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Library of Congress Cataloging-in-Publication Data

Anatomy & physiology made incredibly visual / clinical editor,
Janyce Dyer. — Second edition.
p. ; cm. — (Incredibly visual)
Anatomy and physiology made incredibly visual
Includes bibliographical references and index.
ISBN 978-1-4511-9138-7 (alk. paper)
I. Dyer, Janyce G., editor. II. Title: Anatomy and physiology
made incredibly visual. III. Series: Incredibly visual.
[DNLM: 1. Anatomy—Atlases. 2. Anatomy— Handbooks. 3.
Physiological Phenomena—Atlases. 4. Physiological Phenomena
— Handbooks. QS 39]
QM25
612.0022’3—dc23
2013036674
 Contents
Art school confidential
Contributors and consultants
1 The human body
2 Genetics
3 Chemical organization
4 Integumentary system
5 Musculoskeletal system
6 Nervous system
7 Sensory system
8 Endocrine system
9 Cardiovascular system
10 Hematologic system
11 Immune system
12 Respiratory system
13 Gastrointestinal system
14 Nutrition and metabolism
15 Urinary system
16 Fluids, electrolytes, acids, and bases
17 Reproductive system
18 Reproduction and lactation
Selected references
Credits
Index
 Contributors and Consultants
Helen C. Ballestras, PhD, RN, ANP-BC
Assistant Professor of Nursing
Adelphi University
Garden City, New York

James S. Davis IV, BSN, RN, CCRN, CIC

Senior Infection Prevention Analyst
ECRI Institute
Plymouth Meeting, Pennsylvania

Janyce G. Dyer, PhD, CRNP, CS

Professor of Nursing
South University
West Palm Beach, Florida

Beverly Gilraine, MS, RN, FNP-C

VISN 6 IDES/C&P Coordinator
Veterans Administration Hospital
Salem, Virginia

Jennifer M. Lee, MSN, FNP-C

Nurse Practitioner
Cardiology
Greenville Hospital System
Greenville, South Carolina

Marilyn D. Sellers, MSN, FNP-BC, RN-BC

Family Nurse Practitioner
Environmental Health Clinician & Coordinator/Compensation & Pension
Clinician
Veterans Administration Hospital
Hampton, Virginia

Leigh Ann Trujillo, MSN, RN

Education Supervisor
St. James Hospital & Health Centers
Pulmonary Disease Associates
Olympia Fields, Illinois

Kelly N. White, PhD (c), ARNP, FNP-BC

Assistant Professor of Nursing
South University
West Palm Beach, Florida
Chapter 1
The Human Body
Anatomic terms
Cells
Tissue
Vision quest
Anatomic terms
Directional terms
Generally, directional terms can be grouped into pairs of opposites.
Reference planes
Reference planes are imaginary lines used to section the body and its organs.
These lines run longitudinally, horizontally, and on an angle.

Median sagittal
The median sagittal plane passes through the center of the body, dividing it into
two equal right and left halves.

Parasagittal
Sagittal plane passes through the body, dividing it into unequal right and left
sides.
Transverse
The transverse, or horizontal, plane is at a right angle to both the median and
frontal planes; it divides the body into upper and lower sections.

Frontal
The frontal plane, also called the coronal plane, passes at a right angle to the
medial plane, dividing the body into front and back portions.
Body cavities
Body cavities are spaces within the body that contain internal organs. The dorsal
and ventral cavities are the two major closed cavities—cavities without direct
openings to the outside of the body.
Body regions
 Right and left hypochondriac
■ Contain the diaphragm, portions of the kidneys, the right side of the liver,
the spleen, and part of the pancreas

Epigastric
■ Contains most of the pancreas and portions of the stomach, liver, inferior
vena cava, abdominal aorta, and duodenum

Right and left lumbar (lateral)

■ Include portions of the small and large intestines and portions of the
kidneys

Umbilical
■ Includes sections of the small and large intestines, inferior vena cava, and
abdominal aorta

Right and left iliac (inguinal)

■ Include portions of the small and large intestines

Hypogastric (pubic)
■ Contains a portion of the sigmoid colon, urinary bladder and ureters, and
portions of the small intestine

Cells
Cells are the body’s basic building blocks. They’re the smallest living
components of an organism. The human body consists of millions of cells
grouped into highly specialized units that function together throughout the
organism’s life. Large groups of individual cells form tissues, such as muscle
and blood. In turn, tissues form the organs (such as the brain and heart) that are
integrated into body systems (such as the central nervous system [CNS] and
cardiovascular system).
DNA and RNA
Protein synthesis is essential for the growth of new cells and the repair of
damaged cells. That’s where deoxyribonucleic acid (DNA) and ribonucleic acid
(RNA) come into play.

■ DNA chains exist in pairs held together by weak chemical attractions

between the nitrogen bases on adjacent chains.
■ Because of the chemical shape of the bases, adenine bonds only with
thymine and guanine bonds only with cytosine.
■ Bases that can link with each other are called complementary.
 ■ RNA consists of nucleotide chains that differ slightly from the nucleotide
chains found in DNA.
■ Several types of RNA are involved in the transfer (to the ribosomes) of
genetic information essential to protein synthesis.

Cell reproduction
Cells reproduce through the cell division processes of mitosis and meiosis.
Before a cell divides, however, its chromosomes are duplicated. During this
process, DNA’s double helix separates into two chains.
Mitosis
Mitosis is the equal division of material in the nucleus, followed by division
of the cell body. Before division, a cell must double its mass and content. This
occurs during the growth phase, called interphase (not illustrated). During this
phase, chromatin (the small, slender rods of the nucleus that produce its
granular appearance) begins to form.
 1
Prophase
The chromosomes coil and
shorten, and the nuclear
membrane dissolves. Each
chromosome consists of a pair
of strands called chromatids,
which are connected by a
spindle of fibers called a
centromere.

2
Metaphase
The centromeres divide, pulling
the chromosomes apart. The
centromeres then align
themselves in the middle of the
spindle.
 3
Anaphase
At the onset of anaphase, the
centromeres begin to separate
and pull the newly replicated
chromosomes toward opposite
sides of the cell. By the end of
anaphase, 46 chromosomes are
present on each side of the cell.

4
Telophase
A new membrane forms around
each set of 46 chromosomes.
The spindle fibers disappear,
cytokinesis occurs, and the
cytoplasm divides, producing
two newidentical daughter
cells.
Meiosis
Reserved for gametes (ova and spermatozoa), the process of meiosis
intermixes genetic material between homologous chromosomes, producing
four daughter cells, each with the haploid number of chromosomes (23, or half
of the 46). Meiosis has two divisions separated by a resting phase.
 1
First division
The first division has six phases. Here’s what happens during each.

Interphase
1. Chromosomes replicate, forming a double strand attached at the center by a
centromere.
2. Chromosomes appear as an indistinguishable matrix within the nucleus.
3. Centrioles appear outside the nucleus.

Prophase I
1. The nucleolus and nuclear membrane disappear.
2. Chromosomes are distinct, with chromatids attached by the centromere.
3. Homologous chromosomes move close together and inter-twine; exchange of
genetic information (genetic recombination) may occur.
4. Centrioles separate, and spindle fibers appear.

Metaphase I
1. Pairs of synaptic chromosomes line up randomly along the metaphase plate.
2. Spindle fibers attach to each chromosome pair.

Anaphase I
1. Synaptic pairs separate.
2. Spindle fibers pull homologous, double-stranded chromosomes to opposite
ends of the cell.
3. Chromatids remain attached.

Telophase I
1. The nuclear membrane forms.
2. Spindle fibers and chromosomes disappear.
3. Cytoplasm compresses and divides the cell in half.
4. Each new cell contains the haploid (23) number of chromosomes.

Interkinesis
1. The nucleus and nuclear membrane are well defined.
2. The nucleolus is prominent, and each chromosome has two chromatids that
don’t replicate.

2
Second division
The second division closely resembles mitosis and is characterized by these four
phases.

Prophase II
1. The nuclear membrane disappears.
2. Spindle fibers form.
3. Double-stranded chromosomes appear as thin threads.

Metaphase II
1. Chromosomes line up along the metaphase plate.
2. Centromeres replicate.

Anaphase II
1. Chromatids separate (now a single-stranded chromosome).
2. Chromosomes move away from each other to the opposite ends of the cell.

Telophase II
1. The nuclear membrane forms.
2. Chromosomes and spindle fibers disappear.
3. Cytoplasm compresses, dividing the cell in half.
4. Four daughter cells are created, each of which contains the haploid (23)
number of chromosomes.

Movement within cells

Passive Diffusion
In diffusion, solutes move from an area of higher concentration
transport to one of lower concentration. Eventually, an equal distribution
of solutes between the two areas occurs.
Osmosis
In osmosis, fluid moves across a membrane from an area of lower solute
concentration (comparatively more fluid) to an area of higher solute
concentration (comparatively less fluid). Osmosis stops when enough fluid has
moved through the membrane to equalize the solute concentration on both sides
of the membrane.

Active Sodium–potassium pump

transport The sodium–potassium pump moves sodium from inside the
cell to outside, where the sodium concentration is greater;
potassium moves from outside the cell to inside, where the
potassium concentration is greater. Adenosine triphosphate
(ATP) provides the energy required for this movement.
Pinocytosis
In pinocytosis, tiny vacuoles take droplets of fluid containing dissolved
substances into the cell. The engulfed fluid is used in the cell.

Filtration
In filtration, pressure (provided by capillary blood) forces fluid and dissolved
particles through the cell membrane and into the interstitial fluid.
Tissue
Groups of cells that perform the same general function are known as tissue. The
body has four types of tissue:
 Epithelial

Connective

Muscle

Nerve

Epithelial tissue
Epithelial tissue is classified by the number of cell and the of
surface cells.

Number of cell layers

■ Simple: One layer
■ Stratified: Multilayered
■ Pseudostratified: One layer but appearing to be multilayered

Shape of surface cells

■ Squamous: Containing flat surface cells
■ Columnar: Containing tall, cylindrical surface cells
■ Cuboidal: Containing cube-shaped surface cells
Connective tissue

connective tissue
■ Contains large spaces that separate the fibers and cells
■ Contains a lot of intercellular fluid

connective tissue
■ Provides structural support
■ Has greater fiber concentration
■ Is subdivided into dense regular and dense irregular connective tissue

Dense regular
■ Consists of tightly packed fibers arranged in a consistent pattern
■ Includes tendons, ligaments, and aponeuroses (flat fibrous sheets that attach
muscles to bones or other tissues)
Dense irregular
■ Has tightly packed fibers arranged in an inconsistent pattern
■ Found in the dermis, submucosa of the gastrointestinal (GI) tract, fibrous
capsules, and fasciae

Glandular epithelium
Organs that produce secretions consist of a special type of epithelium called
glandular epithelium. Glands are classified as exocrine or endocrine according
to how they secrete their products.

■ Endocrine glands release their secretions into the blood or

lymph. (For instance, the medulla of the adrenal gland secretes
epinephrine and norepinephrine into the bloodstream.)

■ Exocrine glands discharge their secretions onto external or

internal surfaces. (For example, sweat glands secrete sweat onto
the surface of the skin.)

Age-old story
Fat distribution
In men
■ Nape of the neck
■ Region over seventh cervical vertebra
■ Deltoid muscle
■ Triceps muscle
 ■ Lumbosacral region
■ Buttocks
■ Abdomen

In women
■ Breasts
■ Buttocks
■ Thighs
■ Abdomen

Muscle tissue
Muscle tissue consists of muscle cells with a generous blood supply. Muscle
cells measure up to several centimeters long and have an elongated shape that
enhances their contractility.
 Nerve tissue
Neurons are highly specialized cells composed of nerve tissue that generates and
conducts nerve impulses. Its primary properties are:
: the capacity to react to various physical and chemical agents, and
: the ability to transmit the resulting reaction from one point to
another.
Able to label?
Identify the abdominal regions shown on this illustration.
 Matchmaker
Match the four forms of movement within cells illustrated here
with their definitions.

A. Movement of sodium from inside the

cell to outside, where sodium
concentration is greater, and movement
of potassium from outside the cell to
inside, where potassium concentration
is greater
B. Passive movement of fluid across a
membrane, from an area of lower solute
concentration into an area of higher
solute concentration
C. Passive movement of solutes from an
area of higher concentration to an area
of lower concentration
D. Movement of fluid and dissolved
particles through a cell membrane as a
result of pressure on one side of the
membrane
C (diffusion), 2. B (osmosis), 3. A (sodium–potassium pump), 4. D (filtration).
7. Right iliac (inguinal) , 8. Hypogastric, 9. Left iliac (inguinal); Matchmaker 1.
hypochondriac, 4. Right lumbar (lateral) , 5. Umbilical, 6. Left lumbar (lateral),
Answers: Able to label? 1. Right hypochondriac, 2. Epigastric, 3. Left
Chapter 2
Genetics
Genetics basics
Genes
Vision quest
Genetics basics
Genetics is the study of heredity—the passing of traits from biological parents
to their children. Physical traits, such as eye color, are inherited; these traits
are biochemical and physiologic and may include the tendency to develop
certain diseases.
Genes
Genes are segments of chromosomal DNA chains that are responsible for
inherited traits. Each parent contributes one set of chromosomes (and therefore
one set of genes); every offspring has two genes for every location on the
autosomal chromosomes.
Variations in a particular gene, such as brown, blue, or green eye color, are
called alleles. The effect that gene has on cell structure or function is called gene
expression. Gene expression can vary with the gene.

How genes express themselves

Dominant genes
If genes could speak, dominant genes would be loud and
garrulous, dominating every conversation! Dominant genes
(such as the one for dark hair) can be expressed and
transmitted to the offspring, even if only one parent possesses
the gene.

Recessive genes
Unlike dominant genes, recessive genes prefer to hide their
light under a bushel basket. A recessive gene (such as the one
for blond hair) is expressed only when both parents transmit it
to the offspring.

Codominant genes
Firm believers in equality, codominant genes (such as the
genes that direct specific types of hemoglobin synthesis in red
blood cells) allow expression of both alleles.

Sex-linked genes
Sex-linked genes are carried on sex chromosomes. Almost all appear on the X
chromosome and are recessive. In the male, sex-linked genes behave like
dominant genes because no second X chromosome exists.

Understanding autosomal dominant inheritance

This diagram shows the possible offspring of a parent with recessive normal
genes (aa) and a parent with an altered dominant gene (Aa). Note: With each
pregnancy, the offspring has a 50% chance of being affected.
Understanding autosomal recessive inheritance
This diagram shows the possible offspring of two unaffected parents, each with
an altered recessive gene (a) on an autosome. Each offspring will have a one-in-
four chance of being affected and a two-in-four chance of being a carrier.
Multifactorial inheritance
Multifactorial inheritance reflects the interaction of at least two abnormal genes
and environmental factors. Height is a classic example of a multifactorial trait. In
general, the height of offspring will be in a range between the height of the two
parents. However, nutritional patterns, health care, and other environmental
factors also influence development.

Factors contributing to multifactorial inheritance

■ Maternal age
■ Use of drugs, alcohol, or hormones by either parent
■ Maternal or paternal exposure to radiation
■ Maternal infection during pregnancy or existing diseases in the mother
■ Nutritional factors
■ General maternal or paternal health
■ High altitude
■ Maternal smoking
■ Maternal–fetal blood incompatibility
■ Inadequate prenatal care

Understanding X-linked dominant inheritance

This diagram shows the possible offspring of a normal parent and a parent with
an X-linked dominant gene on the X chromosome (shown by a solid dot). When
the father is affected, only his daughters have the abnormal gene. When the
mother is affected, both male and female offspring may be affected.
Understanding X-linked recessive inheritance
This diagram shows the possible offspring of a normal parent and a parent with a
recessive gene on the X chromosome (shown by an open dot). All of the female
offspring of an affected male will be carriers. The son of a female carrier may
inherit a recessive gene on the X chromosome and be affected by the disease.
X marks the spot
In a male, sex-linked genes
behave like dominant genes
because males have no second
X chromosome. Red-green
color blindness is a result of a
recessive X-linked inheritance.
Male children of a parent who
carries the recessive trait may
be color-blind.
 My word!
Use the clues to help you unscramble terms related to genetics.
Then use the circled letters to answer the question posed.

Question: Which type of genes allows expression of both alleles?

1. Variations in a particular gene
leasell

2. Effect a gene has on cell structure or function

neeg sirensexpo

3. Gene that can be expressed and transmitted to offspring even

when only one parent possesses it
nomadtin

4. Gene that can be expressed only when both parents transmit it

iceserves

Answer:
Answers: My word! 1. Alleles, 2. Gene expression, 3. Dominant, 4. Recessive;
Question: Codominant; Rebus riddle: Genetics is the study of heredity.
about genetics.
Sound out each group of pictures and symbols to reveal a fact
Rebus riddle
Chapter 3
Chemical organization
The body’s chemistry
Atomic structure
Inorganic and organic
compounds
Vision quest
The body’s chemistry
Every cell contains thousands of different chemicals that constantly interact with
one another. Differences in chemical composition differentiate types of body
tissue. What’s more, the blueprints of heredity—DNA and RNA—are encoded in
chemical form.
Atomic structure
Understanding the atomic structure starts with knowing the difference between
atoms, molecules, and compounds.

Atom
■ Smallest unit of matter that can take part in a chemical reaction
Molecule
■ A combination of two or more atoms of the same element (such as
hydrogen)

Compound
■ A combination of two or more atoms that are different—that is, different
elements (such as a carbon atom and an oxygen atom)
Subatomic particles
Atoms consist of three basic subatomic particles:

Protons
✚ Protons have a positive charge.
✚ Each element has a distinct number of protons.

Neutrons
■ Neutrons carry a neutral charge.
■ Not all the atoms of an element necessarily have the same number of
neutrons.
■ Forms of an atom with a different number of neutrons (and a different atomic
weight) than most atoms of the element are called isotopes.

Electrons
▬ Electrons carry a negative charge.
▬ Electrons play a key role in chemical bonds and reactions.
▬ The number of electrons in an atom equals the number of protons in its
nucleus.
▬ Each electron shell can hold a maximum number of electrons and represents
a specific energy level.

Chemical reactions
Chemical reactions depend on energy as well as particle concentration, speed,
and orientation. A chemical reaction involves unpaired electrons in the outer
shells of atoms. In this reaction, one of two events occurs:
Unpaired electrons from the outer shell of one atom transfer to the outer shell
of another atom.
One atom shares its unpaired electrons with another atom.
Chemical bonds
A chemical bond is a force of attraction that binds a molecule’s atoms together.
Types of chemical bonds

Hydrogen bond
A hydrogen bond occurs when there’s an attractive force between the hydrogen
attached to an electro-negative atom of one molecule and an electronegative
atom of another molecule. For example, water molecules are held together by
hydrogen bonds.

Ionic bond
An ionic bond occurs when an electron is transferred from one atom to another.
For example, by forces of attraction, an electron is transferred from a sodium
(Na) atom to a chlorine (Cl) atom. The result is a molecule of sodium chloride
(NaCl).

