Done - Anatomy and Physiology

ANATOMY AND PHYSIOLOGY
Victor Romulo Dumaguing
Physiology – study of the normal functions of different organs in the human body
Temp -37°C/ 98°F; BP- 120/80; Menstrual cycle- 28-32 days heart rate – 72/min
Gestation – duration of intrauterine pregnancy: 9 months, 10 lunar months, 38-42 weeks
Menarche – first menstrual flow; 9 years old
Physiologic – term to describe a clinical finding considered as normal or within healthy conditions
Pathologic – term to denote an abnormal finding or measure
Scope of Physiology
I. Anatomy
Divisions
A. Gross Anatomy – study of organs and structures of human body as uncovered by surgery of dissection
B. Histology – study of ultrafabric tissues with the aid of microscope
C. Cytology – study of cells

Cell – fundamental unit of life
- simplest or basic structural and functional unit of life
- 75 trillion cells
Rule: One cell, one nucleus except:
1. non-nucleated cells
Red blood cell or erythrocyte; platelet or thrombocyte
2. multi-nucleated cells
Skeletal muscle cell; osteoblast
Oncology – study of cancer

Cancer – malignant degeneration of cells = purposeless, uncontrollable growth of abnormal cells
WBC count = 5000-10000/mm
Leukemia – cancer of WBC; increase of abnormal WBC
Leukocytosis – normal increase of WBC due to the infection in the body
Basis for the diagnoses of cancer is on the nucleus

1. Presence of many nuclei when there should only be one
2. A disproportionately of large nucleus
15-35 breast mass is fibroadenoma (benign)
a. Metastasis – process of spread of cancer cells to the distant organs
eg. Melanoma – most malignant skin cancer
b. Malnutrition – cancer cells take up or eat most of nutrients
c. suppression of immune response of cancer patients
Management
1. Surgery – removal of organ and its neighboring lymph node
2. Radiation – cobalt
3. Chemotherapy – injectable and oral medicines
Types of cells Based on Number of Chromosomes

a. Somatic cells – all cells in the body except sperm cell and egg cell
Eg. Nerve cell, muscle cell
b. Sex cells
a. egg cells
b. sperm cells
1|Page MERYL P. RAMIREZ, BSN, RN
Diploid – complete cells of chromosomes
- 44 is diploid number of somatic cells
Haploid – half-set of chromosomes
- 22 is haploid of somatic cells
Somatic Chromosomes or Autosomes – these chromosomes carry the genes that transmit hereditary traits
1. Phenotype – observable, tangible
- physical aspects of heredity
- eg. Color of hair, waviness of hair, dimples
2. Genotype – non-physical aspects of heredity
- eg. Aptitude in math, talent in music, diseases like diabetes, hemophilia, schizophrenia
3. Dominant trait – a trait seen or observed In majority of offsprings in every generation
4. Recessive trait – a trait observed in majority of offsprings. It may skip one generation but will reappear in
future generations
Diploid number of egg cells is 46 (44 are somatic chromosomes, the same as the 44 in her somatic cells plus sex hormones x,x)
Haploid number is 23 (22 somatic chromosomes plus x or x)
Diploid number of sperm cell is 46 (44 are somatic chromosomes, the same as the 44 in her somatic cells plus sex hormones x,y)
Haploid number of sperm cell is 23 (22 somatic chromosomes plus x or y)
Mitosis – process by which a mother cell gives rise to 2 daughter cells; each daughter cell has same number of chromosomes as the
mother cell. All cells undergo mitosis.
Interphase
Prophase
Metaphase – cancer cells grow here
Anaphase
Telophase
Meiosis – special kind of cell division done only by sex cells. Also called Reduction Division because the adult mature form of the cell is
in haploid form.
Oogenesis – development of an adult mature egg or ovum. It occurs in the ovaries and it culminates or ends in ovulation-release of
mature egg or ovum
Graafian follicles – immature egg cells
Fembria – “fingers” of the fallopian tube that catches the mature egg cells
96 hours – life span of egg cells
Menopause – 52 or 47-54
- cessation or stoppage of ovulation
Non-ovulatory menstruation – vaginal bleeding
Spermatogenesis – formation of an adult, mature sperm or spermatozoa. Occurs in the testes, usually at 11 yrs of age.
Spermatosonium Oosonium
1° spermatocyte 46 chromosomes 1° oocyte
2° spermatocyte 2° oocyte
Spermatid Ootid (immature egg)
Spermatozoa 23 chromosomes Ovum (mature egg)
Vasectomy – cutting the vas deferens so no more sperm is mixed with the semen that is ejaculated
Seminal vesicle – produces semen
BTL – bilateral tubal ligation
Female Male
Menarche – 1st menstrual flow, 9 y/o (7-18) Spontaneous ejaculation - 11 yrs old
Menopause – cessation of ovulation, 52 y/o (47-55) Andropause – equivalent of menopause in males. However, there
is no stoppage in production of sperms, only a decrease in
secretion of testosterone
Decreased libido = decreased sexual urge
Limited period of fertility (9-52 y/o) Fertile from 11 y/o throughout life
Best eggs (15-25 y/o)
35 y/o and up – defective eggs (blighted ovum)
Puberty occurs earlier Puberty occurs later
Linear growth stops at 18 Linear growth stops at 20
D. Embryology – study of development of human from fertilization (conception) to parturition (delivery)

Y-carrying sperm – 24 to 36 hrs
X-carrying sperm – 48-72 hrs
Fertilization – union of sperm and egg to form a zygote
Father (x,y) 22 chromosomes
44 + x,x or 44 + x,y
Mother (x,x) 22 chromosomes
Fertilization restores the diploid number of chromosomes in the newly-formed zygote. The sex chromosomes (esp. of the
male) determine the genetic gender of the zygote. The genetic gender of the zygote is the primary sexual characteristic of the fetus.
Transmission and expression of hereditary traits are variable due to phenotype, genotype, dominant trait and recessive trait.
Twinning or having twins is a hereditary predisposition.
1. Monozygotic twin – identical twins; 1 sperm fertilizes 1 egg
- zygote then divides into 2 zygotes that develop into 2 babies. Identical twins have the same gender, physical looks and
genetic endowments
2. Dizygotic twins – fraternal twins; 2 eggs fertilized by 2 sperms
Implantation occurs after 72 hrs in the superior posterior border of the uterus
Ovum – biggest cell in the body
Ectopic pregnancy – development of a zygote in a location or area outside of the uterus
8 weeks – rupture of ectopic pregnancy
Stages in Embryonic Development

1. zygote
2. embryo – when the many cells formed differentiate into 3 germ layers: ectoderm, mesoderm, endoderm
3. fetus – when parts of organ or organs start to form
4. newborn
At the end of the 1st month it is called morula (mulberry)
Ectoderm – nervous system
Mesoderm – muscular/skeletal
Endoderm – visceral or internal organs
The first trimester is the critical or crucial period of pregnancy because of:
Organogenesis – formation of organs of the human body. As much as possible, no x-rays, no drugs, no medicines be given to
a pregnant woman (except iron and B9 or folic acid). Iron to avoid anemia and B9 to continue pregnancy. No aspirins
for pregnant woman. Amoxicillin is the least harmful antibiotic.
Gestation
Full term (FT) – the newborn was delivered from 38-42 weeks, 9 months or 10 lunar months
Prematurity is when fetus is delivered less than 32 weeks AOG
Not all small babies are premature. SGA or Small for Gestation Age babies are those fullterm babies but underweight and small in size
(usually children of smoking mothers).
Abortion – unscheduled termination of pregnancy
Types:
1. Spontaneous abortion – miscarriage
2. Induced or criminal abortion
Abortifacients – drugs given orally or injected which cause violent forceful contraction of uterus leading to expulsion og the fetus.
E. Comparative Anatomy – study of complexities in structure and function of parts of the body as compared to other animals.
Telencephalon – cannot be found in the brain of other animals
Diencephalon - thalamus

II Biochemistry - study of biomolecules and their metabolic roles in health and life processes.
III.Pathology – study of abnormal structures and functions of parts of the body.

IV. Pharmacology – study of drugs or specially-formulated chemicals used to cure a disease process or prevent its
complications.
Features or Characteristics of a living cell

1. Excitability or irritability – ability to respond to a stimulus
Stimulus – a sudden change in the environment enough to elicit a response
2. Conductivity – ability to transmit or spread a wave of excitation to other parts of the body.
3. Contractility – ability to shorten and to return to its original dimension without breaking
4. Respiration – exchange of carbon dioxide and oxygen in the lungs and in the cells.
5. Absorption – passage of nutrients across walls of GIT (esp. jejunum unto the bloodstream)
6. Assimilation – selective uptake of specific nutrients by cells for a special metabolic function
7. Biotransformation or metabolic degradation – ability to convert harmful substances into less toxic or non-toxic particles (liver)
8. Excretion – removal or expulsion of waste or metabolic by-products from the body.

A. Kidneys – major excretory organs. Urinary output is 1ml/min or 60ml/hr
B. Lungs – major excretory organ of volatile (gaseous) acids like Carbolic Acid. 200 ml of carbon dioxide is expelled from the
lungs per minute
C. Skin
Insensible water loss – water lost thru breathing, talking and from evaporation in skin. 10ml/kg of body wt/day
D. Stool – undigested, unabsorbed food residue. 150-200 grams/day
Constipation –irregularity in bowel movement
Obstipation – bowel movement every week
9. Secretion – process by which the cell takes up a substance from the blood, converts it into another substance inside the cell and is
subsequently expelled
10. Growth – increase in bulk or mass of an organism

A. Hyperplasia- increase in number of cells
B. Hypertrophy – increase in size of cells
Permanent cells – cells which from growth throughout life, their number is finite or constant. They do not undergo series of cell division
and multiplication. If they die, they are not replaced by cells of their own type. These are the nerve and muscle cells, they do
not undergo cancer.
Astrocytoma – most malignant cancer
11. Reproduction – ability to produce offsprings with same likeness as parents or progenitors in terms of structure and function of body
parts.
Mutation – significant change in the genetic composition of an organism leading to deformity and abnormality in its structure and
function.
Genome – entire genetic blueprint of man

12. Integration – ability of organs, different as they are from each other in terms of structure and function, to coordinate with each other
so that the body functions as one unit.
Tissues – aggrupation (grouping) of cells based on

1. similarities in structure
2. related functions
Types of tissues
a. Epithelial
b. Connective
c. Muscular
d. Nervous
Functions of Epithelial Cells

1. protective covering of the body
2. lining of body cavities
3. coverings of visceral or internal organs
4. absorption of nutrients
5. secretion and excretion
Classifying epithelial tissues based on:

A. Shape
1. squamous – flattened, oblong
2. cuboidal – squarish
3. columnar – rectangle in upright position
4. transitional – capable of changing shape depending on volume content of organs where it is formal.
Eg. Urinary tract
B. Number of layers
1. simple – one-layered
2. stratified – with several layers
3. pseudostratified – several layers but the nuclei are not on the same level
Specialized Modification of Free surface of Epithelium

