BASIC AND SYSTEMIC ANATOMY

INTRODUCTION
ANATOMY: Is a science that deals with the structure of the body. A

knowledge of these structure is necessary to understand their functions.

Cardiovascular System: The cardiovascular system consists of

heart and bold vessels. It is mainly a transport system. It transports respiratory gases, nutrients and excretory products to various parts of the body. Blood is the medium through which these substances are transported.

HEART: Heart is a conical, hollow, musculotendinous organ. It lies

in the thorax between the lungs and behind the sternum. The base of the heart is above and apex is below.
1) Heart is surrounded by an outer covering called pericardium. It contains two

layers called visceral pericardium and parietal pericardium. Pericardial fluid is present between these two layers. 11) The middle layer is made up of heart muscle fibres. It is called as myocardium. 111) The inner lining is called as endocardium.

Heart Location, Size, and Position

Location: Heart located between the lungs in the lower portion of the mediastinum. Two thirds of the mass of the heart is the left of this line and one third to the right. The hear is often described as a triangular organ, shaped and sized roughly like a closed fist.

Position: The hear is positioned in the thoracic cavity between the sternum in fornt and the bodies of the thoracic vertebrae behind.

Heart chambers: Heart is made of four hallow champers. A partition divides it

into right and left sides. The two upper champers are called atria and the two lower champers are called ventricles. The atria are smaller than the ventricles, and their walls are receiving chambers because blood enters the heart through veins that open into these upper cavities. The ventricle some times referred to as the discharging chambers of the heart. The right side of the heart is having left atrium above and left ventricle below. The left side of the heart having right atrium above and right ventricle below.

HEART ACTION:
SYSTOLE: Contraction of heart is called systole. DIASTOLE: Relaxation of heart is called diastole. The heart serves as a muscular pumping device for distributing blood to all parts of the body. When the heart beats (it contracts), the atria contract first (atrial systole), forcing blood into the ventricles. Once filled, the two ventricles contract (ventricular systole) and force blood out o9f the heart. For the heart to be efficient in its pumping action more than just the rhythmic required. The direction of blood flow must be directed and controlled. This is accomplished by four sets of valves located at the entrance and near the exit of the ventricles.

HEART VALVES
The two valves that separate the atrial chambers above from the ventricles below are called AV or atrioventricular valves. The two AV valves are called the bicuspid or mitral valve, located between the left atrium and ventricle, and the tricuspid valve, located between the right atrium and ventricle. The AV valves prevent backflow of blood into the atria when the ventricles contract.

The SL or semilunar valves are located between the two ventricular chambers and the larfge arteries that carry blood away from the heart when contractkion occurs. Therefore the two semilunar valves open and close at the same time. The pulmonary semilunar valve is located at the beginning of the pulmonary artery and allows blood going to the lungs to flow out of the right ventricle but prevents it from flowing back into the ventricle. The aortic semilunar valve is located at the beginning of the aorta and allows blood to flow out of the left ventricle up into the aorta but prevents backflow into this ventricle.

BLOOD VESSELS ATTACHED TO HEART

1) The right atrium receives superior vena cava and inferior vena cava. They carry venous blood to heart. 2) From the right ventricle arises the pulmonary artery. It carries venous blood to lungs for oxygenation. 3) The left atrium receives four pulmonary viens. They carry oxygenated blood to heart. 4) From the left ventricle arises the aorta. It carries oxygenated blood to all parts of the body.

ARTERIAL AND VENOUS SYSTEM: The heart pumps blood into aarteries.
The arteries divided and subdivide and finally end in capillaries. The capillaries later unit to form veins. The veins return blood to the heart. So arteries carry pure blood away from the heart. Veins carry impure blood to the heart.

Arteries and veins are made of the following three layers.

1)

Tunica adventitia outer fibrous layer Tunica intima-------inner serous layer

2) Tunica media -- -----middle muscle layer 3)

HEART SOUNDS: Two distinct sounds can be heard, they are rhythmical and
repetitive sounds that are often described as lub dup.

Cardiac Cycle: The beating of the heart is a regular and rhythmic process. Each
complete heartbeat is called a cardiac cycle and includes the contraction (systole)

and (diastole) of atria and ventricles. Each cycle takes about 0.8 seconds to complete it the heart is beating at an average rate of about 72 per minute.

Stroke volume: Refers to the volume of blood ejected from the

ventricles during each beat.