Covalent bond
In a covalent bond, atoms share a pair of electrons. This is what happens when
two hydrogen (H) atoms form a covalent bond.
Inorganic and organic compounds
Although most biomolecules (molecules produced by living cells) form organic
compounds, or compounds containing carbon, some form inorganic compounds,
or compounds without carbon.

Inorganic compounds
Inorganic compounds are usually small. Examples include water and
electrolytes.
Organic compounds
Most biomolecules form organic compounds—compounds that contain carbon
or carbon–hydrogen bonds. Carbohydrates, lipids, proteins, and nucleic acids are
all examples of organic compounds.

Carbohydrates
In the body, carbohydrates are sugars, starches, glycogen, and cellulose. There
are three types of carbohydrates:
Monosaccharides, such as ribose and deoxyribose, are sugars with three to
seven carbon atoms.
Disaccharides, such as lactose and maltose, contain two monosaccharides.
Polysaccharides, such as glycogen, are large carbohydrates with many
monosaccharides.
Lipids
Lipids are water-insoluble biomolecules. The major lipids are:

Triglycerides
■ Most abundant lipids in both food and the body
■ Neutral fats that insulate and protect
■ The body’s most concentrated energy source

Lipoproteins
■ Help transport lipids to various parts of the body

Sterols
■ Simple lipids with no fatty acids in their molecules
■ Fall into four main categories:
Bile salts: emulsify fats during digestion and aid absorption of the fat-
soluble vitamins (vitamins A, D, E, and K)
Male and female sex hormones: responsible for sexual characteristics and
reproduction
Cholesterol: a part of animal cell membranes; needed to form all other
sterols
Vitamin D: helps regulate the body’s calcium concentration
 Phospholipids
■ Major structural components of cell membranes
■ Consist of one molecule of glycerol, two molecules of a fatty acid, and a
phosphate group

Eicosanoids
■ Prostaglandins: modify hormone responses, promote the inflammatory
response, and open the airways
■ Leukotrienes: play a part in allergic and inflammatory responses

Proteins
Proteins are the most abundant organic compound in the body. Many amino
acids linked together form a polypeptide. One or more polypeptides form a
protein.
 A protein’s shape determines which function it performs:
■ Providing structure and protection
■ Promoting muscle contraction
■ Transporting various substances
■ Regulating processes
■ Serving as enzymes (the largest group of proteins, which act as catalysts for
crucial chemical reactions).

Nucleic acids
The nucleic acids DNA and RNA are composed of nitrogenous bases, sugars,
and phosphate groups.
Able to label?
Identify the parts of the atom shown in this illustration.
 My word!
Use the clues to help you unscramble terms related to the body’s
chemistry. Then use the circled letters to answer the question
posed.

Question: What’s the most abundant organic compound in the

body?
1. Term used to describe something that has mass and occupies
space
artmet
2. Smallest unit of matter that can take part in a chemical reaction
moat
3. Term that describes a combination of two or more atoms that
are different
copmudno
4. An atom with a different number of neutrons than usual
piestoo
Answer:
Protein.
Neutron; My word! 1. Matter, 2. Atom, 3. Compound, 4. Isotope; Question:
Answers: Able to label? 1. Electron, 2. Electron shell, 3. Nucleus, 4. Proton, 5.
Chapter 4
Integumentary system
Skin layers
Skin functions
Epidermal appendages
Vision quest
Skin layers
Two distinct layers of skin, the epidermis and dermis, lie above a third layer of
subcutaneous tissue—sometimes called the hypodermis.
Layer Sublayers

Epidermis Stratum corneum

■ Outermost layer ■ Outermost layer
■ Varies in thickness from less than ■ Consists of tightly arranged layers
0.1 mm (on the eyelids) to more of cellular membranes and keratin
than 1 mm (on the palms and soles)
Stratum lucidum
■ Composed of avascular, stratified,
■ Lucid or clear layer
squamous (scaly or platelike)
■ Blocks water penetration or loss
epithelial tissue
■ Consists of five sublayers Stratum granulosum
■ Granular layer
■ Responsible for keratin formation
Stratum spinosum
■ Spiny layer
■ Helps with keratin formation
■ Contains a rich supply of
ribonucleic acid
Stratum basale (basal layer)
■ Innermost layer
■ Produces new cells to replace
superficial keratinized cells that are
continuously shed or worn away

Dermis Papillary dermis

 ■ Also called the corium ■ Contains fingerlike projections
■ Contains and supports blood (papillae) that connect the dermis to
vessels, lymphatic vessels, nerves, the epidermis
and the epidermal appendages ■ Contains characteristic ridges
■ Composed primarily of matrix, Reticular dermis
which contains collagen (gives ■ Covers a layer of subcutaneous
strength), elastin (provides tissue, insulating the body to
elasticity), and reticular fibers (bind conserve heat
collagen and elastin fibers together) ■ Provides energy
■ Consists of two sublayers ■ Serves as a mechanical shock
absorber

Skin functions
The integumentary system is the largest body system. In addition to the skin, or
integument, it includes the hair, nails, and certain glands.

Protection
■ Serves as the main framework for the underlying organs
and musculoskeletal system
■ Maintains the integrity of the body surface (through skin
migration and shedding)
■ Repairs surface wounds (by intensifying normal cell
replacement)
■ Protects the body against noxious chemicals and invasion
from bacteria and microorganisms
■ Contains Langerhans’ cells (specialized cells in the skin’s
top layer) that enhance the body’s immune response
■ Contains melanocytes (which produce the brown pigment
melanin, giving us our skin color) that help filter ultraviolet
light

Sensory perception
■ Contains sensory nerve fibers that supply specific areas of
the skin (dermatomes)
■ Allows for perception of temperature, touch, pressure,
pain, and itching
■ Contains autonomic nerve fibers that carry impulses to
smooth muscle in the walls of the skin’s blood vessels, to
the muscles around the hair roots, and to the sweat glands
■ Reflects to a degree of our emotional responses and
changes to our homeostatic balance and deoxygenation

Excretion
■ Excretes sweat, which contains water, electrolytes, urea,
and lactic acid
■ Prevents dehydration by regulating the content and
volume of sweat
■ Prevents unwanted fluids in the environment from
entering the body

Body temperature
■ Contains nerves, blood vessels, and eccrine glands within
the skin’s deeper layer to control body temperature
■ Causes blood vessels to constrict (reducing blood flow
and conserving heat) when exposed to cold, or internal body
temperature falls
■ Causes small arteries within the skin to dilate (increasing
the blood flow and reducing body heat) when skin becomes
too hot, or internal body temperature rises
Epidermal appendages
Numerous epidermal appendages occur throughout the skin. They include the
hair, nails, sebaceous glands, and sweat glands.

Hair

Arrector pili, a bundle of smooth muscle fibers, extend

through the dermis to attach to the base of the follicle.
When these muscles contract, the hair stands on end
(piloerection).

Each hair lies within an epithelium-lined sheath called a

hair follicle. Hair follicles have a rich blood and nerve
supply.

At the expanded lower end of each hair is a bulb or

root.

On its undersurface, the root is indented by a hair

papilla, a cluster of connective tissue and blood vessels
that provide nourishment to the hair.
Nails

The nail plate (surrounded on The lunula is where

three sides by the nail folds, or the distal portion of
cuticles) lies on the nail bed. It’s the matrix shows
formed by the nail matrix, which through as a pale,
extends proximally for about ¼″ crescent moon-
(0.6 cm) beneath the nail fold. shaped area.
The vascular bed imparts the
characteristic pink appearance
under the nails.
Sebaceous glands
Sebaceous glands occur on all parts of the skin, except the palms and soles.
However, they’re most prominent on the scalp, face, upper torso, and genitalia.

Sweat glands
There are two types of sweat glands:
Eccrine glands
■ Widely distributed throughout the body
■ Produce an odorless, watery fluid with a sodium concentration equal to that of
plasma
■ Each contains a duct that passes from the coiled secretory portion, through the
dermis and epidermis, and onto the skin surface.
■ Secrete fluid in response to emotional stress (glands in palms and soles) or
thermal stress (to regulate body temperature)

Apocrine glands
■ Located chiefly in the axillary (underarm) and anogenital (groin) areas
■ Lie deeper in the dermis than eccrine glands
■ Each contains a duct that connects the coiled secretory portion to the upper
portion of the hair follicle.
■ Begin to function at puberty
■ Have no known biological function
■ Bacteria decompose fluids produced by these glands, resulting in body odor.

Age-old story

Integumentary timeline

Changes Results
Loss of subcutaneous fat, thinning Lines around eyes (crow’s feet),
dermis, decreased collagen and mouth, and nose
elastin, decline in cell replacement
Decreased rate of skin-cell Slowed wound healing with tendency
replacement toward infection
Decreased sweat gland output and Dry mucous membranes
number of active sweat glands
Loss of subcutaneous fat (combined Difficulty regulating body
with decreased size, number, and temperature
function of sweat glands)
Decreased melanocyte production Development of brown spots (senile
along with localized proliferation of lentigo), atrophic keratosis
melanocytes
Decreased hair pigment Thinning and graying of hair
 My word!
Unscramble the words using the clues provided. Then use the
circled letters to answer the question posed.

Question: Which sweat glands secrete an odorless fluid in

response to emotional or thermal stress?
1. Skin layer that contains blood vessels
ridsme
2. Outermost layer of the skin
impedesir
3. Cells that produce a brown pigment to help filter ultraviolet
light
castlemoney
4. Smooth muscle fibers that make hair “stand on end” when they
contract
carrotre lipi
Answer:
Answers: My word! 1. Dermis, 2. Epidermis, 3. Melanocytes, 4. Arrector pili;
Question: Eccrine; Able to label? 1. Arrector pili muscle, 2. Hair follicle, 3. Hair
bulb, 4. Hair papilla.
Identify the hair structures shown in the illustration.
Able to label?
Chapter 5
Musculoskeletal
system
Muscles
Tendons and ligaments
Bones
Cartilage
Joints
Bursae
Vision quest
Muscles

Muscles of the axial skeleton

The muscles of the axial skeleton are essential for respiration. The axial
skeleton includes:
■ muscles of the face, tongue, and neck
■ muscles of mastication
■ muscles of the vertebral column situated along the spine.

Muscles of the appendicular skeleton

The appendicular skeleton includes the muscles of the:
■ shoulder
■ abdominopelvic cavity
■ upper and lower extremities.
Muscles of the upper extremities are classified according to the bones they
move. Those that move the arm are further categorized into those with an
origin on the axial skeleton and those with an origin on the scapula.
Muscle structure
Skeletal muscle is composed of large, long cell groups called muscle fibers. Each
fiber has many nuclei and a series of increasingly smaller internal fibrous
structures.
Muscle attachment
Most skeletal muscles are attached to bones, either directly or indirectly.

Direct
In a direct attachment, the epimysium of the muscle fuses to the periosteum, the
fibrous membrane covering the bone.
Indirect
In an indirect attachment (most common), the epimysium extends past the
muscle as a tendon, or aponeurosis, and attaches to the bone.

The muscle origin is the point where a muscle attaches to the less movable bone.
This usually lies on the proximal end of the bone.
The insertion is the point where a muscle attaches to the more movable bone—
typically on the distal end.

Muscle growth
Muscle develops when existing muscle fibers hypertrophy. Muscle strength and
size differ among individuals because of such factors as:
exercise
nutrition
 genetic constitution.

Changes in nutrition or exercise can alter muscle strength and size in an

individual.

Age-old story
Aging muscles
Muscle changes associated with age include:
■ decreased muscle mass
■ weakness
■ difficulty with tandem (heel-to-toe) walking.
Many elderly people walk with shorter steps and a wider leg stance to achieve
better balance and stable weight distribution.

Muscle movements
Skeletal muscles permit several types of movement. A muscle’s functional name
comes from the type of movement it permits.
Muscle functions
Skeletal muscles move body parts or the body as a whole. They’re responsible
for both voluntary and reflex movements. Skeletal muscles also maintain posture
and generate body heat. Muscles voluntarily contract when stimulated by
impulses from the nervous system.

Tendons and ligaments

Tendons are bands of fibrous connective tissue that attach

muscles to the periosteum, the fibrous covering of the bone.
Tendons enable bones to move when skeletal muscles
contract.
 Ligaments are dense, strong, flexible bands of fibrous
connective tissue that bind bones to other bones.

Bones
The human skeleton contains 206 bones: 80 form the axial skeleton and 126
form the appendicular skeleton.
 Bones of the axial skeleton include:
■ facial and cranial bones
■ hyoid bone
■ vertebrae
■ ribs and sternum.

Bones of the appendicular skeleton include:

■ clavicle
■ scapula
■ humerus, radius, ulna, carpals, metacarpals, and phalanges
■ pelvic bone
■ femur, patella, fibula, tibia, tarsals, metatarsals, and phalanges.

Bone classification
Bones are typically classified by shape.
Bone functions
Bones perform various anatomic (mechanical) and physiologic functions, such
as:
■ protect internal tissues and organs
■ stabilize and support the body
■ provide a surface for muscle, ligament, and tendon attachment
■ move through “lever” action when contracted
■ produce red blood cells in the bone marrow (a process called hematopoiesis)
■ store mineral salts—for example, approximately 99% of the body’s calcium.

Blood supply
Blood reaches bones through three paths:
Bone formation

Bone remodeling
Two types of osteocytes—osteoblasts and osteoclasts—are responsible for
remodeling.
Cartilage
Cartilage supports and shapes various structures, such as the auditory canal and
intervertebral disks. It also cushions and absorbs shock, preventing direct
transmission to the bone. Cartilage has no blood supply or innervation.

Hyaline cartilage
■ Most common
■ Covers articular bone surfaces (where one or more bones meet at a joint)
■ Connects ribs to the sternum
■ Appears in the trachea, bronchi, and nasal septum
Fibrous cartilage
■ Strong and rigid
■ Composed of small quantities of matrix and abundant fibrous elements
■ Forms the symphysis pubis and intervertebral disks
Elastic cartilage
■ Elastic and resilient
■ Contains large number of elastic fibers
■ Located in the auditory canal, external ear, Aand epiglottis

Joints
The junction of two or more bones is called a joint. Joints stabilize bones and
allow movement. There are two types of joints:

Nonsynovial
Synovial

Common joints

Ball-and-socket joints
■ Located in the shoulders and hips
■ Allow flexion, extension, adduction, and abduction
■ Rotate in their sockets
■ Assessed by their degrees of internal and external rotation

Hinge joints
■ Include the knee and the elbow
■ Move in flexion and extension

Pivot joints
■ Rounded portion of one bone in a pivot joint fits into a groove
in another bone.
 ■ Allow only uniaxial rotation of the first bone around the second
■ Include the head of the radius, which rotates within a groove of
the ulna

Condylar joints
■ An oval surface of one bone fits into a concavity in another
bone.
■ Allow flexion, extension, abduction, adduction, and
circumduction
■ Include the radiocarpal and metacarpophalangeal joints of the
hand

Saddle joints
■ Resemble condylar joints but allow greater freedom of
movement
■ Only saddle joints are the carpometacarpal joints of the thumb.

Bursae
Bursae are small synovial fluid sacs located at friction points around joints
between tendons, ligaments, and bones. Examples include the subacromial bursa
(located in the shoulder) and the prepatellar bursa (located in the knee).
Able to label?
Label the structures of the muscle fiber shown in this
illustration.
 Matchmaker
Match the five common joint types shown on the left with the
movements they allow.

A. Allow flexion, extension,

abduction, adduction, and
circumduction
B. Allow flexion, extension,
adduction, and abduction
C. Allow greater freedom of
movement than do condylar
joints
D. Move in flexion and
extension
E. Allow only uniaxial rotation
of the first bone around the
second
Perimysium, 5. Epimysium; Matchmaker 1. B, 2. D, 3. E, 4. A, 5. C.
Answers: Able to label? 1. Myofibrils, 2. Sarcolemma, 3. Endomysium, 4.
Chapter 6
Nervous system
Neurons
Neuroglia
Central nervous system
Peripheral nervous system
Vision quest
Neurons
The neuron is the basic unit of the nervous system. This highly specialized
conductor cell receives and transmits electrochemical nerve impulses. Delicate,
threadlike nerve fibers called axons and dendrites extend from the central cell
body and transmit signals. In a typical neuron, one axon and many dendrites
extend from the cell body. Neurons are located in the brain, spinal cord, and
spinal ganglia.
■ Mechanical stimuli ■ Thermal stimuli ■ Chemical stimuli
(such as touch and (such as heat and (either external
pressure) cold) chemicals or a
chemical released by
the body, such as
histamine)

How neurotransmission occurs

When an impulse reaches the end of the axon, it stimulates synaptic

vesicles in the presynaptic axon terminal.
 A neurotransmitter substance is then released into the synaptic cleft
between neurons.
This substance diffuses across the synaptic cleft and binds to receptors
on the postsynaptic membrane. This stimulates or inhibits stimulation of
the postsynaptic neuron.

Neuroglia
Neuroglia (also called glial cells) are the supportive cells of the nervous system,
forming roughly 40% of the brain’s bulk. Unlike neurons, they do not conduct
nerve impulses.

Central nervous system

The central nervous system includes the brain and spinal cord.

The brain
Brain structures
Cerebrum
■ Also known as cerebral cortex
■ Controls ability to think and reason
■ Enclosed by three meninges (dura mater, arachnoid mater, and pia mater)
■ Contains the diencephalon, which consists of the thalamus and hypothalamus

Thalamus
■ Relay station for sensory impulses

Hypothalamus
■ Controls regulatory functions, including body temperature, pituitary hormone
production, and water balance

Brain stem
■ Regulates autonomic body functions, such as heart rate, breathing, and
swallowing
■ Contains cranial nerves III through XII
Cerebellum
■ Contains major motor and sensory pathways
■ Helps maintain equilibrium
■ Controls muscle coordination

Age-old story

Neurologic changes with aging

■ The number of brain cells decreases at a rate of about 1% per year after age
50 years. (Clinical effects usually aren’t noticeable until aging is more
advanced.)
■ The hypothalamus becomes less effective at regulating body temperature.
■ The cerebral cortex undergoes a 20% neuron loss.
■ Nerve transmission typically slows, resulting in a sluggish response to
external stimuli.
Spinal cord
The spinal cord extends from the upper border of the first cervical vertebra to the
lower border of the first lumbar vertebra. It’s encased by a continuation of the
meninges and CSF of the brain. It’s also protected by the bony vertebrae of the
spine.

Reflex arc
Major neural pathways
Sensory pathways
■ Sensory impulses travel via afferent (sensory, or ascending) neural pathways to
the sensory cortex in the parietal lobe of the brain where they’re interpreted.
■ Impulses travel up the cord in the dorsal column to the medulla where they
cross to the opposite side and enter the thalamus.
■ The thalamus then relays all incoming sensory impulses (except olfactory
impulses) to the sensory cortex for interpretation.
■ Pain and temperature sensations enter the spinal cord through the dorsal horn.
■ Touch, pressure, and vibration sensations enter the cord via ganglia (knotlike
masses of nerve cell bodies on the dorsal roots of spinal nerves).