1. Villi – multiple, motile, finger-like projection
- absorption of nutrients (eg. Jejunum)
Microvilli - even smaller projection
- further enhance absorption of nutrients
Brush borders – villi found at proximal convoluted tubules. It increases reabsorption of filtrate back to the blood
2. Stereocilia – same function as villi, however, it is taller, bigger, non-motile. Only 1 stereocilia per epithelium
3. Cilia – motile, multiple, finger-like projections whose tips are moistened by mucin. It traps dirts and airborne microbes and dust
particles. Trachea has a pseudostratified columnar ciliated epithelium. The cilia move upward slowly and when the
dirt reaches the larynx, we cough.
5 pack years – 1 pack of cigarettes/day for 5 years
COPD – Chronic Obstructive Pulmonary Disease
1. Chronic bronchitis – dry, unproductive cough
2. Pulmonary emphysema – dyspnea
4. Flagellum – has same function as cilia
- taller, bigger, non-motile. There is only 1 flagellum per epithelial cell
Epithelial Membranes – several layers of epithelial cells compressed into sheets

1. Serons – thinnest, most fragile, transparent
- has 2 layers

a. outer parietal has 10-20 ml of
b. inner visceral clear, watery fluid between them
- eg. Pleura – covering of lungs

Pericardium – covering of heart
Peritoneum – covering of the abdomen
- pleural effusion – accumulation of too much water in the pleura
2. Mucous membrane – always moist (because of mucin), shiny and glistening. Its basement membrane is Lamina propia
-found in:
a. digestive tract
b. respiratory tract
c. genitor-urinary tract
3. Fibrous – strongest and most durable membrane because of its high fiber content
a. Superficial fascia – separates layers of skin
b. Deep fascia – covers big nerves, blood vessels, tendons and ligaments
c. periosteum – covering of bones
d. perichondrium – covering of cartilages
e. synovium – covering of joints
Osteoarthritis – most common degenerative effect on bones (bigger joints)
Rheumatoid arthritis – smaller joints (fingers and wrists); can affect both hands
- affects females at the age of 35. Mostly affected are females
Gouty arthritis – affected are the big toes of the males ; illness of males
-gout crystals = tophi
4. Cutaneous membranes or skin
Connective Tissues – composed of:

1. Ground substance – a homogenous matrix on which the connective tissue structures be built on. It contains
micropolysaccharides (complex carbohydrates)
a. Hyaluronic acid – most abundant
b. chondroitin sulfate
2. Fibrillar components – they form a meshwork of interconnecting fibers on which cellular components of connective tissues attach
themselves.
a. collagen fibers – most abundant protein fiber in the body. It provides strength to connective tissues
b. elastic fibers – provides elasticity and moldability of connective tissue
c. keratin fibers – keratin is an insoluble, indigestible protein; no human digestive enzyme can digest or break it.
It provides solidity to the connective tissues. Eg. hair, nails
3. Cellular components
a. loose connective tissues – they have more cellular than fiber component
b. dense connective tissues – they have more fibrillar than cellular component (more solid)
1. Dense regular connective tissues
- the fibers are arranged in an orderly, tight and compact manner. Eg. Bone connective tissue
2. Dense irregular connective tissues
- the fibers are arranged in a random, haphazard manner
Cellular components of Connective Tissue

1. Mesenchymal cells – undifferentiated cells deployed among capillaries. They can still be converted into any connective tissue type.
2. Fibroblast – secrete cement substance that binds cell membrane together that anchor epithelium to its basement membrane.
3. Adipocyte – fat cell whose nucleus is displaced to one corner which looks like a glistening drop of oil. Triglycerides are groupings or
colonies of fat in a subcutaneous layer which can be alternate source of energy.
4. Monocyte – biggest white blood cell. It has a nucleus which looks like a kidney or bean.
- Capable of phagocytosis – ability to eat or engulf microbes and dust particles
5. Histiocytes – biggest phagocyte or macrophage in the body. It is not a white blood cell.
6. Eosinophil – white blood cell whose nucleus contains granules that stain with dyes like eosin and hematoxylin.

Eosinophilia – term to describe a significant increase of esinophils in the blood count. Normal is 1-6/100 WBC.
Eosinophilia may be due to:
1. bronchial asthma
2. hypersensitivity or allergy to food or drugs
3. eczema
4. hay fever
5. allergic rhinitis – sneezing upon waking up and at 10 am the symptoms become worse
6. parasitism or worm infection or helminthiasis
7. Plasma cells – small connective tissue cells with a nucleus that looks like a cart wheel.
- mother cell of all antibodies or immunoglobulins which belong to the gamma globulin type
8. Lymphocyte – smallest white blood cell. Capable of phagocytosis and used to combat chronic or long standing infections.
Eg. Pulmonary tuberculosis, leprosy, AIDS
9. Mast cells – big connective tissue cells with granules in their cytoplasm. These granules release:
a. Histamine – substance that causes signs and symptoms of allergy like rashes, itchiness, urticaria and hives
b. Serotonin or 5-hydroxy-tryptamine – derived from tryptophan. Platelets have high amount of serotonin with is a
vasoconstrictor effect
c. Heparin – systematic anti-coagulant. It prevents formation of excessive blood clot, therefore, maintaining its fluidity.
Integumentary System
Skin
– most extensive organ of the body. Surface area is 20 sq. ft. and takes up 10-15% of cardiac output
- thickness = 1/12 inch; 1/8 inch = thickest skin on the sole; 1/32 inch = lower lids
- with 3 pigment colors:
1. melanin – brown, 85%
- all people have the most abundant pigment
- derived from amino tyrosine
Albinism – error of protein metabolism due to the deficiency of enzyme tyrosinase. An albino has very fair skin; soft,
fine, short hairs
2. Hemoglobin – oxygen carrier
- pigment that gives the blood its red color; 10%
3. Carotene – pigment that gives yellowish tinge on oriental skin
Layers of the skin

1. Epidermis – thinnest
- ectodermal in origin
- avascular – no blood supply
-dead skin cells
Layers of Epidermis
1. Stratum corneum – also called horny layer because of its tought cornified surface made of stratified squamous keratinizing
epithelium. It has keratin that makes epidermis impervious (not penetrated) to water.
2. Stratum lucidum – also called clear cell due to the protein eleidin that gives palms and sole their transparent looks.
3. Stratum granulosum – layer where skin cells die. It contains keratohyaline granules which are precursors of keratin. It contains 7-
dehydrocholesterol (ergosterol in mammals) which when exposed to sunlight is converted to vitamin D3 or cholecalciferol.
7 to 8am – best time to sunbath babies (15-30 mins)
4. Stratum spinosum – prickle cell layer; so called because the membrane of skin cells have spines and spicules
5. Stratum basale – innermost layer of epidermis. Layer where new skin cells are born. Active mitosis take place here. Also called
stratum cylindricum, stratum germinativium or stratum basale malphigi
Epidermidization – gradual replacement of dead skin cells on the surface by underlying new skin cells. It takes 28 days.
2. Dermis – thickest
-mesoderm in origin
- vascular
Layer of the Dermis

1. Papillary layer – contains blood vessels that supply oxygen and nutrients to the overlying epidermis
2. Reticular layer – inner layer where most of the skin appendages arise
Eg. Hair follicle, sweat gland, sebaceous gland
3. Subcutaneous layer – tela subcutanea or fat layer

Function:
a. insulation – keep internal body warmth against a cold environment
b. source of energy
Types of fat:
a. oleic acid – mono-unsaturated fatty acid of which human fat is made
b. triglyceride or tri-acylglycerol
Functions of the skin
I. Protection
A. Infection
Commensals – microbes normally found in certain parts of the body without causing any harm.
-eg. Staphylococcus, streptococcus, micrococcus
B. Solar Rays
UV α – drying, wrinkle-forming rays
UV β – deeply penetrating; can cause melanoma
UV γ(gamma) – destructive and killing rays
Ozone layer – deflect, filter, block the UV rays
SPF – Sun Protection Factor
- measure of protective blockade of sun rays by sunblocks or sunscreens
- SPF 15 – most common and for normal skin
- the lighter the skin, the higher the SPF should be
- re-apply sunblock every two hours
II. Sense Organ
A. Receptors are specialized cells in epidermis which are sensitive to a specific stimulus
B. For light touch – Merkel’s disc, meissner corpuscle
For pressure – Vater Pacinian corpuscle or Don Mazzoni. They are the biggest and most deeply located
C. End bulb of Krause – for cold
D. Ruffins corpuscle – for heat
E. Free nerve endings or bare raw endings – pain receptors are most widely stabilized
Types of Pain
1. Somatic pain – those that come from organs derived from ectoderm and mesoderm
- can be relieved by aspirin or acetaminophen or paracetamol
Eg. Cephalalgia- ordinary headache
Myalgia – muscle pain
Arthralgia – joint pain
Otalgia – ear ache
Odontalgia – toothache
Neuralgia- nerve pain
2. Visceral pain – pain arising from organs derived from endoderm
- not relieved by aspirin or acetaminophen; celecoxib can be given
Eg. Dysmenorrhea
III. Temperature Regulation

Thermostat – thermoregulatory center, pre-optic area, anterior hypothalamus
Methods of Heat Loss by Skin
1. Radiation – escape of heat from the body in the form of invisible infrared rays

2. Conduction – escape of heat from warm to cooler substances
3. Convection – escape of heat as carried by cooler air currents.
*every time a child convulses, some nerve cells die
4. Evaporation – most common way of heat loss by skin; with heat passing from liquid to vapor state.
IV. Storage of Vitamin D

7-dehydroxycholesterol
UV rays
or Vitamin D3 or cholecalciferol
from the sun
ergosterol
V. Excretory Organ
- sweat is a hypotonic solution
- NH3, Uric Acid, Urea, Lactic Acid, Ascorbic Acid
VI. Legal Identification

-The pattern or creases and ridges in the fingers and toes are unique in every individual;
Appendages of the Skin

1. Nails – cornified epidermal tissue; keratinized
- sulfur containing amino acids to strengthen methionine, cysteine
- zinc
- it grows 1mm/week
*lunula – crescent-shaped; located at the base of the nail
*eponychium – cuticle
- paronychia – ingrown toe/finger nail when the cuticle is removed
*Felon – entire pulp of pinger is inflamed with pus
*Damaged fingernails – 6 to 9 months to grow back; toe nails – 9 to 12 months
2. Hair – modified cornified epidermal tissue; keratinized
- follicle – living part; shaft – non-living part
- histiologically, the parts of the shaft are; cuticle (outermost), cortex (middle), and medulla (core)
Hereditary aspects of hair