Cardiac output: The volume of blood pumped by one ventricle per

minute, averages about 5.1 L in a normal, resting adult. BLOOD CIRCULATION 1. Systemic circulation 2. Pulmonary circulation 3. Coronary circulation 4. Portal circulation Systemic circulation: It is the circulation involving blood supply to all parts of the body except lungs. This circulation starts from aorta (which carries oxygenated blood from left ventricle). It breaks up into smaller arteries and finally ends in capillaries. The capillaries unite to form venules which join up ultimately to form two large venous trunks namely superior vena cava and inferior vena cava. These two venous trunks open in the right atrium of heart. 2. Pulmonary circulation: It is the part of the circulation involving the purification of blood in lungs. Impure venous blood is pumped by the right ventricle. The pulmonary artery carries this blood to lungs where it is oxygenated (purified). Four pulmonary veins carry this purified blood from lungs. These veins open in the left atrium. 3. coronary circulation: This circulation involves blood supply to the heart itself. The right and left coronary arteries arise from ascending aorta. They supply blood to the heart. The venous blood is collected by the coronary sinus which opens in the right atrium. 4. Portal circulation: It is the circulation of blood through the liver. In this circulation:

1) Portalvein carries blood that has circulated in stomach intestine and pancease to liver.

What Is Digestion?
Digestion is the complex process of turning the food you eat into the energy you
need to survive. The digestion process also involves creating waste to be eliminated. The digestive tract (or gut) is a long twisting tube that starts at the mouth and ends at the anus. It is made up of a series of muscles that coordinate the movement of food and other cells that produce enzymes and hormones to aid in the breakdown of food. Along the way are three other organs that are needed for digestion: the liver, gallbladder, and the pancreas.

Food's Journey Through the Digestive System

Stop 1:

The Mouth The mouth is the beginning of the digestive system, and, in

fact, digestion starts here before you even take the first bite of a meal. The smell of food triggers the salivary glands in your mouth to secrete saliva, causing your mouth to water. When you actually taste the food, saliva increases.Once you start chewing and breaking the food down into pieces small enough to be digested other mechanisms come into play. More saliva is produced to begin the process of breaking down food into a form your body can absorb and use. In addition, "juices" are produced that will help to further break down food.

The Pharynx and Esophagus

Also called the throat, the pharynx is the portion of the digestive tract that receives the food from your mouth. Branching off the pharynx is the esophagus, which carries food to the stomach, and the trachea or windpipe, which carries air to the lungs. The act of swallowing takes place in the pharynx partly as a reflex and partly under voluntary control. The tongue and soft palate -- the soft part of the roof of the mouth -- push food into the pharynx, which closes off the trachea. The food then enters the esophagus.The esophagus is a muscular tube extending from the pharynx and behind the trachea to the stomach. Food is pushed through the esophagus and into the stomach by means of a series of contractions called peristalsis. Just before the opening to the stomach is an important ring-shaped muscle called the lower esophageal sphincter (LES). This sphincter opens to let food pass into the stomach and closes to keep it there. If your LES doesn't work

properly, you may suffer from a condition called GERD, or reflux, which causes heartburn and regurgitation (the feeling of food coming back up).

The Stomach and Small Intestine The stomach is a sac-like organ with
strong muscular walls. In addition to holding food, it serves as the mixer and grinder of food. The stomach secretes acid and powerful enzymes that continue the process of breaking the food down and changing it to a consistency of liquid or paste. From there, food moves to the small intestine. Between meals the nonliquefiable remnants are released from the stomach and ushered through the rest of the intestines to be eliminated. Made up of three segments -- the duodenum, jejunum, and ileum -- the small intestine also breaks down food using enzymes released by the pancreas and bile from the liver. Peristalsis is also at work in this organ, moving food through and mixing it up with the digestive secretions from the pancreas and liver, including bile. The duodenum is largely responsible for the continuing breakdown process, with the jejunum and ileum being mainly responsible for absorption of nutrients into the bloodstream. A more technical name for this part of the process is "motility" since it involves moving or emptying food particles from one part to the next. This process is highly dependant on the activity of a large network of nerves, hormones, and muscles. Problems with any of these components can cause a variety of conditions. While food is in the small intestine, nutrients are absorbed through the walls and into the bloodstream. What's leftover (the waste) moves into the large intestine (large bowel or colon). everything above the large intestine is called the upper GI tract. Everything below is the lower GI tract

Pancreas
Among other functions, the pancreas is the chief factory for digestive enzymes that are secreted into the duodenum, the first segment of the small intestine. These enzymes break down protein, fats, and carbohydrates.