Motor pathways
■ Motor impulses travel from the brain to the muscles via the efferent (motor, or
descending) neural pathways.
■ Motor impulses originate in the motor cortex of the frontal lobe and reach the
lower motor neurons of the peripheral nervous system via upper motor neurons.
■ Upper motor neurons originate in the brain and form two major systems:
– The pyramidal system—responsible for fine, skilled movements of skeletal
muscle
– The extrapyramidal system—controls gross motor movements
Reflex responses
Reflex responses occur automatically, without any brain involvement, to protect
the body. Reflex responses include:
■ deep tendon reflexes—involuntary contractions of a muscle after brief
stretching caused by tendon percussion
■ superficial reflexes—withdrawal reflexes elicited by noxious or tactile
stimulation of the skin, cornea, or mucous membranes
■ primitive reflexes—abnormal in adults but normal in infants, whose central
nervous systems are immature.

Eliciting deep tendon reflexes

Test deep tendon reflexes by moving from head to toe and comparing side to
side.

Biceps reflex
Position the patient’s arm so his elbow is flexed at a 45-degree angle and his arm
is relaxed. Place your thumb or index finger over the biceps tendon. Strike your
finger with the pointed end of the reflex hammer, and watch and feel for the
contraction of the biceps muscle and flexion of the forearm.
Triceps reflex
Ask the patient to adduct his arm and place his forearm across his chest. Strike
the triceps tendon about 2″ (5 cm) above the olecranon process on the extensor
surface of the upper arm. Watch for contraction of the triceps muscle and
extension of the forearm.

Patellar reflex
Ask the patient to sit with his legs dangling freely. If he can’t sit up, flex his knee
at a 45-degree angle and place your nondominant hand behind it for support.
Strike the patellar tendon just below the patella, and look for contraction of the
quadriceps muscle in the thigh with extension of the leg.

Achilles reflex
Ask the patient to flex his foot. Strike the Achilles tendon, and watch for plantar
flexion of the foot at the ankle.

Brachioradialis reflex
Ask the patient to rest the ulnar surface of his hand on his abdomen or lap with
the elbow partially flexed. Strike the radius, and watch for supination of the hand
and flexion of the forearm at the elbow.

Protective structures
Defensive lineup
■ Dura mater: tough, fibrous, leatherlike tissue composed of the endosteal dura
(forms the periosteum of the skull and is continuous with the lining of the
vertebral canal) and the meningeal dura (a thick membrane that covers the brain,
providing support and protection)
■ Subdural space: lies between the dura mater and the arachnoid membrane
■ Arachnoid membrane: thin, fibrous membrane that hugs the brain and spinal
cord
■ Subarachnoid space: lies between the arachnoid membrane and the pia mater
■ Pia mater: continuous, delicate layer of connective tissue that covers and
contours the spinal tissue and brain

Peripheral nervous system

The peripheral nervous system consists of the peripheral nerves, cranial nerves,
and autonomic nervous system.

Peripheral nerves
Peripheral sensory nerves transmit stimuli to the posterior horn of the spinal cord
from sensory receptors located in the skin, muscles, sensory organs, and viscera.
The area of the skin that’s innervated by each sensory nerve is called a
dermatome.

Cranial nerves
The 12 pairs of cranial nerves are the primary motor and sensory pathways
between the brain, head, and neck.
Autonomic nervous system
The autonomic nervous system controls involuntary body functions, such as the
activity of the cardiac muscle and glandular epithelial tissue. It has two
subdivisions:
■ The sympathetic nervous system functions mainly during stress, triggering the
fight-or-flight response (increased heart rate and respiratory rate; cold, sweaty
palms; and pupil dilation).
■ The parasympathetic nervous system activates the gastrointestinal (GI) system
and supports restorative, resting body functions.
Show and tell
Using the illustration as a guide, describe the three steps
involved in neurotransmission.
Answers: Show and tell 1. When an impulse reaches the end of the axon, it
stimulates synaptic vesicles in the presynaptic axon terminal. 2. A
neurotransmitter substance is then released into the synaptic cleft between
neurons. 3. This substance diffuses across the synaptic cleft and binds to
receptors on the postsynaptic membrane. This stimulates or inhibits stimulation
of the postsynaptic neuron; Matchmaker 1. B, 2. D, 3. E, 4. A, 5. C.
E. Patellar
D. Triceps
C. Brachioradialis
B. Biceps
A. Achilles
Match each photo with the type of reflex being tested.
Matchmaker
Chapter 7
Sensory system
The eyes
The ears
The nose
The mouth
Vision quest
The eyes
Measuring about 1″ (2.5 cm) in diameter, eyes are sensory organs for vision.
Each eye is equipped with many extraocular and intraocular structures. Some
structures are easily visible, whereas others can only be viewed with special
instruments.

Extraocular structures
■ Bony orbits protect the eyes from trauma.
■ The eyelids (or palpebrae) and eyelashes protect the eyes from injury, dust,
and foreign bodies.
■ Conjunctivae (thin mucous membranes that line the inner surface of each
eyelid and the anterior portion of the sclera) guard against invasion by foreign
matter.
■ The structures of the lacrimal apparatus (lacrimal glands, punctum,
lacrimal sac, and nasolacrimal duct) lubricate and protect the cornea and
conjunctivae by producing and absorbing tears.
■ Extraocular muscles hold the eyes in place and control movement, helping
create binocular vision.
Intraocular eye structures
 Age-old story

The aging eye

Aging causes a number of changes in the intraocular structures of the eye:
■ Sclera becomes thick and rigid, and fat deposits cause yellowing.
■ Cornea loses its luster and flattens.
■ Iris fades or develops irregular pigmentation.
■ Increased formation of connective tissue may cause sclerosis of the
sphincter muscles.
■ Pupil becomes smaller, reducing the amount of light that reaches the retina.
■ Vitreous humor can degenerate, revealing opacities and floating debris, or
detach from the retina.
■ Lens enlarges and loses transparency; impaired lens elasticity (presbyopia)
can decrease accommodation (optical power and focus).
■ Reabsorption of intraocular fluid can diminish, predisposing an aging
person to glaucoma.

Image perception and formation

Intraocular structures receive and form images and then send them to the brain
for interpretation.
The ears
The ears are organs of hearing; they also maintain the body’s equilibrium. Each
ear is divided into three main parts:
 Age-old story
Hearing loss
Many older people have some degree of hearing loss. One possible cause is a
gradual buildup of cerumen. Another cause is a slow, progressing deafness
called presbycusis or senile deafness. This irreversible, bilateral sensorineural
hearing loss usually starts at middle age, slowly worsens, and affects more
men than women.
The nose
The nose is the sense organ for smell. The mucosal epithelium that lines the
uppermost portion of the nasal cavity houses receptors for fibers of the olfactory
nerve (cranial nerve I). These receptors, called olfactory (smell) receptors,
consist of hair cells that are highly sensitive but easily fatigued.
 Age-old story
The aging nose
Nasal cartilage continues to grow as people age, resulting in nose
enlargement. In addition, the nasal septum, which is straight at birth and in
early life, becomes slightly deviated or deformed in almost every adult.

The mouth
The roof of the mouth and the tongue contain most of the receptors for the taste
nerve fibers (located in branches of cranial nerves VII and IX). Called taste
buds, these receptors are stimulated by chemicals and respond to four taste
sensations:
■ sweet (on the tip of the tongue)
■ sour (along the sides)
■ bitter (on the back)
■ salty (on the tip and sides).
All other taste sensations result when air passing through the nose stimulates
olfactory receptors and taste buds.
Able to label?
Identify the intraocular structures shown on this illustration.
Answers: Able to label? 1. Sclera, 2. Ciliary body, 3. Cornea, 4. Pupil, 5. Lens,
6. Iris, 7. Vitreous humor; Show and tell 1. Light shining on the cornea passes
through the pupil and clear lens. 2. The image projected on the retina is inverted
and reversed. 3. The rods and cones in the retina convert the light into electrical
impulses. 4. The optic nerve collects and sends these impulses to the brain. 5.
The brain interprets the image right-side up.
perception and formation.
Using the illustration as a guide, describe the process of image
Show and tell
Chapter 8
Endocrine system
Glands
Hormones
Receptors
Vision quest
Glands
Endocrine glands secrete hormones directly into the bloodstream to regulate
body function. This illustration shows the location of the major endocrine
glands.

Pituitary gland
The pituitary, a pea-sized gland, rests in the sella turcica, a depression in the
sphenoid bone at the base of the brain.
Thyroid and parathyroid glands
The thyroid, a butterfly-shaped gland, lies directly below the larynx, partially in
front of the trachea.
Adrenal glands
The two adrenal glands each lie on top of a kidney. These almond-shaped glands
contain two distinct structures—the adrenal cortex and the adrenal medulla—
that function as separate endocrine glands.
Pancreas
Nestled in the curve of the duodenum, the pancreas stretches horizontally behind
the stomach and extends to the spleen. It performs both endocrine (inward
secretion) and exocrine (outward secretion) functions.

Pancreatic secretions
Secretions from the pancreas assist with the digestion of many substances. This
chart summarizes the functions of enzymes contained in the pancreatic
secretions.

Enzyme Function
Trypsin, chymotrypsin, and Digest protein
carboxypeptidase
Ribonuclease and deoxyribonuclease Digest nucleic acids
Amylase Digests starch
Lipase Digests fats and other lipids
Cholesterol esterase Splits cholesterol esters into
cholesterol and fatty acids

Pineal gland
The tiny pinecone-shaped gland lies at the back of the third ventricle of the
brain. It produces the hormone melatonin, which has many widespread effects.

Thymus
Located below the sternum and between the lungs, the thymus contains primarily
lymphatic tissue. It reaches maximum size at puberty and then starts to atrophy.
Gonads
Hormones
Hormones are complex chemicals that trigger or regulate the activity of an organ
or a group of cells.

Classification of hormones
Hormones are classified by their molecular structure as polypeptides, steroids, or
amines.

Classification Hormones

Polypeptides ■ Anterior pituitary hormones (GH,

Made of many amino acids connected TSH, FSH, LH, and prolactin)
by peptide bonds ■ Posterior pituitary hormones
(ADH and oxytocin)
■ Parathyroid hormone (PTH)
 ■ Pancreatic hormones (insulin and
glucagon)

Steroids ■ Adrenocortical hormones

Derived from cholesterol (aldosterone and cortisol)
■ Sex hormones (estrogen and
progesterone in females and
testosterone in males)

Amines ■ Thyroid hormones (T4 and T3)

Derived from tyrosine ■ Catecholamines (epinephrine,
norepinephrine, and dopamine)

Hormone release and transport

Although all hormone release results from endocrine gland stimulation, release
patterns of hormones vary greatly.

Hormone action
 Right on target
■ Polypeptides and some amines bind to membrane receptor sites.
■ Smaller, more lipid-soluble steroids and thyroid hormones diffuse through
the cell membrane and bind to intracellular receptors.
■ After binding occurs, each hormone produces unique physiologic changes,
depending on its target site and its specific action at that site.
■ A particular hormone may exert different effects at different target sites.

Hormone regulation
To maintain the body’s delicate equilibrium, a feedback mechanism regulates
hormone production and secretion. The mechanism involves hormones, blood
chemicals and metabolites, and the nervous system. This system may be simple
or complex.

Simple feedback

Complex feedback
Complex feedback occurs through an axis established between the
hypothalamus, pituitary gland, and target organ.
Mechanisms that control hormone release
Four basic mechanisms control hormone release:

1 Pituitary-target gland axis

The pituitary gland regulates other endocrine glands by releasing and inhibiting
hormones. These hormones include:
■ corticotropin, which regulates adrenocortical hormones
■ TSH, which regulates T4 and T3
■ LH, which regulates gonadal hormones.
The pituitary continuously monitors levels of hormones produced by its target
glands. If a change occurs, the pituitary corrects it by increasing or decreasing
the trophic hormones.

2 Hypothalamic-pituitary-target gland axis

The hypothalamus also produces trophic hormones that regulate anterior

pituitary hormones. By controlling anterior pituitary hormones, which regulate
the target gland hormones, the hypothalamus affects target glands as well.
 3 Chemical regulation

Endocrine glands not controlled by the pituitary gland may be controlled by

specific substances that trigger gland secretions. For example, blood glucose
level is a major regulator of glucagon and insulin release.

4 Nervous system regulation

The central nervous system (CNS) helps to regulate hormone secretion in several
ways:
■ Hypothalamic nerve cells stimulate the posterior pituitary to produce ADH
and oxytocin. Therefore, these hormones are controlled directly by the CNS.

■ Nervous system stimuli, such as hypoxia (oxygen deficiency), nausea, pain,

stress, and certain drugs, also affect ADH levels.

■ The autonomic nervous system (ANS) controls catecholamine secretion by

the adrenal medulla.

■ The nervous system also affects other endocrine hormones. For example,
stress, which leads to sympathetic stimulation, causes the pituitary to release
corticotropin.

Receptors
Receptors are protein molecules that bind specifically with other molecules, such
as hormones, to trigger specific physiologic changes in a target cell.
1 When released, a hormone travels to target cells.

2 Cells that have receptors specific to that hormone recognize the

hormone and bind to it. A hormone acts only on cells with receptors
specific to that hormone.

Age-old story
Age-related endocrine changes
As a person ages, normal changes in endocrine function include:
■ reduced progesterone production
■ a 50% decline in serum aldosterone levels
■ a 25% decrease in cortisol secretion rate.
Also, under stressful conditions, an elderly person’s blood glucose level
rises higher and remains elevated longer than does a younger adult’s.
Able to label?
Identify the structures of the endocrine system shown on these
illustrations.
 My word!
Use the clues to help you unscramble the names of some of the
body’s major glands. Then use the circled letters to answer the
question posed.

Question: What chemical substance triggers or regulates the

activity of an organ or group of cells?
1. Serves as storage area for ADH
poetorris tauipitry

2. Part of almond-shaped gland that sits on top of the kidney

leadran dualelm

3. Has two lobes that function as one unit

dryhoit
Answer:
Question: Hormone.
Testes; My word! 1. Posterior pituitary, 2. Adrenal medulla, 3. Thyroid;
parathyroid glands, 4. Thymus gland, 5. Adrenal gland, 6. Pancreas, 7. Ovary, 8.
Answers: Able to label? 1. Pituitary gland, 2. Pineal gland, 3. Thyroid and
Chapter 9
Cardiovascular
system
Location of the heart
Structures of the heart
Flow of blood through the heart
Cardiac conduction
Cardiac output
Arteriovenous circulation
Specialized circulatory systems
Vision quest
Location of the heart
The heart lies beneath the sternum within the mediastinum, a cavity that
alsocontains the great vessels and trachea. In most people, two-thirds of the heart
extends to the left of the body’s midline, close to the left midclavicular line. The
heart rests obliquely so that its broad part (the base) is at its upper right and the
pointed end (the apex) is at its lower left. The apex is the point of maximal
impulse, where heart sounds are loudest.

Structures of the heart

Heart wall layers
■ The epicardium, the outer layer, is made up of squamous epithelial cells
underlying connective tissue.
■ The myocardium, the middle layer, forms most of the heart wall. It has striated
muscle fibers that cause the heart to contract.
■ The endocardium, the heart’s inner layer, consists of endothelial tissue with
small blood vessels and bundles of smooth muscle.
Pericardium
A sac called the pericardium surrounds the heart and roots of the great vessels. It
consists of two layers: the fibrous pericardium (tough, white fibrous tissue) and
serous pericardium (thin, smooth inner portion). The serous pericardium also has
two layers: the parietal layer (lines the inside of the fibrous pericardium) and the
visceral layer (adheres to the surface of the heart).
Between the fibrous and serous pericardium is the pericardial space. This
space contains pericardial fluid (10 to 20 mL), which lubricates the surfaces of
the space and allows the heart to move easily during contraction.

Heart chambers
Within the heart lie four hollow chambers: two atria and two ventricles.
■ The right and left atria serve as volume reservoirs for blood being sent into the
ventricles.
– The interatrial septum divides the atrial chambers, helping them to contract
and force blood into the ventricles below.
■ The ventricles serve as the pumping chambers of the heart.
– The interventricular septum separates the ventricles and also helps them to
pump.
Pump it up!
The thickness of a chamber’s wall depends on the amount of high-pressure work
the chamber does:
■ Because the atria only have to pump blood into the ventricles, their walls are
relatively thin.
■ The walls of the right ventricle are thicker because it pumps blood against the
resistance of the pulmonary circulation.
■ The walls of the left ventricle are thickest of all because it pumps blood
against the resistance of the systemic circulation.
Heart valves
The heart contains four valves: two atrioventricular (AV) valves (the mitral and
tricuspid) and two semilunar valves (the pulmonic and aortic). The valves allow
forward flow of blood through the heart and prevent backward flow.
The tricuspid valve, or right AV valve, prevents backflow from the right
ventricle into the right atrium. The mitral valve, also known as the bicuspid or
left AV valve, prevents backflow from the left ventricle into the left atrium. The
pulmonic valve, one of the two semilunar valves, prevents backflow from the
pulmonary artery into the right ventricle. The other semilunar valve is the aortic
valve, which prevents backflow from the aorta into the left ventricle.

Under pressure!
Pressure changes within the heart affect the opening and closing of the valves.
The amount of blood stretching the chamber and the degree of contraction of
the chamber wall determine the pressure. For example, as blood fills a
chamber, the pressure rises; then, as the chamber wall contracts, the pressure
rises further. This increase in pressure causes the valve to open and blood to
flow out into an area of lower pressure, leading to an equal pressure state.

Flow of blood through the heart

Step 1
Blood fills all heart chambers. The right atrium receives deoxygenated blood
returning from the body through the inferior and superior vena cava and from the
heart through the coronary sinus. The left atrium receives oxygenated blood
from the lungs through the four pulmonary veins. Passive filling of the ventricles
begins with diastole.

Step 2
The atria contract. The remaining blood enters the ventricles. The atria
pump their blood through the two AV valves (mitral and tricuspid) directly into
their respective ventricles.

Step 3
The ventricles contract. Blood enters the aorta and pulmonary arteries. The
right ventricle pumps blood through the pulmonic valve into the pulmonary
arteries and then into the lungs. That blood returns, oxygenated, to the left
atrium, completing pulmonic circulation.
The left ventricle pumps blood through the aortic valve into the aorta and then
throughout the body. Deoxygenated blood returns to the right atrium, completing
systemic circulation.
Cardiac conduction
The conduction system of the heart begins with the heart’s pacemaker: the
sinoatrial (SA) node. When an impulse leaves the SA node, it travels through the
atria along Bachmann’s bundle and the intermodal tract on its way to the AV
node. After the impulse passes through the AV node, it travels to the ventricles,
first down the bundle of His, then along the bundle branches and, finally, down
the Purkinje fibers.

Pacemakers of the heart

The SA node is the heart’s primary pacemaker. Pacemaker cells in lower areas,
such as the junctional tissue and the Purkinje fibers, initiate an impulse only
when they don’t receive one from above, such as when the SA node is damaged
from a myocardial infarction.