a. Color
-250,000 – amount of scalp hair
b. waviness or curliness
straight hair – hair follicle is straight
wavy or curly – follicle is slightly bent
kinky – follicle is extremely crooked
c. premature graying of hair
d. alopecia – estrogen makes the hair long and healthy
DHT – dehydrotestosterone
- responsible for killing the hair follicles
- wavy hair is more predisposed to alopecia than straight hair
Alopecia is more probable in males
- whose grandfather and uncles on the mother side are bald
- whose scalp hair is curly or wavy
- who are more hairy than other guys. This excessive hair implies excess testosterone which could lead
to prostate problems once he reaches 40 y/o (either BPH or prostate cancer)
Types of Hair
a. Lanugo – embryonic hair that covers the body of newborns. These very soft, fine, short hairs are shed off after
1 month and are replaced by coarse, darker vellus hairs
b. Bristle hair – short, stubby hair with a definite length and size. Eg. Nostril hairs, eyebrows, eyelashes
c. Scalp hair – longest hair in the body
Phases of hair
1. Anagen – active growth phase
2. Telogen – resting phase
- scalp hair grows at a rate of ½ inch per month
- seborrheic dermatitis – dandruff
d. Sexual hair – they develop during puberty under the mediation of hormones
- males and females both have axillary and pubic hairs. In addition, ordinary healthy normal males have mustache,
beard and leg hairs. Men with excessive testosterones have goatee, sideburns, hair on the chest, thighs,
back and peri-anal area.
3. Glands
I. Sebaceous Glands – compound tubular glands which grow alongside hair follicle. It secrets sebum (clear, oily liquid that serves as
moisturizer of the skin).
Stages of Pimple formation
a. Folliculitis – clogged skin pore due to secretion of too much sebum.
b. Comedone – an elevation of the skin due to accumulation of dissolved sebum, dirt and other cellular wastes. Depending on
the content, a comedone may either be whitehead or blackhead
c. Acne vulgaris – reddish, swollen, itchy skin lesions especially of the face with pus formation, due to corynebacterium acne
microbe. Active acne may be treated with antibiotics like tetracyclines and macrolides (erythromycin, lincomycin and
clindamycin)
Factors that exacerbate acne
a. hormonal ups and downs
b. erratic sleep cycles
**Pimple breakouts are more common in women who are: ovulating, on the 1st trimester of pregnancy, and on pills
II. Mehbomian glands- modified sebaceous gland. It secretes Mehbom which moisturizes the lower lids
III. Sweat glands – simple tubular gland
Types:
a. Eccrine – more common type. Present at birth and active throughout life. the sole has the most abundant eccrine glands.
b. Apocrine – special type of sweat glands which develop only during puberty, thus, hormonally affected
- found in axilla, underneath the chin, peri-areolar area, groins and anal region
Modified Sweat Glands
a. Ceruminous glands – in the outer part of the ear; secretes a yellow substance called cerumen
b. ciliary gland – secretes a whitish cheesy material that collects at the corner of the eyes called mote.
SKELETAL SYSTEM
- composed of bones, cartilages, joints and other articular surfaces
Functions
I. Protection of vital organs
II. Point of attachment for muscles for movement and posture
III. Storage of mineral salts
IV. Structural framework of the body
V. Hemopoesis – formation of blood cellular elements
Types of Bone Marrow

1. Red marrow – contains progenitors (mother) cells of RBC, WBC and platelets
2. Yellow marrow – contains fatty tissue (purely cholesterol)
Bone Marrow Puncture – a minor surgical procedure to obtain marrow for diagnosis of blood dyscrasia (diseases that arise from bone
marrow abnormalities like leukemia, aplastic anemia, thrombocytopenia). In adults, bone marrow is obtained from corpus
sterni, while in children, it is at the iliac crest or anterior superior iliac spines of pelvis.
Ossification – process of bone formation
10 | P a g e MERYL P. RAMIREZ, BSN, RN
Types of Bone Formation
I. Direct or Intramembraneous Method
- a young bone develops into mature adult bone. Cranial and facial bones, except mandible, develop this way.
II. Indirect or Enchondral or Endochondral Method
- a hyaline cartilage scale model is a starting structure which is slowly replaced by bony structure. Most of the 206 bones in
the adult skeleton develop this way.
Bone is a dense regular connective tissue. The bone is a very vascular tissue receiving about 15% of total cardiac output.
Bone is 60% solid and 40% water. The solid portion of the bone is subdivided into:
I. Inorganic component – mineral salts (calcium) that give the bone its characteristic hardness, resiliency, strength and solidity.
II. Organic components – are those which give the bone its elasticity, moldability and flexibility. They are:
1. mucopolysaccharides
a. hyaluronic acid
b. chondroitin sulfate
c. dermatan sulfate
2. proteins
a. collagen – provides 90% of protein in bones. It is a tri-helical structure made of alternating glycine,
OH-proline, OH-lysine. The collagen in bone is type I and II. Collagen is made more soluble and digestible if
boiled to form a soluble gelatin.
b. elastin fiber – give bone its stretchability
c. reticular fibers – fine delicate fibers that form a mesh on which calcium salts are attached.
d. non-collagenous protein – comprised of 20% of protein in bones
1. Osteocalcin – most abundant non-collagenous protein
2. Osteomectin
3. Ospontin
Fracture – a weakness in the structural intergrity of the bone
Callus – scar tissue of a fractured bone
Adult bones contain 67% Inorganic and 37% Organic component. Children’s bones contain 67% Organic and 37% Inorganic
component. Therefore, despite the hardness and solidity of adult bones, they are more susceptible to fracture, and if broken, it takes a
longer time to heal.
Vitamins involved in Ossification

1. Vitamin C – ascorbic acid
Richest sources are citrus fruits, tomatoes, pepper and guavas. Its role is as co-enzyme in the hydroxycation of proteins and
lysine to form hydroxyproline and hydroxylysine in the formation or synthesis of collagen. Minimum dietary requirement is
75-100mg/day and recommended daily allowance is 500mg/day.
Scurvy or scorbutus – deficiency of vitamin C.
-gum bleeding is the earliest symptom of scurvy, followed by epistaxis
Skeletal deformities of scurvy include
1. Pectus carinatum (gallinatum) or pigeon-breasted deformity
2. Genuvarum- bowlegged
3. Genuvalgum – knock knee
2. Vitamin A – it stabilizes the osseous matrix and epithelium of bone.
3. Vitamin K – for coagulation.
- important in the formation and synthesis of non-collagenous proteins especially osteocalcin.
***Hemostasis – ability to form blood clot
***aplastic anemia – all cells are down
***facial feature is fixed at 16 for males and at 15 for females
***coccyx – 4 bones during childhood and becomes 1 in adults
***fibula – slenderest and most fragile bone in the body
4. Vitamin D – calciferol
-concerned with calcium metabolism
a. D2 – ergocalciferol
- comes from milk, cheese, yogurt, seafoods, shellfish

b. D3 – cholecalciferol
- conversion of 7-dehydroxycholesterol by UV rays of the sun
Inside the body, it is activated thru hydroxylation (+OH)
1. in liver 25-OH-cholecalciferol (calcidiol)
2. in kidneys 1,25 dehydroxycholecalciferol (calcitriol)
***renal-1-alpha-hydroxylase enzyme – convert calcidiol to calcitriol
Calcitriol – most potent, strongest active form of vitamin D
Most important metabolic function of vitamin D is to increase synthesis of transport proteins to carry calcium and phosphorus
across walls of the jejunum.
5. Calcium – most abundant divalent cation in the body

Dietary form of calcium
a. CaSO4
b. CaCO3
c. CaCO2
d. Calcium gluconate – most common injectable form of Ca supplement
Hypocalcemia – decreased blood level of calcium
Signs of hypocalcemia
a. Trosseau’s Sign – hyperextension of wrist and clawing of fingers and toes
b. Chvostek’s sign – spasmodic contraction of face when the front of the ear is tapped
Hypercalcemia – excess Ca in blood
6. Phosphorus – same dietary source of calcium

- absorbed easier than calcium especially in the presence of B2 – riboflavin
- it reacts with 04 in blood to form PO4
Bone Cells
1. Osteoblast – young bone cells. They secrete more osseous matrix materials. An increase in blood levels of enzyme alkaline
phosphatase signifies active bone formation.
2. Osteocyte – adult, mature bone cell
3. Osteoclast – multinucleated bone cells responsible for trimming off or removing excess bone growths. In dynamic remodeling of
adult bones, osteoclast favors the resorption (removal) of excess mineral salts from the bone. However, too much activity of the
osteoclast would result to demineralization. Reabsorption or mobilization of calcium salts from the bone leading to bone weakness. An
increase in serum levels of enzyme acid phosphatase signifies active bone destruction as when prostate cancer metastasizes to the
vertebral column.
Major Hormones in bone formation

1. Parathormone – PTH secreted by the parathyroid glands – the smallest endocrine gland which are 4 in numbers, located at the
superior posterior aspect of the thyroid gland.
- PTH is a single polypeptide chain with 84 amino acids. It is the major regulator of blood levels of Calcium
- Hypocalcemia is the adequate stimulus for the secretion and release of PTH
Effects of PTH
a. Stimulates the activity of osteoblast in bone formation and helps in its maturation into osteocyte.
b. It enhances removal of cacium salts from the bone to the blood
c. together with vitamin D, it increases absorption of calcium and phosphorus in the jejunum
d. it stimulates the enzyme renal-1-alpha hydroxylase in the conversion of calcidiol to calcitriol
e. it increases the excretion of phosphate in the kidneys
Extra-osseus metabolic functions of calcium
a. blood clotting
b. nerve conduction
c. muscle contraction

2. Calcitonin – also called thyrocalcitonin, secreted by the C-cells of thyroid gland. It is a single polypeptide chain of 32 amino acids.
-hypercalcemia is the adequate stimulus for secretion and release of calcitonin. It is the physiologic antagonist of
parathormone.
Major functions of calcitonin
a. It increases the deposition of calcium salts into the bone
b. It inhibits the resorptive actions of osteoclasts
- the effect of calcitonin on bones is sudden and shortlived where as PTH are sustained and longer lasting.
3. Calcitriol – most potent form of Vitamin D. It increases absorption of calcium and phosphorus in the jejunum by increasing the
synthesis of their respective carrier or transport proteins.
Major Hormones in Bone Formation

1. Growth hormone – also called somatotropin. It is secreted by the anterior pituitary in response to sleep, cold weather
and hypoglycemic episodes.
- the actual growth-stimulating and enhancing effects of growth hormone is mediated by somatomedin-C
- growth hormone exerts its greatest effect on epiphyseal or growth plates of hormones during puberty like
femur, tibia, fibula, humerus and ulna radius until 18 for females and 20 for males.
- excessive production of growth hormone before and during puberty leads to gigantism – marked growth of long bones.
- Acromegaly is exaggerated growth and development of plat bones. This is the result of too much production of growth
hormone after puberty.
- Pituitary dwarf is someone deficient in growth hormone since childhood. He is short in stature but IQ is not affected.
2. Thyroid hormones
T3 – tri-iodotyrosine
T4- tetroiodotyrosine or thyroxine
Thyroid hormones do not initiate growth processes. They, however, enhances, magnify and optimize growth by increasing
basal metabolic rate.
Cretinism - hypothyroidism in children
Cretin dwarf – short in stature, mentally retarded and underdeveloped genitals.
Idiotic IQ – 60 to 70
Myxedema – hypothyroidism in adults
- height not affected
- very slow, lethargic, intolerant to cold
3. Sex hormones
Male:
Testosterone
a. sebaceous gland
b. hair follicles
c. vocal chords
d. reproductive
i. testicles
ii. seminal vesicle
iii. penis – 13-17 y/o (growth) 18 y/o – 80% is already developed
iv. prostate – at 45 y/o prostate cancer usually occurs
BPH – Benign Prostatic Hypertrophy
- frequent urination at night
e. epiphyseal plates
Female:
A. estrogen – makes the breast larger and the skin smoother
- effects are more on the long bones
- affects the scalp hair
B. Progesterone – affects the hips and shoulders
- effects are more on the sebaceous gland and flat bones
- affects long hairs and fuzz of hair above the lips and in the arms

