��������������������������������������������������������������������   11
Lecture 3: The Integument������������������������������������������������������������������������������   25
Lecture 4: Thermoregulation and Homeostasis��������������������������������������������   31
Lectures 5 and 6: Musculo-Skeletal System��������������������������������������������������   37
Lectures 7 and 8: Digestive System����������������������������������������������������������������   51
Lectures 9 and 10: Endocrine System & Hormones������������������������������������   65
Lectures 11 and 12: Urinary (Renal) System������������������������������������������������   77
Lectures 13–16: Nervous System��������������������������������������������������������������������   89
Lecture 17: Special Senses������������������������������������������������������������������������������ 109
Lecture 18: Blood �������������������������������������������������������������������������������������������� 115
Lecture 19: Cardiovascular System: Anatomy of the Heart������������������������ 127
Lecture 20: Anatomy, Structure and Function of Blood Vessels ���������������� 135
Lecture 21: Pressure and Fluid Dynamics���������������������������������������������������� 141
Lecture 22: Control of Blood Pressure���������������������������������������������������������� 149
Lectures 23 and 24: Anatomy and Physiology of Respiration �������������������� 159
Lectures 25 and 26: Reproductive System���������������������������������������������������� 171

Suggested Answers to the Lecture Revision Homework Exercises ������������ 181

ix
Lecture 1: Cells and Tissues

1 Cell Theory

The cell is the basic structural and functional unit of the body.
Procaryotes – bacteria (no nucleus or organelles except ribosomes)
Eucaryotes – plant and animal cells

2 Components of (Animal) Cells

1. Plasma membrane
2. Cytoplasm is the content of the cell, excluding the nucleus. Cytosol is the vis-
cous gel-like fluid in which the organelles and inclusions are suspended and in
which proteins, enzymes, ions and many other small molecules are dissolved.
Many metabolic reactions occur in the cytosol.
3. Organelles – specialised structures of a characteristic shape that carry out spe-
cific roles in the cell.
• Mitochondria: inner membrane folded into cristae (large surface area); they
produce ATP (adenosine triphosphate); Krebs cycle occurs inside. They are
able to replicate themselves.
• Lysosomes: membrane-enclosed vesicles (formed in the Golgi) containing an
acidic environment with enzymes capable of digesting (lysing) a wide variety
of molecules.
• Centrosome: contains two centrioles that function in a cell division.
• Ribosomes: contain large amounts of RNA (ribonucleic acid); they synthe-
sise proteins from amino acids.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 1

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_1
2 Lecture 1: Cells and Tissues

• Nucleus: largest organelle; a nuclear membrane with pores, which contains

(one or more) nucleolus and chromatin (deoxyribonucleic acid (DNA) and
associated proteins).
• (Multi-nucleate cells: muscle fibres, osteoclasts
• Cells without a nucleus: erythrocytes)
• Endoplasmic reticulum: a system of membrane-enclosed channels continu-
ous with the nuclear membrane (providing a large surface area); the rough
ER is studded with ribosomes and stores newly synthesised molecules (by
ribosomes); the smooth ER is the site of fatty acids, phospholipids and
­steroid synthesis;
• Golgi complex (apparatus): four to six flattened sacs (cisterns) stacked on top
of each other; it processes and delivers (via Golgi vesicles) lipids and proteins
to the plasma membrane for secretion.
• Flagella and Cilia: motile structures – sperm has a flagellum; the respiratory
tract, the brain ventricles, some ducts in the testes and the fallopian tubes have
ciliate cells.
• Cytoskeleton: responsible for the movement of cells (e.g. phagocytes) and
the movement of organelles and molecules within the cell and support and
shape of the cell. Microfilaments – e.g. in muscle cells; microtubules – e.g.
in the cilia.

3 Cell Membrane (Plasma Membrane)

It is a thin (6–10 nm) barrier separating the internal components of the cell from
the exterior environment. It regulates the passage of substances into and out of
the cell.
Fluid mosaic model of membrane structure: the membrane is a bilayer of lipids
and has a mosaic of proteins “floating” (like icebergs) in a “sea” of lipids.
Lipids are phospholipids (75%), which form a bilayer, and cholesterol (20%).
Proteins are integral (one end in the cell and the other end out of the cell) or
peripheral.
Membrane proteins act as:
• Enzymes (catalyse reactions)
• Receptors (for signalling chemicals, e.g. hormones)
• Transporters (selectively allow entry to some solutes via channels (ATP-ases))
• Joiners (allow cells to adhere to each other)
• Recognisers (glycoproteins = identification tags)
• Attachment (to the cell’s internal cytoskeleton and to extracellular structures)
5 Transport of Ions and Molecules Through the Plasma Membrane 3

4 Diffusion

All molecules and ions are in constant motion. In fluids, these particles move quite
separately; the higher the temperature is, the faster is the motion. As particles
approach each other, electrostatic forces cause them to repel. That is, particles are
continually “bouncing off” each other as they move. Particles suffer millions of col-
lisions per second. This continual random movement of particles amongst each
other is called diffusion. It is the way particles move about inside and around cells
(in the absence of specific transport mechanisms).

5 Transport of Ions and Molecules Through

the Plasma Membrane

1. Diffusion of ions and molecules occurs along a concentration gradient (from Hi

concentration to Lo concentration):
(a) Lipid-soluble molecules (O2, CO2, NH3, urea, alcohol, N2, steroids, some
vitamins) pass through the lipid bilayer.
(b) Water-soluble molecules pass through pores formed by integral proteins
(e.g. K+, Ca2+, Cl−, HCO3−).
(c) H2O molecules pass rapidly through channels called aquaporins.
Facilitated diffusion (of e.g. glucose) along a concentration gradient is
assisted by specific protein carrier molecules in the membrane.
2. Osmosis: the net movement (diffusion) of water through pores (aquaporins) in a
selectively permeable membrane along its concentration gradient.
3. Active transport: requires energy (from ATP) to move ions, amino acids and
monosaccharides against their concentration gradient or charge gradient, e.g.
the “Na+-K+ pump”.
(Secondary active transport: some substances, e.g. monosaccharides and
amino acids, pass through the membrane using energy expended producing the
Na+/K+ gradient.)
4. Bulk transport: a plasma membrane engulfs the substance, and the membrane-­
enclosed vesicle moves through the membrane. Endocytosis brings large sub-
stances (e.g. red blood cells (RBC), bacteria, proteins, polysaccharides) into the
cell, and exocytosis takes large substances out of the cell (e.g. at synapses, neu-
rotransmitters are released from their vesicles by exocytosis).
4 Lecture 1: Cells and Tissues

6 Tissues

Tissue: a group of similar cells (usually of common embryonic origin) that function
together to carry out specialised activities
Biopsy: the removal of the sample of living tissue for staining and examination
under the microscope
Histology: the microscopic study of tissues

Four Primary Types of Body Tissue

1. Epithelial tissue: (3% of the body) covers body surfaces; lines hollow organs,
body cavities and ducts; and forms glands.
• Cells closely packed (little extracellular material) and tightly bound together
• One end of the cell is attached to the basement membrane (basal lamina) and
the other end is the internal surface of the cavity or duct to a space
• No blood supply (diffusion or absorption)
• High rate of cell division
2. Connective tissue (CT): (45% of the body) widely distributed tissue; basement
membranes, bone, fat, blood, tendons, cartilage. It protects and supports the
body and organs, binds organs together, stores energy as fat and provides
immunity.
• It consists of cells surrounded by an intercellular matrix (= ground substance
and fibres).
• The matrix may be fluid, semi-fluid, gelatinous, fibrous or calcified.
• It has few cells and much matrix (extracellular material).
• It is highly vascular (except cartilage)
1. Muscle tissue: it consists of 50% of the body.
2. Neural tissue: it forms 2% of the body.
3. Epithelial Tissue (Epithelium)
(Layers of cells or glands)
• Simple squamous: it consists of a single layer of flat (squashed) cells, so dif-
fusion through the layer takes place easily. It lines the heart, lymph and blood
vessels (known as endothelium). It is called mesothelium when in serous
membranes.
• Simple cuboidal: it forms a single layer of cube-shaped cells. The cells
secrete or absorb, e.g. kidney tubules or the retina.
• Simple columnar: it is a single layer of rectangular cells (column like). The
cells secrete or absorb, e.g. line the GI tract, where some are goblet cells and
some have microvilli.
7 Connective Tissue 5

• Stratified transitional: this consists of variable-shaped cells that are several

layers thick and are able to stretch. The cells line the urinary bladder.
• Stratified squamous: it consists of several layers of cells for protection in
areas of high wear. It is cuboidal to columnar in deep layers and squamous in
superficial layers. Keratinised cells form the outer layer of the skin. Non-­
keratinised cells line the mouth, oesophagus, tongue, vagina and anus.
• Pseudostratified columnar: this forms a single “layer”. All cells are attached
to the basement membrane, but some do not reach the surface of the layer. The
cells line the male urethra and upper respiratory tract. Some are ciliated, and
some are goblet cells.
• Glandular epithelium: Exocrine glands secrete oil, wax, milk, sweat, tears,
saliva and digestive enzymes into ducts. Endocrine glands secrete hormones,
which diffuse into extracellular fluid and into the blood.

7 Connective Tissue

(-blast = an immature cell; it secretes the matrix -cyte = a mature cell.)

Nine (or So) Cell Types
• Fibroblasts (form fibres): they are always present in CT. They secrete hyal-
uronan and protein (= proteoglycans) and also secrete collagen, elastin and
glycoprotein, which make up collagen fibres, elastic fibres and reticular fibres
(respectively) in the matrix. Some become fibrocytes.
• Chondroblasts: in the cartilage, they secrete matrix and become
chondrocytes.
• Osteoblasts: in the bone, they produce the organic matrix of bone and become
osteocytes.
• Haemocytoblasts: in the bone marrow, they become red blood cells and
white blood cells (WBC).
• Adipocytes: fat storage cells.
• Leucocytes (white blood cells): these function for defence. They include neu-
trophils and eosinophils (= microphages), basophils, monocytes and
lymphocytes.
• Macrophages (develop from monocytes – a WBC): these are large cells that
can engulf bacteria and cellular debris (perform phagocytosis).
• Mast cells: they produce histamine and heparin, which stimulate inflammation.
• Plasmocytes (develop from B lymphocytes – a WBC): they secrete antibod-
ies and hence provide immunity.
Intercellular matrix composition – it has two components: protein fibres (col-
lagen, elastin and reticulin) embedded in liquid and gel or solid ground substance
(which contains a diversity of large molecules). The ground substance is amorphous
and surrounds cells. It binds, lubricates, supports and provides a medium through
which substances can diffuse.
6 Lecture 1: Cells and Tissues

8 Classification: Four Types of Connective Tissue

(In terms of the nature of the ground substance and the types and organisation
of fibres)
1. Loose CT: packing material in space between organs
(a) Areolar: widely distributed; contains many cells; mostly collagenous fibres;
contains hyaluronic acid; around vessels, nerves and muscles; forms the
synovial membrane, subserous fascia and superficial fascia (= hypodermis)
layer under the skin
(b) Adipose: fat cells (adipocytes) in loose CT; stores fat (triglyceride) and,
hence energy; supports and protects organs
(c) Reticular: with mainly reticular fibres; in the spleen, liver and lymph nodes
2. Dense CT: fibres occupy most of the volume.
(a) Dense regular: shiny white appearance, tough and mainly collagen fibres
arranged in a regular pattern; form tendons, ligaments, deep fascia and
aponeuroses
(b) Dense irregular: irregularly arranged collagen fibres; found in the dermis,
heart valves, around cartilage (perichondrium), periosteum, fibrous capsules
around kidney, liver, spleen, dura mater
(c) Elastic: strong and stretchy; elastic fibres allow the tissue to stretch and snap
back. Occur in lung, artery walls, vocal cords, vertebral ligaments, suspen-
sory ligament of penis.
3. Supportive CT
(a) Cartilage: very tough; it has no blood vessels or nerves. Cells are chondro-
cytes, which occur in spaces called lacunae. Perichondrium surrounds carti-
lage. e.g. Collagen and elastin fibres. It contains chondroitin sulphate in the
ground substance.
• Hyaline cartilage (gristle): the most common; bluish white; the ends of long
bones, the nose, the trachea, and bronchi; flexible
• Fibrocartilage: rigid; vertebral discs; menisci in the knee
• Elastic cartilage: is elastic; found in ear lobe, epiglottis, eustachian tube.
(b) Bone: it is rigid but not brittle. Osteocytes are in the lacunae and connected
by canaliculi. Bone consists of: Inorganic calcium hydroxyapatite, collagen
fibres and water matrix.
4. Liquid CT – has no fibres
(a) Blood: erythrocytes (RBC), leucocytes (WBC) and platelets in a liquid
matrix called plasma
(b) Lymph = lymphocytes + interstitial fluid
10 Additional Information 7

9 Serous Membranes and Mucous Membranes

Serous membranes (serosa) consist of thin layers of areolar CT and are covered by
mesothelium. They line internal body “cavities” and organs within the cavity. They
secrete serous fluid, a lubricating fluid. Has parietal and visceral portions.
e.g. Pleura, peritoneum, pericardium.
Mucous membranes (mucosa) consist of epithelium on top of CT (lamina pro-
pria) and are often surrounded by smooth muscle (muscularis mucosae). They line
body cavities that open to the exterior (mouth, oesophagus, stomach, intestine).
They secrete mucous to lubricate and prevent drying.
Location of Systems Within Cavities
The dorsal cavity contains the brain and spinal cord.
The thoracic cavity contains the heart and great blood vessels in the medias-
tinum, the lungs and some air passages.
The abdominal cavity contains the renal system and most of the diges-
tive system.
The pelvic cavity contains the bladder, female reproductive organs and part
of the large intestine.
Viscera = body organs of the abdomino-pelvic cavity
Abdomino-pelvic cavity = ventral cavity
Structures Outside Body Cavities
Skeletal system, integumentary system, skeletal muscle, kidneys (and adre-
nals), pancreas, duodenum, testes, sense organs, peripheral nerves and
blood vessels

10 Additional Information

Mitochondria
In addition to energy production, mitochondria play a role in several other cellular
activities. For example, mitochondria help regulate the self-destruction of cells
(apoptosis). They are also necessary for the production of substances such as cho-
lesterol and heme (a component of haemoglobin, the molecule that carries oxygen
in the blood).
Mitochondrial DNA contains 37 genes, all of which are essential for normal
mitochondrial function. Thirteen of these genes provide instructions for making
enzymes involved in oxidative phosphorylation. The remaining genes provide
instructions for making molecules called transfer RNAs (tRNAs) and ribosomal
RNAs (rRNAs), which are chemical cousins of DNA. These types of RNA help
assemble protein building blocks (amino acids) into functioning proteins.
8 Lecture 1: Cells and Tissues

The Human Body Described

The human organism is a complex arrangement of many different cells arranged
into four types of tissues. These are epithelial, muscular, nervous and connective.
Two or more tissue types that perform specific functions form a structure called an
organ. A group of organs that act together to perform a particular body function is
an organ system, of which there are 11. Together, all these organ systems maintain
a living organism, such as a human being.
Organisational units (from smallest to largest): chemicals/molecules, organelles,
cells, tissues, organs, organ systems, and human organisms.
Body Cavities
The body is made up of a number of “cavities” that are filled with organs and
enclosed by a membrane. The body has two main cavities: the ventral cavity (which
includes thoracic, abdominal and pelvic cavities) and the dorsal cavity (comprising
the cerebral and spinal cavities).
Cavity Membranes
Organs within a cavity are surrounded by a serous membrane. The outer membrane
is called the parietal membrane, and the layer in contact with the organs is known as
the visceral membrane. The cerebrospinal membranes are called meninges.
Anatomical Directional Terms
It is necessary to be able to describe the location of any body structure in relation to
another, in a language that everyone can understand (especially other health profes-
sionals). For this reason, a number of scientific DIRECTIONAL TERMS are used
that refer to any area of the body.
For a body standing in the “anatomical position”, the following pairs of oppos-
ing directional terms are used: anterior/posterior, superior/inferior, medial/lateral,
proximal/distal and superficial/deep.
Abdominal Regions
The nine abdominal regions are named: left hypochondriac, epigastric, right hypo-
chondriac, left lumbar, umbilical, right lumbar, left inguinal, hypogastric and right
inguinal.
Body Planes
The body may be (theoretically) “sliced” in order to look at cross-sectional views
and be able to recognise internal structures. Such views, produced by imaging
machines, are used for diagnostic purposes. The terminology used to describe these
body planes are frontal (or coronal), sagittal and transverse planes.
Regional Anatomical Terminology
It is useful to learn names of anatomical body regions as they form the stem words
of many medical terms: cephalic, cranial, frontal, buccal, mental, facial, orbital,
oral, acromial, axillary, brachial, carpal, palmar, mammary, umbilical, inguinal,
pubic, phalangeal, lumbar, sacral, coxal, gluteal, femoral, popliteal, patellar, sural,
crural, calcaneal, tarsal, pedal and plantar.
11 Cells and Tissues Homework Exercise 1 9

11 Cells and Tissues Homework Exercise 1

1. Name four of the organelles in a cell and describe their function.

2. Describe the structure of the plasma membrane (cell membrane).
3. Define the processes of “diffusion” and “osmosis”.
4. What roles do proteins play in a cell’s plasma membrane?
5. What is active transport?
6. Name and briefly describe the four types of tissue.
7. What are the functions of the epithelial tissue?
8. What is the difference between “loose” connective tissue and “dense” connec-
tive tissue?
9. From which of the four types of tissue are the following seven structures made:
bone, lymph, tendon, cartilage, adipose tissue, glands and epidermis?
10. What structure separates the thoracic and abdominal cavities, and what is it
made of?
11. What is the collective name for the contents of the ventral cavity?
12. What are the main functions of these membranes and the potential space
they form?
13. What is the clinical condition that develops when air is able to enter the poten-
tial space of the pleural membrane?
14. What is the clinical condition called when the membrane of the abdominal cav-
ity is inflamed?
15. How does an organ differ from a tissue?
16. Using the gastrointestinal tract as an example, list the cavity/cavities in which
organs of this system are found.
17. Do all organs of the body lie within a body cavity? If not, give examples.
18. Using directional terms, describe the appearance of the body when it is stand-
ing in the “anatomical position”.
19. Describe the position of each of the following using anatomical, directional
terms: ear (compared to the nose and chin), elbow (compared to the wrist and
shoulder) and vertebrae (compared to the sternum and kidneys).
Lecture 2: Review of Chemistry
(Text ref: Caon & Hickman 3rd ed pp 9–10,
53–54, 80–81 (sec 3.), 158–164, 170–180
and 224–2s26.)

1 Some Terms Defined

Most matter is usually “impure”, being a mixture of variable amounts of several

different substances.
Iron ore (is a mixture), iron (Fe) (an element), iron oxide (a compound of 2 ele-
ments), steel (an alloy), haemoglobin (a molecule with four atoms of Fe)
Element: refers to 90 naturally occurring simplest substances (listed in the “peri-
odic table” – have chemical symbols)
http://www.chemicalelements.com/index.html
(or http://www.periodicvideos.com/)
Atom: the smallest particle of an element (contains protons, neutrons and electrons)
Proton: +vely charged subatomic particle in the nucleus of an atom (atoms of dif-
ferent elements have different numbers of protons)
Neutron: subatomic particle in the nucleus of an atom
Electron: −vely charged subatomic particle outside of the nucleus; tiny yet occu-
pies the bulk of space in an atom
Chemical bond: occurs when the outer electron(s) of an atom participate with those
of another atom in joining two or more atoms together to form a new substance
(a “compound”)
Metal elements (left-hand side (LHS) of the periodic table): always lose (donate)
electrons in chemical reactions
Non-metal elements (right-hand side (RHS) of the periodic table): always gain
electrons in chemical reactions
Compound: a substance formed when atoms from two or more elements are chemi-
cally combined in fixed proportions (have a formula, e.g. H2O, C6H12O6)
Molecular compounds: atoms forming the molecule are from non-metal elements,
covalently bonded

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 11

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_2
12 Lecture 2: Review of Chemistry

Covalent bond: the bond between two non-metal atoms in a molecule (the atoms
share electrons, so BOTH gain electrons)
Molecule: the smallest particle of a molecular compound; consists of two or more
atoms joined by covalent bonds
Ionic (non-molecular) compounds: formed when metal atoms (ionically) bond to
six to eight surrounding non-metal atoms (and vice versa) – continuous crystal
lattice structure.
Ionic bond: the attraction between a metal atom and all the surrounding non-metal
atoms in the lattice (the non-metal atoms gain electron(s), while the metal atoms
lose electron(s)
Ion: an atom that has gained (if a non-metal) or lost (if a metal) one (or more)
electron(s) (when an ionic substance dissolves in water, ions separate and move
about freely as electrolytes).
Molecules can be ions too!
Organic molecules: contain long chains of carbon atoms bonded to each other.

2 Suspensions and Solutions

These are mixtures in which one or more substances are dispersed throughout
another.
Mechanical suspensions: the dispersed substance consists of relatively large par-
ticles that settle to the bottom quite quickly (e.g. medicines labelled “shake well
before use”, like Mylanta and injectable insulin).
Colloidal suspensions: particles are not large enough to settle quickly but are too
large to pass through semi-permeable membranes (e.g. kaolin, proteins in the
blood – produce colloid osmotic pressure)
Solutions: particles are so small that they never settle out and can often pass
through S-PM
Solutions consist of:
(a) Solvent – usually liquid (water); the major component of the mixture
(b) Solute(s): the minor component of the mixture; may be electrolytes, large ions
or molecules of solid, liquid or gas (O2, CO2)
(electrolyte – a solid substance that will conduct electricity when dissolved in
water. An electrolyte dissociates into ions, e.g. Na+, Cl−, K+, Ca++, NO3−, HCO3−,
NH4+ PO4− −, H3O+)
5 Working with Moles 13

3 Solution Concentration

The concentration of a solution is a statement about the relative amounts of the

solvent and solute present in the solution.
Per cent concentration: a common way of expressing solution concentration
(e.g. on intravenous (IV) bags):

Mass  g 
%Conc  100
Volume  ml 

Percentage concentration tells the number of grams of solute present in each 100 ml
of solution.
For example, normal saline is 0.9% Na+Cl−, which is 0.9 g of sodium chloride
per 100 ml of solution.

4 Density & Specific Gravity

Mass  g 
Density 
Volume  ml 

Density has units of grams per millilitre.

As a solution becomes more concentrated, its density increases (because adding
solute increases the mass much more than it increases the volume).
Specific gravity – density written without the units
(If urine SG = 1.009 ⇒ density = 1.009 g/ml.)
Urine specific gravity is a measure of urine’s (an aqueous solution) concentration
and may be measured with a clinical refractometer.

5 Working with Moles

The SI unit for the “amount of substance” (number of particles) is mole (symbol
mol, 1/1000 of a mole = millimole = mmol)
To measure out the mass of a mole, you must:
(a) Know or find out the chemical formula of the substance; for example, glucose
has the formula

C6 H12 O6
14 Lecture 2: Review of Chemistry

(b) Know or find out (from the periodic table) the relative atomic mass (RAM) (=
atomic weight) value for each type of atom present in the formula

 GlucoseC6 H12 O6  RAMsareC  12, H  1, O  16.

(c) Multiply the RAM values by the number of atoms of each element appearing in
the formula

12  6 atoms  72
1  12 atoms  12
16  6 atoms  96
Total  180  relative formu
ula mass

A mole of any substance is a sample of the substance having a mass, in grams, equal
to its relative formula mass.
Hence, a mole of glucose is an amount having a mass of 180 g.
For example, 1 mole of ammonia (NH3) is:
(1 × ) + (3 × ) = g.
1 mole of water (H2O) is:
(2 × ) + (1 × ) = g.
(RAM values: N = 14, O = 16, H = 1.)

A mole of any substance will always contain a fixed number of particles,

and this is what makes the mole the most suitable unit for the measurement of
the amount of any chemical.

1 mole is 6 × 1023 particles.

Molarity is solution concentration expressed in moles/L.

6 Osmosis

Osmosis is the diffusion of water molecules (H2O) across a cell membrane from the
side where the solution concentration is more dilute (i.e. where there are more water
molecules) to the side where the solution concentration is greater (i.e. where there
are fewer water molecules).
Osmosis always results in the more concentrated solution becoming more dilute.
8 A Question! 15

This means that water molecules diffuse from where their concentration is high
to where their concentration is low (NOTE: concentration of molecules ≠ number
of molecules).
Water molecules cross the membrane by passing through pores (aquaporins).
If a solution is placed on one side of a semi-permeable membrane and pure sol-
vent on the other, pure solvent will tend to move across the membrane into the solu-
tion. This movement can be prevented by applying hydrostatic pressure to the
solution. The amount of pressure required to prevent a net movement of water mol-
ecules is the osmotic pressure of that solution.
Osmotic pressure (stated in mmHg or Pa) is a measure of the tendency of water
to move into an aqueous solution. It is also another measure of solution
concentration.

7 Tonicity

Isotonic solution: a solution with an osmolarity within the range of blood’s osmolar-
ity (280–300 mmol/l). When added to blood, an isotonic solution causes no net
movement of water into or out of red blood cells.
Examples: 5% glucose, 0.9% sodium chloride and 9.5% sucrose (0.3% NaCl
+ 3.3% glucose)
Hypotonic solution: a solution with an osmolarity less than that of blood. It causes
the movement of water into RB cells (causing them to swell and perhaps lyse).
Hypertonic solution: a solution with an osmolarity greater than that of blood. It
causes the movement of water out of RB cells (causing them to shrink and
crenate).

8 A Question!

What do 5% glucose, 9.5% sucrose and 0.9% sodium chloride solutions have in
common that makes them all isotonic?
Let us compare 5% glucose with 9.5% sucrose.

5% glucose → 5 g / 100 ml → 50 g / l.

A mole of glucose is 180 g.

Therefore, 5% glucose contains
50 g ÷ 180 g = 0.28 mole of glucose in each litre of solution.

9.5% sucrose → 9.5 g / 100 ml → 95 g / l.

16 Lecture 2: Review of Chemistry

Sucrose has the formula C12H22O11, and a mole of sucrose is 342 g (check this
yourself!); therefore, 9.5% sucrose contains 95 = 0.28 mole of sucrose in
each litre. 342
So, 5% glucose and 9.5% sucrose both contain the same number of moles per
volume and therefore the same number of particles per volume.
Let us now look at sodium chloride.

0.9% NaCl → 0.9 g / 100 ml → 9 g / l.

One mole of Na+Cl− is 58.5 g; therefore, 0.9% NaCl contains 9 ÷ 58.5 = 0.15
mole of Na+Cl− in each litre of solution.
But remember! Na+Cl− is an ionic compound, and when it dissolves, it forms
separate Na+ ions and Cl− ions!
Therefore, the number of moles of particles in each litre of solution is 0.30,
which is close to that for 5% glucose and 9.5% sucrose.
So, isotonic solutions contain the same concentration of dissolved (non-­
penetrating) particles.
To note, 5% glucose, 9.5% sucrose and 0.9% Na+Cl− solutions are all isotonic.

9 The Osmole

Osmole: this is the amount of substance that must be dissolved in order to produce
6 × 1023 solute particles (be they ions or molecules) of whatever size.
For most covalent-molecular substances
No. of moles = no. of osmoles (e.g. glucose, sucrose).
For ionic substances
No. of osmoles = no. of moles × no. of ions in the formula (e.g. Na+Cl− has
two ions
∴ osmolarity = 2 × molarity).
(Osmolality – the number of osmoles dissolved in each kilogram of water
Osmolarity – the number of osmoles dissolved in each litre of solution)

10 Definitions of Acid

Acid: substance that reacts with water producing H3O+ (hydronium) ions
Strong acid: reacts completely with water producing large concentration of H3O+,
for example:
12 Self-Ionisation of Water 17

HCl  H 2 O  H 3 O  aq  Cl  aq

Hydrochloric acid (100% ionised)

Weak acid: reacts partly with water producing a relatively low concentration of
H3O+, for example:

CO2  H 2 O  H 2 CO3  H 2 O  HCO  3aq  H3O  aq

Carbonic acid (only 0.2% ionised)

(However, H2CO3 is unstable, so it exists as CO2. Carbonic anhydrase converts CO2
to H2CO3 very quickly.)

11 Definition of Bases

Substances that react with water producing OH−aq (hydroxide) ions:

NaOH  Na  aq  OH  aq

Strong base (sodium hydroxide)

NH 3  H 2 O  NH  4 aq  OH  aq

Weak base (ammonia)

12 Self-Ionisation of Water

H 2 O  H 2 O  H 3 O  aq  OH  aq

Pure water contains small, equal amounts of both H3O+aq and OH−aq.
∴ It is neutral (neither acidic nor basic).
When other substances are mixed with water, the concentration of H3O+aq or
OH−aq may go up or down depending on the nature of the substance, but in all aque-
ous solutions:

H 3 O  aq   OH  aq   constant  10 14 mol / L

For example, if H3O+aq conc. goes up, then OH−aq conc. must come down and
vice versa.
18 Lecture 2: Review of Chemistry

That is, for pure water:

H 3 O  aq   OH  aq   10 7 mol / L

13 pH, Measure of Acidity (“Puissance” of Hydrogen)

pH = −log of H3O+aq conc. (concentration expressed in mol/L); hence, there is a fac-

tor of 10 difference in concentration between pH of 7 and 8.

pH  7 Acid
pH  7 Neutral
pH  7 Basic  alkaline 

pH of stomach juice is ~1.5.

pH of blood is 7.35–7.45.
At pH = 7.4, [H3O+aq] = 4.0 × 10−8 mol/L
and [OH−aq ] = 2.5 × 10−7 mol/L.

14 Buffer

Buffer is a solution that resists change to its pH. A buffer solution contains two
components, a weak acid and its slightly basic salt. These components are “conju-
gate pairs”. One component (the basic one) is able to remove hydronium ions from
the solution; the other (the acidic one) is able to remove hydroxide ions from the
solution.
1. H2CO3/HCO3− (bicarbonate buffer in blood)
2. H2PO4−/HPO42− (phosphate buffer in cells)
3. Protein buffer (carboxylic acid group/amine group), e.g. plasma proteins in
blood and haemoglobin in RBC.

15 Additional Information

Osmolality determines osmotic pressure, but osmolarity is more often stated as it is

easier to express body fluid quantities in litres rather than kilograms of water (and
for the dilute solutions in the normal human body, the difference is small).
Osmotic pressure (mm Hg) = 19.3 × osmolality milliosmole/kilogram of water.
The osmotic pressure of blood is about 5500 mm Hg = 732 kPa.
Of seawater = 27 atm!
15 Additional Information 19

Note:
• About 0.8 of the total osmolality of interstitial fluid is due to sodium and chlo-
ride ions.
• Around 0.5 of total intracellular osmolality is caused by potassium ions.
• The osmotic pressure of plasma in capillaries is ~20 mm Hg greater than that in
interstitial fluid due to the effect of plasma proteins.
• “Calculated” mosmol/L is > “corrected” osmolar activity (mosml/L) because the
ions and molecules exert an attraction (or repulsion) on each other that decreases
(or increases) osmotic “activity”.
• Stated osmotic pressures would be exerted if the fluids were on one side of a cell
membrane and pure water on the other.
• Total osmotic pressure for plasma, 5450 mm Hg, is 19.3 times the corrected
osmolality (282.5 mosmol/L).
• Any lack of osmolalic equilibrium within a cell is corrected within seconds to a
minute (except if drinking is required, in which case it will take up to 30 mins for
fluid to distribute via the gut and blood).
• The osmolalities of extracellular and intracellular fluids remain exactly equal to
each other except for a few minutes after a change in one of the fluids occurs.
• The number of osmoles of osmotically active substance in each compartment, in
the extracellular fluid or in the intracellular fluid, remains constant unless one of
the osmotically active substances moves through the cell membranes to the other
compartment.
• The tendency for osmosis to occur is expressed in pressure units because in some
parts of the body, water also moves by filtration due to pressure differences.
Hence, the net effect of water movement by osmosis and filtration can be
assessed.
Hickman definition: isotonic solution = one that causes no net movement of
water into or out of cells.
Isotonic – solutions with ~300 mosmol/L concentration of non-penetrating solutes
Iso-osmotic – solutions with ~300 mosmol/L concentration of solutes of either a
penetrating or a non-penetrating nature
Non-penetrating solute – large polar organic molecules, plasma proteins and Na+,
Cl−, and K+ (these ions actually can pass through the plasma membrane but are
actively pumped back and, hence, are “de facto” non-penetrating)
Penetrating solute – urea
Normal range in blood:
[HCO3−] = 22–31 mmol/L.
[H+] = 35–42 nmol/L.
CO2 produced in cells dissolves in water (blood) to produce carbonic acid.
Carbonic acid disassociates into bicarbonate ions and hydrogen ions.
Hydrogen ions are buffered by phosphate, plasma proteins and bicarbonate.
20 Lecture 2: Review of Chemistry

CO2  H 2 O  H 2 CO3  HCO3   H 

(Excess CO2 is excreted by the lungs.)

(Excess H+ is excreted by the kidneys.)
Calcium is used:
–– In most stages of blood clotting
–– To bind to troponin to remove tropomyosin, which exposes the actin-binding site
in muscle contraction
–– As intracellular messenger to signal synaptic vesicles to fuse with the pre-­
synaptic membrane
–– For bone mineralisation

16 Lipoproteins in Human Plasma

ρ % lipid
Chylomicrons <0.96 98–99
VLDL 0.96–1.006 90–93
LDL 1.006–1.019 79–89
HDL 1.019–1.21 43–67

Blood Lipids
–– Total cholesterol
–– Triglycerides
–– High-density lipoprotein (HDL)-cholesterol
–– Low-density lipoprotein (LDL)-cholesterol
HDL sub-fractions (HDL2 and HDL3)
LDL sub-fractions (total apo-B, LDL apo-B, LDL-c/LDL, apo-B ratio, LDLRf)
What Is a Logarithm?
Numbers can be written as a power of 10.
For example, in 20 = 101.3010, 1.3010 is the “power of 10” that produces the
number 20.
Log10 of a number is that power of 10 that would produce that number. For
example:
1 = 100, so log(1) = 0.
10 = 101, so log(10) = 1.
100 = 102, so log(100) = 2.
1000 = 103, so log(1000) = 3.
20 = 101.3010, so log(20) = 1.3010.
4 = 100.6026, so log(4) = 0.6026.
17 Basic Chemistry Revision: Homework Exercise 2 21

log(10−8) = −8.
0.00000004 = 4.0 × 10−8 = 10−7.4.
log(4.0 × 10−8) = log (4.0) + log (10−8) = 0.6026 – 8 = -7.4.
Calculator Example
Enter:
10, xy,
8, +/−,
×, 4, =, (4 × 10−8)
Log, =, (−7.4)
So, log(4 × 10−8) = −7.4.

17 Basic Chemistry Revision: Homework Exercise 2

1. Write out the definition of each of the following 15 things:

Element:
Atom:
Proton:
Neutron:
Electron:
Chemical bond:
Metal element:
Non-metal element:
Compound:
Molecular compounds:
Covalent bond:
Molecule:
Ionic (non-molecular) compounds:
Ionic bond:
Ion:
2. Identify the name of the elements and the number of atoms in the following:
(a) C6H12O6
(b) CH3COOH
(c) NH4+ OH−
3. Which of the following compounds are covalent, and which are ionic?
(a) C6H12O6
(b) CH3COOH
(c) Na+ Cl−
(d) K+ Cl−
(e) Ba++ SO4− −
22 Lecture 2: Review of Chemistry

Chemistry Calculations:
1. By following the steps below, calculate the mass of substance per 100 ml for an
IV solution that contains 0.3% Na+Cl− and 3.3% glucose.
If a solution has a concentration of x%, then there is x gram of substance per
100 ml of solution.
(a) What mass of sodium chloride is in 100 ml of 0.3% Na+Cl−?
___________________________________
(b) What mass of glucose is in 100 ml of 3.3% glucose?
___________________________________
(c) Now add the two masses together to get the total mass dissolved in 100 ml. of a
0.3% Na+Cl− and 3.3% glucose solution.
2. Perform a similar calculation to find the mass of substance per 100 ml for a
0.224% K+ Cl− solution.
3. Perform the following steps to calculate the number of millimoles per litre in a
5% glucose solution.
(a) First calculate the mass of glucose in 1 L:
mass g  in100 ml   ________ g
(b) Multiply this answer by 10 to get grams per litre:
__________ 10  __________ gperlitre
(c) Calculate the number of moles in this many grams of glucose in two steps:
(i) Number of grams in one mole of glucose C6H12O6 (RAMs are C = 12, H
= 1, O = 16). Multiply the RAM values by the number of atoms of each
element appearing in the formula:

12  ___   1 ___   16  ___   ____  ____  ____  ________
The answer is the “relative formula mass”.
(ii) Divide the number of grams per litre [from b) above] by the relative for-
mula mass [from c) part (i)]:
_________________________ mole / l
The answer is the number of moles per litre (it should be a decimal number
less than 1.0).
(d) Multiply the answer in (c) part (ii) by 1000 (shift the decimal three places to
the right) to get the answer in mmol/l:
________ mol / l1000 ________ mmol / l
4. Calculate the number of millimoles per litre in 1 L of IV bag of normal saline
(0.9% Na+ Cl−).
5. Give the definition of an osmole.
(a) What are the particles in the glucose solution called?
(b) What are the particles in the saline solution called?
17 Basic Chemistry Revision: Homework Exercise 2 23

6. Use the number of moles per litre calculated in Q3 to state the number of osmoles
per litre in 1 L of IV bag of 5% glucose (a covalent molecular substance ← hint!).

________ moles / litre of glucose = ________ osmoles / litre of glucose

7. Calculate the number of osmol/l in a 1 L bag of 0.9% Na+ Cl- (normal saline –
an ionic substance).
8. Characterise the following solutions as hypotonic, isotonic or hypertonic to
blood plasma:
(a) 0.9% sodium chloride
(b) 0.3% sodium chloride
(c) 5% glucose
(d) 4% glucose
(e) a solution containing 3.3% glucose and 0.3% sodium chloride
(f) a solution containing 4% glucose and 0.18% sodium chloride
(g) 9% sodium chloride
9. (a) What is the pH of a solution that contains H+ at a concentration of 10−5 mol/L?
(b) Is the solution in (a) acidic or basic?
(c) What is the pH of a solution that contains H+ at a concentration of 3.2 ×
10−5 mol/L?
Lecture 3: The Integument

The skin, hair, nails, glands and several specialised receptors make up the integu-
mentary system.
Functions of the Skin
1. Body temperature regulation
2. Protection
3. Perception of stimuli
4. Excretion
5. Synthesis of vitamin D (calcitriol)
6. Immunity
7. (Social function: makeup, piercing, tattoos, keloid scars)

1 Structure of the Skin

About 7% of body weight, from 0.5 (eyelids) to 4.0 (heels) mm thick

Epidermis (outer layer): composed of epithelial cells and a dead layer
Dermis (inner layer): composed of fibrous connective tissue and exocrine glands
(Hypodermis (or “superficial fascia”): composed of adipose (and some areolar
connective) tissue; not part of the skin; stores fat, anchors skin to the muscle and
allows the skin to slide over the muscle)
1. Epidermal Cells (Four Distinct Types)
(a) Basal cells (stem cells that divide to form keratinocytes). Keratinocytes are
tightly connected to each other (by desmosomes), produce keratin (a fibrous
protein).

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 25

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_3
26 Lecture 3: The Integument

(b) Melanocytes have numerous branching processes that touch all keratino-
cytes in the basal layer; they produce melanin (a pigment that protects
against ultraviolet (UV)), which is transferred to nearby keratinocytes.
(c) Dendrocytes (Langerhans cells and Granstein cells) arise from the bone
marrow and migrate to the epidermis. They interact with lymphocytes (T
cells) to assist in the immune response against micro-organisms and skin
cancer. They are macrophages.
(d) Merkel cells are associated with a sensory nerve ending (called Merkel disc)
for fine touch and pressure.
The epidermis is NOT VASCULARISED! Nutrients reach epidermal cells by
diffusion.

2 Strata (Layers) of the Epidermis

1. Stratum germinativum/basale: it is the deepest layer, attached to the underlying

dermis by protruding epidermal ridges (epidermal ridges push the overlying epi-
dermis into “fingerprints”). It is single-cell thick and the youngest rapidly divid-
ing keratinocytes. New cells push up the older ones above. Of the layer, 10–25%
are melanocytes.
2. Stratum spinosum: this layer is 8–10 cells thick. The cells contain keratin fila-
ments that span cells, attach to desmosomes and so hold the cells together.
Blisters (from repeated rubbing) are fluid-filled pockets in the stratum spinosum
caused by the disruption of junctions between the cells – the layers of the skin
separate.
3. Stratum granulosum: it is a layer 3–5 cells thick. It contains granules that aggre-
gate keratin and contains waterproofing glycolipid*. Cells flatten and dehydrate,
and nuclei organelles disintegrate (*glycolipids are lipids that contain carbohy-
drates, usually simple sugars like glucose).
4. (Stratum lucidum (only present in thick skin – palms, soles): it consists of a few
rows of clear, dead and flattened keratinocytes.)
5. Stratum corneum: it is the most superficial layer, 20–30 cells thick – up to ¾ of
the thickness of the epidermis. It consists of dead, flat cells filled with keratin and
is durable and expendable. It protects the body against heat, light, chemicals,
bacteria and abrasion. Cholesterol and glycolipid between the cells waterproof
this layer. Burn victims lose much water because the skin is absent.
2. Dermis
The dermis contains hair follicles, oil and sweat glands, nerve fibres, blood and
lymph vessels.
It is a strong flexible connective tissue containing collagen, elastin and reticular
fibres. (The dermis of animals can be tanned to make leather.)
4 Sudoriferous (Sweat) Glands 27

Papillary Dermal Layer

This layer has folds and ridges called papillae that push up into the epidermal
layer. It contains capillaries and lymphatics that supply the skin and sensory
neurons.
The papillae contain capillary loops and light touch receptors – Meissner’s
corpuscles.
Dermal ridges – produce our fingerprints
Reticular Dermal Layer (is deep to papillary layer)
It is 80% of the thickness of the dermis. It contains Pacinian corpuscles sensi-
tive to deep pressure.
It consists of interlacing collagen fibres arranged in parallel bundles, giving
the skin strength and resilience (lines of cleavage).
Elastin fibres provide the stretch/recoil properties of the skin.
Flexure lines (occur at bone joints).

3 Glands of the Dermis

Sebaceous (oil) glands are found all over the body (except the palms and soles).
They secrete sebum into hair follicles and keep the skin and hair from drying out.
They contain triacyl glycerides, cholesterol, proteins, electrolytes and cell fragments.
Sebum inhibits the growth of bacteria.
Blocked ducts – produce “whiteheads”, and “blackheads”

4 Sudoriferous (Sweat) Glands

Eccrine (merocrine) sweat glands are coiled tubes in the dermis discharging
through the duct to the pore on the skin.
Sweat is a hypotonic filtrate of blood. It contains 99% water, Na+Cl−, vitamin C,
dermicidin (a peptide with antibiotic properties), urea, uric acid and K+ (pH = 4–6.8).
These glands have a function in thermoregulation under the control of the sym-
pathetic division of the autonomic nervous system (NS).
Apocrine sweat glands are found in the axillary, nipple and anogenital areas. They
function after puberty.
Ducts empty sweat + fatty substances and proteins into hair follicles.
Ceruminous glands in the ear canal secrete cerumen (ear wax).
Mammary glands (under the influence of pituitary hormones) secrete milk.
About 100 sweat glands, 15 oil glands, 230 sensory receptors per cm2 of skin.
28 Lecture 3: The Integument

Hair consists of keratinised cells, and it has a protective function. The arrector pili
muscle stands the hair up when cold (goosebumps).

Nails are modified epidermis consisting of keratin, useful for scratching and pick-
ing things up. A rich bed of capillaries underlies the nails (in the dermis).

5 Burns

First degree: only the epidermis is damaged (sunburn); it heals in 2–3 days.
Second degree: it injures the epidermis and upper dermis; blisters appear (partial-­
thickness burns). The skin regenerates (1–2 weeks) with little or no scarring.
Third degree (full thickness): it involves whole thickness of the skin. The nerve end-
ings are destroyed. Extensive burns cannot heal themselves. Skin grafting is
required to avoid fluid loss and infection.
If >10% of skin the area is full-thickness burnt ➔ critical.
If >20% of the skin area is burnt ➔ life-threatening.

6 Ageing of the Skin

Newborn skin is thin. During infancy and childhood, skin thickens and subcutane-
ous fat is deposited. During adolescence, the skin and hair become oilier; acne may
appear. After 30 years, the skin begins to show the effects of “environmental
assault”. With old age, the rate of epidermal cell replacement slows, the skin thins
and glands secrete less. Elastin fibres clump and degenerate, collagen fibres become
fewer and stiffer, and the hypodermal fat layer diminishes → wrinkling. The number
of active hair follicles diminishes → hair thinning.

7 Drug Administration

Topical: patted or wiped onto the skin, absorbed through the skin and acts locally
(e.g. corticosteroids)
Transdermal: absorbed through the skin, acts systemically (e.g. nicotine patch, hor-
mone replacement therapy (HRT), nitroglycerin, scopolamine patch, transder-
mal oxycodone patch)
Intradermal: injections of <1 cm3 into the dermis
Subcutaneous: injected into the subcutaneous fat (hypodermis) layer
Lipid-soluble substances (e.g. steroids) can penetrate the skin because glycolip-
ids between the cells of the stratum corneum present no barrier.
9 Additional Information 29

8 Sensory Receptors in the Skin

Tactile Receptors
1. Merkel cells monitored by sensory terminals called tactile discs: in the basal
layer of hairless skin, detect fine touch
2. Meissner’s corpuscles: for fine touch in the dermal papillae
3. Pacinian (lamellated) corpuscles: for deep pressure in the reticular layer
4. Ruffini corpuscles: for pressure and distortion in the skin (in the reticu-
lar layer)
5. Root hair plexus: to detect the movement/distortion of hair follicles
6. Free nerve endings between the epidermal cells: have small receptive fields
for touch sensation
Thermoreceptors
1. Free nerve endings for heat: detect heat
2. Free nerve endings for cold: detect cold
Nociceptors
Pain receptors are free nerve endings with large receptive fields.
(Three types: extremes of temp, mechanical damage, dissolved chemicals –
strong stimuli excite all 3!
➔ “burning sensation” is excited by many stimuli)
Vitamin D
= Calcitriol – required for the uptake of Ca++ from the gut
In the skin: UV radiation causes “modified cholesterol molecules” (cholecalciferol =
provitamin D3) to be converted to “vitamin D precursor”.
In the liver: enzymes modify this precursor (by adding a hydroxyl group [-OH]).
In the kidneys: “modified precursor” is used to produce (add a second hydroxyl
group) and release calcitriol (vitamin D3) upon being signalled by the parathy-
roid hormone (PTH). So “vitamin” D3 is not necessarily a part of the diet but is
actually a “hormone”, so the skin can be considered an endocrine organ!

9 Additional Information

Human beta-defensin 2 is a natural anti-microbial peptide produced by keratino-

cytes when injured. It is part of the skin’s natural defence mechanism (against atopic
dermatitis and psoriasis).
Malignant melanoma incidence is ~20 cases/100,000 individuals. The majority
are cured by surgery.
30 Lecture 3: The Integument

Patients with stage IV disease have a dismal prognosis. Metastatic melanoma

patients’ median survival is between 6.4 and 9.1 months. (Dacarbazine is the only
FDA-approved drug!)
Non-malignant Skin Cancers+
1. Superficial basal cell carcinoma
2. Nodular basal cell carcinoma – surgically removed with scarring
3. Squamous cell carcinoma
Actinic keratoses (solar keratoses = sun spots) are reported in 40% of the
Australian population! They can progress to squamous cell carcinoma. Treatment is
cryotherapy with liquid nitrogen or CO2 slush, surgical removal or topical therapy
with fluorouracil cream.

10 Integument Revision: Homework Exercise 3

1. List the components of the integument.

2. What are the principal functions of the skin?
3. Describe the five layers of the epidermis.
4. List the types of cells in the epidermis. How do they differ?
5. Describe the structure of the two strata in the dermis.
6. What are the two types of glands in the skin, and what is their purpose?
Lecture 4: Thermoregulation
and Homeostasis
(Caon & Hickman 3rd ed sect 5.10 and 5.11)

Physical Means of Heat Gain/Loss:

Radiation, convection, conduction, evaporation of water (perhaps ingesting
hot liquids?)
Biological Means of Heat Loss/Gain:
Basal metabolism (BMR); sweating; shivering; skeletal muscle activity; sub-
cutaneous fat insulation; vasoconstriction or vasodilation; eating, which
increases liver activity; eliminating; and urinating.

1 Behavioural Temperature Control

–– Seek an environment of appropriate temperature.

–– Adapt the level of physical activity.
–– Ingest hot/cold liquids.
–– Adjust the level of clothing/exposed skin.
(Skin temp may be 32 °C when room temp is 24 °C.) Body core is maintained at
~37 °C (36.5–37.5), 0.4 °C less if measured orally. Why?
If not, chemical reaction rates and blood viscosity change, denaturation of pro-
tein occurs (convulsions at 41 °C)
Hyperthermia >38 °C (may be due to exercise)
Hypothermia <35 °C
When the capillary beds of the dermis are flushed with blood (at 37 °C), heat is
transferred from the core to the epidermis and can be lost from the body (by radia-
tion, conduction, convection, evaporation).

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32 Lecture 4: Thermoregulation and Homeostasis

Heat transfer to the skin is controlled by the degree of vasoconstriction of the

arterioles and arterio-venous anastomoses (= capillary network) that supply blood
to the venous plexus of the skin. Vasoconstriction is controlled by the sympathetic
nervous system.
Vasoconstriction → skin temp approaches the temp of the surroundings.
Heat energy is lost from the body by:
(a) Evaporation of sweat, breathing
(b) Radiation, convection and conduction
(c) Eliminating, urinating

2 Conduction

When two objects touch, the one at the higher temperature will pass energy to the
one at the lower temperature. The energy transferred is known as heat.
The particles of the object at the higher temperature are, on average, vibrating
faster than the particles of the object at the lower temperature.
Each particle passes energy to the particle next to it by contact. The faster-­moving
particles of the high-temperature object collide with the slower-moving particles of
the low-temperature object (and vice versa!). The result will be an increase in speed
(and kinetic energy) for the slower-moving particles and a decrease in speed (and
kinetic energy) for the faster-moving particles.
When heat is transmitted through a solid body in this way, the process is called
conduction. A “warm” human body will heat “cold” hands (i.e. hands at a lower
temperature than the skin of the body) placed in contact with it by conduction; a
hot-water bottle in bed also transfers heat by conduction.
Clinical thermometers gain heat by conduction when applied to a patient.
Substances differ quite markedly in the ease with which they allow conduction
to occur.
The skin, subcutaneous tissue and fat are heat insulators for the body. They main-
tain the core temp while allowing the skin temp to approach the temp. of the
surroundings.
(At an ambient temp of 24–29 °C, most resting unclothed humans are in thermal
equilibrium – metabolic heat produced is lost to the environment.)
Adipose tissue of the hypodermis insulates the body against heat loss as fat is 1/3
as conductive as muscle.
Each millimetre of fat insulates to the extent that a person can feel comfortable
in a 1.5 °C lower temperature.
Most good conductors are metals or metal alloys (steel k = 400, aluminium k =
2100, copper k = 3900, silver k = 4200). Because these substances easily conduct
heat, they “feel cold” when in contact with our skin. They can withdraw heat rapidly
from us, and its loss produces the sensation of “coldness” even though the metal is
at room temperature. For this reason, the nurse should heat the bedpans and other
3 Convection 33

metal objects (like the bell of a stethoscope) before placing them in contact with the
patient’s body.
“Ice packs” help control swelling after sprains, bruises and muscle strains by
“applying cold”, i.e. withdrawing heat and causing vasoconstriction. If the ice is
wrapped in a wet towel, heat transfer by conduction is facilitated because the wet
towel makes good contact with the skin and the ice keeps the wet towel at almost
0 °C until it has all melted.
The body loses little heat through conduction to the air. Conduction to solids and
liquids occurs if the bare skin is in contact with something (e.g. water in a swim-
ming pool).

3 Convection

The flow of heated particles from one place to another at a lower temperature is
called a convection current and allows heat to be transferred by convection. Clothing
our bodies traps air close to the body. This trapped air is heated (by conduction) but
is prevented from forming convection currents and so prevented from transferring
heat away.
Convection may be enhanced by causing the warm air to move away from the
body faster – by opening windows to admit breezes or by using electric fans.
The amount of heat lost by convection depends on:
1. The temperature difference between the skin and air and
2. On the area of the exposed skin
The movement of blood around our bodies through our blood vessels is a form of
“forced convection”. The energy released in one part of our body is transferred to
another part, which may be at a lower temperature.

Radiation

All objects emit invisible infrared (IR) electromagnetic radiation due to their
temperature.
Radiated energy – W ∝ T4.
Infrared thermometers measure this energy.
About half of the human body’s heat loss is through radiation.
The amount of heat lost as radiation depends on:
1. The degree of vasodilation of blood vessels in the dermis
2. The temperature difference between the skin and the surrounding objects
3. The surface area of the body
4. Our behaviour
34 Lecture 4: Thermoregulation and Homeostasis

The human sensations of “hot” and “cold” depend on:

1. The local skin temperature
2. The temperature of the object being touched
3. Whether the object is a good or poor conductor of heat

Evaporation of Sweat

The temperature of an object is a measure of the average kinetic energy of its par-
ticles (hence their speed of movement). The particles have a range of speeds, from
low to very high.
Only the fastest (most energetic) water molecules in sweat become vapour (it
takes lots of kinetic energy to evaporate). The average kinetic energy of water mol-
ecules that have not evaporated is lower (than those that do), so their temperature is
lower. These water molecules on the skin are continually gaining energy from blood
near the skin’s surface. Eventually, these water molecules have enough energy to
evaporate. So while evaporation continues, each evaporating water molecule
removes more than the average amount of kinetic energy (of a water molecule) from
the skin, thus leaving the skin at a lower temperature.
If the atmosphere is saturated with water vapour or the humidity is very high,
perspiration cannot evaporate, so the effectiveness of this heat loss mechanism is
decreased.
Evaporative heat loss is involved when a patient with elevated temperature is
sponged with water

Respiratory Heat Loss

We also lose 10–15% of our heat with the air and water vapour we exhale (at 37 °C).
The respiratory heat loss from our alveoli may be understood as evaporative loss.