Generation and transmission of electrical impulses depend on four
characteristics of cardiac cells:

ability to spontaneously initiate an impulse

(pacemaker cells have this ability)
a cell’s response to an electrical stimulus (results
from ion shifts across the cell membrane)
ability of a cell to transmit an electrical impulse
to another cardiac cell
ability of a cell to contract after receiving a
stimulus

Depolarization–repolarization cycle
As impulses are transmitted, cardiac cells undergo cycles of depolarization and
repolarization. The depolarization–repolarization cycle has five phases:
Cardiac output
Cardiac output refers to the amount of blood the heart pumps in 1 minute. This is
measured in liter per minute. To determine cardiac output, multiply the heart rate
by the stroke volume (the amount of blood ejected with each heartbeat). Stroke
volume depends on three factors:
Preload is the stretching of muscle fibers in the ventricles as the ventricles fill
with blood. Think of preload as a balloon stretching as air is blown into it. The
more air being blown, the greater the stretch.
Contractility refers to the inherent ability of the myocardium to contract
normally. Contractility is influenced by preload. The greater the stretch, the
more forceful the contraction—or, the more air in the balloon, the greater the
stretch, and the farther the balloon will fly when the air is allowed to expel.

Afterload refers to the pressure that the ventricular muscles must generate to
overcome the higher pressure in the aorta to get the blood out of the heart.
Resistance is the knot on the end of the balloon, which the balloon has to work
against to get the air out.

Pulling it together
When a muscle cell is in the resting state, tropomyosin and troponin (a
cardiac-specific protein) inhibit contractility by preventing actin–myosin
binding.

Electrical stimulation causes calcium release. Calcium binds to troponin,

changing the configuration of tropomyosin and exposing actin-binding sites.
Myosin and actin bind, creating cross-bridges, and the muscle contracts.
Arteriovenous circulation
Blood flows through the body in five types of vessels:
■ Arteries—have thick, muscular walls to accommodate high speed and
pressure of blood flow.
■ Arterioles—have thinner walls than arteries; control blood flow to
capillaries.

■ Capillaries—have microscopic walls composed of a single layer of

endothelial cells.

■ Venules—gather blood from the capillaries; have thinner walls than

arterioles.
■ Veins—have thinner walls but larger diameters than arteries.
Valves in the veins prevent blood backflow. Pressure from the moving
volume of blood from below pushes pooled blood in each valved segment
toward the heart.
Specialized circulatory systems
The circulatory system involves more than the circulation of blood out of the
heart. The heart muscle itself, as well as the liver, must receive a steady supply
of oxygenated blood.

Circulation to the heart muscle

The heart relies on the coronary arteries and their branches for its supply of
oxygenated blood. It also depends on the cardiac veins to remove oxygen-
depleted blood.
During diastole, blood flows out of the heart and into the coronary arteries.
The right coronary artery supplies blood to the right atrium, part of the left
atrium, most of the right ventricle, and the inferior part of the left ventricle. The
left coronary artery, which splits into the anterior descending and circumflex
arteries, supplies blood to the left atrium, most of the left ventricle, and most of
the interventricular septum.
The cardiac veins lie superficial to the arteries. The largest vein, the coronary
sinus, opens into the right atrium. Most of the major cardiac veins empty into the
coronary sinus; the anterior cardiac veins, however, empty into the right atrium.
Circulation to the liver
Seventy-five percent of the blood in the liver comes from the portal vein that
drains the gastrointestinal (GI) tract. This blood is full of nutrients. The other
25% is oxygenated blood coming from the hepatic artery.
Capillary beds form the sinusoids of the liver, where hepatocytes filter and
store nutrients and toxins. The sinusoids empty into the hepatic vein for venous
return to the heart.
 Age-old story
Age-related cardiovascular changes
The heart
As a person ages, normal changes in endocrine function include:
■ Heart becomes slightly smaller.
■ Contractile strength declines, making the heart less efficient.
■ Resting cardiac output diminishes 30% to 35% by age 70 years.
■ The aorta becomes more rigid, causing systolic blood pressure to rise
disproportionately higher than the diastolic pressure, resulting in a widened
pulse pressure.
■ Between ages 30 and 80 years, the left ventricular wall grows 25% thicker
from its increased efforts to pump blood.
■ Heart valves become thicker from fibrotic and sclerotic changes. This can
prevent the valves from closing completely, causing systolic murmurs.

Circulatory system
■ Veins dilate and stretch with age.
■ Coronary artery blood flow drops 35% between ages 20 and 60 years.
Able to label?
Label the heart chambers and heart valves indicated on this
illustration.
 My word!
Unscramble the names of the five vessel types in the circulatory
system. Then use the circled letters to answer the question
posed.

Question: Which node is the heart’s primary pacemaker?

1. elvesun
2. areelsriot
3. siven
4. isacalliper
5. eatersir
Answer:
Question: Sinoatrial.
My word! 1. Venules, 2. Arterioles, 3. Veins, 4. Capillaries, 5. Arteries;
Pulmonic valve, 5. Left atrium, 6. Mitral valve, 7. Left ventricle, 8. Aortic valve;
Answers: Able to label? 1. Right atrium, 2. Tricuspid valve, 3. Right ventricle, 4.
Chapter 10
Hematologic system
Hematology basics
Blood components
Blood clotting
Blood groups
Vision quest
Hematology basics
The hematologic system consists of the blood and bone marrow. Blood delivers
oxygen and nutrients to all tissues; removes wastes; transports gases, blood cells,
immune cells, and hormones throughout the body; and maintains acid–base
balance.

The development of blood cells

The hematologic system manufactures new blood cells through a process called
hematopoiesis. This process occurs in three stages (mitosis, maturation, and
differentiation).

1 Multipotential stem cells in bone marrow give rise to…

2 …five distinct types of unipotential stem cells.

Unipotential stem cells differentiate into the various types of blood

3 cells.
Blood components
Blood consists of various formed elements, or blood cells, suspended in a fluid
called plasma. Formed elements in the blood include:
 Age-old story
Age-related hematologic changes
As a person ages, fatty bone marrow replaces some of the body’s active blood-
forming marrow—first in the long bones and later in the flat bones. The
altered bone marrow can’t increase erythrocyte production as readily in
response to such stimuli as hormones, anoxia, hemorrhage, and hemolysis.
Vitamin B12 absorption may also diminish with age, resulting in reduced
erythrocyte mass and decreased hemoglobin levels and hematocrit.

Red blood cells

RBCs, or erythrocytes, transport oxygen and carbon dioxide to and
from body tissues. They contain hemoglobin, the oxygen-carrying
substance that gives blood its red color. The RBC surface carries
antigens, which determine a person’s blood group, or blood type.
White blood cells
WBCs, or leukocytes, protect the body against harmful bacteria and infection.
Most WBCs are produced in the red bone marrow from a precursor stem cell
called a hemocytoblast. WBCs are classified as granulocytes or agranulocytes.

Granulocytes
(Contain a single multilobular nucleus and granules in the cytoplasm)

Neutrophils

■ Most numerous, accounting for 50% to 75% of circulating WBCs

■ Engulf, ingest, and digest foreign materials (phagocytosis)
■ Worn-out neutrophils form the main component of pus

Eosinophils
■ Account for 0.3% to 7% of circulating WBCs
■ Migrate from the bloodstream as a response to an allergic reaction
■ Defend against parasites and fight lung and skin infections

Basophils

■ Constitute fewer than 2% of circulating WBCs

■ Possess little or no phagocytic ability
■ May release heparin and histamine into blood and participate in delayed
allergic reactions

Agranulocytes
(Lack specific cytoplasmic granules and have a nucleus without lobes)

Monocytes

■ Largest of the WBCs

■ Constitute 1% to 9% of WBCs in circulation
■ Devour invading organisms by phagocytosis
■ Migrate to tissue where they develop into macrophages, which participate in
immunity

Lymphocytes

■ Smallest of the WBCs

■ Constitute 20% to 43% of WBCs
■ Derive from stem cells in the bone marrow
■ Consist of two types:
– T lymphocytes, which directly attack an infected cell
– B lymphocytes, which produce antibodies against specific antigens

On the front line

Granulocytes, with “platoons” of basophils, neutrophils, and eosinophils, are
the first forces “marshaled” against invading foreign organisms.

Basophils spit histamine at inflammatory and immune stimuli.

Neutrophils eat foreign bodies.

Eosinophils eat antigens and antibodies.

In the trenches
Agranulocytes, with platoons of lymphocytes and monocytes, may roam
freely on “patrol” when inflammation is reported, but they mainly “dig in” at
structures that filter large amounts of fluid (such as the liver) and defend
against invaders.
 Lymphocytes eat the enemy or produce antibodies.

Monocytes eat bacteria, cellular debris, and necrotic tissue.

Platelets

Platelets, or thrombocytes, are small, colorless, disk-shaped cytoplasmic

fragments split from cells in bone marrow called megakaryocytes. These
fragments, which have a life span of approximately 10 days, perform three vital
functions:
 ■ Initiate contraction of damaged blood vessels to minimize blood loss

■ Provide materials (along with plasma) that accelerate blood

coagulation

■ Form hemostatic plugs in injured blood vessels

Blood clotting
Hemostasis is the complex process by which platelets, plasma, and coagulation
factors interact to control bleeding.

When a blood vessel ruptures, local

vasoconstriction (decrease in the caliber of blood
vessels) occurs to decrease blood flow to the area.

Platelets and clotting factors become activated

when exposed to the collagen layer of the damaged
blood vessel.

Platelets clump together (aggregate) by binding to

the collagen, forming a loose platelet plug.
How blood clots
Coagulation factors
Coagulation factors are:
■ made up of plasma proteins, except for factor IV (calcium), which is a mineral,
and factor III (thromboplastin), which is a lipoprotein released from tissue
■ produced in the liver
■ activated in a chain reaction, with each one in turn activating the next factor in
the chain.

Factor I
■ Fibrinogen
■ Converts to fibrin when blood clots

Factor II
■ Prothrombin
■ Inactive precursor to thrombin
Factor III
■ Tissue thromboplastin
■ Converts prothrombin to thrombin as
blood starts to clot

Factor IV
■ Consists of calcium ions
■ Required throughout the entire
clotting sequence

Factor V
■ Labile factor (proaccelerin)
■ Functions during the combined
pathway phase of the coagulation
system

Factor VII
■ Also known as serum prothrombin
conversion accelerator or stable factor
(proconvertin)
■ Activated by factor III in the extrinsic
system

Factor VIII
■ Antihemophilic factor
■ Required during the intrinsic phase of
the coagulation system

Factor IX
 ■ Plasma thromboplastin component
■ Required in the intrinsic phase of the
coagulation system

Factor X
■ Stuart factor (Stuart-Prower factor)
■ Required in the combined pathway of
the coagulation system

Factor XI
■ Plasma thromboplastin antecedent
■ Required in the intrinsic system

Factor XII
■ Hageman factor
■ Required in the intrinsic system

Factor XIII
■ Fibrin-stabilizing factor
■ Required to stabilize fibrin strands in
the combined pathway phase of the
coagulation system

Blood groups
Blood groups are determined by the presence or absence of genetically
determined antigens or agglutinogens (glycoproteins) on the surface of RBCs.
(A, B, and Rh are the most clinically significant blood antigens.) Plasma may
contain antibodies that interact with the antigens on other RBC types, causing
the cells to agglutinate, or clump together.
Rh typing
Rh typing determines whether the Rh antigen (called the Rh factor) is present or
absent in the blood:
■ If RBCs have the Rh antigen, the blood is Rh positive.
■ If RBCs don’t have the Rh antigen, it’s Rh negative.
When a person who is Rh negative becomes sensitized to the Rh antigen,
such as following a transfusion of Rh-positive blood or when an Rh-negative
female carries an Rh-positive fetus, anti-Rh antibodies can develop.
Making a match
Precise blood typing and crossmatching (mixing and observing for agglutination
of donor cells) are essential, especially for blood transfusions. A donor’s blood
must be compatible with a recipient’s or the result can be fatal. These blood
groups are compatible:
■ Type A with type A or O
■ Type B with type B or O
■ Type AB with type A, B, AB, or O
■ Type O with type O only
 Matchmaker
Match each type of blood component with its main function.

1. Erythrocytes A. Perform a key role in blood clotting

2. Leukocytes B. Protect the body against harmful bacteria
3. Platelets C. Transport oxygen and carbon dioxide to and from body
4. Stem cells tissues
D. Give rise to the cells that differentiate into the various
types of blood cells
Answers: Matchmaker 1. C, 2. B, 3. A, 4. D; Show and tell 1. When a blood
vessel ruptures, local vasoconstriction occurs to decrease blood flow to the area.
2. Platelets and clotting factors become activated when exposed to the collagen
layer of the damaged blood vessel. 3. Platelets aggregate by binding to the
collagen, forming a loose platelet plug.
Describe the steps in blood clot formation illustrated here.
Show and tell
Chapter 11
Immune system
Immune system structures
Functions of the immune system
Vision quest
Immune system structures
Organs and tissues of the immune system are referred to as lymphoid because
they’re all involved with the growth, development, and dissemination of
lymphocytes, one type of white blood cell (WBC).
The immune system has three major divisions:

1 Central lymphoid organs and tissues

2 Peripheral lymphoid organs and tissues

3 Accessory lymphoid organs and tissues

Central lymphoid organs and tissues
The bone marrow and thymus play distinctive roles in the development of B
cells and T cells, two major types of lymphocytes.
Peripheral lymphoid organs and tissues

Lymph nodes
The lymph nodes are small, oval-shaped structures located along a network of
lymph channels. Most abundant in the head, neck, axillae, abdomen, pelvis, and
groin, they help remove and destroy antigens (substances capable of triggering
an immune response) that circulate in the blood and lymph.
Lymph and lymphatic vessels
Lymph is a clear fluid that bathes the body tissues, moving through the
intracellular spaces via the lymphatic vessels.

The path of lymph
Lymphatic vessels drain into lymph node chains that, in turn, empty into large
lymph vessels, or trunks, that drain into the subclavian vein of the vascular
system.
Spleen
The spleen is a dark red, oval structure that’s approximately the size of a fist.
The interior, called the splenic pulp, contains white and red pulp.

White pulp
■ Contains compact masses of lymphocytes
■ Surrounds branches of the splenic artery
 Red pulp
■ Consists of a network of blood-filled sinusoids
■ Supported by a framework of reticular fibers and mononuclear
phagocytes, along with some lymphocytes, plasma cells, and
monocytes

The spleen’s functions

■ Engulfs and breaks down worn-out red blood cells (RBCs), causing the release
of hemoglobin, which then breaks down into its components
■ Retains and destroys damaged or abnormal RBCs and cells with large amounts
of abnormal hemoglobin

■ Filters and removes bacteria and other foreign substances that enter the
bloodstream

■ Initiates an immune response

■ Stores blood and 20% to 30% of platelets

Accessory lymphoid organs and tissues
The tonsils, adenoids, appendix, and Peyer’s patches remove foreign debris in
much the same way lymph nodes do. They’re located in food and air passages—
areas where microbial access is likely to occur.

Functions of the immune system

The immune system is designed to recognize, respond to, and eliminate antigens,
including bacteria, fungi, viruses, and parasites. It also preserves the body’s
internal environment by scavenging dead or damaged cells and patrolling for
antigens. To perform these functions efficiently, the immune system uses three
basic strategies:

Protective surface phenomena

Strategically placed physical, chemical, and mechanical barriers work to prevent
the entry of potentially harmful organisms.
 General host defenses
When an antigen does penetrate the skin or mucous membrane, the immune
system launches nonspecific cellular responses in an effort to identify and
remove the invader.
 Specific immune responses
Invasion of a foreign substance can trigger two types of immune responses—
antibody-mediated (humoral) and cell-mediated immunity:
■ In antibody-mediated immunity, antigens stimulate B cells to differentiate into
plasma cells and produce circulating antibodies that disable bacteria and viruses
before they can enter host cells.
■ In cell-mediated immunity, T cells move directly to attack invaders. Three T-
cell subgroups trigger the response to infection. Helper T cells spur B cells to
manufacture antibodies. Effector T cells kill antigens and produce lymphokines
(proteins that induce inflammatory response and mediate the delayed
hypersensitivity reaction). Suppressor T cells regulate T and B types of immune
responses.

How macrophages accomplish phagocytosis
Microorganisms and other antigens that invade the skin and mucous membranes
are removed by phagocytosis, a defense mechanism carried out by macrophages
(mononuclear leukocytes) and neutrophils (polymorphonuclear leukocytes).
Here’s how macrophages accomplish phagocytosis:
1
Chemotaxis
Chemotactic factors attract macrophages to the antigen site.

2
Opsonization
Antibody (immunoglobulin G) or complement fragment coats
the microorganism, enhancing macrophage binding to the
antigen, now called an opsinogen.

3
Ingestion
The macrophage extends its membrane around the opsonized
microorganism, engulfing it within a vacuole (phagosome).

4
Digestion
As the phagosome shifts away from the cell periphery, it
merges with lysosomes, forming a phagolysosome, where
antigen destruction occurs.

5
Release
When digestion is complete, the macrophage expels digestive
debris, including lysosomes, prostaglandins, complement
components, and interferon, which continue to mediate the
immune response.

Complement system
Indispensable to the humoral immune response, the complement system consists
of about 25 enzymes that “complement” the work of antibodies by aiding
phagocytosis or by destroying bacteria cells (through puncture of their cell
membranes).

By-products of the complement cascade also produce:

■ the inflammatory response (resulting from release of the contents of mast cells
and basophils)
■ stimulation and attraction of neutrophils (which participate in phagocytosis)
■ coating of target cells by C3b (an inactivated fragment of the complement
protein C3), making them attractive to phagocytes.
Able to label?
Identify the organs of the lymphatic system indicated in this
illustration.
Answers: Able to label? 1. Cervical lymph nodes, 2. Submandibular lymph
nodes, 3. Axillary lymph nodes, 4. Inguinal lymph nodes, 5. Popliteal lymph
nodes; Rebus riddle Intact tissue is the first line of defense in the immune
system.
about the immune system.
Sound out each group of pictures and symbols to reveal a fact
Rebus riddle
Chapter 12
Respiratory system
Respiratory system structures
Inspiration and expiration
Vision quest
Respiratory system structures

Upper airways
Nasopharynx
 Bony structures called conchae, or turbinates, form the posterior walls of the
nasal passages. The conchae warm and humidify air before it passes into the
nasopharynx. Their mucus layer also traps finer foreign particles, which the cilia
carry to the pharynx to be swallowed.

Sinuses
Four pairs of paranasal sinuses open into the internal nose:
Oropharynx and laryngopharynx
Lower airways
The lower respiratory tract consists of the trachea, bronchi, and lungs.
Bronchioles
Each bronchiole divides into terminal bronchioles and an acinus—the chief
respiratory unit for gas exchange.
Within the acinus, terminal bronchioles branch into yet smaller respiratory
bronchioles. These respiratory bronchioles feed directly into alveoli at sites
along their walls. The respiratory bronchioles eventually become alveolar ducts,
which terminate in clusters called alveolar sacs.