Steroid hormone – result to brittleness and fragility of bones when used for prolonged period of time
Muscular System
Specialized properties
1. Contractility
2. Excitability
Properties of nervous system
3. Conductivity
Functions
1. Movement
Isotonic contraction – contraction in which the muscle fiber length varies but tone/tension within muscles remains the same
Isokinetic contraction – repetitive contraction of large groups of muscles (for stroke/heart attack)
2. Posture and leverage
Isometric contraction – contraction in which the length of muscle fibers does not change but tone/tension within the muscles
increases. Eg. Reading a book for a long time, the muscles in the neck contracts to prevent the head from going up
or down)
Leverage is maintenance of a steady balance positioning of body against force or gravity
3. Generation of internal heat
Shivering is an adaptive mechanism to cold
Arrhythmia – irregular movement of the heart
- blood vessels constrict during winter which causes stroke or heart attack
4. Digestion/Absorption
5. Respiration – exchange of oxygen and carbon dioxide
6. Excretion –have 2 aspects:
a. Defecation b. Urination
7. Parturition
8. Reproduction
Types of Muscles
1. Striated muscles – so called because of cross striations in their myofibrils, which give them striped appearance
Voluntary – controlled by will or volition
80% of striated muscles are attached to bones so they are called skeletal muscles; all skeletal muscles are striated
Origin – point of bone attachment which is fixed
Insertion – point of bone attachment which is movable
Sartorius – longest skeletal muscle, also called Tailor muscle
Stapedius – shortest skeletal muscle, located at the middle ear
2. Smooth muscles – non-striated because they don’t have cross striations found in visceral and internal organs, tunica media or
middle layer of the blood vessels
Involuntary – not controlled by the will. It is controlled by:
A. Intramural nerve plexus embedded in walls of muscle (intra – within; mural – walls)
- have nerve fibers
B. Autonomic Nervous System
Smooth muscles do basal metabolic contraction; 13-15/min if active, 9-11/min if asleep
3. Cardiac Muscle – found in myocardium of the heart, pericardium and ascending aorta
A. Cross striations
B. involuntary
-fibers are arranged in syncitium – arrangement of muscle fibers therefore faster velocity on conduction making the heart the
fastest in conductivity
syncitium

Intercalated disc – branching of terminal endings of each muscle fiber surrounded by an electromagnetic field which contributes to
fastness of transfer or velocity.
Muscles based on group action

1. Agonist – also called Prime Movers because they contract actively to produce specific movement
2. Antagonist – muscle that must relax while the agonist muscles contract.
Eg. In flexing or flexion of arm at the elbow joint, the agonist is the biceps and the antagonist is the triceps
3. Fixators – large groups of muscles, usually axial or truncal in location, that stabilizes and steadies a big joint
Eg. Shoulder girdle muscle, pelvic girdle
4. Synergist – muscles that contract simultaneously with agonist to enhance and magnify the desired muscle contraction
Muscle bundle – biggest gross structure of a muscle
Belly – anatomic center of the muscle bundle
There is NO direct connection between the muscle and the bone. A tendon connects them.
Aponeurosis – flat, broad tendon
Fascial coverings of muscles

1. Epimysium – fascia that covers the entire muscle bundle
2. Perimysium – fascia that covers fascicle- collection of 10 or more fibers
3. Endomysium – covering of a single muscle fiber
Vitamin B1, B6, B12 – provides ATP to the brain
Myofibril – smallest contractile unit of a muscle fiber. A myofibril contains myofilaments

Types of myofilaments
a. Actin – thin myofilaments
b. Myosin – thick filaments
There is a 2:1 ratio of actin to myosin
Structure of Actin
It is a double helical structure which contains a colloid (protein) between the 2 helices. In the center of the tropomyosin colloid
is another protein called troponin.
1. Troponin T – connects with tropomyosin
2. Troponin I – locks the cross bridges connecting the actin and the myosin
3. Troponin C – reacts with calcium
Actin Tropomyosin Troponin
Myosin has 2 components:

1. Light meromyosin
2. Heavy meromyosin
Steps in Muscle Contraction

1. NAP or Nerve Action Potential or a nerve impulse originates in motor area or Broadmann Area #4, in pre-central gyrus of the brain
Broadmann – mapped the brain and determine the function of its parts
2. NAP descends into the anterior motor neurons at the ventral horn or anterior column of the spinal cord
Cervical – 1 to 8
Thoracic – 1 to 12
Lumbar – 1 to 5
Sacral – 1 to 5
Coccyx – 1
3. NAP is carried by the spinal nerve (motor half) then divides into many somatic nerves to supply skeletal muscles

Somatic nerves – supply a voluntary muscle
Autonomic nerves – supply an involuntary muscle
4. Motor Unit or Motor End plate is a somatic nerve and the muscle fiber it supplies
5. Arrival of NAP at tips of nerve fiber causes release of acetylcholine into synapse and into sarcolemma
6. Acetylcholine reacts with receptor sites in muscle membrane leading to increased permeability of sarcolemma
7. Sodium enters muscle cell, potassium exits from the muscle
8. This Na-entry-K-exit is signal for Ca++ in the membrane to enter the cell
9. Ca reacts with Troponin C, thereby unlocking the crossbridges
10. Creatine phosphate + ADP (Creatine phosphokinase) ATP + creatine
11. With ATP available as energy, the Actin slides over the stationary myosins towards the middle of the intermediate bond
12. Shortening of sacromere shortens the myofibril, shortens muscle fibers leading to muscle contraction
Myasthenia gravis – low Ach; causes paralysis
Choline esterase – destroys Ach
Muscle dystrophy – primary muscle disease in which muscle cells progressively die causing the person to have
difficulty in moving its muscles
Metabolic or Biochemical Requirements for Muscle Contraction

1. source of energy
a. creatine phosphate + ADP ATP + creatine
b. phosphagens – alternate source of energy in which phosphorus couples with nitrogen instead of oxygen
c. food that we eat
i. glucose – most abundant blood sugar
ii. fatty acids
2. Calcium
3. Oxygen
Lactic acid muscle cramps
ATP harvested from glucose is higher under aerobic conditions (36 ATP) than in anaerobic conditions (2 ATP). Insulin makes
the wall of the muscle more permeable so that the glucose can enter.
Most common findings in diabetes:
a. high blood sugar
b. high urine sugar
Glycolysis – conversion of glucose to pyrovate to increase oxygen
Nervous System
- most highly integrated system in the body. Together with endocrine system, it directly and indirectly affects the activity of
other organs.
Divisions of the Nervous System

1. Central Nervous System (CNS) – brain and spinal cord
2. Peripheral Nervous System (PNS) – 12 pairs cranial nerve, 31 pairs spinal nerves, Autonomic Nervous System
Cells of Nervous System

1. Neuron – nerve cells
2. Neuroglia – glia cells
Neuron – fundamental, structural and functional unit of the Nervous System
Functions of the Nervous System

1. cognitive function
2. storage and recall memories IQ
3. analysis – conclusion, judgment
4. reason and logic

5. motor
6. sensation, interpretation or perception
7. Autonomic functions
Neuron or nerve cell – 1 nucleus, several nucleoli
- many mitochondria thus actively metabolizing
- permanent cell
Source of energy of neuron:
1. Glucose is freely diffusible; 80-90%
2. Glutamine – 10% (protein)
3. Under severe situations (starvation), the body may use ketone bodies from fats
a. acetone
b. acetoacetate
c. beta-OH – butyric acid
Processes of Neurons
1. Dendrite – short, thin processes that carry impulses toward the cell body
2. Axon or axon cylinder – big, thick, long processes that carries impulses away from cell body of neuron
Types of Neurons According to Number of Processes

1. Unipolar – one axon, no dendrite
Eg. Cerebrospinal ganglia
Ganglion – collection of neurons outside the central nervous system

2. Bipolar neurons – one axon, one dendrite
Axons fuse to form cranial nerve VIII
Eg. Basilar membrane (ear)

Olfactory membrane (nose)
Retina (eye)
3. Multipolar – many dendrites, only one axon. Most common type
Based on function, a neuron is:

1. Sensory, if it integrates sensations and feelings
2. Motor, if it controls muscle activity
3. Association or Internuncial Neuron – also called linking because they connect sensory impulses with motor responses
Dorsal horn – sensory

Ventral horn - motor

A reflex arc contains
1. receptor
2. sensory arm
3. dorsal root ganglion
4. posterior column cells
5. internuncial neuron
6. anterior motor neuron cells
7. motor arm
8. skeletal muscle
Based on direction of impulse

1. Afferent neurons – send impulses towards the spinal cord and brain- ascending
2. Efferent neurons – sends impulses away from the brain and spinal cord - descending
Neurolemma – cell membrane of neuron. It also has 4 layers. 70% of it is fat to conductivity
- high LDL
Neurofilament – needle-like structures within the neuron that conducts impulses inside the neuron. Neurolgia does not have
neurofilaments.
- located along the longitudinal axis of neuron
Nissl granules or Nissl bodies – also called tigroid bodies or Chromidial bodies, which are specialized endoplasmic reticulum. They are
the first to dissolve (chromatolysis) if the nerve does not receive oxygen for 6 minutes. Even if the patient is revived, he goes
into a vegetative state.
Meaning of fainting:
1. syncope
2. Myocardial infarction
Myelin sheath – made of fat phospholipid - sphingomyelin

Schwann cells – secrete myelin sheath
Nodes of Ranvier – areas along axon cylinder divested or not covered by myelin sheath
Saltatory conduction – a very fast method of conduction in which the impulse jumps from one node to next node of Ranvier
As a rule, a nerve conducts impulses faster if:
1. it has a big diameter
2. it is myelinated

Myelinization or investment of myelin sheath on nerve fibers to all parts of the body is completed by age *.
A fibers – big nerves, myelinated Arcoxia – 60 mg= osteoarthritis
B fibers – medium-sized, myellinated - 90 mg = rheumatoid arthritis
C fibers – thin, small nerves, unmyelinated - 120 mg= dsymenorrhea, migraine
Pain is carried by A and C fibers
- blocks A and C fibers
One of the last nerves to be myelinated is nerve to the urinary bladder
Enuresis – “bed wetting”, uncontrollable urination at night
Nocturia – the need to wake up at night due to the urge to urinate
Synapse – physical space between neurons

Types of Synaptic Connections
I. Axodendritic – between a dendrite and an axon; most common
II. Axosomatic – between an axon and body of terminal receptor organ
III. Axoaxonic – between 2 axons; rarest type, found only in the brain
Neurohumoralism – process by which a nerve impulse is transmitted or spread from one neuron to next neuron involving release of
chemical agents called neurotransmitters into the synapse. The process is called neurotransmission.
Nerve impulse is an electrochemical process
Neurotransmitters in human Nervous System

1. Ach – acetylcholine
- major neurotransmitter in Nervous System
- major hormone of Parasympathetic Nervous System
- main neurotransmitter at neuromuscular junction
-inactivated by enzyme choline esterase
-it has excitatory, stimulant effect on Nervous System functions (helps us memorize)
-depresses heart rate
2. Serotonin –also called 5-hydroxytryptamine
- derived from the amino acid Tryptophan
Tryptophan –found mostly in milk and dairy products like cheese and yogurt
-it induces sleep by depressing the center of wakefulness
-it stimulates the ventromedial nucleus of Hypothalamus (satiety center), thus, the person does not get hungry easily.
Hunger center or feeding center- activated 1 hour before meal
-contained by platelets for muscle constriction
Milk – contains carbohydrate – lactose
- protein – whey, casein, rennin
- fats – linoleic acid, oleic acid
- minerals - Ca++, Phosphorus
- Vitamin – D, A, E
- water
Catecholamine – hormones and neurotransmitters

Tyrosine – non-essential amino acid or dispensable amino acid
+OH Tyrosine Hydroxylase

3,4 Dihydroxy Phenylalanine (DOPA)
-CO2 DOPA decarboxylase
Dopamine- inhibitory
+OH Dopamine Hydroxylase
Nor – Epinephrine – excitatory
19 | P a g e +CH3 Mepinephrine
E R Y L P .methylase
RAMIREZ, BSN, RN
Epinephrine - excitatory
A. Nor-Epinephrine (Nor-E) or Nor-Adrenaline
- excitatory neurotransmitter
- major hormone of Sympathetic Nervous System (80-85%)
- Phenylethylamine is a relative of Nor-E. Found in chocolates or cocoa-based foods and drinks. It provides an “emotional lift”
to depressed and sad persons
Amphetamines- so called “UPPER” because they give the user a feeling of Euphoria –
sense of optimum physical and mental well-being
Euphoria is the basis of addiction to certain substances. Metamphetamine is “SHABU”.