Homeostasis

This refers to the body's automatic tendency to maintain a relatively constant (i.e.
oscillating within a narrow range) internal environment (temperature, cardiac out-
put, ion concentrations, pH, hydration, dissolved CO2 concentration in blood, blood
glucose concentration, wastes prevented from accumulating).
3 Convection 35

The body is in a dynamic state of equilibrium; internal conditions change and

vary (oscillate) within relatively narrow limits.
Homeostasis returns the body to a healthy state after stressful stimuli by biofeed-
back mechanisms.
1. RECEPTORS monitor changes in a variable – receive the stimulus.
• afferent pathway to an integrating centre
2. INTEGRATING CENTRE determines the normal level of the variable – the
“set point”.
• efferent pathways to the effector organ
3. EFFECTOR produces a response that moves the variable value back to the
set point.
“Negative” feedback-response opposes stress.
(For example, the hormonal regulation of blood-sugar level by insulin/glucagon
and the nervous regulation of body temperature by shivering, sweating and adaptive
behaviour)
If body temp is too low, this is noticed by receptors in hypothalamus and core
thermoreceptors. Hypothalamus is the control centre:
• Smooth muscle in blood vessels to vasoconstrict, shivering, release of norepi-
nephrine to increase metabolic rate, behavioural responses (and enhanced thy-
roxine release in winter).
• Body temp rises (again noticed by hypothalamus and core temperature receptors).
• Hypothalamus turns off heat gain mechanisms.
Positive feedback-response (to infrequent events) enhances(!) stress (for
example:
• Contractions of childbirth
• Blood clotting with platelets
• Activation of Na+ channels in the axon hillock when nerve signals are generated
• Ca++ combining with diacylglycerol (DAG) to open Ca channels and Ca acting as
a “second messenger” in the hormone action).
Disease can be thought of as a disruption of homeostasis or as uncontrolled posi-
tive feedback.
For example, in chronic heart failure, the perfusion of peripheral tissues is com-
promised and coronary blood flow is compromised as well → poor blood flow to the
endocardial portion of the heart muscle → subendocardial muscle cells die to be
replaced by fibrous tissue → heart becomes weaker → blood flow to the endocardial
portion of the heart deteriorates still further…
36 Lecture 4: Thermoregulation and Homeostasis

Regulation of Blood Sugar Levels by Pancreas Hormones

Stimulus: ↑ blood sugar level beyond the set point (after digestion of a meal)
Afferent the blood system
pathway:
Integrating insulin-secreting cells of the pancreas
centre:
Response: insulin secreting cells ↑ insulin secretion into the blood
Efferent the blood system
pathway:
Effector: the liver takes up glucose and stores it as glycogen; muscles take up glucose
and store it as glycogen; cells take up more glucose.
Result (new blood sugar level ↓ towards the set point (so secretion of insulin ↓)
stimulus):

Stimulus: ↓ blood sugar level below the set point (after a period without eating)
Afferent pathway: the blood system
Integrating centre: glucagon-secreting cells of the pancreas
Response: glucagon secreting cells ↑ glucagon secretion into blood
Efferent pathway: the blood system
Effector: the liver breaks down stored glycogen into glucose and releases it into
the blood
Result (new blood sugar level ↑ towards the set point (so secretion of glucagon ↓)
stimulus):

4 Thermoregulation Revision: Homework Exercise 4

1. Define what heat is.

2. Define what temperature is.
3. What are the means by which the body can lose heat?
4. Outline the skin’s role in temperature regulation.
5. Explain how sweating allows the body to lose heat.
6. Define what is meant by homeostasis.
7. Explain how negative feedback maintains homeostasis.
Lectures 5 and 6: Musculo-Skeletal System
(Comprising: Muscles, Bones, Tendons,
Ligaments, Retinaculum, Articulations)

1 Functions of Bones

(a) Support – bones provide an internal framework that supports and anchors all
soft organs.
(b) Protection – vertebrae around the spinal cord, skull around the brain, ribs
around lungs, patella.
(c) Movement – bones act as levers moved by muscles attached to the bones by
tendons.
(d) Blood cell formation (haemopoiesis) – red marrow produces red blood cells,
white blood cells and platelets.
(e) Storage – fat stored in internal cavities as yellow marrow; minerals are stored
(Ca, P).

2 Bone Naming

There are 206 bones in the (adult) body.

Axial skeleton (80 bones: head, ribs and vertebrae)
• Eight cranial bones (frontal, parietal (two), temporal (two), occipital, eth-
moid and sphenoid), 14 facial bones (maxilla (two), zygomatic (two), nasal
(two), lacrimal (two), palatine (two), nasal conchae (two), vomer and mandi-
ble) and hyoid (one), plus wormians (number varies) and six ossicles in mid-
dle ears.
• Twenty-six vertebrae (seven cervical vertebrae, 12 thoracic vertebrae, five
lumbar vertebrae, sacrum and coccyx); it has four curves (cervical, thoracic,
lumbar and pelvic).

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 37

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_5
38 Lectures 5 and 6: Musculo-Skeletal System

Thoracic cage: 25 bones (12 pairs of ribs and one sternum)

Appendicular skeleton (126 bones: shoulder girdle and arms/hands, hip girdle and
legs/feet)
Pectoral (shoulder) girdles: (two clavicles and two scapulae)
Upper limbs: 30 bones each (humerus, radius, ulna, carpals (eight), metacarpals
(five) and phalanges (14))
Pelvic (hip) girdle: two coxal (or innominate) bones
Lower limbs: 30 bones each (femur, patella, tibia, fibula, tarsals (seven), meta-
tarsals (five) and phalanges (14))
Classification of Bones (by Shape)
–– Long: humerus, tibia and phalanges
–– Short: carpals and tarsals
–– Flat: parietal, sternum and ribs
–– Irregular: vertebrae and hip bones
–– Sesamoid: embedded within a tendon (patella, fabella)
–– Sutural: wormian

3 Bone Markings

They fall into two categories:

(i) Projections or processes (bumps, roughening), which are raised above the
bone surface
(ii) Depressions or cavities, which are indentations in the bone
Projections That Are Sites for Muscle Attachment

Tuberosity Large rounded projection, may be roughened (e.g. deltoid tuberosity of humerus)
Trochanters Very large blunt irregular-shaped processs (only on the femur)
Tubercles Small rounded projections or processes (e.g. greater tubercle of the humerus)
Crest Narrow, usually prominent, ridge of bone (iliac crest, anterior tibial crest)
Line Narrow ridge of bone, less prominent than crest (e.g. linea aspera in the femur)
Spine Sharp, slender, often pointed projection (e.g. posterior-superior iliac spine in the
pelvis)

Projections That Help Form Joints (Articulations)

Head Bony expansion carried on a “neck” (e.g. head of the humerus)

Facet Smooth, nearly flat articular surface (e.g. facet for the tubercule of the rib)
Condyle Rounded articular projection (e.g. medial/lateral condyles in the femur)
Ramus Arm-like bar of bone (e.g. ischial ramus, ramus of mandible)
Fossa Shallow basin-like depression in a bone, often serving as an articular surface (e.g.
olecranon fossa of the humerus, subscapular fossa)
4 Anatomy of the Bone 39

Depressions for Tendons and Openings for Blood Vessels and Nerves

Meatus Large canal-like passage (e.g. external auditory meatus)

Sinus Cavity within a bone, filled with air and lined with mucous membrane (e.g. frontal
sinus)
Groove Furrow (e.g. intertubercular groove of the humerus for the tendon of biceps)
Fissure Narrow slit-like opening (e.g. superior orbital fissure in the sphenoid)
Foramen Round or oval opening through a bone (e.g. infraorbital foramen, vertebral foramen)

4 Anatomy of the Bone

Gross Anatomy
Long bones: (1) the diaphysis (tubular shaft) of compact bone contains a medul-
lary cavity and is covered by a periosteum (containing osteoblasts – which
deposit bone – and osteoclasts – which are multi-nucleate). (2) The epiphysis
(end) is separated from the shaft by an epiphysial line/plate. The interior is
spongy bone, and the exterior is compact bone and covered (at articulations) by
articular cartilage.
Short, irregular and flat bones: these are thin plates of periosteum-covered compact
bone on the outside sandwiching the endosteum-covered spongy bone within.
Histology
Bone is connective tissue, so it has cells (osteocytes, osteoblasts and osteoclasts), a
matrix (hydroxyapatite) and fibres within the matrix (collagen).
Two types of bone tissues are distinguished:
1. Compact (hard) bone – e.g. the shaft of a long bone
2. Cancellous (spongy) bone – e.g. the ends of a long bone
Compact bone: the functional units are called Haversian systems or osteons. These
are concentric cylinders of calcified bone matrix (lamellae) between which are
scattered osteocytes (in the lacunae). Lamellae surround Haversian canals (tun-
nels through the bone which contain blood vessels). The osteocytes in the lacu-
nae are linked to each other and the haversian canal by canaliculi. Volkmann’s
canals run at right angles to the haversian canals and link the periosteum and the
medullary cavity.
Spongy bones consist of marrow-filled spaces surrounded by trabeculae (irregularly
aligned lamellae and osteocytes interconnected by canaliculi) – no osteons.
Chemical Composition
The bone consists of 60% inorganic salts by weight [calcium hydroxyapatite –
Ca10(PO4)6(OH2) and CaCO3]
and 40% organic matrix, i.e. collagen fibres, glycoproteins (protein + carbohy-
drate) and cells.
40 Lectures 5 and 6: Musculo-Skeletal System

5 Fractures

A fracture is any break in the bone, which may be caused by a sudden injury, fatigue
or stress, or pathologic conditions (e.g. neoplasia, osteomalacia, osteomyelitis,
osteoporosis).
Sprain = torn ligament or tendon.
Strain = painful overstretch of muscle, tendon or ligament.
Fractures may be classified according to aetiology, location (proximal, distal,
midshaft), direction of fracture line (transverse, oblique, spiral), type (open/closed,
complete/partial, displaced/non-displaced, greenstick, avulsion) and other
descriptors.
Reduction is the restoration of a fractured bone to its normal anatomical posi-
tion. It is then immobilised.
Union of a fracture occurs when it could already withstand normal stress.
Bone is regenerated rather than healed with a scar.

6 Classification of Joints (Articulations)

1. Functionally
(a) Immovable joints (synarthroses), e.g. sutures between skull bones
(b) Slightly movable joints (amphiarthroses), e.g. between vertebrae
(c) Freely movable joints (diarthroses), e.g. knee, shoulder etc.
2. Structurally (by material between bones)
(a) Fibrous joints – articulating bones are separated by fibrous connective tis-
sue (sutures, tibiofibular (syndesmoses), gomphoses).
(b) Cartilaginous joints – articulating bones have cartilage between them (ster-
num and rib#1 = synchondrosis, pubic symphysis).
(c) Synovial joints – articulating bones have a fluid-filled space between them,
e.g. plane (between carpals), hinge (elbow), pivot (proximal radio-ulnar),
ellipsoidal, saddle (thumb carpo-metacarpal) and ball and socket (shoulder).
Synovial joints are freely movable with the following distinguishing features:
1. Articulating bone surfaces covered by smooth hyaline cartilage ~3 mm on the
femur and 4 mm on the tibia (which minimises friction).
2. Joint cavity – a potential space filled with lubricating synovial fluid (also pro-
vides nutrients, removes wastes, distributes pressure).
3. Joint surrounded by an articular capsule composed of two layers: the inner layer
of the synovial membrane (secretes synovial fluid) and the outer layer of fibrous
connective tissue (often ligaments) attached to the periosteum to limit the range
of movement.
8 Types of Muscles 41

4. Reinforcing ligaments – some joints have a fibrocartilaginous pad (meniscus of

the knee) to aid shock absorption and improve the fit between bones. Closed
fibrous fluid-filled sacs (bursae) reduce friction and absorb shock around
the joints.

7 Description of Synovial Joint Movement

–– Flexion/extension (and hyperextension)

–– Abduction/adduction (and circumduction)
–– Pronation/supination (of the forearm)
–– Inversion/eversion (of the foot)
–– Dorsiflexion/plantar flexion (of the foot)
–– Rotation
Lever action: muscles that pull on bones causing them to move around freely
movable joints describe a “lever action”. Levers are bones that have three forces
acting on them:
1. Fulcrum (joint)
2. Effort (muscle force) and
3. Load/resistance (weight of limb)
The arrangement of these three (and the position of the lever in space) deter-
mines the class of the lever:
First class: tsriF Fulcrum in the middle, e.g. to nod the head to say yes.
Second class: seconD Daol (load) in the middle, e.g. to stand on tiptoes.
Third class: drihT Troffe (effort) in the middle, e.g. to hold the forearm horizon-
tally then flex it;
this class is common but “inefficient” ➔ the effort exceeds the load that is
shifted.

8 Types of Muscles

(a) Smooth muscle – not striated, uninucleate, involuntary, not individually named
and exists in walls of tubes (e.g. blood vessels, ureters, gut, reproductive tract,
bronchioles)
(b) Cardiac muscle – cells are “striated”, branched, uninucleate, involuntary, and
intercalated discs separate adjacent cells
(c) Skeletal muscle – striated, multi-nucleate and voluntary (700 muscles, ~40%
of body weight)
42 Lectures 5 and 6: Musculo-Skeletal System

9 Skeletal Muscles

They produce movement, maintain posture, stabilise joints, generate heat and
communicate.
A. Terms
• Origin: is a muscle’s attachment point to the “stationary” bone
• Insertion: is a muscle’s attachment point to the “movable” bone
• (Origin and insertion are separated by a joint.)
• Agonist (or prime mover): a major muscle, the contraction of which produces
specified movement (In pharmacology, the term agonist-antagonist is used
to refer to a drug. Agonist drugs bind to and activate a receptor. An antago-
nist, on the other hand, is a drug that attenuates the effect of an agonist.)
• Antagonist: opposes or reverses a particular movement
• Synergist: aids agonists by promoting the same movement or reducing unnec-
essary or undesirable movements
• (One muscle may act differently – as an agonist, antagonist and synergist – in
different movements.)
• Fixators: muscles that immobilise a bone. e.g. scapula is stabilised by
­(rhomboid major and trapezius) muscles attached to axial skeleton, posture-
maintaining muscles are fixators
B. Muscle-Naming Criteria
• Direction of muscle fibres (rectus abdominus, transversus abdominus, exter-
nal oblique)
• Location in the body (temporalis, tibialis anterior, intercostal, biceps brachii,
biceps femoris)
• Relative size (gluteus maximus, gluteus minimus, peroneus longus, peroneus
brevis, pectoralis major)
• Number of origins (bi-, tri-, quadriceps)
• Shape (deltoid, trapezius, teres)
• Origin and insertion (sternocleidomastoid, pubococcygeus)
• Action (adductor longus, extensor digitorum longus, flexor carpi radialis,
supinator)
• Whimsy (sartorius, gracilis, soleus)
C. Superficial Muscles
You should know (or be able to find) the positions, actions, approximate
insertions and origin of the following:
(a) Head (mastication): temporalis, masseter, buccinator, tongue
(b) Neck, upper chest: sternocleidomastoid, deltoid, pectoralis major, serratus
anterior
(c) Abdomen: external obliques, rectus abdominus
(d) Upper arm: biceps brachii, brachialis, triceps brachii
10 Histology of Muscle 43

(e) Lower arm: forearm flexors (brachioradialis, flexor carpi radialis, palmaris
longus, flexor carpi ulnaris), forearm extensors (extensor carpi ulnaris,
extensor digiti minimi, extensor digitorum, extensor carpi radialis brevis)
(f) Back: trapezius, latissimus dorsi
(g) Buttocks: gluteus maximus and medius
(h) Thigh: hamstrings (biceps femoris, semitendinosus, semimembranosus),
quadriceps femoris (vastus lateralis, vastus intermedius, vastus medialis,
rectus femoris)
(i) Leg: gastrocnemius, soleus (together = triceps surae), tibialis anterior.
The deep thoracic muscles promote movement for breathing:
(a) External intercostals – a more superficial layer that lifts the rib cage and
increases thoracic volume to allow inspiration
(b) Internal intercostals – a deeper layer that aids in forced expiration
(c) Diaphragm – the most important muscle in inspiration (accessory muscles
for forced inspiration = sternocleidomastoid, scalenes, pectoralis minor)
D. Muscle-Bone Attachment
Muscles attach to the bone or cartilage via (rope-like) tendons or a (flat
broad) aponeurosis.

10 Histology of Muscle

The skeletal muscle cell (= a muscle fibre) is a huge multi-nucleate cell (a syncy-
tium), 3cm long on average, can be up to 30 cm long, and 10–100 microns diameter.
Plasma membrane = sarcolemma; it has invaginations (T-tubules).
Cytoplasm = sarcoplasm (filled with myofibrils of 1–2 microns in diameter).
Endoplasmic reticulum = sarcoplasmic reticulum.
The endomysium (connective tissue) surrounds individual muscle cells and con-
tains capillaries, nerves and myosatellite cells (stem cells that repair damaged mus-
cle cells).
Myosin is the protein of thick myofilaments.
Actin (and tropomyosin and troponin) is the protein of thin myofilaments.
Thick myofilament is composed of myosin (15nm).
Thin myofilament is composed of actin (6nm).
Sarcomere is a bundle of interdigitated thick and thin myofibrils.
Myofibril is a long line of sarcomeres joined end to end.
Muscle fibre (a cell containing many myofibrils).
Fasciculus (contains many muscle fibres).
Muscle (contains many fasciculi).
(A muscle contains many fasciculi, a fasciculus contains many muscle fibres
(cells), a muscle fibre is composed of many myofibrils, myofibrils are many
44 Lectures 5 and 6: Musculo-Skeletal System

sarcomeres joined end to end, a sarcomere is a bundle of thick and thin myofila-
ments, thick myofilaments are made of the protein myosin, while thin myofilaments
are made of the proteins actin, tropomyosin and troponin.)
Neuromuscular junction, the meeting point of the motor end plate on the sar-
colemma of a muscle cell and the axon terminal of a motor nerve cell, is a gap
crossed by ACh (acetylcholine).
Sarcomere is a length of myofibril – between two “Z-lines” – in which we iden-
tify five sections using the letters: I, A, H, A and I defined below.
As thick and thin myofilaments interdigitate, the sarcomere shortens, which in
turn shortens the myofibril; hence, the muscle fibre contracts.
The Z-line is attached to the I-band (thin myofilaments only).
The A-band consists of thick and thin myofilaments together.
The “H-zone” (which contains only thick filaments when relaxed) exists within
the A-band. Thin filaments move into the H-zone during contraction.
The I-band is attached to the Z-line.

11 Mechanism of Contraction

Consider the events between depolarisation and contraction: one cycle of the sliding
filament mechanism
1. ACh from the axon terminal causes an action potential (i.e. depolarisation) to
propagate along the sarcolemma and into the T-tubules, which pass through the
sarcoplasmic reticulum (SR). (ACh is then destroyed.)
2. Depolarisation causes the release of Ca2+ (from the terminal cisternae of the
sarcoplasmic reticulum).
3. Ca2+ diffuses through the sarcoplasm and binds to the troponin. The troponin
changes shape and pulls the tropomyosin away from the actin molecule.
4. The energised myosin head (with adenosine di-phosphate (ADP) + inorganic
phosphate (Pi)) from the thick myofilament is able to engage in (the now exposed)
binding site on the actin molecule; that is, a “cross-bridge” is formed.
5. The engagement of the cross-bridge causes the myosin molecule to change
shape, resulting in a “power stroke” (a thick filament sliding over the thin fila-
ment until they overlap; the muscle fibre contracts, i.e. the muscle fibre becomes
shorter than before, but the myofilaments are of the same length).
6. ADP + Pi detach from the head of the myosin cross-bridge. This allows the
adenosine tri-phosphate (ATP) to attach to the place vacated by ADP.
7. The binding of ATP causes the myosin head to disengage from the binding site
on the actin molecule (thin filament).
8. The cross-bridge retreats from the thin filament, and ATP hydrolyses into ADP +
Pi + energy. Energy is stored in the myosin head – it is “energised”.
Note: ATP = (ADP + Pi + energy); this energy is stored in the cross-bridge (Pi
= HPO42−).
13 Intramuscular (IM) Injection Sites 45

12 Energy for Contraction

ATP is an energy source. Its rate of production must equal its rate of use since very
little is stored in the muscle – enough for only a few seconds of vigorous activity.
Three Methods of Production of ATP
1. Direct phosphorylation of ADP by creatine phosphate (CP): CP breaks down to
creatine and energy, and the energy is used to form ATP from ADP. This mecha-
nism provides enough energy for about 15 s of vigorous activity.

CP  energy  ADP  ATP  C.

2. Anaerobic glycolysis and the production of lactic acid: glucose from the blood
(which enters fibres through facilitated diffusion) and from the breakdown of
muscle glycogen is converted to pyruvic acid and energy for ATP; then (in the
absence of oxygen) pyruvic acid is converted to lactic acid and energy for ATP.
This mechanism provides enough energy for about 30 to 100 s of vigorous
activity – such as 400 m sprints.

Glucose  2 ATP  2 pyruvic acid  4 ATP, then pyruvic acid  lactic acid.

3. Aerobic respiration: in the presence of O2, pyruvic acid enters the mitochondria,
and a slow series of reactions called oxidative phosphorylation occurs.

Pyruvic acid  O2  18 ATP  CO2  heat.

This mechanism provides enough energy for about 40 min of vigorous activ-
ity – such as jogging.

13 Intramuscular (IM) Injection Sites

(i) Gluteus medius (avoids sciatic nerve)

(ii) Vastus lateralis
(iii) Deltoid
All are easily accessible, thick muscles, with a large number of muscle fibres,
extensive fascia ➔ large surface area for absorption and an extensive blood supply.
IM injection is used for the prompt absorption of larger doses than can be given
subcutaneously (or too irritating for SC).
Drugs with low solubility in water can be administered IM. No cell membrane to
cross to be absorbed into capillaries (pass through spaces between cells of capillary
wall). May be painful.
46 Lectures 5 and 6: Musculo-Skeletal System

14 Pelvic Floor (Pelvic Diaphragm) Muscles

The “pelvic floor” separates the pelvic cavity from the perineum.
Left and right levator ani muscles consist of:
Iliococcygeus
Pubococcygeus
Puborectalis - which may be part of the external anal sphincter (sphincter ani
­externis). The coccygeous (left and right) are frequently tendinous rather than
muscular. The vaginal orifice, urethral orifice & anal orifice, all penetrate the
pelvic floor.
(Why does the knee have such a complicated arrangement of ligaments?)
Tendons and Ligaments That Cross the Knee Joint
Ligaments
–– Quadriceps femoris tendon-patellar ligament
–– Fibular collateral ligament
–– Tibial collateral ligament
–– Oblique popliteal ligament
–– Anterior cruciate ligament
–– Posterior cruciate ligament

Tendons
–– Gracilis tendon
–– Sartorius tendon
–– Semitendinosus tendon
–– Semimembranosus tendon
–– Biceps femoris tendon
–– Iliotibial tract (from gluteus the maximus and tensor fasciae latae)
–– Gastrocnemius tendon
–– Popliteus tendon
–– Plantaris tendon
(Osteoarthritis is a chronic disease characterised by pain, biochemical and
enzymatic changes, cartilage fragmentation and loss, osteophyte formation and
bony sclerosis. It is the most prevalent and costly joint disease in older adults. In the
Western world, at least 10% of the population has symptoms of this disease. Around
? 50% will require (?) treatment with drugs. Treat this with strontium ranelate,
which stimulates bone formation and inhibits bone resorption. Also, it strongly
stimulates human cartilage formation in vitro.
Rheumatoid arthritis is an autoimmune disease characterised by chronic
inflammation of the synovial membrane leading to deformity, loss of function, pain,
swelling and, ultimately, joint destruction.
Psoriatic arthritis is associated with the skin condition psoriasis.)
15 Additional Information 47

15 Additional Information

Osteoporosis
Osteoporosis = low bone mass ➔ vertebral fractures (back pain) and hip frac-
tures (very debilitating).
Osteoporosis = bone mineral density (BMD) t-score ≤ −2.5 (?means what?).
Vitamin D deficiency = serum 25 OHD level (25-hydroxyvitamin D) < 9 ng/mL
➔ osteomalacia.
Vitamin D insufficiency = serum 25 OHD level (25-hydroxyvitamin D) < 15 ng/mL.
Osteoporosis takes 1000–1500 mg Ca and 400–1200 IU of vitamin D daily.
Serum Ca ref values are 2.08–2.60 mmol/l.
Zoledronic acid is a third-gen bisphosphonate drug (phosphorus-carbon-phospho-
rous bond is resistant to phosphatases and binds to calcified bone matrix and
inhibits osteoclastic bone resorption). Intravenous (IV) injection 4 mg once per
year increases bone mass.
The majority of vitamin D is produced in the skin when ultraviolet B (UVB)
photons stimulate the conversion of 7-dehydrocholesterol to pre-vitamin D. Pre-­
vitamin D is then spontaneously converted to vitamin D3 and sequentially converted
to 25-hydroxyvitamin D3 in the liver and to the active hormone 1,25-­dihydroxyvitamin
D3 in the kidney. Vitamin D2, a yeast-and-plant-derived vitamin D analogue, is con-
verted by the same enzymes, and its metabolites have approximately the same bio-
logical activity as those of vitamin D3. The principal action of 1,25-dihydroxyvitamin
D3 is to increase the intestinal absorption of both calcium and phosphate as well as
to regulate bone turnover. Circulating 1,25-dihydroxyvitamin D3 decreases serum
parathyroid hormone (PTH) by indirectly increasing serum Ca levels (thus decreas-
ing PTH release) and by directly decreasing parathyroid gland activity.
(USA data) Cardiovascular disease is the leading cause of death in women
(exceeds the next 16 causes of death combined and more than twice the number of
all cancer deaths combined).
Skin cancer incidence is > breast cancer incidence (breast cancer is one in every
three cancer diagnoses in the USA).
Lung cancer mortality > breast cancer mortality.
Paget’s Disease
A chronic bone disorder is characterised by localised areas of accelerated bone
remodelling leading to structurally flawed bone ➔ bone deformity, pain, fractures
and deafness. It can affect any bone but mainly the pelvis, femur, skull, tibia, verte-
brae, clavicle and humerus.
It has a prevalence in 4% of people aged over 55 (a 1978 WA radiological study).
It is treated with drugs like biphosphonates, e.g. zoledronic acid.
Raised serum alkaline phosphotase is one of the main indicators of Paget’s
disease.
48 Lectures 5 and 6: Musculo-Skeletal System

16 Musculo-Skeletal System Revision: Homework Exercise 5

1. List the functions of the skeletal system. What are the two major divisions of
the skeletal system?
2. How does compact bone differ from cancellous bone?
3. Describe the histology of bone (and name the structures).
4. Characterise the following seven types of joints (symphyses, syndesmoses, syn-
chondroses, gomphoses, sutures, hinge, and ball and socket) according to:
(a) Structure, as one of fibrous, cartilaginous or synovial.
Fibrous joints:
Cartilaginous joints:
Synovial joints:
(b) Function, as one of syn-, amphi-, or diarthroses.
Synarthroses:
Amphiarthroses:
Diarthroses:
5. Give an example of each of the following types of bones: long, short, flat, irreg-
ular and sesamoid.
Long:
Short:
Flat:
Irregular:
Sesamoid:
6. Perform the following movement with your left upper extremity: with the
thumb and third fourth fingers fully flexed and the first and second fingers fully
extended, circumduct the arm in a flexed position with the lower arm pronated.
7. Compare AND contrast the anatomy of the knee joint and elbow joint. In what
way(s) does(do) their structure reflect their function?
8. Find an example of a superficial muscle that is descriptively named according
to each of the eight types of descriptors: direction of muscle fibres, location in
the body, relative size, number of origins, shape, origin and insertion, action
and whimsy.
Direction of muscle fibres:
Location in the body:
Relative size:
Number of origins:
Shape:
Origin and insertion:
Action:
Whimsy:
16 Musculo-Skeletal System Revision: Homework Exercise 5 49

9. Choose six muscles (different from those in Q 8), one from each of the lower
arm and leg, upper arm and leg, and front and back of the body, and list their
origin, insertion and action.
Forearm:
Leg:
Arm:
Thigh:
Anterior of the body:
Posterior of the body:
10. Describe the relationship between the three proteins actin, troponin and tropo-
myosin in thin myofilaments.
11. In which directions do the muscle fibres in the external obliques and rectus
abdominus muscles lie?
12. Comment on the relative size of the gluteus maximus and the gluteus medius.
13. Which muscles extend the spine, and which muscles extend the arm?
14. What actions do the following muscles perform?
(a) Pronator quadratus
(b) Adductor magnus
(c) Extensor digitorum
(d) Sartorius
15. Over which bones do the extensor carpi ulnaris and the extensor carpi radialis
brevis lie?
16. What part of the name biceps femoris indicates its location?
17. How many origins do the triceps brachii have, and where are they?
18. What is the origin and insertion of the sternocleidomastoid muscle?
19. What broad general shapes do the (a) rhomboid major muscle and (b) deltoid
muscle resemble?
20. What action is performed by the masseter?
21. Under which gluteal muscle does the sciatic nerve lie?
22. List the muscles that comprise the quadriceps group. Where are they?
23. List the muscles that comprise the hamstrings group.
24. Where are the locations of the triceps brachii and the triceps surae?
25. Give five reasons why the deltoid, vastus lateralis and gluteus medius muscles
are preferentially chosen as the sites for intramuscular injection.
Lectures 7 and 8: Digestive System

1 Gastrointestinal (Alimentary) System and Accessory

Digestive Organs

GIT organs Accessory organs

Mouth Teeth and tongue
Pharynx Salivary glands
Oesophagus * Parotids submandibular and
Stomach * Sublingual glands
Small intestine
 Duodenum Pancreas
 Jejunum Liver and gall bladder
 Ileum
Large intestine
 Caecum and appendix
 Ascending colon
 Transverse colon
 Descending colon
 Sigmoid colon
 Rectum
Anus

2 Digestive Processes

Digestion (disassembly) is necessary to reduce the very large molecules (polymers)

ingested as food to particles small enough to pass into the cells lining the gut.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 51

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_6
52 Lectures 7 and 8: Digestive System

(i) Ingestion
(ii) Propulsion (swallowing and peristalsis)
(iii) Mechanical digestion
(iv) Physically preparing food for digestion
(v) Chewing, mixing with saliva, churning in the stomach and segmentation
(mixes food with digestive enzymes and moves food over the intestinal wall)
(vi) Chemical digestion
(vii) Hydrolysation of complex food molecules into monomers via enzymes
(viii) Absorption
(ix) Passage of end products of digestion into the blood or lymph after entering
mucosal cells by active or passive transport processes
(x) Defecation
(xi) Elimination of indigestible substances (faeces)

3 Histology of the Alimentary Canal

From the oesophagus to the anal canal, the wall of the alimentary canal is made up
of the same four layers (called tunics) 2–5 mm thick:
1. Mucosa (Includes the Lamina Propria)
• Secretes mucus, digestive enzymes and hormones
• Absorbs end products of digestion
• (Lymphoid nodules) protects against infectious disease and self-digestion
• (Muscularis mucosae) wiggles the epithelial folds
2. Sub-mucosa
• Dense connective tissue containing blood vessels, lymphatics (transport
products of digestion and combat bacteria) and nerve plexus (innervate gut).
3. Muscularis Externa
• Gut motility: peristalsis (propulsion) and segmentation (mixing)
• Inner circular muscle layer (→ sphincters), outer longitudinal muscle layer
4. Serosa (= Visceral Peritoneum)
• Areolar connective tissue, which suspends the gut’s abdominal organs (how-
ever, the oesophagus has adventitia – a fibrous connective tissue)
• Visceral peritoneum attached to the parietal peritoneum by double-sheeted
mesenteries (greater omentum, lesser omentum, falciform ligament, mesen-
tery proper, mesocolon), which attach the gut to the adjacent structures.
• Cardiac (gastro-oesophageal) sphincter, pyloric sphincter, ilio-cecal valve,
internal anal sphincter, external anal sphincter
4 Functional Anatomy 53

4 Functional Anatomy

Mouth
• Food ingestion
• Mechanical digestion, mixing (teeth, tongue) to increase the surface area of food
for enzyme access.
• Chemical digestion (salivary glands produce saliva, salivary amylase acts on
starch, lysozyme – a proteolytic enzyme that acts on bacteria and protein)
• Propulsion of food into the pharynx
Pharynx
Has two layers of skeletal muscle to propel food into the oesophagus (deglutition).
Oesophagus
A muscular tube that conducts food to the stomach
Stomach
The surface epithelium of the stomach mucosa is a simple columnar epithelium
composed of mucous cells.
Gastric glands below the epithelium secrete “gastric juice”:
1. Mucous cells secrete mucus.
2. Parietal cells secrete H+Cl− – H+ from H2O via carbonic anhydrase (required to
activate pepsinogen and kill bacteria and unfold (denature) protein molecules)
and intrinsic factor (required for the absorption of vitamin B12 in the small intes-
tine (SI))
3. Zymogenic (chief) cells secrete pepsinogen.
4. Enteroendocrine G cells secrete the hormone gastrin, D cells secrete somatosta-
tin and P/D1 cells secrete ghrelin (stimulates hunger) and obestatin (induces
satiety).
The mucosal barrier prevents the stomach from digesting itself (bicarbonate in
the mucus reacts with HCl → CO2, stomach epithelial cells joined by “tight”
junctions).
Food Storage
The sub-mucosa has elastic fibres enabling the stomach to regain shape after storing
a large meal.
The muscularis externa has three layers of smooth muscle. They relax to allow
the stomach to expand and stretch without increasing their tension.
Mechanical Digestion
Mixing waves (3/min) churn contents to mix chyme and gastric juice. About 3 ml at
a time of liquid chyme squirts through the pyloric sphincter into the duodenum.
Chemical Digestion
Pepsinogen + HCl → pepsin.
Pepsin digests (hydrolyses) protein to polypeptides.
54 Lectures 7 and 8: Digestive System

Regulation of Gastric Secretion (Three Phases)

1. Cephalic (Reflex) Phase
Thought, sight, smell and taste of food – a conditioned reflex that increases
gastric secretion (occurs before food enters the stomach)
2. Gastric Phase
Stomach distension increases secretion.
Peptides (partially digested proteins) and caffeine stimulate the release of
gastrin (a hormone that stimulates the secretion of hydrochloric acid (HCl)).
Also, a rise in pH level stimulates the release of gastrin.
3. Intestinal Phase
(a) Excitatory: food entering the duodenum stimulates the release of intestinal
gastrin, a hormone that stimulates gastric secretion (briefly).
(b) Inhibitory: the distension of the duodenum and the presence of acidic chyme,
fats and partially digested food trigger the enterogastric reflex. This pro-
duces the tightening of the pyloric sphincter and causes a decrease in gastric
secretion.
In addition, intestinal hormones are released (secretin, cholecystokinin
(CCK), vasoactive intestinal peptide), inhibiting gastric secretion.
CCK and secretin also stimulate the release of bile and pancreatic juice.
Small-Diameter Intestine (Duodenum, Jejunum and Ileum)
It is the major digestive and absorptive organ, about 2 m long (during life, but longer
when muscle tone is lost and a cadaver is dissected!) and ~2.5 cm in diameter.
The internal absorptive surface area increased beyond that available to a smooth
tube by:
• Plicae circularis (circular folds 1 cm deep)
• Villi (finger-like projections 1 mm long)
• Microvilli (tiny projections of the plasma membrane of mucosal cells), the
“brush border”
The mucosa consists of:
• Simple columnar epithelium (absorptive cells)
• Goblet cells (secrete mucus)
• Entero-endocrine cells (secrete secretin, CCK)
• Paneth cells (secrete lysozyme, phagocytic)
• Intestinal crypts, which secrete “intestinal juice”
The sub-mucosa consists of areolar connective tissue and contains:
• Lymphoid nodules (called Peyer’s patches) to combat bacteria
• Mucus-secreting duodenal glands (bicarbonate-rich mucus to neutralise stom-
ach acid)
Large-Diameter Intestine (Cecum, Appendix, Colon, Rectum and Anal canal)
The large intestine (LI) is about 2 m long, functions to absorb water (H2O) from
indigestible food residue and expels faeces (defecation).
Electrolytes (Na+ & Cl−) are absorbed.
6 Absorption in the Small Intestine 55

Some bacteria are not killed by the action of lysozyme, defensins, HCl and
protein-­digesting enzymes. They are the bacterial flora of the LI. They ferment
some indigestible carbohydrates (cellulose) and produce gas (flatus).
The flora also synthesises B complex vitamins (thiamine, riboflavin, B12) and
vitamin K2 (required by the liver to synthesise clotting proteins).

5 Chemical Digestion in the Small Intestine

Chemical digestion involves the hydrolysis of carbohydrates, peptides and lipids.

Hydrolysis is the splitting of a large molecule into two smaller molecules by the
addition of a (or a few) water molecule(s). The addition is catalysed by enzymes.

C12 H 22 O11  H 2 O  C6 H12 O6  C6 H12 O6

Sucrose Glucose Fructose

Enzymes are from the “brush border” of the SI and from the pancreas.
Carbohydrates are hydrolysed with the aid of dextrinase, glucoamylase, lactase,
maltase, sucrase (from the brush border) and pancreatic amylase.
The products are monosaccharides.
Proteins are hydrolysed with the aid of carboxypeptidase, aminopeptidase and
dipeptidase (from the brush border) and trypsin and chymotrypsin (from the
pancreas).
The products are amino acids and small peptides.
Lipids (triglycerides and their hydrolysis products) are insoluble in water. The fat glob-
ules that they form are emulsified by the detergent action of bile salts. The emulsi-
fied fatty droplets are hydrolysed with the aid of pancreatic lipases (lingual lipase
and gastric lipase also contribute to the digestion of fats). Phospholipids are hydro-
lysed by phospholipidases; cholesterol does not need to be digested for absorption.
The products are free fatty acids (FFAs) and monoglycerols.
Nucleic acids (deoxyribonucleic acid (DNA) and ribonucleic acid (RNA)) are
hydrolysed by pancreatic nucleases into nucleotides and then hydrolysed by brush
border enzymes (nucleosidases and phosphatases) into their free bases, pentose sug-
ars and phosphate (PO4) ions.

6 Absorption in the Small Intestine

Virtually, all foodstuffs, 80% of electrolytes (iron in the duodenum) and most of the
water are absorbed in the small intestine (before the ileum). Endothelial cells are
joined by “tight junctions” → molecules must pass through their plasma membrane
(cannot pass between them). Is this passive or active transport?
56 Lectures 7 and 8: Digestive System

Monosaccharides and amino acids are actively transported into the epithelial
cells, pass through them unchanged and enter the interstitial fluid before entering
the blood capillaries (to be carried to the liver by the hepatic portal vein).
FFA and monoglycerols enter the epithelial cells by diffusion through the PlaM
(from micelles) and are reconstituted into triglycerides. They then combine with
phospholipids and cholesterol and are coated with protein to form water-soluble
chylomicrons. Chylomicrons enter the lymphatic system (via lacteals) and eventu-
ally the bloodstream via the thoracic duct.
Bile is absorbed from the ileum and recycled.
(Vitamin B12 + intrinsic factor complex are taken up by endocytosis from the
lower end of the ileum.)

7 Accessory Digestive Organs

Chemical digestion in the SI depends on the function of the following three acces-
sory organs.

Pancreas

It lies mostly retroperitoneal and dorsal to the stomach.

It is connected to the duodenum via the “main pancreatic duct”. The exocrine
function of the pancreas is accomplished by clusters of secretory cells called acini.
These produce alkaline pancreatic juice (enzymes and bicarbonate ions).
Pancreatic Juice Enzymes
• Amylase (digests carbohydrates)
• Lipase (digests fats and oils)
• Nuclease (digests nucleic acids)
• Inactive procarboxypeptidase, chymotrypsinogen, trypsinogen and proelastase
(Trypsinogen is activated to trypsin in the duodenum by enteropeptidase and in
turn activates carboxypeptidase, elastase and chymotrypsin so the pancreas does not
digest itself.)
The pancreas is stimulated to release enzymes by cholecystokinin (CCK) (a
local hormone from the duodenal mucosa), which is released when protein and fats
enter the duodenum, and by secretin (a hormone from duodenal mucosa), released
when HCl is present in the duodenum.
Bicarbonate Ions (HCO3−)
They cause pancreatic juice alkaline (pH 7.1–8.2) to raise the pH of acidic chyme
from the stomach.
7 Accessory Digestive Organs 57

H   Cl   Na   HCO3   Na   Cl   H 2CO3 .

Carbonic acid dissociates into carbon dioxide (CO2) and water.

Liver

This is the large (1.4 kg) organ in the right upper abdomen under the diaphragm
inside the ribcage. It filters monosaccharides and amino acids out of the blood from
the gastrointestinal tract (GIT) and processes them.
The functional unit of the liver is the (microscopic) six-sided lobule consisting
of hepatocytes.
Hepatocytes are arranged in lines that radiate from a central vein. Between lines
of hepatocytes are blood-filled sinusoids (without basal lamina) containing Kupffer
cells (macrophages), which remove debris such as bacteria and worn-out blood cells.
Hepatocytes secrete bile into tiny canals (canaliculi), which drain into bile ducts
(at the edge of a lobule), which drain into the common hepatic duct, which joins
with the cystic duct (from the gall bladder (GB)) to become a bile duct.
Blood Supply of a Lobule
1. Hepatic artery (carrying oxygenated blood)
2. Hepatic portal vein (deoxygenated blood with nutrients absorbed from the diges-
tive tract)
Blood from the hepatic artery and hepatic portal vein enters the portal arteriole
and portal venule (respectively), which are alongside the bile ducts in each lobule.
The arterial and venous blood mix in the sinusoids and drain into the central vein of
each lobule.
This mixed blood enters the hepatic vein, which drains into the inferior vena cava
and enters the right atrium of the heart.
Functions of Liver Hepatocytes 1. Carbohydrate Metabolism
It maintains blood glucose levels at 3.3–6.1 mmol/l (glucose buffer function)
(a) If blood glucose is low (fasting)
• Glycogen stored in the liver is converted to glucose and released into the
blood (glycogenolysis).
• Amino acids are deaminated and converted to glucose (gluconeogenesis).
• Other sugars (galactose and fructose) are converted to glucose.
• (Deamination = removal of an amine group – NH –from a molecule – it
produces (toxic) ammonia.
• Gluconeogenesis = conversion of non-carbohydrate molecules to glucose.)
58 Lectures 7 and 8: Digestive System

(b) If blood glucose is high (after meal)

• Glucose is absorbed and converted to glycogen or triglycerides and stored in
the liver and adipose tissue.
2. Lipid Metabolism
• Stores triglycerides
• Converts fatty acids to acetyl CoA and then to ketones
• Synthesises lipoproteins to transport fatty acids, triglycerides and cholesterol
• Synthesises cholesterol from acetyl CoA for use in bile salts
• (Converts carbohydrates and proteins to fats, which are then transported in lipo-
proteins to adipose tissue)
3. Protein Metabolism
• Synthesises plasma proteins (albumin, clotting proteins, transport proteins) and
enters sinusoids easily as there is no basal lamina
• Deaminates amino acids to form keto acids, which are then used for adenosine
triphosphate (ATP) or glucose synthesis or converted to fat
• Converts toxic NH3 from deamination into (less harmful) urea for excretion
in urine
• Transamination – forms non-essential amino acids from the parent keto acid
4. Removal of Drugs and Hormones and Antibodies
• Metabolises blood-borne hormones to forms that may be excreted in urine
• Detoxifies alcohol
• Metabolises drugs (via cytochrome P450 isozymes) – sulphonamides, penicillin,
ampicillin, erythromycin (inactivates them for excretion in the bile or alters their
activity)
• (e.g. converts capecitabine – an oral anti-cancer pro-drug – into a precursor of
5-fluorouracil)
5. Excretion of Bilirubin
(In the spleen, red blood cells (RBC) break down, haeme is split from the
haemoglobin, iron (Fe) is salvaged and stored and the remaining haeme frag-
ment is degraded to bilirubin.) The liver picks up bilirubin and secretes it in bile.
(Bilirubin → urobilinogen (by bacteria in the gut) → urobilin and stercobilin
(a yellow-brown pigment, hence faecal colour))
(The bilirubin in blood should be < 20 μmol/l. If >34 μmol/l, then there is
impaired liver function.)
6. Storage of Fat-Soluble Vitamins (A, B12, D, E, K)
1–2 year supply of A
1–4 months supply of D and B12
7. Storage of Minerals
Fe (as ferritin) and copper (Cu)
8. Phagocytosis
7 Accessory Digestive Organs 59

Kupffer’s cells (in the sinusoids of liver lobules) remove bacteria originating
from the intestines, as well as worn-out RBC and white blood cells (WBC).
9. Activation of Vitamin D
It modifies cholecalciferol (pro-vitamin D3) prior to its activation in the kid-
ney – D is needed for the absorption of calcium (Ca) from the GI tract.
10.   Synthesis of Bile Salts
Bile salts are needed in the small intestine for the emulsification of fats.
11.   Storage of Blood
The liver normally holds ~ 10% (450 ml) of the body’s blood. It can expand
to hold up to a litre more, so it stores or supplies blood as required.
12.   Production of the “Pro-hormone” Angiotensinogen
(+ renin ➔ angiotensin I) (+ACE ➔ angiotensin II).
It converts the hormone cortisol to cortisone.
13.   Lactic Acid (LA) Removal and Recycling
LA (produced by anaerobic muscle metabolism of pyruvic acid) is con-
verted back to pyruvic acid, then to glucose (gluconeogenesis).
14.   Synthesis of Plasma Proteins
Examples of plasma proteins are albumin, globulin (e.g. angiotensinogen),
prothrombin, fibrinogen and transferrin.
The liver can regenerate! The turnover of cells is gradual.
Hepatitis is an inflammatory disease of the liver.
Prolonged inflammation, e.g. due to chronic alcoholism, may cause cirrhosis
(hepatocytes replaced by connective tissue).

Gall Bladder

It is a muscular sac located on the posterior surface of the liver, which stores and
concentrates bile (by absorbing water and ions).
When acidic fatty acids enter the SI, CCK is released. This causes the smooth
muscle of the GB to contract and the hepatopancreatic sphincter to relax; hence, bile
enters the duodenum.
Bile consists of H2O, bile salts (cholic acid, chenodeoxycholic acid, glycolic
acid, taurocholic acid), bile pigments (bilirubin and biliverdin), cholesterol, lecithin
(a phospholipid), fatty acids and ions (Na+, K+, Ca++, Cl−, HCO3−).
Note: Bile salts have a hydrophobic tail (which dissolves in fats) and an ionic
head (which dissolves in water).
Vagus Nerve
• It is the longest of the cranial nerves.
• It can be thought of as the “spinal cord” of the autonomic nervous system (NS).
60 Lectures 7 and 8: Digestive System

• Together with three sacral nerves, the vagus is the primary pathway for parasym-
pathetic NS communication to and from the brain.
• The vagus regulates much of the digestive system:
–– Stomach
Post-prandial gastric volume (accommodation)
Gastric contractions (food processing)
Acid secretion
Gastric emptying
–– Pancreas and gall bladder
Pancreatic exocrine secretion
Gall bladder emptying
Bile flow
–– Small intestine
Intestinal motility
Intestinal content transit
Absorption of Nutrients from the Small Intestine
Digestion is the chemical and mechanical breakdown of food into smaller units that
can be taken across the intestinal epithelium into the body.
MONOSACCHARIDES are transported into epithelial cells by protein carriers
and then through facilitated diffusion into capillary blood (fructose moves entirely
through facilitated diffusion).
As well as specific AMINO ACIDS, short chains of two or three amino acids
(dipeptides and tripeptides) can be actively transported into epithelial cells. Di- and
tripeptides are digested in epithelial cells into amino acids before entering capillary
blood by diffusion.

8 Additional Information

MONOGLYCERIDES and FREE FATTY ACIDS (FFAs) become associated with

bile salts and lecithin to form MICELLES (also included are cholesterol and fat-­
soluble vitamins).
• At the plasma membrane of epithelial cells, monoglycerides, FFA, cholesterol,
and fat-soluble vitamins leave micelles and diffuse through the lipid plasma
membrane.
• Inside epithelial cells, FFA and monoglycerides are reconstituted to
triglycerides.
• These combine with phospholipids and cholesterol and gain a protein skin to
form CHYLOMICRONS.
8 Additional Information 61

Chylomicrons are processed by a Golgi apparatus for extrusion from the cell to
pass into lacteal ➔ the lymphatic system ➔ venous blood via the thoracic duct.
NUCLEIC ACIDS: the pentose sugars, nitrogenous bases and phosphate ions are
transported actively across the epithelium by special carriers.
Vitamin B12 (cobalamin) is absorbed when complexed with intrinsic factor,
which is secreted by the stomach.
Mineral absorption (magnesium (Mg), Fe, Ca) and ions (PO4, sulphate (SO4))
occur by active transport (the absorption of Fe and Ca is linked to their concentra-
tion in the body); water osmotically follows electrolytes.
Toxic Nitrogenous Wastes
Ammonia – from the deamination of amino acids
Urea – from protein catabolism (3–8 mmol/L)
Uric acid – from the metabolism of nucleic acids
Creatinine – from creatine phosphate (0.06–0.13 mmol/L)
HCL Production in Parietal Cells of the Stomach Wall
H2O ➔ H+ + OH−
(H3O+ transported quickly into the stomach lumen in exchange for K+)
OH− + CO2 ➔ HCO3− via carbonic anhydrase
(HCO3− transported into interstitial fluid in exchange for Cl−, Cl− leaks into the
stomach)
This increase in HCO3− in stomach blood supply raises blood pH slightly (alka-
line tide).
➔ Vomiting causes the loss of Cl− and K+ as well as acid.
pH parietal cells = 7.2
pH stomach = 1 or 2, so the [H3O+] gradient is large; the stomach has 10,000 times
the acid concentration of parietal cells.
Portal Hypertension
Cirrhosis of the liver accounts for 90% of cases of portal hypertension. Bands of
fibrous tissue distort liver sinuses and increase resistance to portal venous flow. The
resulting increased pressure causes large collateral channels to develop between the
portal and systemic veins that supply the lower rectum and oesophagus (and in the
umbilical veins in people in which these have not been obliterated).
This gives rise to haemorrhoids and dilated veins around the umbilicus.
The most important collateral channels are those that divert blood to the coro-
nary (gastric) veins and form thin-walled varicosities in the sub-mucosa of the
oesophagus. They are subject to rupture, with massive and sometimes fatal
haemorrhage.
Pancreatic cancer is the fourth leading cause of cancer deaths in the
USA. Incidence in Europe 11.4/105 in males, mortality rate 11.3/105. pt with
advanced pancreatic cancer median survival without therapy = 15 weeks, with
chemo and radiotherapy, med survival = 47 weeks.
Gastric cancer incidence in Japan is 69/105 males (lower in females and lower
in Western countries).
62 Lectures 7 and 8: Digestive System

Bowel cancer is the most common internal cancer affecting Australians and the
second-highest cause of cancer-related deaths, lagging behind lung cancer.
Overweight and Obesity
Excess energy not required by the body is stored as sub-cutaneous fat, and the
amount stored in this form varies greatly between individuals. The stored fat is usu-
ally measured as a percentage of total body mass. A percentage body fat (%BF) of
15% or less is desirable for men, and 25% or less for women is desirable. Women
generally have a greater fat store than men to support menstruation, pregnancy and
lactation. Marathon runners, ballet dancers and thin models can have as low as 7%
BF. These women usually cease to menstruate.
The normal amount of body fat (expressed as a percentage of body mass) is
between 25% and 30% in women and 18% and 24% in men. Women with over 32%
body fat and men with over 25% body fat are considered obese.
Essential fat is the level below which physical and physiological health would be
negatively affected.
In the Western world, obesity is probably the most prevalent disturbance related
to food intake. Since the mid-1960s, there has been increasing concern that over-­
nutrition contributes to heart disease, cancer, diabetes and liver disease.
In many cases, persons with extra fat located around the middle (“apple” shaped)
are at a higher risk for diseases, such as heart disease and diabetes, than those who
carry weight around their hips and thighs (“pear” shaped). (A waist circumference
of >88 cm for women or >102 cm for men defines abdominal obesity and substan-
tially increased risk of obesity-related disease.)
For both men and women, a waist-to-hip ratio of 1.0 or higher is considered “at
risk” for heart disease or other problems associated with being overweight (e.g. type
II diabetes).
For men, a ratio of less than 0.90 is considered safe.
For women, a ratio of 0.80 or less is considered safe.

9 Digestive System Revision: Homework Exercise 6

1. List the organs of the digestive system and the accessory organs.
2. Name the three regions of the small intestine and describe what digestive and
absorptive events happen in each region.
3. Describe the functions of each of the four tunics of the wall of the alimen-
tary canal.
4. Draw up a table with three columns and ten lines (make up your own headings)
that lists:
(a) Each digestive enzyme
(b) Which structure/cells secrete the enzyme
(c) What the enzyme does
9 Digestive System Revision: Homework Exercise 6 63

5. Name AND describe all the processes that constitute mechanical digestion.
6. Summarise the regulation of gastric secretion.
7. Summarise the events in the chemical digestion of carbohydrates.
8. Summarise the events in the chemical digestion of proteins.
9. Summarise the events in the chemical digestion of lipids.
10. Describe the basic anatomy of the liver (the functional unit and the cells).
11. State the functions of the liver (give details for three of those functions).
12. What is the effect of pepsin on protein?
13. Consider two men: one of 70 kg with 15% BF and the other of 100 kg
and 12% BF.
(a) Which one has a lower percentage of fat?
(b) Calculate 12% of 100 kg and 15% of 70 kg. Which one has the greater mass
of body fat?
14. In what clinical situations would skinfold measurements (or body mass index)
provide useful information about the nutritional status of clients?
Lectures 9 and 10: Endocrine System &
Hormones

1 Endocrine System Overview

Hypothalamus, pituitary (anterior & posterior parts), pineal, thyroid, 4 parathyroids,

thymus, pancreas (islets of Langerhans, not acini), 2 adrenals, 2 gonads, placenta.
(skin – vit D; gut – digestion controlling hormones, kidneys – erythropoietin, liver –
angiotensinogen, adipose tissue – leptin)
Hormone: a molecule = a chemical messenger, made in very small quantities by
endocrine cells/glands & released into circulation.
Some hormones (e.g. PTH, insulin, aldosterone) released in direct response to blood
levels of ions/ nutrients.
Some (e.g. epinephrine, norepinephrine) released in response to neural signal.
Many released when directed to by a “releasing” or “stimulating” hormone from
the hypothalamus.