Liver
The liver has multiple functions, but two of its main functions within the digestive system are to make and secrete an important substance called bile and to process the blood coming from the small intestine containing the nutrients just absorbed.

The liver purifies this blood of many impurities before traveling to the rest of the body.

Gallbladder
The gallbladder is a storage sac for excess bile. Bile made in the liver travels to the small intestine via the bile ducts. If the intestine doesn't need it, the bile travels into the gallbladder where it awaits the signal from the intestines that food is present. Bile serves two main purposes. First, it helps absorb fats in the diet and secondly, it carries waste from the liver that cannot go through the kidneys.

The Colon, Rectum, and Anus

The colon (large intestine) is a five- to seven -foot -long muscular tube that
connects the small intestine to the rectum. It is made up of the ascending (right) colon, the transverse (across) colon, the descending (left) colon and the sigmoid colon, which connects to the rectum. The appendix is a small tube attached to the ascending colon. The large intestine is a highly specialized organ that is responsible for processing waste so that defecation (excretion of waste) is easy and convenient.

Stool, or waste left over from the digestive process, passes through the colon by
means of peristalsis, first in a liquid state and ultimately in solid form. As stool passes through the colon, any remaining water is absorbed. Stool is stored in the sigmoid (S-shaped) colon until a "mass movement" empties it into the rectum, usually once or twice a day. It normally takes about 36 hours for stool to get through the colon. The stool itself is mostly food debris and bacteria. These bacteria perform several useful functions, such as synthesizing various vitamins, processing waste products and food particles, and protecting against harmful bacteria. When the descending colon becomes full of stool it empties its contents into the rectum to begin the process of elimination.

The rectum is an eight-inch chamber that connects the colon to the anus. The
rectum: Receives stool from the colon. Lets the person know there is stool to be evacuated. Holds the stool until evacuation happens. When anything (gas or stool) comes into the rectum, sensors send a message to the brain. The brain then decides if the rectal contents can be released or not. If they can, the sphincters relax and the rectum contracts, expelling its contents. If the contents cannot be expelled, the sphincters contract and the rectum accommodates so that the sensation temporarily goes away. The anus is the last part of the digestive tract. It consists of the muscles that line the pelvis (pelvic floor muscles) and two other muscles called anal sphincters (internal and external). The pelvic floor muscle creates an angle between the rectum and the anus that stops stool from coming out when it is not supposed to. The anal sphincters provide fine control of stool. The internal sphincter is always tight, except when stool enters the rectum. It keeps us continent (not releasing stool) when we are asleep or otherwise unaware of the presence of stool. When we get an urge to defecate (go to the bathroom), we rely on our external sphincter to keep the stool in until we can get to the toilet.

RESPIRATORY SYSTEM Inspiration is an active process, but normal expiration is a passive process. Forced expiration recruits the abdominal muscles to help force out air. Muscles of breathing Diaphragm this is the main muscle of inspiration. It flattens out. During normal quiet breathing it is only really the diaphragm that does any work (other muscles are often not involved). It is controlled by the phrenic nerve which has nerve roots in C3-5. External intercostals they raise the ribcage, and also pull the sternum outwards slightly, which increases the volume of the thorax in a different dimension to the diaphragm (horizontal and vertical vectors) Sternocleidomastoid this will lift the sternum up slightly Anterior serrate this lifts up many of the ribs. It attaches to the inside of the scapula, and its other ends attach to the lateral surfaces of the ribs. Scalene these lift the first two ribs. They attach to the front of the first two ribs, and their other end is at the anterior prominence (cant remember the name!) on top and at the front of the scapula.

Pectoralis minor this lifts ribs III-IV

The rectus abdominis and the internal intercostals can aid with expiration when needed. Compliance is a term used to describe how easily the lungs will expand and contract how compliant they are. The lower the compliance, the greater the pressure needed to fill the lungs. The compliance is determined by the elastin and collagen fibres found in the lung parenchyma. These fibres will help the lung to expel air as a passive process. However, they only account for 1/3 of the contractility of the normal lung. The other 2/3 is caused by the fluid-air surface tension inside the alveoli and other lung spaces as a result of the fluid that lines these spaces. However it is important to remember that this surface tension is only present when there

is an air fluid interface in the lungs. I guess the excess mucus produced in COPD will have an adverse effect on this surface tension effect. Surfactants are present in this fluid lining, and these reduced the fluid tension effect, and stop the effect becoming too strong and causing a collapsing of the lung tissue. Respiratory distress syndrome sometimes exists in new born infants and it is caused by a lack of surfactant it makes it very difficult for the baby to breathe because the high fluid tension makes it difficult for the lungs to expand.