Depressed and suicidal people have very low Nor-E in their brain
B. Epinephrine or Adrenaline
- stress hormone
-fight or flight hormone
- anger, fear, pain, cold, excited
- burns glycogen glucose ATP for use of the body
- major hormone from Adrenal medulla
- 20% of hormone of Sympathetic Nervous System
C. Dopamine
- inhibitory to nervous system
- counteracts and balances the effect of Ach in muscle movement
- major hormone in the basal ganglia
- Parkinson’s Disease – low dopamine in the brain
- Dopamine is the cause of dependence and addiction to certain substances
Stages:
1. Habituation – increase in frequency and amount of substance taken in
2. Dependence – a worse form of habituation; already affecting personal and professional life
3. Addiction – obsessive-compulsive and irrational craving for that substance with patient forgetting ethical, moral and legal
Norms
D. GABA or Gamma Amino Butyric Acid
Glutamic Acid
Vit. B6 or Pyridoxine as Glutamic Acid Decarboxylase
co-decarboxylase
GABA
Proteins are brain foods

a. egg
b. lean meat
c. fish
d. nut
e. beans (the darker the bean is, the richer it is)
- GABA is an inhibitory neurotransmitter. Muscle relaxants, sedatives, tranquilizers, hypnotics (sleeping pills) exert their
calming effect on brain by acting on GABA receptors
2mg – muscle relaxants; 5mg – tranquilizers; 10mg – convulsion
Excitatory Inhibitory
Ach Dopamine
Nor-Epinephrine GABA
20 | P a g e Epinephrine M E R Y L Serotoni
P. RAMIREZ, BSN, RN
Neuroglia or Glial Cells
- same structure as neuron except that they have no neurofilament. They support cells and have no mental function.
Types:
1. Astroglia or astrocytes
- biggest and most abundant glia
a. Protoplasmic astroglia are found in grey matter of brain and spinal cord
b. fibrous astroglia – found mostly in white matter of brain and spinal cord
Astrocytoma or Glioblastoma multiforme – most malignant type of brain tumor
2. Oligodendroglia or oligodendrocyte
- responsible for maintaining normal water and electrocyte environment of the neuron
- <130 mEq/L of Na+ - results to convulsion
3. Microglia or microcyte
- smallest glia
- derived from mesoderm
- capable of phagocytosis or engulfing microbes and other particles
If the injury to a nerve in CNS is minor, microglia can repair it. Repair of cut nerves is possible only in the Peripheral Nervous
System. 98% of the nervous system is ectoderm. Microglia and meninges are mesoderm.
4. Ependyma – simple cuboidal cells that lien the ventricles of brain and central canal of spinal cord
Ventricle – a cavity or a container
Causes of brain cell death

A. Anoxia – Oxygen deprivation for 6 minutes
B. Trauma
1. Contusion is direct blow to brain tissue as in fractured cranial bone
Depressed fracture – the brain is depressed by the skull
2. Concussion – severe jarring of entire brain against cranial vault
3. Metabolic
a. hypoglycemia
b. hypocalcemia
c. hypokalemia
d. hyponatremia
4. Microbes
Eg. Meningitis, encephalitis
Transmembrane potential or Resting Membrane Potential

- a negative 80 millivolt of the inside, with Na+ outside, K+ inside and Ca++ on the cell membrane
The inside of all cells in the body is electronegative because of the presence of non-diffusible colloid particles (proteins) acting
as anions. Within every cell is an intracellular sodium pump which expels or extrudes any sodium that gets into the cells. That’s why
sodium is always extracellular.
Na+ Ca++
K+ -80mv
Depolarization – process of successfully stimulating a nerve in order to elicit a response in the form of a NAP (Nerve Acting Potential)
or nerve impulse.
Prerequisites of Depolarization
1. stimulus of sufficient strength/intensity
2. Application of stimulus
3. State of excitability of the nerve

Threshold stimulus – stimulus with least strength, strong enough to elicit a response. Also called Liminal stimulus.
Subthreshold stimulus – stimulus whose strength is just a little below threshold stimulus. If applied alone and just once, it will not
produce a response. However, repeated application in rapid succession will lead to approximation of threshold stimulus, by
then the nerve will respond.
Suprathreshold stimulus – stimulus whose strength is way above and beyond threshold intensity. The excess strength does not
increase the magnitude of the nerve response.
Chronaxie – time it takes to apply a stimulus whose strength is ½ rheobase
Absolute refractory period – time during which the nerve is totally excitable and is sensitive to any form of stimulation. This coincides
with its compulsory period of rest.
Relative refractory period – time during which the nerve is slightly excitable to generate an impulse, apply threshold stimulus
repeatedly.
All or None Law
A nerve (muscle) will always respond maximally provided it is applied with a stimulus of sufficient intensity, applied for correct
duration of time, when the nerve is sensitive to stimulation. Anything less, and the nerve (muscle) will not respond at all.
Steps in Depolarization
1. Sodium influx – massive, transient entry of sodium inside the nerve cell, changing its polarity to +30 mv
2. Potassium Efflux – exit of K+ the amount of which is the same as the number of Na+ that went in bringing polarity back to -80 mv
3. Activation of Sodium Pump – the Na+ that went inside is expelled outside, resulting to the most hyperpolarized state of the nerve.
Hyperpolarized – difference of the charges inside and outside is too much
4. Potassium influx – return of K+ back into the nerve cell, restoring its transmembrane potential

NAP or nerve impulse is an electrochemical force. The “electro” aspect is the exchange of Na+ and K+ across membrane
changing its electrical charges. The “chemical” aspect is the neurotransmitter released at the tip of the nerve fibers.
Role of Calcium in Nerve Conduction

- Ca++ guards the opening of pores or channels through which pass Na+ and K+
Hypocalcemia – low calcium in blood. There will be faster rate of nerve conduction. If too low, there might be excessive motor impulses
leading to convulsions – too much muscle contraction.
Hypercalcemia – excessive calcium in the blood. There is general slowing down of nerve conduction. If too much, it may even lead to
paralysis.
Divisions of the Human Brain

I. Prosencephalon or forebrain – youngest part
II. Mesencephalon or midbrain – smallest part
III. Rhombencephalon or hind brain – oldest part
Prosencephalon is subdivided into:

1. Telencephalon
A. Cerebral cortex
B. Rhinencephalon
C. Basal ganglia
2. Diencephalon
A. Dorsal portion – epithalamus
B. Middle portion – thalamus
C. Ventral portion – hypothalamus; subthalamus
Mesencephalon
1. Corpora quadrigemina
2. Edinger Westphal nucleus
Rhombencephalon
1. Metencephalon
A. Cerebellum
B. Pons varolii
2. Myencephalon – which includes medulla oblongata
Brainstem refers to midbrain, plus pons varolii and medulla oblongata
Matters of Nervous System

1. Gray matter – consists of neurons, neuroglia, cell bodies
2. White matter – does not contain nerve cells, only nerve fibers, nerve tracts
In the brain, the Gray matter is outer, white matter is inner. In the spinal cord, the white matter is outer, gray matter is inner.
The intellectual or mental part of the brain consists of 10 mm thick gray matter. This corresponds to the “mind” of the person.
Type of Nerve Tracts

1. Commissural – fiber that connects R and L cerebral hemisphere. Eg. Corpus callosum – biggest commissural fiber
2. Association fibers – fibers that connect structures within the same hemisphere. Does not cross to opposite hemisphere.
3. Projection fibers
a. ascending fibers – carry impulses towards CNS. Eg. Sensory impulses
b. descending fibers – carry impulses away from the CNS. Eg. Motor impulses
Sensory Pathways to Brain

I. Dorsal Column Tract – carries sensation of:
A. light touch
B. 2-point discrimination
C. Stereognosis
D. Graphesthesia
E. Proprioception
F. Kinesthesia – joint sense
G. Vibratory sense
II. Spinothalamic tract carries sensations of:
A. Pain
B. Heat
C. Cold
D. Deep pressure
Divisions
1. Lateral spinothalamic tract
2. Anterior or ventral spinothalamic tract
Motor nerve tract originates at motor area or Broadman area $, where pyramidal cells called BETZ cells control voluntary muscle
activity.
Divisions of Pyramidal tract

1. Lateral Corticospinal tract – 80% - crossed
2. Anterior or ventral corticospinal tract – uncrossed 20&; it reaches only cervical 8
Brachial plexus – C5,6,7,8; T1
- movement of the upper extremities
Ipsilateral – same side; Contralateral – opposite side
The sensory and motor function of Right half and Left half of the body is controlled by the opposite or lateral hemisphere.
Linea alba – separates the body into 2 equal sections
Paresis – muscle weakness
Plegia – muscle paralysis
Cerebral Dominance – from birth to age 6, both hemispheres share equal control of nervous functions. At 6, one of them becomes
dominant or active hemisphere and is evidenced by Handedness of the person
Handedness – strong preference for use of one hand in the performance of difficult, highly-skilled motor activity.
Ambidextrous – can use the left and right hand with ease and facilities
Rule of Handedness
1. All R handed persons are L cerebral dominant
2. Majority of L handed persons are (60%) L cerebral dominant
3. Minority (40%) of L handed persons are R cerebral dominant
4. The speech area is always on dominant hemisphere
Lobes of the Brain
I. Frontal lobe – one

- forms the convexity of the forehead. First lobe to regress (reduce in size) at age 65.
Functions:
a. Estabhlishment of future-oriented plans, ambitions, aspirations (encourages to move at present for the future)
b. Storage of old, childhood memories whose recall is easy, detailed and clear.
c. Frontal Gaze Center which together with Pontine Gaze Center, controls and regulates conjugate movement of 2 eyeballs.
Squint or strabismus – loss of conjugate movement of eyeballs
Types of squint:
PHORIA – latent squint
TROPIA – obvious squint

d. Premotor area, which prepares motor area for maximum muscle activity
Frontal lobotomy is a surgical procedure cutting off connection of frontal lobe with the rest of the brain.
II. Temporal lobe – two

- forms the base and lower sides of the brain.
Functions:
a. Heschl gyrus – auditory cortex which interprets all sounds in terms of:
1. amplitude – loudness
2. frequency – pitch
3. timbre – quality
4. laterality or source or origin of sound
b. Storage of recent memory
Ammon horn cells serve to receive and process all incoming sensory experiences
Amygdala and Hippocampus – serve to classify memories based on their intellectual and emotional value and importance to the person
Amnesia – temporary loos of memory
Retrograde Amnesia – inability to remember events of the immediate past
Brocca’s Area – speech area at junction of frontal and temporal lobe. Responsible for language formation and communication skills.
Wernicke’s Area – for understanding of written and verbal communication
Aphasia – abnormality in language and communication
Types:
1. Receptive aphasia – inability to understand and comprehend either written or spoken words.
2. Expressive aphasia – inability to find the correct words to say or to write, or to convey an idea, thought, emotion or feeling.
III. Occipital lobe – one