2 Cell Communication

Cells can communicate with other cells by:

1. direct exchange of ions & small molecules through “gap junctions” between
adjacent cells in contact.
2. paracrine communication (using cytokines, local hormones) through extracellu-
lar fluid between cells of a single tissue
3. synaptic communication – neurons release neurotransmitters at a synapse.
4. Endocrine communication uses hormones released into blood to coordinate cel-
lular activities in distant tissues (=circulating hormones).

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 65

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_7
66 Lectures 9 and 10: Endocrine System & Hormones

• Chemical messengers may be BOTH hormones AND neurotransmitters (e.g.

noradrenaline, dopamine).
• Some neurons secrete hormones (e.g. hypothalamus secretes oxytocin & ADH
which are transported along the axon to posterior pituitary gland).
Endocrine glands/cells: secrete their hormones direct into blood stream. (≠ exo-
crine glands)
Target cell: point of action of a hormone – has a specific receptor site for that
hormone.
Hormones persist in blood for from <1 minute to ~30 minutes. But because of
“amplification” (see below) their action may persist for from ~20 minutes to sev-
eral hours.

3 Chemical Structure of Hormones

Classified into 2 groups:

• amino acid (AA) based hormones
• steroid hormones.
• (see molecule structure diagrams)
1a. Amino acid derivatives. (AA are the structural units of proteins).
“Catecholamines” (adrenaline, noradrenaline – from adrenal medulla, & dopa-
mine – from hypothalamus) and thyroid hormone (T4 & T3) are all derived from
tyrosine.
Melatonin is derived from tryptophan.
1b. Peptide hormones are chains of AA. Includes all h. released by hypothalamus,
post. pit., heart, thymus, digestive tract, pancreas & most of ant. pit. h.
e.g. ADH & oxytocin (9AA long), glucagon (29AA), calcitonin (32AA), ANP
(45AA), insulin (51AA), leptin (146AA), EPO (166AA), GH (191AA), PRL
(198AA).
Glycoproteins e.g. TSH, LH, FSH from ant. pit. (>200 AA + carbohydrate
side-chain)
Angiotensinogen (from liver) is 452 AA long
Amino acid-based hormones are transported dissolved in blood (except thyroid hor-
mone which binds to a plasma protein).
2. Steroid hormones. Produced by
1. Gonads: testes (testosterone), ovaries (estradiol, progesterone),
2. Adrenal cortex (corticosteroids):
Mineralocorticoids = aldosterone
Glucocorticoids = cortisol, corticosterone
Gonadocorticoids = testosterone, estrogens
5 Hormone action 67

3. Kidneys: calcitriol (active vitamin D3) via skin & liver.

Steroid h. (lipids) are poorly soluble in blood so bind to plasma proteins for trans-
port ⇒ stay in circulation longer. Liver eventually absorbs them, converts them
to soluble form for excretion (in urine).
[a 3rd chemical group are the “local” hormones known as eicosanoids (lipids
derived from arachidonic acid - a poly-unsaturated 20 C conditionally essential fatty
acid). They include leukotrines, prostaglandins (which may become thromboxanes
& prostacyclins) involved in paracrine communication]

4 Receptor Sites

To be affected by a hormone, a cell must have a specific receptor for that hormone.
Receptors are either on outside of cell membrane (for AA based hormones) or inside
(!) the cell.
Catecholamines (adrenalin, noradrenalin, dopamine) and peptide hormones are
NOT lipid soluble (so are unable to penetrate cell membrane) so receptor proteins
for these hormones are on outside of membrane.
Thyroid hormones cross membrane by a carrier mechanism & bind to receptors
within nucleus or mitochondria.
Steroid hormones are lipid soluble so diffuse through cell membrane to bind to
receptors in cytoplasm or nucleus and “switch on” a gene (i.e. prompts transcription
to produce mRNA & thus proteins)
[Eicosanoids are lipid soluble so diffuse across membrane to receptor proteins on
inside of cell membrane.]

5 Hormone action

Hormones can alter the physical shape of target proteins or biochemical properties
of its target cells by:
1. (By activating appropriate genes in cell nucleus) Stimulating synthesis of an
enzyme or a structural protein in the cytoplasm.
2. Activating or deactivating an enzyme by altering its shape or structure.
3. Altering plasma membrane permeability or electrical state by opening or closing
membrane channels.
4. Stimulating mitosis.
5. Inducing secretory activity.
68 Lectures 9 and 10: Endocrine System & Hormones

Proteins & peptides cannot penetrate cell membranes ➔ AA-based hormones

(are 1st messengers) exert their effect via intracellular second messengers (e.g.
cAMP, cGMP, Ca++) after binding to a receptor on plasma membrane.
(i) hormone binds to a receptor which
(ii) activates a “G-protein” inside the cell which then moves along the membrane to
(iii) activate an enzyme that produces cAMP.
(iv) cAMP (the 2nd messenger) triggers a cascade of chemical reactions, produc-
ing increasing numbers of molecules at each step – amplification !
(theoretically receptor binding of a single hormone molecule could generate mil-
lions of final product molecules!)

6 Control of Endocrine Activity by the Hypothalamus

The hypothalamus is a region of the brain, below the thalamus, posterior to the optic
chiasma and anterior to the mammillary body. it connects to the pituitary gland by
a “stalk” (called the infundibulum).
Hypothalamus controls the endocrine system and integrates the activities of the
nervous & endocrine systems (in the following three ways:)
1. Hypothalamus secretes regulatory hormones that:
(a) control endocrine cells in the ant. pit. gland. (releasing hormones e.g.
GnRH = gonadotropin releasing h.
GHRH = growth hormone releasing h
TRH = thyrotropin releasing h
CRH = corticotropin releasing h
& inhibitory hormones that stimulate the anterior pituitary gland to secrete
hormones)
(b) In turn, the seven hormones released by the ant. pit. control the activities of
endocrine cells in the thyroid; cortex of adrenal glands; & reproduc-
tive organs.
(c) these endocrine organs then release hormones that target different parts of
the body.
2. Hypothalamus produces ADH & oxytocin which are transported to post. pit.
stored and released into blood from post. pit.
3. Hypothalamus contains “autonomic centres” that exert neural control (via
impulses through nerve fibres) over endocrine cells of the medullae of the adre-
nal glands. (When “sympathetic division” of the autonomic nervous system is
activated, adrenal medullae release hormones into bloodstream).
7 Thyroid Gland 69

[thus hypothalamus releases GnRH which stimulates ant. pit. to release FSH (&
LH) which stimulates testes to release inhibin & ovaries to release inhibin & estro-
gens (LH stimulates testes to release androgens & ovaries to release progesterone &
estrogens]

Pituitary Gland (=Hypophysis)

Connects to hypothalamus by the infundibulum

(a) anterior pituitary (glandular tissue which communicates with hypothalamus
via capillary plexus and portal veins). =adenohypophysis Produces 6 hormones
which are released when ant pit is stimulated by the arrival of releasing hor-
mones from the hypothalamus:
1. growth hormone (GH = somatotropic h.);
2. prolactin (PRL);
& four “tropic” hormones (Tropic = “turn on or cause release”)
3. TSH = thyroid stimulating h.,
4. ACTH = adrenocorticotropic h.,
5. FSH = follicle stimulating h.,
6. LH = luteinising h.).
7. (MSH = melanocyte stimulating hormone, and β-endorphin &
met-enkephalin)
(b) posterior pituitary (= neural tissue: axons from hypothalamus enter the post pit.
ie it is part of brain)
It stores & releases oxytocin (OT) & antidiuretic h. (ADH) that are made in
hypothalamus. OT & ADH transported to post. pit inside axons from the
hypothalamus.
(infundibulum + posterior pituitary = neurohyopophysis)

7 Thyroid Gland

Composed of spherical sacs called “follicles”. Thyroid hormones (as thyroglobulin)

made by follicular cells & stored in follicles (3–4 month’s supply!).
TRH causes release of TSH.
Under influence of TSH (from ant pit), thyroglobulin from follicle is endocy-
tosed by follicular cells. T3 and T4 are produced & diffuse from follicular cells into
blood stream where they attach to globulins and albumins (plasma proteins) for
transport.
70 Lectures 9 and 10: Endocrine System & Hormones

Thyroid gland produces thyroxine (tetra-iodothyronine) (T4 with 4 I atoms)

90% & tri-iodothyronine (T3 with 3 I atoms) 10% (T4 is converted to T3 in target
tissues).
T3 affects all body cells except brain, spleen, testes, uterus.
T3 causes:
• Increase in rate of ATP formation (in mitochondrian).
• Increases metabolic rate of cell by stimulating synthesis of enzymes con-
cerned with glucose metabolism (➔ heat generated).
• Accelerates production of the protein “Na-K ATPase” (Na-K pump)
• In children T3 essential for normal development of skeletal, muscular & ner-
vous systems.
Parafollicular (“C”) cells of the thyroid produce calcitonin which aids in low-
ering of [Ca2+] in blood (range 2.0–2.5 mmol/L). When plasma Ca2+ levels rise,
more calcitonin produced which decreases Ca2+ levels by:
1. slowing release of Ca2+ from bone
2. stimulating Ca2+ excretion at kidneys
Acts in children & pregnant women.

8 Parathyroid Glands (Two Pairs of)

Secrete parathyroid hormone when plasma levels of Ca2+ drop. PTH increases
plasma Ca2+ by:
1. accelerating release of Ca2+ from bone (by increasing osteoclast numbers)
2. reducing Ca2+ deposition in bone (inhibits osteoblasts)
3. enhancing reabsorption of Ca2+ from filtrate in kidneys
4. stimulating formation & release of calcitriol (=vit. D) in kidneys (which in turn
enhances absorption of Ca2+ from gut)

9 Adrenal Glands (Two of)

Firmly attached to superior portion of each kidney. Project into peritoneal cavity.
Divided into superficial adrenal cortex (3 zones) and deeper adrenal medulla.
(a) Adrenal cortex produces corticosteroids from cholesterol (>24 of them!).
Either “mineralocorticoids” (e.g. aldosterone) or “glucocorticoids” (e.g. corti-
sol, corticosterone) or “gonadocorticoids” (estrodiol & the weak androgens
androstenedione, dehydroepiandrosterone).
10 1% of Pancreas (Islets of Langerhans) 71

Corticosteroids determine which genes are transcribed in the nucleus ➔

enzymes produced.
Glucocorticoids increase rate of glucose formation from fatty acids & pro-
teins, & glycogen formation. Adipose tissue responds by releasing fatty
acids into blood. (Topically applied glucocorticoid creams reduce
inflammation)
Adrenal androgens (from zona reticularis) in women promote muscle mass,
blood cell formation & libido.
Cortex (zona glomerulosa) produces aldosterone.
If plasma [Na+] (137–143 mmol/L), blood volume or blood pressure drop, or
[K+] (3.2–4.3 mmol/L) increases, then aldosterone is secreted.
Aldosterone is also released when “angiotensin II” is present in plasma.
Aldosterone causes Na+ to be reabsorbed in kidneys (& sweat glands, saliva
& pancreas) in exchange for K+.
Furthermore, if normal levels of ADH are present, water will be reabsorbed
from kidney too (water “follows” Na+ osmotically).
ADH also causes contraction of smooth muscle in blood vessels.
(b) Adrenal medulla produces catecholamines: adrenaline & noradrenaline (= epi-
nephrine & norepinephrine).
Noradrenalin produces vasoconstriction
Adrenalin produces vasoconstriction in skin & viscera, but vasodilation in
skeletal muscle.
Both cause bronchodilation, increase HR & contractility.

10 1% of Pancreas (Islets of Langerhans)

alpha (α) cells produce glucagon which targets the liver and causes:
• breakdown of glycogen to glucose (glycogenolysis)
• synthesis of glucose from lactic acid & from fats & amino acids
(gluconeogenesis).
• Release by the liver cells of glucose into the blood
i.e. Glucagon raises blood sugar level.
beta (β) cells produce insulin which causes:
• enhanced membrane transport of glucose into body cells (esp. muscle &
fat cells).
• Inhibits glycogenolysis.
• Inhibits gluconeogenesis.
72 Lectures 9 and 10: Endocrine System & Hormones

(Once glucose is inside cells, insulin:

• Catalyses oxidation of glucose for ATP production
• Promotes glycogen formation in cells
• Converts glucose to fat)
i.e. Insulin lowers blood sugar level (range 6.1–8.3 mmol/L) (& promotes protein
synthesis & fat storage).
[estimated that 300 × 106 people will have type II diabetes by 2025. Oral thera-
pies are: increase insulin secretion (sulphonylureas); increase insulin sensitivity
(thiazolidinediones); reducing hepatic glucose production (metformin); delaying
absorption of glucose from GIT (α-glucosidase inhibitors)]

11 Gonads (etc)

(a) ovaries produce estrogens (e.g. estradiol), inhibin and progesterone.

(b) Testes produce androgens (e.g. testosterone) and inhibin.
Kidneys Erythropoietin is produced by interstitial fibroblasts in close association
with the peritubular capillary and proximal convoluted tubule. EPO signals red
bone marrow to increase production of rbc. Kidneys also produce calcitriol, and
renin (an enzyme which converts angiotensinogen to angiotensin I).
Pineal gland produces melatonin (which has a mysterious function).
Atria of heart produce atrial natriuretic peptide (ANP) which blocks renin secretion.
(Thymus produces thymopoietins & thymosins which promote the maturation of
T cells.
Leucocytes release leucotrienes, most tissues produce prostaglandins.
The intestines produce a variety of hormones that coordinate the activities of the
digestive system.
Placenta produces estrogens, progesterone & hCG).

12 Homeostatic Role of Hypothalamus in Water Balance

(Negative Feedback)

Stimulus: increase in plasma osmotic pressure due to

1. Large intake of salt, or
2. Dehydration.
Receptor: osmoreceptors in hypothalamus
Response: Hypothalamus stimulates post. pit. to release more ADH from axons in
post. pit. & from there into blood stream.
Effector: collecting duct of nephron of kidney.
13 Additional Information 73

Collecting duct becomes permeable to water, more water is reabsorbed from

“urine filtrate” (into extracellular fluid, then into plasma), small volume of concen-
trated urine produced. Also ADH stimulates the thirst centre ➔ we drink water.
If the plasma osmotic pressure decreases due to large intake of water (say), less
ADH released, less water reabsorbed from filtrate, large volume of dilute urine
produced.
Effect: plasma osmotic pressure is returned to within healthy range.

13 Additional Information

Diabetes
Diabetes is a chronic illness associated with both microvascular complications such
as nephropathy, retinopathy, and neuropathy; and macrovascular complications
including cardiovascular disease, stroke, and peripheral vascular disease. These
complications are associated with reduced quality of life and increased morbidity
and mortality and contribute significantly to the nations’ healthcare costs. Life
expectancy for a patient with Type 2 Diabetes Mellitus (T2DM) between the ages of
40–70 years is reduced by approximately 30–40%, yielding a loss of 8–10 years
of life.
It is well recognized that the prevalence of T2DM has increased dramatically in
recent decades, and this is generally attributed to environmental and behavioural
factors such as diet and physical inactivity. The International Diabetes Federation
estimates that there are approximately 248.8 million diabetics worldwide in 2010.
A recent survey in China estimated that there were 92.4 million adult diabetics in
China, and an additional 55.8 million with ‘pre-diabetes’, making China the second
largest diabetic population in the world after India
Current pharmacologic treatments for T2DM include a diverse range of antidia-
betic drugs.
However, a number of these are associated with clinically important and, in rare
cases, life-threatening side effects, such as hypoglycemia (sulfonylurea and insu-
lin), lactic acidosis (metformin), weight gain (sulfonylurea, insulin, and thiazolidin-
ediones (TZDs), fluid retention and heart failure (insulin, TZDs), and gastrointestinal
side effects (metformin, exenatide), potentially limiting their long-term use.
[Cure for T2DM = eat less and exercise more.]
Normal blood glucose = 6.1–8.3 mmol/L
Hypoglycaemia = blood glucose <3.3 mmol/L with symptoms present (or
<2.7 mmol/L)
Hyperglycemia = BG >22 mmol/L
Insulin given sc, or orally (metformin), or by lung inhalation!
Hypoglycaemia = blood glucose <3.3 mmol/L with symptoms present (or
<2.7 mmol/L)
Normal blood glucose = 6.1–8.3 mmol/L
74 Lectures 9 and 10: Endocrine System & Hormones

Hyperglycemia = BG >22 mmol/L

Type 2 diabetes is present in ~6% of adult western population! (& incidence is
growing at 6% per year)
Type 2 diabetes is most common form (85–90% of pt) of diabetes.
Type 2 diabetes is associated with obesity in 80% of afflicted pt. (most important
contributor to pathogenesis of disease)
Major cause of death in pt with type 2 diabetes is macrovascular disease (coro-
nary artery, cerebrovascular & peripheral vascular). In addition microvascular dis-
ease (retinopathy, nephropathy & neuropathy) has significant effect on quality
of life.
Glycosylated Haemoglobin A1c 5.6–7.5 mmol/L (Hb A1c)
Providing red cell lifespan is normal, Hb A1 measures mean blood glucose con-
centration over the preceding 60 days – i.e. half-life of red cell.
Some assays measure total glycosylated haemoglobin whilst others measure Hb
A1c produced by glycosylation of the N-terminal valine of the B-chain of
haemoglobin.

The relationship values of GHB and PG is defined in the table below:

Glycosylated haemoglobin Approximate mean plasma Approximate mean plasma

(HBA(1c)) (%) glucose (mmol/l) glucosea (mg/dL)
4 3.5 65
5 5.5 100
6 7.5 135
7 9.5 170
8 11.5 205
9 13.5 240
10 15.5 275
11 17.5 310
12 19.5 345

a
Mean blood glucose results are 10–15% lower. Most blood glucose meters are cali-
brated to read as plasma glucose

(males) Inhibin (produced by sustentacular cells of testes) released when sperm

count is high. It inhibits release of GnRH (by hypothalamus) & release of FSH (by
ant pit)
(females) inhibin released by granulose cells to inhibit FSH release
The reduction in the circulating levels of estrogen during menopause is associ-
ated with osteoporosis (loss of bone mass & deterioration of microarchitecture of
bone tissue) ➔ increase in bone fragility and bone fracture. Treat with Ca & vit D
& drugs (e.g. biphosphonate, calcitonin, selective serum estrogen modulator
(SERM) & monitoring BMD.
14 Endocrine System Revision: Homework Exercise 7 75

14 Endocrine System Revision: Homework Exercise 7

1. (a) What are hormones?

(b) Describe their chemical classification (and give an example of each)
2. Briefly describe the anatomical relationship between the hypothalamus and the
pituitary gland.
3. What are the three ways that the hypothalamus controls the endocrine system
and integrates the activities of the nervous and endocrine systems?
(a)
(b)
(c)
4. Briefly describe the structure of the pituitary gland and name the two hormones
stored in the posterior pituitary.
5. How are hormone receptors related to hormones?
6. How does the difference in hormone chemical structure determine where their
receptors are located?
7. Describe an example that shows how the hypothalamus is able to control the
secretion of a hormone from a “subservient” endocrine gland.
8. Copy and complete the table below: list the major one (or two) hormones pro-
duced; state a brief function for the hormone.

Gland Hormone(s) Function

Thyroid
Parathyroid
Adrenal cortex
Adrenal medulla
Pancreas
Testes
Ovary
Pineal
Anterior pituitary
Posterior pituitary
Thymus

9. How do hormones exert their influence on target cells?

10. Describe how “second messengers” allow amino acid-based hormones to exert
their influence on target cells.
Lectures 11 and 12: Urinary (Renal)
System

Almost 12% of Australia’s population has chronic kidney disease (CKD). In

2020-2021, haemodialysis treatment for end-stage kidney disease (ESKD) was the
most common reason for hospitalisation in Australia, constituting 14% of all
hospitalisations.
• Diabetes is the leading cause of CKD (and obesity → diabetes).
• A majority of patients with CKD do not survive to end-stage renal disease
(ESKD needs dialysis or transplant).
• CKD and diabetes are associated with increased risk for mortality and cardiovas-
cular (CV) disease.

1 Introduction

Two kidneys, two ureters, one bladder, one urethra (2–3 cm in females, ~20 cm in
males and passes through the prostate gland)
Functions
1. Major excretory organs of the body (organic wastes, urea, uric acid,
creatinine).
2. Regulate volume of blood (and hence blood pressure).
3. Regulate blood pH (loss of H+ or HCO3−; deaminate amino acids to produce
toxic NH+4 (excreted) and HCO3− retained in blood).
4. Maintain blood osmolarity at ~300 mosml/l (by Na+, K+, Cl−, Ca++, Mg++,
SO42−, PO43−) and healthy electrolyte concentrations.
5. Conserve nutrients by re-absorbing them from the filtrate (glucose,
amino acids).
6. Produce the enzyme renin (which catalyses the formation of angiotensin I).

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 77

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_8
78 Lectures 11 and 12: Urinary (Renal) System

7. The hormone erythropoietin (stimulates red blood cell (RBC) production in

the marrow) is produced by interstitial fibroblasts in the kidney.
8. Produce calcitriol (active vitamin D3).
9. Provide temporary storage for urine.

2 Kidney Anatomy

The kidneys are located between the body wall and the parietal peritoneum
(retroperitoneal).
The renal hilus is the entry point for the renal artery, renal vein, lymphatics
and nerves.
The fibrous renal capsule encases the kidney.

Internal Anatomy

(a) Cortex: superficial light-coloured tissue. All glomeruli are located here.
(b) Medulla: darker tissue containing ~8 “pyramids” – base towards cortex, apex
(papilla) towards the pelvis. Pyramids have a striped appearance due to parallel
urine-collecting tubules. Renal “columns” – with blood vessels – separate
pyramids.
(c) Pelvis: a tube lined with smooth muscle, continuous with the ureter, which
divides into two to three major calyces, each of which branches into several
minor calyces, which form a cup around a papilla.

3 The Nephron

Nephron = blood-processing functional unit of the kidneys, > million per kidney
Eighty percent are cortical nephrons (located entirely – except for a small part
of L. of H. – in the cortex).
Twenty percent are juxtamedullary nephrons (have long L. of H. extending
deep into the medulla and have a vasa recta) – important in the production of con-
centrated urine.
Nephron = glomerulus + renal tubule.
1. Glomerulus is the vascular part of the nephron. The endothelium of glomerular
capillaries is fenestrated, i.e. porous ⇒ large amounts of solute-rich, protein-free
liquid pass from the blood into Bowman’s capsule, thence to proximal convo-
luted tubule (PCT).
2. Tubule cells absorb ions from or secrete into the filtrate.
5 Bowman’s Capsule and Glomerulus 79

Renal tubule (3–5 cm long) = Bowman’s capsule + proximal convoluted

tubule + loop of Henle + distal convoluted tubule.
The distal convoluted tubule (DCT) of ~8 tubules empties into a common
collecting duct.
3. The loop of Henle is “hairpin” shaped. The descending limb (thin segment) has
a squamous epithelium, so it is freely permeable to water. The ascending limb
may have some thin segment then becomes a thick segment (has cuboidal epithe-
lial cells), which is impermeable to water.

4 Blood Supply

Descending aorta → renal artery → interlobar arteries (pass between pyramids) →

arcuate arteries (arch over bases of pyramids) → cortical radiate artery (supply cor-
tical tissue) → afferent arteriole (enters the glomerulus) → glomerulus (a capil-
lary bed)
Glomerulus → efferent arteriole (small diameter, leaves glomerulus) → either
peritubular capillaries (surround proximal & distal convoluted tubules) or in juxta-
medullary nephrons vasa recta (a bed of permeable capillaries that surrounds Loop
of Henle) → interlobular vein.
Nephrons have two capillary beds separated by efferent arteriole: the first bed
(glomerulus) produces the filtrate, while the second (peri-tubular capillaries) carry
away the water and molecules re-absorbed from the filtrate.

5 Bowman’s Capsule and Glomerulus

(Renal corpuscle = glomerulus + Bowman’s capsule)

Bowman’s capsule surrounds the capillaries of the glomerulus. Gaps in the
plasma membrane of the endothelial cells of glomerular capillaries make them very
porous (100× compared to those of other capillaries).
Since an efferent arteriole has a smaller diameter than an afferent arteriole, blood
in the glomerulus is under high hydrostatic pressure (55 mm Hg compared to
40–20 mm Hg in most capillaries).
Net filt press = G.H.P – G.COsP – B.C.Fl.P
Net filt press ≈ 55 – 30 − 15 = 10 mm Hg
Net filtration pressure (~10 mmHg) remains high throughout the length of the capil-
lary – no venous end to the capillary.
High pressure forces liquid and solutes (wastes, ions, glucose, amino acids, fatty
acids, vitamins) through the pores in fenestrated capillary walls, across the base-
ment membrane (lamina densa), through the “filtration slits” of podocytes that
80 Lectures 11 and 12: Urinary (Renal) System

surround a capillary and into the Bowman’s capsule (proteins and blood cells remain
in the blood).
(The Basement Membrane is an anionic barrier to albumin, in diabetes evidence
that proteoglycan content of Glom BM is diminished so filtration barrier degraded.)

6 Autoregulation

Within limits, the kidney is able to maintain constant blood flow into glomerular
capillaries by three mechanisms:
1. When BP increases, the afferent arteriole is stretched. It responds by constricting
(a myogenic response), which decreases blood flow into the glomerulus, which
causes the glomerular filtration rate (GFR) to decrease.
When BP falls, the afferent arteriole can be dilated to increase GFR.
Juxtaglomerular apparatus (= macula densa + granular cells)
The JGA is where the distal end of the ascending limb of L. of H passes
between (and touches) the afferent (and efferent) arterioles.
2. At this point, the cells of the DC tubule are called the macula densa. Macula
densa cells are chemoreceptors that respond to changes in solute (Na+ & Cl−
ions) concentration in the filtrate in the DCT. If [Na+] and [Cl−] are high:
• GFR too high or
• High blood pressure
The macula densa sends a paracrine message (either ATP, or adenosine) to
the afferent arteriole to constrict, which decreases blood flow to the glomerulus
(which decreases glomerular pressure, which decreases GFR, which decreases
ion concentration because more of them can be re-absorbed).
If GFR is low ⇒ the macula densa sends a paracrine message (NO), which
inhibits the action of adenosine triphosphate (ATP) and adenosine on the afferent
arteriole. This increases blood flow and pressure in the glomerulus as well as GFR.
3. Adjacent to the macula densa, the afferent arteriole walls have specialised cells
called granular cells (=juxtaglomerular cells) that produce renin. Granular
cells are mechanoreceptors & sense blood pressure in afferent arteriole (respond
to low pressure by releasing renin).
Renin is an enzyme that converts angiotensinogen to angiotensin I;
angiotensin-­converting enzyme (ACE) in lung capillaries converts A1 to angio-
tensin II, which causes the constriction of systemic arterioles (which causes
blood pressure to increase, which causes GFR to increase, which causes ion
concentration in the filtrate to rise).
Angiotensin II also (1) causes the adrenal cortex to release aldosterone and
(2) stimulates thirst.
9 Re-absorption 81

7 Urine Formation

(a) Filtration: in the glomerulus, blood cells and proteins are too big to pass through
a filter. The Bowman’s capsule receives everything else – water, nutrients, elec-
trolytes and metabolic waste products – which is called the filtrate.
(b) Re-absorption from the filtrate (to reclaim useful substances for the blood)
occurs in the renal tubules.
(c) Secretion from peritubular capillaries into the renal tubules occurs. Undesirable
substances are disposed of this way, and blood pH is adjusted.
(d) The concentration of the filtrate may be increased in the collecting ducts. The
walls of collecting ducts are impermeable to water, except when antidiuretic
hormone (ADH) is present. Antidiuretic hormone (from the posterior pitu-
itary) allows water to leave the filtrate through the wall of collecting ducts and
causes filtrate volume to decrease and urine concentration to increase.

8 Filtration

Fenestrated capillaries of the glomerulus are more permeable than other capil-
lary beds.
Glomerular filtration rate (GFR): ~120–125 ml/min. GFR ∝ net filtration
pressure.
Approximately 20% of plasma passes into BC
• 180 litres of filtrate containing 25 mole Na+ are produced daily.
Molecules smaller than 3 nm (water, glucose, amino acids, nitrogenous waste
(urea, uric acid, creatinine), some albumin) and electrolytes pass through a filter.
Must produce 450 ml urine per day to eliminate soluble wastes.

9 Re-absorption

This returns most of the water and required solutes from the filtrate to the blood.
• Na+ is actively re-absorbed.
• Water moves osmotically.
• Cl− follows its electrical gradient.
PCT (surrounded by porous peritubular capillaries) re-absorbs:
• ~all glucose (secondary active transport)
• ~all amino acids (secondary active transport)
• 65% Na+ (active transport)
• 65% H2O (passive)
82 Lectures 11 and 12: Urinary (Renal) System

• 90% HCO3− (passive)

• 50% Cl− (passive)
• 50% K+
• 50% urea (passive by diffusion)
• ~100% uric acid
• 100% albumin (endocytosis)
If the parathyroid hormone (PTH) is present, less PO43− is absorbed.
L. of H. re-absorbs:
From the descending limb: 15% H2O
And from the ascending limb:
• 25% Na+ (active)
• 25% K+ (active, but it leaks back into the filtrate)
• 35% Cl− (active)
DCT and collecting duct re-absorbs:
• Na+ and Cl− (active)
• ~15% H2O if ADH is present
• More Na+ from the end if aldosterone is present.
• Ca++ if parathyroid hormone is present.
• If ANP is present Na+ re-absorption is inhibited
(Diuretics are substances that cause elevated urine flow because they slow renal
re-absorption of water (causing diuresis). Most diuretics act by interfering with the
re-absorption of Na+.
(Caffeine inhibits Na+ re-absorption; alcohol inhibits the secretion of ADH).

10 Secretion

Around 80% of plasma (and some unwanted substances) remains in the blood as it
passes out of the glomerulus and moves into peritubular capillaries.
Some substances, rather than being filtered from the blood in the glomerulus, are
secreted from the blood of peritubular caps into the filtrate:
• Ions: K+ secreted into the DCT and collecting ducts under the influence of aldo-
sterone (Na+ is absorbed, and K+ is secreted), Ca++ and PO43−
• Certain drugs (penicillin, aspirin, phenobarbital, methotrexate, morphine,
frusemide etc.), hormones and organic ions.
• Histamine and neurotransmitters
• Urea and uric acid in the DCT (after they have been re-absorbed passively in
the PCT)
• H+ in the PCT and DCT (in exchange for Na+)
• Either H+ (if blood pH falls) or HCO3− (if blood pH rises) throughout tubules
11 Urine Concentration and Volume 83

• NH+4 in exchange for Na+ in the PCT and DCT

• Cl− in exchange for HCO3−

11 Urine Concentration and Volume

The filtrate entering the descending limb of L. of H. is iso-osmotic (300 mosmol/L)

with blood.
The osmolarity of the interstitial fluid of the medulla increases from
~400 mosmol/L in the outer medulla to ~1200 mosmol/L in the inner medulla.
As the descending limb is permeable to water (impermeable to solutes except for
urea) and the interstitial fluid of the medulla is hyper-osmotic (due to urea), urea
diffuses in and water diffuses out of the descending limb L. of H into the interstitial
fluid (so the filtrate volume decreases). The osmolarity of the filtrate in the renal
tubule increases to 1200 mosmol/L.
As the ascending limb is impermeable to water, Na+ is actively transported out of
the filtrate into the interstitial fluid (Cl− follows passively). The osmolarity of the
filtrate decreases to 100 mosmol/L, volume being unaltered.
• Dilute urine: 15–29 ml/min of urine at a concentration of 65 mosmol/l urine
enters the pelvis.
If ADH is present (it usually is), the cells of the collecting duct become per-
meable to water.
• Concentrated urine: 1 ml/min up to 1200 mosmol/L
Distal parts of collecting ducts are permeable to urea (and have membrane
transporters for urea). Urea diffuses out into interstitial fluid (medulla), mak-
ing it hyper-osmotic (from here, urea diffuses back into the descending limb
L. of H. (other downstream parts of the tubule are impermeable to urea) and
again travels with the filtrate into the collecting duct).
Vasa Recta
(1–2% of blood flows into the vasa recta)
The structure of the vasa recta (VR) allows the osmolarity of blood in the vessel
to increase from 300 to 1200 mosmol/l (Wow! Blood becomes hyper-tonic). As
blood from the efferent arteriole descends from the cortex to the medulla in the vasa
recta, it loses some water and gains lots of Na+, Cl− and K+. As blood ascends back
to the interlobular veins, it gains lots of water re-absorbed from the filtrate in the
descending limb of L. of H. (and loses some Na+, Cl−), so the osmolarity of blood
in VR decreases from 1200 to 300 mosmol/L (becomes isotonic again).
This prevents the osmotic gradient in the interstitial fluid of the medulla from
dissipating due to blood flow and water moving from the filtrate into the interstitial
fluid. The water that leaves the descending limb of L. of H. enters the (ascending)
vasa recta by osmosis.
84 Lectures 11 and 12: Urinary (Renal) System

12 Urine Storage and Elimination

The bladder is closed by the involuntarily controlled internal urethral sphincter.

When relaxed, urine passes into the upper part of the urethra.
Voiding (micturition) occurs when the voluntarily controlled external urethral
sphincter is relaxed.
Urinary incontinence – inability to prevent the leakage of urine.
Urinary retention – when the bladder is unable to expel its urine (catheter inserted
in the urethra to drain the urine)
Polyuria = excess urine production (≫2 L/day)
Oliguria = inadequate urine production (50–500 ml)
Anuria = negligible urine (0–50 ml/day)
Uremia = the accumulation of nitrogenous waste (urea) in the blood due to end-­
stage renal disease that alters fluid, electrolyte and acid-base balance and pro-
duces symptoms (hypertension, anaemia, osteodystrophy).
Albuminuria = albumin in urine (bad) Haematuria = RBC in the urine
(Blue urine! due to ingesting methylene blue)

13 Urine Analysis

This is a common, economical and non-invasive diagnostic test to gather informa-

tion about kidney/lower urinary tract disease. Drug testing! Normal results were
used to exclude some diagnoses.

Urinalysis

Osmolality 50–1200 mosmol/kg

Specific gravity 1.003–1.029
Glucose Negative
Bilirubin Negative
Ketone Negative
Occult blood Negative
RBC 0–3/5 per HPF
pH 4.5–7.8
Protein Negative
Urobilinogen 4–20 μmol/l
Nitrite Negative
Leucocytes 0–5 per HPF
Creatinine 50–120 μmol/L
14 Additional Information 85

Twenty-Four-Hour Urine Sample

Ca 100–300 mg/day
Creatinine clearance 8.8–17.7 mmol/day
Renal calculus No stones present
Na 40–220 mmol/day
Cl 110–250 mmol/day
K 25–125 mmol/day
HPO42− 13–42.00 mmol/day
Mg 3–5 mmol/day
Protein 40–150 mg /24 hrs
Uric acid 1.48–4.43 mmol/day
Urea 450 mmol/day

(Test for human chorionic gonadotropin (hCG) in urine provides an early, reli-
able test for pregnancy. hCG appears in the blood soon after implantation.)

14 Additional Information

Creatinine is an acid waste of protein metabolism (increased in muscle atrophy/

necrosis). Creatinine clearance is used to assess renal function (decreased in renal
disease/failure).
[If creatinine in the blood >200 μmol/l ⇒ impaired renal function!]
During oliguria, the filtrate volume is so slow that renal transport mechanisms
can re-absorb virtually all of Na and Cl, causing complete absorption of water as
well. Consequently, urine production ceases and kidney failure follows.
In 2013, kidney-related disease directly or indirectly contributed to 11% of the
deaths of Australians (more than deaths due to breast cancer, bowel cancer, prostate
cancer, suicide and motor vehicle accidents combined). It is one of the few diseases
in which mortality rates are worsening over time.
https://www.youtube.com/watch?v=SGGLq_vG1Gc
Young Doctors in Love (1982)
Episode “Diagnosis by Tasting Bodily Fluids”
Where madly crazed scientist Doctor Oliver Ludwig (Harry Dean Stanton)
instructed a pathology class of young hospital interns, residents and interns about
body fluids and orifices:
86 Lectures 11 and 12: Urinary (Renal) System

Osmotic Diuresis

Glucose is normally completely re-absorbed from the filtrate in the kidney tubules.
However, if the level of glucose in the plasma is too high (uncontrolled diabetes),
the kidneys cannot re-absorb all of it. Excess glucose contributes to the osmotic
pressure of the filtrate; hence, less water than normal will be re-absorbed.
Diabetics with very high plasma glucose (>28 mmol/l) [normal fasting glucose
level 3.9–6.1 mmol/l] produce abnormally high volumes of urine ≫2l (polyuria).
• Frequent urination and great thirst are symptoms of uncontrolled diabetes.
Diabetic nephropathy (an early sign of kidney disease) occurs when the kid-
neys leak a small amount of protein into urine (= microalbuminuria). This is due to
thickening of glomerular basement membrane and partial depletion of anionic gly-
cosaminoglycan moieties (mainly heparan sulphate) and resultant diminution of
physiologic electrostatic charge barrier. The loss of glycoprotein anions, which
present an ionic barrier to the albumin, allows the escape of albumin into glomerular
filtrate (and later proteins) ➔ albuminuria/proteinuria. Albuminuria/proteinuria is
toxic to tubular endothelial cells, leading to inflammation and scarring.
PCT is permeable to urea, so as the volume of the filtrate decreases due to the
absorption of water, urea concentration in the filtrate increases. This promotes the
passive re-absorption of urea along its concentration gradient. Rest of renal tubule
is only slightly permeable to urea.
Blood in the afferent arteriole enters glomerular capillaries and is filtered into the
Bowman’s capsule.
Filtrate moves into the PCT.
Filtered blood leaves the glomerulus through the efferent arteriole and enters the
capillary bed surrounding the PCT.
Material re-absorbed from the PCT ➔ interstitial fluid ➔ very porous capillaries
around the PCT by rapid osmosis (colloid osmotic pressure and low (~13 mm Hg)
hydrostatic blood pressure draw in water).
Filtrate moves into the loop of Henle.
Water re-absorbed from the descending limb ➔ interstitial fluid of the medulla
➔ into vasa recta capillaries by osmosis.
Electrolytes re-absorbed from the ascending limb ➔ interstitial fluid of the
medulla ➔ into the descending limb of the loop of Henle to be transported deeper
into the medulla.
Establishing a marked increase in the osmolarity of medullary interstitial fluid
(1200–1400 mosml/l) due to:
1. The active transport of ions (Na+, Cl−, K+) out of the thick portion of the loop of
Henle (much of these ions re-enter the descending thin limb and the descending
vasa recta to be transported deeper into the medulla, where most of them diffuse
out into the interstitium again – those that do not continue up the ascending limb,
from where they are actively transported out again!)
2. The active transport of ions (Na+, Cl−) from collecting ducts
3. The passive diffusion of large amounts of urea from collecting ducts
15 Further Information 87

Vasa recta is a porous “counter-current” exchanger – descending limbs

absorb sodium chloride and urea from the interstitium, and water flows out. (This
makes the osmolarity of blood ~1200 mosmol/l!)
Ascending limbs lose almost all of the absorbed sodium chloride and urea to the
interstitium while water diffuses back into the blood.
(In effect, the descending vasa recta absorbs what comes out of the ascending vasa
recta, leaving the concentration gradient in the medullary interstitium unchanged.)

Making Concentrated Urine

When ADH is present, the collecting duct is permeable to water.

As filtrate moves through the duct, water moves by osmosis into highly concen-
trated interstitial fluid of the medulla.
(?Then what – this fluid moves into ascending vasa recta?)

15 Further Information

• Almost 5% of the US population have moderate to severely decreased kidney

function, and ~20 million have kidney disease (proteinuria or GFR <90ml/
min/1.73m2)
• Diabetes is the leading cause of chronic kidney disease (CKD).
• The majority of patients with CKD do not survive to end-stage renal dis-
ease (ESRD).
• CKD and diabetes are associated with an increased risk for mortality and CV
disease.
• Anaemia appears to be an independent risk factor for CV disease in this
population.
• Hence, patients with CKD, diabetes and anaemia are at an increased risk of
CV events!
Estimated GFR using the Modification of Diet in Renal Disease (MDRD)
equation:

eGFR  186   serum creatinine    age 

1.154 0.203

  0.742 if the subject is female   1.210 if the subject is black 

GFR (creatinine clearance) in ml/min estimated with the Cockroft-Gault formula:

140 age    actual body mass  kg  

GFR    0.85 for women 
72  serum creatinine  mg / dL 
88 Lectures 11 and 12: Urinary (Renal) System

For females, GFR = 0.85 × male GFR

GFR should be? >60 mL/min
Creatinine
0.07–1.00 mmol/L – the reference range for women
0.06–1.30 mmol/L – for men
Toxic Nitrogenous Waste
Ammonia – from the deamination of amino acids
Urea – from protein catabolism (3–8 mmol/L)
Uric acid – from the metabolism of nucleic acids
Creatinine – from creatine phosphate (0.06–0.13 mmol/L)
Blood urea nitrogen (BUN) is a blood test to measure amount of urea nitrogen in
the blood. A raised BUN indicates kidney disease.

16 Urinary System Revision: Homework Exercise 8

1. Draw or trace a diagram of a kidney in the coronal section. Label the cortex,
medulla, pyramids, columns, papilla, pelvis, major calyces and minor calyces.
2. Name the sections of the renal tubule in the order that filtrate passes through them.
3. What is meant by the terms glomerulus, vasa recta and Bowman’s capsule?
4. With reference to the kidney tubule, distinguish between filtration and osmosis.
5. Which parts of the renal tubule are impermeable to water?
6. Name and briefly describe the four stages of urine formation.
7. Define and describe the function of the juxtaglomerular apparatus.
8. Describe the changes in the composition of the filtrate as it passes through the
descending limb and then the ascending limb of the loop of Henle.
9. Explain how the kidney can produce concentrated urine when the body needs to.
10. Explain the effect of aldosterone on the composition of urine.
11. What is the role of ADH?
12. What is the role of aldosterone?
13. Describe the feedback response that results in:
(a) ADH secretion
(b) Aldosterone secretion
14. What is the function of each of the four structures of the nephron in urine
formation?
15. Write a paragraph describing the blood supply to the kidney and nephron.
16. (a) How (and under what conditions) does the kidney excrete bicarbonate ions?
(b) How (and under what conditions) does the kidney re-absorb or manufacture
new bicarbonate ions?
Lectures 13–16: Nervous System

1 Overview

Cells = neurons (cell body + axon) and neuroglia (support cells)

Organs = brain, spinal cord, special sense organs, nerves
A. Central nervous system (CNS) = brain + spinal cord
It integrates, processes and co-ordinates sensory data and motor commands.
The brain is the seat of higher functions (intelligence, memory, learning, emo-
tion, personality).
B. Peripheral nervous system (PNS)
= neural tissue outside the CNS
It delivers sensory information to the CNS and carries motor commands from
the CNS to the peripheral tissues.
Bundles of axons (or nerve fibres) = a nerve.
Cranial nerves connect to the brain.
Spinal nerves attach to the spinal cord.
A “nucleus” is a brain structure consisting of a relatively compact cluster of neu-
ron cell bodies.
Ganglion = the concentration of nerve cell bodies outside the CNS (= a nucleus).
PNS is divided into two divisions:
B.1. Afferent (= sensory neurons, carries impulses towards the brain)
B.2. Efferent (= motor neurons, away from the brain)
The efferent division carries motor commands to the muscles and glands (effec-
tors). It is subdivided into:
B.2(a) Somatic nervous system (SNS) and
B.2(b) Autonomic nervous system (ANS)

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 89

M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_9
90 Lectures 13–16: Nervous System

The SNS controls the skeletal muscle (voluntary contractions and reflexes).
The ANS controls the smooth muscle, cardiac muscle, diaphragm and glands
(involuntary, automatic function).
The ANS is sub-subdivided into:
B.2(b) (i) Sympathetic division (SD) (prepares the body for “fight or flight”: for
energetic muscular activity)
B.2(b) (ii) Parasympathetic division (PSD) (prepares the body for “rest and
repose”: conserves energy, promotes non-emergency function)
Senses
General senses: position in space, touch, pressure, temperature, pain
Special senses: located in special organs (vision, hearing, taste, smell, balance and
acceleration)

2 Neurons

Nerve cells (neurons) conduct messages (= nerve impulses). They consist of:
• Dendrites: multiple processes that carry incoming impulses to the cell body as
graded potentials.
• Cell body: containing nucleus and organelles.
• Axon: a single process that carries an action potential (= nerve impulse) away
from the cell body.
• An axon is connected to the cell body by an “axon hillock”, may be sheathed in
“myelin” and ends with multiple terminal branches (may be 1 m long!).
• Telodendria: branching terminals of an axon (+ synaptic knobs) that synapse
with another cell.
• Neurons are long-lived (100 years).
• They are amitotic (cannot replace themselves if destroyed).
• PNS nerve axons can regenerate if cut.
• CNS neurons do not regenerate.
• Neurons have a high metabolic rate (require abundant oxygen (O2) and glucose –
survive only a few minutes without oxygen).
Unipolar neuron: one attachment to the cell body, which is attached to a single
combined dendrite-axon. Most sensory neurons, e.g. from the skin, are unipolar
(afferent neurons) (cell bodies of somatic sensory neurons lie in dorsal root gan-
glia (outside the CNS).
Bipolar neuron: two processes from the cell body – one axon and one fused den-
drite, in the retina and the olfactory receptor cell.
Multipolar neuron: many dendrites attached to the cell body, from which a single
axon arises, which ends in synaptic terminals. This is the major type in the CNS.
3 Neuron Function 91

Some are “interneurons” (association neurons) connecting to another neuron

(located in the CNS).
All motor neurons are multipolar.
The cell bodies of somatic motor neurons lie in the CNS.
The cell bodies of some autonomic motor neurons are located in the sympathetic
ganglia (outside the CNS).
Neuroglia/glial (Support) Cells – Six Types
In the CNS, there are four types (10× more abundant than neurons but comprise half
of the mass of the brain):
• Ependymal cells (ciliated, circulate CSF )
• Astrocytes (control the chemical environment around neurons, hold neurons in
place, function in synaptic transmission, form the blood-brain barrier (BBB))
• Microglia (monitor neuron health, are macrophages so can phagocytose
microbes),
• Oligodendrocytes (produce myelin sheath and cholesterol)
In the PNS, there are two types:
• Satellite cells (surround cell bodies in the ganglia, supply nutrients, provide
structure)
• Schwann cells (form myelin sheath) – form regeneration tubes to guide axon
regrowth; phagocytise debris
The myelin sheath (a Schwann cell) surrounds (and insulates) axons – inter-
rupted by “nodes of Ranvier” – and functions to prevent the leakage of charge from
axons. Consequently, impulse propagation is much faster (120 m/s) (through “salta-
tory” conduction from node to node).

3 Neuron Function

Motor (efferent) neurons carry impulses from the brain to the muscles.
Sensory (afferent) neurons carry impulses from sense organs to the brain.
Interneurons (association neurons) lie in the CNS: they connect (synapse with)
motor neurons to sensory neurons and make up approx 20–30% of all neurons.
Resting Membrane Potential
Cell membranes can maintain a difference in the distribution of ions between the
interior of a cell and the extracellular fluid. This results in a difference in electrical
charge. This charge difference is called the resting membrane potential.
• Inside cells, the concentration of large organic anions (proteins), phosphate
(PO43−), bicarbonate (HCO3−) and K+ is high (Na+ is low).
92 Lectures 13–16: Nervous System

• Outside cells, the concentration of Cl− and Na+ is high (K+ is low). Differences in
ion concentrations result in the intracellular fluid of cells being negative
with respect to extracellular fluid (i.e. the membrane is polarised).
• Differences in Na+ and K+ concentration are maintained by the cell membrane’s
sodium-potassium pump (this takes energy).
• Membrane potential most marked in the muscle and nerve cells (inside is
−70 mV with respect to outside).
• Muscle and nerve cell membranes are excitable (i.e. produce action potentials in
response to a stimulus that is above the threshold).
Graded Potential
A stimulus to a dendrite produces a “graded potential” (a small stimulus produces a
small change in membrane potential while a larger stimulus a larger change), which
travels a few millimetres in the membrane. That is, the resting membrane potential
is changed to −55 or −60 mV.
A graded potential (if it is above a threshold) changes to an action potential at the
“axon hillock”.
Action Potential
Resting membrane potential (−70 mV) can “flip” to +30 mV (when a stimulus
above the threshold is received) and then “flop” back to −70 mV. This flip-flop in
membrane potential is called the action potential, which lasts ~3 ms and propa-
gates along the length of the axon as a nerve impulse.
• Following an (above-threshold) stimulus to the cell membrane, Na+ rushes into
the cell through channels (flipping the potential from −70 mV to +30 mV).
Immediately after this, K+ rushes out of the cell (flopping the resting potential
from +30 mV back to −70 mV).
• The voltage surge of depolarisation (flip-Na+ in) and repolarisation (flop-K+ out)
of the membrane propagates along the axon and constitutes an electric current.
Synapse
It is the point of “contact” between two neurons or between a neuron and the muscle
or gland cell it stimulates.
1. When an action potential arrives at the end of a transmitting axon (= the synaptic
knob of a pre-synaptic neuron), extra-cellular Ca++ enters the knob (via voltage-­
gated channels). The knob has synaptic vesicles in the cytoplasm, which contain
a neurotransmitter (a molecule, e.g. acetylcholine) that is released when trig-
gered by Ca++.
2. The gap between the transmitting cell’s membrane and the receiving cell’s mem-
brane (= synaptic cleft) is crossed by the neurotransmitter (released from synap-
tic vesicles), which then lodges in the receptor of the ion channel.
3. The membrane of the receiving neuron/muscle cell/gland cell (= post-synaptic
membrane) has gated Na+ ion channels that open when a neurotransmitter mol-
ecule lodges in the receptor. This in-rush of Na+ transmits the action potential to
the target cell.
4 Brain 93

4. Then acetylcholinesterase hydrolyses ACh into acetate and choline; choline is

absorbed by the neuron to synthesise more ACh.
Neurotransmitters (>100 types)
Most neurons produce two or more neurotransmitters for release at different times
(or the same time), e.g. acetylcholine (ACh), norepinephrine (NE) (also dopamine,
serotonin, gamma-aminobutyric acid (GABA), glutamate, adenosine triphosphate
(ATP), glycine, nitric oxide (NO), carbon monoxide (CO), substance P etc.).
All somatic motor neurons release acetylcholine (ACh) at their synapses with
skeletal muscle fibres. They are always excitatory. (Somatic motor pathways involve
two motor neurons: the upper motor neuron (UMN), whose cell body is located in
a CNS processing centre; the UMN synapses with a lower motor neuron, whose cell
body lies in a brain stem nucleus or the spinal cord and whose axon ends in a skel-
etal muscle.)

4 Brain

The brain is composed of the cerebrum, diencephalon, brainstem and cerebellum

[and cerebrospinal fluid (CSF)!])
http://ellenjmchenry.com/brain-­hemisphere-­hat/
The brain (and spinal cord) is surrounded by three meninges (membranes),
which when inflamed ➔ meningitis:
1. Dura mater: a tough outer coat of fibrous connective tissue (adjacent to the skull,
two layers separated by a thin layer of fluid except where sagittal and transverse
sinuses – filled with venous blood returning to the internal jugular – pass between
them). The dura extends into the brain as dural septa and holds the brain in place.
2. Arachnoid mater: attached to the inner surface of the dura mater. Web-like exten-
sions tie the arachnoid to the pia mater (CSF fills the sub-arachnoid space
between the arachnoid and the pia mater and cushions the brain against shock).
Sub-arachnoid space also contains blood vessels.
3. Pia mater (contacts the brain): contains many tiny blood vessels.
Blood Supply
Right (R) and left (L) internal carotid arteries supply 80% of the cerebrum (via two
middle cerebral arteries).
R & L vertebral arteries join to form the basilar artery (which branches into two
posterior cerebral arteries). The “circle of Willis” is an arterial anastomosis encir-
cling the pituitary gland and optic chiasma – it unites the brain’s anterior and poste-
rior blood supplies, connecting the basilar (vertebral) artery to the carotids; equalises
blood pressure; and provides an alternate route for blood if occlusion occurs.
CVA (stroke) – block to blood circulation in the brain due to clot. The brain tis-
sue dies. Survivors are typically paralysed down one side of the body and may have
a sensory deficit (e.g. speech). Thirty-five per cent survive beyond 3 years.
94 Lectures 13–16: Nervous System

Undamaged neurons may sprout new branches that grow into damaged areas and
take over some lost functions.
Blood-Brain Barrier
The endothelial cells of the capillaries that serve the brain are seamlessly joined to
each other by “tight junctions”, i.e. no gaps between cells. A basement membrane
surrounds the endothelial cells, and pericytes wrap around this. Also, astrocytes
extend processes that envelop the capillaries and regulate their permeability. Hence,
BBB capillaries are very selectively permeable.
BBB separates the brain from fluctuations in hormones, amino acids and ions
that occur in the blood. Some hormones are neurotransmitters, and K+ modifies
threshold potential, so without BBB, brain neurons would “fire” uncontrollably.
O2, carbon dioxide (CO2), water (H2O), fats, fatty acids and fat-soluble mole-
cules (alcohol, nicotine, anaesthetics, steroid hormones, psychotropic drugs) can
diffuse into brain interstitial fluid.
Glucose, essential amino acids and some electrolytes pass through passively by
means of facilitated diffusion. Some viruses (measles) can enter the brain.
However, blood-borne metabolic wastes, toxins, proteins, small non-essential
amino acids, K+ and most pharmaceuticals are denied entry to the brain (non-­
essential amino acids and K+ are actively pumped out of the brain).
BBB is absent in certain parts of the hypothalamus (to allow the release of and
detection of hormones) and the vomiting centre of the brainstem. BBB is incom-
plete in newborn and premature infants.
The choroid plexus is part of BBB but contains capillaries that are porous.
Instead, the ependymal cells that surround the capillaries are joined by continuous
tight junctions. Plasma that filters through the choroid plexus forms CSF.
Cerebrospinal Fluid (CSF)
About 150 ml of CSF is found in (two lateral ventricles + the third and fourth ven-
tricles and the central canal) and around the brain and the spinal cord. CSF has less
protein, Ca2+ and K+ and more Na+, Cl− and H+ than plasma.
CSF solution exchanges freely with the interstitial fluid of the brain.
The brain is supported by (floats in) CSF. CSF cushions the brain and transports
dissolved gases, nutrients, wastes and chemical messengers.
CSF circulates through ventricles (aided by ciliated ependymal cells in the ven-
tricles), the central canal of the spinal cord and the sub-arachnoid space. CSF re-­
enters blood in the superior sagittal sinus via “arachnoid granulations”. It is replaced
every 8 hours.