Bronchodilation is stimulated by adrenaline and the sympathetic nervous system Bronchoconstriction is stimulated by histamine and the parasympathetic nervous system. Cold air and chemical irritants can also have a similar affect

Respiratory rate the normal respiratory rate in an adult is 12-18 breaths per minute this is roughly one for every 4 heartbeats. Children will breathe more rapidly at approximately 18-20 breaths per minute. Anatomical dead space about 150ml of every 500ml of inhaled air (so 30%) will fill the bronchi and not the alveoli and this air is obviously not available for gaseous exchange. This space that the air fills is known as the anatomical dead space. Physiological dead space this is the sum of the anatomical dead space, and any extra dead space caused by alveolar damage. In healthy individuals the anatomical dead space = physiological dead space

Gas concentrations The air at the alveoli contains more CO2 than room air because obviously there is a residual volume, thus total gaseous exchange does not occur with each breath there is some air left in the alveoli that waters down air coming in from outside the body.

Normal air: 78% nitrogen 21% oxygen 0.5% water 0.04% carbon dioxide Alveolar Air: 75% nitrogen 13.6% oxygen 6.2% water 5.3% carbon dioxide

Expired air: 75% Nitrogen 15.7% oxygen 3.6% carbon dioxide 6.2% water Note that: Both the composition of air, and the distance it has to diffuse across the alveoli will affect how much gas makes it into the blood stream. Increasing the distance the gas has to diffuse e.g. due to inflammation or production of excess mucus will decrease the amount of gas getting into the bloodstream. Nervous control You cannot continue to breathe if the nervous supply to the muscles is cut off (unlike the heart) because breathing is controlled by skeletal muscle. The breathing centre in the medulla coordinates all the muscles required for breathing. However, this can be regulated by conscious activity in the cerebrum. Ondines curse this is a condition where there is damage to the autonomic nervous

system such that a person may forget to breathe, usually during sleep. It occurs in 1 in 200,000 live births, but can also occur as a result of trauma to the brainstem, or poliomyelitis. These patients will require mechanical ventilation for the rest of their lives (but usually only during sleep). It is also known as primary alveolar hypoventilation. The DRG (Dorsal respiratory group) is a group of neurons in the medulla. They are I (inspiratory) neurons. They are active in every breath, whether quiet or forced.

The VRG (ventral respiratory group) are also found in the medulla. This contains both I and E (expiratory) neurons, and it is active in forced breathing.

There are also the apneustic (in the pons) and pneumotaxic (in the cerebrum) centres these regulate the rate and depth of respiration, by causing the activation or inhibition of the DRG and VRG. The apneustic centre will stimulate the DRG for approxmatley 2 seconds, before stopping stimulation and allowing expiration. This centre basically controls rate of respiration The pneumotaxic centre controls the depth of respiration. E.g. an increase in ouput by the pneumotaxic centre will cause a short duration of inspiration, thus reducing the depth of inspiration.

Baroreceptor reflexes: When blood pressure falls, respiratory rate increases When blood pressure rises, respiratory rate decreases

The Hering-Breur Reflexes These are active when there are large tidal volumes, and prevent the lungs from becoming overinflated or collapsing. They are controlled by stretch receptors that feedback info to VRG and DRG. Conscious breathing Bypasses the DRG and VRG altogether, and using pyramidal fibres, will connect directly with the same LMNs used by the DRG and VRG. This type of breathing is controlled by the motor cortex in the frontal lobe. Accessory muscles of respiration By putting your hands on your hips you raise the scapula, and thus raise the pectoralis minor and serratus anterior, thus increasing the distance they can raise the rib-cage.

Gaseos exchange A normal breath exchanges about 350ml of air in the lungs compare this to the total lung volume of about 1300ml. This relatively small change prevents sudden changes in gas concentrations in the blood.

Ellicit drugs and the respiratory system Cannabis increases the risk of COPD. A very heavy cannabis smoker could possibly get COPD in their 30s or 40s even without an -1 antitrpysin deficiency. Some evidence suggests that one spliff is equivalent to smoking 20 cigarettes Cocaine can cause MI in young people, as well as emphysema Heroin can cause severe respiratory depression for which you would give naloxone in the acute situation. This drug can be used to treat respiratory depression in any opioid overdose. A couple of terms that arent so obvious are: Kussmaul breathing this is deep rapid breathing that is induced y acidosis Orthopnoea this is dyspnoea (shortness of breath) that occurs whilst lying down Eupnoea normal breathing .Login or register to post comments