- forms the posterior convexity of the brain
Calcarine gyrus is the visual center which interprets all objects seen in terms of:
a. quality
b. 3 dimensional size
c. color
d. clarity
e. movement
IV. Parietal lobe – two

- forms the roof and upper walls of the brain
Functions:
a. Sensory cortex I or somesthetic center or Broadman 1,2
b. Sensory cortex II or Broadman 3
c. Angular Gyrus – located equidistant to sensory, visual and auditory cortices. Also called Gnostic are, knowing area or tertiary
association area. It integrates the sensation of touch, vision and audition as one meaningful memory.
V. Insula
- also called hidden or buried lobe because of its deep core location. Together with thalamus and hypothalamus, amygdale
and hippocampus, it forms the limbic lobe or visceral brain which regulates activity, responses, behavior of different visceral organs to
environmental stimuli.
Fissures of the Brain

1. Longitudinal fissure – divides left and right hemisphere
2. Rolandic fissure/ fissure of Rolando/ central fissure – separates the motor area from the sensory area
3. Fissure of Sylvius or Sylvian fissure or transverse fissure – separates the parietal from the temporal
Postponed gratification – can control gratification
Pre-senile dementia – loss of some memory before 65; memory deficient
*temporal (temporary) – elevate to frontal *EOM - Exta Ocular Movement
– last 5 yrs of memory *audition – first introduction to language
- most sensitive part of the brain *Amoral – child don’t know what’s right or wrong

*Frontal – stores the 1st 10 yrs of your memory
- wakes up the temporal during amnesia
*Broca’s area – determines particular sound for a particular letter
Autonomic Nervous System
- part of Peripheral Nervous System
- involuntary
- consists of 2-neuronal connection, thus the terminal effector organs/cell
1. heart
2. Tunica media of blood vessels
3. Smooth muscles of visceral organs
4. glands
a. exocrine – duct glands
b. endocrine – ductless glands
Most parts of the body receive dual (sym & Para) in which effects are antagonistic to each other. The sweat gland receive
only Sym nerves but the neurotransmitter is acetylcholine, not Nor-E or E
Cholinergic – term to describe nerve fibers that release Ach

Adrenergic – term to describe nerve fibers that release Nor E and E
Uagotonic – term to describe nerve impulses that increases Para effect
Under Sym stimulation (anger, fear, cold, pain, joy) the entire body is affected because its effects are generalized and
widespread. The effects or Para are localized confined within the immediate vicinity of the target effector organ.
Cardiovascular System
consists of the:
1. Heart – central pump
2. Blood – 5 Liters of fluid that carries oxygen and nutrients to cells and carries carbon dioxide and wastes from the cells
3. A network of blood vessels (arteries, capillaries, veins) that carry blood from heart to cells then back to the heart and lungs for
oxygenation.
Heart – a hollow muscular organ

- size of one’s clenched fist
- weighs 300-350 grams
- actually in the middle of the chest cavity with the apex pointing to the left
- females have a lighter heart
Dextropositioned heart – heart is in the middle of the chest cavity with the apex pointing downward to the right
Dextrocardia – the heart is actually on the right side of the chest cavity; abnormal; not compatible with life
Kartagener’s Syndrome
1. Dextrocardia
2. Situs inversus
3. Bronchiectasis – dilatation of alveolar sack of the lungs
Layers of the heart

1. Epicardium – outermost layer of the heart. It corresponds to the inner visceral layer of the pericardium
2. Myocardium – middle, muscular layer
3 sub-layers:
a. outer spiral layer
b. middle concentric
c. inner spiral layer
***Contraction of spiral muscles shorten base are dimensions of the heart. Contraction of middle concentric layer shortens
the side to side dimensions of the heart.
3. Endocardium – innermost layer. It comes in contact with the bloodin the chambers of the heart.
Trabeculae Carnae – rough, irregular, undersurface of the endocardium
Papillary muscles – elongated or oblong muscles that arise from tuberculae carnae
Chorda Tedinae – ligaments from papillary muscles to hold steady the cusps or leaflets of valves
Chambers of the Heart

Atria – receiving chambers
Ventricles – contracting chambers
1. Right Atrium – first to receive unoxygenated blood thru

a. Inferior Vena Cava –(IVC) central vein (biggest vein)
- it is connected with anything below the nipple line
b. Superior vena cava (SVC) – connected with anything above the nipple line
c. Cardiac or Coronary vein
2. Left Atrium – first to receive freshly oxygenated blood from the lungs through the pulmonary veins. It is behind RA. Most posterior
chamber of the heart
**esophagus – just behind the LA
LAH – dysphagia (difficulty swallowing)
- enlarged LA
3. Right Ventricle – most anterior chamber
4. Left Ventricle – biggest, thickest and most inferior chamber
- has 6x the thickness of the RV
Aorta – central artery

- biggest artery in the body
Fetal Circulation
1. lungs of the fetus not yet expanding
2. RV not yet contracting
3. Foramen Ovale – a hole between RA and LA allows blood flow from R to L
4. Umbilical cord connects fetus to mother thru
a. umbilical arteries carrying unoxygenated blood tot the mother
b. umbilical veins carrying oxygenated blood to the baby
During parturition (delivery) when the child gets his Pneuma Primera Viva (first breath of life)
1. his lungs suddenly expand
2. The RV starts to contract rushing blood into the pulmonary artery then to the lungs
3. Foramen Ovale physiologically closes (actual anatomic closure occurs 1 month after birth)
Congenital Heart Defects – these are inborn heart diseases due to anatomic defect or structural deformity.
I. Early Cyanotic Type – “Blue Babies”
- so called because of the bluish discoloration of skin, lips, mucous membranes
Cyanosis – bluish discoloration due to mixture of unoxygenated and oxygenated blood or when reduced hemoglobin is more than 6 gm
II. Late Cyanotic Congenital Heart Disease – babies born with these look as normal and healthy as other babies except for a heart
murmur. They are well up to early adolescence when they start having cyanotic episodes especially when tired
Early Cyanotic Congenital Heart Diseases

I. Tetralogy of Fallot - earliest
- components:
a. overriding of aorta
b. large ventricular septal defect
c. small opening of pulmonic vlave to the pulmonary artery
d. enlarged right ventricle
II. Tricuspid atresia – failure or inability of tricuspid valve to form

III. Truncus arteriosus – the aorta comes out from RV, pulmonary artery comes out from LV.
Late Cyanotic Congenital Heart Disease – patients are also called Cardiacos Negros Tardos because cyanosis occurs late in childhood
I. Atrial Septal Defect – due to persistence or non-closure of foramen ovale
II. VSD or Ventricular Septal Defect – most common congenital heart disease
III. Patent Ductus Arteriosus – (PDA)
- abnormal connection between aorta and pulmonary artery. Seen in newborns whose mothers contract Rubella or German
measles during the first trimerster of pregnancy.
Rheumatic Heart Disease – an acquired heart disease due to destruction of valve(s) of the heart resulting to heart enlargement.
Valves of the Heart

I. Atrioventricular or AV valves
a. Tricuspid valves
b. Mitral valves
II. Semilunar valves
a. Pulmonic valve
b. Aortic valve
Valves are specialized modification or endocardial tissues. Clinical valvular area is an area on anterior chest wall where a
particular valve is best evaluated.
Tricuspid valve – 3 cusps or leaflets between RA and RV. It has the biggest opening. Clinical valvular area is 3rd and 4th ICS Left
Parasternal Line.
Mitral valve – bicuspid valve between LA and LV. It has 2 leaflets. It is best heard at 5th ICS, LMCL
Apex beat is an area on the chest wall where the LV beats against during contraction. PMI of Point of Maximal Impulse is
area on the chest wall where the sound of heart contraction is loudest. In a normal healthy heart, the apex beat and PMI should be on
the same spot, the mitral area, also referred to as ‘apex of the heart”.
Pulmonic valve – between RV and pulmonary artery. Best heard at 2nd ICS, LPSL
Aortic valve – between LV and aorta. It has the smallest opening. Best heard at 2nd ICS RPSL.
The term “bases” of the heart refers to pulmonic and aortic valves.
Stages of RHD
I. Tonsilopharyngitis or sore throat caused by Group A Beta Hemolytic streptococcus
Treatment – Phenoxymethyl penicillin (Gram +) 500mg TID x 2 days
- if allergic to PCN, give Erythromycin 500mg TID x 7 days
II. Rheumatic fever – RF; occurs two weeks after strep throat
A. Arthritis – big, red, swollen, hot-to-touch and very painful big joints. Most common symptom of Rheumatic Fever.
B. Pancarditis – inflammation of all layers of the heart
1. easy fatiguability
2. chest pains
3. shortness of breath
4. fast HR even at rest
C. Erythema Multiforme – a non-itchy rash on volar surface of the arm
D. Subcutaneous nodules
E. Uncontrollable jerky movement or wrist and fingers
Treatment:
a. PCN or Erythromycin for 7 days
b. for inflammation, aspirin 3-4 grams/day for 6-8 weeks
If allergic to ASA, steroids like Prednisone 1-2mg/kg/BW/day for 6-8 weeks
III. Rheumatic Heart Disease – irreversible stage in which a heart murmur develops due to destruction of valve(s)
- would results from 10 days to 2 weeks of not treating inflamm
* Rheumatic – not inherited nor inborn
*only until the 7th rib is attached to the sternum; 8th to 12th rib floats
*PCN and Aspirin – most allergenic medicine
28 *pulmonic-
| P a g e L side; aortic – RM side
ERYL P. RAMIREZ, BSN, RN
2 ways of how our hearts are damaged:
1. Stenosis – the leaflets become thick so the opening becomes smaller
2. Regurgitation or insufficiency – leaflets become too thin and weak so it easily opens
2 ways by which our hearts enlarge:

1. Cardiac hypertrophy – with thick walls
- angina pectoris
- chest pain because of less oxygen
- die from MI
2. Cardiac dilatation – with thin walls
- die from congestive heart failure
If a person have RHD, he should take prophylaxis every month up to 35 years old.
1. Benzathine penicillin – 1.2 million “IU” Im ANST
2. Phenoxymethyl penicillin – 500mg TID x 7 days
3. Eryhtromycin – 500mg TID x 7 days
Mitral valve – most affected by RHD
Valve prosthesis – replaces damaged valves in RHD
Cardiac Cycle – sequence of events that transpire during one heart contraction, and is repeated in the next contraction
Phases:
I. Pre-sytole – very short moment before a contraction
II. Systole – ventricular contraction
A. Isometric contraction
B. Rapid Ejection phase
C. Reduced Ejection phase
D. Protodiastole
III. Diastole – ventricular relaxation
A. Isometric relaxation
B. Rapid inflow phase
C. Diastasis – there is an active atrial contraction to fully empty blood into the ventricles
Stroke Volume – amount of blood ejected from each ventricle everytime thte heart contracts; 70-90ml
Females have lower stroke volume than males
End-systolic volume – amount of blood that remains in the ventricle after its contraction; 40-60ml
Heart Sounds
- produced by:
1. Valvular factors – closure and opening of valves contribute 80% of heart sounds
2. Muscular factors – thick-walled hearts produce stronger, louder heart sounds
3. Vascular factors- blood flows within the heart causes heart sounds
4. Atrial factors – atrial enlargement also produces abnormal heart sounds
S1 – first heart sound; LUBB sound