Cerebrum

The cerebrum surface consists of ridges (gyri) and grooves (sulci) organised
into lobes.
4 Brain 95

Sulci and gyri increase the brain surface area so more neurons can be accommo-
dated. Humans have a great capacity for “higher functions”.
It is divided into left and right cerebral hemispheres by longitudinal fissure.
The central sulcus separates the frontal lobe (with the pre-central gyrus) from the
parietal lobes (with post-central gyri).
Each hemisphere has a superficial layer of “grey matter” called the cerebral
cortex, lying over “white matter”. Within white matter are “islands” of grey matter
called basal nuclei.
Grey matter is predominantly neuron cell bodies.
White matter is myelinated axons (fibres).
1. Cerebral cortex: this is our conscious mind (it allows us to be aware of ourselves
and our sensations and to communicate, remember, understand and initiate vol-
untary movements). Sulci divide each hemisphere into five sections called lobes:
(i) Frontal lobe (higher intellectual functions) and four motor areas:
• Primary motor area (= pre-central gyrus, controls contractions of the
skeletal muscles)
• Pre-motor cortex (co-ordinates learned movements, relays instructions
to the primary motor area)
• Speech (= Broca’s area, regulates vocalisation)
• Frontal eye field (part of the pre-motor cortex)
(ii) Parietal lobes (sensory cortex = post-central gyrus)
(iii) Temporal lobes (auditory cortex)
(iv) Occipital lobe (visual areas)
(v) Insula (equilibrium, gustatory)
We can identify the following functional areas:
• Motor areas (four) – all in the frontal lobe.
• Sensory areas (eight) – in the parietal, temporal, insula and occipital lobes.
• Association areas (eight+) in all lobes – these communicate (i.e. “associate”)
with motor, sensory and other multi-modal association areas and use past
experience to analyse, interpret and act on sensory input.
• Post-central gyrus (of the parietal lobe) houses the primary somatosensory area.
Neurons in this area receive information from general sensory receptors in the
skin and skeletal muscle (and taste).
• Pre-central gyrus (of the frontal lobe) houses the primary motor cortex. Neurons
(pyramidal cells) in these gyri allow us to consciously control skilled voluntary
muscle movements.
• The cerebrum encloses the left and right lateral “ventricles” (= “spaces” filled
with CSF).
2. Cerebral white matter (communication tracts of three types):
(i) Commissural fibres connect corresponding areas in the two hemispheres
(corpus callosum).
96 Lectures 13–16: Nervous System

(ii) Association fibres connect different parts of the same hemisphere.

(iii) Projection fibres enter the hemispheres from the lower brain or cord areas.
3. Basal nuclei/ganglia are grey matter adjacent to the lateral ventricles.
The main components are the striatum, both the dorsal striatum (= caudate
nucleus + putamen) and the ventral striatum (nucleus accumbens + olfactory
tubercle); globus pallidus; ventral pallidum; substantia nigra; and sub-thalamic
nucleus.
(The basal nuclei do not initiate movement but regulate the initiation and termi-
nation of skeletal movements. Have a complex role in controlling movement by
inhibiting the skeletal muscle tone, suppressing unwanted movements and co-ordi-
nating slow sustained contractions of posture, e.g. controlling the subconscious
swing of the arms and legs during walking and “picking up a pencil”).

Diencephalon

It consists of the thalamus, hypothalamus, pituitary gland and pineal gland.

Links the (inferior) brainstem with the surrounding cerebral hemispheres (relays
and processes info).
The thalamus surrounds the third CSF ventricle. It contains about 13 “nuclei”
that receive sensory information before passing it onto basal nuclei and the cerebral
cortex (our consciousness) – but not all of it! (It directs attention to the stimuli of
interest and elicits emotional responses.)
The hypothalamus (with ~12 nuclei) lies below the thalamus and forms the floor
of the third ventricle. It is found behind the optic chiasma and in front of mammil-
lary bodies. It receives sensory impulses from somatic and visceral sensors and has
receptors for osmotic concentration, blood glucose and temperature.
(The optic chiasma is the crossover of optic nerves II. Mammillary bodies relay
olfactory information and contain reflex centres for eating and swallowing
movements.)
The hypothalamus is the main visceral control centre of body homeostasis. It is
the autonomic control centre from which orders flow to lower CNS centres for
execution.
It has many homeostatic roles:
1. Heart activity and blood pressure
2. Emotional response centre (facial expression)
3. Body temp regulation
4. Regulation of food intake and gut movement
5. Regulation of urine output and thirst
6. Regulation of sleep-wake cycles
7. Production of two posterior pituitary hormones
8. Release of regulatory hormones to the anterior pituitary for secretion
9. Control of uterine contractions and milk ejection
4 Brain 97

The pituitary gland “dangles” inferior to the hypothalamus by the infundibulum

(stalk).
The pineal gland produces the hormone melatonin, which regulates circadian
rhythm and reproductive functions. It is not isolated by BBB!

Brainstem

It consists of the midbrain, pons and medulla oblongata. Centres in the brainstem
produce rigidly programmed, automatic behaviours necessary for survival, e.g.
respiratory centre (breathing rhythm), cardiovascular centre (force and rate of heart
contraction, vasoconstriction), vomiting, coughing, hiccoughing and swallowing.
Cranial nerves (12 pairs associated with the brain)
I = olfactory nerves
II = optical nerves
The nuclei of the brainstem are associated with ten of the 12 cranial nerves.
Midbrain (corpora quadrigemina = superior colliculi, which receive and process
visual info, + inferior colliculi, which receive and process auditory info)
The substantia nigra releases dopamine.
III = oculomotor nerves
IV = trochlear nerves
Pons contains many fibres running to and from the cerebellum.
V = trigeminal nerves (trigeminal neuralgia)
VI = abducens nerves
VII = facial nerves
Medulla oblongata (MO) – fibre tracts of the spinal cord between higher and
lower neural centres pass through the medulla.
The point of “decussation of the pyramids” is in the medulla (90% of cortico-­
spinal pathways cross over in the MO; hence, each cerebral hemisphere controls the
voluntary movements of the opposite side of the body).
The medulla is an autonomic reflex centre containing visceral motor nuclei (car-
diovascular centre, respiratory centres, vasomotor centres).
VIII = vestibulocochlear nerves
IX = glossopharyngeal nerves
X = vagus nerves
XI = accessory nerves
XII = hypoglossal nerves
X = vagus nerves
The vagus nerve is the only cranial nerve that extends beyond the head and
neck region.
98 Lectures 13–16: Nervous System

Sensory function (taste, baroreceptors in carotid sinus, chemoreceptors in carotid

& aortic bodies). Parasympathetic motor function (heart, lungs, digestive system
activity, liver & kidneys)

Cerebellum

The cerebellum processes inputs from the cerebral motor cortex, various brainstem
nuclei and sensory receptors. The cerebellum subconsciously provides precise tim-
ing and appropriate patterns of learned skilled skeletal muscle contraction for
smooth co-ordinated movements, posture and agility (= “automatic pilot”).
Cerebellar injury results in the loss of muscle tone and clumsy unsure movements.

[Cerebrum (telencephalon)
Diencephalon (between the cerebrum and the brain stem)
Midbrain (mesencephalon – brainstem)
Pons (metencephalon – brainstem)
Medulla oblongata (myelencephalon – brainstem)
Cerebellum (metencephalon)
Forebrain = cerebrum + diencephalon]

5 Brain Function

The “limbic system” is a network of neurons that span large distances in the brain
but work together. They are a functional grouping rather than an anatomical one.
It is our motivational system – the limbic system makes us want to do tasks.
Limbic System
It sits on the border between the cerebrum and the diencephalon. It includes the
cingulate gyrus (of the frontal lobe), the dentate gyrus and the parahippocampal
gyrus (of the temporal lobe), several other nuclei (amygdala, septal nuclei, two in
the thalamus), the mammillary bodies, the olfactory bulbs and the fornix.
It is our emotional or affective brain. It:
• Recognises angry or fearful facial expressions
• Expresses our emotions through gestures etc.
• Triggers emotional reactions to smells
• Produces emotion-induced illness (high blood pressure, heartburn, psychoso-
matic illnesses)
• Allows emotion to override logic
• Allows reason to prevent emotional response
• Is involved in memory and learning
6 Spinal Cord (SC) 99

(Fibres from parietal and temporal lobes go to association areas in the frontal
lobe that are part of the limbic system. Through these connections, sensory informa-
tion can be invested with emotional and motivational significance! An animal’s
behaviour can be changed from savage to docile and back again simply by stimulat-
ing different areas of the limbic system (e.g. amygdala).
Reticular formation (reticular activating system)
• net-like interconnection of neurons throughout the brain stem that connects to
the cerebrum, hypothalamus, thalamus, cerebellum and spinal cord
• receives and integrates all incoming sensory input(!)
• keeps the cortex alert and us aroused and conscious
• filters out repetitive, familiar or weak sensory signals but allows significant,
unusual or strong stimuli to reach consciousness (like your mobile phone
ring tone!)

6 Spinal Cord (SC)

• The spinal cord extends from the foramen magnum of the skull to L1/L2(below
L2, the dorsal and anterior roots of the remaining spinal nerves continue within
the vertebral column until they exit at the lumbar, sacral and coccygeal regions).
• Spinal reflexes initiate and complete at the spinal cord level.
• The spinal cord contains “ascending” nerve tracts (transmitting sensory informa-
tion) and “descending” tracts (transmitting motor information).
• It is protected by bone, meninges and CSF.
• Thirty-one pairs of spinal nerves attach to the SC.
The SC is enclosed by a single-layer dura mater (spinal dural sheath). External
to the dura mater is the epidural space containing fats and veins within the vertebral
foramen. The SC ends at L1, but dural and arachnoid membranes (and the roots of
some spinal nerves) continue inferiorly to S2. The sub-arachnoid space contains
CSF and delicate spinal nerves (cauda equina) ➔ lumbar tap here.
SC Cross-Section
SC is divided by the anterior median fissure and the posterior median sulcus into left
and right.
The grey matter of the SC has an “H” or “butterfly” shape; that is, the left and right
halves are joined by “grey commissure”.
The posterior/dorsal horn contains interneurons.
The anterior/ventral horns contain cell bodies of motor neurons.
The white matter (myelinated and unmyelinated nerve fibres) is divided into ante-
rior, lateral and posterior “columns” (funiculi). Each funiculus contains several
“tracts” made up of axons with similar destinations that connect the brain to the
peripheral body (i.e. pathways). Most motor pathways cross from one side of the
CNS to the other (decussate) in the brainstem.
100 Lectures 13–16: Nervous System

Ascending pathways (spino-thalamic and spino-cerebellar tracts) conduct sen-

sory information from the body to the brain (upward(!) and afferent).
Descending pathways (cortico-spinal and all tracts ending with “-spinal tracts”)
conduct efferent impulses from brain to body.
SC breaks above L1 ⇒ paraplegia.
SC breaks above ~C7 ⇒ quadriplegia.
SC breaks above C5 ⇒ respiratory failure and death?
CVA ⇒ hemiplegia?
Spinal Nerves
• 31 pairs issue from the SC (1 pr. for each vertebra)
• eight pairs from C1 to C7 (C4–C7 serve the arms)
• 12 pairs from T1 to T12
• five pairs from L1 to L5 (serve the legs)
• five pairs from S1 to S5
• one pair from the coccyx
Each spinal nerve is formed by a dorsal root and a ventral root (surrounded by
dura mater) coming together in the vertebral foramen.
The dorsal root links to the posterior grey horn. It contains sensory fibres carry-
ing incoming/afferent impulses from peripheral sensory receptors. These sensory
fibres arise from neurons whose cell bodies are located in dorsal root ganglia.
The ventral root (with motor neurons carrying outgoing/efferent impulses) links
to the anterior grey horn (autonomic NS efferents are also in the ventral roots).
Each spinal nerve is short (1–2 cm), then it divides as it leaves the vertebral fora-
men into dorsal ramus, ventral ramus, grey ramus, white ramus etc.
Note:
The phrenic nerve arises from spinal nerves C3, C4 and C5 and innervates the
diaphragm.
The sciatic nerve (L4, L5, S1–S3) may be damaged by the improper administration
of injection into the buttocks.
(Inborn) Spinal Reflexes
This refers to a rapid predictable motor response (unlearned and involuntary) to a
stimulus (without processing by the brain).
1. Receptor
2. Sensory neuron (transmits afferent impulses to the CNS)
3. Integration centre in the CNS (spinal cord)
4. Motor neuron (conducts efferent impulses to an effector organ)
5. Effector (muscle fibre or gland cell)
Reflexes are used by physicians to assess the condition of the nervous system.
Exaggerated, distorted or absent reflexes indicate the degeneration/pathology of
specific nervous system regions.
7 The Autonomic Nervous System 101

Stretch Reflex
The stretch reflex (e.g. patellar reflex) automatically controls the length of the skel-
etal muscle.
“Muscle spindles” are proprioceptors within a muscle. They are special muscle
fibres wrapped in sensory nerve endings. When the spindles in a muscle are
stretched, afferent fibres carry impulses to the SC, where 2 synapses occur – one
with a motor neuron and another with an interneuron; the motor neuron carries an
impulse to the stretched muscle, causing it to contract (i.e. oppose the initial stretch),
and the interneuron synapses with another motor neuron, which signals the antago-
nistic muscle to relax (i.e. to not oppose the contraction of the first muscle).In this
way, muscle tone is maintained, and we can control our leg muscles and maintain
standing posture (the patellar – “knee-jerk” – is a manifestation of a monosynaptic
stretch reflex).
(The tendon reflex responds to increased stretch in the tendon organ. The sen-
sory neuron synapses with two interneurons, one of which synapses with a motor
neuron, which then causes muscular relaxation to relieve tendon stretch, and the
other causes contraction in the antagonistic muscle.)
Cranial reflexes involve the cranial nerves. They are used to check for damage
to the cranial nerves or their associated processing centres in the brainstem.

7 The Autonomic Nervous System

• The ANS stimulates the cardiac muscle, smooth muscle, diaphragm and glands.
Hence, it controls heart rate (HR), vasodilation, blood pressure, body tempera-
ture, respiration, digestive function, urinary function, reproductive function and
endocrine function.
• The ANS has two neurons in a motor pathway:
–– neuron #1 (the pre-ganglionic neuron) runs from the CNS to a ganglion (then
synapses), and
–– neuron #2 (unmyelinated post-ganglionic neuron) runs from the ganglion to
the effector (then synapses). The ganglion contains the cell body of neuron #2.
• The ANS has two divisions:
–– “Sympathetic” division (which mobilises the body during extreme situations,
e.g. exercise, excitement, emergency) and
–– “Parasympathetic” division (maintains body activities, e.g. digestion, defeca-
tion and diuresis, and conserves energy).
(Some organs, like the eye, heart, pancreas, lungs, gut, bladder and reproductive
system, are innervated by both SD and PSD.)
102 Lectures 13–16: Nervous System

Sympathetic Division (SD)

SD fibres emerge from the thoracic and lumbar vertebrae (hence are “thoraco-­
lumbar” T1-L2).
SD has short pre-ganglionic fibres and long post-ganglionic fibres.
SD have ganglia that lie close to the SC.
SD supplies sweat glands, arrector pili muscles, and smooth muscle of blood vessels
(vasoconstriction).
SD stimulates the adrenal gland to release NE and epinephrine (adrenaline) and the
kidneys to release renin (an enzyme) into the blood.
Parasympathetic Division (PSD) = Vagus
PSD fibres emerge from the brain and the sacral spinal cord (hence are
“cranio-sacral”).
PSD has long pre-ganglionic fibres and short post-ganglionic fibres.
Most PSD ganglia lie in a visceral effector organ.
Ninety per cent of PSD impulses are via the two vagus nerves (X).
Parasympathetic Neurotransmitters and Receptors
All parasympathetic neurons release ACh as a neurotransmitter.
ACh is released by all ANS (both PSD and SD) pre-ganglionic fibres, i.e. at the first
synapse (called cholinergic), to nicotinic acetylcholine receptors.
ACh is released by all ANS-PSD post-ganglionic fibres, i.e. at the second synapse
(called cholinergic), to nicotinic or muscarinic receptors.
Parasympathetic effect on:
HEART – decreases HR
LUNGS – constricts bronchioles
EYE – constricts pupil
GUT – increases motility and secretions
REPRO SYS – causes sexual arousal
Sympathetic (stirs you up) effect on:
HEART – increases HR and strength of contraction
LUNGS – dilates bronchioles, increases respiratory rate and depth of breathing
EYE – dilates the pupil
GUT – decreases motility and secretion
URINARY – decreases blood flow to the kidneys
BLOOD VESSELS – assists in constriction (NE) or dilation (ACh)
SWEAT GLANDS – stimulates sweating (ACh)
SKEL MUSC – increases glycolysis and muscle tone
ADIPOSE TISSUE – assists in lipolysis
Two Neurotransmitters and Seven Receptors
Parasympathetic Neurotransmitters and Receptors
All parasympathetic neurons release ACh as a neurotransmitter.
7 The Autonomic Nervous System 103

ACh is released by all ANS (both PSD & SD) pre-ganglionic fibres, i.e. at the
first synapse (called cholinergic), to nicotinic acetylcholine receptors.
ACh is released by all ANS-PSD post-ganglionic fibres, i.e. at the second
synapse (called cholinergic), to nicotinic or muscarinic receptors.
[NE is released by most ANS-SD post-ganglionic fibres, i.e. at the second syn-
apse (called adrenergic)
(some release ACh to muscarinic receptors).]
It is the type of receptor (not the neurotransmitter) that determines the response
of the post-synaptic cell.
Cholinergic (Nicotinic and Muscarinic) Receptors
ACh binds (on the post-synaptic membrane of ganglionic neurons or on effector
cells) to two types of (cholinergic) receptors: nicotinic and muscarinic (M1, M2,
M3, M4).
Nicotinic receptors bind ACh and are always stimulatory.
Nicotinic receptors are found on:
–– All ganglionic neurons
–– The hormone-producing cells of the adrenal medulla
–– (And motor end plates of skeletal muscle cells)
Muscarinic receptors may be stimulatory or inhibitory.
Muscarinic receptors are found on all effector cells stimulated by post-­ganglionic
cholinergic fibres (= all parasympathetic target organs, a few sympathetic targets).
Sympathetic Neurotransmitters and Receptors
ACh is released by all ANS pre-ganglionic fibres, i.e. at the first synapse
(called cholinergic), to nicotinic receptors.
NE is released by most ANS-SD post-ganglionic fibres, i.e. at the second
synapse (called adrenergic) (some release ACh to muscarinic receptors).
Adrenergic (Alpha 1,2 and Beta 1,2,3) Receptors
Norepinephrine (and epinephrine) binds to five types of (adrenergic) receptors: α1,
α2, β1, β2 and β3. Binding may produce stimulation or inhibition depending on the
target organ.
NE binding α1 ➔ release of Ca and contraction of the smooth muscle in the blood
vessels and sphincters in the gut
NE binding α2 ➔ lowers the cAMP level in the cytoplasm, which inhibits
NE binding β1 ➔ stimulates metabolic activity in the skeletal muscle, heart rate and
force of contraction increases
NE binding β2 ➔ inhibits smooth muscles, respiratory passageways dilate
NE binding β3 ➔ lipolysis in the adipose tissue, free fatty acids (FFAs) into
circulation
104 Lectures 13–16: Nervous System

8 Additional Information

Knowing the location of receptor types allows the use of drugs to block nerve trans-
mission across those synapses!
For example:
Atropine (an anticholinergic) binds to ACh muscarinic but not ACh nicotinic
receptors to block PSD stimulation (but not SD stimulation).
Ephedrine (a sympatho-mimetic) binds to α adrenergic receptors to stimulate
“feeling good”.
A beta-blocker (an anti-hypertensive) binds to cardiac β1 receptors to inhibit
an increase in HR or the strength of contraction.
Ventolin (a bronchodilator) binds to lung β2 receptors to mimic stimula-
tion by NE.
LAS-3427 in development (a muscarinic antagonist bronchodilator) binds to
lung M3 receptors to block the normal response to ACh.
(The M1 cholinergic receptor is common in exocrine glands bound to G proteins,
which use intracellular calcium as a signalling pathway.
M2 muscarinic receptors are located in the heart, where they act to slow the heart
rate down to normal sinus rhythm after stimulatory actions of the sympathetic ner-
vous system by slowing the speed of depolarisation. They also reduce contractile
forces of the atrial cardiac muscle and reduce the conduction velocity of the atrio-
ventricular node (AV node).
M3 muscarinic receptors are located at many places in the body, e.g. smooth
muscles, endocrine glands, exocrine glands, the lungs, the pancreas and the brain.
These receptors are highly expressed on pancreatic beta cells and are critical regula-
tors of glucose homoeostasis by modulating insulin secretion. In general, they cause
smooth muscle contraction and increased glandular secretions.)
Multiple Sclerosis is an autoimmune demyelinating disease of CNS
Current USA Statistics for Stroke Survival Rates
• Ten per cent of stroke victims recover almost completely.
• Twenty-five per cent of stroke victims recover with minor impairments.
• Forty per cent of stroke victims experience moderate to severe impairments
requiring special care.
• Ten per cent of stroke victims require care in a nursing home or other long-term
care facility.
• Fifty per cent die shortly after the stroke.
• Meanwhile, 7.6% of ischemic strokes and 37.5% of haemorrhagic strokes result
in death within 30 days.
• While sub-arachnoid haemorrhage (SAH) represents only about 7% of all
strokes, it is the deadliest – with more than 50% fatality rate. Of the survivors,
approximately half will suffer permanent disability.
8 Additional Information 105

• Twenty-two per cent of men and 25% of women die within a year of their
first stroke.
• Fourteen per cent of people who had a stroke or transient ischemic attack (TIA)
will have another within a year.
• About 25% of stroke victims will have another within 5 years.
• Each year, 28% of people who suffer a stroke are under the age of 65.
Reflexes
Information about the environment around us (both internal and external) is detected
through a variety of sensory receptors which convert (transduce) various stimuli
into nerve action potentials. These action potentials are relayed to our CNS for
processing.
Our bodies have receptors sensitive to mechanical, thermal, electromagnetic and
chemical stimuli. Without any prior learning, relatively simple, inbuilt patterns of
motor responses called REFLEXES can be exhibited. These reflexes are mediated
over functional units called REFLEX ARCS.These responses to stimuli do not
require voluntary intervention – that is, they do not require conscious efforts on our
part to take place. They are, in the narrowest sense, “built in”. For instance, there is
a reflexive pulling away of one’s hand from a hot object or the shutting of one’s eyes
as an object rapidly approaches one’s face. In these cases, we may only be aware of
the stimulus and the final event in the sequence (the reflex response). No matter how
basic they appear to be, most reflexes are subject to alternation by learning. For
instance, you can – if you want to – resist the impulse to remove your hand from a
hot object or keep your eyes open when an object is hurtling rapidly towards your
face. The testing of reflexes is an important and objective part of the examination of
neurological functioning. Abnormal reflex responses can indicate specific patholo-
gies in the CNS. Somatic reflexes involve skeletal muscles, whereas autonomic
reflexes involve smooth muscles and/or glands.
The essential components of all reflex arcs (although most are more complex
than this) are:
1. A SENSORY RECEPTOR, which reacts to a stimulus and transduces it into an
electrical impulse
2. An AFFERENT (or SENSORY) neuron, which conducts transduced informa-
tion from the receptor to the CNS
3. A CENTRAL region in the CNS where an incoming sensory impulse generates
an outgoing motor impulse (here the impulse may be inhibited, transmitted or
rerouted)
4. An EFFERENT (MOTOR) neuron, which conducts the integrated neural output
from the CNS to an effector organ
5. An EFFECTOR ORGAN – the muscle or gland that responds to the stimulus.
Some reflexes have pathways where signals can pass via only two neurons,
linked by one synapse. These are called MONOSYNAPTlC reflex arcs. Others are
more complex, having one or more intermediary (internuncial) neurons in the reflex
arc pathway. These are POLYSYNAPTIC reflex arcs.
106 Lectures 13–16: Nervous System

Since delay (or inhibition) of the reflex may occur at the synapses, the larger the
number of synapses in a pathway, the greater the time required to effect the reflex.
(In humans and other mammals, the fastest impulses in the largest nerve fibres travel
at a speed of over 120 m/s – i.e. over 400 km/h.)Many reflexes occur without the
involvement of higher brain centres and will function as long as the spinal cord
remains intact. Others require the involvement of functional brain tissues because
many different inputs have to be evaluated before the appropriate reflex is deter-
mined. In some of the “spinal” “reflexes”, while the brain is not required to produce
a reflex response, it is frequently “advised” of spinal cord reflex activity and may
alter it by facilitating or inhibiting the reflex.
Based on the distribution of effector organs in the body, reflexes are commonly
recognised as belonging to one of two large groups:
1. Somatic reflexes: these are associated with the stimulation of the skeletal mus-
cle by the somatic division of the nervous system. Some somatic reflexes require
only spinal cord activity, e.g. the PATELLAR (KNEE JERK) and ACHILLES
reflexes, while some require brain involvement as well, e.g. CORNEAL and
PHARYNGEAL (GAG) reflexes.
2. Autonomic (visceral) reflexes: these are associated with visceral structures.
These are mediated through the autonomic nervous system and are not subject to
direct conscious control. They involve the regulation of such body functions as
digestion, peristalsis, elimination, blood pressure and salivation.

9 Nervous System Revision: Homework Exercise 9

1. Distinguish between the following entities:

(a) The CNS and the PNS
(b) The efferent nervous system and the afferent nervous system
(c) The autonomic NS and the somatic NS
(d) The sympathetic NS and the parasympathetic NS
2. Describe the role of the sympathetic division of the ANS and its effects on
the body.
3. Draw a simple diagram of CNS meninges consisting of three concentric circles.
Label the three meninges, the epidural space, the sub-arachnoid space and the
CSF. Further draw two needles: one delivering an epidural anaesthetic and the
other in place for a lumbar puncture to draw out CSF.
4. Distinguish between a unipolar and a multipolar neuron.
5. (a) What is a “graded potential”?
(b) What is an “action potential”?
6. Name four neurotransmitters. What is their function?
7. (a) What are the five main structures of the CNS?
9 Nervous System Revision: Homework Exercise 9 107

(b) In which of the five are the following structures/areas located: conus
medullaris, respiratory centres, motor areas, cauda equina, autonomic control
centre, visual association areas, area for the control of body temperature, cervi-
cal enlargement, arbor vitae, basal nuclei, substantia nigra and posterior
median sulcus?
8. What constitutes a reflex arc? Describe the stretch reflex.
9. What type of chemical is stored in the synaptic vesicles of a neuron?
10. Draw diagrams that distinguish between a unipolar, a bipolar and a multipo-
lar neuron.
11. Draw a cross-sectional diagram of the spinal cord and label it with the struc-
tures: spinal meninges, grey matter, white matter, dura mater, arachnoid, pia
mater, dorsal (posterior) grey horns, ventral (anterior) grey horns, sensory
fibres, dorsal (posterior) root ganglion, spinal nerves, grey commissure, lateral
grey horns, central canal, anterior median fissure and posterior median sulcus.
12. What is the cauda equina?
13. What is the difference between the spinal cord at L1 and L3?
14. Which two meninges enclose the CSF?
15. What is the name of the “space” between meninges that contains CSF?
16. If a patient has raised intracranial pressure, would CSF pressure in the lumbar
region (measured by spinal tap) be higher or lower than normal? (Think of
Pascal’s principle.)
17. What structures separate the epidural space from the sub-arachnoid space?
18. What major nerves pass through the epidural space?
19. Where are the cell bodies of peripheral sensory neurons located?
20. Where are the cell bodies of peripheral motor neurons located?
Lecture 17: Special Senses
(Caon & Hickman 3rd ed, Ch11, pp. 297–300, Ch
12, pp 314–320)

1 General Senses

Sensory receptors are located throughout the body. They may be free nerve endings
or nerve endings surrounded by a capsule.
Free nerve endings (including the Merkel disc in the skin and hair follicles)
respond to cold, heat, vibration, pressure, touch, itch, pain and stretch.
Encapsulated nerve endings include Meissner’s corpuscles (in hairless skin),
Pacinian corpuscles (in skin, around the bones and joints), Ruffini’s corpuscles (der-
mis, hypodermis, joints), muscle spindles (skeletal muscle) and Golgi tendon organs
(tendons).

2 The Eye

Our eye is the structure that detects visible em radiation (light). A benefit of having
two eyes is stereoscopic vision (we perceive three dimensions), so we can estimate
distances and the position of objects in space.
• Fibrous tunic (sclera, cornea), aqueous humour (in the anterior cavity, between
the lens and cornea)
• Vascular tunic (choroid, ciliary body and suspensory ligament, pupil, iris, lens),
vitreous humour (posterior cavity, post. to lens)
• Sensory tunic (retina = pigmented layer, rods and cones, bipolar cells, ganglion
cells), macula lutea, fovea centralis (cones), except at blind spot (optic disc)
(Light photons traverse the cornea, aqueous humour, pupil, lens, vitreous humour,
axons, ganglion cells, amacrine cells, bipolar cells and horizontal cells to strike the
rods and cones.)

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 109
M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_10
110 Lecture 17: Special Senses

Light enters the posterior chamber of the eye through the black pupil, then passes
through the lens and then traverses the vitreous. The diameter of the pupil may be
varied by the colourful iris (a sphincter muscle under autonomic nervous system
(ANS) control), from about 3 mm in diameter in bright light to about 8 mm in the
dark. This change will vary the amount of light entering the eye by a factor of 7; the
retina is able to adapt to different lighting conditions also (the anaxonic horizontal
cells and amacrine cells of the retina also have a role in the eye’s adjustment to dim
or bright conditions).
The retina is the light-sensitive part of the eye. It converts light energy into elec-
trical nerve impulses, which are sent to the brain. The retina covers the back half of
the eyeball, enabling wide-angle vision.
Most vision is restricted to a small area called the macula lutea (yellow spot)
and all detailed vision to a very small area called the fovea centralis (0.4 mm in
diameter). At the fovea, the several layers of nerve tissue that overlie the retina are
pushed aside so light strikes the cones directly (without having to traverse axons,
ganglion cells and bipolar cells).
Rods and cones are the two types of photoreceptor cells in the retina.
The cones are used mainly for daylight (photopic) vision and colour vision and
are primarily found in the fovea (but occur throughout the retina); each cone in the
fovea has its own nerve connection to the brain (hence, vision is acute here), while
in the rest of the retina, several cones share one nerve fibre.
The rods are used for low light (scotopic) vision (e.g. at night) and peripheral
vision. They cover most of the retina and are much more numerous than cones.
Hundreds of rods share the same nerve fibre, so rods have a poor ability to resolve
close sources of light.
The blind spot on the retina is without rods or cones. Here, the blood vessels and
axons of ganglion cells come together as the optic nerve and leave the eye at the
“optic disc”.
Visual Pathway
Axons from retinal ganglion cells, issue from each eye as optic nerves (II). At the
optic chiasma, fibres in the left (L) and right (R) optic nerves from the medial
aspect of each eye cross over and continue (along with those from the lateral aspect
of the contralateral eye) as L and R optic tracts and synapse with neurons in the
lateral geniculate body (of the thalamus).
(Superior colliculi are involved in pupillary and eye movement reflexes via col-
lateral connection.)
Many axons then continue as optic radiation of fibres into the primary visual
cortex (in the occipital lobes).
(Note: Images of objects to our right fall onto the left half of the retina, and
nerves from the left side of each eyeball go to the left side of the brain.)
Lenses
A lens is any transparent object with curved faces. If the curve is “outwards”, mak-
ing the middle of the lens fat and the edges thin, the lens is convex; the opposite
curve is concave.
2 The Eye 111

The focal length of a lens is the closest distance to the lens that an image can be
formed (~2 cm for our eye).
Our eye can be thought of as a two-lens system. Both the cornea and the eye lens
have curved faces, so both refract (and aid in focussing) light that enters our eye.
Accommodation
This refers to our ability to alter our eye’s lens so that it can focus on objects at any
distance away.
A thick, highly curved lens has a short focal length (for focussing light diverging
from close objects); a thin, slightly curved lens has a long focal length (for focus-
sing parallel light rays from distant objects).
Our lens is a “fat” biconvex shape, flexible and elastic, so it can be stretched
thinly (by relaxing, the ciliary muscle retreats from the lens into a large circle,
which pulls on the ciliary fibres, causing them to stretch the lens). This brings dis-
tant objects into focus.
Our lens can elastically recoil into a rounder, thick lens (by contracting ciliary
muscles into a small circle, which releases the tension on ciliary fibres, allowing the
lens to “ooze” back to shape). This brings close objects into focus.

Defects of Vision

Myopia – nearsightedness (too much refraction); it can be corrected with a con-

cave lens.
Hyperopia – long-sightedness (too little refraction); it can be corrected with a con-
vex lens.
Astigmatism – the cornea is unevenly curved, i.e. non-spherical.
Presbyopia (old-age vision) is caused by the lens losing its elasticity, so it cannot
ooze into the short focal lengths of a youthful lens.
Corneal transplant: there is no rejection problem as there are no blood vessels to
carry white blood cells (WBC).
Age-related macular degeneration: this refers to a blurred area near the centre of
vision (the macula lutea).
“Colour blindness”: this happens when three pigments in the cones are sensitive to
red, green or blue light and also have some sensitivity beyond their major colour.
If the red-sensitive cones are missing, then red is perceived as green, and the condi-
tion is called protanopia.
In the reverse situation, green cones are missing, so green light stimulates red cones
only, a condition called deuteranopia.
Anomalous trichromats: in people with this condition, all of their three cone types
are used to perceive light colours, but one type of cone perceives light slightly
differently.
Cataracts: there is opacity in the lens. The lens is removed (by phacoemulsifica-
tion) and replaced with a soft plastic trifocal intraocular lens (IOL).
Other eye problems include glaucoma, a retinal bleed, retinal detachment
112 Lecture 17: Special Senses

3 Ear Structure

Outer ear: auricle, external auditory meatus, tympanic membrane

Middle ear (filled with air): eardrum, tensor tympani, malleus, incus, stapes, stape-
dius muscle, oval window (OW), Eustachian tube
Inner ear: vestibule, cochlea, semi-circular canals, endolymph
The Transmission of Sound Waves to the Auditory Nerve
The ear is an “impedance matching” device, thereby directing sound propagating
through air, via the middle ear, into the liquid endolymph of the cochlea.
(Resonance in the ear canal, leverage by ossicles, area ratio of eardrum and OW)
The tympanic membrane (TM, eardrum) separates air of the external ear canal
from air in the middle ear (air in the middle ear is vented to the atmosphere through
the Eustachian tube). TM vibrates due to pressure variations associated with the
compressions and rarefactions of sound waves. TM moves the malleus, which
moves the incus, which moves the stapes (the three ossicles), which presses on the
oval window (of the cochlea). Hence, vibrations of air pass through OW into the
fluid of the cochlea (the snail-like inner ear). Vibrations in the cochlear fluid cause
movement in a certain part of the basilar membrane (on which sits the organ of
Corti). The o. of C. is covered by the tectorial membrane so that its hair cells rub
against the TM, which causes nerve impulses to be generated in the o. of C., which
are transmitted to the brain via the cochlear nerve (part of Chapter VIII).

Sensitivity of Human Hearing

Sound intensity (in watts per square metre, W/m2) is the objectively measurable
amount of sound energy carried by a sound.
10−12 W/m2 = silence (threshold of hearing).
1 W/m2 = pain.
Sound level (in decibels (dB)) is a subjective measure of the loudness of a sound.
0 dB = silence.
0 dB does not mean that the amount of sound energy is zero. Just that we cannot
hear it!
Two sounds that differ by 0.1 dB can barely be perceived as different in loudness;
a sound that is 3 dB louder than another sounds twice as loud. Continuous noise at
90 dB will produce hearing damage without causing pain (→ encourage the wearing
of ear-muffs – an occupational health requirement!)
The human ear is not equally sensitive to all audible frequencies.
Perceived loudness (in phons) – e.g. 60 dB “phon” (or equal loudness curve) is
a graph of the sound level (in dB and over the range of audible frequencies) that we
perceive to be the same loudness as a sound of 1000 Hz at 60 dB.
4 The Sense of Equilibrium 113

Audible range is ~20 Hz to ~20,000 Hz; infrasonic: <20 Hz, ultrasonic: >20 kHz.
The sounds of different frequencies stimulate our hearing in different amounts.
The ear is most “sensitive” from 500 to 6000 Hz. It is not very sensitive below
200 Hz or above 12,000 Hz.
As we age, we progressively lose the ability to hear frequencies >~12,000 Hz
(presbycusis).
For audible range test (Google “human audible range”). Try:
http://www.youtube.com/watch?v=qNf9nzvnd1k (continuous range)
http://www.youtube.com/watch?v=2G9Q-­r2leyw (step changes)
http://www.youtube.com/watch?v=VxcbppCX6Rk (how old are you hearing test –
wear headphones)
Other hearing problems include noise-induced hearing loss, Conductive deaf-
ness, Sensorineural loss.

4 The Sense of Equilibrium

(Involves input from the eyes, stretch receptors in muscles/tendons, and the vestibu-
lar apparatus)
The vestibule contains two membranous sacs (linked by a duct) called saccule
and utricle. Each contains a sensory receptor called a macula, which is sensitive to
linear acceleration forces.
The dense otoliths (embedded in the jelly-like otolithic membrane) have a rela-
tively large inertia and, hence, respond more slowly than the body to changes
in motion.
“Hairs cells” in the macula are bent (and stimulated) when the overlying oto-
lithic membrane, in which they are embedded, moves.
The membrane in the saccule is vertical (responds to vertical acceleration). The
membrane in the utricle is horizontal (responds to horizontal acceleration).
The three semi-circular canals each have an enlargement called an ampulla. The
ampulla houses an equilibrium receptor called a crista ampullaris, with “hair cells”
that respond to the rotation of the head. The endolymph in the ducts, because of
inertia, remains stationary when the head (i.e. the “hair cells”) begins to move (or
the endolymph continues to move when the hair cells suddenly stop).
When these hair cells are moved through the stationary endolymph (or the mov-
ing endolymph moves over the stationary hair cells), they are stimulated.
The maculae and cristae ampullaris send impulses via the vestibular nerve (part
of Chapter VIII).
Motion sickness is an equilibrium problem
114 Lecture 17: Special Senses

5 Taste and Smell

Five basic tastes:

1. Sweet (sugars, alcohols, saccharins)
2. Sour (acids, lemon juice)
3. Salty (metal ions, esp. Na+)
4. Bitter (quinine, caffeine, nicotine)
5. Umami (glutamate – beef taste, aged cheese, monosodium glutamate (MSG))
Also involved in “taste” are temperature, texture and pain, e.g. chilli. And “taste”
is 80% smell!
Smell relies on volatile chemicals – molecules must enter the nose to be smelled.
Olfactory receptors are neurons (replaced every ~60 days). Classifying “primary
odours” is problematic.

6 Special Senses Revision: Homework Exercise 10

1. Describe the function of the (a) cornea, (b) lens, (c) retina, (d) canal of Schlemm,
(e) choroid and (f) pupil.
2. Describe the role of the ciliary body and suspensory ligaments in the process
known as accommodation.
3. Why does the retina have a blind spot?
4. What are the names commonly given to the two types of lenses?
5. Describe the effect on the light rays of each type of lens (diverge/converge).
6. Which one produces a magnified image when placed over some writing
on a page?
7. Which one has the same curvature as your eye’s lens?
8. Define what is meant by hyperopia.
9. Describe the function of the (a) pinna, (b) ossicles, (c) Eustachian tube and (d)
cochlea.
10. What are the average sound frequency endpoints of the audible range
for humans?
Lecture 18: Blood

Blood is the complex liquid component of the cardiovascular system (CVS). It is a

connective tissue.

1 Functions

(a) Transport: oxygen (O2) from lungs to cells, carbon dioxide (CO2) from cells to
lungs, nitrogenous waste from cells to kidneys and sweat glands, nutrients
from digestive organs to the liver and cells, and hormones from the endocrine
system to target cells and enzymes
(Plasma proteins transport lipids, drugs etc.)
(b) Regulation: temperature (transfers heat around the body), pH (through the use
of buffers), fluid volume and electrolyte balance
(c) Protection: coagulation; antibodies, white blood cells (WBC) and complement
proteins defend against toxins and foreign microbes
(Hydrostatic function in reproduction!)
Blood volume is ~8% of body mass. Hence, an average male has 5-6 litres and a
female 4-5 litres. It is 45% formed elements (cells and cell fragments such as plate-
lets) and 55% straw-coloured plasma.
Serum = plasma minus fibrinogen, Ca++ (i.e. the clotting factors).
Plasma
Its composition is 90% water and 8% protein (albumins 58%, globulins 37% (α, β,
γ), fibrinogen 4%, peptide hormones, prothrombin, transferrin, plasminogen, clot-
ting factors). The protein component helps maintain blood volume due to colloid
osmotic pressure (and they act in clotting and transport lipids and iron).
Plasma also contains dissolved ions, wastes, dissolved gas, glucose &
cholesterol.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 115
M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_11
116 Lecture 18: Blood

Formed Elements
–– Made in red bone marrow
Haemopoiesis: haemocytoblasts →
→ Proerythroblast for red blood cells (RBC)
→ Lymphoid stem cell for lymphocytes
→ Myeloblast (and monoblast) for “….ophils” (and monocytes)
→ Megakaryoblast for platelets
RBC (erythrocytes) are 7–8 μm in diameter, have no nucleus (or mitochondria,
endoplasmic reticulum) and contain haemoglobin (1/3 of the weight of the cell) to
carry O2. Of cells, 99.9% are RBC (5 × 106/μL).
Their bi-concave shape allows distortion (folding) at constant volume without
tearing.
WBC (leucocytes) have a nucleus and do not contain haemoglobin. They func-
tion as a body defence mechanism: “specific” (NK, T and B lymphocytes) and
“non-specific” (macrophages, microphages).
* Leucocytes can migrate out of the blood by squeezing between endothelial cells
(diapedesis). They can also squish up to pass through capillaries.
* They are all capable of amoeboid movement.
* They are attracted to specific chemical stimuli.
Five Types
• 50–70% are neutrophils (microphages – phagocytes of bacteria).
• 25% are lymphocytes (they recognise specific “non-self” antigens ➔ T cells
migrate to targets; B cells become plasma cells, which produce antibodies; and
NK cells destroy abnormal cells – e.g. cancerous ones).
• <8% are monocytes (➔ macrophages and osteoclasts). They attract fibroblasts to
form scars.
• <4% are eosinophils (microphages – attack parasitic worms by exocytosis).
• <1% consists of basophils (they release histamine to promote vasodilation and
inflammation, as well as heparin and chemicals to attract other WBC).
See http://www.biochemweb.org/neutrophil.shtml for neutrophil “chasing” a
bacterium.
Neutropenia =
Granulocytopenia =
Leukopenia =
Lymphocytosis =
Platelets (Thrombocytes) (Blood Clotting)
–– Size is 1 × 4 μm
–– Circulate for 9–12 days before removal by spleen phagocytes
–– 150,000–400,000 per μL of blood
–– Thrombocytopenia < 80 000/μL
–– Thrombocytosis = excessive # platelets
2 Haemostasis 117

Haemocytoblasts undergo differentiation into the fourth immature cell line, the
megakaryoblast, and transform into a large cell, which sheds fragments of cyto-
plasm surrounded by a membrane.
These non-nucleated cell fragments are thrombocytes or platelets, involved in
haemostasis (the prevention of bleeding).
Platelets are non-sticky to normal endothelium.
Platelets adhere to the collagen of damaged endothelial cells.

2 Haemostasis

Haemostasis = prevention of blood loss.

Holes in damaged vessels must be plugged very rapidly.
Blood Clotting
1. A cascade of reactions resulting in the activation of the enzyme (thrombin) that
forms the clot.
2. A mechanism of clot formation by that enzyme.
All necessary inactive precursor proteins are present in the blood.
Thrombin is the enzyme that converts fibrinogen to an insoluble fibrin clot
(thrombus formation).
(a) THE VASCULAR PHASE: almost immediately (2 s) after a blood vessel is cut,
the vessel walls contract in a spasm to slow the flow of blood (the vessel diam-
eter decreases). Endothelial cells release chemical factors and local hormones.
Endothelial cells become sticky.
(b) THE PLATELET PHASE: platelets adhere to exposed collagen fibres from the
damaged vessel wall, to endothelial cells and to the basal lamina and release
substances that cause other platelets to aggregate (+ve feedback), forming a
platelet plug (within 15 s). Platelets release various compounds. The platelet
plug is limited to the local area.
(Aspirin inhibits the production of factors causing platelet aggregation and
is used in low doses in people susceptible to inappropriate clotting, which can
lead to strokes and heart attacks.)
(c) The Coagulation Phase
Over 50 substances in the blood affect coagulation!
Clotting begins <2 mins from vessel damage.
Clot fills vessel opening in 3–6 mins.
Clot retracts after 20 mins (torn edges of vessel pulled together, reducing
bleeding and the area of damage).
Clot changes to connective tissue over 1–2 weeks.
118 Lecture 18: Blood

Three-Step Process of Blood Clotting (Coagulation)

1. Formation of “Prothrombinase” (= Prothrombin Activator) from Factor X

This “first step” is actually the end result of a series of reactions from two path-
ways: the extrinsic pathway and the intrinsic pathway.
(In the extrinsic pathway, factor III combines with factor VII to form an “enzyme
complex” that activates factor X.
In the intrinsic pathway, factor VIII combines with factor IX to form an “enzyme
complex” that activates factor X.)
Extrinsic Pathway
It is called “extrinsic” because the substance (called tissue factor III) that initiates
the formation of prothrombinase is released from damaged vessels (i.e. external to
the blood).
It occurs rapidly (within seconds).
(Then prothrombinase converts prothrombin to thrombin.)
Intrinsic Pathway
It is more complex and occurs more slowly (several minutes).
Damaged tissues cause platelet damage, and the platelets (internal to the blood)
release phospholipids, which combine with various “clotting factors” to produce
prothrombinase.
(Then prothrombinase converts prothrombin to thrombin.)
2. Formation of Thrombin
Prothrombinase converts prothrombin to thrombin.
Thrombin formation has positive feedback, causing platelet aggregation and
increased phospholipid release, leading to the formation of more prothrombinase
(and therefore more thrombin etc).
Vitamin K is essential for prothrombin synthesis by the liver. Ca++ is essential for
prothrombin conversion.
3. Formation of Fibrin
Thrombin acts as an enzyme to convert plasma fibrinogen to insoluble fibrin
polymer.
Fibrin forms a network of fibres, covering the platelet plug, which traps blood
cells and fragments to form a clot.
(Fibrin – a monomer – can polymerise to form a “soft clot”; then cross-linking
between fibrins produces a stable, web-like “hard clot” that entangles with RBC.)

3 Lysis of Clots (Fibrinolysis)

As repair proceeds, the clot gradually dissolves.

Plasminogen is converted to plasmin (by a tissue plasminogen activator (t-PA)).
Plasmin destroys fibrin.
4 Anticoagulants 119

Summary of Coagulation
1. Factor XII (and platelet factor 3 from platelets) begins a cascade of reactions to
form an enzyme complex (intrinsic p).
2. Tissue factor III (from damaged endothelial cells) begins a cascade of reactions
to form an enzyme complex (extrinsic p).
3. Inactive factor X (is converted to -->) active factor X (by an enzyme complex).
4. Activated factor X binds to activated factor V to form the “prothrombinase
complex”
5. Prothrombin (is converted to -->) thrombin (by prothrombinase).
6. Fibrinogen (is converted to -->) fibrin (by thrombin).
7. Plasminogen (is converted to -->) plasmin (by a tissue plasminogen activator).
8. Plasmin digests fibrin.
Ca++ and vitamin K are required for nearly every step in the clotting cascade
(we always have enough Ca++).
About half of our vitamin K is produced by intestinal bacteria and half from diet.
Vitamin K is a fat-soluble vitamin essential to prothrombin synthesis in the liver
(and for three other factors).
People suffering from liver disease (cholecystitis, hepatitis, cirrhosis) may expe-
rience uncontrolled bleeding.
Disorders that prevent fat absorption may result in vitamin K deficiency.
Injected vitamin K should be given 4–8 h pre-operation.
Haemophilia
Thrombocytopenia is a condition where the amount of platelets are less than the
healthy range

4 Anticoagulants

Two anticoagulants used extensively in the clinical setting are heparin and warfarin.
Heparin
• Given intravenously
• Produced by basophils and mast cells (extracted from the tissue of cattle and pigs)
• Prevents the conversion of prothrombin to thrombin
• Involves rapid action and so is used extensively post-op (open heart surgery,
bypass, valve replacement) and to prevent further thrombus formation in
stroke victims
• Antidote = protamine sulphate (IV)
Warfarin
• Coumarins, rat poison
• Given orally
• Antagonist to vitamin K
• Involves slower acting, often taking days to have a therapeutic effect
• Antidote = vitamin K administration (IV)
120 Lecture 18: Blood

Heparin must be administered intravenously, while warfarin can be taken orally.

A standard anticoagulation regime would involve immediate IV heparin administra-
tion continued while warfarin builds up to therapeutic levels, allowing the patient to
eventually go home on oral warfarin alone.
Purpura – purple spot areas of spontaneous bleeding into the skin due to platelet
and vascular defects
Petechiae – small, punctuate skin haemorrhages; pinpoint, purplish red spots
Ecchymoses – bruises
Idiopathic thrombocytopenic purpura – an autoimmune disorder where antibod-
ies to platelets form ➔ excess destruction of platelets
Splenomegaly occurs in cirrhosis with portal hypertension, as well as lympho-
mas ➔ an enlarged spleen captures and sequesters 80% of platelets.
Phlebitis – inflammation of a vein, often in the leg
Chronic venous hypertension (high blood pressure in the leg veins) may cause
leg swelling, pain, varicose veins, ulcers.

5 Blood Groups

The surfaces of erythrocytes contain genetically determined glycoproteins called

antigens (or agglutinogens).
1. ABO System
The ABO group is based on the presence or absence of two antigens on RBC:
symbolised type A and type B. Your ABO blood group will be one of A, B, AB or O.
Circulating in the blood are pre-formed antibodies (= agglutinins = immuno-
globulin) that recognise ABO antigens NOT present on your own RBC and attack
introduced RBC, causing agglutination (clumping).
(A newborn lacks these antibodies, but these appear within a few months of birth,)
A person of blood group A has the A antigen on their RBC (consequently, their
blood contains agglutinins against B).
A person of group AB has both A and B antigens on their RBC (consequently,
their blood does NOT contain agglutinins against A or B).
A person of blood group O has neither the A nor B antigen on their RBC (conse-
quently, their blood contains both agglutinins against A and B).
A person given incompatible blood will suffer a transfusion reaction.
The antibodies in the recipient’s blood attack the foreign RBC, causing donated
RBC to agglutinate.
Such intravascular clotting can lead to severe kidney damage.
2. Rh System
(It is so named because antigen D was first found in the blood of Rhesus
monkeys.)
5 Blood Groups 121

It has more than eight antigens on the RBC, the most important of which is anti-
gen D (C and E are also common).
People with antigen D on their erythrocytes are called “Rh+” (81% of Australians)
and those without “Rh-”.
An Rh+ person (of course) does not contain antibodies against D.
An Rh- person also does not usually contain antibodies against D!
When an Rh- person receives Rh+ blood, their body will begin to produce agglu-
tinins against the foreign Rh antigen D.
These agglutinins will remain in the blood.
If a second transfusion of Rh+ blood is given later, the agglutinins against D will
now attack the donor erythrocytes, and a severe reaction may occur.
One of the most common problems with Rh incompatibility occurs during preg-
nancy if the mother is Rh- and the first baby is Rh+. During delivery, foetal blood
may enter the maternal system from the placenta. The mother will then produce
agglutinins against D. These can cross the placenta in a subsequent pregnancy, and
if the second baby is Rh+, they will attack the foetal erythrocytes, causing newborn
haemolytic disease.
Affected babies can have all their blood supply removed and replaced with Rh-
blood. If identified, the disorder can be easily prevented by the administration of
anti-D antibodies to the mother after the first delivery (17% of Australian mothers
require these). These tie up the Rh+ erythrocytes from the foetus before the mother
can start manufacturing her own agglutinins.
Blood/Blood Product Transfusions
Advances in transfusion technology allow for the separation of various blood com-
ponents, and these can then be administered as needed.
Whole blood – used to increase blood volume, for example, after a haemorrhage
Packed cells – boost haemoglobin to restore O2 carrying capacity without plac-
ing hypervolaemic stress on the system
Plasmapheresis: blood is removed, but RBC, WBC and platelets are returned to
the donor. Plasma is used to make 17 products for various trauma, burns, cancer and
blood disease treatments (see Red Cross at http://www.donateblood.com.au/all-­
about-­blood/different-­donation-­types/plasma-­products).