Age-old story
Insufficient surfactant
Without surfactant, surface tension can restrict alveolar expansion during
inspiration and cause alveolar collapse during expiration. Surfactant is
commonly lacking in preterm neonates (those born before 28 weeks’
gestation) and can cause respiratory distress syndrome.
Surfactant deficiency in adults also causes alveolar collapse and adult
respiratory distress syndrome, which is a life-threatening condition.

Lungs and accessory structures

The cone-shaped lungs hang suspended in the right and left pleural cavities,
straddling the heart and anchored by root and pulmonary ligaments.
Pleura and pleural cavities
The pleura—the membrane that totally encloses the lung—is composed of a
visceral layer and a parietal layer.
Mediastinum
The space between the lungs is called the mediastinum. It contains the:
■ heart and pericardium
■ thoracic aorta
■ pulmonary artery and veins
■ venae cavae and azygos veins
■ thymus, lymph nodes, and vessels
■ trachea, esophagus, and thoracic duct
■ vagus, cardiac, and phrenic nerves.
 Age-old story
Age-related respiratory changes
Structural changes
■ Nose enlargement (from continued cartilage growth)
■ General atrophy of the tonsils
■ Tracheal deviations (from changes in the aging spine)
■ Increased anteroposterior chest diameter (resulting from altered calcium
metabolism)
■ Calcification of costal cartilages (resulting in reduced mobility of the chest
wall)
■ Kyphosis (due to osteoporosis and vertebral collapse)
■ Increased lung rigidity
■ Decreased number and dilation of alveoli
■ Reduction in respiratory fluids by 30% (heightening the risk of pulmonary
infection and mucus plugs)
■ Reduction in respiratory muscle strength; more in men than women

Pulmonary function changes

■ Diminished ventilatory capacity
■ Decline in diffusing capacity
■ Diminished vital capacity (due to decreased inspiratory and expiratory
muscle strength)
■ Decreased elastic recoil capability (resulting in an elevated residual volume)
■ Decreased ventilation of basal areas (due to closing of some airways)
Thoracic cavity
The thoracic cavity is an area that’s surrounded by the diaphragm (below); the
scalene muscles and fasciae of the neck (above); and the ribs, intercostal
muscles, vertebrae, sternum, and ligaments (around the circumference).

Thoracic cage
Anterior thoracic cage
The anterior thoracic cage consists of the manubrium, sternum, xiphoid process,
and ribs. It protects the mediastinal organs that lie between the right and left
pleural cavities.
Posterior thoracic cage
The vertebral column and 12 pairs of ribs form the posterior portion of the
thoracic cage.

Inspiration and expiration

Breathing involves two actions: inspiration (an active process) and expiration (a
relatively passive process). Both actions rely on respiratory muscle function and
the effects of pressure differences in the lungs.

Inspiration

Expiration
External and internal respiration
Effective respiration requires gas exchange in the lungs (external respiration)
and gas exchange in the tissues (internal respiration).
External respiration occurs through three processes:
Ventilation—gas distribution into and out of the pulmonary airways
Pulmonary perfusion—blood flow from the right side of the heart, through the
pulmonary circulation, and into the left side of the heart
Diffusion—gas movement through a semipermeable membrane from an area
of greater concentration to one of lesser concentration

Ventilation
Ventilation is the distribution of gases (oxygen and carbon dioxide) into and out
of the pulmonary airways. Airflow distribution can be affected by:
■ airflow pattern
■ volume and location of the functional reserve capacity (air retained in the
alveoli that prevents their collapse during respiration)
■ degree of intrapulmonary resistance
■ presence of lung disease.
If airflow is disrupted, airflow distribution follows the path of least
resistance.

Comparing airflow patterns

The pattern of airflow through the respiratory passages affects airway resistance.

Laminar flow
Laminar flow, a linear pattern that occurs at low flow rates, offers minimal
resistance. This flow type occurs mainly in the small peripheral airways of the
bronchial tree.

Turbulent flow
The eddying pattern of turbulent flow creates friction and increases resistance.
Turbulent flow is normal in the trachea and large central bronchi. If the smaller
airways become constricted or clogged with secretions, however, turbulent flow
may also occur there.
Transitional flow
A mixed pattern known as transitional flow is common at lower flow rates in the
larger airways, especially where the airways narrow from obstruction, meet, or
branch.

Pulmonary perfusion
In pulmonary perfusion, the right ventricle powers blood flow from the right side
of the heart through the lungs and into the left side of the heart.

1 The right and left pulmonary arteries carry deoxygenated blood from the right
ventricle to the lungs.
2 These arteries divide to form distal branches called arterioles, which
terminate as a concentrated capillary network in the alveoli and alveolar sac,
where gas exchange occurs.

3 Venules—the end branches of the pulmonary veins—collect oxygenated

blood from the capillaries and transport it to larger vessels, which carry it to the
pulmonary veins.
 4 The pulmonary veins enter the left side of the heart, and the left ventricle
distributes oxygenated blood throughout the body.

Diffusion
Blood in the pulmonary capillaries gains oxygen and loses carbon dioxide
through the process of diffusion. In this process, oxygen and carbon dioxide
move from an area of greater concentration to an area of lesser concentration
through the pulmonary capillary. This illustration shows how the differences in
gas concentration between blood in the pulmonary artery (deoxygenated blood
from the right side of the heart) and alveolus make this process possible. Gas
concentrations depicted in the pulmonary vein are the end result of gas exchange
and represent the blood that’s delivered to the left side of the heart and systemic
circulation.

Ventilation-perfusion ratio
Gravity can affect oxygen and carbon dioxide transport in a positive way. It
causes unoxygenated blood to travel more to the lower and middle lung lobes
than to the upper lobes. This explains why ventilation and perfusion differ in the
various parts of the lungs.

Areas where perfusion and ventilation are similar have a ventilation-

perfusion ( ) match. Gas exchange is most efficient in such areas. For example,
in normal lung function, the alveoli receive air at a rate of about 4 L/minute,
while the capillaries supply blood to the alveoli at a rate of about 5 L/minute,
creating a ratio of 4:5, or 0.8 (normal ratio range is 0.8 to 1.2).
A mismatch indicates ineffective gas exchange between the alveoli and
pulmonary capillaries. Such a mismatch can affect all body systems by changing
the amount of oxygen delivered to living cells.

What happens in ventilation-perfusion mismatch

Key
Blood with CO2
Blood with O2
Blood with CO2 and O2
 With a match, unoxygenated blood from the venous system returns to the right
side of the heart through the pulmonary artery to the lungs, carrying carbon
dioxide. The arteries branch into the alveolar capillaries where gas exchange
takes place.

Causes

1 Shunting (reduced ventilation to a lung unit) causes unoxygenated blood to

move from the right side of the heart to the left side of the heart and into
systemic circulation; it may result from physical defects or airway obstruction.

When the ratio is low, pulmonary circulation is adequate but not enough
oxygen is available to the alveoli for normal diffusion. A portion of the blood
flowing through the pulmonary vessels doesn’t become oxygenated.

2 Dead-space ventilation (reduced perfusion to a lung unit) occurs when

alveoli don’t have adequate blood supply for gas exchange to occur, such as with
pulmonary emboli and pulmonary infarction.

When the ratio is high, ventilation is normal but alveolar perfusion is reduced
or absent. Note the narrowed capillary, indicating poor perfusion. This
commonly results from a perfusion defect, such as pulmonary embolism or a
disorder that decreases cardiac output.

3A silent unit (a combination of shunting and dead-space ventilation) occurs

when little or no ventilation and perfusion are present, such as in cases of
pneumothorax and acute respiratory distress syndrome.

The silent unit indicates an absence of ventilation and perfusion to the lung area.
The silent unit may help compensate for a V./Q. imbalance by delivering blood
flow to better ventilated lung areas.
Able to label?
Identify the paranasal sinuses in this illustration.
Answers: Able to label? 1. Frontal, 2. Ethmoidal, 3. Maxillary; Show and tell 1.
During inspiration, the diaphragm contracts (pressing the abdominal organs
downward and forward), and the external intercostal muscles also contract. The
rib cage expands, the volume of the thoracic cavity increases, and air rushes in to
equalize the pressure. 2. During expiration, the lungs passively recoil as the
diaphragm and intercostal muscles relax, pushing air out of the lungs.
as a guide.
Describe the mechanics of breathing using the illustrations here
Show and tell
Chapter 13
Gastrointestinal
system
GI system basics
Alimentary canal
GI tract innervation
Accessory organs of digestion
Digestion and elimination
Vision quest
GI system basics

Alimentary canal
The alimentary canal is a hollow muscular tube that begins in the mouth and
extends to the anus.
Stomach
The stomach is a collapsible, saclike structure.
Sphincters
■ Cardiac (protects the entrance to the stomach)
■ Pyloric (guards the exit to the duodenum)

Functions
■ Serves as a temporary storage area for food
■ Begins digestion with stomach acids
 ■ Breaks down food into chyme, a semifluid substance
■ Moves gastric contents into the small intestine

Small intestine
The small intestine is a tube that measures about 208 (6 m) long. It’s the longest
organ of the GI tract.
Functions
■ Completes food digestion
■ Absorbs food molecules through its wall into the circulatory system, which
then delivers them to body cells
■ Secretes hormones that help control secretion of bile, pancreatic juice, and
intestinal juice

More than meets the eye

The intestinal wall has structural features that significantly increase its
absorptive surface area. These include:
 ■ villi—fingerlike projections on the mucosa
■ microvilli—tiny cytoplasmic projections on the surface of epithelial cells.

Other structures found in the small intestines include:

■ intestinal crypts—simple glands lodged in the grooves separating villi
■ Peyer’s patches—collections of lymphatic tissue within the submucosa
■ Brunner’s glands—glands that secrete mucus.

Large intestine

Functions
■ Absorbs excess water and electrolytes
■ Stores food residue
■ Eliminates digestive waste products in the form of feces
GI tract innervation

Parasympathetic stimulation

Sympathetic stimulation
Accessory organs of digestion
Accessory organs include the liver, biliary duct system, and pancreas. These
organs contribute hormones, enzymes, and bile, which are vital to digestion.

Liver
Functions
■ Metabolizes carbohydrates, fats, and proteins
■ Detoxifies blood
■ Converts ammonia to urea for excretion
■ Synthesizes plasma proteins, nonessential amino acids, vitamins, and
essential nutrients
■ Secretes bile

Biliary duct system

Gallbladder and pancreas
Together the gallbladder and pancreas constitute the biliary tract.

Gallbladder
■ Pear-shaped organ joined to the ventral surface of the liver by the cystic duct
■ Covered with visceral peritoneum
■ Stores and concentrates bile produced by the liver
■ Releases bile into the common bile duct for delivery to the duodenum in
response to the contraction and relaxation of Oddi’s sphincter

Pancreas
■ Measures 69 to 89 (15 to 20.5 cm) in length
■ Consists of a head, body, and tail
■ Beta cells secrete insulin to promote carbohydrate metabolism (endocrine
function).
■ Alpha cells secrete glucagon to stimulate glycogenolysis in the liver
(endocrine function).
■ Produces enzymes that aid in digestion (exocrine function)

Digestion and elimination

What happens in swallowing
Before peristalsis can begin, the neural pattern that initiates swallowing must
occur. This process is described here and illustrated below:
■ Food pushed to the back of the mouth stimulates swallowing receptor areas
that surround the pharyngeal opening.
■ These receptor areas transmit impulses to the brain by way of the sensory
portions of the trigeminal and glossopharyngeal nerves.
■ The brain’s swallowing center (located in the brainstem) then relays motor
impulses to the esophagus by way of the trigeminal, glossopharyngeal, vagus,
and hypoglossal nerves, causing swallowing to occur.
Sites and mechanisms of gastric secretion
The body of the stomach lies between the lower esophageal sphincter (LES), or
cardiac sphincter, and the pyloric sphincter. Between these sphincters lie the
fundus, body, antrum, and pylorus. These areas have a rich variety of mucosal
cells that help the stomach carry out its tasks.
Glands and gastric secretions
Cardiac glands, pyloric glands, and gastric glands secrete 2 to 3 L of gastric juice
daily through the stomach’s gastric pits. Here are the details:
■ Both the cardiac gland (near the LES) and the pyloric gland (near the pylorus)
secrete thin mucus.
■ The gastric gland (in the body and fundus) secretes hydrochloric acid (HCl),
pepsinogen, intrinsic factor, and mucus.

Protection from self-digestion

Specialized cells line the gastric glands, gastric pits, and surface epithelium.
Mucous cells in the necks of the gastric glands produce thin mucus. Mucous
cells in the surface epithelium produce an alkaline mucus. Both substances
lubricate food and protect the stomach from self-digestion by corrosive enzymes.

Other secretions
Argentaffin cells produce gastrin, which stimulates gastric secretion and motility.
Chief cells produce pepsinogen, which breaks proteins down into polypeptides.
Large parietal cells scattered throughout the fundus secrete HCl and intrinsic
factor. HCl degrades pepsinogen, maintains acid environment, and inhibits
excess bacteria growth. Intrinsic factor promotes vitamin B12 absorption in the
small intestine.
Specialized mucosa
Multiple projections of the intestinal mucosa increase the surface area for
absorption several hundredfold, as shown in the enlarged views at right.
Circular projections (Kerckring’s folds) are covered by villi. Each villus
contains a lymphatic vessel (lacteal), a venule, capillaries, an arteriole, nerve
fibers, and smooth muscle.
Each villus is densely fringed with about 2,000 microvilli, making it resemble
a fine brush. The villi are lined with columnar epithelial cells, which dip into the
lamina propria between the villi to form intestinal glands (crypts of Lieberkühn).
Types of epithelial cells
The type of epithelial cell dictates its function. Mucus-secreting goblet cells are
found on and between the villi on the crypt mucosa. In the proximal duodenum,
specialized Brunner’s glands also secrete large amounts of mucus to lubricate
and protect the duodenum from potentially corrosive acidic chyme and gastric
juices.
Duodenal argentaffin cells produce the hormones secretin and
cholecystokinin. Undifferentiated cells deep within the intestinal glands replace
the epithelium. Absorptive cells consist of large numbers of tightly packed
microvilli over a plasma membrane that contains transport mechanisms for
absorption and produces enzymes for the final step in digestion.

Intestinal glands
The intestinal glands primarily secrete a watery fluid that bathes the villi with
chyme particles. Fluid production results from local irritation of nerve cells and,
possibly, from hormonal stimulation by secretin and cholecystokinin. The
microvillous brush border secretes various hormones and digestive enzymes that
catalyze final nutrient breakdown.

Age-old story
Age-related GI changes
Diminished mucosal elasticity and reduced GI secretions, leading to impaired
digestion and absorption
■ Decreased GI tract motility, bowel wall and anal sphincter tone, and
abdominal muscle strength, leading to complaints ranging from loss of
appetite to constipation
■ Wearing away of tooth enamel, leaving the teeth prone to cavities
■ ncreased incidence of periodontal disease
■ Decreased number of taste buds, diminished sense of smell, and decreased
salivary gland secretion, leading to appetite loss
■ Reduced hepatic enzyme production, leading to impaired ability to
metabolize drugs and detoxify substances
Able to label?
Identify the parts of the small intestine indicated in this
illustration.
 Matchmaker
Match each of the organs shown with its major function.

A. Detoxifies blood
B. Completes food digestion
C. Stores and concentrates bile
D. Serves as a temporary storage area for food
E. Absorbs excess water and electrolytes
Vermiform appendix; Matchmaker 1. D, 2. B, 3. E, 4. A, 5. C.
Answers: Able to label? 1. Duodenum, 2. Jejunum, 3. Ileum, 4. Cecum, 5.
Chapter 14
Nutrition and
metabolism
Components of nutrition
Digestion and absorption
Metabolism
Vision quest
Components of nutrition
Nutrition refers to the intake, assimilation, and utilization of nutrients.

Food group recommendations

Find your balance between food and physical activity
■ Know your daily calorie needs.
■ Be physically active for at least 30 minutes 3 to 5 days of the week.
■ About 60 minutes a day of physical activity 3 to 5 days/week may be needed
to prevent weight gain.
■ For sustaining weight loss, at least 60 to 90 minutes a day of physical activity
3 to 5 days/week may be required.
■ Children and teenagers should be physically active for 60 minutes every day,
or most days.

Know the limits on fats, sugars, and salt (sodium)

■ Make the most of your fat sources from fish, nuts, and vegetable oils.
■ Limit solid fats such as butter, stick margarine, shortening, and lard as well as
foods that contain these.
■ Check the Nutrition Facts label to keep saturated fats, trans fats, and sodium
low.
■ Choose food and beverages low in added sugars. Added sugars contribute
calories with few, if any, nutrients.
Carbohydrates
Carbohydrates are organic compounds composed of carbon, hydrogen, and
oxygen and are stored in muscles and the liver. They can be converted quickly
when the body needs energy.

Monosaccharides
■ Are simple sugars
■ Can’t be broken down by the digestive process
■ Are absorbed through the small intestine
■ Examples: glucose (dextrose), fructose, galactose

Disaccharides
■ Are synthesized from monosaccharides
■ Consist of two monosaccharides minus a water molecule
■ Examples: sucrose, lactose, maltose

Polysaccharides
■ Are synthesized from monosaccharides
■ Are ingested and broken down into simple sugars and used for fuel
 ■ Consist of a long chain of monosaccharides linked by glycoside bonds
■ Examples: glycogen, starch

Proteins
Components of every living cell, proteins are large, complex molecules
composed of individual building blocks known as amino acids.

Protein is:
■ required for normal growth and development
■ broken down by the body as a source of energy when the supply of
carbohydrates and fats is inadequate
■ stored in muscle, bone, skin, cartilage, and lymph.

Fats
Also known as lipids, fats are organic compounds that don’t dissolve in water
but do dissolve in alcohol and other organic solvents.
Triglycerides
■ Account for about 95% of the fat in food
■ Are the major storage form of fat in the body
■ Contain fatty acids that can be saturated or unsaturated.
Saturated fatty acid
■ Saturated or filled with hydrogen ions
■ Found in meat, poultry, full-fat dairy products, and tropical oils (such as palm
and coconut oils).
Unsaturated fatty acid
■ Not completely filled with hydrogen ions
■ Usually soft or liquid at room temperature
■ Originate from plant fat and oils
■ Have lower melting points
■ Can become rancid when exposed to extended periods of light and oxygen

Trans fats
■ Produced by hydrogenation
■ Found in vegetable shortening, certain margarines, crackers, cookies, snack
foods, and other foods made with hydrogenated oils

Phospholipids
■ Complex lipids that are similar to fat but that have a phosphorus- and nitrogen-
containing compound that replaces one of the fatty acid molecules
■ Are major structural components of cell membranes
■ Occur naturally in all foods

Sterols
■ Complex molecules in which the carbon atoms form four cyclic structures
attached to various side chains
■ Contain no glycerol or fatty acid molecules
■ Example: cholesterol
Cholesterol
■ Most common sterol
■ Manufactured daily by the body
■ Produced and filtered by the liver
■ Necessary for the production of some hormones (estrogen, cortisone,
adrenaline, and testosterone)

Vitamins and minerals

■ Organic compounds needed in small

quantities for normal metabolism, growth,
and development
■ Classified as water-soluble or fat-soluble
■ Water-soluble vitamins include B complex
and C vitamins.
■ Fat-soluble vitamins include vitamins A,
D, E, and K.
■ Inorganic substances found in bones,
hemoglobin, thyroxine, and vitamin B
■ Play important roles in:
– enzyme metabolism
– membrane transfer of essential
compounds
– regulation of acid–base balance
– osmotic pressure
– muscle contractility
– nerve impulse transmission
– growth.