- occurs during systole
- due to snap closure of tricuspid and mitral valve during systole
- longer, softer, lower pitched
- best heard with a bell at 5th ICS, LMCL (apex or mitral area)
S2 – second heart sound; DUBB sound
- occurs during diastole
- due to opening of tricuspid and mitral valve allowing atrial blood to flow into ventricles
- higher, sharper, shorter
- best heard with diaphragm at bases (pulmonic and aortic area)

*pulmonic – 5th ICS parasternal area; *aortic – 2nd ICS parasternal area
S3 – third heart sound
- heard in children and young adolescents
- a fast, regular, strong heartbeat like the chantel of a galloping horse
S4 – fourth heart sound
- this is an abnormal sound
- due to enlargement of atria
Fundamental Properties of the Heart

1. Conductivity
2. Automaticity
3. Rhythmicity
4. Contractility
5. Expandability
CONDUCTIVITY
The conducting system of the heart is made of specialized muscle fibers located at Subendocardium. This exerts Primary
Regulatory control of heart rate and rhythm.
SA node or Sinoatrial node is pacemaker of the heart

Av node – at the atrial septum. There is a physiologic pause or delay of impulse to give time to depolarize RA and LA
Purkinje fibers – terminal branches that depolarize all portions of the ventricles
AUTOMATICITY
- ability of a cell/tissue to generate its own impulse (self-depolarization). This is a specialized property of SA node because
the cells there are “naturally leaking to sodium”.
RHYTHMICITY
- regularity in contraction of the heart
- affected by:
a. Potassium – 3.5 -5.5
b. Calcium – 9-11mg
c. Sodium – 138-142mg

Arhythmia – loss of regularity of heart contraction
Ventricular fibrillation – most serious and deadly form of arrhythmia
X’s K increases HR with more diastole than systole. The heart stops in its dilated state
X’s Ca increases HR with more systole than diastole. It stops in its contracted state
X’s Na increases HR with equal diastole and systole. It stops in its contracted state
Lethal injection – Na amytal – Phenobarbital – depresses the brain
- KCl
- CaCl2 stops the heart
CONTRACTILITY
- heart muscle is made of cardiac tissue with intercalated disc and arranged in syncitium
EXPANDABILITY
- ability of the heart to be stretched beyond its original dimension to accommodate excess volume
AUTONOMIC NERVOUS SYSTEM in Heart

- ANS nerves exert only secondary modifying effects on the level
Sym nerves are found in both atria and ventricles. Under Sym stimulation (anger, fear, oain, cold, joy, excitement) the hormones Nor-
Epinephrine (80%) and Epinephrine (20%) are secreted
Sym effects on the Heart

1. Positive Chronotropic effects – increase in heart rate
2. Positive Inotropic effects – increases in strength and force of muscle contraction. Thus, there is increased stroke volume on blood
vessels - there is vasoconstriction or narrowing of lumen or opening of blood vessels.
Para nerves reach only the atria. The R vagus terminates in SA node while L vagus terminates in AV node
Para effects (Ach) on the heart
1. Negative Chronotropic effects – slowing down of the heart
2. Negative Inotropic effects – decrease in force of contraction
Para effects in blood vessels are not significant. They do not induce vasodilatation. If at all, they just reverse vasoconstriction done by
Sym.
HR – 60 to 100/min
Cardiac output
(5 liters) stroke volume 70 to 90/beat
Blood Pressure
Total Peripheral Resistance (TPR)

- pressure exerted in the walls of blood vessels by blood following thru. The opening of the blood
vessel is balanced by vasoconstriction versus vasodilatation.
Cardiac Centers
- a vital center located at the medulla (myencephalon)
1. CIC – Cardioinhibitory Center – dominant when at rest
2. CAC – Cardioacceleratory Center – takes over only in emergency situation
Laws of the Heart

1. Marey’s law
As in in Stroke volume - in Heart Rate
A in Stroke volume - in Heart Rate
- mediated by baroreceptors – sensitive to changes in blood volume

2 Types of Baroreceptors:
1. Aortic sinus
2. Carotid sinus
**Ascending Aorta – 1st part of the aorta and gives rise to the blood
2. Frank Starling’s Law – the head can only eject what it can receive
CIRCULATORY SYSTEM
- considered as closed system because there is no escape of blood outside
HEART
IVC Aorta
Veins Elastic Artery
Venule Muscular Artery
Capillaries Distributing artery

(slowest rate of blood flow)
Arteriole
Bronchial artery – delivers blood to the lungs

Subclavian artery – delivers blood to the upper extremities, axillary, brachial, radial/ulna
Sphincter – lessens the capillary hydrostatic pressure of the blood in the arterioles
Stroke volume depends on the Venous Return
3 layers of blood vessels:

1. Tunica adventitia – made of fibrous material; outermost
2. Tunica media – lastic and smooth muscle; where the receptors of the ANS are located especially the Sym
3. Tunica intima – innermost
Arteries Vein
- deeper in location (Radial artery- most superficial in location - superficial in location
-thick-walled -thin-walled
-reddish blood color - bluish or purplish color because of reduced amount of
oxyhemoglobin
-with sphincters - have bulbs which are specialized modifications of tunica intima
that helps the blood to be pushed farther
- carry oxygenated blood except pulmonary artery and umbilical - carry unoxygenated blood except pulmonary vein and umbilical
Artery Vein
- spurts when bleeding - continuous bleeding
**lymph – fluid that accumulates in the interstitial space

**Thoracic duct – largest lymphatic duct in the body
Blood volume of adults is 5 liters
1. Liquid (60% or 3/5)
- plasma = liquid
- serum – plasma without running factors
2. formed elements (40% or 2/5)
a. RBC
b. WBC
C. platelets
Mother Blood Cell – comes from the bone marrow and can be made into anything
(pluripotential, multipotential, totipotential cells)
Erythropoesis Thrombopoesis
(RBC formation) (platelet formation)
Leukopoesis
(WBC formation)
Hypoxia – decreased PO2 inside the cell Stimulus for Mother Blood Cell
Hypoxemia – decreased PO2 in blood to be RBC
Kidney – 1st to respond in hypoxia
- releases Eryhtropoetin or Hemopoetin and convert MBC into hemocytoblast
Hemocytoblast – cell committed to RBC formation
- undergoes several stages until it becomes mature RBC and released in the bloodstream
Eryhtrocyte – adult, mature RBC
- no endoplasmic reticulum and nucleus, mitochondria and Kreb’s cycle
- only source of ATP is glycolysis
- no Calcium inside
- more acidic pH than plasma (7.28-7.32)
- normal life cycle is 120 days
- dies in the spleen (graveyard of the RBC)
- major function is to deliver oxygen to the tissues and carbon dioxide from tissues because of its hemoglobin content
Hemoglobin – one that carries oxygen into the cells
- α1, α2, β1, β2
- in higher altitudes, the hemoglobin of local residents should be higher because the air we breathe has less oxygen
Hematocrit – percentage of suspended RBC in a centrifuged specimen of blood
Anemia – decreased RBC count or;
- decreased Hemoglobin count
- decreased in both RBC and Hgb
**low BP is not anemia. Anemia has nothing to do with low BP
- people with anemia are pale; with paleness of mucus membrane, lips, conjunctiva and skin
- clinical symptoms:
a. easy fatiguability
b. frequent chest pain
c. shortness of breath
d. tachycardic even when resting
e. dizziness
f. Hemic murmur – soft blowing systolic murmur; removed when anemia is solved
g. cardiomegaly – heart enlargement
Polycythemia excessive production of RBC

I. Polycythemia vera or Primary Polycythemia
- a form of bone cancer in which there is not only an increase in RBC, but also WBC and platelets. Thus, the blood becomes
very viscous, concentrated and hypercoagulable. The skin is ruddy (shiny, bronzed brown-black discoloration)
II. Secondary polycythemia
- compensatory polycythemia. This is an adaptive adjustment to changes in personal oxygen (pO2). The increase in RBC is
accompanied by increase in hemoglobin.
BLOOD TYPING
Landsteines – father of blood typing who based it on protein found in membrane of RBC
Blood Type % Population RBC Plasma
A 37% A antigen or agglutinogen Anti-B agglutinin
B 13% B antigen Anti-A agglutinin
AB 7% A,B antigen No anti A and B agglutinin
O 43% No A and B antigen Both anti A and B agglutinin
Principles of Blood Transfusion

1. Ideally, a patient receives blood of his own type. However, in real situations where blood is scarce, Type O is the universal donor and
Type AB is the universal recipient
2. A blood should not be mixed with anti-A; B blood should not be mixed with anti-B.
3. Incompatible blood transfusion results to Hemagglutination or clumping together of RBC leading to their hemolysis – breakage or
rupture.
4. The kidneys get clogged with cellular debris and may go into acute renal failure.
Rh factor – a protein identified in RBC of Rhesus monkey

In the world, 85% of people is Rh+ and 15% is Rh-
In Asia, 95% of people is Rh+ and 5% is Rh-
Rh incompatibility or Erythroblastosis fetalis occurs when the father is Rh+ and the mother is Rh-, and the 1st child is Rh+
Oyxgen is dissolved in the plasma in the fetus. After cutting of the umbilical cord, the mother produces antibodies vs Rh+ blood and if
the 2nd baby is Rh+, it destroys the RBC of the baby which leads to baby’s death. There is no antibodies during pregnancy.
Hydrops fetalis – stillbirth babies which are swollen and edematous (edema is the most common sign of CHF)
ABO incompatibility
- milder form of hemolysis
- may affect firstborns
- jaundice at birth, disappears within 10 days
- mother is Type O, baby is A, B, or AB
A blood type is carried by a pair of genes called alleles
Type A homozygous has A,A; Type A heterozygous has A,O
Type B homozygous has B,B; Type B heterozygous has B, O
Type O is only homozygous, i.e., O,O
Type AB is only heterozygous, i.e., A,B
Geneticist – studies the paired genes
The couple with types O and AB cannot have an AB child
Father O,O Mother A,B
A B
Leukocytes- white blood cells

- true cells because they have nucleus
- infection is adequate stimulus for Leukopoesis or Leukogenesis or WBC formation
Types
I. Granulocyte – they have granules in their nucleus; take up stain
a. Neutrophil
b. Eosinophil
c. Basophil
II. Mononuclears
a. Monocyte
b. Lymphocyte
Red Blood cell – no nucleus
CBC differential – complete blood count with percentage of WBC in 100 cells counted
WBC – 5,000-10,000/cm – how high indicates how virulent the microbe is
Neutrophil – 60-65%- how high indicates how well the immune system is coping with the infection
Lymphocyte – 20-25%
Eosin – 1-5%
Basophil – 0-1%
Monocyte – 0-1%
Neutrophils – they do not take stains

- also called PMN (polymorphonuclears) because of segmented nature of their nucleus that’s why they are sometimes called
segmenters.
- most abundant and first to fight infection
- forms pus or suppuration
- Bands – young PMN their presence indicates
Stabs – immature PMN overwhelming infection
Eosinophil – big WBC whose nucleus contains granules that stain with Eosin and Hematoxylin
- have biolobed nucleus
- capable of phagocytosis
Eosinophilia – any increase in eosinophils. Seen in:
1. bronchial asthma
2. allergy or hypersensitivity
3. Hay fever
4. Allergic rhinitis
5. Eczema
6. Parasitism
Basophil – small WBC whose granules stain with basic dyes like methylene blue
Monocyte – biggest white blood cell
- capable of phagocytosis
- has a kidney-shaped or bean-shaped nucleus
Primary Lymphoid Organ