Incidence in the
Blood USA West. Euro Antigen Compatible Agglutinins (in Compatible
group Africa (on RBC) recipient of plasma) donor to
A 40% 29% A A&O Against-B A & AB
B 11% 17% B B&O Against-A B & AB
AB 4% 4% A&B AB, A, B, O neither AB
O 45% 50% neither O Against-A & A, B, AB, O
Against-B

Persons with blood group AB+ are “universal recipients” – will not agglutinate
any ABO blood.
122 Lecture 18: Blood

Persons with blood group O- are “universal donors” – have no antigens and so
will provoke no agglutination.
There are eight different blood types. The graph shows the percentage of
Australians who have a particular blood type.

It is preferable for patients to receive blood transfusions of the same ABO and
Rh(D) groups. However, in an emergency, if the required blood group is not avail-
able, a patient may be given another group as below.

Spleen
–– In the L hypochondriac region; the largest single mass of lymphoid tissue.
–– Adjacent and inferior to the diaphragm, dorsal to the stomach and lateral to the
L kidney.
6 Additional Information 123

–– A soft textured, red organ about 12 cm long

–– Contains “red pulp” and “white pulp”.
–– Arterioles deliver blood to the red pulp, which is drained by sinusoids to venules.
Functions:
1. Phagocytosis of abnormal blood cells
2. Storing iron (Fe) recycled from RBC
3. Storing up to 1/3 of the body’s platelets
4. Initiating immune response by T and B cells against antigens in the blood (in the
white pulp)
5. A major storage of monocytes; released into the blood after myocardial infarc-
tion (MI) to participate in healing
A splenic vein empties into the hepatic portal vein.

6 Additional Information

(CO2 combines with the N-terminal groups on the four globin chains (not to the O2
binding site). However, because of allosteric effects on the haemoglobin molecule,
the binding of CO2 decreases the amount of oxygen that is bound for a given partial
pressure of oxygen.
The Haldane effect: the decreased binding to carbon dioxide in the blood due to
increased oxygen levels; it is important in the transport of carbon dioxide from the
tissues to the lungs.
The Bohr effect: a rise in the partial pressure of CO2 or a lower pH will cause
the offloading of oxygen from haemoglobin.
An immunoglobulin (Ig), also known as an antibody (Ab), is a large Y-shaped
protein produced by B cells that is used by the immune system to identify and neu-
tralise foreign objects such as bacteria and viruses. The antibody recognises a
unique part of the foreign target, called an antigen.
Antibodies are secreted by a type of white blood cell, called a plasma cell.
Antibodies can occur in two physical forms: a soluble form that is secreted from the
cell and a membrane-bound form that is attached to the surface of a B cell and is
referred to as the B cell receptor (BCR).
Blood Products from Plasma
(a) Intramuscular immunoglobulin (normal immunoglobulins – extracts from
plasma that carry antibodies against common infectious diseases such as mea-
sles, rubella and hepatitis A)
(b) Hepatitis B immunoglobulin, Zoster immunoglobulin, cytomegalovirus
(CMV) immunoglobulin, tetanus immunoglobulin (hyper immunoglobu-
lins – prepared from a pool of donations from donors who have strong antibod-
ies against diseases such as tetanus, chicken pox, hepatitis B and
cytomegalovirus)
124 Lecture 18: Blood

(c) Rh(D) immunoglobulin (anti-D – prevents Rhesus disease in newborns;

Rhesus disease is an incompatibility of the mother’s and baby’s blood, resulting
in the mother developing antibodies against her baby’s blood, which can lead to
the baby’s red cells being destroyed. This disease has almost been eradicated,
thanks to the availability of anti-D produced from selected blood donors.)
(d) Factor VIII and von Willebrand factor (vWF) (biostate (factor VIII concen-
trate) – a blood clotting factor used in the treatment of people with bleeding
disorders such as haemophilia A or von Willebrand disease.)
(e) Prothrombin complex concentrate (prothrombinex is rich in coagulation fac-
tors II, IX and X and is used in the management of bleeding due to a deficiency
of these proteins.)
(f) Intravenous immunoglobulin IVIg (Intragam – used to boost the immune
system and in the treatment of some muscle and nerve conditions)
(g) Albumin (Albumex 20 is a concentrated solution of the main blood protein,
albumin, present in human plasma. Albumex 20 is used in the correction of
protein deficiency sometimes associated with kidney and liver diseases.
Albumex 4 is a more dilute solution of albumin. It is used in the treatment of
shock due to blood loss. It is also used in the treatment of shock after a person
suffers severe burns.)

7 Blood Lecture Revision: Homework Exercise 11

1. Outline the functions of the blood and state which components (plasma, eryth-
rocytes, leucocytes and platelets) are responsible for which properties of blood.
2. What is the structure, composition and function of RBC? And outline briefly
the functions of white cells.
3. State briefly the effects of iron deficiency, amino acid deficiency and vitamin
B12 deficiency on the blood. (Some research may be necessary!)
4. Outline the role of thrombocytes in haemostasis and describe the three main
processes in coagulation, including the differences between extrinsic and
intrinsic formation of prothrombin activators (exclude clotting factor names).
5. State the role of vitamin K in clotting and explain how uptake from the gut can
be affected by disorders in fat absorption (fat-soluble enzyme).
6. Explain the clinical uses of heparin and warfarin in relation to their speed of
effectiveness as anticoagulants.
7. Explain transfusion reactions by your knowledge of the ABO blood group and
relate newborn haemolytic disease to the Rh blood group.
8. What are whole blood, packed cells and cryoprecipitate (clotting factors) used
for in blood transfusions?
9. One microlitre (1 μL = 10-3 mm3) of blood contains about 5 million (5 × 106)
RBC, and each RBC contains about 280 million (280 × 106) Hb molecules.
Estimate how many Hb molecules there are in an adult human.
10. Name the three types of white blood cells depicted below.
7 Blood Lecture Revision: Homework Exercise 11 125
Lecture 19: Cardiovascular System:
Anatomy of the Heart

The cardiovascular system consists of the heart (the muscular pump) and a closed
system of arteries, capillaries and veins for the circulation of the blood.
The cardiovascular system is functional long before any other major organ sys-
tem in the human embryo, and the primitive heart is beating regularly early in the
fourth week following fertilisation.

1 Position

The heart is a four-chambered muscular organ roughly the size of a closed fist. It lies
between the lungs in the mediastinum from the second to sixth ribs. About 2/3 of its
mass lies on the left of the body’s midline.
The base (broad end) of the heart consists mostly of the atria and is directed
superior-dorsally and to the right. The apex (pointy end) is formed by the tip of the
left ventricle and rests on the diaphragm pointing inferio-ventrally and to the left.

2 Covering

The heart is enclosed in a loose-fitting, two-layered sac called the pericardium.

The outer layer, or fibrous pericardium, consists of tough, fibrous connective tissue.
It is continuous with the connective tissue surrounding the great vessels that enter
the heart. The inner layer, or the serous pericardium, consists of two membranes: a
parietal membrane (a layer of thin, flattened cells called the mesothelium), which
is fused to the inside of the fibrous pericardium, and a visceral membrane (also
called the epicardium) adhering to the outside of the myocardium.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 127
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and Physiology, https://doi.org/10.1007/978-3-031-56296-9_12
128 Lecture 19: Cardiovascular System: Anatomy of the Heart

Between the parietal and visceral membranes of the serous pericardium is a

potential space, which usually contains a thin film of serous fluid for lubrication.
Inflammation of the pericardium, called pericarditis, may occur following infec-
tion or myocardial infarction as a result of excess pericardial fluid, fibrin or pus
accumulation. (A feature of pain diagnosis after a myocardial infarction is to deter-
mine if the pain is worse on inspiration. If so, it is likely to be due to pericarditis and
not associated with further infarction and can best be relieved with aspirin.)
Accumulation of too much pericardial fluid can exert a compression on the heart
called cardiac tamponade, possibly necessitating the removal of fluid from the
pericardium or sometimes stripping the whole fibrous pericardium and its
serous lining.

3 Heart Wall

It has three layers:

1. Epicardium or the outer layer is the same as the visceral membrane of the
serous pericardium.
2. Myocardium: the bulk of the heart is a thick, contractile middle layer of spe-
cially arranged muscle cells called the myocardium. Cardiac muscle fibres are
striated, uni-nucleate, intricately branched and joined to each other by “interca-
lated discs” (to form a functional syncytium). Skeletal muscle fibres are arranged
in parallel (and are a syncytium!). Skeletal muscle is also classed as voluntary,
while cardiac and smooth muscles are involuntary.
3. The myocardium is richly supplied throughout with nerves, blood vessels and
lymphatic vessels to enable it to carry out its heavy workload.
4. Endocardium is the thin layer of epithelium lining the inside of the heart and
valves and continuous with the endothelium of the large blood vessels.

4 Cardiac Tissue

Cardiac muscle cells are typically uninucleate and are 10–20 μm in diameter and
50–100 μm in length.
Twenty-five per cent (25%) of the cell volume is taken up by mitochondria!
Cells connected by porous junctions = intercalated discs (cell membranes of
adjacent muscle cells extensively intertwined). They permit sodium, potassium and
calcium to easily diffuse from cell to cell. This makes it easier for depolarisation and
repolarisation in the myocardium. Because of these junctions and bridges, the heart
muscle is able to act as a single coordinated unit. Cardiac muscle is a “functional
syncytium”.
6 Valves of the Heart 129

Cardiac cells are held together by connections called desmosomes and commu-
nicate via “gap junctions” (interlocked membrane proteins that form a channel to
allow the passage of ions and small molecules). Cardiac cells are also held together
by myofibrils anchored to intercalated discs.

5 Chambers of the Heart

The interior of the heart is divided into four chambers. The upper two chambers are
called the atria and are separated by the interatrial septum. The right atrium
receives blood from the body via the superior vena cava (blood from the upper
body) and inferior vena cava (blood from the lower body). The coronary sinus also
empties into the right atrium and drains blood from the vessels supplying the heart.
The interior of the right atrium has a depression called the fossa ovalis, which is the
remnant of the opening in the foetal heart, called the foramen ovale.
The left atrium (LA) receives blood from the four pulmonary veins coming from
the lungs. Each atrium has a pouched appendage called an auricle, which serves to
increase the volume of the atrium. The right ventricle receives blood from the right
atrium and pumps it via the pulmonary artery to the lungs.
The left ventricle (LV) has the thickest muscle walls as it must pump blood out
through the aorta to the rest of the body. The right and left ventricles are separated
by the interventricular septum.

6 Valves of the Heart

The heart has four valves (structures that ensure that blood flows in one direction
only). They prevent blood re-entering the chamber that it just left.
Two atrioventricular (AV) valves: the tricuspid separates the right atrium and the
right ventricle. The bicuspid (or mitral) lies between the left atrium and the left
ventricle. (Remember alphabetically, L and M for left and mitral and R and T for
right and tricuspid).
They are constructed of flaps of the endocardium and are anchored to the papil-
lary muscles by chord-like structures called chordae tendinae (the AV valves are
sometimes called “parachute valves” because of their appearance). As the ventricles
contract, the papillary muscle contracts to tighten the chordae tendinae, thus pre-
venting the flaps from moving too far. Hence, blood flows from the atria to the
ventricles but is prevented from backflow into the atria.
The other two valves are called semilunar valves and are located at the start of
the pulmonary and aortic arteries. They prevent the backflow of blood into the ven-
tricles from these vessels when the ventricles relax.
130 Lecture 19: Cardiovascular System: Anatomy of the Heart

Tough elastic tissue encircles the heart valves and the base of the aorta and pul-
monary trunk. This is the fibrous skeleton of the heart. It electrically isolates ven-
tricular cells from atrial cells.

7 Blood Flow Through the Heart

(From the upper body via) the superior vena cava and from the lower body via the
inferior vena cava into the right atrium, through the tricuspid valve into the right
ventricle; from RV through the pulmonary valve into the pulmonary trunk and pul-
monary circulation; from the lungs (via two left and two right) into pulmonary veins
into LA, then through the mitral valve into LV; and from LV through the aortic valve
into the aorta and systemic circulation.

8 Blood Supply to the Heart

The walls of the heart, like any other tissue, need oxygen, nutrients and various
other substances in order to survive. These are supplied via the coronary circula-
tion. The left and right coronary arteries arise from the ascending aorta, immedi-
ately above the aortic valve, and branch out to supply blood to the myocardium.
Blood enters the coronary arteries during ventricular systole.
(Left coronary ➔ circumflex and anterior interventricular arteries. Right coro-
nary ➔ marginal(s) and posterior interventricular arteries)
Small branches of the left and right coronary arteries eventually join (anasto-
mose) so that there is an alternate path for blood to a portion of the myocardium
otherwise isolated by a vessel blockage.
Coronary artery disease, due principally to underlying atherosclerosis (build-up
of fatty deposits, especially cholesterol, in the arteries), is a condition in which the
heart muscle receives an inadequate amount of blood (becomes ischemic) because
of an interruption of its blood supply. This may lead to angina pectoris (chest pain)
due to the lack of oxygen to the part of the heart affected. Total occlusion of an arte-
rial branch leads to the death of the myocardial tissue that it supplies and constitutes
a myocardial infarction.

9 Cardiac Cycle

Cycle – the time period between the start of one heartbeat and the beginning of
the next.
Ventricular systole (contraction of ventricles): the myocardium contracts; when
pressure is high enough, blood is pushed through semilunar valves into the aorta/
pulmonary trunks.
13 Electrocardiogram 131

Ventricular diastole (relaxation of ventricles): blood in the aorta and the pulmo-
nary trunk force semilunar valves shut, blood flows into atria and ventricles (through
the AV valves).

10 Heart Sounds

The noise made by blood squirting through AV valves as they close = “lub”, while
the closing of semilunar valves = “dup”.
Heart murmur = some blood “regurgitated” through the mitral valve back into
the left atrium (not uncommon).

11 Conduction System

The conduction system of the heart – sinoatrial (SA) node, atrioventricular (AV)
node, AV bundle, L and R bundle branches and the Purkinje system – consists of
muscle tissue in which the cells have lost their ability to contract and have become
specialised for generating and transmitting impulses that stimulate the cardiac mus-
cle tissue to contract (see the physiology of the cardiovascular system).

12 Nerve Supply

The contraction of the atria and ventricles is initiated by the internal conduction
system of the heart. However, the rate and force of contraction are largely under the
control of the autonomic nervous system. Sympathetic nerve fibres from the cardio-­
accelerator centre in the medulla oblongata increase the rate and force of contrac-
tion. Parasympathetic connections from the cardio- inhibitor centre via the vagal
nerve (CN. X) decrease cardiac activity (see blood pressure control later).
The 6-second electrocardiogram (ECG) simulator: https://www.skillstat.com/
six-­second-­ecg-­resources/

13 Electrocardiogram

Resting cardiac muscle cells have a negative voltage on the inside of their sarco-
lemma when compared to the outside of the sarcolemma. In this state, they are said
to be “polarised”.
The ECG is a graph of voltage generated by the heart versus time – as the heart
is stimulated to contract, measured at the body surface.
132 Lecture 19: Cardiovascular System: Anatomy of the Heart

The significant features (movements away from the horizontal) of this graph are
labelled with the letters P, Q, R, S and T.
The heart generates a measurable voltage (electrical potential) when the cells of
the atria electrically depolarise, when the atria repolarise, when the cells of the ven-
tricles electrically depolarise and when they repolarise.
Atrial depolarisation produces the “P wave”.
Ventricular depolarisation produces the “QRS wave”.
Ventricular repolarisation produces the “T wave”.
Soon after depolarisation, the atria and ventricles contract (ventricular systole).
Soon after repolarisation, the atria and ventricles relax (ventricular diastole).

14 Additional Information

The valve of the coronary sinus (Thebesian valve) is a semi-circular fold of the lin-
ing membrane of the right atrium, at the orifice of the coronary sinus. It is situated
at the base of the inferior vena cava. The valve may vary in size or be com-
pletely absent.
The Vieussens valve of the coronary sinus is a valve and anatomic landmark
between the coronary sinus and the great cardiac vein. It is often a flimsy valve
composed of one to three leaflets found in 80–90% of people.
Other valves exist in the posterior veins of LV (e.g.) often at venous branches.
The anterior cardiac veins do not drain into the coronary sinus but drain directly
into the right atrium. Some small veins, known as the smallest cardiac veins, drain
directly into any of the four chambers of the heart(!)

A Normal ECG Trace

P Wave: Atrial Depolarisation

This represents The P wave is defined as the electrical activity associated with the
original impulse from the S-A node and its subsequent spread through the atria – in
other words, depolarisation of the atrial section of the myocardium. If P waves are
present, it can be assumed that the stimulus began in the S-A node. Following depo-
larisation, the atria must repolarise, but this occurs during the QRS complex and
cannot be identified while the ventricles are repolarising.
P-R Interval:
Passage of Impulse from Atria to Ventricles. The period from the beginning of
the P wave to the beginning of the QRS complex is called the P-R interval. It nor-
mally takes no more than 0.2 s and represents the time taken for the electrical
impulse to pass from the right atrium to the ventricles and to initiate ventricular
contraction.
15 Heart Lecture Revision: Homework Exercise 12 133

QRS Complex: Ventricular Depolarisation

This is the largest feature of the ECG and generally consists of an initial downward
deflection (Q wave), a larger upward deflection (R wave) and a second downward
deflection (S wave). This complex represents the activation of the ventricles and is
normally less than 0.12 s in duration. It should be noted that the relative size of the
deflections in the QRS complex varies according to the lead from which the record-
ing has been taken.
ST Segment
The period between the completion of depolarisation and the beginning of repolari-
sation of the ventricular muscle is represented by the segment from the completion
of the QRS complex to the beginning of the T wave. This segment may be elevated
above the zero line or depressed if there is acute cardiac muscle injury, as in a myo-
cardial infarction.
T Wave: Ventricular Repolarisation
This wave represents the recovery phase (repolarisation of the heart muscle) after
ventricular depolarisation. It is usually of longer duration and somewhat larger than
the P wave. The T wave is variable, being influenced by physiological as well as
pathological conditions; for example, raised serum potassium levels cause tall,
tented T waves, while low K+ levels cause depressed T waves. If the myocardium is
damaged in some way, e.g. from tissue injury or ischaemia, the T wave may be flat-
tened or inverted.
The passage of the P, QRS and T waves represents one cardiac cycle.

15 Heart Lecture Revision: Homework Exercise 12

1. Which heart valve is also known as the tricuspid? (Which other heart valves
also have three flaps?)
2. Which of (ventricular) systole or diastole refers to the contraction of the
heart muscle?
3. Apart from the heart, what other structures lie within the mediastinum?
4. Arrange (write down) the four chambers of the heart (LA, RA, LV, RV), the four
valves (Ra-v, La-v, Pul v, Ao v), the blood vessels (aorta, pulmonary trunk,
pulmonary veins, vena cavae) in the order in which blood flows through them.
5. Name the membrane that adheres to the outside of the myocardium.
6. Distinguish cardiac muscle from skeletal muscle.
7. Where are the coronary arteries, and what do they do?
8. What do the heart valves do as the ventricles progress through systole?
9. Why is the myocardium of the left ventricle so thick?
10. On the schematic (i.e. not anatomically faithful) diagram of the heart below,
draw in and label the aortic and pulmonary valves and label all the structures
listed in question 4. In addition, use arrows to indicate the flow of blood.
134 Lecture 19: Cardiovascular System: Anatomy of the Heart

││ ║║ ║ ║ │ │ │ │
● ● ● ● ●&●  ●+● & ●+●
││ ║║ ║ ║ │ │ │ │
a) 1 cell, chromatids b) 2 cells c) 4 cells after
duplicate meiosis I meiosis II

11. What is the general function of the heart valves, and what would happen to the
circulation of blood through the heart if the action of the valves was impaired?
12. How does the structure of the left ventricle wall differ from that of the right?
13. How do these differences in ventricle walls relate to resistance to blood flow in
pulmonary and systemic circulations?
14. Describe how and during which part of the heart cycle blood enters the coro-
nary arteries.
15. What effect would a blockage of a coronary artery have on the myocardium
(heart muscle)?
16. How many cusps does the RIGHT atrioventricular valve have? What is the
other name for this valve?
17. How many cusps does the LEFT AV valve have? What is the other name for
this valve?
Lecture 20: Anatomy, Structure
and Function of Blood Vessels

1 Blood Vessels

There are three types of blood vessels: arteries, veins and capillaries.
Artery: a vessel that carries blood away from the heart. After birth, all arteries,
except the pulmonary artery and branches, carry oxygenated blood. A small
artery (diameter of 30 μm) is called an arteriole.
Vein: a vessel that carries blood towards the heart. All veins except the 4 pulmonary
veins contain deoxygenated blood. A small vein is called a venule.
Capillaries: short (1 mm) microscopic vessels (diam 8 μm) that carry blood from
the arterioles to the venules. The exchange through vessel walls occurs only in
the capillaries. (William Harvey (c1630) first proposed that blood circulated
from the heart through arteries and veins back to the heart. This hypothesis was
rejected by many on the basis that there was no way for blood to get from the
arteries to the veins. Only the advent of the microscope revealed the capillaries
connecting arteries and veins.)

2 Arteries

They are composed of three coats or “tunics” and a central lumen:

1. Tunica intima – inner coat or wall composed of simple squamous epithelial tis-
sue (endothelium)
2. Tunica media – the middle and usually thickest layer, composed of elastic fibres
and smooth muscle; sympathetic NS innervation that causes vasoconstriction
and vasodilation

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 135
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and Physiology, https://doi.org/10.1007/978-3-031-56296-9_13
136 Lecture 20: Anatomy, Structure and Function of Blood Vessels

3. Tunica externa (adventitia) – an outer coat of white fibrous tissue (collagen and
elastic fibres) that causes the artery to stand open instead of collapsing when cut
The largest arteries (up to diam 2.5 cm) are called conducting arteries (or elastic
arteries) such as the aorta first brachiocephalic (→ R. common carotid, R. subclavian,
R. vertebral), second L. common carotid and third L. subclavian (→ L. vertebral).
The descending aorta bifurcates into L & R common iliac arteries. Their tunica
media contains more elastic than muscle tissue.
The extra pliability of the conducting arteries causes them to bulge when the
heart contracts and forces blood into the aorta, thus accommodating the surge in
blood and storing some systolic pressure as elastic potential energy. As the heart
rests, the arteries recoil, moving the blood forward in a more continuous flow than
could occur through rigid vessels. The alternate expansion and contraction of an
artery constitute the arterial pulse.
Medium-sized arteries (diam 0.4 cm) are called muscular arteries (or distribut-
ing arteries) and include the axillary, brachial, radial, femoral, popliteal and tibial
arteries. Their tunica media contains more smooth muscle than elastic tissue,
enabling greater autonomic control of vasoconstriction and vasodilation.
About 15% of the blood volume is in arteries at any one moment.

3 Veins

Veins have the same three tunics as arteries, but since they do not have to cope with
the same high pressures as arteries, the tunics are thinner and with less elastic tissue
and smooth muscle.
Two common iliac veins join to form the inferior vena cava.
R internal jugular + external jugular + vertebral + subclavian veins join to form
R brachiocephalic (same on the left). The two b–c join into the superior vena cava.
Factors Assisting Venous Return
Most larger veins, especially those in the limbs, have valves to prevent the backflow
of blood under the influence of gravity. Venous return is assisted by skeletal muscle
contraction. On contraction, muscles press against the blood in the veins, forcing
the valves open and driving blood towards the heart (much as toothpaste is squashed
out of the tube). (On long aeroplane flights, people often complain of feet swelling
and being unable to put their shoes back on. This is a direct result of compromised
venous return due to the skeletal muscles being immobilised.)
Breathing assists venous return since the downward movement of the diaphragm
during inspiration causes an increase in abdominal pressure and a decrease in tho-
racic pressure. Thus, blood is forced up from the abdominal to the thoracic veins
along the pressure gradient.
Suction effect of the heart: during early systole, the atrioventricular (AV) ring
moves downwards, which expands the volume of the atria, creating a negative
pressure.
4 Capillaries 137

Veins as Blood Reservoirs Assisting Blood Distribution

The veins also constitute a large blood reservoir (59% of the total blood volume),
which can be manipulated via the vasomotor control mechanism to influence the
distribution of blood within the system (see later section on blood pressure). (For
example, if we suddenly require strenuous muscular activity, the vasomotor centre
in the brain increases the sympathetic impulses to the veins in the intestine, liver,
spleen and skin, causing vasoconstriction and diverting blood to the muscles
and heart.)

4 Capillaries

The primary function of the capillaries is to permit the exchange of dissolved gases,
nutrients, hormones and waste products between the interstitial fluid and the blood.
Therefore, as one might expect, the walls are extremely thin (0.5 μm) and composed
of just a single layer of endothelial cells (tunica intima) surrounded by a basement
membrane.
Diffusion Across the Capillary Wall
Lipid-soluble substances (including oxygen (O2) and carbon dioxide (CO2)) diffuse
through the plasma membrane.
Water-filled channels in the plasma membrane allow ions and polar molecules to
diffuse through.
Intercellular clefts allow molecules to pass into and out of the capillary.
Endocytosis (via endosomes), followed by exocytosis, allows a small amount of
protein to exit.
Capillaries are found in close proximity to most cells and are in the highest con-
centration in those areas where activity is greatest (muscles, liver, kidneys, lungs,
nervous system).
Continuous capillaries (most common): the endothelium forms a complete lin-
ing. The cells are joined by “tight junctions” interrupted by “intercellular clefts”
(except in the blood-brain barrier!). Allow the diffusion of water, small solutes and
lipid-soluble materials, e.g. skin, muscles, lungs.
Fenestrated capillaries: the endothelium has pores (windows) to allow the rapid
movement of water and solutes (incorporated peptides) between the plasma and
interstitial fluid, e.g. villi of the small intestine, endocrine organs and glomerulus of
the kidney.
Sinusoids appear as leaky “fenestrated capillaries” with gaps between adjacent
endothelial cells (and little or no basement membrane). They allow the free exchange
of water, plasma proteins, blood cells and phagocytic cells (in the liver, the bone
marrow, the spleen and some endocrine organs).
Capillary beds (or plexus): dozens of capillaries may arise from one arteriole.
Hence, blood flow is the slowest in the capillaries (about 1 mm/s), and this allows
for the exchange of materials between the capillary blood and the interstitial fluid.
138 Lecture 20: Anatomy, Structure and Function of Blood Vessels

Entrance to each capillary is governed by a pre-capillary sphincter. Contraction

causes a decrease in blood flow.
Most substances are exchanged by diffusion; hence, cells must be in close prox-
imity to capillaries (within 0.125 mm).
Nutrients and oxygen move from the capillaries (where they are in high concen-
tration) via the interstitial fluid to the tissues (lower concentration). Similarly, waste
products, due to metabolic activity, move from the tissues (high concentration) into
the interstitial fluid and then the blood (or lymph system; see later), to be trans-
ported for disposal via the lungs, kidneys or sweat glands.
Capillaries, Starling’s Law and Microcirculation
Differences between the pressure in the capillaries and that in the interstitial fluid,
and also between the osmotic pressure of the blood (colloid osmotic pressure due to
blood proteins) and that of the interstitial fluid, result in a small net movement of
fluid and solutes from the capillaries to the interstitial fluid at the arterial end of the
capillary.
At the venous end of the capillary, this net movement is reversed. However, not
all fluid filtered out at one end filters back in at the other. Some enter the lymphatic
system before an eventual return to the cardiovascular system. The state of near
equilibrium, in which fluid leaving the capillaries at the arterial end is balanced by
that entering at the venous end, plus that returned by lymphatics, is known as
Starling’s law of the capillaries.
This movement of fluid between blood (via the capillaries), the interstitial fluid,
cells and the lymph constitutes microcirculation and is vital for maintaining the
internal environment of the human body.

5 Circulatory Routes

In systemic circulation, oxygenated blood (bright red) circulates from the left ven-
tricle out through the aorta to the arteries, then to arterioles and, finally, to the capil-
laries, to supply the tissues with nutrients and oxygenated blood.
Deoxygenated blood (dark red) continues along the capillaries into the venules
to the veins and via the superior and inferior vena cava into the right atrium.
Deoxygenated blood is pumped into the pulmonary circulation by the right
ventricle (RV) via the pulmonary artery to the lungs, where gaseous exchange
occurs and oxygenated blood returns via the pulmonary veins (the only veins carry-
ing oxygenated blood), to the left atrium and then again into the left ventricle to
complete the cycle. Blood vessels are shorter and more distensible than systemic
circulation ∴ lower pressure
Coronary Circulation
The right and left coronary arteries branch from the ascending aorta and carry oxy-
genated blood to the arterial system of the myocardium. Deoxygenated blood
returns to the right atrium via the coronary sinus (and anterior cardiac veins).
7 HLTH1004 Blood Vessels Revision: Homework Exercise 13 139

6 Disorders Affecting Blood Vessels

Arteriosclerosis: this happens when there is a build-up of fatty deposits (atheromas

or plaque), especially cholesterol, in the walls of the arteries. It may result from
damage to the artery lining, possibly as a result of high blood pressure, smoking,
diabetes and high-cholesterol diets. Complications include angina pectoris, myocar-
dial infarction, peripheral vascular disease and strokes (probably as a result of
emboli detaching from the atheromatous plaques.
Aneurysm: this refers to the weakened section of the arterial wall that bulges
out, forming a balloon-like sac, most commonly in the abdominal aorta and in the
brain. The contributing factors are atherosclerosis, trauma and congenital vessel
defects. A ruptured aneurysm commonly causes massive haemorrhage and death.
Varicose veins: weakened venous valves allow blood to flow back under gravity
into the distal parts of the vein. Repeated overloading in this way causes the walls
to become permanently dilated, losing their elasticity. Haemorrhoids are varicosi-
ties in the anal area. Contributing factors may be heredity, mechanical stress (pro-
longed standing, pregnancy) or age.
Deep vein thrombosis (DVT): a blood clot forms in a deep vein of the lower leg
or thigh. Deep veins pass through the centre of your leg and are surrounded by a
layer of muscle. A pulmonary embolism happens when a piece of the blood clot
from a DVT breaks off and travels to the lungs, where it blocks one of the blood
vessels. This is serious and can be fatal.
Arteriosclerosis – a disease of the arteries where the wall is thickened and loses
elasticity due to the build-up of atheromas (plaque).
Atherosclerosis – fatty deposits (cholesterol and Ca++) in the tunica media; it is
the most common form of arteriosclerosis.
Arteriolosclerosis – arteriosclerosis of the arterioles.

7 HLTH1004 Blood Vessels Revision: Homework Exercise 13

1. What are the three tunics that comprise the walls of veins and arteries?
2. Name some differences between veins and arteries.
3. What is the systemic circulation?
4. What is the difference between muscular and elastic arteries?
5. What is the function of the smooth muscle in blood vessel walls?
6. Name the three types of capillaries. What is the difference between them?
7. What would result if “Starling’s law of the capillaries” does not hold?
8. (a) What causes blood to flow in the arterial side of the systemic circulation?
(b) What causes venous return (blood flow) in the venous side of the circuit?
Lecture 21: Pressure and Fluid Dynamics
(Caon & Hickman 3rd ed. pp 234–242, pp. 266–
278 & Qu 33–40)

1 Definition and Units for Pressure

Pressure is the force (in N) being exerted, divided by the area (in m2) on which the
force acts. Note that pressure is NOT a force (nor is it a length, though one unit is
“mm Hg”).

P  F / A or Pressure  Force  Area

The unit is N/m2 = Pascal (Pa).

(When performing CPR, why use the heel of the hand rather than the whole palm
to press down on the sternum?)
One pascal is a small unit, so pressure is usually expressed in kilopascals (kPa).
Other Units
–– Millimetres of mercury (mm Hg) – for BP!
–– Centimetres of water (cm H2O)
–– Standard atmospheres (atm.) – for hyperbaric!
–– Bars (hence baroreceptors and barometers)
–– Pounds per square inch (psi) – for car tyres!
Conversion Factors
1 kPa = 1000 Pa = 7.5 mm Hg = 10.23 cm H2O
1 mm Hg = 0.133 kPa = 1.36 cm H2O

120 / 80 mm Hg  16 / 10.6 kPa 

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 141
M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_14
142 Lecture 21: Pressure and Fluid Dynamics

2 Atmospheric Pressure and Pressure Shown on the Gauge

The air around us (79% N2, 21% O2, 0.5% H2O, 0.04% CO2) exerts a pressure due
to the weight of the atmosphere above us, called atmospheric pressure.
It was first measured by Torricelli using a mercury barometer (atm. P. was mea-
sured by how high – in mm – a column of mercury could be supported by the pres-
sure of the atmosphere).
The standard atmospheric pressure on 1 m2 of area at sea level is due to the
weight of air in the column rising to the top of the atmosphere. The column contains
about 10,100 kg of air (which has a weight of about 101,000 N), but the amount
varies from day to day.
1 atm = 101,000 N/m2 = 1.01 × 105 Pa
101 kPa = 1010 hPa = 1010 millibars 760 mm Hg = 1030 cm H2O = 14.7 psi
Atmospheric pressure decreases with altitude above sea level. At 3000 m, atm. P
= 70 kPa. Our middle ear contains air that is separated from the atmosphere by our
eardrum but may be vented by the Eustachian tube. The middle ear is sensitive to
rapid changes in air pressure.
Atmospheric pressure is used as a relative zero. Pressures greater than atm. press.
are “positive”. Those less than atm. Press. are “negative” (suction).
The readings on pressure gauges show pressure values above or below atm.
press. (and are called “gauge pressure”).
That is, a systole pressure of 120 mm Hg means 120 above atmospheric and is
actually 120 + 760 = 880 mm Hg. And car tyre pressures are 192 kPa (28 psi)
greater than atm. press.

3 Suction

Suction involves creating a negative pressure so that atmospheric pressure will push
the fluid in the direction of the negative pressure (e.g. drinking with a straw, filling
a syringe, wound drainage using a Bellovac or RediVac or PortaVac bottle, taking
blood using a Vacuette).

4 Boyle’s Law

“The pressure in a fixed amount of gas will increase as its volume decreases (pres-
sure is inversely proportional to volume).”

P ∝1/V
5 Hydrostatic Pressure 143

Examples are expanding the lungs to breathe, a syringe and other “bicycle pump”
style devices.

5 Hydrostatic Pressure

Pressure in liquids increases with depth because the weight of liquid above increases
with depth (about 1 atm. per 10 m).
Pressure due to the weight of liquid or the “head” of liquid above a point is
called hydrostatic pressure (HP), stated in units “cm H2O”, e.g. pressure at the
cannula of an intravenous (IV) saline infusion with a head of liquid of 40 cm

P  9.8  density  head

 9.8  1000 kg / m 3  0.4 m
 3920 Pa  3.9 kPa   29 mm Hg 

This pressure must be greater than blood pressure for IV liquid to flow in.
While standing, there is a pressure difference between feet and head due to grav-
ity acting on the “head of liquid”. Hence, when standing, blood pressure in the feet
will be increased by the head of the blood contained in the vessels (blood pressures
in the body are stated as if the body is supine).
Note that:
1. At the surface of the liquid (where depth is zero), pressure is atmospheric.
2. Pressure difference, due to the head of liquid, depends only on the depth in the
liquid, not on the amount of the liquid nor on the shape of the vessel.
3. The pressure at any point in a liquid that is at rest acts equally in all directions
(otherwise, the liquid would not be at rest).
4. PASCAL’S PRINCIPLE: Because liquids are incompressible, “pressure
applied to an enclosed liquid at rest is transmitted undiminished to every portion
of the liquid and to the walls of the containing vessel”.
(For example, relief of pressure sores; Queckenstedt’s test of cerebrospinal fluid
(CSF) pressure; squeezing an IV bag that cannot be hung up; increased eyeball pres-
sure in glaucoma; distribution of pressure in the knee joint, thanks to enclosed syno-
vial fluid; foetus enclosed by amniotic fluid)
Soon after the heart’s ventricles fill with blood, they contract, and pressure on the
blood in the left ventricle (LV) rises rapidly from about 0 mm Hg to 80 mm Hg. The
atrioventricular (AV) valves (mitral and tricuspid) close immediately, but the semi-
lunar aortic (and pulmonary) valves do not open until LVP = 80 mm Hg (and RVP
= 8 mm Hg). That is, tension builds up in the cardiac muscle until the pressure
exerted by the (incompressible) blood builds up enough to push open the semilunar
valves (which are, until then, held shut by the pressure of the blood on the aorta side
of the valve).
144 Lecture 21: Pressure and Fluid Dynamics

Pressure considerations in flowing fluids are slightly different than in static fluids.

6 Gases Dissolved in Water

Soluble gases like oxygen (O2) and carbon dioxide (CO2) dissolve in body fluids if
the gas is in contact with the fluid.
The concentration of dissolved gas depends on the solubility of the gas and on its
partial pressure.
Henry’s Law

Conc n of dissolved gas  Pgas  solubility coeff

This means that the higher is the partial pressure of gas adjacent to a liquid sur-
face (e.g. in the lungs), the greater the concentration of gas that will dissolve (→
oxygen therapy!).
Concentrations of blood gases are usually stated as “partial pressures” rather
than as “dissolved concentrations”.
This means that if the partial pressure of O2 in the alveolar air is 100 mm Hg
(13 kPa) after inhalation, the arterial blood that leaves the lungs will contain dis-
solved O2 with a concentration of ~100 mm Hg.
Partial pressure is another way of expressing solution concentration (for gases in
a solution).

7 Pressure Gradient

If the pressure between two places is different, pressure gradient = pressure differ-
ence ÷ the distance between two places (unit = kPa/m).
Fluids (= liquids or gases) flow from places of high pressure to places of lower
pressure. They flow down the pressure gradient. (Why do we press down hard with
the hand during CPR?)
So blood flows from the LV to the arteries. Thus, air moves into and out of
the lungs.
The rate of fluid flow (unit ml/s) is proportional to the pressure gradient (ΔP ÷ l).
Molecules dissolved in a gas or liquid undergo net diffusion along their concen-
tration gradient: e.g. if 100 mm Hg O2 is dissolved in alveolar fluid and 40 mm Hg
O2 is dissolved in the venous blood of the alveolar capillary, diffusion occurs from
the alveolar fluid to the venous blood.
8 Factors That Affect Volume Flow Rate 145

8 Factors That Affect Volume Flow Rate

Volume flow rate (V) is the number of litres flowing past per minute (rather than
the speed of flow). It is the same thing as cardiac output:

CO  ml / min   HR  bpm   SV  ml  .

1. Pressure gradient is the difference in pressure in the fluid at either end of the
tube divided by the length of the tube (units kPa/m or mm Hg/m).
2. Resistance to flow through a tube depends on the length of the tube (l), the
radius of the tube (R) and the internal friction between fluid particles (the fluid’s
viscosity, η “eta”).
Poiseuille’s law relates the pressure gradient (ΔP/l) and resistance to flow to the
volume flow rate V.

P  R 4
CO   V 
l  2.54 
 in m / s 
3

“The volume flow rate, V, equals the pressure drop ΔP, divided by the resis-
tance to flow (2.54 η l) ÷ R4.”

V  1 / l, V  R 4 , V  1 /  V  P

Pressure Gradient in the Body (V α ΔP/l)

• If the pressure gradient doubles, other things being equal, so does the flow
rate (V α ΔP/l).
• While lying horizontally, the pressure gradient is due to the pumping action of
the heart.
(16 kPa (120 mm Hg) in the aorta to 4 kPa (30 mm Hg) at the start of the
capillaries
2 kPa (15 mm Hg) at the end of the capillaries about 530 Pa (4 mm Hg) or less at
the right atrium)
Radius of Tube (V α R4)
• A wider tube produces less friction; in fact, if the radius is doubled (vasodila-
tion), the flow rate increases 16 times! (V ∝ R4).
Conversely, if the radius is halved, the flow rate decreases to 1/16! (Coronary
arteries narrowed by plaque lead to angina and myocardial infarction (MI).)
(vasoconstriction and vasodilation are potent mechanism to alter blood flow)
Blood viscosity (η) (V α 1/η)
146 Lecture 21: Pressure and Fluid Dynamics

It is ≈ 0.004 Pa s for blood (0.001 Pa s for water) but changes with its speed.
Blood vessels are not rigid tubes. Flow is pulsatile.
The higher the viscosity, the lower the flow rate (V α 1/η).
Friction increases with the percentage of cells in the blood (99% of cells are red
blood cells (RBC)).
A “normal” man has about 42% of his blood volume taken up by cells (haema-
tocrit of 42).
Haematocrit of 15 = anaemia.
Haematocrit of 70 = polycythemia.
(dehydration or hypothermia will cause blood friction to increase)
Length of Blood Vessels (V α 1/l)
There is greater resistance in the peripheral circulation than in the pulmonary
circulation because of the greater length of the blood vessels.

9 Capillaries

The purpose of the circulatory system is to deliver blood to the capillaries.

The primary function of the capillaries is the exchange of gases, nutrients and
waste products between body cells and the blood.
Average length = 1 mm
Average diameter = 8–10 μm (RBC slip-through in a single file)
O2, CO2, amino acids, glucose, lipids, wastes, drugs, electrolytes and hormones
pass between the capillary blood and interstitial fluid by diffusion along their con-
centration gradient (from where they are in high concentration towards where they
are in lower concentration).

10 Fluid Movement Through Capillaries

“Equation of continuity”:

Volume flow rate  V  = Cross  section  CS area  speed.

In the aorta, the cross-section area = 4 cm2, and the speed of flow = 30 cm/s.
∴ V = 30 × 4 = 120 ml/s.
The volume flow rate must be the same in the capillaries, but the CS area =
4500 cm2, so in the capillaries:
11 Type of Flow 147

Speed = V  CSarea = 120  4500 = 0.03cm / s!  = 0.3mm / s  .

This slow speed of blood flow allows exchange through the capillary wall
to occur.
The capillary “bed” (extensive branching networks of capillaries) provide a large
surface area for diffusion and filtration; ∴ the exchange of materials is rapid.
Movement Across the Capillary Wall
Blood enters the capillary bed from the terminal arteriole at ~35 mm Hg. Precapillary
sphincters open to allow blood into the capillary.
More sphincters open as more blood flow is required (if closed, blood bypasses
the bed via the “thoroughfare channel”).
Blood exits the bed into the post-capillary venule at ~17 mm Hg.
In addition, bulk fluid flow (H2O) through capillary walls occurs due to pressure
differences between the inside and outside of the wall.
At the arteriole end:
HP (35 mm Hg) − OP (26 − 1) = 10 mm Hg
(hence, fluid moves OUT of the capillary).
At venule end:
HP (17 mm Hg) − OP (26 − 1) = −8 mm Hg
(hence, fluid moves INTO the capillary).
• Excess fluid returns to the blood via lymph vessels.

11 Type of Flow

Laminar (smooth, streamlined) flow is usual in long smooth vessels.

Turbulent flow is when fluid continually mixes in swirls and eddies. Turbulence
adds to the resistance to blood flow by increasing friction. It will occur if blood
velocity is high (e.g. 30 cm/s in the aorta) and when blood passes through a narrow-
ing or constriction in a vessel (a stenosis).
Turbulent flow is “noisy”.
• The opening and closing of the heart valves produce turbulent flow (heart valve
sounds).
• Auscultatory blood pressure measurements “listen” for turbulent blood flow. The
cuff causes turbulent flow in the squashed brachial artery (Korotkoff sounds).
148 Lecture 21: Pressure and Fluid Dynamics

12 Pressure Lecture Revision: Homework Exercise 14

1. Define pressure and explain how it is different from force.

2. Convert a blood pressure measurement of 130 mm Hg/80 mm Hg to units of kPa.
3. Use P = F/A to determine the pressure exerted during CPR for the two cases
below. In each case, the resuscitator can apply a force of 200 N.
(a) If the whole hand (area = 140 cm2 = 0.014 m2) is used
(b) If only the “heel” of the hand is used (area = 40 cm2)
4. What is meant by positive pressure?
5. Write out Pascal’s principle. Apply it to bed sore prevention or glaucoma or
Queckenstedt’s test or the knee or to a foetus surrounded by amniotic fluid.
6. Use Henry’s law to describe why breathing air enriched to 30% O2 is often a
beneficial therapy.
7. Describe inhalation and exhalation using Boyle’s law and pressure gradient.
8. In about four sentences, describe and explain the movement of fluid into and out
of capillaries.
Lecture 22: Control of Blood Pressure

1 Introduction

Blood flows only when its pressure is higher at one place than in another, and it
flows always from the place of higher pressure towards the place of lower pressure.
Blood pressure (BP) is highest in the arteries and falls progressively with dis-
tance from the heart. Arterial blood pressure is pulsatile, with waves of pressure
being created by the contraction and relaxation of the ventricles.
The skeletal muscle pump and valves aid venous return in the limbs.

2 Arterial Blood Pressure (ABP)

ABP depends on:

(a) The compliance of the elastic arteries close to the heart (peripheral resis-
tance (PR)).
(b) The volume of blood forced into them (cardiac output (CO)).
Blood contained in the aorta exerts a “backpressure” (about 80 mm Hg) on the
aortic valve. This “afterload” must be overcome by the myocardium before blood
can be ejected from the left ventricle (LV). Afterload results from the resistance to
blood flow causing a limit to how fast the blood in aorta can drain away from heart.
LV begins to contract, the mitral valve closes and the myocardium undergoes
isovolumetric contraction until ventricular pressure is greater than that of the
afterload.
Arterial blood pressure is continuously oscillating between maximum and mini-
mum values.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 149
M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_15
150 Lecture 22: Control of Blood Pressure

Systolic pressure: the peak pressure in the blood due to the contraction of LV
(~120 mm Hg while resting). It is actually 120 mm Hg greater than atmospheric
pressure, denoted as +120 mm Hg.
Diastolic pressure: the minimum pressure in the aorta prior to LV contraction
(~+80 mm Hg while resting).
Pulse pressure = the difference between systolic and diastolic pressure.
Mean arterial pressure (MAP): pressure remains closer to diastolic P than systolic
P during the greater part of the cardiac cycle.

MAP  diastolic pressure  1 / 3 pulse pressure.

Capillary pressure: ~40 mm Hg at the arterial end and ~20 mm Hg at the

venous end.
Venous blood pressure: ~20 mm Hg in venules and ~0 mm Hg at vena cavae.

3 Hydrostatic Pressure

Pressure in the fluid increases with depth below the surface of the liquid.
The feet may be 120 cm below the level of the heart when standing. Consequently,
BP in the veins and arteries of the feet may be at a pressure of +120 cm H2O (=
+90 mm Hg) simply due to the weight of blood in the vessels.
Hence, when one states that arterial pressure is 100 mm Hg, it usually means that
this is the pressure at the “hydrostatic level” of the heart, i.e. as if supine.

4 Factors Influencing Blood Pressure

Three factors (and posture) can be identified as influencing BP in the closed cardio-
vascular system:
(i) Cardiac output (CO) – this is the amount of blood ejected each minute by the
left ventricle into the aorta. It is calculated by multiplying the stroke volume
(millilitres pumped by each beat) by the heart rate (HR) (no. of beats/min).
An increase in CO will increase BP. The “average” resting output is ~5 l/min.

CO  SV  HR

(ii) Peripheral resistance – this refers to resistance to blood flow due to the fric-
tion between the blood and the vessel walls. It depends on the viscosity (inter-
nal friction) of the blood and the diameter and length of the vessels, particularly
the arterioles.
5 Measuring Blood Pressure 151

The smaller the diameter of the vessel is, the more resistance it offers to
blood flow. The greater is the length of the blood vessels, the greater is the
resistance to flow.
Pulmonary resistance < peripheral resistance.
Greater peripheral resistance to blood flow will increase BP in the arteries.

MAP  CO  TPR

(iii) Blood volume – decreased fluid volume within a closed system decreases the
pressure on the vessels within that system.
(Exercise: In heavy exercise, arterial pressure will rise by 30–40% and blood
flow increases.)

5 Measuring Blood Pressure

It is the auscultatory method to measure pressure in the brachial artery. It is taken

with the arm at the same level as the heart!
The pressure cuff (of the sphygmomanometer) squashes the brachial artery when
inflated and prevents blood flow.
The pressure gauge reads air pressure in the cuff.
If cuff P > systolic P, the brachial artery is squashed closed.
If cuff P < systolic P but ≫ diastolic P, the artery opens partially for the short time
that BP exceeds cuff pressure.
Blood flow through a partially squashed artery is turbulent and “noisy” →
Korotkoff sounds.
Hypertension (resting BP > 140/90 mm Hg) – the heart pumps against greater
resistance; if it works harder, the left ventricle enlarges.
There are many known causes (hormonal, renal, neurogenic), but 95% are still
unknown aetiologically (origin). The devastating long-term effects are blindness,
renal failure, myocardial infarction (heart attack), cerebrovascular accidents
(strokes) and aneurysms.
The risk factors include heredity, obesity, smoking, stress and high salt intake.
Women appear to suffer far fewer complications from persistent hypertension
than men.
Hypotension – excessive decrease in BP:
1. Due to haemorrhage
2. Orthostatic (postural) blood pressure on standing up, may lead to syncope
(fainting)
152 Lecture 22: Control of Blood Pressure

6 Cardiovascular Regulation

Arterial pressure is not controlled by a single pressure-regulating mechanism – sev-

eral interrelated systems each perform a specific function.
The cardiovascular function is regulated by:
• Local factors
• Neural mechanisms
• Endocrine mechanisms
If the blood volume is constant, mean arterial pressure (blood pressure) is deter-
mined primarily by how much blood is pumped into the arteries (CO) and how
much blood leaves the arteries – determined by the resistance of the arterioles to the
blood flow.
Recall #1 … MAP(BP) = CO × TPR.
Vasoconstriction causes the total peripheral resistance (TPR) to increase.
An increase in PR causes BP to increase.
Recall #2 … CO = SV × HR
Hence if heart rate increases, CO increases
An increase in CO causes BP to increase.

7 Local Factors (Autoregulation of Blood Flow)

In normal resting conditions, CO is stable and PR is adjusted within individual tis-

sues to control local blood flow. Autoregulation responds to local factors – indepen-
dent of systemic factors (neural and hormonal).
Blood flow through an organ is regulated by adjusting the diameter of local arte-
rioles and pre-capillary sphincters. Local vasodilators act at the tissue level.
Chemical changes such as (1) decreased concentration of O2; (2) increased CO2,
H+, metabolites and K+; and (3) osmolarity and the release of eicosanoids, bradyki-
nin and NO all cause arteriolar dilation.

8 Short-Term Control of Blood Pressure (Neural Regulation)

–– Mechanisms respond quickly – in seconds

8 Short-Term Control of Blood Pressure (Neural Regulation) 153

Cardiovascular Control Centre (CVC)

CVC (= cardiac centre + vasomotor centre) is an autonomic centre – a group of
neurons in the medulla oblongata (of the brain stem) that regulate the heart rate,
contractility and blood vessel diameter (by acting on smooth muscle).
CV centre receives input from:
• Higher brain centres (the hypothalamus and cerebrum)
• Baroreceptors and
• Chemoreceptors
The output from the CV centre flows along sympathetic and parasympathetic (=
vagus nerve) fibres.
(a) Sympathetic impulses along cardioaccelerator nerves (increase CO):
• Increase heart rate via the sinoatrial (SA) node
• Shorten conduction time via the atrioventricular (AV) node
• Increase the force of myocardial contraction
(b) Parasympathetic impulses along the vagus nerve (decrease CO):
• Decrease heart rate and
• Decrease the force of contraction
(c) Sympathetic impulses along vasomotor nerves to blood vessel walls maintain
moderate vasoconstriction (vasomotor tone):
• An increase in impulses causes generalised vasoconstriction (i.e.
increased PR).
• A decrease in activity causes the dilation of arterioles, allowing faster blood
flow out of arteries (i.e. decreased PR).
Baroreceptor Reflexes
Baroreceptors are pressure-sensitive neurons that monitor the stretching of blood
vessel walls and atria. They are located in the wall of the carotid sinus, the aortic
arch and the wall of most large arteries in the neck and thorax.
(a) Aortic reflex maintains general systemic BP, initiated by baroreceptors in the
wall of the arch of the aorta.
(b) Carotid sinus reflex maintains normal BP in the brain.
(1) A rise in arterial pressure stretches baroreceptors. (2) They send a faster
stream of impulses to the vasomotor centre (VM), (3) which inhibits it. (4) Hence,
the VM centre sends fewer impulses to the vasculature, (5) so vasodilation results.
(6) The decrease in PR causes a decrease in arterial pressure.
If BP falls, baroreceptor reflexes increase heart rate and the force of contraction
and promote vasoconstriction.
Immediately upon standing, arterial pressure in the head and upper body falls (as
blood pools in the lower extremities). Baroreceptors respond immediately (by
decreasing their firing rate) and cause the CV centre to increase sympathetic
154 Lecture 22: Control of Blood Pressure

discharge → HR increases, and vasoconstriction occurs (and decreases parasympa-

thetic discharge), which minimises the decrease in pressure.
However, over 1–2 days of abnormal BP, baroreceptors are “reset” and cease to
send impulses even if arterial pressure remains above 200 mm Hg. Hence, the pro-
longed regulation of arterial pressure needs other (renal) mechanisms.
An aside: During extended bed rest, the blood is distributed more evenly through-
out the body than is the case when standing – gravity does not cause pooling in legs.
This raises arterial pressure. Over ~3 days, the kidneys excrete what they perceive
to be excess fluid, so blood volume decreases (by ~12%). When the person finally
gets out of bed, due to decreased blood volume, baroreceptors cannot compensate
for the orthostatic hypotension. The patient may feel dizzy/faint.
Chemoreceptor Reflexes
Chemoreceptors are located in two carotid bodies and several aortic bodies, close to
baroreceptors.
They respond to the decrease of O2, increase of CO2 and decreased pH in the
blood that occurs as arterial pressure falls. They transmit signals to the vasomotor
centre, which excites it to produce vasoconstriction, and to the cardioaccelerator
centre, which increases CO → more blood to the lungs.
An aside: Increased CO2 in cerebrospinal fluid (CSF) also stimulates chemore-
ceptors in the medulla oblongata. This increases respiratory rate so that increased
CO is accompanied by an increased rate of resp. so that CO2 in the blood is
blown off and oxygenation occurs.