Major minerals
■ Calcium
■ Chloride
■ Magnesium
■ Phosphorus
■ Potassium
■ Sodium
 Trace minerals
■ Chromium
■ Cobalt
■ Copper
■ Fluorine
■ Iodine
■ Iron
■ Manganese
■ Molybdenum
■ Selenium
■ Zinc

Guide to vitamins and minerals

Good health requires intake of adequate amounts of vitamins and minerals to
meet the body’s metabolic needs. A vitamin or mineral excess or deficiency can
lead to various disorders. This chart reviews major functions of vitamins and
minerals.
Vitamin or mineral Major functions

Water-soluble vitamins
Vitamin C (ascorbic acid) Collagen production, fine bone and
tooth formation, iodine conservation,
healing, red blood cell (RBC)
formation, infection resistance

Vitamin B1 (thiamine) Blood formation, carbohydrate

metabolism, circulation, digestion,
growth, learning ability, muscle tone
maintenance, central nervous system
(CNS) maintenance

Vitamin B2 (riboflavin) RBC formation; energy metabolism;

cell respiration; epithelial, eye, and
mucosal tissue maintenance

Vitamin B6 (pyridoxine) Antibody formation, digestion, DNA

and RNA synthesis, fat and protein
utilization, amino acid metabolism,
hemoglobin production, CNS
maintenance

Folic acid (folacin, pteroylglutamic Cell growth and reproduction,

acid) digestion, liver function, DNA and
RNA formation, protein metabolism,
RBC formation

Niacin (nicotinic acid, nicotinamide, Circulation, cholesterol level

niacinamide) reduction, growth, hydrochloric acid
production, metabolism
(carbohydrate, protein, fat), sex
hormone production

Vitamin B12 (cyanocobalamin) RBC formation, cellular and nutrient

metabolism, tissue growth, nerve cell
maintenance, appetite stimulation
Fat-soluble vitamins

Vitamin A Body tissue repair and maintenance,

infection resistance, bone growth,
nervous system development, cell
membrane metabolism and structure,
night vision

Vitamin D (calciferol) Calcium and phosphorus metabolism

(bone formation), myocardial
function, nervous system
maintenance, normal blood clotting

Vitamin E (tocopherol) Aging retardation, anticlotting factor,

diuresis, fertility, lung protection
(antipollution), male potency, muscle
and nerve cell membrane
maintenance, myocardial perfusion,
serum cholesterol reduction

Vitamin K (menadione) Liver synthesis of prothrombin and

other blood-clotting factors

Minerals

Calcium Blood clotting, bone and tooth

formation, cardiac rhythm, cell
membrane permeability, muscle
growth and contraction, nerve
impulse transmission

Chloride Maintenance of fluid, electrolyte,

acid–base, and osmotic pressure
balance
Magnesium Acid–base balance, metabolism,
protein synthesis, muscle relaxation,
cellular respiration, nerve impulse
transmission

Phosphorus Bone and tooth formation, cell

growth and repair, energy production

Potassium Cardiac rhythm, muscle contraction,

nerve impulse transmission, rapid
growth, fluid distribution and osmotic
pressure balance, acid–base balance

Sodium Cellular fluid-level maintenance,

muscle contraction, acid–base
balance, cell permeability, muscle
function, nerve impulse transmission

Fluoride (fluorine) Bone and tooth formation

Iodine Thyroid hormone production, energy

production, metabolism, physical and
mental development

Iron Growth (in children), hemoglobin

production, stress and disease
resistance, cellular respiration,
oxygen transport

Selenium Immune mechanisms, mitochondrial

adenosine triphosphate synthesis,
cellular protection

Zinc Burn and wound healing,

carbohydrate digestion, metabolism
 (carbohydrate, fat, protein), prostate
gland function, reproductive organ
growth and development, cell growth

Digestion and absorption

Nutrients are digested in the GI tract by enzymes that split large units into
smaller ones—a process called hydrolysis.

Carbohydrate digestion and absorption

Digestion begins in the mouth and continues through the small intestines. After
the nutrients are broken down, they’re absorbed through the intestinal mucosa.

Protein digestion and absorption

Enzymes active in protein digestion

Fat digestion and absorption

Most fat digestion occurs in the small intestine.

1 Pancreatic lipase breaks down fats and phospholipids into a mixture of:
■ glycerol
■ short-chain fatty acids
■ long-chain fatty acids
■ monoglycerides.

2 Because fat doesn’t dissolve in water, it enters the duodenum in a congealed

mass. To help with digestion, the gallbladder releases bile into the duodenum.
Bile acts to emulsify the fat (disperse the fat into small droplets that can become
suspended in the watery content of the digestive tract). This allows lipase to
accelerate its digestion of the fat.

Meanwhile, back in the small intestines…

3Absorption of fat occurs in the villi of the small intestines. Glycerol diffuses
directly through the intestinal mucosa, whereas short-chain fatty acids are
absorbed into the bloodstream via the intestinal capillaries. After they’re in the
bloodstream, they’re carried to the liver via the portal venous system.
4 Long-chain fatty acids and monoglycerides are too large to be absorbed by
the capillaries. Therefore, they’re absorbed into the fatty walls of the villi and
changed into triglycerides. These triglycerides are then coated with cholesterol
and protein, forming lipoprotein particles called chylomicrons.
The chylomicrons enter a lacteal, where they’re carried through the lymphatic
channels to the thoracic duct. From the thoracic duct, they enter the bloodstream
and are distributed to body cells. In the cells, fats are extracted from the
chylomicrons and broken down by enzymes into fatty acids and glycerol. Then
they’re absorbed and recombined in fat cells, reforming triglycerides for storage
and later use.

Enzymes active in fat digestion

Metabolism
Through metabolism, food substances are transformed into energy or materials
that the body can use or store. Metabolism involves two processes:
■ anabolism—synthesizing complex substances out of simpler ones
■ catabolism—breaking down complex substances into simpler ones or into
energy.

Carbohydrate metabolism

Glucose catabolism generates energy in three phases:

Regulation of blood glucose levels
Because all ingested carbohydrates are converted to glucose, the body depends
on certain organ systems to regulate blood glucose levels.

The role of the liver

When blood glucose levels exceed the body’s immediate needs, hormones
stimulate the liver to convert glucose into glycogen or lipids.
The role of muscles

1 During vigorous muscular activity, when oxygen requirements exceed the

oxygen supply, muscle cells break down glycogen to yield lactic acid and energy.
Lactic acid then builds up in the muscles, and muscle glycogen is depleted.

2 Some of the lactic acid diffuses from muscle cells, is transported to the liver,
and is reconverted to glycogen. The liver converts the newly formed glycogen to
glucose, which travels through the bloodstream to the muscles and reforms into
glycogen.
3 When muscle exertion stops, some of the accumulated lactic acid converts
back to pyruvic acid. Pyruvic acid is oxidized completely to yield energy by
means of the Krebs cycle and electron-transport system.

The role of hormones

Hormones regulate blood glucose levels by stimulating certain metabolic
processes. Insulin, produced by the pancreatic islet cells, is the only hormone
that significantly reduces blood glucose levels. In addition to promoting cell
uptake and use of glucose as an energy source, insulin promotes glucose storage
as glycogen (glycogenesis) and lipids (lipogenesis).
Protein metabolism
Proteins are absorbed as amino acids and carried by the portal venous system to
the liver and then throughout the body by blood. Absorbed amino acids mix with
other amino acids in the body’s amino acid pool. These other amino acids may
either be synthesized by the body from other substances (such as keto acids) or
produced by protein breakdown. The body can’t store amino acids. Instead, it
converts them to protein or glucose or catabolizes them to provide energy.

Deamination
■ This occurs when an amino group (–NH2) splits off from an amino acid
molecule.
■ A molecule of ammonia and one of keto acid are formed as a result.
■ Most of the ammonia is converted to urea and excreted in the urine.
Transamination
■ This occurs when the amino acid is converted to a keto acid.
■ The original keto acid is then converted to an amino acid.

Essential and nonessential amino acids

Amino acids are the structural units of proteins. They’re classified as essential or
nonessential based on whether the human body can synthesize them.
Lipid metabolism
Until required for use as fuel, lipids are stored in adipose tissue within cells.
When needed for energy, each fat molecule is hydrolyzed to glycerol and three
molecules of fatty acids. Glycerol can be converted to pyruvic acid and then to
acetyl CoA, which enters the Krebs cycle.

Leftovers
The liver normally forms ketone bodies from acetyl CoA fragments, derived
largely from fatty acid catabolism. Acetyl CoA molecules yield three types of
ketone bodies:

1 Acetoacetic acid
■ Results from the combination of two acetyl CoA molecules and subsequent
release of CoA from these molecules

2 Beta-hydroxybutyric acid
■ Forms when hydrogen is added to the oxygen atom in the acetoacetic acid
molecule
■ Term “beta” indicates the location of the carbon atom containing the OH
group

3 Acetone
■ Forms when the COOH group of acetoacetic acid releases carbon dioxide
 ■ Oxidized by muscle, brain, and other tissues for energy

Too much of a good thing

When the supply of glucose for energy is inadequate, such as from fasting,
starvation, or uncontrolled diabetes (in which the body can’t break down
glucose, the body must switch to fat as its primary energy source. This results in
an excess production of ketone bodies. The accumulation of ketone bodies
lowers the body’s pH, disturbing normal acid–base balance and leading to
ketosis.

Age-old story
Age-related nutrition changes
Caloric needs decrease with age, but protein, vitamin, and mineral
requirements usually remain the same throughout life. The body’s ability to
process these nutrients, however, is affected by the aging process. Listed here
are physiologic changes related to aging along with their effects on nutrition:
■ Diminished intestinal motility > Constipation
■ Decreased renal function > Susceptibility to dehydration and formation of
renal calculi
■ Impaired mobility > Loss of calcium and nitrogen
■ Reduced pepsin and hydrochloric acid secretion > Diminished absorption of
calcium and vitamins B1 and B2
■ Decreased salivary flow and diminished sense of taste > Decreased appetite
■ Thinning of tooth enamel > Brittle teeth
■ Decreased biting force > Difficulty chewing
■ Diminished gag reflex > Choking
Rebus riddle
Sound out each group of symbols and letters to reveal
information about one of the body’s main nutrients.
Answers: Rebus riddle Carbohydrates can be converted quickly for energy;
Show and tell 1. In hydrolysis, a compound unites with water and then splits into
simpler compounds. 2. The smaller units are then absorbed from the small
intestine and transported to the liver through the portal venous system.
which nutrients are digested and then absorbed.
Using the illustrations as a guide, describe two processes by
Show and tell
Chapter 15
Urinary system
Components of the urinary
system
Urine formation
Hormones and the urinary
system
Vision quest
Components of the urinary system
The urinary system consists of two kidneys, two ureters, one bladder, and one
urethra.

Kidneys
The kidneys are bean-shaped, highly vascular organs. They form urine to remove
waste from the body, maintain acid–base and fluid-electrolyte balance, and assist
in blood pressure control.
Functions of the kidneys
■ Eliminate wastes and excess ions
■ Balance chemicals in your body
■ Release hormones and help control blood pressure
■ By filtering the blood, remove wastes and water
■ Maintain fluid-electrolyte and acid–base balance
■ Produce erythropoietin (hormone that stimulates red blood cell production)
and enzymes (such as renin, which governs blood pressure and kidney function)
■ Convert vitamin D to a more active form that keeps bones strong and healthy
Functions of the nephron
■ Filters fluids, wastes, electrolytes, acids, and bases into the tubular system
■ Selectively reabsorbs and secretes ions
 Age-old story
Age-related urinary system changes
■ Diminished kidney function (begins at age 40 years; by age 90 years, may
decrease by 50%)
■ Decreased glomerular filtration rate (due to changes in kidney vasculature)
■ Decreased kidney blood flow (due to reduced cardiac output and
atherosclerotic changes)
■ Decline in tubular reabsorption and renal concentrating ability (due to a
decrease in the size and number of functioning nephrons)
■ Tendency to develop bladder infections (due to chronic urine retention from
weakened bladder muscles)
■ Impaired renal clearance of drugs
■ Reduced bladder size and capacity
 ■ Decreased renal ability to respond to variations in sodium intake
■ Increased blood urea nitrogen levels

Ureters, bladder, and urethra

Urine formation
Urine formation is one of the main functions of the urinary system. Urine
formation results from three processes that occur in the nephrons: glomerular
filtration, tubular reabsorption, and tubular secretion.
How the kidneys form urine

STEP 1
Glomerular filtration
As blood flows into the glomerulus, filtration occurs. In glomerular filtration,
active transport from the proximal convoluted tubules leads to reabsorption of
sodium (Na+) and glucose into nearby circulation. Osmosis then causes water
(H2O) reabsorption.

STEP 2
Tubular reabsorption
In tubular reabsorption, a substance moves from the filtrate back from the distal
convoluted tubules into the peritubular capillaries. Active transport results in
Na+ reabsorption. The presence of antidiuretic hormone causes H2O
reabsorption.

STEP 3
Tubular secretion
In tubular secretion, a substance moves from the peritubular capillaries into the
tubular filtrate. Peritubular capillaries then secrete ammonia (NH3) and hydrogen
(H+).
Hormones and the urinary system
Hormones play a major role in the urinary system, including helping the body to
manage tubular reabsorption and secretion.

Antidiuretic hormone
Antidiuretic hormone (ADH) regulates levels of urine output.

How ADH works

Renin-angiotensin-aldosterone system
The renin-angiotensin-aldosterone system regulates the body’s sodium and water
levels and blood pressure.
1 Juxtaglomerular cells near the glomeruli in each kidney secrete the enzyme
renin into the blood.

2 Renin circulates throughout the body and converts angiotensinogen, made in

the liver, into angiotensin I.

3 In the lungs, angiotensin I is converted by hydrolysis to angiotensin II.

4 Angiotensin II acts on the adrenal cortex to stimulate production of the
hormone aldosterone.

5 Aldosterone acts on the juxtaglomerular cells to increase sodium and water

retention and to stimulate or depress further renin secretion, completing the
feedback system that automatically readjusts homeostasis.
Able to label?
Identify the key structures of the urinary system shown in this
illustration.
Answers: Able to label? 1. Ureter, 2. Renal pelvis, 3. Ureter, 4. Bladder,
5.Urethra; Show and tell 1. Low blood volume and increased serum osmolality
are sensed by the hypothalamus, which signals the pituitary gland. 2. The
pituitary gland secretes ADH into the bloodstream. 3. ADH causes the kidneys
to retain water. 4. Water retention boosts blood volume and decreases serum
osmolality.
regulates fluid balance.
Using the illustration provided as a guide, describe how ADH
Show and tell
Chapter 16
Fluids, electrolytes,
acids and bases
Fluid balance
Electrolyte balance
Acid–base balance
Vision quest
Fluid balance
Each day, the body takes in fluid through the gastrointestinal (GI) tract, from
foods and liquids as well as from the oxidation of food, and loses it in the form
of urine and stool and through the skin and lungs.
Water weight
Water in the body exists in two major compartments that are separated by
capillary walls and cell membranes. About two thirds of the body’s water is
found within cells as ICF; the other one third remains outside cells as ECF.
 Age-old story
Age-related fluid changes
The risk of suffering a fluid imbalance increases with age. Skeletal muscle
mass declines, and the proportion of fat within the body increases. After age
 60 years, water content drops to about 45%.
Likewise, the distribution of fluid within the body changes with age. For
instance, about 15% of a typical young adult’s total body weight is made up of
ISF. That percentage progressively decreases with age.

Fluid forms and movement

Fluids in the body generally aren’t found in pure forms. They’re most commonly
found in three different types of solutions: isotonic, hypotonic, and hypertonic.
Fluid movement within cells
Fluids and solutes move constantly within the body. That movement allows the
body to maintain homeostasis, the constant state of balance the body seeks.

In diffusion, solutes move from areas of high concentration to areas of lower

concentration, until the concentrations in both areas become equal.
In active transport, solutes move from an area of lower concentration to an area
of higher concentration.

In osmosis, fluid moves passively from areas with more fluid (and fewer solutes)
to areas with less fluid (and more solutes).
Fluid intake and output
Water normally enters the body from the GI tract through consumed liquids and
solid foods, which may contain up to 97% water. Also, oxidation of food in the
body yields carbon dioxide and about 300 mL of water (water of oxidation).

Electrolyte balance
Electrolytes are substances that break up into ions (electrically charged particles)
when dissolved in water. To function normally, the body requires adequate
amounts of each major electrolyte as well as a proper balance among the
electrolytes.

Electrolyte composition in ICF and ECF

Ions exist in low concentrations in body fluids. Because ICF and ECF cells are
permeable to different substances, these compartments normally have different
electrolyte compositions.
Electrolytes profoundly affect the body’s:
■ water distribution
■ osmolarity
■ acid–base balance.
Acid–base balance
Physiologic survival requires acid–base balance, a stable concentration of
hydrogen ions in body fluids. The degree of acidity or alkalinity of a solution is
commonly expressed as pH, which refers to the concentration of hydrogen ions
in a solution.
A neutral solution contains equal amounts of hydrogen (H+) and hydroxide
(OH–) ions. A pH of 7 indicates neutrality.

An acidic solution contains more hydrogen ions than hydroxide ions; its pH is
less than 7.

An alkaline, or basic, solution contains more hydroxide ions than hydrogen ions;
its pH exceeds 7.
Matchmaker
Match the types of body fluids with their locations in the body,
shown on the right.
Answers: Matchmaker A. 2, B. 3, C. 4, D. 1; Show and tell Energy from ATP
moves solutes from an area of lower concentration to an area of higher
concentration.
transport.
Using the illustration as a guide, describe the process of active
Show and tell
Chapter 17
Reproductive System
Male reproductive system
Female reproductive system
Vision quest
Male reproductive system
The male reproductive system consists of the organs that produce, transfer, and
introduce mature sperm into the female reproductive tract, where fertilization
occurs.

Duct system
The male reproductive duct system conveys sperm from the testes to the
ejaculatory ducts near the bladder.
Accessory reproductive glands
Spermatogenesis
Sperm formation, or spermatogenesis, begins when a male reaches puberty and
normally continues throughout life. It occurs in four stages.
Hormonal control and sexual development
 Age-old story
Age-related male reproductive changes
■ Decreased testosterone production (“low T”), which can cause:
– decreased libido
– softening and atrophy of the testes
– reduction in sperm production by 48% to 69% between ages 60 and 80
years.
■ Enlargement of the prostate gland
■ Diminished prostate secretions
■ Decreased volume and viscosity of seminal fluid
■ Slower and weaker physiologic reactions during intercourse

Female reproductive system

The female reproductive system consists of external and internal genitalia.