Thymus Bone Marrow or Bursa of Fabricius
Secondary Lymphoid organs
Spleen Lymph nodes Reticuloendothelial cell
T-lymphocyte B-lymphocyte

T-lymphocyte B-lymphocyte
1. cell-mediated immunity 1. humoral immunity (have to be antibody to be able to fight)
2. has direct killing of cytotoxic effect 2. may convert to antibodies
3. directed against a fixed antigen 3. against circulating antigens
Steroids – decreases the effect of T-lymphocytes

Thymus – found at birth between our heart, release thymosin
T4 – induces or helps lymphocyte
- one that is significantly decreased in AIDS
Leukocytosis – physiologic increase in WBC
Leukopenia – decrease in WBC (found in Typhoid fever in the first week)
Leukemia – cancer of WBC
- tremendous increase in abnormal WBC
a. acute – short time exposure to chemical
b. chronic
Types of Acute and Chronic Leukemia:
1. Granulocytic or Myelocytic
2. Lymphocytic
3. Monocytic
4. Stem cell – most serious type; mother cell
Antibodies or Immunoglobulins (Ig) or Gammaglobulins

Types:
1. IgM- Macroglobulin
- biggest Ig but because of its size it is unable to cross the placenta
- first to fight an infection together with Eosinophil
- has short life span – 24 to 36 hrs
2. IgG – classic antibody
- most numerous and the longest life span of a lifetime
- could easily pass through the placenta to the fetus
3. IgA – immunosurface protection, antigen
- found in breastmilk, saliva and semen
**the baby should not get sick for the first 6 months
4. IgE – reagin or homocytotropic antibody
-increased by the conditions that also increases eosinophils
5. IgD- exact function is not known but it is increased in certain cancers
Platelets or Thrombocytes
-fragments of megakaryocytes
Properties :
a. Cohesion – ability to adhere to one another
b. Adhesion – ability to adhere or stick to any wettable surface
c. Vasoconstrictive effects – ability to constrict a blood vessel because of its high level of serotonin
Thrombocytosis – increase in platelets
Thrombocytopenia – decrease in platelets
Thromboasthenia – formation of defective platelets
Clotting Factors:
I. Fibrinogen – synthesized in the liver
II. Prothrombin
III. Thromboplastin – tissue factor
IV. Calcium – most important ion for blood clotting
V. Pro-Accerin or Labile Factor – most easily destroyed
VII. Pro-convertin or Stable Factor
VIII. AHG – Antihemophilic Globulin – lacking in hemophilia
IX. PTC – Plasma Thromboplastin Component or Christmas Factor
X. Stuart Prower Factor
XI. PTA – Plasma Thromboplastin Antecedent
XII. Contact Factor or Grease Factor or Hageman Factor
XIII. Laki-Lorand Factor or Fibrin Stabilizing Factor
Prothrombin – synthesized in the liver

- Vit. K is needed to synthesize it
K1 - Phylloquinone (from leaves of plants particularly alfalfa leaves)
K2 – Menaquinone (from fish; can be formed by our intestinal bacteria)
K3 – Menadione – synthetic
- given to baby (1mg IM)
Fresh Blood – one that has been collected for the last 48 hrs
Hemophilia – there is prolonged clotting time
- Factor 8 is destroyed if stored blood is used, it must be fresh blood
Extrinsic Pathway in Blood Clotting
Prothrombinase (Factor X) Fibrinogen
Prothrombin Thrombin Ca++

Ca ++
Fibrin (loose)
Ca++ XIII
Solid Fibrin Clot
Respiration – exchange of O2 and CO2 in lungs and in cells

Laws of Physics that Affects Human Respiration
1. Atmospheric air contains:
78% Nitrogen – inert gas; not respiratory gas
18.6% oxygen
1.3% Carbon dioxide
0.1% Argon, Xenon
2. At sea levels where barometric pressure is 760mmHg, oxygen saturation of air is 100%. At higher altitudes and places O2 in the air is
less (thin or rarified air).
3. Gases diffuse from region of higher concentration to a region of lower concentration as influenced by pressure gradients.
Lungs- major organ of respiration. Each minute, 200ml of CO2 is expelled from it and 250 ml of O2 is absorbed thru it. It is a pinkish
gray spongy tissue shaped like an inverted funnel, whose blood supply is provided by Bronchial artery from thoracic aorta.
- right lung has 3 lobes and 10 bronchopulmonary segments
- left lung has 2 lobes and 8 bronchopulmonary segments
Cupola – apex of lungs; most aerated portion
Hilum – root of the lungs
O2 + Hgb HbO2 oxyhemoglobin
Hb O2
CO2

Carboxyhemoglobin HbCO2
TB of Children Adult PTB
1. Primary Complex 1. Re-infection TB
2. Hilum/Base 2. Apical location
3. Not contagious 3. maybe contagious (depends on the lesion)
4. Minimal tissue reaction; thus NO SCARRING 4. Even when healed, x-ray shows fibrocalcific densities
5. Posterior cervical lymph node enlargement (no cough) 5. afternoon rises of temperature
Night sweats
Cough is a late symptom
Unexplained weight loss
Intensive Treatment – 2 months

Maintenance Treatment – 4 months
1. INH – Isoniazid
- Isonicotinic acid hydrazide
- first drug used to cure TB
2. Ethambutol
3. Rifampicin – most effective and strongest medicine for TB
4. PZA or Pyrazinamide
Maintenance Treatment – 1, 2, 3
Spirometry – process of measuring lung capacities and pulmonary volumes by a spirometer

1. Tidal volume – air that gets in or out of the lungs with each quiet breathing.
- 500ml
2. Vital Capacity – air that gets in and out of the lungs with maximal inspiration and maximal expiration.
- 4500 to 5000ml
3. Inspiratory Reserve Volume – air that can be inhaled over and above what is inhaled with normal inspiration.
4. Functional Expiratory Capacity – air that stays in lungs after normal expiration.
5. Residual Volume – air that stays in lungs after most forceful expiration. This serves to aerate the lungs in between breathing.
6. Total Lung Capacity – biggest of all lung volumes. Sum of vital capacity and residual volume.
7. Minimal Air – air that stays in the lungs after its collapse.
**stillbirth – if the lungs of the baby sink in a bowl of water
**alive ( killed or left to die) - if the lungs float
Inspiratory Muscles
1. Diaphragm – dome-shaped muscular organ. Major muscle of inspiration. Supplied by the Phrenic nerve (C2, C3, C4). Its contraction
increases the top to bottom dimension of the thorax.
Singultus or hiccups – due to spasmodic contraction of the diaphragm
2. External Intercostals – outermost muscle. Muscles between the ribs. Supplied by intercostals nerves, it raises the rib cage upward
and outward increasing its front to back dimensions.
During quiet, normal breathing, inspiration is brought about by contraction of diaphragm and external intercostals while
expiration is done by their relaxation.
Eupnea – normal breathing
1. Males use diaphragm more
2. Females are thoracic breathers and uses external intercostals
Dyspnea – difficulty of breathing
Accessory Muscles of Inspiration:
1. Sternocleidomastoid
2. Anterior Serratus
3. Arectores spinalis
4. Levator scapularis
Muscles of Expiration:
1. Internal Intercostal Muscle
2. Posterior Inferior Serratus
3. Abdominal Muscles like vectus abdomnis
Asthmatic people have more difficulty in expiration
Chemoreceptors – specialized cells sensitive to changes in chemical composition of blood

I. Peripheral Chemoreceptors – outside of the CNS
- most sensitive to a pO2, a decrease in partial pressure of O2
A. Aortic body – found in the aortic arch
B. Carotid body – found in the bifurcation of common carotid arch
II. Central Chemoreceptors – sensitive to pCO2 and in H+ ion conc/liter
A. Medulla – works under normal respiration
1. Inspiratory Center
2. Expiratory Center
B. Pons Varolii – under extraordinary respiration
1. Apneustic Center
Apneusis is prolonged inspiration as in breathholding when diving into water
2. Pneumotaxic Center
Interrupts the apneustic center so that the person eventually exhales from his prolonged inspiration.
Autonomic Nervous System or Respiratory Tract

Sym
Adrenaline (Epinephrine) causes bronchodilatation or opening of respiratory passages
Nor-E has no effects on lungs
Para
Ach and other Para substances causes bronchoconstriction or narrowing of air passages
Atropine sulfate is an anti-cholinergic agent, which is sometimes, added to conventional treatment of asthmatic patients
Status Asthmaticus – term to describe patients who have asthmatic attacks for 24 hrs.
Beta-2 selective agonists – drugs that stimulate only Beta 2 receptors in lungs without stimulating Beta 1 receptors in the heart
- for people who are both asthmatic and have BP and heart problems.
1. Salbutamol – ventolin
2. Terbutaline – Bricanyl
3. Orciprenaline - alupent

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ANATOMY AND PHYSIOLOGY

Victor Romulo Dumaguing

B. Histology – study of ultrafabric tissues with the aid of microscope

C. Cytology – study of cells

Oncology – study of cancer

Basis for the diagnoses of cancer is on the nucleus

Types of cells Based on Number of Chromosomes

D. Embryology – study of development of human from fertilization (conception) to parturition (delivery)

Stages in Embryonic Development

3|Page MERYL P. RAMIREZ, BSN, RN

III.Pathology – study of abnormal structures and functions of parts of the body.

Features or Characteristics of a living cell

8. Excretion – removal or expulsion of waste or metabolic by-products from the body.

10. Growth – increase in bulk or mass of an organism

4|Page MERYL P. RAMIREZ, BSN, RN

Tissues – aggrupation (grouping) of cells based on

Functions of Epithelial Cells

Classifying epithelial tissues based on:

Specialized Modification of Free surface of Epithelium

Epithelial Membranes – several layers of epithelial cells compressed into sheets

5|Page MERYL P. RAMIREZ, BSN, RN

- eg. Pleura – covering of lungs

Connective Tissues – composed of:

Cellular components of Connective Tissue

6|Page MERYL P. RAMIREZ, BSN, RN

Layers of the skin

Layer of the Dermis

3. Subcutaneous layer – tela subcutanea or fat layer

III. Temperature Regulation

8|Page MERYL P. RAMIREZ, BSN, RN

IV. Storage of Vitamin D

VI. Legal Identification

Appendages of the Skin

Hereditary aspects of hair

Types of Bone Marrow

Vitamins involved in Ossification

11 | P a g e MERYL P. RAMIREZ, BSN, RN

5. Calcium – most abundant divalent cation in the body

6. Phosphorus – same dietary source of calcium

Major Hormones in bone formation

12 | P a g e MERYL P. RAMIREZ, BSN, RN

Major Hormones in Bone Formation

13 | P a g e MERYL P. RAMIREZ, BSN, RN

14 | P a g e MERYL P. RAMIREZ, BSN, RN

Muscles based on group action

Fascial coverings of muscles

Myofibril – smallest contractile unit of a muscle fiber. A myofibril contains myofilaments

Actin Tropomyosin Troponin

Myosin has 2 components:

Steps in Muscle Contraction

15 | P a g e MERYL P. RAMIREZ, BSN, RN

Metabolic or Biochemical Requirements for Muscle Contraction

Divisions of the Nervous System

Cells of Nervous System

Neuron – fundamental, structural and functional unit of the Nervous System

Functions of the Nervous System

16 | P a g e MERYL P. RAMIREZ, BSN, RN

Types of Neurons According to Number of Processes

Eg. Cerebrospinal ganglia