9 Long-Term Control of Blood Pressure

Blood pressure can be stabilised or maintained within normal limits only when
blood volume is stable.
Four hormones (angiotensin II, antidiuretic hormone (ADH), aldosterone and
atrial natriuretic peptide (ANP)) regulate blood volume (and hence BP).
Antidiuretic Hormone (or Vasopressin)
ADH is released from the posterior pituitary in response to:
• A decrease in blood volume
• Increased blood osmolarity (>280 mosmol/l)
• Circulating angiotensin II
It causes an increase in permeability to the water of the collecting duct of the
nephron → less water excreted in urine → blood volume does not decrease.
It also causes peripheral vasoconstriction and hence an increase in BP (an imme-
diate response).
10 Level of Water and Salt Intake 155

Angiotensin II
Angiotensin II appears in the blood after the protein enzyme renin is released by
(the juxtaglomerular cells of) the kidney when arterial pressure falls.
Renin catalyses the formation of angiotensin I (from angiotensinogen in the
blood), which is converted to angiotensin II (in small vessels of the lung) by an
angiotensin-converting enzyme (ACE).
(What effect would the drug Captopril – an “ACE inhibitor” – have on blood
pressure?)
Angiotensin II persists in the blood for ~2 min. It causes four things to happen:
1. The adrenal glands release aldosterone, which increases the re-absorption of
Na+ from the filtrate by kidney tubules.
2. ADH is secreted by the posterior pituitary (hence kidney tubules become perme-
able to water, which osmotically follows Na+ out of the filtrate).
Thus, urine production decreases as water is reclaimed from the filtrate and
returns to the blood – this maintains the circulating blood volume.
3. In addition, angiotensin II stimulates thirst → we drink, which increases extra-
cellular volume and hence blood volume.
4. Angiotensin II is also a vasoconstrictor. It causes:
• The rapid, intense vasoconstriction of arterioles (increases PR).
• Mild vasoconstriction in the veins (promotes venous return).
• Constriction of renal blood vessels, decreasing blood flow to the kidneys,
hence decreasing the glomerular filtration rate. This decreases the excretion
of salt and water.
Atrial Natriuretic Peptide (ANP)
(Produced by muscle cells in the right atrium in response to excessive stretching
of atria)
It acts to reduce blood volume and blood pressure by:
• Increasing Na+ excretion in the kidneys
• Increasing the volume of urine produced (↑GFR)
• Reducing thirst
• Blocking the release of ADH, aldosterone, adrenaline and noradrenaline
(vasoconstrictors)
• Stimulating peripheral vasodilation.

10 Level of Water and Salt Intake

If the kidney is normally healthy, then the level of water and salt intake determines
the long-term arterial pressure.
(If well hydrated) Water is normally excreted by the kidneys as rapidly as it is
ingested.
156 Lecture 22: Control of Blood Pressure

Salt is not so readily excreted in the following:

• If excess salt is present in the diet, the osmolarity of the extracellular body
fluids (blood) increases. Hence, water moves out of the cells into the extracel-
lular fluid (ECF) → blood volume increases.
• Osmolarity that is >280 mosmol/l stimulates the thirst centre, and you drink
more in order to reduce the increasing osmolarity. This water is absorbed into
the blood.
• Hence, extracellular fluid volume increases (so blood volume increases).
• Concurrently, the increased osmolarity stimulates the pituitary to secrete
more ADH.
• ADH causes the kidneys to re-absorb more water before it is excreted as urine.
• Hence, the extracellular fluid volume increases (so blood volume increases).
(Note: Drinking – not decreased osmolarity – relieves thirst. Receptors in the
mouth respond to cold water by decreasing thirst. Hence, sucking ice chips relieves
thirst without putting significant amounts of fluid in the body.)
This salt-driven increase in blood volume means that venous return must increase.
Hence, cardiac output increases, which causes arterial pressure to increase.
(Note: The advice to decrease salt intake to avoid high blood pressure is for this
reason.)

11 Hypertension

MAP >110 mm Hg when resting, or

Systolic pressure >140 mm Hg, and
Diastolic pressure >90 mm Hg.
The moderate elevation of arterial pressure leads to shortened life expectancy. If
MAP is 50% or more above normal, a person can expect to live for only a few more
years. Death occurs due to either of the following:
1. Excess work on the heart leads to LV hypertrophy (more muscle → more O2
needed, coronary artery cannot supply → ischemia). If PR remains high, the
heart is unable to cope with the workload. LV pumps less blood than RV! This
creates pulmonary oedema, then the development of congestive heart failure,
coronary heart disease or both (→ heart attack).
2. The high pressure ruptures a major blood vessel in the brain (→ cerebral infarct).
3. Very high pressure causes multiple haemorrhages in the kidney (→ kidney
failure).
4. Hypertension in arteries damages the endothelial lining of vessels → atheroscle-
rotic plaque.
11 Hypertension 157

Drugs to Treat Hypertension

“Essential hypertension” (hypertension of unknown origin) may be treated by drugs

that reduce the re-absorption of salt and water in the kidneys, called diuretics (or
natriuretics: natrium = Na = sodium).
Calcium Channel Blockers
These drugs can be used to treat hypertension. They block the entry of Ca++ ions to
the vascular smooth muscle (recall that Ca++ ions are necessary for muscle contrac-
tion) so it cannot contract → arterioles dilate, causing peripheral resistance to
decrease.
Beta Blockers
The neurotransmitters adrenalin and noradrenalin attach to the beta-1 receptor sites
of the heart and cause HR and contractility to increase. Drugs called “beta blockers”
may be used to treat hypertension. These drugs attach to the beta-1 receptors; hence,
they block adrenalin’s access to the receptors. Thus, heart rate and arterial pressure
are not increased.
Mineralocorticoid receptor antagonists (MRAs) block the action of aldosterone
by preventing its binding to the receptor.
The aldosterone synthase inhibitor prevents the synthesis of aldosterone.
ACE Inhibitors
e.g. captopril
Angiotensin II Antagonists
Also called Angiotensin receptor blocker (ARBs, molecules that block/prevent AII
binding to the receptor and hence stimulating it – antagonists(=blocker) do not stim-
ulate the receptor), e.g. irbesartan.
Which “blood pressure” do you mean?
• Mean arterial pressure
• Systolic arterial pressure (while supine)
• Systolic arterial pressure (while seated)
• Diastolic arterial pressure (while supine)
• Diastolic arterial pressure (while seated)
• Blood pressure during exercise!
• Capillary blood pressure
• Central venous pressure
(From haemodynamic monitoring)
• Right atrial pressure (2–8 mm Hg)
• Right ventricular systolic pressure (20–30 mm Hg)
• Right ventricular diastolic pressure (8–15 mm Hg)
• Pulmonary artery systolic pressure (20–30 mm Hg)
• Pulmonary artery diastolic pressure (8–15 mm Hg)
158 Lecture 22: Control of Blood Pressure

Mean Arterial Blood Pressure

Blood Volume Diameter of arterioles Pumping action of the Heart Distribution of blood
(cardiac output) between arteries & veins

fluid intake fluid loss peripheral resistance heart rate stroke volume diameter of
(drinking) (excluding haemorrhage) veins

passive via kidneys increased by increase increased by increased by dilated by decrease

(sweating, breathing) (urine) in sympathetic output sympathetic output sympathetic output in sympathetic output
decreased by decrease decreased by para- decreased by para- constricted by increase
in sympathetic output sympathetic output sympathetic output in sympathetic output

Factors affecting mean arterial pressure

12 Control of Blood Pressure Revision: Homework

Exercise 15

1. Define mean arterial blood pressure.

2. What are the three basic factors that determine arterial blood pressure?
3. State the formula that relates peripheral resistance, stroke volume and heart rate
to mean arterial blood pressure.
4. What effect does vasoconstriction have on arterial blood pressure and why?
5. What are the effects on blood volume and arterial pressure of the following:
(a) Increased GFR?
(b) Decreased GFR?
(c) An increase in sympathetic stimulation to the heart and vascular
smooth muscle?
(d) An increase in parasympathetic stimulation to the heart?
(e) ADH secretion?
(f) Drinking water?
6. (a) What is the stimulus for renin release?
(b) How does angiotensin II arise from the release of renin?
(c) What effects do angiotensin II have?
(d) How do the drugs known as ACE inhibitors work?
(e) Why do “calcium channel blockers” help reduce blood pressure?
7. Name the major mechanisms for the short-term regulation of blood pressure.
8. Write a paragraph about the role of the kidneys in the long-term control of blood
pressure.
Lectures 23 and 24: Anatomy
and Physiology of Respiration

Functions of the Respiratory System

1. Exchange of gases between the atmosphere and the blood in alveolar
capillaries.
2. Regulation of blood pH.
3. Protection from inhaled pathogens and irritants (+ sneezing and coughing).
4. Vocalisation and smell!
5. Alveolar capillary endothelial cells produce angiotensin-converting enzymes.

1 Respiration

(Means many things)

• Ventilation of the lungs (breathing).
• External respiration: exchange of gases in the lungs (between alveolar air and
blood in pulmonary capillaries).
• Internal respiration: exchange of dissolved gases in body tissues (between capil-
lary blood and body tissues).
• Cells produce adenosine triphosphate (ATP) (carbon dioxide (CO2)) from organic
molecules by using oxygen (O2) (cellular respiration).
The goal of respiration is to control the concentration of O2, CO2 and H+ ions
dissolved in the blood. Respiratory activity responds to changes in these.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 159
M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_16
160 Lectures 23 and 24: Anatomy and Physiology of Respiration

2 Anatomy

Upper respiratory tract (= nose, pharynx, larynx)

Lower respiratory tract (= trachea, bronchi, bronchioles, alveoli)
Pleurae (left lung 87% size of the right lung (RL))
Nose (is between the nares and choanae): It consists of: nares (nostrils), external
nose (composed of cartilage), nasal cavity contains threefold of tissue (conchae)
through which pass three passages (meatus) for air. Air passing through a meatus
contacts the mucus membrane and is warmed, humidified and filtered.
The olfactory mucosa (smell) on the cribriform plate of ethmoid bone is a route
for infection.
Extensive plexus of thin-walled veins under the epithelium ⇒ nose bleeds easily.
Sinuses mucus-membrane-lined cavities in the skull bones – frontal, ethmoid,
sphenoid and maxillary; drain into the nose via small holes

Pharynx (between the choanae and larynx): nasopharynx connected to the middle
ear by the Eustachian tube (auditory tube)

Larynx (voice box): a cartilaginous chamber; upper opening = glottis, lower open-
ing = trachea.
The epiglottis covers the glottis during swallowing. It functions to ensure that
only air enters the trachea and to keep the airway patent. It also produces sound
(our voice)
Vestibular folds attached to the vocal cords also close off the glottis.
The laryngeal prominence of the thyroid cartilage = “Adam’s apple”.
The lower respiratory tract has a conducting zone (moves gases to and from the
respiratory zone) and a respiratory zone (alveoli where gas exchange takes place).
Trachea (windpipe): kept open by “C” shaped rings of the cartilage. The gap in
“C” closed by a muscle allows the oesophagus to expand as food bolus passes.
L and R – primary bronchi
3R and 2L – secondary bronchi (one per lobe)
10R and 8L – tertiary bronchi
The bronchi is supported by cartilage. The trachea and bronchi have muscles
between the cartilage.
Bronchioles are <1 mm diameter and have smooth muscle but NO cartilage
in walls.
A cross-sectional area for airflow is the greatest in bronchioles and least in
trachea!
A bronchiole branches into 50–80 terminal bronchioles (lobule = the smallest
section of the lungs, supplied by a terminal bronchiole).
3 Respiratory Membrane 161

Terminal bronchioles divide into respiratory bronchioles with little smooth mus-
cle (then into alveolar ducts, which end in alveolar sacs – alveoli open from these sacs).
There are ~65,000 terminal bronchioles. The contraction of their smooth muscle
causes many obstructive lung diseases.
There are 20–25 “generations” of branching before air reaches alveoli.
There are about 3 × 108 alveoli in the two lungs. An alveolus is a pouch
~0.2–0.5 mm in diameter, formed by the respiratory membrane.
Mucus (secreted by goblet cells) coats all passages from the nose to terminal
bronchioles. The bronchial tree is lined with ciliated cells except for most distal
respiratory bronchioles. The cilia move mucus and trapped particles up the bron-
chial tree and keeps airways moist.
(Cilia are very important in moving mucus out of the bronchial tree – the accu-
mulation of mucus leads to persistent cough and recurrent infection (bronchiecta-
sis); see cystic fibrosis.)
Lungs and Pleura
The lungs extend from the apex (superior to the clavicle) to the base at the sixth rib
(medially) and to the seventh rib laterally. The left lung is smaller than the right.
The hilum (hilus) is the point where the primary bronchus and pulmonary artery/
veins enter and leave the lungs. The lungs are suspended from the hilum and adhere
to the chest walls via pleurae. A pleura is a (two-layer) serous membrane (a sac) that
surrounds each lung separately.
The visceral pleura adheres to the lung, while the parietal pleura adheres to the
chest wall. In between is a small amount (a few millilitre) of slippery pleural fluid –
lubricates movement between the chest and the lung. It also ensures that when the
chest expands, so do the lungs (a negative pressure is maintained between the pleurae).
If air enters between two pleurae (e.g. from a wound) → pneumothorax and the
lung collapses.

3 Respiratory Membrane

The total surface area for gas exchange >70 m2. Alveolar surfaces enclose about
2700 ml of alveolar air “in contact” with 60–140 ml blood.
The respiratory membrane is only 0.5 μm thick and consists of fluid and surfac-
tants, epithelial cells of alveolus, fused basement membranes (of the alveolar epi-
thelial cell and the capillary endothelial cell) and capillary endothelial cells. A small
distance allows the rapid diffusion of O2 and CO2 between the capillary blood and
gas in an alveolus.
Red blood cells (RBC) remain in alveolar capillaries for ~0.8 s (less if cardiac
output is high), O2 and CO2 exchange takes about 0.3 s.
Alveolar epithelial cells produce an angiotensin-converting enzyme, while some
(septal cells) produce a “surfactant”, i.e. a detergent that reduces the surface ten-
sion of alveolar fluid – allows the alveolus to expand more easily against the
162 Lectures 23 and 24: Anatomy and Physiology of Respiration

tendency of surface tension to contract alveoli. Its absence in premature babies

→“respiratory distress syndrome”.
Alveolar macrophages patrol inside of the alveolus engulfing inhaled infectious
organisms. They are swept up the bronchial tree by cilia.
Gas Exchange Through the Respiratory Membrane
Standard atmospheric pressure is 1016 hPa (760 mm Hg), of which 79%
(600 mm Hg) is due to N2 and 21% (160 mm Hg) is due to O2.
In alveoli, gas “partial pressures” are N2 = 570, O2 = 104, CO2 = 40 and H2O =
47 mm Hg (570 + 104 + 40 + 47 = 760 mm Hg)
Note well!
1. Gases (even when dissolved in liquid) move from where they are at high par-
tial pressure to where they are at low partial pressure. For example, if gas in
alveoli has pO2 = 104 and blood contains O2 at the concentration of 40
mmHg, then O2 will move into the blood from the alveolar gas – and then
from the plasma onto haemoglobin (Hb).
2. Gases dissolve in liquid in proportion to their partial pressure in the gas mix-
ture (Henry’s law).
Henry’s law: Amount of diss O2 = k × pO2
For example, if blood entering the lung has pCO2 = 46 and alveolar air has pCO2
at 40 mmHg, then CO2 will move out of the blood into the alveolar gas until the CO2
pp in gas and in the blood are the same.
In de-oxgenated blood entering the lungs:
pO2 = 40 mm Hg, pCO2 = 46 mm Hg
(∴ Hb 75% saturated)
Air in alveoli:
pO2 = 104 mm Hg, pCO2 = 40 mm Hg
In oxygenated blood leaving the lungs:
pO2 = 100 mm Hg, pCO2 = 40 mm Hg
(∴ Hb 99% saturated)
Gas exchange through the respiratory membrane is efficient because (/if!):
1. Gas pressure gradients (ΔpO2) are substantial.
2. Diffusion distance is small (x).
3. O2 and CO2 are lipid soluble.
4. The total surface area of alveoli (A) is large.
5. Blood flow and airflow are coordinated.
Fick’s law (for rate Q, of diffusion):
4 Pulmonary Ventilation 163

pO 2 A d
Q d is diffusion coeff .
x

4 Pulmonary Ventilation

We exhale (some) alveolar air – high in CO2 and deficient in O2 – and inhale some
fresh air that mixes with residual alveolar volume.
Normal quiet breathing: 12–18 bpm and ~500 ml/breath; diaphragm is moved
down, external intercostals are contracted to move the sternum forward and the
ribs outward. This increases the volume of the chest; hence, alveolar air pressure
decreases (Boyle’s law) by 400 Pa (3 mm Hg).
1
Boyle’s law: P ∝
V
This pressure difference forces air into the lungs. Normal exhalation is accom-
plished passively by the elastic recoil of the thorax.
Deep inspiration is aided by neck muscles (scalene, sternocleidomastoid) and the
pectoralis minor and serratus anterior.
Forced exhalation uses internal intercostals, external and internal obliques, and
rectus and transversus abdominus.
Innervation
The diaphragm is innervated by phrenic nerves arising from C3–C5 vertebrae!
Intercostals are innervated by spinal nerves that arise from each thoracic vertebrae.
Airway Resistance
The change in lung volume for a given pressure difference (between the atmosphere
and lungs) is called compliance (= ease with which the lung can be expanded). Low
compliance means it is difficult to inflate the lungs ⇒ poor ventilation.
In healthy people, resistance to airflow is mainly in large airways (bronchi) as
their X-sectional area is < that of the 65,000 bronchioles.
In diseases, small bronchioles are easily occluded, contributing to airway resis-
tance. The smooth muscle of bronchioles constricts them easily (no cartilage to hold
them open!).
Bronchoconstriction is triggered by parasympathetic nerve impulses, hista-
mine, smoke and dust (airborne irritants).
Bronchodilation (↓ resistance) is stimulated by sympathetic nerve impulses,
adrenalin and noradrenalin.
Alveolar Ventilation
Air that gets into the alveoli is available for gas exchange.
Air in the conducting zone of the bronchial tree is (anatomical) dead space – this
air cannot exchange gases.
164 Lectures 23 and 24: Anatomy and Physiology of Respiration

Physiological dead space = anatomical dead space + pathological dead space due
to non-functioning alveoli.
About 150 ml of the 500 ml of resting inhalation is “dead air”. Only ~13–15% of
lung air is changed over on one breath at rest.
Deep breathing (>500 ml) increases the proportion of fresh air to dead air that
enters alveoli – rapid shallow breathing (<500 ml) increases the proportion of
already-breathed air in the dead space that re-enters alveoli to fresh air.

5 Regulation of Respiration

The nervous system automatically adjusts the rate of ventilation so that blood O2
and CO2 concentration is maintained within homeostatic limits even during heavy
exercise.
Normal arterial blood gas values:
CO2 = 35–45 mm Hg
O2 = 90–110 mm Hg
“Respiratory centres” of the brain are located in the brain stem (medulla oblon-
gata and pons). They respond to incoming signals from peripheral chemical recep-
tors (when CO2 ↑, pH ↓ or O2 ↓) by sending signals to respiratory muscles via nerves.
H+ (and CO2) affect the respiratory centre directly. H+ cannot cross the blood-­
brain barrier, but CO2 does. CO2 in cerebrospinal fluid (CSF) produces H+ – central
chemoreceptors are very responsive to H+ as there is no buffer in CSF. Thus CO2
(via H+) is the main controller of ventilation.
Anaesthesia or narcotics (e.g. morphine) can depress respiratory centres, so can
they raise intracranial pressure or brain oedema.
If arterial blood O2 concentration falls to <60 mm Hg (a rare occurrence), periph-
eral chemoreceptors (in aortic bodies and carotid bodies) are strongly stimulated →
impulses to respiratory centre.
Eupnoea = normal resting breathing (12–20 bpm)
Bradypnoea = abnormally slow (<12 bpm)
Tachypnoea = abnormally fast (>20 bpm)
Dyspnoea = laboured, difficult breathing
Apnoea = cessation of breathing!

6 Gas Transport in Blood

N2 is inert in the body.

CO2 is much more soluble than O2.
7 Spirometry 165

Transport of Oxygen in the Blood

97% of O2 is carried bound to haemoglobin (Hb) in RBC, only 3% dissolved
in plasma.
Oxygen binds loosely and reversibly to Hb:
when blood pO2 is high (in alveolar capillaries), O2 binds (or stays bound) to Hb;
when blood pO2 is low (in systemic capillaries), O2 is released from Hb.
Percentage saturation of Hb with bound O2:
95–99% in the arterial blood
75% for venous blood (venous reserve!)
Normal Hb concentrations in RBC:
♂ = 13–17.5 g/ml, ♀ = 12–16 g/ml
Transport of Carbon Dioxide in the Blood CO2 leaves the cell as dissolved gas.
Seven per cent (7%) are transported in solution in plasma.
Twenty-three per cent (23%) are bound to haemoglobin (HbCO2) in RBC.
Seventy per cent (70%) reacts with water to form carbonic acid.
In RBC, “carbonic anhydrase” (enzyme) increases the rate of formation of H2CO3
5000-fold!

Carbonic anhydrase

CO2 + H 2 O → H 2 CO3 → HCO3- + H +

H2CO3 then dissociates into bicarbonate (HCO3−) and H+.

HCO3− moves out of RBC into plasma in exchange for Cl− (the “chloride shift”
maintains electrical neutrality).
H+ stays in RBC and binds with Hb after it releases O2 to the tissues (i.e. H+ is buff-
ered by Hb and does not contribute to the acidity of tissues).
In alveoli, O2 binds to Hb and reverses the above reactions.

7 Spirometry

Respiratory volumes are measured using a spirometer:

Tidal volume: ~500 ml (volume inhaled/exhaled in one quiet breath)
Inspiratory reserve volume: ~3 L (volume in excess of tidal that can be inhaled with
max effort).
Expiratory reserve volume: ~1.2 L (volume in excess of tidal that can be exhaled
with max effort).
Residual volume: ~1.2 L (volume of air remaining in the lungs after max effort
exhalation) (difficult to measure)
166 Lectures 23 and 24: Anatomy and Physiology of Respiration

Vital capacity ERV TV IRV.

Total lung capacity RV VC 5.9L male,4.3L female .

Flow rates, e.g. one of which is: FEV1 = maximum volume of air that can be
forcefully exhaled in 1 s.
(Used to measure the degree of pulmonary obstruction, e.g. with asthma. Healthy
lungs can expel ≥80% of their volume in 1 s.)
Forced vital capacity (FVC) is decreased in obstructive lung disease (forced
expiratory flow at 25%, 50% and 75% of FVC reflects the obstruction of large,
medium and small airways, respectively). Calculating the ratio between forced
expiratory volume in the first second (FEV1) and FVC is particularly helpful in
deciding whether a person’s lung disease is an obstructive or restrictive type.
(Obstructive lung diseases include conditions (e.g. asthma, bronchitis, bronchiolitis)
that make it hard to exhale all the air in the lungs. People with restrictive lung disease (e.g.
pulmonary fibrosis, asbestosis) have difficulty in fully expanding their lungs with air.)

8 Additional Information

Lung cancer is the leading cause of cancer (ca) mortality in men and women in the
USA (30% of all ca deaths).
Eight per cent (80%) is non-small cell lung cancer (NSCLC) (no curative therapy
for locally advanced stage); 20% is small-cell lung ca
More women die from lung ca than from breast, ovarian and uterine ca combined.
Four times as many men die from lung ca than from prostate ca. (Do not smoke.)
Lung cancer has been the most common cancer in the world for several decades,
and by 2008, Lung ca were 12.7% of all new cancers. 18.2% of all cancer deaths
were due to lung cancer.
NSCLC represents approximately 80% to 85% of all lung cancers. Unfortunately, at
the time of diagnosis, approximately 70% of NSCLC patients already have
advanced or metastatic disease not amenable to surgical resection.
(NSCLC is the most common type of lung cancer, and it accounts for 85% of
lung cancer cases in the United States.)
The mean age at diagnosis is 61.6.
The median overall survival (OS) (95% confidence interval) from the first line of
therapy (N = 694) was estimated at 20.27 (18.27, 22.70) months.
Most of the NSCLC patients were former (n/N = 382/758, 50.4%) or current
smokers (n/N = 216/758, 28.5%).
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of
morbidity and mortality in the USA. It affects ~20% of chronic smokers. It involves
the airways of all size, ultimately leading to alveolar destruction and the loss of gas-­
8 Additional Information 167

exchange capacity, dyspnoea, limited exercise tolerance, mucus hypersecretion,

cough and poor quality of life.
Pulmonary circulation contains ~0.5 L of blood (10% of total), with ~75 ml in
capillaries spread out over ~60 m2 contact with alveoli.
Pulmonary circulation flows very rapidly.
Pulmonary blood press is ~ 25/8 mm Hg.
As much blood flows through the lungs as through the rest of the body, that is,
5 L/min.
As a breath is inhaled, atmospheric air mixes with (1) water vapour that evapo-
rates from the epithelium of the nasal passages, (2) CO2 that enters the alveoli from
lung capillaries and (3) the residual gas volume of the lungs from which O2 has left
the alveoli for the capillaries.
These gases dilute the inhaled air and contribute to the pressure of gas in the
alveoli so that the pO2 in the alveoli is less than that in the atmosphere.
Chronic obstructive pulmonary disease (COPD), a common preventable and
treatable disease, is characterized by persistent airflow limitation that is usually pro-
gressive and associated with an enhanced chronic inflammatory response in the
airways and the lung to noxious particles or gases.
Cigarette smoking is the most common risk factor for COPD. Exacerbation and
comorbidities contribute to the overall severity in individual patients. COPD is a
major cause of morbidity and mortality worldwide and results in economic and
social burden, which is both substantial and increasing.
COPD is characterized by structural changes in the airways resulting from
repeated injury and repair and by bronchoconstriction, which is an important target
for pharmacologic interventions.
Dyspnoea, chronic cough and sputum production are the most common clinical
symptoms.
Transport of CO2 from Tissues to Lungs in the Blood
• Cells produce CO2, which dissolves in water and diffuses through the plasma
membrane out of cells.
• Some CO2 dissolved in blood is carried as dissolved gas to the lungs (7%).
• CO2 dissolved in plasma reacts with H2O to form H2CO3 (slow reaction).
• Dissolved CO2 diffuses into RBC, where carbonic anhydrase converts CO2 to
H2CO3 very rapidly (70%).
• Also, in RBC, H2CO3 dissociates into HCO3− and H+.
• Most of this H+ combines with haemoglobin (it is a protein buffer).
• HCO3− diffuses out of RBC into plasma (while Cl− moves into RBC, thanks to a
bicarbonate-chloride carrier protein known as the “chloride shift”).
• This allows more H2CO3 in RBC to dissociate into HCO3− and H+.
• In addition, CO2 combines (in a slow reaction) directly with haemoglobin to
form a loosely bound carbaminohaemoglobin compound. Furthermore, a small
amount of CO2 combines directly with plasma proteins (15–25%).
The Carbon Dioxide (Carbonic Acid)/Bicarbonate Buffer System
Carbonic acid is a weak acid (it can destroy a base and in the process transform into
a bicarbonate ion), and bicarbonate ion is a weak base (it can destroy acid and in the
168 Lectures 23 and 24: Anatomy and Physiology of Respiration

process transform into a carbonic acid molecule). Carbonic acid is unstable, so it

“exists” as CO2(aq) in the blood, and because of the work of carbonic anhydrase, we
can use CO2(aq) as a stand in for H2CO3.
CO2(aq) is able to neutralise hydroxide directly by the reaction:

CO2aq   OH   HCO3  aq 

H+ appears because we eat much acidic food, and many products of metabolism
are acidic.
HCO3− appears because our body makes it in kidney tubules, in cells lining the gut,
in the pancreas, in the liver (bile) ?? and in RBC.
CO2 appears since it is the product of using oxygen in cells.
Once in existence, CO2, HCO3− and H+ can participate in the reversible reac-
tions below:

CO2  H 2 O  H 2 CO3  HCO3   H 

400 1 8000

Of the CO2 that is dissolved in plasma, some reacts with H2O to form H2CO3
(slow reaction) some of which in turn can dissociate into HCO3− + H+. (Carbonic
acid is a very weak acid, so very little of it dissociates into ions!)
However, H2CO3 also is unstable, so it dissociates rapidly into CO2 and H2O
(ratio of H2CO3:CO2 = 1:400). The net result is ratio of CO2:HCO3− = 1:20.
As CO2 concentration increases, more H2CO3 is produced (particularly in RBC)
and consequently more HCO3− and H+ too. This would decrease blood pH EXCEPT
for reaction in RBC and for protein and phosphate buffers.
When acid is neutralised by the bicarbonate buffer, the blood’s CO2(aq) concentra-
tion increases.
CO2(aq) can “disappear” by being breathed out as gas, and H+ can “disappear” by
being excreted in urine.
Laplace’s law for cylindrical membrane (capillary): membrane tension,
T = P × r.
Note 1: Capillaries have a small r, so tension in the capillary wall is smaller for a
given pressure than in a more thick-walled larger diameter artery.
Note 2: An aneurysm has a large r with the same pressure as in the rest of the artery,
so the wall is at greater tension and greater risk of bursting.
Laplace’s law for spherical membrane with one surface (alveolus): membrane
Pr
tension, T  .
2
Note 1: The surface tension of the liquid provides the necessary membrane strength
to maintain the alveolus.
Note 2: For two connected “spheres” containing gas, pressure in both is the same
(Pascal’s principle) – changes in wall tension do not arise from differences in pressure.
Note 3: If surface tension is too high (insufficient surfactant), the radius of alveoli
will decrease for the same pressure (alveoli collapse). A premature baby has
insufficient strength to expand the lungs.
9 Respiratory System Revision: Homework Exercise 16 169

Note 4: If surface tension is too low (excess surfactant), the radius of the alveoli will
increase for a given air pressure.
Note 5: Bubbles are unstable, and the surfactant/alveolar radius self-regulates – as
the alveoli radius decreases, the surfactant gets more concentrated, lowering the
surface tension and halting its collapse (and vice versa).
COPD results from inflammatory damage of the airways and alveoli after
chronic exposure to noxious airborne particles, principally from cigarette smoking.
It comprises several conditions:
• Chronic bronchitis – persistent and recurring inflammation of the bronchi with
the consequent release of active enzymes to the surrounding tissues
• Emphysema – abnormal and permanent enlargement of the airspaces distal to
the terminal bronchioles with destruction of their walls
• Peripheral airway disease – histopathologically characterized by an increase in
goblet cells, intraluminal mucus, inflammation, increased smooth muscle mass,
fibrosis resulting in the narrowing and obliteration of small airways.

9 Respiratory System Revision: Homework Exercise 16

1. Define the following: dead space, lung compliance and respiratory distress
syndrome.
2. How does the construction of the walls of bronchi and bronchioles differ?
3. What can cause bronchodilation, and what can cause bronchoconstriction?
4. Why does hyperventilation (= rapid shallow breaths) result in an increase in
dissolved CO2 in the blood?
5. To what do the chemoreceptors in the respiratory centre of CNS respond? (And
explain your answer.)
6. How and why is the composition of alveolar air different from atmospheric air?
7. What is FEV1, and why is it decreased in obstructive diseases such as asthma?
8. Describe the chemical changes that occur in the RBC that facilitate carbon
dioxide transport.
9. State Henry’s law. Use Henry’s law to describe why breathing air with 30% O2
is often a beneficial therapy.
10. State Boyle’s law. Describe inhalation and exhalation using Boyle’s law and
pressure gradient.
11. What are the functions of the mucous glands and the ciliated epithelial cells?
12. Give definitions for the following: eupnoea, apnoea, bradypnoea, tachypnoea
and dyspnoea.
13. Why would you encourage an anxious person to breathe deeply rather than with
shallow breaths? (Hint: think about “dead-space”.)
14. What would you anticipate would be the effect of pneumothorax (air in the
intrapleural space) on the lungs and breathing?
15. What could you anticipate would be the effect on breathing of a spinal cord
injury at the level of the sixth cervical vertebra? (Hint: from where is the dia-
phragm innervated?)
Lectures 25 and 26: Reproductive System

(i) The purpose of sexual reproduction is to produce offspring that are genetically
different from each other and from their parents.
(ii) Puberty confers the ability to produce gametes capable of being fertilised.

1 Male Anatomy

• It consists of two testes, two epididymis, a scrotum, two vas deferens, two semi-
nal vesicles, two ejaculatory ducts (prostate glands), urethra, two bulbourethral
glands, a penis and an external urethral meatus.

2 Male Reproductive Tract

Seminiferous tubules produce sperm, and cilia produce currents that transport
them to the epididymis.
The epididymis stores sperm, regulates their fluid environment and facilitates their
maturation.
The vas (ductus) deferens stores sperm and transports the sperm by peristaltic
contractions.
(The inguinal canal lies between the deep inguinal ring and the superficial ingui-
nal ring. In men, it contains the spermatic cord (= vas deferens, blood vessels, lym-
phatics, nerves). In women, it contains the round ligament of the uterus.)
The ejaculatory ducts (~2 cm long) begin at the end of the vas deferens. Here,
seminal vesicles empty seminal fluid into the tract, and it mixes with and
dilutes sperm.

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 171
M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9_17
172 Lectures 25 and 26: Reproductive System

The two ejaculatory ducts enter the prostate and join the urethra (distal to the inter-
nal urethral sphincter), which carries semen (or urine) out through the meatus of
the penis.

♂ Reproductive Physiology
3 

Testes are kept at ~1.1 °C less than the body temperature (the cremaster muscle
raises/lowers). The scrotal cavity lines with the tunica vaginalis (a serous membrane).
Testes produce androgens (testosterone) and “physically mature” spermatozoa.
They provide ~5% of ejaculate.
Seminal vesicles produce alkaline seminal fluid (fructose, prostaglandins(!),
ascorbic acid, fibrinogen), make sperm motile (flagellum begins to beat) and pro-
vide ~60% of ejaculate volume.
The prostate produces alkaline prostatic fluid containing citric acid, clotting
enzymes and fibrinolysin to liquefy coagulated semen (20–30% of ejaculate into the
urethra).
Bulbourethral (Cowper’s) glands add <5% of alkaline lubricating fluid into the
urethra.

4 Spermatogenesis

A 64-day process by which 46-chromosome germ cells, “spermatogonia”, are trans-

formed into 23-chromosome mature sperm “spermatozoa”
In seminiferous tubules:
One stem cell undergoes mitosis (division) to produce two cells, and one of these
produces two more.
These two produce four primary spermatocytes (46 chromos).
Each primary spermatocyte undergoes meiosis → four spermatids with 23 chromos
(remain connected to each other and are surrounded by a nurse cell cytoplasm).
Spermatids mature into spermatozoa (= sperm) by extruding cytosol and some
organelles in a process called spermiogenesis.
Spermatozoa are capacitated when mixed with seminal vesicle fluid and fluid from
“peg” epithelial cells of the fallopian tube in the ♀ reproductive tract.

5 Semen

Ejaculate (2–5 ml) contains 30–150 × 106 spermatozoa/ml, enzymes, electrolytes,

protein, fructose, lipids, vitamin C, carnitene, prostaglandins, water and mucus.
8 Female Anatomy 173

♂ Hormones
The gonadotropin-releasing hormone (GnRH) (produced in the hypothalamus)
stimulates the anterior pituitary to release a follicle-stimulating hormone (FSH) and
luteinising hormone (LH) (= gonadotropins).
LH targets interstitial (Leydig) cells (of the testes) to produce testosterone.
FSH targets nurse (sustentacular/Sertoli) cells (in the testes), which (in the presence
of testosterone) promote spermiogenesis.

6 Testosterone

(Formed from cholesterol)

• Stimulates spermiogenesis (along with FSH)
• Affects the central nervous system (CNS) function (libido)
• Stimulates the metabolic rate
• Stimulates muscle and bone growth
• Establishes and maintains secondary sex characteristics (hair distribution, mus-
cle mass, body size, fat deposits, thicker vocal cords, Adam’s apple, thicker skin,
body shape, larger hands and feet, behavioural effects)
• Maintains glands and organs of the reproductive tract

7 “Men’s (XY) Health”

• Cryptorchidism
• Inguinal hernias, testicular cancer
• Prostatitis, prostate cancer
• Orchiectomy (surgical removal of the testicles)
• Infertility (<20 × 106 sperm/ml), impotence
• X-linked genetic disease
• Vasectomy
• Klinefelter’s syndrome = polysomy X (XXY – i.e. have two X chromosomes like
female but “are male”), small penis, tall stature (treated with testosterone); inci-
dence ~ 1/600–750

8 Female Anatomy

• It consists of two ovaries, a pelvic cavity, two fallopian tubes, a uterus, a cervical
os, a vagina, two greater vestibular (Bartholin’s) glands and a vulva.
174 Lectures 25 and 26: Reproductive System

• Bartholin’s glands secrete lubricating mucus.

Note: The clitoris is the most anterior/ventral, the urethral opening is anterior to
the vaginal opening and the anus is posterior/dorsal.

9 Female Reproductive Tract

The fallopian tubes move the ovum towards the uterus via the cilia and peristalsis
over 3–4 days. Fertilisation occurs here.
The uterus is subdivided into the fundus, body and cervix (neck). The wall of the
uterus has three layers: the serous perimetrium, the muscular myometrium
(where the muscle cells expand and elongate as the uterus expands to accommo-
date the foetus) and the glandular endometrium (which receives blastocyst/
sloughs off).
The cervical canal dilates to allow the passage of the baby through the cervical os
and into the vagina).

♀ Reproductive Physiology
10 

Ovaries store primordial follicles (= ovum surrounded by a single layer of follicle

cells) paused in “prophase I” of meiosis. These are present at birth.
The FSH targets granulosa cells, causing the growth of 6–12 primary follicles
each month.
1. An ovum increases in size.
2. Follicle cells proliferate into several layers and are called granulosa cells.
3. Theca cells surround the follicle.
Thecal cells produce androgens, which diffuse to granulosa cells, which convert
androgens (i.e. androstenedione) to oestrogens.
Granulosa cells secrete a fluid that accumulates in the antrum within the sur-
rounding granulosa cells: secondary follicle → one follicle outgrows the others
(they become atretic) and grows to 1–1.5 cm = mature (Graafian/vesicular/tertiary)
follicle.
Ovulation: the tertiary follicle releases secondary oocytes – paused in “meta-
phase II” of meiosis (meiosis completes after fertilisation) – into the pelvic cavity.
Cilia on the fimbriae of the infundibulum beat and produce currents, which move
the oocyte into the fallopian tube.
Fertilisation occurs in the fallopian tube and zygote implants in the uterine wall.
The uterus provides mechanical protection, nutritional support and waste removal
for the embryo.
12 Estradiol 175

The vagina is a passage for the elimination of menstrual fluids, receives the penis
and forms the birth canal.
Gestation = 38 weeks, ~3.2 kg.
Premature = 28–36 weeks, >1 kg.

♀ Hormones of the Ovarian Cycle

11 

The ovarian cycle is a monthly cycle of events associated with the maturation of the
ovum – occurs in the ovary.
1. The hypothalamus releases GnRH (at 1 pulse/60–90 min).
2. GnRH causes FSH (and LH) release from the anterior pituitary.
(a) Follicular (pre-ovulatory) phase (days 1–14, may vary)
3. The FSH acts on the ovary to stimulate follicle development.
4. The developing follicle produces oestrogen (which inhibits LH release) and
inhibin (which causes FSH levels to decline, i.e. −ve feedback).
5. So the blood oestrogen level rises, which causes the pulse frequency of
GnRH release to increase to 1 pulse/30–60 min.
6. This increased GnRH and stimulates LH release from the anterior pituitary.
This “surge” in LH at day 13 → the completion of meiosis I by the oocyte
and ovulation and development of the corpus luteum (CL) (= granulosa
cells of the tertiary follicle).
(b) Luteal (post-ovulatory) phase (days 14–28)
7. The corpus luteum releases progesterone – which prepares the uterus for
pregnancy (and some oestrogen).
8. As the progesterone level rises and oestrogen falls, GnRH pulse frequency
declines to 1–4 pulses/day.
9. This stimulates LH secretion (which maintains CL) more than it does FSH.
10. If pregnancy does not occur, CL deteriorates (after 10 days) and oestrogen
and progesterone levels drop.
11. This drop allows the frequency of pulses of GnRH release to increase,
which stimulates FSH release → next cycle.

12 Estradiol

Thecal cells produce androgens (formed from cholesterol via testosterone), which
diffuse to granulosa cells, which convert androgen to oestrogen.
Oestrogen:
176 Lectures 25 and 26: Reproductive System

• Stimulates bone and muscle growth

• Maintains secondary sex characteristics (hair distribution, breasts, location of
adipose tissue, voice, pelvis)
• Affects the CNS (sexual behaviour)
• Maintains accessory reproductive glands/organs
• Initiates the growth and repair of the endometrium
• Promotes the development of breasts

13 The Menstrual (Uterine) Cycle

• Occurs in the uterus

• ~28-day cycle
• The cyclical preparation of the uterus to receive a fertilised ovum and the subse-
quent destruction of tissue if no embryo implants
(a) Menses (menstruation) (days 1–7) – endometrial sloughing; 35–50 ml of
blood is lost.
(b) Proliferation (days 5–14) – the uterine epithelium regrows under the stimu-
lation of oestrogen (secreted by developing ovarian follicles).
(c) Secretory phase (days 15–28) begins at ovulation and continues while the
corpus luteum is intact (endometrial glands secrete glycogen – a nutrition
source for embryo).
(The day of ovulation is determined by counting back 14 days from the first day
of menses to the start of the luteal phase of the ovarian cycle.).
(Menarche, menstrual cycles, menopause)

14 “Women’s Health” XX

• Ovarian cancer, cervical cancer

• Ectopic pregnancy
• Pelvic inflammatory disease, endometriosis
• Breast cancer, hysterectomy
• Menarche, menopause, amenorrhea
• Preeclampsia (= pregnancy-induced hypertension, albuminuria, oedema at
32 weeks+)
• Tubal ligation
• Salpingectomy (salpinx = tube)
• Turner’s syndrome = monosomy (single) X (i.e. have one X chromosome like
males but “are female”), short stature, no ovaries (no penis), no secondary sex
characteristics; incidence: ~1/2500–10,000
16 Genetics 177

15 Fertilisation

Sperm are deposited near the cervical os and so must pass through the cervical
mucus. A less viscous mucus is produced when the oestrogen level is high (at ovula-
tion), which allows sperm’s easy passage. Thick mucus impedes sperm entry to
the uterus.
Sperm reach the fallopian tube ~30 min after ejaculation and live for ~50 h.
Mature eggs release the sperm chemoattractant “allurin”.
The acrosomal enzymes of many sperm are required to tunnel through the ovum’s
zona pellucida. The fusing of one sperm to an ovum’s plasma membrane prevents
the entry of any other sperm.

16 Genetics

Cells of ♀ have 46 chromosomes, including XX (22 + X from the mother and 22 +

X from the father).
Cells of ♂ have 46 chromosomes (22 + X from the mother and 22 + Y from the
father).

=23 n=
, 46 2 n

In turn, each chromosome may be composed of one chromatid (after mitosis) or

(after duplication) two identical chromatids.

││ ║║ ║ ║ │ │ │ │
● ● ● ● ●&●  ●+● & ●+●
││ ║║ ║ ║ │ │ │ │
a) 1 cell, chromatids b) 2 cells c) 4 cells after
duplicate meiosis I meiosis II

(a) A chromosome pair has one chromatid per chromosome. Then chromatids
duplicate, and the chromosome pair (with two chromatids per chromosome) is
called a tetrad (at metaphase I of a single cell).
(b) Each chromosome of the pair moves to a separate cell – we now have two cells.
(c) At anaphase II, the double chromatids of each chromosome separate into single
chromatids, which become four separate cells (gametes).
The purpose of sexual reproduction is to produce genetic variability in
individuals.
Spermatogenesis starts with the mitosis of a stem cell (which is 2n, and each
chromosome consists of two chromatids).
178 Lectures 25 and 26: Reproductive System

The chromatids of each chromosome detach and move apart to form two new
cells (primary spermatocytes). New cells are 2n, but each chromosome consists of
one chromatid.
Each chromatid then duplicates itself so that each chromosome of the new sper-
matocyte again consists of two chromatids.
A primary spermatocyte undergoes meiosis to produce two new cells (secondary
spermatocytes), each with n chromosomes of two chromatids (the exchange of
genetic material (crossing over) during the pro-phase of meiosis I introduces vari-
ability, and independent assortment during the meta-phase of meiosis I also intro-
duces variability).
In each secondary spermatocyte, the chromatids separate and move apart again
(to form a total of four cells – called spermatids – each with n chromosomes of one
chromatid). (Two of these spermatids will contain an “X”, while the other two will
contain a “Y”.)
Thus, each spermatid (and sperm) has 23 chromosomes (not 46).
Spermiogenesis – undifferentiated spermatids differentiate into mature sperma-
tozoa (major changes in internal and external structures).
Oogenesis – the stem cell divides by mitosis into primary oocytes (2n) before
birth. After puberty, the primary oocyte completes meiosis to produce (up to) three
polar bodies and one ovum with 23 chromosomes.
Genetic variability (in the sperm and ovum) is introduced at synapsis (crossing
over between adjacent chromatids) and at metaphase I (maternal and paternal chro-
mosomes separate randomly).
Fertilisation – one sperm (with 23 chromosomes) enters the ovum (which con-
tains 23 chromosomes) to form a zygote which has 46 chromosomes.
Zygote = ovum fertilised by one sperm
Pre-embryo (morula, blastocyst, <1 week)
Embryo (weeks 1–8), foetus (weeks 9 to term)
Oestrogens – estradiol, estrone, estriol
Androgens – testosterone (and androstenedione, dihydrotestosterone)
Gametes – spermatozoa, ovum
Gonads – testes, ovaries
Primary sex characteristics – gonads, external genitalia and reproductive tract
Secondary sex characteristics – structures that appear after puberty in response to
sex hormones and are not involved in the production of gametes

17 Additional Information

Seminal fluid contains enzymes.

Protease dissolves vaginal mucus.
Seminal plasmin kills bacteria.
Prostatic enzyme converts fibrinogen to fibrin to coagulate semen.
18 Reproductive System Revision: Homework Exercise 17 179

Fibrinolysin liquefies clotted semen after 20–30 min.

The beginning (Harvard):
https://www.youtube.com/watch?v=ieYdgon-­wT4
Androgens, especially dihydrotestosterone (DHT), mediate hair growth through-
out the body and have opposite effects depending on the area of the body, increasing
hair growth on the face, chest, pubic, axillae and extremities and inhibiting hair
growth on the scalp in men who are genetically predisposed to male pattern hair loss
or male androgenetic alopecia.
Prostate cancer is the most commonly diagnosed cancer in Australian men and is
the second-leading cause of cancer mortality in Western men (lung cancer is first,
and colorectal is third).
Twenty-nine percent (29%) of all diagnosed ca are prostate; 1/6 of men will be
affected (mean age = 71 years).
(Treated with bilateral orchidectomy or luteinising hormone-releasing hormone-­
receptor agonists or prostatectomy, with seminal vesicles or radiotherapy)
In females, breast cancer is the first most frequent malignancy; colorectal
is second.
Endometriosis is defined as the presence of endometrial-like tissue outside the
uterus (often on the peritoneum). It affects 6–10% of women; symptoms = pel-
vic pain.

18 Reproductive System Revision: Homework Exercise 17

1. List the structures of the male reproductive tract in the order that a spermato-
zoon would pass through them.
2. What is the function of testosterone in males?
3. Where do spermatozoa physically mature, and where do they become
“capacitated”?
4. What happens in the ejaculatory duct?
5. What is the composition of semen?
6. Write a paragraph that summarises the events of spermatogenesis. (Do not
merely copy out the textbook!)
7. What is the function of estradiol?
8. Summarise the hormonal control of the ovarian cycle up to the luteal phase.
9. What are the male secondary sex characteristics?
10. What are the female primary sex characteristics?
11. Define menstrual cycle, menarche and menopause.
12. Outline the major changes in FSH, LH, estradiol and progesterone before and
after ovulation.
13. What is the function of GnRH and the result of its release in males and females?
 uggested Answers to the Lecture Revision
S
Homework Exercises

Exercise 1: Cells and Tissues

1. Name four of the organelles in a cell and describe their function.

Mitochondria: produce ATP (95% of ATP required by the cell).
Lysosomes: membrane-enclosed vesicles that contain enzymes capable of
breaking down a variety of molecules; removal of damaged intracellular organ-
elles or pathogens.
Nucleus: contains DNA and associated protein (chromatin); control of protein
synthesis and metabolism
Endoplasmic reticulum: stores newly synthesised molecules; synthesise fatty
acids, phospholipids and cholesterol. Rough ER: modifies and packages newly
synthesised protein. Smooth ER: synthesise lipids and carbohydrates.
Golgi complex: processes and delivers lipids and proteins to the plasma mem-
brane for secretion.
2. Describe the structure of the plasma membrane (cell membrane).
Double layer of phospholipid molecules – the lipid ends of the two layers of
molecules face each other, while the phosphate heads face either the inside of
the cell or the extracellular environment. Cholesterol molecules are scattered
throughout the phospholipid molecules, and there are protein molecules
embedded in the membrane as well – some of these form channels that allow
the passage of some substances through the membrane. Others may act as
receptor proteins that are sensitive to the presence of specific extracellular mol-
ecules, e.g. calcium, hormones, etc.

© The Editor(s) (if applicable) and The Author(s), under exclusive license to 181
Springer Nature Switzerland AG 2024
M. Caon, Lecture Notes, Worksheets, and Exercises for Basic Anatomy
and Physiology, https://doi.org/10.1007/978-3-031-56296-9
182 Suggested Answers to the Lecture Revision Homework Exercises

3. Define the processes of “diffusion” and “osmosis”.

Diffusion is the random movement of molecules (particles) within a gas or
liquid. The effect of diffusion is to eventually distribute particles from regions
where they are in high concentration to regions where they are in low
concentration.
Osmosis is the diffusion of water molecules through a semi-permeable mem-
brane from one solution to another solution that contains a higher solute
concentration.
4. What roles do proteins play in a cell’s plasma membrane?
Some proteins are enzymes (they make chemical reactions happen faster),
some are receptor proteins (for signalling chemicals, e.g. hormones), some are
channels that transport molecules and ions (selectively allow entry to some
solutes, e.g. ions), some are anchoring proteins that act as attachments (to cells’
cytoskeleton and to extracellular structures) or join cells to adjacent cells (e.g.
desmosomes), some are recognition protein used to identify the cell (glycopro-
teins = identification tags) and some are carrier proteins that bind solutes and
transport them across the plasma membrane.
5. What is active transport?
It is the movement of particles against their concentration gradient across the
plasma membrane using ATP.
6. Name and briefly describe the four types of tissue.
Epithelial: covers body surfaces (skin), lines the interior or exterior of hollow
organs and ducts and forms glands.
Connective: connects the epithelium to the rest of the body and protects (cush-
ions and immunity) and supports (bone and cartilage) the body and organs;
consists of specialised cells and an intercellular matrix. Other types are blood,
bone and fat.
Muscle: produces movement by contracting. Three types: skeletal, smooth and
cardiac muscle.
Nervous: the brain and spinal cord and peripheral nerves. Gray matter: nerve
cell bodies; white matter: axons.
7. What are the functions of epithelial tissue?
(a) Physical protection: it lines the cavities of hollow organs, ducts and body
cavities and covers the body – places that are likely to dehydrate or lose
tissue from abrasive action.
(b) Controlling permeability: every substance that enters or leaves the body
must cross an epithelium.
(c) Sensation: most epithelia have a large nerve supply and hence are extremely
sensitive to stimulation.
(d) Providing specialised secretions: it makes up the bulk of glands and pro-
duce secretions.
Suggested Answers to the Lecture Revision Homework Exercises 183

8. What is the difference between “loose” connective tissue and “dense” connec-
tive tissue?
Loose connective tissue (adipose tissue, synovial membrane): much of the
space is occupied by “ground substance”.
Dense connective tissue (tendons, ligaments, heart valves, dermis) – fibres
occupy more space than cells or ground substance.
9. From what type of tissue are the following structures made: bone, lymph, ten-
don, cartilage, adipose tissue, glands, epidermis?
Bone: connective tissue.
Lymph: a liquid; lymph tissue is connective tissue.
Tendon, cartilage: both are dense connective tissue.
Adipose tissue: loose connective tissue.
Glands, epidermis: both are epithelial tissue.
10. What structure separates the thoracic and abdominal cavities, and what is it
made of?
The diaphragm. It is made of skeletal muscle (it can be under our conscious
control).
11. What is the collective name for the contents of the ventral cavity
The viscera
12. What are the main functions of these membranes and the potential space
they form?
To secrete serous fluid, which allows the parietal membrane to slide over the
visceral membrane without friction.
13. What is the clinical condition that develops when air is able to enter the poten-
tial space of the pleural membrane?
Pneumothorax.
14. What is the clinical condition called when the membrane of the abdominal cav-
ity is inflamed?
Peritonitis.
15. How does an organ differ from a tissue?
Tissues are collections of specialised cells and cell products that perform a
relatively limited number of functions (or a specific function) [or one or more
specific functions].
Organs are combinations of tissues that perform complex functions (or two or
more tissues working in combination to perform several functions).
184 Suggested Answers to the Lecture Revision Homework Exercises

16. Using the gastrointestinal tract as an example, list the cavity/cavities in which
organs of this system are found.
(Buccal cavity), thoracic cavity (oesophagus), abdomino-pelvic cavity (rest of
organs) – may separate organs into abdominal cavity and pelvic cavity.
17. Do all organs of the body lie within a body cavity? If not, give examples.
No. Muscles and bones lie outside cavities; kidneys (and part of the pancreas
and duodenum) are “retroperitoneal”, so they lie “outside” the peritoneum. The
abdominal cavity encloses the organs surrounded by the peritoneum and retro-
peritoneal organs.
18. Using directional terms, describe the appearance of the body when it is stand-
ing in the “anatomical position”.
Body vertical, feet inferior to the waist and knees, feet not everted, legs neither
flexed nor extended, arms lateral and parallel to the trunk, hands inferior to the
elbows, face directed anteriorly, neck neither flexed nor extended.
19. Describe the position of each of the following using anatomical, directional
terms: ear (compared to the nose and to the chin), elbow (compared to the wrist
and shoulder) and vertebrae (compared to the sternum and kidneys).
The ear is lateral to the nose and superior to the mandible.
The elbow is proximal to the wrist but distal to the shoulder.
Vertebrae are posterior (or dorsal) to the sternum and medial to kidneys.