Female external genitalia

The external genitalia, collectively called the vulva, consist of the mons pubis,
labia majora, labia minora, clitoris, vaginal opening, urethra, and Skene’s and
Bartholin’s glands.
Female internal genitalia
The internal genitalia include the vagina, uterus, ovaries, and fallopian tubes.

Ovary, fallopian tube, uterus, and vagina

Mammary glands
The mammary glands, located in the breast, are specialized accessory glands that
secrete milk.
 Age-old story
Age-related female reproductive changes
As estrogen levels decrease and menopause approaches, usually at about age
50 years, changes affect most parts of the female reproductive system.
 ■ Ovulation stops 1 to 2 years before menopause.
■ Ovaries atrophy and become thicker and smaller.
■ Vulva atrophies, exposing sensitive area around the urethra and vagina to
abrasions and irritations.
■ Vagina atrophies and becomes thin and dry, making it susceptible to
abrasion. Vaginal pH becomes more alkaline, increasing the risk of vaginal
infections.
■ The uterus shrinks until it reaches one fourth its premenstrual size.
■ The cervix atrophies and no longer produces mucus for lubrication.
■ In the breasts, glandular, supporting, and fatty tissues atrophy. Cooper’s
ligaments lose their elasticity, and breasts become pendulous.
■ Relaxation of the pelvic support commonly occurs, causing pressure and
pulling sensations in the area above the inguinal ligaments, lower backaches,
and difficulty rising from a sitting position.

Hormonal function and the menstrual cycle

When a female reaches the age of menstruation, the hypothalamus, ovaries, and
pituitary gland secrete hormones—estrogen, progesterone, FSH, and LH—that
affect the buildup and shedding of the endometrium during the menstrual cycle.
During adolescence, the release of hormones causes a rapid increase in
physical growth and spurs the development of secondary sex characteristics.
This growth spurt begins at approximately age 11 years and continues until early
adolescence, or about 3 years later.
 Gonadotropin secretion

Ovarian cycle
■ Beginning the first day of the ■ When the follicle matures, a spike
menstrual cycle, low estrogen and in LH level occurs, causing the
progesterone levels stimulate the follicle to rupture and release the
hypothalamus to secrete ovum, thus initiating ovulation.
gonadotropin-stimulating hormone ■ After ovulation (the luteal stage),
(Gn-RH). the collapsed follicle forms the
■ In turn, Gn-RH stimulates the corpus luteum. If fertilization doesn’t
anterior pituitary gland to secrete occur, the corpus luteum degenerates.
FSH and LH.
■ Elevated levels of FSH trigger
development of a follicle within the
ovary (follicular stage).
Sex hormone cycle
■ During the follicular phase of the ■ In the luteal phase of the ovarian
ovarian cycle, the increasing FSH and cycle, the corpus luteum is formed
 LH levels that stimulate follicle and begins to release progesterone
growth also stimulate secretion of and estrogen.
estrogen. ■ As the corpus luteum degenerates,
■ Estrogen secretion peaks just levels of both of these ovarian
before ovulation; this triggers the hormones decline.
spike in LH levels, causing ovulation.
■ After ovulation, estrogen levels
decline rapidly.
Endometrial (menstrual) cycle
■ In the first 5 days of the ■ After ovulation (about day 14),
reproductive cycle, the endometrium increased progesterone secretion
sheds its functional layer, leaving the stimulates conversion of the
deepest layer intact. functional layer into a secretory
■ The endometrium begins mucosa (secretory stage), which is
regenerating its functional layer at more receptive to implantation of a
about day 6 (the proliferative stage), fertilized ovum. (The endometrium is
spurred by rising estrogen levels. most receptive to implantation of a
fertilized ovum about 7 days after
ovulation.)
■ If implantation doesn’t occur, the
corpus luteum degenerates,
progesterone levels drop, and the
endometrium again sheds its
functional layer (menstruation).
Able to label?
Identify the key structures of the male reproductive system
shown in this illustration.
Answers: Able to label? 1. Vas deferens, 2. Prostate gland, 3. Penis, 4. Testis, 5.
Scrotu; Rebus riddle Sperm formation is called spermatogenesis.
information about the male reproductive system.
Sound out each group of symbols and letters to reveal
Rebus riddle
Chapter 18
Reproduction and
Lactation
Fertilization
Pregnancy
Labor and the postpartum
period
Lactation
Vision quest
Fertilization
The spermatozoon, which has a covering called the acrosome,
1 approaches the ovum.

The acrosome develops small perforations through which it releases

2 enzymes necessary for the sperm to penetrate the protective layer of
the ovum before fertilization.
 The spermatozoon penetrates the zona pellucida (the ovum’s inner
3 membrane). This triggers the ovum’s second meiotic division
(following meiosis), making the zona pellucida impenetrable to other
spermatozoa.

The spermatozoon’s nucleus is released into the ovum, its tail

4 degenerates, and its head enlarges and fuses with the ovum’s nucleus.
This fusion provides the fertilized ovum, called a zygote, with 46
chromosomes.
Pregnancy
Pregnancy starts with fertilization and ends with childbirth. During this period
(called gestation), the zygote divides as it passes through the fallopian tube and
attaches to the uterine lining through implantation.

Stages of fetal development

A close look at a blastocyst
The blastocyst consists of a thin trophoblast layer (which includes the blastocyst
cavity) and the inner cell mass.
Ectoderm
The ectoderm, the outermost layer, develops into the:
■ epidermis
■ nervous system
■ pituitary gland
■ tooth enamel
■ salivary glands
■ optic lens.

Mesoderm
The mesoderm, the middle layer, develops into:
 ■ connective and supporting tissue
■ the blood and vascular system
■ musculature
■ teeth (except enamel)
■ the mesothelial lining of the pericardial, pleural, and peritoneal cavities
■ the kidneys and ureters.

Endoderm
The endoderm, the innermost layer, becomes the epithelial lining of the:
■ pharynx and trachea
■ auditory canal
■ alimentary canal
■ liver
■ pancreas
■ bladder and urethra
■ prostate.

Fetal development
Significant growth and development take place within the first 3 months
following conception, as the embryo develops into a fetus that nearly resembles
a full-term neonate.
Structural changes in the ovaries and uterus
Specialized tissues support, protect, and nurture the embryo and fetus throughout
its development. Among these tissues, the decidua and fetal membranes begin to
develop shortly after conception.
Placenta
The placenta is flat, pancakelike, and is round or oval. The maternal side is
lobulated; the fetal side is shiny.

Types of placental circulation
The placenta contains two highly specialized circulatory systems:
Labor and the postpartum period
Childbirth, or delivery of the fetus, is achieved through labor—the process in
which uterine contractions expel the fetus from the uterus. When labor begins,
these contractions become strong and regular. Eventually, voluntary bearing-
down efforts supplement the contractions, resulting in delivery of the fetus and
placenta.

Fetal presentation
Cephalic
(Head-down presentation)
This position may be classified as:
■ vertex—where the topmost part of the head presents first (shown here)
■ brow or sinciput—where the forward, upper part of the skull presents first
■ face—where the face presents first
■ mentum—where the chin presents first.
Breech
(Head-up presentation)
This position may be classified as:
■ complete: where the knees and hips are flexed (shown here)
■ frank: where the hips are flexed and the knees remain straight
■ footling: where the knees and hips of one or both legs are extended
■ kneeling: where the knees are flexed and hips extended
■ incomplete: where one or both hips remain extended and one or both feet or
knees lie below the breech.
Shoulder
(Includes several variations)
■ Because examination can’t differentiate among them, all transverse lies are
considered shoulder presentations.
Compound
■ Occurs where an extremity prolapses alongside the major presenting part so
that two presenting parts appear at the pelvis at the same time.

Onset of labor
The onset of labor results from several factors.
■ As the uterus stretches over the course of the pregnancy, nerve impulses
stimulate the posterior pituitary lobe to secrete oxytocin (a hormone that
stimulates uterine contractions).
■ During pregnancy, the uterus becomes progressively more sensitive to the
effects of oxytocin, peaking just before labor onset.

Stages of labor
The duration of the three stages of labor varies with the size of the uterus, the
woman’s age, and the number of previous pregnancies.

Stage 1
Hallmark signs of this stage include:
■ cervical effacement: the progressive shortening of the vaginal portion of the
cervix and the thinning of its walls, and
■ cervical dilation: progressive enlargement of the cervical os to allow the fetus
to pass from the uterus into the vagina.
The first stage of labor, which lasts until the cervix is completely dilated, is
divided into three phases:
Stage 2
The second stage of labor begins with full cervical dilation and ends with
delivery of the fetus.
Stage 3
The third stage of labor starts immediately after childbirth and ends with
delivery of the placenta.
Postpartum period
After childbirth, the reproductive tract takes about 6 weeks to revert to its former
condition in a process called involution. The uterus quickly grows smaller, with
most of its involution taking place during the first 2 weeks after delivery.
Postpartum vaginal discharge (lochia) persists for several weeks after
childbirth.

Lochia rubra
■ Consists of a bloody discharge
■ Appears 1 to 4 days postpartum

Lochia serosa
■ Consists of a pinkish brown, serous discharge
■ Occurs from 5 to 7 days postpartum

Lochia alba
■ Consists of a grayish white or colorless discharge
■ Appears from 1 to 3 weeks postpartum

Uterine involution
After birth, the uterus begins its descent back into the pelvic cavity. It continues
to descend about 1 cm/day until it isn’t palpable above the symphysis at about 9
weeks after birth.
Lactation
After delivery of the placenta, the body undergoes changes to stimulate the
production of milk.

First, progesterone and estrogen levels drop, which triggers the

1 production of prolactin.
Prolactin stimulates milk production by the acinar cells in the
2 mammary glands.
Milk flows from the acinar cells through small tubules to the
3 lactiferous sinuses.
When the neonate sucks at the breast, oxytocin is released, causing
4 the nipple to contract and pushing the milk forward through the
nipple to the neonate.
Show and tell
Using the illustrations here as a guide, describe how fertilization
occurs.
Answers: Show and tell 1. The spermatozoon approaches the ovum. 2. The
acrosome develops small perforations through which it releases enzymes
necessary for the sperm to penetrate the protective layer of the ovum before
fertilization. 3. The spermatozoon penetrates the zona pellucida, triggering the
ovum’s second meiotic division (following meiosis), making the zona pellucida
impenetrable to other spermatozoa. 4. The spermatozoon’s nucleus is released
into the ovum, its tail degenerates, and its head enlarges and fuses with the
ovum’s nucleus, producing a zygote; Matchmaker 1. D, 2. A, 3. B, 4. C.
D. Cephalic
C. Compound
B. Shoulder
A. Breech
Identify the types of fetal presentation shown here.
Matchmaker
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 Credits
Chapter 1
Reference planes, page 3. Willis MC. Medical Terminology: A Programmed
Learning Approach to the Language of Health Care. Baltimore, MD: Lippincott
Williams & Wilkins; 2002.
Adipose tissue, page 15; Types of muscle tissue, page 16. Premkumar, K. The
Massage Connection Anatomy and Physiology. Baltimore, MD: Lippincott
Williams & Wilkins; 2004.

Chapter 7
Taste buds, page 79. Bear MF, Connors B, Paradiso M. Neuroscience: Exploring
the Brain. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.

Chapter 8
Adrenal glands, page 85. Premkumar K. The Massage Connection Anatomy and
Physiology. Baltimore, MD: Lippincott Williams & Wilkins; 2004.

Chapter 11
Inside a lymph node, page 122. Adapted from Eroschenko VP. di Fiore’s Atlas of
Histology with Functional Correlations. 9th ed. Baltimore, MD: Lippincott
Williams & Wilkins; 2000.
The path of lymph, page 125, illustration 1. Adapted from Cohen BJ, Taylor J.
Memmler’s Structure and Function of the Human Body. 8th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2005.

Inside the spleen, page 126, illustration 1. Adapted from Stedman’s Medical
Dictionary. 27th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000.

Chapter 12
Inspiration and expiration, page 144. Weber J, Kelley J. Health Assessment in
Nursing. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.
Pulmonary perfusion, pages 146 and 147. Moore KL, Dalley AF II. Clinical
Oriented Anatomy. 4th ed. Baltimore, MD: Lippincott Williams & Wilkins;
1999.

Chapter 13
Stomach, page 154. Adapted from Cohen BJ, Taylor J. Memmler’s Structure and
Function of the Human Body. 8th ed. Philadelphia, PA: Lippincott Williams &
Wilkins; 2005.
Small intestine: How form affects digestion, pages 168 and 169, illustrations 1
and 2. Cohen BJ, Taylor J. Memmler’s Structure and Function of the Human
Body. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.

Small intestine: How form affects digestion, pages 168 and 169, illustration 3.
Eroschenko VP. di Fiore’s Atlas of Histology with Functional Correlations. 9th
ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000.

Chapter 14
Food group recommendations, page 173. Adapted from U.S. Department of
Agriculture, Center for Nutrition Policy and Promotion. MyPyramid Mini-
Poster. http://www.mypyramid.gov/downloads/miniposter.pdf. Accessed
September 5, 2006.
We also gratefully acknowledge Anatomical Chart Company and LifeART for
the use of selected images.
 Index
A
Abdominopelvic cavity, 4
Abduction, 48
Absorptive cells, 168
Accessory lymphoid organs and tissues, 127
Acetoacetic acid, 188
Acetone, 188
Achilles reflex, 66
Acid–base balance, 108, 178, 211
electrolytes and, 210
kidneys and, 193
Acinar cells, 86
Acinus, 138
Actin, 46
Active transport, 13, 207
Adenine, 8
Adduction, 48
Adenoids, 127
ADH. See Adrenocorticotropic hormone
Adipose tissue, 15
Adrenal glands, 82, 85
Adrenocorticotropic hormone (ADH),83, 88, 90
Afferent neural pathway, 65
Afterload, 101
Age-related changes
in body fluids, 204
in cardiovascular system, 105
in endocrine system, 91
in eyes, 74
 in gastrointestinal system, 169
in hematologic system, 109
in muscles, 47
in nose, 78
in nutrition, 189
in reproductive system, 218, 221
in respiratory system, 142
in urinary system, 195
Agranulocytes, 108, 110, 111
Airflow patterns, 144
Aldosterone, 91, 199
Alimentary canal, 152-157, 160-161, 163
fluids in, 202
immune function of, 128
innervation of, 159
specialized cells in, 155
structures of wall of, 158
Alleles, 21
Alveolar-capillary membrane, diffusion across, 148
Alveolar sacs, 138
Alveoli, 138, 139
Amines, 88, 89
Amino acids, 174, 186, 187
Ammonia, 160
Amniotic sac, 233
Amylase, 86
Anabolism, 182
Anaphase, 10
Anatomic terms, 2-5
Androgens, 85, 218
Angiotensin II, 199
Anions, 31, 209
ANS. See Autonomic nervous system
Anterior direction, 2
Anterior pituitary, 83
Antibody-mediated immunity, 130
Antidiuretic hormone, 83, 198
Aortic valve, 96, 97
Apocrine glands, 41
Appendicular skeleton
bones of, 50, 51
muscles of, 44, 45
Appendix, 127
Arachnoid membrane, 67
Argentaffin cells, 167
Arrector pili, 40
Arteries, 102
of brain, 62
Arterioles, 102, 146
Arteriovenous circulation, 102, 103
Ascending colon, 157
Atoms, 27-30
Atria, 96
Atrioventricular node, 99
Atrioventricular valves, 96, 97
Atrophic keratosis, 41
Automaticity, 100
Autonomic nervous system (ANS), 69
catecholamines and, 90
Autosomal dominant inheritance, 22
Autosomal recessive inheritance, 22
Axial skeleton
bones of, 50, 51
muscles of, 44, 45
Axon, 58

B
Bacteria, 72
 body odor and, 41
in large intestine, 165
Ball-and-socket joint, 55
Bartholin’s glands, 219
Basophils, 108, 110, 111
B-cell formation, 119, 120
Beta-hydroxybutyric acid, 188
Biceps reflex, 66
Biliary duct system, 161
Bladder, 196
Blastocyst, 229
Blood. See also Red blood cells; White blood cells
cells, development of, 108
circulation of, 102, 103
clotting of, 112-114
in heart, 98
typing and crossmatching, 115
Blood glucose levels
age-related changes in, 91
hormones and, 90
regulation of, 184-186
Blood pressure
age-related changes in, 105
renin-angiotensin-aldosterone system and, 199
Body
cavities of, 4
chemistry of, 25-34
reference planes of, 3
regions of, 5
Body fluids, 202-208
age-related changes in, 204
daily gains in, 202
daily losses in, 202
forms of, 205
 intake and output of, 208
movement of, 206, 207
types of, 203
weight of, 204
Body odor, 41
Bonds, 30
Bone marrow, 119
Bones, 50-51
blood supply to, 52
classification of, 51
formation of, 53
functions of, 52
remodeling of, 53
Bowman’s capsule, 195, 197
Brachioradialis reflex, 66
Brain
arteries of, 62
neurons of, 58
structures of, 60
Brainstem, 60
swallowing and, 166
Breast, 221
Breathing, mechanism of, 144
Broca’s center, 61
Bronchi, 137
Bronchioles, 137, 138
Buccal cavity, 153
Bulbourethral glands, 214, 216
Bursae, 55

C
Calcitonin, 84
Calvaria, 4
Capillaries, 102
Carbohydrates, 32, 174
digestion and absorption of, 179
liver and, 160
metabolism of, 182, 183
Carboxypeptidase, 86
Cardiac cells, characteristics of, 100
Cardiac conduction, 99-100
Cardiac muscle, 16
Cardiac output, 101
Cardiac sphincter, 154
Cardiovascular system, 94-105
age-related changes in, 105
Carina, 137
Carotid arteries, 62
Cartilage, 54
Catabolism, 182
Catecholamines, 85, 90
Cations, 31, 209
Cecum, 156, 157
Cell-mediated immunity, 130
Cell membrane, 7
Cells, 6-13
components of, 6-7
movement within, 12-13
protein synthesis and, 8
reproduction of, 9-11
Central lymphoid organs and tissues, 119-121
Central nervous system, 60-67. See also Brain; Spinal cord
hormone regulation and, 90
Cerebellum, 60
Cerebral cortex, 60, 61
Cerebrospinal fluid (CSF), 59, 63
Chemistry, 25-34
atoms, 27
 bonds in, 30
reactions in, 29
subatomic particles, 28
Chemotaxis, 131
Childbirth, 236
Cholecystokinin, 162
Cholesterol, 175
biliary duct system and, 161
Cholesterol esterase, 86
Chorion, 233
Chorionic villi, 233
Choroid, 73
Chromosomes, 20
Chyme, 164
Chymotrypsin, 86
Cilia, 135
Ciliary body, 73
Circumduction, 48
Clavicle, 143
Clitoris, 219
Coagulation factors, 114
Codominant genes, 21
Collecting tubule, 195
Columnar epithelium, 14
Complement system, 131
Complex feedback, 89
Compounds, 27
inorganic, 31
organic, 32-33
Conchae, 135
Conduction, cardiac, 99
Conductivity, 17, 100
Condylar joints, 55
Conjunctivae, 72
Connective tissue, 15
Contractility, 100, 101
Cornea, 73
Coronary arteries, 104
Coronary veins, 104
Corticotropin, 86, 89, 90
Cortisol, 91
Coughing, 135
Covalent bond, 30
Cowper’s glands, 214, 216
Cranial cavity, 4
Cranial nerves, 68
Crypts of Lieberkühn, 167
CSF. See Cerebrospinal fluid
Cuboidal epithelium, 14
Cytoplasm, 6
Cytosine, 8