Exercise 2: Basic Chemistry Revision

1. Write out the definition of each of the following 15 things:

Element: the 90 naturally occurring simplest substances (listed in the “periodic
table” – have chemical symbols).
Atom: the smallest particle of an element (contains protons, neutrons and
electrons).
Proton: +vely charged subatomic particle in the nucleus of an atom (atoms of
different elements have different numbers of protons).
Neutron: subatomic particle in the nucleus of an atom.
Electron: −vely charged subatomic particle outside of the nucleus; tiny yet
occupies the bulk of space in an atom.
Chemical bond: the outer electron(s) of an atom participate with those of
another atom in joining two or more atoms together to form a new substance (a
“compound”).
Metal elements (LHS of the periodic table): always lose (donate) electrons in
chemical reactions.
Suggested Answers to the Lecture Revision Homework Exercises 185

Non-metal elements (RHS of the periodic table): always gain electrons in

chemical reactions.
Compound: a substance formed when atoms from two or more elements are
chemically combined in fixed proportions (have a formula, e.g. H2O, C6H12O6).
Molecular compounds: atoms forming the molecule are from non-metal ele-
ments, covalently bonded.
Covalent bond: the bond between two non-metal atoms in a molecule (the
atoms share electrons, so BOTH gain electrons).
Molecule: the smallest particle of a molecular compound; consists of two or
more atoms joined by covalent bonds.
Ionic (non-molecular) compounds: formed when metal atoms (ionically) bond
to six to eight surrounding non-metal atoms (and vice versa) – continuous crys-
tal lattice structure.
Ionic bond: the attraction between a metal atom and all the surrounding non-­
metal atoms in the lattice (the non-metal atoms gain electron(s), while the metal
atoms lose electron(s)).
Ion: an atom that has gained (if a non-metal) or lost (if a metal) one (or more)
electron(s) (when an ionic substance dissolves in water, ions separate and move
about freely as electrolytes). Molecules can be ions too!
2. Identify the name of the elements and the number of atoms in the following:
 (a) C6H12O6 Carbon (six atoms), hydrogen (12 atoms), oxygen (six atoms)
 (b) CH3COOH Carbon (two atoms), hydrogen (four atoms), oxygen (two atoms)
 (c) NH4+ OH− Nitrogen (one atom), hydrogen (five atoms), oxygen (one atom)

3. Which of the following compounds are covalent, and which are ionic?
 (a) C6H12O6 covalent
 (b) CH3COOH covalent
 (c) Na+ Cl− ionic
 (d) K+ Cl− ionic
 (e) Ba++ SO4−− ionic

Chemistry Calculations
1. By following the steps below, calculate the mass of substance per 100 ml for an
IV solution that contains 0.3% Na+Cl− and 3.3% glucose.
(a) Consider sodium chloride first. What mass of sodium chloride is in 100 ml
of 0.3% Na+Cl−? 100 ml × 0.3% (g/ml) = 0.3 g.
(b) Repeat the procedure for glucose. What mass of glucose is in 100 ml of
3.3% glucose? 100 ml × 3.3% = 3.3 g.
(c) Now add the two masses together to get a total mass per 100 ml of 0.3%
Na+Cl− and 3.3% glucose. 0.3 g + 3.3 g = 3.6 g.
2. Calculate the mass of substance per 100 ml for a 0.224% K+ Cl− solution.
The mass of KCl: 100 ml × 0.224% = 0.224 g.
186 Suggested Answers to the Lecture Revision Homework Exercises

3. Calculate the number of millimoles per litre in a 5% glucose solution.

(a) First calculate the mass of glucose in 1 l: mass (g) in 100 ml = 5 g.
(b) Multiply this answer by 10 to get grams per litre: 5 ×10 = 50 g/l.
(c) Calculate the number of moles in this many grams of glucose in two steps:
(i) Number of grams in one mole of glucose C6H12O6 (RAMs are C = 12, H
= 1, O = 16). Multiply the RAM values by the number of atoms of each
element appearing in the formula:

12  6   1 12   16  6   72  12  96  180 

The answer is the “relative formula mass”.
(ii) Divide the number of grams per litre [from b) above] by the relative
formula mass [from c) part (i)].
The answer is the number of moles per litre (it should be a decimal less
than 1.0). 50 ÷ 180 = 0.278 mol/l.
(d) Multiply the answer in (c) part (ii) by 1000 (shift the decimal three places
right) to get the answer.

0.278 mol / l  1000  278 mmol / l.

4. Calculate the number of millimoles per litre in a 1 l IV bag of normal saline

(0.9% Na+ Cl−).
1000 ml × 0.9 g/ml = 9 g. Relative formula mass of NaCl = 23 + 35.5 =
58.5 g/mol.
Number of moles/l = 9 g ÷ 58.5 g/mol = 0.154 mol = 154 mmol.
5. Give the definition of an osmole.
The amount of substance that must be dissolved to produce 1 mole (which is
6.02×1023 molecules) of separate solute particles
(a) What are the particles in the glucose solution? Molecules of glucose.
(b) What are the particles in the saline solution? Sodium ions and chloride ions.
6. State the number of moles per litre calculated in Q3 to state the number of
osmoles per litre in 1 l IV bag of 5% glucose (a covalent molecular substance
← hint!)

=
278 mmol / l 0=
.278 mol / l 0.278 osmol / l.

7. Followed by Q4, calculate the number of osmol/l in a 1 l bag of 0.9% Na+ Cl−
(normal saline – an ionic substance)
Suggested Answers to the Lecture Revision Homework Exercises 187

154 mmol / l = 0.154 mol / l.

 
0.154 mol / l  2 dissolved particles : Na  and Cl   0.308 osmol / l.

8. Characterise the following solutions as hypotonic, isotonic or hypertonic to

blood plasma:
(a) 0.9% sodium chloride – isotonic
(b) 0.3% sodium chloride – hypotonic
(c) 5% glucose – isotonic
(d) 4% glucose – hypotonic
(e) A solution containing 3.3% glucose and 0.3% sodium chloride – isotonic
(f) A solution containing 4% glucose and 0.18% sodium chloride – isotonic
(g) 9% sodium chloride – hypertonic
9. (a) What is the pH of a solution that contains H+ at a concentration of 10−5 mol/l?

 
pH   log  c  H      log 10 5  5.

(b) Is the solution in (a) acidic or basic? Acidic.

(c) What is the pH of a solution that contains H+ at a concentration of
3.2×10−5 mol/l?

     log 3.2 10   4.49.

pH   log c H  5

Exercise 3: Integument

1. List the components of the integument.

Two major parts – the cutaneous membrane and the accessory structures:
(a) Cutaneous membrane: epidermis (stratum basale, spinosum, granulosum,
lucidum – thick skin only; corneum – on the outside) and dermis (reticular –
on the inside – and papillary dermal layers).
(b) Accessory structure: hair, exocrine glands and nails; they are located in the
dermis and protrude through the epidermis to the skin surface.
2. What are the principal functions of the skin?
(a) Body temperature regulation (either insulation or evaporative cooling).
(b) Protection of underlying tissues and organs against impact, abrasion (pro-
duction of keratin), dehydration, UV (production of melanin) and chemi-
cal attack.
188 Suggested Answers to the Lecture Revision Homework Exercises

(c) General sense, detection of touch, pain, perception of stimuli etc., which
provide information on the external environment.
(d) Excretion of salt, water and organic wastes by integumentary glands.
(e) Synthesis of vitamin D, which is converted to calcitriol (a hormone that is
important to calcium metabolism).
(f) Immune response to pathogens and cancers in the skin.
3. Describe the five layers of the epidermis. (**Give a description similar to that
supplied in the lecture handout.)
(a) Stratum basale: the deepest basal layer; attachment to the underlying dermis
by protruding epidermal ridges; single-cell thick; contains basal cells, which
push up the older ones above, tactile cells that are sensitive to touch and
melanocytes.
(b) Stratum spinosum: eight to ten layers of keratinocytes bound together by
desmosomes.
(c) Stratum granulosum: three to five layers of keratinocytes derived from the
stratum spinosum and accumulate keratin and keratohyalin; keratohyalin
promotes waterproofing.
(d) Stratum lucidum: appears as a glassy layer in thick skin only (palm and
sole), flattened dense cells filled with keratin and without organelles.
(e) Stratum corneum: the most superficial layer; 15–30 layers; 75% of the thick-
ness of the epidermis; dead, flat, durable, expendable; filled with keratin;
water resistant but not waterproof; permits slow water loss by insensible
perspiration.
4. List the types of cells in the epidermis, how do they differ?
(a) Basal cells (germinative cells): stem cells that divide to replace the more
superficial keratinocytes.
(b) Keratinocytes: produce keratin (a fibrous protein).
(c) Melanocytes: produce melanin, a pigment that protects against UV.
(d) Dendrocytes (Langerhans’ cells and Granstein cells): interact with lympho-
cytes (T cells) to assist in the immune response; are macrophages.
(e) Merkel cells (tactile cells): associated with a sensory nerve ending.
5. Describe the structure of the two strata in the dermis. (**Give a description
similar to that supplied in the lecture handout.)
(a) Papillary layer: has folds and ridges called papillae that push up into the
epidermal layer; contains capillaries, lymphatic vessels and sensory neurons
that supply the skin.
(b) Reticular layer: 80% thickness of the dermis, contains Pacinian corpuscles
sensitive to deep pressure, contains both collagen fibres and elastic fibres,
gives skin strength and resilience.
6. What are the two types of glands in the skin, and what is their purpose?
Suggested Answers to the Lecture Revision Homework Exercises 189

(a) Sebaceous (oil) glands: they secrete sebum into hair follicles and keep the
skin and hair from drying out. Sebum is bactericidal.
(b) Sudoriferous (sweat) glands: apocrine sweat glands; sweat glands in the
axillary, nipple and anogenital areas. The ducts produce sweat and fatty sub-
stances and proteins into hair follicles. Merocrine sweat glands: coiled tubes
in the dermis discharge their secretions directly onto the surface of the skin.
They are far more widely distributed than apocrine sweat glands.
Exercise 4: Thermoregulation
1. Define what heat is.
When two objects are close to each other, the one at the higher temperature will
pass energy to the one at the lower temperature. The energy that is transferred
due to the temperature difference is known as heat.
2. Define what temperature is.
The temperature of an object is the measure of the average kinetic energy of the
particles of the object. That is, both the speed of the particles and their mass are
involved. All particles are in constant motion (or constantly vibrating); the
greater is the average KE, the greater is the temperature of the object.
3. What are the means by which the body can lose heat?
Heat energy is lost from the body by (a) the evaporation of sweat (and water
from the lungs), (b) radiation of infrared waves, and (c) convection and conduc-
tion to air or other objects (also by eliminating and urinating).
4. Outline the skin’s role in temperature regulation.
Heat is radiated through the skin surface – the greater the surface area, the
greater the amount of heat lost.
Heat is lost by convection from the skin – the greater the exposed area of the
skin, the greater the amount of heat lost.
Heat is lost due to the evaporation of sweat from the skin surface when sweat is
released under the influence of the sympathetic division of the autonomic NS.
5. Explain how sweating allows the body to lose heat.
When sweat evaporates, water is changing from liquid form to gaseous form.
For this to happen, water molecules must separate themselves from the attrac-
tive forces of their neighbours. They cannot do this unless they are travelling
quite fast, that is, have more than the average kinetic energy. Some of the water
molecules are travelling fast enough and do evaporate. This means the more
energetic water molecules escape from the skin (taking their kinetic energy with
them), thus leaving the skin cooler by virtue of the fact that some energy (heat)
has left the body surface. The fastest molecules are at a higher temperature, so
the molecules left behind have a lower average kinetic energy – i.e. are cooler
190 Suggested Answers to the Lecture Revision Homework Exercises

than the evaporated ones. This cooler sweat can then gain heat from the body as
blood transfers it to the surface.
6. Define what is meant by homeostasis.
The physiology of the body is in a dynamic state of equilibrium; internal condi-
tions change and vary (oscillate) within relatively narrow limits. Homeostasis is
the body’s automatic tendency to maintain a relatively constant (i.e. within a
narrow range) internal environment. This includes maintaining a relatively con-
stant temperature, blood pressure, ion concentration, pH, hydration, dissolved
gas concentration and food molecules and the prevention of the accumulation of
wastes (among others).
7. Explain how negative feedback maintains homeostasis.
Homeostasis returns the body to a healthy state after stressful stimuli by bio-
feedback mechanisms. “Negative” feedback means that the body’s response is
to make a change that opposes the stress (i.e. moves the body’s physiology in the
opposite direction to the change detected by a receptor).
A receptor receives a stimulus about a variable and sends a message via an affer-
ent pathway to an integrating centre. The integrating centre determines the nor-
mal level of the variable – the “set point” – and if the stimulus indicates a move
away from the set point, a message is sent via an efferent pathway to the effector
organ. The effector organ produces a response that moves the variable value
back towards the wet point.

Exercise 5: Musculo-Skeletal System

1. List the functions of the skeletal system.

The skeletal system has five primary functions:
(a) Support: it provides structural support for the entire body and a framework
for the attachment of soft tissue and organs.
(b) Minerals and lipid storage: calcium is the most abundant mineral in the
human body. The calcium salts of bones maintain the concentrations of cal-
cium and phosphate ions in body fluids; meanwhile, bones store energy as
lipids in areas with yellow bone marrow.
(c) Blood cell production: RBC, WBC and platelets are produced in the red
bone marrow.
(d) Protection: it surrounds many soft tissues and organs. For example, the rib
protects the heart and lungs; the skull encloses the brain.
Suggested Answers to the Lecture Revision Homework Exercises 191

(e) Leverage and movement: it functions as levers that can change the magni-
tude and direction of force generated by skeletal muscles.
What are the two major divisions of the skeletal system?
(a) The axial skeleton forms the longitudinal axis of the body (the skull, verte-
bral column, thoracic cage).
(b) The appendicular skeleton includes the bones of the limbs and the support-
ing bone girdles that connect them to the trunk.
2. How does the compact bone differ from the cancellous bone?
Compact bone is constructed of osteons (haversian systems); there are concen-
tric layers (lamellae) between which are scattered osteocytes (one osteocyte
per lacunae). Lamellae surround the central canal, which contains blood ves-
sels. The osteocytes in lacunae are linked to each other and the central canal by
canaliculi. Compact bone is denser than cancellous bone (spongy bone), which
contains trabeculae but has no osteons. Trabeculae are a meshwork of bone
struts with spaces in between.
3. Describe the histology of bone (and name the structures).
Compact bone is constructed of osteons. An osteon consists of a central canal
or haversian canal (which contains blood vessels) surrounded by concentric
lamellae of bone. Between lamellae are spaces (called lacunae) that contain
bone cells (osteocytes). Between lacunae and the haversian canal are narrow
corridors (called canaliculi) through which osteocytes extend “processes” in
order to obtain nourishment.
4. Characterise the following types of joint (symphyses, syndesmoses, synostosis,
synchondroses, gomphoses, sutures, hinge, and ball and socket) according to:
(a) Structure: as fibrous, cartilaginous or synovial
Fibrous joints = syndesmoses, gomphoses, sutures
Cartilaginous joints = synchondroses, symphyses
Synovial joints = hinge, ball and socket
Bony = synostosis (fusion of the epiphysis and the diaphysis at the cessa-
tion of ling bone growth)
(b) Function as synarthroses = sutures, synchondroses, gomphoses, synostosis

Amphiarthroses = syndesmoses, symphyses

Diarthroses = hinge, ball and socket
5. Give an example of each of the following types of bone: long, short, flat, irregu-
lar and sesamoid.
Long: femur (and many others, e.g. arm, forearm, thigh, leg, palms, soles, fin-
gers and toes etc.)
Short: any carpal or tarsal
192 Suggested Answers to the Lecture Revision Homework Exercises

Flat: all cranial bones, sternum, ribs

Irregular: vertebrae, os coxae (hip bone)
Sesamoid: patella
6. Perform the following movement with your left upper extremity: with the thumb
and third and fourth fingers fully flexed and the first and second fingers fully
extended, circumduct the arm in a flexed position with the lower arm supinated.
(Find out how to do it!)
7. Compare AND contrast the anatomy of the knee joint and the elbow joint. In
what way(s) does(do) their structure reflect their function?
Both are synovial joints and hinge joints and involve more than two bones.
Both have collateral ligaments for stability. The knee involves a fourth bone –
the patella; it is weight bearing, so it has a greater area; has menisci (fibrocar-
tilaginous pads) to cushion and extend the articulating surface and has
“cruciate” ligaments within the joint capsule.
8. Find an example of a superficial muscle that is descriptively named according
to each of the eight types of descriptors: direction of muscle fibres, location in
the body, relative size, number of origins, shape, origin and insertion, action
and whimsy.
• Direction of muscle fibres: rectus femoris
• Location in the body: erector spinae
• Size: pectoralis major
• Number of origins: biceps femoris
• Shape: serratus anterior
• Origin and insertion: sternohyoid (O = manubrium, I = hyoid bone)
• Action: extensor hallucis longus (extends the big toe)
• Whimsy: soleus (resembles the flat fish known as the “sole”!)
9. Choose six muscles (different from those in Q 8), one from each of the lower
arm and leg, upper arm and leg, and front and back of the body, and list their
origin O, insertion I and action A.
For example (for the anatomical position):
Lower arm: flexor carpi radialis, O = medial epicondyle of the humerus, I =
second + third metacarpal bones, A = flexion of the wrist (see Table 11.13 in
Martini 3rd ed.).
Forearm: flexor carpi ulnaris, O = medial epicondyle of the humerus; I = pisi-
form, the hook of hamate and the base of the fifth metacarpal; A = flexes and
adducts, hand at wrist.
Leg: tibialis anterior, O = upper 1/2 and lateral condyle of the tibia, I = medial
cuneiform and first metatarsal bones of the foot, A = dorsiflexion and inversion
of the foot.
Arm: biceps brachii, O = long head (passes over the top of the joint laterally to
the scapula), I = via a strong tendon to the radial tuberosity and bicipital apo-
Suggested Answers to the Lecture Revision Homework Exercises 193

neurosis, A = strong flexor and supinator of the forearm, also weaker effects of
abducting (long head) and adducting (short head) the shoulder.
Thigh: rectus femoris, O = straight head from the anterior inferior iliac spine,
reflected head from groove just above acetabulum; I = inserts into the patellar
tendon as one of the four quadriceps muscles; A = knee extension, hip flexion.
Anterior of the body: pectoralis major, O = clavicular head, sternal head; I =
lateral lip of the intertubercular (bicipital) groove of the humerus, crest of the
greater tubercle of the humerus, A = clavicular head (flexes the humerus), ster-
nocostal head (extends the humerus).
Posterior of the body: trapezius, O = external occipital protuberance, nuchal
ligament, medial superior nuchal line, spinous processes of vertebrae C7-T12;
I = posterior border of the lateral third of the clavicle, acromion process and
spine of the scapula; A = rotation, retraction, elevation and depression of the
scapula.
10. Describe the relationship between the three proteins of the thin myofilaments –
actin, troponin and tropomyosin – and how they interact.
Tropomyosin twines around an actin molecule so that tropomyosin covers the
sites on actin, to which myosin molecules can bind to produce muscular
contraction.
Troponin is attached to tropomyosin.
Troponin changes shape when a Ca++ ion binds to it and as a consequence shifts
tropomyosin away from the binding sites of actin – i.e. the sites at which myo-
sin binds to actin are now exposed. Once the active sites are exposed, the ener-
gised myosin heads bind to them, forming a cross-bridge, and the contraction
cycle begins.
11. In which directions do the muscle fibres in the external obliques and rectus
abdominus muscles lie?
Obliques run at an angle to vertical (not vertical and not horizontal).
Rectus fibres are vertical (if the person is standing, hence are “erect”).
12. Comment on the relative size of the gluteus maximus and the gluteus medius.
Maximus – as the word implies – is the bigger of the two.
Medius is the smaller of the two (implies that there is a minimus!).
13. Which muscles extend the spine, and which muscles extend the arm?
Erector spinae (spine), triceps brachii (arm).
14. What actions do the following muscles perform?
(a) Pronator quadratus – pronates the forearm.
(b) Flexor carpi ulnaris – flexes the wrist.
(c) Extensor digitorum – extends the fingers.
(d) Extensor carpi ulnaris – extends the wrist.
194 Suggested Answers to the Lecture Revision Homework Exercises

15. Over which bones do the extensor carpi ulnaris and the extensor carpi radialis
brevis lie?
The ECU is over the ulna; the ECR is over the radius.
16. What part of the name biceps femoris indicates its location?
The femoris part = along the femur.
17. How many origins do the triceps brachii have, and where are they?
Three – the tri- part of the name tells us this. They are infraglenoid tubercule of
the scapula, posterior shaft of the humerus and posterior humeral shaft distal to
the radial groove.
18. What is the origin and insertion of the sternocleidomastoid muscle?
Origin = sternum (the manubrium part) and clavicle.
Insertion = mastoid process of the temporal bone.
19. What broad general shapes do the a) rhomboid major muscle and b) deltoid
muscle resemble?
A rhombus (tilted square) and a capital Greek letter delta, respectively.
20. What action is performed by the masseter?
It elevates the mandible (i.e. gritting teeth, biting, chewing food) – by using this
muscle we “masticate” food.
21. Under which gluteal muscle does the sciatic nerve lie?
Gluteus maximus. Hence, into which gluteal muscle do you insert the needle
for IM injection?
22. List the muscles that comprise the quadriceps group. Where are they?
(Quadriceps implies four muscles!) They are rectus femoris, vastus interme-
dius, vastus lateralis and vastus medialis. They can be found on the anterior
surface of the thigh. Note that the three vastus muscles are on the medial sur-
face or the lateral surface or between (i.e. intermediate) the two. Rectus femo-
ris is over the femur and has muscle fibres that are “vertical” (if you are
standing).
23. List the muscles that comprise the hamstrings group.
Hamstrings lie on the dorsal part of the thigh. They are biceps femoris (lateral),
semimembranosus (medial-ish) and semitendinosus (central).
24. Where are the locations of the triceps brachii and the triceps surae?
The triceps brachii is on the posterior surface of the arm; the triceps surae is on
the posterior surface of the leg (= gastrocnemius, which has two heads + soleus
muscle).
Suggested Answers to the Lecture Revision Homework Exercises 195

25. Give five reasons why the deltoid, vastus lateralis and gluteus medius muscles
are chosen as the sites for intramuscular injection.
(a) They are easily accessible.
(b) Large thick muscles can take larger quantities of drug than sub-cut or
intradermally.
(c) The drug will be absorbed gradually into the bloodstream (more gradually
than for IV injection).
(d) They are well vascularised with extensive fascia, so they have large surface
areas for drug absorption.
(e) They are situated away from major nerves and arteries – so less chance of
accidental puncture.
(f) Vastus lateralis is the site of choice for children (who have small deltoid
and gluteal), and for the elderly who have atrophied muscles.
Exercise 6: Digestive System
1. List the organs of the digestive system and the accessory organs.
Gastrointestinal tract (GIT) organs: mouth, pharynx, oesophagus, stomach,
small intestine, large intestine and anus.
Accessory organs: teeth, tongue, and various glandular organs, salivary glands,
liver, gall bladder, pancreas
2. Name the three regions of the small intestine and describe what digestive and
absorptive events happen in each region.
Duodenum, jejunum and ileum.
Most digestion and absorption happens in the duodenum and jejunum. The
duodenum is the site of chemical digestion, a mixing bowl. It receives chyme
from the stomach and digestive secretions (mucus) from the pancreas and liver.
Iron and calcium are absorbed in the duodenum. The bicarbonate-­rich mucus
(from mucus-secreting duodenal glands in the sub-mucosa) neutralises stom-
ach acid and raises pH to ~8. The duodenum receives bile from the gall bladder
(it emulsifies fats), enzyme-containing pancreatic juice from the pancreas and
“brush border” enzymes from the microvilli.
In the jejunum, the bulk of chemical digestion and nutrient absorption occurs.
It receives “intestinal juice” from intestinal crypts. Virtually all foodstuffs, 80%
of electrolytes and most of the water are absorbed in the small intestine (before
the ileum).
The ileum is the final segment of the small intestine and is also the longest. The
ileum’s major absorptive role is to reclaim water and bile salts for recycling to
the liver to be secreted in bile again. The ileum also absorbs vitamin B12 intrin-
sic factor.
3. Describe the functions of the four tunics of the wall of the alimentary canal.
(a) Mucosa: secretes mucus, digestive enzymes and hormones; absorbs end
products of digestion; protects against infectious disease (lymphoid nod-
ules) and self-digestion.
196 Suggested Answers to the Lecture Revision Homework Exercises

(b) Sub-mucosa: dense connective tissue containing blood vessels, lymphatics

(transport products of digestion) and nerve plexus (innervate gut). In some
regions, it also contains exocrine glands, which secrete buffers and enzymes
into the lumen of the digestive tract.
(c) Muscularis externa: smooth muscle cells dominate this region. Gut motil-
ity: peristalsis (propulsion) and segmentation (mixing). Inner circular mus-
cle layer (→sphincters), outer longitudinal muscle layer. These layers play
an essential role in mechanical processing and peristalsis (moving materi-
als along the digestive tract).
(d) Serosa (visceral peritoneum): areolar connective tissue covers the muscu-
laris externa along most portions of the digestive tract inside the peritoneal
cavity. The adventitia – fibrous connective tissue covering the muscularis
externa of the oral cavity, pharynx and oesophagus rectum – attaches the
gut to adjacent structures.
4. Draw up a table with three columns and ten lines (make up your own headings)
that lists (page 950) (a) each digestive enzyme, (b) which structure/cells secrete
the enzyme and (c) what the enzyme does.

(b) Which structure/cells

(a) Each digestive enzyme secrete the enzyme (c) What the enzyme does
Salivary amylase Salivary gland Starch hydrolysis
Pancreatic amylase Pancreas Starch hydrolysis
Pancreatic lipase Pancreas Digest fats and oil
Pancreatic nuclease Pancreas Digest nucleic acids
Lactase, maltase, sucrase Intestinal brush border Lactose, maltose, sucrose
hydrolysis
Pepsin Gastric glands Proteins hydrolysis
Dextrinase, glucoamylase Intestinal brush border Oligosaccharides hydrolysis
Chymotrypsin Pancreas Protein hydrolysis (proteolysis)
to amino acid and small peptide
Carboxypeptidase, Intestinal brush border Protein hydrolysis
aminopeptidase, dipeptidase
Nucleosidases, phosphatases Intestinal brush border Nucleic acid hydrolysis

5. Describe all the processes that constitute mechanical digestion.

Mastication: it involves using the teeth and tongue to break food into small
pieces, crushing it and mixing it with saliva in the mouth to form a bolus for
swallowing.
Swallowing (deglutition): the pharynx is a passageway between the oral cav-
ity and the oesophagus. It has two layers of skeletal muscles to propel food into
the oesophagus (deglutition). The oesophagus is a muscular tube that conducts
solids and liquids from the pharynx to the stomach.
Stomach churning: in the stomach, peristaltic waves (3 per min) mix contents
with gastric juice and squirt about 3 ml of liquid chyme through the pyloric
sphincter into the duodenum.
Suggested Answers to the Lecture Revision Homework Exercises 197

Segmentation: this refers to an activity that mixes food with digestive enzymes
and moves food backwards and forwards over the intestinal wall.
6. Summarise the regulation of gastric secretion.
(a) Cephalic (reflex) phase: it involves thought, sight, smell and taste of food.
This is directed by the CNS – a conditioned reflex that increases gastric
secretion (before the food enters the stomach). This phase only lasts
minutes.
(b) Gastric phase: the stimuli that initiate the gastric phase are as follows: (1)
stomach distension increases secretion; (2) the presence of undigested
materials in the stomach, especially proteins, peptides (partially digested
proteins) and caffeine, stimulates the release of gastrin (a hormone that
stimulates the secretion of HCl); (3) a rise in pH level (indicating not
enough acid in the stomach) stimulates the release of gastrin. This phase
may continue for 3–4 h.
(c) Intestinal phase Excitatory: food entering the duodenum stimulates the
release of intestinal gastrin, which again stimulates gastric secretion
(briefly).
7. Summarise the events in the chemical digestion of carbohydrates.
Chemical digestion involves the hydrolysis of carbohydrates. The products are
monosaccharides. This includes two steps: one step involves carbohydrases
produced by the salivary glands and pancreas. The other step uses brush border
enzymes. Carbohydrates are digested into disaccharides and trisaccharides by
two enzymes: salivary amylase and pancreatic alpha-­amylase. Brush border
enzymes (dextrinase, glucoamylase, lactase, maltase, sucrase) of the intestinal
microvilli covert disaccharides and trisaccharides into monosaccharides prior
to absorption.
8. Summarise the events in the chemical digestion of proteins.
The chemical digestion of protein begins in the stomach through the action of
HCl, which disrupts the tertiary and secondary protein structure, exposing pep-
tide bonds to enzymatic attack. Pepsin (proteolytic enzyme) in the stomach
severs the peptide bonds within a polypeptide chain. When entering the duode-
num, proteins are digested with the aid of trypsin and chymotrypsin (from the
pancreas), carboxypeptidase, aminopeptidase and dipeptidase (from the brush
border). Chemical digestion involves the hydrolysis of proteins and peptides.
The products are amino acids. The pancreas is stimulated to release enzymes
by parasympathetic nerves and by cholecystokinin (CCK), a local hormone
released when protein and fats enter the duodenum. The release of HCO3 is
stimulated by secretin (a hormone released by the presence of acid in the
duodenum).
198 Suggested Answers to the Lecture Revision Homework Exercises

9. Summarise the events in the chemical digestion of lipids.

This involves lingual lipase from glands of the tongue and pancreatic lipase
from the pancreas. Lipids (triglycerides and their breakdown products) are
insoluble in water. In the duodenum, where most lipid digestion happens
(80%), the fat globules that they form are emulsified by the detergent action of
bile salts. The emulsified fatty droplets are digested with the aid of pancreatic
lipases. Chemical digestion involves the hydrolysis of lipids. The products are
free fatty acids and monoglycerides.
10. Describe the basic anatomy of the liver (the functional unit and the cells).
The functional unit is the lobule (1 mm diameter) – a six-sided structure with a
central vein and a portal triad at each “corner”. The portal triad consists of the
hepatic artery, hepatic portal vein and bile duct. Blood from the hepatic portal
vein enters sinusoids (capillaries without a basal lamina) and mixes with arte-
rial blood before draining into the central vein. Sinusoids contain Kupffer cells
(macrophages). Plates/lines of hepatocytes radiate from the central vein. Bile
drains from these via canaliculi, which connect with fine bile ductules, and
they carry bile to the bile ducts in the nearest portal area.
11. State the functions of the liver.
(a) Carbohydrate metabolism: the liver stabilises blood glucose levels; it also
synthesises glucose from other carbohydrates or from available amino
acids (gluconeogenesis).
(b) Lipid metabolism: stores triglycerols and regulates the levels of triglycer-
ides, fatty acids and cholesterol.
(c) Protein metabolism: removes excess amino acids from the bloodstream;
these can be used to synthesise proteins or converted to lipids or glucose.
(d) Removal of drugs (inactivation) and hormones: deamination, converts toxic
ammonia to fairly harmless urea.
(e) Excretion of bilirubin and synthesis of bile and bile salts: bile salt plays a
role in lipid digestion (emulsification).
(f) Storage of vitamins: fat-soluble vitamins (A, B12, D, E, K) are absorbed by
the blood and stored in the liver.
(g) Storage of minerals: converts iron reserves to ferritin and stores this protein-­
iron complex.
(h) Phagocytosis by Kupffer’s cells in the sinusoids: engulf old or damaged
RBC, cell debris and pathogens.
(i) Activation of vitamin D: it modifies cholecalciferol (provitamin D3) prior
to its activation in the kidney.
(j) Storage of blood.
12. What is the effect of pepsin on protein?
Pepsin is a stomach enzyme that digests (hydrolyses) protein into smaller poly-
peptide pieces. As a pink/violet colour appears, this indicates that polypeptides
Suggested Answers to the Lecture Revision Homework Exercises 199

are present – so pepsin must have converted some large protein molecules into
smaller polypeptide units (the first stages of digestion have occurred).
13. Consider two men: one of 70 kg with 15% BF and the other of 100 kg
and 12% BF.
(a) Which one has a lower percentage of fat?
(b) Calculate 12% of 100 kg and 15% of 70 kg. Which one has the greater mass
of body fat?

The 100 kg chap is leaner (has less % body fat).

The 100 kg chap has a greater mass of fat (12 kg) than the little guy (who
has 10.5 kg).
14. In what clinical situations would skinfold measurements (or body mass index)
provide useful information about the nutritional status of clients?
(a) Patients with morbid obesity – to look for changes in their fat levels (per-
haps the callipers would not fit over the skinfold!).
(b) Comatose patients who are being fed intravenously using a calculated kJ
value diet – to see if energy intake is adequate.
(c) Anorexia nervosa sufferers – to see if they are putting on weight.
(d) Patients who are not very active (are not athletes) and who have low body
fat – to check if they are undernourished (?).
(e) Cancer patients who are not eating much (cancer cachexia).
(f) To monitor cancer patients who may be experiencing cancer cachexia
(reduced desire to eat).
(g) To monitor problems of absorption from the gut.
(h) To classify the heart disease risk category of someone who is overweight.
(i) To classify the diabetic risk category for someone who is overweight.
(j) Perhaps to monitor weight in patients prescribed diabetic drugs as some
diabetes drugs cause weight gain.

Exercise 7: Endocrine System

1. (a) What are hormones? (b) Describe their chemical classification (and give an
example of each).
(a) Hormones are chemical messengers made in small quantities by endocrine
cells and released into circulation. They travel through the bloodstream and
bind to specific receptors in their “target cells” and produce a profound effect.
(b) Hormones are classified into one of three structures: (1) amino acid deriva-
tive (“tyrosine” (e.g. adrenalin) or “tryptophan” (e.g. melatonin); (2) peptide
derivative, which are those consisting of long chains of amino acids, e.g.
prolactin (and ADH, OT, GH), or of long chains of AA with a carbohydrate
side chain (also called glycoproteins), e.g. follicle-stimulating hormone
(and TSH, LH); and (3) lipid derivatives, which are steroid hormones (e.g.
200 Suggested Answers to the Lecture Revision Homework Exercises

testosterone, estradiol, progesterone) and eicosanoids (e.g. leucotrenes,

prostaglandins. These hormones are soluble in plasma membrane).
2. Briefly describe the anatomical relationship between the hypothalamus and the
pituitary gland.
The pituitary lies below (inferior to) the hypothalamus, connected to it by a stalk
(the infundibulum) and cradled by a bony depression in the skull called the
hypophyseal fossa within the sella turcica.
3. What are the three ways that the hypothalamus controls the endocrine system
and integrates the activities of the nervous and endocrine systems?
The hypothalamus provides the highest level of endocrine control in three ways:
(a) The hypothalamus produces the hormones ADH and oxytocin, which are
transported along axons to the posterior pituitary to be stored and released
into the blood.
(b) The hypothalamus secretes regulatory hormones that control endocrine cells
in the anterior pituitary gland (releasing hormones, e.g. gonadotropin-
releasing hormone (GnRH) and inhibitory hormones that stimulate the ante-
rior pituitary gland to secrete hormones). In turn, the hormones released by
the anterior pituitary control the activities of endocrine cells in the thyroid,
cortex of adrenal glands and reproductive organs.
(c) The hypothalamus contains “autonomic centres” that exert neural control
(via impulses through nerve fibres) over the endocrine cells of the medullae
of the adrenal glands. That is, when the “sympathetic division” of the auto-
nomic nervous system is activated, adrenal medullae release hormones (epi-
nephrine and norepinephrine) into the bloodstream.
4. Briefly describe the structure of the pituitary gland and name the two hormones
stored in the posterior pituitary.
The pituitary gland sits nestled within the sella turcica, a depression in the sphe-
noid bone. It is inferior to the hypothalamus and is connected to it by the infun-
dibulum. The infundibulum lies between the optical chiasm and m ­ ammillary
bodies. It is divided into the anterior lobe (glandular epithelial tissue), which is
able to produce hormones (nine kinds of hormones), and a posterior lobe (made
of neural tissue), which stores hormones that are made in the hypothalamus and
transported to the posterior pituitary through the axons of nerve fibres. ADH and
oxytocin are stored in the posterior pituitary.
5. How are hormone receptors related to hormones?
Receptors are sites on the plasma membrane (extracellular receptor), organelles
within the cell or in the nucleus (intracellular receptor) that have a shape that
Suggested Answers to the Lecture Revision Homework Exercises 201

allows only that specific hormone with a complementary shape to bind to it.
That is, receptors are specific to their hormone.
6. How does the difference in the chemical structure of hormones determine where
their receptors are located?
Hormones are classified into two groups: amino acid (AA)-based hormones
(AA derivatives and peptide hormones) and lipid derivatives (steroid hormones
and eicosanoids).
The plasma membrane of a cell is made of lipid molecules; steroid hormones are
lipid soluble, so they can diffuse through the cell membrane to bind to receptors
in the cytoplasm or nucleus. Eicosanoids are lipid soluble, so they diffuse across
the membrane to receptor proteins on the inside of the cell membrane.
Hormones that are not lipid soluble (amino-acid-derived hormones, e.g. cate-
cholamines) and peptide hormones are unable to penetrate the cell membrane.
So their receptors are membrane proteins on the outside of the cell membrane,
except for thyroid hormones, which can cross the membrane by diffusion or by
a carrier mechanism and bind to receptors within the nucleus or mitochondria
(energy dependent).
7. Describe an example that shows how the hypothalamus is able to control the
secretion of a hormone from a “subservient” endocrine gland.
The hypothalamus releases TRH to the anterior pituitary (in response to
decreased T3 and T4 concentration in the blood or low body temperature, the
anterior pituitary releases TSH).
TSH causes thyroid follicles to release T3 and T4 into the blood (which increases
their concentrations back to normal); whereupon, they move to their target cells.
(Or) The hypothalamus releases GnRH, which stimulates the anterior pituitary
to release FSH (and LH).
FSH stimulates the testes to release inhibins and the ovaries to release inhibins
and oestrogens.
LH stimulates the testes to release androgens and the ovaries to release proges-
terones and oestrogens.
8. Complete the table below: list the major (one or two) hormones produced; state
a brief function for the hormone.
Gland Hormone(s) Function
Thyroid Thyroxin (T3,T4) Raises the body’s metabolic rate
Calcitonin Lowers calcium concentration in the body fluid
Parathyroid Parathyroid h. Raises calcium concentration in the body fluid
Adrenal Aldosterone Na+ to be re-absorbed in the kidneys in exchange for
cortex Cortisol K+
(glucocorticoids) Raises the rate of glucose synthesis and glycogen
formation from fatty acids and proteins; has anti-
inflammatory effects; inhibits the activities of the WBC
(continued)
202 Suggested Answers to the Lecture Revision Homework Exercises

Adrenal Adrenalin Speeds up the use of cellular energy and the

medulla (epinephrine) mobilization of energy reserves; prepare for “action”
Pancreas Insulin Lowers blood glucose
Glucagon Raises blood glucose
Testes Testosterone Allows the development and maintenance of masculine
characteristics
Ovary Estradiol Allows the development and maintenance of feminine
Progesterone characteristics
Supports pregnancy
Pineal Melatonin (Suggested functions) inhibits reproductive functions,
protects CNS neurons against free radicals, sets
circadian rhythms
Anterior Thyroid SH (TSH) Causes the secretion of thyroid hormones
pituitary ACTH Causes glucocorticoid secretion, stimulates the release
Follicle SH of steroid hormones by the adrenal cortex
Luteinising H Causes oestrogen secretion, follicle development and
Prolactin sperm maturation
GH Induces ovulation, the formation of corpus luteum,
oestrogens and progesterone secretion
Stimulates the production of milk
Assists in growth, protein synthesis and lipid
catabolism
Posterior Oxytocin Promotes labour contractions and delivery, milk
pituitary ADH ejection,
The re-absorption of water and an increase in blood
volume and pressure
Thymus Thymosins Coordinates and regulates immune response

9. Describe how amino-acid-based hormones exert their influence on target cells.

Proteins and peptides cannot penetrate cell membranes; AA-based hormones
(first messengers) exert their effect via intracellular second messengers (e.g.
cAMP) after binding to a receptor on the plasma membrane. The hormone
bound to the receptor activates a “G-protein” inside the cell, which then moves
along the membrane to activate an enzyme (adenylate cyclase) that produces
cAMP. cAMP triggers a cascade of chemical reactions, producing increasing
numbers of molecules at each step – this increase is called amplification!

Exercise 8: Urinary System

1. Draw or trace a diagram of a kidney in the coronal section. Label the cortex,
medulla, pyramids, columns, papilla, pelvis, major calyces and minor calyces.
2. Name the sections of the renal tubule in the order that filtrate passes
through them.
Bowman’s capsule, PCT, descending limb of the loop of Henle, ascending limb
of the loop of Henle, DCT and collecting duct.
Suggested Answers to the Lecture Revision Homework Exercises 203

3. What is meant by the terms glomerulus, vasa recta and Bowman’s capsule?
Glomerulus: a capillary bed that filters blood cells and plasma proteins from
the filtrate. It is fed by the afferent arteriole and drained by the efferent arteriole.
Vasa recta: a “counter-current” capillary bed that surrounds the loop of Henle
of juxtamedullary nephrons. It redistributes water and solutes that are re-­
absorbed in the medulla and stabilises the concentration gradient of the
medulla. The vasa reacta returns water and solutes to the general circulation.
Bowman’s capsule: a structure that surrounds the glomerulus and receives the
filtrate.
4. With reference to the kidney tubule, distinguish between filtration and osmosis.
Filtration: the process of separating large structures in the blood (cells and
plasma proteins) from smaller structures. It is driven by a pressure difference.
It happens in the glomerulus.
Osmosis: the process of movement of water through a semi-permeable mem-
brane, from a solution with a high concentration of solutes to a solution with a
lower concentration of solutes. It is a diffusion process driven by differences in
solution concentration. It happens in the renal tubule, where water is recovered
from the filtrate after Na ions are actively transported.
5. Which parts of the renal tubule are impermeable to water?
The thick portion of the ascending limb of the loop of Henle but the collecting
duct and proximal convoluted tubule in the absence of the antidiuretic hormone.
6. Name and briefly describe the four stages of urine formation.
Filtration: blood cells and proteins are separated from (filtered out of) the rest
of the blood and retained in the glomerular capillaries. Small particles (water,
electrolytes, glucose, nitrogenous wastes etc.) pass into the Bowman’s capsule
and are known as the filtrate.
Re-absorption: useful substances (water, electrolytes, glucose etc.) are
reclaimed from the filtrate and returned to the blood.
Secretion: some substances that were not present in the filtrate (H+, K+,
HCO3− ions) are secreted through the tubule walls into the filtrate. Some sub-
stances that were re-absorbed from the filtrate are secreted back into the filtrate
(urea, uric acid).
Concentration of urine: the concentration of the filtrate is adjusted in the
DCT and collecting ducts by the influence of aldosterone (which causes Na+ to
be re-absorbed) and ADH (which causes water to be re-absorbed) depending
on the body’s state of hydration and the blood’s osmolality. After concentra-
tion, the filtrate is known as urine.
7. Describe the function of the juxtaglomerular apparatus.
The JG apparatus is the junction of the afferent arteriole, the efferent arteriole
and the distal end of the ascending limb of the loop of Henle. It consists of the
granular cells (JG cells) in the arteriole walls (which produce and release renin)
204 Suggested Answers to the Lecture Revision Homework Exercises

and the macula densa cells in the tubule walls (which sense the concentration
of Na+ and Cl− ions in the filtrate). The macula densa causes the afferent arte-
riole to dilate if the concentration of Na+ and Cl− ions in the filtrate is too low.
Dilation increases the GFR, which causes more filtrate to be produced so fewer
ions can be re-absorbed from the greater volume flowing through the tubule.
The JG cells are mechanoreceptors and produce and release renin. They sense
the degree of stretch (i.e. the blood pressure) in afferent arterioles. Reduced
stretch ⇒ decrease in BP ⇒ release of renin ⇒ formation of angiotensin II,
which causes the constriction of arterioles throughout the body to raise
BP. Angiotensin II also stimulates the release of aldosterone, which causes
sodium ions to be re-absorbed from the DCT and collecting ducts. Water will
“follow” sodium (through osmosis) back into the bloodstream to increase
blood volume and so raise BP. Angiotensin II also stimulates thirst and increases
ADH secretion.
8. Describe the changes in the composition of the filtrate as it passes through the
descending limb and then the ascending limb of the Loop of Henle.
In the descending limb (which is permeable to water but not to sodium or chlo-
ride) water leaves the filtrate by osmosis, so the volume of the filtrate decreases
but the concentration of the filtrate increases. In the ascending limb (which is
permeable to sodium and chloride but not to water), sodium and chloride are
re-absorbed – but not water – so the concentration of urine decreases but the
volume stays about the same.
9. Explain how the kidney can produce concentrated urine when the body needs to.
The wall of the collecting duct is impermeable to water unless the hormone
ADH is present. In this case, water is able to pass out of the collecting duct into
the cells of the tubule wall. This happens because (1) the walls are permeable
due to the ADH-regulated expression of aquaporins and (2) there is an osmotic
gradient allowing water to move osmotically from the filtrate into the tubule
cells. The osmotic gradient exists because of the high concentration of urea in
the medulla of the kidney.
10. Explain the effect of aldosterone on the composition of urine.
Maintaining sodium ion balance is aldosterone’s primary role. It targets (pri-
marily) the DCT, where it stimulates the re-absorption of sodium ions from the
filtrate (and chloride ion is co-transported). As sodium is absorbed from the
filtrate, potassium is secreted into the filtrate in a one-for-one exchange. If the
DCT is permeable to water, then water will also be absorbed by the DCT. If a
person is well hydrated and if aldosterone is present in the absence of ADH,
large volumes of sodium-free urine can be produced.
11. What is the role of ADH?
The antidiuretic hormone (ADH) makes the collecting duct (and distal convo-
luted tubule) of the nephron more permeable to water (i.e. pores for water to
pass through (aquaporins) are inserted into the plasma membranes of the cells
Suggested Answers to the Lecture Revision Homework Exercises 205

that make up the collecting duct). In this way, water can be re-absorbed from
the filtrate (by osmosis), and the kidney will produce a more concentrated urine.
12. What is the role of aldosterone?
Aldosterone will cause Na+ to be absorbed from the filtrate (and K+ to be
secreted into the filtrate in exchange – this maintains electrical neutrality). This
absorption increases the solution concentration in the cell cytoplasm, intersti-
tial fluid and blood so that water will move (if ADH is present) from the filtrate
into the cells etc. Hence, it could be said that aldosterone also causes more re-
absorption of water.
13. Describe the feedback response that results in:
(a) ADH secretion
(b) Aldosterone secretion
If the osmolarity of blood increases towards 300 mosmol/L, osmorecep-
tors in the hypothalamus include neurons that produce ADH notice (or
ECF volume decreases or angiotensin II is present), and then ADH (=
vasopressin) is secreted (the neurons release ADH in the posterior pitu-
itary) to cause more water to be absorbed from the filtrate (the kidney
conserves water). This conservation of water will limit the further increase
in blood osmolarity (thirst will also be stimulated; that is, drinking water
will reduce blood osmolarity).
If Na concentration in the blood falls or blood volume or pressure decreases,
the hormone rennin is released (then angiotensinogen is activated to angio-
tensin I, then to angiotensin II, and then aldosterone is released from the
adrenal glands), aldosterone causes more Na+ to be absorbed by distal
convoluted tubules and collecting ducts (by inserting more Na channels in
the plasma membrane). The absorption of Na causes the [Na] of blood to
increase, ECF volume to increase and BP to increase, so the stimulus to
produce more aldosterone is removed.
14. What is the function of each of the four structures of the nephron in urine
formation?
1. Glomerulus: filtration of blood
2. Proximal convoluted tubule: reabsorption of most of the required substances
from the filtrate.
3. Loop of Henle: absorption of water (from descending limb), absorption of
Na (from ascending limb)
4. Distal convoluted tubule: absorption of more Na (if aldosterone present)
absorption of more water (if ADH is present)
15. Write a paragraph describing the blood supply to the kidney.
I want the paragraph to contain: renal artery comes off the abdominal aorta.
206 Suggested Answers to the Lecture Revision Homework Exercises

I want afferent arteriole and efferent arteriole mentioned.

I want the peri-tubular capillaries and vasa recta to also be included.
16. (a) How (and under what conditions) does the kidney excrete bicarbonate ions?
(b) How (and under what conditions) does the kidney re-absorb or manufacture
new bicarbonate ions?
(a) When the body is in alkalosis, type-B intercalated cells in collecting ducts
effectively secrete bicarbonate ions in the reverse of the process described
in part b) below.
(b) The body excretes HCO3− into filtrate all the time because the body usually
has excess acid to excrete but particularly during acidosis.
In kidney tubule cells, CO2 combines with water to form carbonic acid.
Carbonic acid splits into H+ and HCO3− (i.e. new bicarbonate is formed).
HCO3− is passed to the peritubular capillary (absorbed by the body) – in
exchange for Cl− or Na+.
H+ is secreted into the filtrate and combines with HCO3− there (which was
filtered from the blood) to form carbonic acid – which the disassociates
into CO2 and water. CO2 is re-absorbed to make more carbonic acid.
Amino acid glutamine is deaminated to form NH4+ (or NH3) and HCO3− –
ammonia is secreted into the filtrate, and bicarbonate is absorbed into
the blood.
Exercise 9: Nervous System
1. Distinguish between (a) the CNS and the PNS, (b) the efferent nervous system
and the afferent nervous system, (c) the autonomic NS and the somatic NS, (d)
the sympathetic NS and the parasympathetic NS.
(a) CNS = the brain and the spinal cord. It integrates, processes and co-­
ordinates sensory data and motor commands. The brain is the seat of higher
functions. PNS = neural tissue outside the CNS. It consists of motor nerves,
sensory nerves, receptors and autonomic nervous system nerves. The PNS
delivers sensory information to the CNS and carries motor commands from
the CNS to peripheral tissues and systems.
(b) The efferent system carries nerve impulses away from the CNS and towards
some effector, e.g. a muscle (including skeletal, smooth and cardiac mus-
cles) or gland; afferent system fibres carry impulses towards the CNS from
peripheral sensory receptors.
(c) The somatic NS sends motor messages from the CNS to the skeletal muscle
and is under our conscious control. The autonomic NS conducts impulses
from the CNS to the cardiac muscle, smooth muscle and glands (i.e. our
viscera). It is not under our voluntary control.
(d) The sympathetic division stirs you up and mobilises the body during emer-
gency (stressful) situations (e.g. increases HR, dilates bronchioles, r­ edirects
blood supply, decreases gut motility, stimulates sweat glands). The para-
sympathetic division promotes non-emergency function and conserves
Suggested Answers to the Lecture Revision Homework Exercises 207

energy (e.g. decreases HR, constricts bronchioles and pupil, increases gut
motility and secretions).
2. Describe the role of the sympathetic division of the ANS and its effects on
the body.
When stimulated, sympathetic preganglionic neurons release Ach at synapses
with ganglionic neurons, and most sympathetic ganglionic neurons release NE
at their varicosities, and the NE released affects its targets until it is re-absorbed
or inactivated by enzymes; for example, it stimulates the release of renin from
the kidney. Renin causes the formation of angiotensin II, which stimulates the
release of aldosterone (from the adrenal cortex), ultimately raising blood pres-
sure. Sympathetic preganglionic fibres also enter the centre of the adrenal
gland (adrenal medullae) and stimulate the release of epinephrine (adrenaline)
and norepinephrine. The bloodstream carries NE and E throughout the body,
where they cause changes in the metabolic activities of many different cells.
For example, NE and E increase metabolic rate and BP and engage in a “fight
or flight” response.
3. Draw a simple diagram of CNS meninges consisting of three concentric circles.
Label the three meninges, the epidural space, the sub-arachnoid space and the
CSF. Further draw two needles: one delivering an epidural anaesthetic and the
other in place for a lumbar puncture to draw out CSF.
208 Suggested Answers to the Lecture Revision Homework Exercises

(Lumbar puncture draws CSF from within the sub-arachnoid space. An epi-
dural anaesthetic is delivered into the epidural space, superficial to the dura
mater but inside the vertebral foramen.)
4. Distinguish between a unipolar and a multipolar neuron.
A “multipolar” neurone has more than two processes extending from the cell
body: one of them is an axon, and the rest are dendrites. A “unipolar” neurone
has only one process extending from the cell body. The dendrites and axons are
continuous, and the cell body lies off to one side.
5. (a) What is a “graded potential”?
A typical stimulus produces a temporary localised change in the resting mem-
brane potential. The effect, which decreases with distance from the stimulus, is
called a graded potential.
(b) What is an “action potential”?
If the graded potential is large enough, it triggers an action potential in the
membrane of the axon.
“Na gates” open, and extracellular Na rushes into the axon till the gate closes.
Then “K gates” open, and intracellular K rushes out of the axon till the
gate closes.
An “action potential” is an electrical impulse that is propagated along the sur-
face of an axon and does not diminish as it moves away from its source. This
impulse travels along the axon to one or more synapses.
The resting potential is −90 mV. An action potential changes this to +30 mV
then back to −70 mV.
6. Name four neurotransmitters. What is their function?
(1) Acetylcholine (Ach) released at the neuromuscular junction; (2) norepi-
nephrine, the main neurotransmitter of ganglion cells in the sympathetic NS;
(3) nitric oxide (NO); (4) dopamine; (5) and GABA (gamma amino butyric
acid), a principal inhibitory neurotransmitter in the brain.
Neurotransmitters are released by the axon terminal when a nerve impulse
reaches the end of the nerve. The neurotransmitters then cross the synaptic
cleft, bind to receptors on the post-synaptic membrane and cause changes in
the permeability of that membrane (i.e. transmit the nerve impulse to the
next cell)
7. What are the five main structures of the CNS? In which of the five are the fol-
lowing structures/areas located: conus medullaris, respiratory centres, motor
areas, cauda equina, autonomic control centre, visual association areas, area
for the control of body temperature, cervical enlargement, arbor vitae, basal
nuclei, substantia nigra and posterior median sulcus.
The brain and the spinal cord make up the CNS. The CNS includes the (1)
cerebrum, (2) diencephalon, (3) brain stem, (4) cerebellum, and (5) spinal cord.
Suggested Answers to the Lecture Revision Homework Exercises 209

Cerebrum: motor areas, visual association areas and basal nuclei

Brain stem: substantia nigra (midbrain), respiratory centres (medulla oblon-
gata) and autonomic control centre (the pons and medulla oblongata)
Diencephalon: area for the control of body temperature
Cerebellum: arbor vitae
Spinal cord: conus medullaris, cervical enlargement, cauda equina and poste-
rior median sulcus
8. What constitutes a reflex arc? Describe the stretch reflex.
The route followed by nerve impulses to produce a reflex is called a reflex arc.
It is a rapid predictable motor response (unlearned and involuntary) to a stimu-
lus (without processing by the brain).
The reflex arc involves five steps:
(a) The arrival of a stimulus and the activation of a receptor.
(b) The activation of a sensory neuron (transmits afferent impulses to the CNS).
(c) Information processing in the CNS (sensation relayed to the brain by axon
collaterals).
(d) The activation of a motor neuron (conducts efferent impulses to an effec-
tor organ).
(e) The response of a peripheral effector (muscle fibre or gland cell).
Stretch reflex: this is an example of a monosynaptic reflex because there is
only one synapse. The patellar reflex is an example of a stretch reflex. The
stimulus is a tap on the patellar tendon. This stretches receptors within the
quadriceps muscles. The response is a brief contraction of those muscles,
which produces a noticeable kick.
9. What chemical is stored in the synaptic vesicles?
A neurotransmitter.
10. Distinguish between a unipolar, a bipolar and a multipolar neurone.
Uni = one fused axon dendrite (one process attached to cell body).
Bi = one axon and one dendrite attached to each cell body (i.e. two processes).
Multi = many dendrites attached to the cell body (and one axon).
11. Draw a cross-sectional diagram of the spinal cord and label it with the struc-
tures: spinal meninges, grey matter, white matter, dura mater, arachnoid, pia
mater, dorsal (posterior), grey horns, ventral (anterior) grey horns, sensory
fibres, dorsal (posterior) root ganglion, spinal nerves, grey commissure, lateral
grey horns, central canal, anterior median fissure and posterior median sulcus.
(Consult your textbook.)
12. What is the cauda equina?
(Horse’s tail) the spinal cord ends at about L1. Inferior to this, the spinal nerves
continue within the vertebral foramina (before they exit). This a­ ggregation of
individual fibres has the appearance of separate “hairs”, like the tail of a horse.
210 Suggested Answers to the Lecture Revision Homework Exercises

13. What is the difference between the spinal cord at L1 and L3?
The spinal cord covered by the pia, arachnoid and dura maters ends as a taper-
ing structure called the conus medullaris at about L1. The pia mater continues
as a fibrous extension (the filum terminale) to the posterior coccyx. Below L2,
spinal nerves are outside the pia but enclosed by the arachnoid and dura and are
in contact with CSF. The spinal cord can be punctured by an epidural needle
that is advanced too far, but this potential danger is avoided by administering
below L2.
14. Which two meninges enclose the CSF?
Arachnoid mater and pia mater.
15. What is the name of the “space” that contains CSF?
The sub-arachnoid space.
16. If a patient has raised intracranial pressure, would CSF pressure in the lumbar
region (measured by lumbar tap) be higher or lower than normal?
Higher! (Pascal’s principle = increased pressure applied at one place (in the
cranium) is transmitted throughout the enclosed liquid (CSF)).
17. What structures separate the epidural space from the sub-arachnoid space?
Dura mater and arachnoid mater.
18. Does the epidural space contain major nerves?
YES. It contains adipose tissue between the dura mater of the spinal cord and
the bone of the vertebrae, but also the spinal nerves traverse this space – hence,
they can be anaesthetised.
19. Describe where the cell bodies of sensory neurons are located.
The dorsal root ganglion, i.e. outside the CNS.
20. Describe where the cell bodies of motor neurons are located.
The ventral horn (of grey matter in the spinal cord), i.e. within the CNS.

Exercise 10: Special Senses

1. Describe the function of the (a) cornea, (b) lens, (c) retina, (d) canal of Schlemm,
(e) choroid and (f) pupil.
The cornea converges (refracts) and focuses light rays.
The lens focuses light from objects onto the retina (accommodates).
Suggested Answers to the Lecture Revision Homework Exercises 211

The retina absorbs light photons (in rods and cones) and converts energy into
nerve impulses (in bipolar and ganglion cells, which leave the eye via the
optic nerve).
The canal of Schlemm allows the aqueous humour in front of the anterior com-
partment of the eye to drain away – its blockage can cause raised intraocular
pressure damage to the retina.
The choroid is sandwiched between the retina and sclera. It contains the blood
capillaries that supply the retina.
The pupil is the transparent space (in the centre of the iris) that allows light to
enter the eye. It may expand and contract.
2. Describe the role of the ciliary body and suspensory ligaments in the process
known as accommodation.
The ciliary body is a muscle that is shaped like an annulus. When it contracts,
its central hole gets smaller in diameter, the tension on the attached suspensory
ligaments of the lens is relaxed and the elastic lens can ooze back towards a
spherical shape (to focus light from near objects). When the ciliary body
relaxes, its hole enlarges; this pulls on the suspensory ligaments, which stretch
the lens into a flatter shape and enable the lens to focus light from distant
objects.
3. Why does the retina have a blind spot?
The axons and neural tissue lie above the rods and cones; in order for the axons
to carry impulses to the brain, they come together into the optic nerve, which
exits the posterior chamber at the blind spot. At this spot, there are no rods and
cones because the optic nerve has blasted through where they would otherwise
have been. There is no light sensitivity at this spot.
4. Describe the effect on the light rays of each type of lens (diverge/converge).
A concave lens diverges light rays (so with corrective eyeglasses, the focal spot
is moved further from the eye lens).
A convex lens diverges the light rays (so the focal spot is moved closer to the
eye lens).
5. What are the names commonly given to these two types of lenses?
Concave and convex lenses.
6. Which one produces a magnified image when placed over some writing
on a page?
Convex.
7. Which one has the same curvature as your eye’s lens?
Convex.
212 Suggested Answers to the Lecture Revision Homework Exercises

8. Define what is meant by hyperopia.

(Long-sightedness = lens-to-retina distance is too short.) The eye can accom-
modate seeing distant objects clearly, but close objects are out of focus as the
light from them is focused “behind” the retina – a convex lens placed in front
of the eye provides the extra convergence for clear vision.
9. Describe the function of the (a) pinna, (b) ossicles, (c) Eustachian tube and (d)
cochlea.
Pinna funnels sound onto the tympanic membrane.
Ossicles in the middle ear convert/transfer a vibration in the air (detected by a
tympanic membrane) to a vibration in the cochlear liquid (they are an imped-
ance-matching device that also provides a mechanical advantage, i.e. some
amplification).
The Eustachian tube (normally squashed flat) allows the air space of the middle
air to be vented, i.e. allows air pressure in the middle ear to be equalised to that
outside.
10. What are the average sound frequency endpoints of the audible range
for humans?
It is ~40 Hz to 18,000 Hz for youngsters. Mature people will not hear beyond
15,000 Hz.

Exercise 11: Blood

1. Outline the functions of the blood and state which components (plasma, eryth-
rocytes, leucocytes and platelets) are responsible for which properties of blood.
Functions:
(a) Transporting dissolved gases, nutrients, hormones and metabolic wastes:
blood carries oxygen from the lungs to the cells and CO2 from the cells to
the lungs, distributes nutrients absorbed by the digestive tract or released
from storage in adipose tissue or the liver, carries hormones from the endo-
crine system to target cells and receives wastes from cells and carries them
to the kidney for excretion.
(b) Regulating the pH, temperature and ion composition of interstitial fluids:
blood absorbs and neutralises acids generated by active tissues; it absorbs
the heat generated by active skeletal muscles and redistributes it to other
tissues or heat is lost from the body across the surface of the skin.
(c) Defending against toxins and pathogens: blood transports WBC and spe-
cialised cells to fight infections or remove debris; it delivers antibodies and
proteins to attack invading organisms.
Suggested Answers to the Lecture Revision Homework Exercises 213

(d) Restricting fluid losses at injury sites: blood contains enzymes and other
substances that respond to breaks in vessel walls by initiating the process of
clotting, coagulation and clotting act as a temporary patch that prevents
further blood loss.
Plasma makes 55% of the volume of whole blood; it contains water, ions, clot-
ting factors, nutrients, albumins, globulins and fibrinogen. The function of
plasma includes helping maintain blood volume and osmotic pressure (albu-
mins), defence (globulins), clotting (fibrinogen) and transporting lipids and
small ions (globulins).
Erythrocytes transport respiratory gases. Each developing RBC loses cellular
organelles. Molecules of haemoglobin make up more than 95% of its intercel-
lular proteins. Of the oxygen carried by blood, 98.5% are bound to Hb mole-
cules inside RBCs.
Leucocytes contribute to the body’s defences; they help defend the body against
invasion by pathogens. They also remove toxins, wastes and abnormal or dam-
aged cells. Leucocytes comprise the non-specific defence (neutrophils, eosino-
phils, basophils and monocytes) and specific defence (lymphocytes) of
the body.
Platelets are involved in the blood clotting process. They release chemicals
important to the clotting process, form a temporary patch in the wall of dam-
aged blood vessels and reduce the size of a break in the vessel wall.
2. What is the structure, composition and function of RBC and outline briefly the
functions of white cells.
RBC structure: each RBC is a bi-concave disc about 7 μm in diameter with a
thin central region and a thicker outer margin.
Composition: molecules of haemoglobin (Hb) make up more than 95% of its
intracellular proteins. They have no nucleus or mitochondria.
Function of RBC: they are involved in the transport of respiratory gases;
98.5% of the oxygen carried by the blood is bound to Hb molecules inside RBCs.
Function of WBC: WBC contribute to the body’s defences; they help defend
the body against invasion by pathogens. Lymphocytes (T, B and NK cells)
recognise specific “non-self” antigens. Neutrophils and eosinophils are micro-
phages. Basophils promote inflammation. Monocytes are macrophages, and
they engulf foreign bodies and digest them. They also remove wastes and
abnormal or damaged cells.
3. State briefly the effects of iron deficiency, amino acid deficiency and vitamin
B12 deficiency in the blood.
Iron is required to make haemoglobin for RBC. Iron deficiency will affect
RBC formation because Hb has four chains of polypeptides and each chain
contains a single molecule of heme and each heme holds an iron ion to interact
with an oxygen molecule, forming oxyhaemoglobin (i.e. four atoms of iron per
Hb). A deficiency in iron will result in anaemia (low levels of RBC) and is
called iron-deficiency anaemia.
214 Suggested Answers to the Lecture Revision Homework Exercises

AA deficiency will affect the synthesis of plasma proteins: plasma proteins

(e.g. transferrin) serve as carriers for other molecules. Many types of small
molecules bind to specific plasma proteins and are transported from organs that
absorb these proteins to other tissues for utilisation. Proteins also act as a pH
buffer to keep blood at a stable pH. Plasma proteins (fibrinogen, prothrombin
and plasminogen) interact in specific ways to cause the blood to coagulate.
Plasma proteins govern the distribution of water between the blood and tissue
fluid by producing what is known as a colloid osmotic pressure. Protein defi-
ciency anaemia is an anaemia that results from an inadequate intake of dietary
protein that disrupts normal haemoglobin synthesis.
Vitamin B12 deficiency impairs RBC production, causing megaloblastic
anaemia (= red blood cells become larger than normal)
4. Outline the role of platelets in haemostasis and describe the three main pro-
cesses in coagulation, including the differences between extrinsic and intrinsic
formation of prothrombin activator (exclude clotting factor names).
Platelets’ role in haemostasis: (1) releasing chemicals important to the clotting
process; they help initiate and control the clotting process; (2) forming a tem-
porary patch in the walls of damaged blood vessels; the platelet plug can slow
blood loss while clotting takes places; and (3) reducing the size of a break in
the vessel wall after the clot has formed. Three main processes in coagulation:
(1) the extrinsic pathway – it begins when damaged endothelial cells or periph-
eral tissues (i.e. external to the blood) release factor III, which initiates the
formation of prothrombinase, which converts prothrombin to thrombin; (2) the
intrinsic pathway – it is more complex and occurs more slowly; damaged tis-
sues cause platelet damage, and the platelets that are internal to the blood (i.e.
intrinsic pathway) release phospholipids, which combine with various clotting
factors to produce prothrombinase; and (3) the common pathway: it begins
when prothrombin 9 sometimes called factor X complexes with calcium phos-
pholipid and modified factor V to convert prothrombin to thrombin. Thrombin
then completes the clotting process by converting fibrinogen to insoluble fibrin.
5. State the role of vitamin K in clotting and explain how uptake from the gut can
be affected by disorders in fat absorption (fat soluble enzyme).
Vitamin K affects the blood clotting process; adequate amounts of vitamin K
must be present for the liver to synthesise four of the clotting factors, including
prothrombin. Vitamin K is a fat-soluble vitamin that is absorbed with dietary
lipids. We obtain half of our daily requirement from the diet. Hence, if there is
a disorder in fat absorption, vitamin K absorption will be affected. Vitamin K
deficiency will cause the eventual breakdown of the common pathway due to a
lack of clotting factors.
Suggested Answers to the Lecture Revision Homework Exercises 215

6. Explain the clinical uses of heparin and warfarin in relation to their speed of
effectiveness as anticoagulants.
Heparin accelerates the activation of antithrombin-III and prevents the conver-
sion of prothrombin to thrombin. Clinically, it used extensively post-­operatively
to impede or prevent clotting in stroke victims. It must be administered intrave-
nously. It is rapid acting.
Warfarin is antagonist to vitamin K (it prevents the formation of vitamin-K-­
dependent clotting factors). Warfarin can be taken orally and is slower acting,
taking days to have a therapeutic effect. A standard anticoagulation regime
would be immediate IV heparin administration continued while warfarin builds
up to therapeutic levels, allowing the patient to eventually go home on oral
warfarin alone.
7. Explain transfusion reactions by your knowledge of the ABO blood group and
relate newborn haemolytic disease to the Rh blood group.
The ABO group is based on the presence or absence on RBC of two antigens
called type A and type B.
Blood group A only has type A surface antigen on RBC and anti-B agglutinins
in the plasma.
Blood group B only has type B surface antigen on RBC and anti-A agglutinins
in the plasma.
Blood group AB has both type A and type B surface antigens on RBC but does
not contain anti-A or anti-B agglutinins in the plasma.
Blood group O has neither surface antigen on RBC and contains both anti-A
and anti-B agglutinins in the plasma.
Hence, these agglutinins will attack the antigens on foreign RBC. When these
antibodies attack, the foreign cells agglutinate (clump together), causing agglu-
tination and haemolysis of the affected RBC.
Haemolytic disease of the newborn (HDN): HDN is an RBC-related disorder
caused by a cross-reaction between the foetal and maternal blood types. If the
mother is Rh− and the first baby is Rh+, during delivery, foetal blood may
enter the maternal system from the placenta; hence, the mother will produce
anti-Rh agglutinins. It will not affect the first baby; however, these agglutinins
can cross the placenta in a subsequent pregnancy, and if the second baby is
Rh+, the agglutinins will attack the RBC of the second baby, causing HDN.
8. What are whole blood, packed cells and cryoprecipitate (clotting factors) used
for in blood transfusions?
Whole blood: the combination of plasma and the formed elements; used to
increase blood volume (e.g. after haemorrhage).
Packed cells: boost haemoglobin to restore oxygen carrying capacity without
placing hypervolaemic stress on the system.
Plasma: RBCs are returned to the donor, the fluid matrix of blood. It is used to
make 17 products for various trauma burns, cancer and blood disease treat-
216 Suggested Answers to the Lecture Revision Homework Exercises

ments. Cryoprecipitate contains blood clotting substances, called fibrinogen

and factor VIII. Cryoprecipitate can be used for patients with particular defi-
ciencies of these proteins. Cryoprecipitate is also used for trauma and liver
transplants.
9. One microlitre (1μl) of blood contains about 5 million (5 × 106) RBC; each
RBC contains about 280 million (280 × 106) Hb molecules. Estimate how many
Hb molecules are there in an adult human.
An adult female contains 4–5 l of whole blood. An Adult man contains 5–6 l of
whole blood

 280  10    5  10   5  10
6 6 6
 l  7  10 21 Hb molecules.

10. Name the three types of white blood cells depicted below.

Exercise 12: Cardiovascular System: Anatomy of the Heart

1. Which heart valve is also known as the tricuspid? (Which other heart valves
also have three flaps?)
The right atrioventricular valve (the aortic and pulmonary valves).
2. Which of (ventricular) systole or diastole refers to the contraction of the
heart muscle?
Systole.
3. Apart from the heart, what other structures lie within the mediastinum?
Thymus, oesophagus, the great vessels of the heart (e.g. descending aorta,
ascending vena cava), trachea (in the upper part), the phrenic nerve, the cardiac
nerve, the thoracic duct and the lymph nodes of the central chest.
4. Arrange (write down) the four chambers of the heart (LA, RA, LV, RV), the four
valves (R a-v, L a-v, Pul v, Ao v) and the blood vessels (aorta, pulmonary trunk,
pulmonary veins, vena cava) in the order in which blood flows through them.
(Superior and inferior) vena cava, RA, Ra-v valve (tricuspid), RV, pulmonary
valve, pulmonary trunk (right and left pulmonary arteries), (lungs) pulmonary
veins, LA, La-v valve (= mitral, bicuspid), LV, aortic valve and aorta (systemic
circulation).
5. Name the membrane that adheres to the outside of the myocardium.
Visceral pericardium (epicardium).
Suggested Answers to the Lecture Revision Homework Exercises 217

6. Distinguish cardiac muscle from skeletal muscle.

Cardiac muscle: the cardiac muscle is involuntary; cardiac muscle cells are
relatively small and have a single centrally placed nucleus, although a few have
two or more nuclei; the cells are generally branched and are interconnected by
“intercalated discs”.
Skeletal muscle: the skeletal muscle is voluntary; skeletal muscle cells are
cylindrical and much longer than cardiac muscle cells, and they have multiple
nuclei; cells are not branched, and there are no intercalated discs presented in
skeletal muscles. They are adjacent muscle fibres tied together by connective
tissue fibres.
7. Where are coronary arteries, and what do they do?
The coronary arteries lie over the myocardium and supply the muscle tissue of
the heart with oxygenated blood. The two openings to the coronaries (left and
right coronary arteries) lie just superior to the aortic valve so that at diastole,
when the aortic valve closes, blood can flow into the openings to the left and
right coronary arteries.
8. What do the heart valves do as the ventricles progress through systole?
At the commencement of systole, the atrioventricular valves shut (the chor-
dae tendineae and papillary muscles prevent the valve flaps from being
pushed up into the atria); this traps blood in the ventricles so that the pres-
sure in the blood contained in the ventricles rises as the ventricles apply
compression. When the pressure of blood in the ventricles exceeds the back
pressure exerted on the aortic valve (or the pulmonary valve for the right
ventricle) by the blood already in the aorta (or pulmonary trunk), the ven-
tricular blood forces the aortic valve (or the pulmonary valve) open and
pushes the aortic blood further along the aorta and the ventricular blood into
the aorta (or pulmonary arteries).
9. Why is the myocardium of the left ventricle so thick?
The LV has to pump blood through the systemic circuit. The length of blood
vessels in this circuit causes it to have a high resistance to blood flow; this
means that the LV has to pump hard (harder than the RV) in order to create
sufficient pressure to ensure that blood flows throughout the systemic arter-
ies and arterioles. The RV, on the other hand, does not need to work very
hard to push blood through the pulmonary circuit because the lungs are close
to the heart, and the pulmonary blood vessels are relatively short and wide.
10. On the schematic (i.e. not anatomically faithful) diagram of the heart below,
draw in and label the aortic and pulmonary valves and label all the structures
listed in question 4. In addition, use arrows to indicate the flow of blood.
218 Suggested Answers to the Lecture Revision Homework Exercises

11. What is the general function of the heart valves, and what would happen to the
circulation of blood through the heart if the action of the valves was impaired?
Valves allow blood to flow in one direction only (the correct way). The valves
close to prevent backflow. If valve function is impaired, some blood would flow
the wrong way (backwards); this would result in a “murmur” and would make
the heart pump less efficiently.
(Heart valves may become impaired for a variety of reasons. Rheumatic fever,
the most common cause of valve malfunction, causes a valve to stiffen over
time. This limits the ability of the valve to open and close properly. Some
people are born with heart valve abnormalities, which may be corrected at birth
or later in life. Other people may acquire valve damage from infection (as with
bacterial endocarditis) or other diseases. The results are a tight, rigid valve
limiting forward blood flow (called a stenotic valve) or a valve that does not
close properly, permitting backflow (called a regurgitant valve).
12. How does the structure of the left ventricle differ from that of the right?
The LV has a much thicker muscle wall than the RV. The LV also is circular in
cross-section, while the RV is a “crescent moon” shaped pocket attached to the LV.
13. How do these differences relate to resistance to blood flow in pulmonary and
systemic circulations?
Resistance to blood flow in a systemic circuit is higher than in a pulmonary
circuit, so high blood pressure is required to overcome the resistance to flow
(and so push blood into the arterial circulation); thus, a strong muscle (= thick)
is required to provide this higher BP. Pulmonary resistance to blood flow is
lower (because the length of blood vessels in the pulmonary circuit is shorter
than in the systemic circulation. So a less powerful pump is required.
14. Describe how and during which part of the cardiac cycle blood enters the coro-
nary arteries.
Openings to the two coronary arteries are in the wall of the aorta, immediately
beyond the tricuspid aortic valve. During heart contraction (systole), the aortic
valve is open and the coronary artery openings are squashed shut.
During diastole, the aortic valve shuts as blood fills the cusps when blood from
the heart stops rushing into the aorta.
Thus, during diastole, the coronary arteries are no longer squashed shut, and
blood from the aorta then enters the coronary arteries.
Suggested Answers to the Lecture Revision Homework Exercises 219

15. What effect would a blockage of the coronary arteries have on the myocardium
(heart muscle)?
(Part of) the myocardium would not be sufficiently perfused (not receiving
oxygen); this means it would be ischemic (i.e. lacks oxygen), or some tissue
would die (an infarction). That is, a “heart attack” (= MI) ensues. Rapid medi-
cal intervention will minimise the size of the infarct. The MI may or may not
be fatal.
16. How many cusps does the RIGHT atrioventricular valve have? What is the
other name for this valve?
Three, so it is called the tricuspid valve (or right parachute valve).
17. How many cusps does the LEFT AV valve have? What is the other name for
this valve?
Two. It is also known as the mitral valve.

Exercise 13: Blood Vessels

1. What are the three tunics that comprise the walls of veins and arteries?
Tunica intima (or tunica interna), tunica media and tunica externa (or tunica
adventitia).
2. Name some differences between veins and arteries.
(a) Vessel walls: veins have thinner walls than arteries; the tunica media of an
artery contains more smooth muscle and elastic fibres than does that of a
vein; the tunica media of an artery also has an internal and an external elastic
membrane, whereas the tunica media of a vein does not.
(b) Vessel lumen: when not opposed by blood pressure, the elastic fibres in the
arterial walls recoil, constricting the lumen. Veins are larger in diameter than
the corresponding arteries. Arteries usually keep their cylindrical shape, but
veins tend to collapse.Veins typically contain valves, internal structures that
prevent the backflow of blood towards the capillaries.
(c) Veins carry blood towards the heart, while arteries carry blood away.
(d) Veins – except for pulmonary veins – carry deoxygenated blood; arteries –
except for pulmonary arteries – carry oxygenated blood.
3. What is the systemic circulation?
The blood vessels that carry oxygenated blood from the left ventricle to body
tissues and organs other than the lungs and return deoxygenated blood via the
veins to the right atrium.
4. What is the difference between muscular and elastic arteries?
Elastic arteries are large vessels with a diameter of up to 2.5 cm. They carry
large volumes of blood away from the heart. The tunica media of elastic arter-
220 Suggested Answers to the Lecture Revision Homework Exercises

ies contains a high density of elastic fibres and relatively few smooth muscle
cells; as a result, elastic arteries are extremely resilient and can tolerate the
pressure changes of the cardiac cycle. Muscular arteries are medium-sized
arteries (diam 0.4 cm) (e.g. the axillary, brachial, radial, femoral, popliteal
and tibial arteries). They distribute blood to the body’s skeletal muscles and
internal organs. They have thick tunica media layers, which contain more
smooth muscle than elastic, enabling greater autonomic control of vasocon-
striction and vasodilation.
5. What is the function of the smooth muscle in blood vessel walls?
Smooth muscle allows for vasodilation (when the degree of muscle tone is
decreased, e.g. smooth muscle at the entrance to capillaries regulate the amount
of blood flow into each vessel. If the tissue becomes starved for oxygen, the
smooth muscle cells relax, whereupon capillary diameter increases and so blood
flow increases, delivering additional oxygen) and vasoconstriction. This mecha-
nism allows the volume flow rate of blood to be altered.
6. Name the three types of capillaries. What is the difference between them?
(a) Continuous capillaries: the endothelium forms a complete lining. These cap-
illaries allow the diffusion of water, small solutes and lipid-soluble materials
into the interstitial fluid; they prevent the loss of blood cells and plasma
proteins.
(b) Fenestrated capillaries: the endothelium has pores (windows) to allow the
rapid movement of water and solutes (including peptides) between the
plasma and interstitial fluid.
(c) Sinusoids (sinusoidal capillaries): these resemble fenestrated capillaries that
are flattened and irregularly shaped. In addition to being fenestrated, sinu-
soids commonly have gaps between adjacent endothelial cells. They allow
the free exchange of water and solutes as large as plasma proteins and
phagocytic cells (i.e. are “leaky”).
7. What would result if “Starling’s law of the capillaries” does not hold?
If the same amount of fluid did not return to the capillaries at the venous end as
the left at the arterial end (less than which returns via the lymphatic vessels),
then the tissues would swell with retained fluid (become oedematous).
8. (a) What causes blood to flow in the arterial side of the systemic circulation?
The pumping action of the heart.
(b) What causes venous return (blood flow) in the venous side of the circuit?
1. The presence of valves in the veins to prevent backflow ensures that blood
keeps moving back to the heart.
2. Venous return is assisted by skeletal muscle contraction, the squashing action
of the skeletal muscle acting on veins pressing against the blood in the veins,
forcing the valves open and driving blood towards the heart.
Suggested Answers to the Lecture Revision Homework Exercises 221

3. In the abdomen, the action of breathing creates a lower pressure in the thorax
than in the abdomen, and this encourages blood to flow along the vena cava
(blood from the head flows to the heart under gravity usually).
Exercise 14: Pressure
1. Define pressure and explain how it is different from force.
Pressure is the amount of force (expressed in newtons) being exerted divided
by the amount of area (expressed in square metres) on which the force is act-
ing. The units of pressure are Pascals (Pa), which are equal to newtons per
square metre. Since pressure is force divided by area, they are different (pres-
sure is not a force). Furthermore, the same force may exert different pres-
sures – a large pressure if the area is small or a small pressure if the area
is large.
2. Convert a blood pressure measurement of 130 mm Hg/80 mm Hg to units of kPa.
1 mm Hg = 0.133 kPa, so to convert mm Hg to kPa, the number of mm Hg is
multiplied by 0.133: 130 mm Hg × 0.133 = 17.3, and 80 mm Hg × 0.133 = 10.6.
So 130/80 (in mm Hg) is equivalent to 17.3/10.6 (in kPa).
3. Use P = F/A to determine the pressure exerted during CPR for the two cases
below. In each case, the resuscitator can apply a force of 200 N.
(a) If the whole hand (area = 140 cm2 = 0.014 m2) is used.

200 N  0.014 m 2  14285.7 Pa  14.2857 kPa.

(b) If only the “heel” of the hand is used (area = 40 cm2 = 0.004 m2).

200 N  0.004 m 2  50 000 Pa  50 kPa.

Thus, a much greater pressure may be exerted (using the same force) if the heel of
the hand is used rather than the palm!
4. What is meant by positive pressure?
A pressure that is greater than atmospheric pressure (which is about 101 kPa);
for example, a positive pressure of 10 kPa is in fact 10 kPa + 101 kPa.
5. Write out Pascal’s principle. Apply it to bed sore prevention or glaucoma or
Queckenstedt’s test or the knee or to a foetus surrounded by amniotic fluid.
Pascal’s principle: the pressure exerted on an enclosed fluid is transmitted
undiminished to all parts of the fluid and to its container’s walls.
PP applied to BSP: a patient lying on a water-filled mattress is exerting pres-
sure on the enclosed water due to their weight. If the mattress cover is stretchy
enough to follow the contours of the patient’s body, then the mattress is in con-
tact with the patient’s entire lower surface. That is, the area over which the
222 Suggested Answers to the Lecture Revision Homework Exercises

patient’s weight is acting is the entire lower surface of the patient rather than just
their bony prominences (such as shoulder blades, buttocks, heels etc). This large
area of contact means that the pressure exerted by the patient’s weight is smaller
and the chance of producing pressure sores is reduced.
PP applied to glaucoma: glaucoma occurs when the intraocular pressure is
high. The eyeball is a bag of fluid. The pressure in the “bag” is transmitted to the
walls of the bag. The blood vessels of the retina are in the wall. They are com-
pressed by this pressure, and consequently, the cells of the retina are deprived of
their blood supply. Damage to sight is the result.
PP applied to QT: Queckenstedt’s test involves compressing the jugular vein,
thus causing the venous sinus in the cranium to swell with blood (as the blood is
prevented from draining away). The excess blood exerts an increased pressure
in the cranium, which is passed onto the cerebrospinal fluid.
PP applied to the knee joint: the pressure in the knee joint can be distributed
because of the enclosed synovial fluid.
PP applied to a foetus: a foetus is surrounded by amniotic fluid; hence, pres-
sure on the abdomen of a pregnant woman is transmitted to the entire surface of
the foetus and to the mother’s abdominal wall via the amniotic fluid. Thus, the
baby can be protected from high pressure.
6. Use Henry’s law to describe why breathing air with 30% O2 is often a beneficial
therapy.
Atmospheric air contains about 20% O2, so 30% O2 is air enriched with oxygen.
Henry’s law says that the amount of gas that dissolves in water is p­ roportional
to the pressure of the gas in contact with the water. (The higher is the partial
pressure of gas adjacent to a liquid surface (e.g. in the lungs), the greater the
amount of gas that will dissolve in the liquid). If the gas contains 30% O2 (rather
than 20% O2), MORE oxygen will dissolve in the water; hence, breathing
enriched air will allow more oxygen to dissolve in the alveolar fluid, so more
oxygen will dissolve in the blood, and so more oxygen will be transported. This
is beneficial for someone who has a gas exchange problem, is anaemic and has
a pulmonary obstruction.
7. Describe inhalation and exhalation using Boyle’s law and pressure gradient.
Inhalation is achieved by contracting the diaphragm and/or the intercostal mus-
cles. This causes the volume of the chest to increase. By Boyle’s law, the pres-
sure of the gas in the lungs will decrease to below that of the atmosphere. That
is, there will be a higher air pressure outside the lungs than inside the lungs. This
constitutes a pressure gradient. Consequently, the outside air will push its way
into the lungs. On exhalation, the volume of the chest will decrease (as the dia-
phragm relaxes and the ribs recoil). By Boyle’s law, a decreased volume will
produce a higher pressure – higher than the pressure of the air in the atmosphere.
This difference in pressure once again causes a flow of gas. Hence, “stale” air is
pushed out of the lungs in the direction of the pressure gradient.
8. In about four sentences, describe and explain the movement of fluid into and out
of capillaries.
Suggested Answers to the Lecture Revision Homework Exercises 223

The capillary hydrostatic pressure ranges from 35 mm Hg at the arterial end of

a capillary to 18 mm Hg at the venous end. At the arterial end, blood enters the
capillary from the arteriole at BP (capillary hydrostatic pressure) ~35 mm Hg,
and this pressure is higher than blood colloid osmotic pressure ~25 mm Hg
(which attracts water into the blood by osmosis); therefore, water flows out of
the capillary at the arterial end. At the venous end, blood leaves via a venule at
BP (capillary hydrostatic pressure) ~18 mm Hg, which is lower than blood col-
loid osmotic pressure ~25 mm Hg; hence, water flows into the capillary at the
venule end.

Exercise 15: Blood Pressure and Control of Blood Pressure

1. Define mean arterial blood pressure.

MAP  diastolic pressure 1 / 3 pulse pressure.

The average pressure lies somewhere between the maximum (and momentary)
systolic pressure and the minimum diastolic pressure.
2. What are the three basic factors that determine arterial blood pressure?
(a) Cardiac output: the amount of blood ejected each minute by the left ventricle
into the aorta; an increase in CO will increase the blood pressure.
(b) Peripheral resistance: the resistance to blood flow due to friction between
the blood and the vessel walls; it depends on the viscosity of the blood and
the diameter and length of the vessels, especially the arterioles. The smaller
the diameter of the vessel is, the more resistance it offers to blood flow. The
greater the length of the blood vessels, the greater the resistance to flow.
(c) Blood volume: decreased fluid volume within a closed system decreases the
pressure on the vessels within that system.
3. State the formula that relates peripheral resistance, stroke volume and heart rate
to mean arterial blood pressure.

MAP  SV  HR  PR

4. What effect does vasoconstriction have on arterial blood pressure and why?
Vasoconstriction raises blood pressure. The reason is that vasoconstriction or
vasodilation can change the vessel diameter and, hence, change resistance to
blood flow, therefore changing blood pressure. The smaller the diameter of
blood vessels, the higher the resistance for the blood to pass; that is, the heart
has to exert greater pressure.
224 Suggested Answers to the Lecture Revision Homework Exercises

5. What are the effects on blood volume and arterial pressure of:
(a) Increased glomerular filtration rate (GFR)?
Filtrate production is increased. Blood volume would decrease, and so
would arterial pressure.
(b) Decreased GFR?
BV would increase, and BP would increase.
(c) An increase in sympathetic stimulation to the heart and vascular
smooth muscle?
HR and the force of contraction would increase. Vasoconstriction would
increase, so BP would increase.
(d) An increase in parasympathetic stimulation to the heart?
HR would decrease, the force of contraction would decrease, and so BP
would decrease.
(e) ADH secretion?
ADH causes the walls of the collecting ducts of the kidney to become per-
meable to water. Consequently, water is re-absorbed and moves from the
filtrate to the interstitial fluid. This ultimately causes blood volume to rise
and hence blood pressure to rise.
(f) Drinking water?

As water is absorbed from the gastrointestinal tract, blood volume increases,

and so does pressure.
6. (a) What is the stimulus for renin release?
A fall in blood pressure.
(b) How does angiotensin II arise from the release of renin?
Renin converts angiotensinogen to angiotensin I; then in the capillaries in the
lungs, an angiotensin-converting enzyme changes angiotensin I to angio-
tensin II.
(c) What effects do angiotensin II have?
(1) It causes adrenal glands (cortex) to release aldosterone, which increases
the re-absorption of Na+ from the filtrate by kidney tubules. (2) It causes the
secretion of ADH by the posterior pituitary (hence, kidney tubules become
permeable to water, which osmotically follows Na+ out of the filtrate; there-
fore, urine production decreases as water is reclaimed from the filtrate and
returns to blood – this maintains the circulating blood volume). (3) Angiotensin
II stimulates thirst; we drink, which increases extracellular volume and hence
Suggested Answers to the Lecture Revision Homework Exercises 225

blood volume. (4) Angiotensin II stimulates cardiac output and is also a vaso-
constrictor, in turn increasing systematic blood pressure.
(d) How do the drugs known as ACE inhibitors work?
They prevent the enzyme from acting to convert angiotensin I to angiotensin
II; hence, blood pressure does not increase.
(e) Why do “calcium channel blockers” help reduce blood pressure?
It is because Ca ++ ions are necessary for muscle contraction, and these block-
ers block the entry of Ca++ ions to the vascular smooth muscle; hence, it can-
not contract. Therefore, the arterioles dilate, causing the peripheral resistance
to decrease, i.e. lower blood pressure.
7. Name the major mechanisms for the short-term regulation of blood pressure.
The aortic reflex (a baroreceptor reflex) maintains systemic BP – baroreceptors
located in the aortic arch. The carotid sinus reflex (a baroreceptor reflex) main-
tains adequate and constant blood flow in the brain – baroreceptors located in
the carotid sinus.
8. Write a paragraph about the role of the kidneys in the long-term control of blood
pressure.
When arterial pressure falls, the juxtaglomerular cells of the kidney release
renin, which catalyses the formation of angiotensin I, which is converted to
angiotensin II by ACE. The effects of angiotensin II are the release of aldoste-
rone, which increases the re-absorption of Na+ from the filtrate by kidney
tubules and the secretion of ADH by the posterior pituitary; hence, kidney
tubules are more permeable to water, which osmotically follows Na+ out of the
filtrate. Angiotensin II is also a vasoconstrictor and stimulates thirst. The atrial
natriuretic peptide is produced by muscle cells in the right atrium in response to
the excessive stretching of atria; it reduces blood volume and blood pressure.
The effect of ANP is it increases Na+ excretion in the kidneys and increases
GFR, i.e. urine volume, so blood volume decreases and BP decreases. It also
reduces thirst and blocks the release of ADH and aldosterone.

Exercise 16: Respiratory System

1. Define the following: dead space, lung compliance and respiratory distress
syndrome.
Dead space: that volume of air that is inhaled but does not reach the alveoli (air
in the conducting zone of the bronchial tree) and hence does not participate in
gas exchange.
Lung compliance: the ease with which the lung can be expanded – low com-
pliance means that the lung is difficult to expand and the greater is the force
226 Suggested Answers to the Lecture Revision Homework Exercises

required to expand the lungs. The greater the compliance, the easier it is to fill
the lungs.
Respiratory distress syndrome: afflicts premature babies whose alveolar epi-
thelial cells are not mature enough to produce the surfactant. It is required so
that the surface tension of alveolar fluid is decreased to allow for easy expan-
sion of the lung. Consequently, expanding their lungs without assistance is
beyond their capability.
2. How does the construction of the walls of the bronchi and bronchioles differ?
Bronchi have cartilage in their walls to hold them open. However, the walls of
the primary, secondary and tertiary bronchi contain progressively less carti-
lage. Bronchioles have no cartilage in their walls – they do have smooth muscle
so that they can constrict. The amount of tension in those smooth muscles has
a great effect on bronchiole diameter and resistance to airflow.
3. What can cause bronchodilation, and what can cause bronchoconstriction?
Bronchodilation happens when adrenalin or noradrenalin is present in the
blood, CO2 concentration goes up or the sympathetic nerves carry impulses to
the lungs. Bronchoconstriction is triggered by parasympathetic nerve stimula-
tion, by histamines released during allergic reactions and by irritants carried in
air (smoke, dust and dander).
4. Why does hyperventilation (= rapid shallow breaths) result in an increase in
dissolved CO2 in the blood?
Rapid shallow breathing will not ventilate the lungs adequately as a large pro-
portion of each intake of breath will simply move into the dead space – shallow
breaths do not have sufficient volume to refresh the alveolar volume with fresh
air. Hence, CO2 in the blood will not be “blown off”. CO2 then will accumulate
in the blood and decrease blood pH.
5. To what do the chemoreceptors in the respiratory centre of CNS respond? (And
explain your answer.)
The respiratory centre responds to H+. However, this ion cannot cross the
blood-brain barrier. CO2 from the blood can; when it enters the CSF, it dis-
solves to form carbonic acid, which in turn dissociates into bicarbonate and
H+. The more CO2 in the blood, the more H+ will be formed in the CSF. So it
might be said that CO2 affects the chemoreceptors via H+.
6. How and why is the composition of alveolar air different from atmospheric air?
Alveolar air has less O2 (because it is continually moving into the blood) and
has more CO2 (because it is continually moving out of the blood) and is satu-
rated with water vapour (because it is in contact with moist membranes).
Suggested Answers to the Lecture Revision Homework Exercises 227

7. What is FEV1, and why is it decreased in obstructive diseases such as asthma?

It is the maximum volume of air that can be forcefully exhaled in one second
(two or three attempts are allowed). It depends on the airways being open – i.e.
unobstructed and unconstricted. The constriction caused by asthma means that
the diameters of the airways are smaller; consequently, less air can pass through
them. Healthy lungs can expel ≥80% of their volume in 1 s.
8. Describe the chemical changes that occur in the RBC that facilitate carbon
dioxide transport.
Of the CO2 formed by cellular respiration and dissolved in plasma, 70% moves
into the RBC where it reacts with water to form carbonic acid. This reaction is
EXTREMELY rapid because it is catalysed by the enzyme carbonic anhydrase.
The acid then dissociates into bicarbonate ions and hydrogen ions. The bicar-
bonate then diffuses out of the RBC and is transported back to the lungs in
plasma (chloride ions swap places with bicarbonate ions so that the electrical
potential stays the same on each side of the membrane; this ion exchange pro-
cess does not require ATP). Hydrogen ions combine with oxyhaemoglobin,
forming HbH+ and releasing oxygen in the process. Consequently, oxygen is
unloaded in the tissues that are producing CO2 – and this is good because that
is just where oxygen is needed.
9. State Henry’s law. Use Henry’s law to describe why breathing air with 30% O2
is often a beneficial therapy.
Henry’s law says that at a given temperature, the amount of gas that dissolves
in water is proportional to the partial pressure of the gas in contact with
the water.
Atmospheric air contains about 20% O2, so 30% O2 is air enriched with oxy-
gen. Henry’s law says that the amount of gas that dissolves in water is propor-
tional to the pressure of the gas in contact with the water. (The higher is the
partial pressure of gas in contact with a liquid surface (e.g. in lungs), the greater
will be the concentration of the dissolved gas in that liquid.) If the gas contains
30% O2 (rather than 20% O2), MORE oxygen will dissolve in the water. Hence,
breathing enriched air, will allow more oxygen to dissolve in the alveolar fluid,
so more oxygen will dissolve in the blood and more oxygen will be trans-
ported. This is beneficial for someone who has a gas exchange problem, is
anaemic or has a pulmonary obstruction as gas exchange is enhanced. For
anaemic patients (whose RBC concentration is lower), the extra amount of
oxygen dissolved in plasma means more oxygen is available to the tissues than
would be the case if they were breathing 20% oxygen.
10. State Boyle’s law. Describe inhalation and exhalation using Boyle’s law and
pressure gradient.
See Homework Exercise 14, question 7.
228 Suggested Answers to the Lecture Revision Homework Exercises

For gas in a closed container and at a constant temperature, pressure (P) is

inversely proportional to volume (V); this relationship, which can be presented
as P = 1/V, is Boyle’s law.
Inhalation is achieved by contracting the diaphragm and/or the intercostal mus-
cles. This causes the volume of the chest to increase. Based on Boyle’s law, the
pressure of the gas in the lungs will decrease to below that of the atmosphere.
That is, there will be higher air pressure outside the lungs than inside the lungs.
This constitutes a pressure gradient. Consequently, outside air will push its way
into the lungs. On exhalation, the volume of the chest will decrease (as the
diaphragm relaxes and the ribs recoil). As per Boyle’s law, a decreased volume
will produce a higher pressure – higher than the pressure of air in the atmo-
sphere. This difference in pressure once again causes a flow of gas. Hence,
“stale” air is pushed out of the lungs in the direction of the pressure gradient.
11. What are the functions of the mucous glands and the ciliated epithelial cells?
Mucous glands secrete mucous onto the surface of large airways. Mucous traps
particles suspended in inhaled air (also contains immunoglobulins to disable
pathogens). Ciliated epithelial cells have cilia that wave the mucous towards
the top of the bronchial tree so that it may be swallowed (then stomach acid
acts on any pathogens).
12. Give definitions for the following: eupnoea, apnoea, bradypnoea, tachypnoea
and dyspnoea.
Eupnoea – normal breathing (12–20 bpm).
Apnoea – cessation of breathing (may be temporary).
Bradypnoea – abnormally slow breathing (? <10 bpm).
Tachypnoea – rapid breathing (? >20 bpm) may be due to exercise.
Dyspnoea = subjective sensation of difficulty in breathing and response to that
sensation (= shortness of breath, breathlessness).
13. Why would you encourage an anxious person to breathe more deeply?
Deep breaths increase the volume of air intake – this decreases the ratio of
“dead air” (expired air from the alveoli that is still in the airways after exhala-
tion and is then drawn back into the lungs with a new breath) to fresh air taken
into the alveoli. Thus, a deep breath draws more fresh air (with more oxygen
and less carbon dioxide) into the alveoli, and this improves gas exchange across
the respiratory membrane (which in turn will calm the subject as they decrease
CO2 in their blood).
14. What would you anticipate would be the effect of pneumothorax (air in the
intrapleural space) on breathing?
A pneumothorax takes up space within the chest cavity, so lungs cannot expand
as fully as they should. This leads to decreased gas exchange and “difficulty in
breathing” and perhaps increased CO2 in the blood and respiratory acidosis. If
the lung collapses, breathing difficulty will increase.
Suggested Answers to the Lecture Revision Homework Exercises 229

15. What could you anticipate would be the effect on breathing of a spinal cord
injury at the level of the sixth cervical vertebra?
If spinal cord is severed at C6, then the spinal nerves that leave the spinal cord
below C6 will not carry impulses (this results in quadriplegia). So intercostal
muscles of the chest will not work in breathing (because the spinal nerves will
not function). However, the diaphragm is innervated by the phrenic nerve,
which leaves the SC (via cervical plexus) from C3, C4 and C5. Hence, the
diaphragm will still work. The subject will be able to breathe unassisted using
the diaphragm and so will not die of suffocation at the trauma site. (Severing
the SC above C3 means lung ventilation (breathing) will cease.)

Exercise 17: Reproductive System

1. List the structures of the male reproductive system in the order that a sperma-
tozoon would pass through them.
Testis (seminiferous tubule – straight tubules, rete testis – efferent ductules),
epididymis, ductus (vas) deferens, ejaculatory duct, urethra (and out through
the penis via the external urethral meatus).
2. What is the function of testosterone in males?
(a) It stimulates spermiogenesis (in the sustentacular cells of the testes).
(b) It Affects CNS function (libido and male behaviour).
(c) It stimulates metabolism (masculine body shape, muscle growth).
(d) It establishes and maintains secondary sex characteristics (hair, muscle
mass, body size, fat deposits, thicker vocal cords, Adam’s apple, larger
hands and feet, thicker skin).
(e) It maintains glands and organs of the reproductive tract.
3. Where do spermatozoa physically mature, and where do they become
“capacitated”?
They physically mature in the epididymis but are still immobile.
They become capacitated in (1) the ejaculatory duct (after mixing with the
secretions of the seminiferous glands and (2) when exposed to conditions in the
female reproductive tract.
4. What happens in the ejaculatory duct?
Spermatozoa capacitation: secretions of the seminal glands are added to sperm
and fluid from the epididymis; sperm become motile.
5. What is the composition of semen?
Typical ejaculate is 2–5 ml. Semen typically contains spermatozoa (20 million
to 100 million spermatozoa per millilitre of semen), seminal fluid (a mixture of
230 Suggested Answers to the Lecture Revision Homework Exercises

glandular secretions with a distinct ionic and nutrient composition) and

enzymes. It also contains electrolytes, protein, fructose, lipids, vitamin C,
water and mucus (caritene, prostaglandins)
6. Write a paragraph that summarises the events of spermatogenesis. (Do not
merely copy out the textbook!)
The complete process of spermatogenesis takes about 64 days. It involves three
processes:
1. Mitosis: stem cells undergo cell divisions. One daughter cell from each divi-
sion remains in place, while the other is pushed towards the lumen of the
seminiferous tubule, and the displaced cells differentiate into primary sper-
matocytes, which prepare to begin meiosis.
2. Meiosis: it is a special form of cell division involved in gamete production.
Human gametes contain 23 chromosomes, half the amount found in somatic
cells. As a result, the fusion of the nuclei of a male gamete and a female
gamete produces a cell that has a normal number of chromosomes.
3. Spermiogenesis: spermatids are small unspecialised cells. In spermiogene-
sis, spermatids differentiate into physically mature spermatozoa, which are
among the most highly specialised cells in the body.
7. What is the function of estradiol?
(a) Stimulates bone and muscle growth (female pattern)
(b) Maintains female secondary sex characteristics (hair distribution, breasts,
location of adipose tissue, voice, pelvis)
(c) Affects the CNS (sexual drive and female behaviour)
(d) Maintains accessory reproductive glands/organs
(e) Initiates growth and the repair of the endometrium
(f) Promotes the development of breasts
8. Summarise the hormonal control of the ovarian cycle up to the luteal phase.
(a) Release of GnRH: the cycle begins with the release of GnRH by the hypo-
thalamus (at 1 pulse every 60–90 min), which stimulates the production
and secretion of FSH (from the anterior lobe of the pituitary gland) and the
production of LH.
(b) Follicular phase of the ovarian cycle: FSH acts on the ovary to stimulate
follicle development, and the developing follicles produce oestrogen
(which inhibits LH release) and secrete inhibin, which causes the FSH level
to decrease due to negative feedback effects.
(c) Luteal phase: as one or more tertiary follicles begin to form, the concentra-
tion of circulating oestrogen rises steeply; hence, GnRH pulse frequency
increases to 36 per day. Around day 10 of the cycle, the combination of
increased GnRH pulse frequency and elevated oestrogen levels stimulates
LH secretion (the effect of oestrogen on LH secretion changes from inhibi-
Suggested Answers to the Lecture Revision Homework Exercises 231

tion to stimulation). On around day 14, a massive LH level triggers the

completion of meiosis I, ovulation and the formation of the corpus luteum.
The corpus luteum secretes progesterone, which stimulates and sustains
endometrial development. After ovulation, progesterone levels rise and
oestrogen levels fall, which suppress GnRH secretion. If pregnancy does
not occur, the corpus luteum will degenerate after 12 days, and as the pro-
gesterone level decreases, GnRH secretion increases, and a new cycle begins.
9. What are the male secondary sex characteristics?
Hair distribution (beard), thicker skin, thicker vocal cords and deeper voice
(than females), body shape (larger hands and feet, broad shoulders, narrow
hips, muscle development), body size, fat distribution (around the abdomen)
and Adam’s apple.
10. What are the female primary sex characteristics?
The ovaries, the reproductive tract (uterine tubes (fallopian tubes), uterus,
vagina) and external genitalia.
11. Define menstrual cycle, menarche and menopause.
The menstrual cycle is a repeating series of changes in the structure of the
endometrium (~28–day cycle); it is the preparation of the uterus (proliferation
of the uterine epithelium) to receive the fertilised ovum and the subsequent
destruction of tissue (and the passing of blood and debris out through the
vagina) if no embryo implants.
Menarche is the onset of a female’s first menstrual cycle (the first cycle).
Menopause is the ultimate cessation of the menstrual cycle as a result of a
woman’s ageing.
12. Outline the major changes in GnRH, FSH, LH, estradiol and progesterone
before and after ovulation.
Similar to Q8.
Before ovulation: GnRH stimulates the production and secretion of FSH and
the production of LH. FSH stimulates follicle development, and developing
follicles produce oestrogen, which inhibits LH, and inhibin, which causes FSH
levels to decline. An increase in oestrogen causes the pulse frequency of GnRH
release to increase to 1 pulse/30–60 mins. Persistently high oestrogen com-
bined with a high level of GnRH also stimulates LH secretion.
After ovulation: the corpus luteum releases progesterone – which prepares the
uterus for pregnancy (and some oestrogen). As the progesterone level rises and
oestrogen falls, GnRH pulse frequency declines to 1–4 pulses/day. This stimu-
lates LH secretion (which maintains CL) more than it does FSH. The proges-
terone levels remain high for the next week, but unless pregnancy occurs, the
CL begins to degenerate. As progesterone and oestrogen levels fall markedly,
the GnRH pulse frequency increases, and the cycle begins again.
232 Suggested Answers to the Lecture Revision Homework Exercises

13. What is the function of GnRH and the result of its release in males and females?
GnRH (produced in the hypothalamus) stimulates the release of FSH and LH
from the anterior pituitary (in both males and females).
In males: FSH targets sustentacular (Sertoli) cells (in the testes), which (in the
presence of testosterone) promote spermiogenesis. LH targets interstitial
(Leydig) cells (of the testes), which produce testosterone.
In females (at 1 pulse/60–90 min): GnRH causes FSH release from the ante-
rior pituitary. FSH targets the ovary and stimulates follicle development. At the
pulse/30–60 min, GnRH, together with oestrogen, stimulates LH release from
the anterior pituitary. This “surge” in LH stimulates the completion of meiosis
I by oocytes and the ovulation and development of the corpus luteum.