D
Dead-space ventilation as cause of ventilation-perfusion mismatch, 149
Deamination, 187
Decidua, 233
Decomposition, 29
Deep tendon reflexes, 66
Defecation, 165
Deglutition, 164
Dendrites, 58
Deoxygenation, 38
Deoxyribonuclease, 86
Deoxyribonucleic acid (DNA), 8, 9, 33
genes and, 21
Depolarization–repolarization cycle, 100
Dermatome, 68
Dermis, 36-37
Descending colon, 157
Differentiation, 108
Diffusion, 12, 148, 206
Digestion, 155, 164-165
of carbohydrates, 179
of fats, 181
of proteins, 180
Digestive enzymes, 86
Dilation, 238
Directional terms, 2
Disaccharides, 174
Distal convoluted tubule, 195
Distal direction, 2
DNA. See Deoxyribonucleic acid
Dominant genes, 21, 22
Dorsal cavity, 4
Duodenum, 156, 163
Dura mater, 67

E
Ears, 76-77
hearing loss and, 76
Eccrine glands, 41
Effacement, 238
Efferent neural pathways, 65
Eicosanoids, 32
Elastic cartilage, 54
Electrolytes, 209-210
osmotic regulation of sodium and water in, 210
as inorganic compounds, 31
Electrons, 28
Electron-transport chain, 182, 183
Elimination, 165
Embryonic development, 230-231
Endocardium, 95
Endocrine system, 82-91. See also specific glands and hormones
age-related changes in, 91
glandular epithelium and, 15
Endomysium, 46
Energy, 26
Enzymes, 180
Eosinophils, 108, 110, 111
Epicardium, 95
Epidermis, 36-37
Epididymis, 214, 215
Epigastric region, 5
Epimysium, 46
Epiphyseal plates, 53
Epithelial cells, types of, in small intestine, 168, 169
Epithelial tissue, 14
Erythrocytes. See Red blood cells
Esophagus, 153
Estrogen, 85, 88
Ethmoidal sinus, 135
Eversion, 48
Exchange as chemical reaction, 29
Excitability, 100
Exocrine glands, 15, 86, 163
Expiration, 144
Extension, 48
External respiration, 144-148
External rotation, 48
Extracellular fluid, 203, 204
electrolyte composition in, 209
Extrapyramidal system, 65
Extrinsic pathway, clotting and, 113
Eyelids, 72
Eyes
 age-related changes in, 74
extraocular structures of, 72
image perception with, 75
intraocular structures of, 73, 74, 75
muscles of, 72

F
Fallopian tubes, 220
Fats, 15, 175. See also Adipose tissue
biliary duct system and, 161
digestion and absorption of, 181
Fat-soluble vitamins, 176, 177
Feedback mechanism, hormone regulation and, 89
Female reproductive system, 219-223
age-related changes in, 221
Fertilization, 226, 227
Fetal development, stages of, 228-232
Fetal presentation, forms of, 236, 237
Fetoplacental circulation, 235
Fibrous cartilage, 54
Fight-or-flight response, 69
Filtration, 13
Flatus, 165
Flexion, 48
Fluids. See Body fluids
Follicle-stimulating hormone (FSH), 83, 88, 218
Food group recommendations, 173
Frontal plane, 4
Frontal sinuses, 135
Fruits, daily recommendations for, 173
FSH. See Follicle-stimulating hormone

G
Gallbladder, 163
Gas exchange, respiration and, 145-148
Gastric inhibitory peptides, 162
Gastric secretion, sites and mechanisms of, 167
Gastrin, 155, 162
Gastrointestinal hormones, 162
Gastrointestinal system, 152-169
age-related changes in, 169
components of, 152-158, 160-163
functions of, 164-169
Gastrointestinal tract. See Alimentary canal
G cells, 155
Gene expression, 21
Genes, 21-23
Genetics, 19-24
muscle growth and, 47
Gestation. See Pregnancy
GH. See Growth hormone
Glands, 82-88. See also specific glands
location of, 82
Glandular epithelium, 15
Glial cells, 59
Glomerular filtration, 197
Glomerulus, 195, 197
Glucagon, 86
Glucocorticoids, 85
Gluconeogenesis, 184
Glucose catabolism, 182, 183
Glycogen, conversion of glucose to, 86, 184-186
Glycogenesis, 184, 186
Glycogenolysis, 184
Glycolysis, 182, 183
Golgi apparatus, 7
Gonads, 88
Grains, daily recommendations for, 173
Gram-positive bacteria, 41
Granulocytes, 108, 110, 111
Growth hormone (GH), 83
somatostatin and, 86
Guanine, 8

H
Hair, 40
Haversian canals, 52
Hearing loss, 76
Heart
blood flow through, 98
conduction system of, 99
location of, 94
muscle, circulation to, 104
structures of, 95-97
Hematologic system, 108-115
age-related changes in, 109
Hematopoiesis, 108, 119
Hemostasis, 112-114
Hepatocytes, 160
Hinge joints, 55
Homeostatic balance, 38
Hormones. See also specific hormones
classification of, 88
from kidneys, 193
menstrual cycle and, 222-223
receptors and, 91
regulation of, 89, 90
release of, 89, 90
role of, in blood glucoseregulation, 186
sexual development and, 218
urinary system and, 198, 199
Host defenses, 129
Humoral immunity, 130
Hyaline cartilage, 54
Hydrogen bond, 30
Hydrolysis, 179
Hypertonic fluid, 205
Hypochondriac regions, 5
Hypogastric region, 5
Hypothalamic-pituitary-target gland axis, hormone release and, 90
Hypothalamus, 60, 83
complex feedback and, 89
Hypotonic fluid, 205
Hypoxia, 90

I
Ileocecal valve, 156
Ileum, 156, 157
Iliac regions, 5
Image perception and formation, 75
Immune responses, 130
Immune system, 118-131
functions of, 128-131
structures of, 118-127
thymus and, 87
Inferior direction, 2
Inflammatory response, 129
Inorganic compounds, 31
Insertion, of muscles, 47
Inspiration, 144
Insulin, 86
effect of, on blood glucose level, 186
Intake and output of fluid, 208
Integumentary system, 36-41
age-related changes in, 41
Internal respiration, 144
Internal rotation, 48
Interstitial fluid, 203, 204
Intestinal glands, 168, 169
Intracellular fluid, 203, 204
electrolyte composition in, 209
Intravascular fluid, 203, 204
Intrinsic cascade system, 113
Inversion, 48
Ionic bond, 30
Iris, 73
Irritability, 17
Islets of Langerhans, 86
Isotonic fluid, 205

J
Jejunum, 156, 158
Joints, 54, 55
Juxtaglomerular cells, 199

K
Kerckring’s folds, 168
Ketone bodies, 188, 189
Kidneys, 192-195
urine formation and, 197
Krebs cycle, 182, 183

L
Labia majora, 219
Labia minora, 219
Labor
onset of, 238
stages of, 238-240
Lacrimal apparatus, 72
Lactation, 88, 241
Lactic acid
blood glucose regulation and, 185
sweat and, 38
Laminar airflow, 144
Large intestine, 157
Laryngopharynx, 136
Larynx, 136
Lateral direction, 2
Left hypochondriac region, 5
Left iliac region, 5
Left lumbar region, 5
Left ventricle, 96
Lens, 73
Leukocytes. See White blood cells
LH. See Luteinizing hormone
Ligaments, 49
Limbic system, 61
Lipids, 32, 175
biliary duct system and, 161
metabolism of, 188, 189
Lipogenesis, 184
Lipoproteins, 32
Liver, 160
blood glucose regulation and, 184
circulation to, 105
Lochia, 241
Loop of Henle, 195
Lower airways, 137-139
Lumbar regions, 5
Lungs, 140
Lunula, 40
Luteinizing hormone (LH), 83, 218
Lymph, 123
path of, 124
Lymphatic vessels, 123-125
Lymph nodes, 122, 125
Lymphocytes, 108, 119
Lysosome, 6

M
Macrophages, phagocytosis and, 131
Male reproductive system, 214-218
age-related changes in, 218
Male secondary sexualcharacteristics, 218
Mammary glands, 221
ovaries and, 88
Manubrium, 143
Mastication, 164
Matter, 26
Maturation, 108
Maxillary sinus, 135
Meats, daily recommendations for, 173
Medial direction, 2
Median sagittal plane, 3
Mediastinum, 142
Megakaryocytes, 112
Meiosis, 11
Melanocyte-stimulating hormone, 83
Melatonin, 87
Memory cells, 120
Meninges, 67
Menstrual cycle
hormonal function and, 222-223
ovaries and, 88
Messenger RNA, 8
Metabolism, 172, 182-189
Metaphase, 8
Middle ear cavity, 4
Midline, 2
Milk, daily recommendations for, 173
Mineralocorticoids, 85
Minerals, 176, 178
Mitochondrion, 7
Mitosis, 10, 108
Mitral valve, 96, 97
Molecule, 27
Monocytes, 108, 110, 111
Monosaccharides, 174
Mons pubis, 219
Motilin, 162
Motor neural pathways, 65
Mouth, 79, 153
Mucosa villi, 158, 168
Multifactorial inheritance, 22
Muscle fibers, 46
Muscles, 44-45
age-related changes in, 47
attachment of, 47
blood glucose and, 185
of eye, 72
functions of, 49
growth of, 47
movements of, 48
role of, in blood glucose regulation, 185
structure of, 46
tissue, 16
Musculoskeletal system, 44-55
skin and, 38
Myocardium, 95
Myofibrils, 46
Myosin, 46

N
Nails, 40
Nasal cavity, 4
Nasopharynx, 135
Nephron, 194-195
Nerve tissue, 17
Nervous system, 58-69. See also specific systems and components
age-related changes in, 60
hormones and, 90
Neural pathways, 65
Neuroglia, 59
Neuron, 17, 58-59
Neurotransmission, 59
Neutrons, 28
Neutrophils, 108, 110, 111
Nonsynovial joints, 54
Nose, 78
immune function of, 128
Nucleic acids. See Deoxyribonucleic acid; Ribonucleic acid
Nucleus, 7
chromosomes and, 20
Nutrition
age-related changes in, 189
muscle growth and, 47
components of, 172-178

O
Occipital lobe, 61
Olfactory receptors, 78
Opsonization, 131
Optic nerve, 73
Oral cavity, 4
structures of, 153
Orbital cavities, 4
Organic compounds, 32-33
Origin, of muscles, 47
Oropharynx, 136
Osmosis, 12, 207
Osteoblasts, 53
Osteoclasts, 53
Ovaries, 88, 220
structural changes in, during pregnancy, 233
Oxytocin, 83, 90

PQ
Pacemakers, 99
Pain sensation, 65
Pancreas, 82, 86, 163
Parasagittal plane, 3
Parasympathetic nervous system, 69
alimentary canal and, 159
Parathyroid glands, 84
Parathyroid hormone (PTH), 84, 88
Parotid gland, 153
Passive transport, 12
Patellar reflex, 66
Penis, 214
Pericardial fluid, 95
Pericardium, 95
Perimysium, 46
Peripheral lymphoid organs and tissues, 122-127
Peripheral nerves, 68
Peripheral nervous system, 68-69
Peristalsis, 159, 164
Peyer’s patches, 127
pH, 211
Phagocytes, 119
Phagocytosis, 131
Pharynx, 153
Phospholipids, 32, 175
Photosynthesis, 174
Pia mater, 67
Pineal gland, 87
Pinocytosis, 13
Pituitary gland, 82, 83, 90
complex feedback and, 89
Pituitary-target gland axis, hormone release and, 90
Pivot joints, 55
Placenta, 234
circulatory systems in, 235
Plasma, 109
Plasma cells, 120
Platelets, 112
development of, 108
Pleura, 141
Pleural cavity, 141
Polypeptides, 88, 89
Polysaccharides, 174
Posterior direction, 2
Posterior pituitary, 83
Postpartum period, 241
Preembryonic development, 228-229
Pregnancy, 228-235
ovaries and, 88
Preload, 101
Primitive reflexes, 66
Progesterone, 88, 91
Prolactin, 83
Prophase, 8
Prostate gland, 214, 216
Protective surface phenomena, 128
Proteins, 33, 174
digestion and absorption of, 180
metabolism of, 186-187
synthesis of, 8
Protons, 28
Protraction, 48
Proximal convoluted tubule, 195, 197
Proximal direction, 2
Pseudostratified columnarepithelium, 14
Pulmonary arteries, 146-147, 148
Pulmonary function, age-related changes in, 142
Pulmonary perfusion, 146-147
Pulmonary veins, 146-147, 148
Pulmonic valve, 96, 97
Pupil, 73
Purkinje fibers, 99
Pyloric sphincter, 154, 163
Pyramidal system, 65
Pyruvic acid
blood glucose regulation and, 185
lipid metabolism and, 188

R
Receptors, 91
olfactory, 78
Recessive genes, 21, 22
Rectum, 157
Red blood cells, 109
development of, 108
life span of, 109
Reference planes, 3
Reflex arc, 63
Reflex responses, 66
Renal corpuscle, 195
Renin-angiotensin-aldosterone system, 199
Reproduction, 225-242
fertilization, 226-227
labor and postpartum, 236-241
pregnancy, 228-235
Reproductive system, 213-224
of females, 219-223
of males, 214-218
Respiratory system, 134-149
age-related changes in, 142
structures of, 134-143
Respiratory tract, immune function of, 128
Retina, 73, 74
Retraction, 48
Reversible chemical reaction, 29
Rh typing, 115
Ribonuclease, 86
Ribonucleic acid (RNA), 8, 33
Ribosomal RNA, 8
Ribosome, 7
Ribs, 143
Right hypochondriac region, 5
Right iliac region, 5
Right lumbar region, 5
Right ventricle, 96
RNA. See Ribonucleic acid

S
Saddle joints, 55
Salivary glands, 153
Sarcolemma, 46
Sarcomeres, 46
Saturated fatty acid, 175
Scapula, 143
S cell, 155
Sclera, 73
Scrotum, 214
Sebaceous glands, 41
Secretin, 155, 162
Self-digestion, protection from, 167
Semilunar valves, 96, 97
Seminal vesicles, 214, 216
Sensory neural pathways, 65
Sensory system, 72-79
Sex-linked genes, 21, 23
Sexual development, hormonal control and, 218
Shunting as cause of ventilation-perfusion mismatch, 149
Sigmoid colon, 157
Silent unit as cause of ventilation-perfusion mismatch, 149
Simple columnar epithelium, 14
Simple cuboidal epithelium, 14
Simple squamous epithelium, 14
Sinoatrial node, 99
Sinuses, 135
Sinusoids, 160
Skeletal system, 50
Skene’s glands, 219
Skin
functions of, 38-39
layers of, 36-37
Small intestine, 156
digestion and absorption and, 168
Smooth muscle, 16
Sneezing, 135
Sodium–potassium pump, 13
Somatostatin, 86
Spermatids, 217
Spermatoblasts, 217
Spermatocytes, 217
Spermatogenesis, 217
Spermatozoa, 88, 217
Sphenoidal sinus, 135
Spinal cavity, 4
Spinal cord, 63-64
neurons of, 58
Spleen, 126-127
Splenic pulp, 126
Squamous epithelium, 14
Stem cells, 119, 121
Sternum, 143
Steroids, 88
Sterols, 32, 175
Stomach, 154
Stratified columnar epithelium, 14
Stratified squamous epithelium, 14
Stress, 90, 91
sweat glands and, 41
Striated muscle, 16
Stroke volume, 101
Subarachnoid space, 67
Subatomic particles, 28
Subcutaneous tissue, 36
Subdural space, 67
Sublingual gland, 153
Submandibular gland, 153
Superficial reflexes, 66
Superior direction, 2
Supination, 48
Suprasternal notch, 143
Surfactant, 139
Swallowing, mechanism of, 166
Sweat glands, 36, 41
Sympathetic nervous system, 69
adrenal glands and, 85
alimentary canal and, 159
Synovial cavities, 4
Synovial fluid, 55
Synovial joints, 54
Synthesis, 29

T
Target cells, 91
Taste buds, 79
T cells, 87
formation of, 119, 121
Telophase, 8
Tendons, 49
Testes, 88, 214, 215
Testosterone, 88, 218
Thalamus, 60
sensory pathway and, 65
Thermoregulation, skin and, 39
Thoracic cage, 143
Thoracic cavity, 4, 142
Thymine, 8
Thymopoietin, 87
Thymosin, 87
Thymus, 87, 119
Thyroid gland, 84
Thyroid-stimulating hormone, 83
Thyroxine, 84
Tissue, 14-17
Tonsils, 127
Trachea, 136, 137
Transamination, 187
Trans fats, 175
Transfer RNA, 8
Transitional airflow, 144
Transverse colon, 157
Transverse plane, 3
Triceps reflex, 66
Tricuspid valve, 96, 97
Triglycerides, 175
Trigone, 196
Triiodothyronine, 84
Trypsin, 86
Tubular reabsorption, urine formation and, 197
Tubular secretion, urine formation and, 197
Tunica muscularis, 158
Turbinates, 135
Turbulent airflow, 144

U
Umbilical cord, 234
Umbilical region, 5
Undifferentiated cells, 168
Unsaturated fatty acid, 175
Upper airways, 135-136
Urea, 160
Ureters, 192, 196
Urethra, 196, 214, 215, 219
Urinary system, 192-199
age-related changes in, 195
components of, 192-196
hormones and, 198-199
Urinary tract, immune function of, 128
Urine formation, 197
Urine output, 197
 antidiuretic hormone and, 198
Uterine involution, 241
Uteroplacental circulation, 235
Uterus, 220
structural changes in, during pregnancy, 233-234

V
Vagina, 220
Vaginal opening, 219
Vas deferens, 214, 215
Vasopressin, 83
Vegetables, daily recommendations for, 173
Veins, 102
Vena cava, 98
Ventilation, 144
Ventilation-perfusion ratio, 148-149
Ventral cavity, 4
Ventricles, 96
Venules, 102, 147
Vermiform appendix, 156, 157
Vertebral canal, 4
Vertebral column, 143
Villi epithelium, 158
Visceral peritoneum, 158
Vitamins, 176-177
Vitreous humor, 73
Volkmann’s canals, 52
Vulva, 219

W
Water as inorganic compound, 31
Water-soluble vitamins, 176, 177
Water weight, 204
Wernicke’s center, 61
White blood cells, 110
classifying, 110-111
development of, 108

X
Xiphoid process, 143
X-linked dominant inheritance, 23
X-linked recessive inheritance, 23

Y
Yolk sac, 233

Z
Zygote, 227, 228, 230