ANATOMY, PHYSIOLOGY,

& DISEASEF O U N DAT I O N S F O R

T H E H E A LT H P R O F E S S I O N S

second e dition

Deborah Roiger,
M.Ed.
St. Cloud Technical &
Community College
St. Cloud, Minnesota

Nia Joyner
Bullock, Ph.D.
Miller-Motte College
Wilmington, North Carolina

Digital Author
Jason LaPres, M.A.
Lone Star College
University Park, Texas
ANATOMY, PHYSIOLOGY, & DISEASE: FOUNDATIONS FOR THE HEALTH PROFESSIONS,
SECOND EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2019 by
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Library of Congress Cataloging-in-Publication Data

Roiger, Deborah, author. | Bullock, Nia Joyner, author.

Anatomy, physiology & disease: foundations for the health
professions
/Deborah Roiger, M.Ed., St. Cloud Technical & Community College, St.
Cloud, Minnesota, Nia Joyner Bullock, Ph.D., Miller-Motte College
Wilmington, North Carolina; digital author, Jason LaPres, M.A., Lone
Star College, University Park, Texas.
Anatomy, physiology, and disease
Second edition. | New York, NY: McGraw-Hill Education, [2019]
|
Includes bibliographical references and index.
LCCN 2017036993 | ISBN 9781259709166 (alk. paper)
LCSH: Human anatomy—Examinations, questions, etc. | Human
physiology—Examinations, questions, etc.
LCC QM32 .R65 2019 | DDC 612.0076—dc23 LC record available
at https://lccn.loc.gov/2017036993

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a
website does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill
Education does not guarantee the accuracy of the information presented at these sites.

mheducation.com/highered
 Brief Contents
Preface xvii

1 The Basics 1

2 Levels of Organization of the Human Body 31

3 The Integumentary System 82

4 The Skeletal System 113

5 The Muscular System 174

6 The Nervous System 222

7 The Nervous System—Senses 270

8 The Endocrine System 305

9 The Cardiovascular System—Blood 337

10 The Cardiovascular System—Heart and Vessels 370

11 The Lymphatic System 423

12 The Respiratory System 457

13 The Digestive System 501

14 The Excretory/Urinary System 542

15 The Male Reproductive System 576

16 The Female Reproductive System 605

Appendices
A The Metric System A-1

B Nutrition Table A-3

C Spot Check Answers A-5

D Prefixes, Suffixes, and Additional Word Roots A-11

Endnotes A-13

Glossary G-1

Index I-1

iii
Dedication
I would like to dedicate this book to all of my anatomy and physiology students who
have taught me so much.
~Deborah Roiger
I would like to dedicate this book to my family for all of their support and to my
students, whose drive and dedication are awesome sources of inspiration.
~Nia Bullock

iv
Contents
Preface xvii

1 The Basics 1
1 .1 Overview 2

1.2 Terms of Anatomy

Anatomical Regions 2
Anatomical Planes 6
Anatomical Positions 6
2
Anatomical Terms of Direction 2

Anatomical Cavities 8
Serous Membranes 10
1.3 Terms of Physiology 13
Homeostasis 13
©Stuart Gregory/Getty Images 1.4 Terms of Pathology 15
Introduction to Disease 15
Predisposing Factors of Disease 15
Signs and Symptoms of Disease 18
Classification of Disease 21
Diagnosing Disease 23
Treatment of the Disease 24
Epidemiology 25

2
Levels of Organization of the
Human Body 31
2.1  Overview 32

2.2 Chemical Level 33

Atoms and Isotopes 33
Bonding to Form Molecules 35
Water 37
Solutions 37
Acids, Bases, and pH 37
Organic Molecules 39
Chemical Reactions 44
2.3 Organelle Level 46
©Fuse/Corbis/Getty Images
Cell Membrane 48
2.4 Cellular Level 50
Membrane Transport 50
Protein Synthesis   54

v
 Cell Division 58
Effect of Aging on Cells 60
2.5 Tissue Level 61
Epithelial Tissues 61
Connective Tissues 65
Muscle Tissues 69
Nervous Tissue 71
Modes of Tissue Growth, Change, Shrinkage, and Death 72

2.6 Organ Level 73

2.7 System Level 76

3 The Integumentary System 82

3.1 Word Roots and Combining Forms
3.2 Overview

Epidermis 83
Dermis 87
83

3.3 Anatomy of the Skin, Hair, and Nails

83

83

Hair 91
Nails 93
3.4 Physiology of the Integumentary System 94
©liza5450/Getty Images
Functions of Skin 94
3.5 Injuries to the Skin 97
Regeneration versus Fibrosis 97
Burns 99
3.6 Effects of Aging on the Integumentary System 100

3.7 Diagnostic Tests for Integumentary System Disorders 101

3.8 Integumentary System Disorders 102

Skin Cancer 102
Skin Infections 104
Other Common Skin Disorders 106
Putting the Pieces Together–The Integumentary System 110

4 The Skeletal System 113

4.1 Word Roots and Combining Forms
4.2 Overview 114

4.3 Anatomy of the Skeletal System

Classification of Bones 115
Axial Skeleton 117
114
114

Appendicular Skeleton 129

Histology of the Skeletal System 139
Anatomy of a Long Bone 142
Joints 144
4.4 Physiology of the Skeletal System 152
Mineral Deposition 152
©Juice Images/Getty Images Bone Development 152

vi CONTENTS
 Bone Growth 154
Bone Remodeling 156
Nutritional Requirements of the Skeletal System 157
Hormonal Regulation of Bone Deposition and Reabsorption 157
Functions of the Skeletal System 159
4.5 Effects of Aging on the Skeletal System 160

4.6 Fractures 161

Types of Fractures 161
Fracture Healing 162
4.7 Diagnostic Tests for Skeletal System
Disorders 164
4.8 Skeletal System Disorders 164
Osteoporosis 164
Osteomyelitis 165
Cancers Affecting the Skeletal System 165
Gout 166
Cleft Palate 166
Mastoiditis 167
Putting the Pieces Together–The Skeletal System 169

5 The Muscular System 174

5.1 Word Roots and Combining Forms
5.2 Overview 175

5.3 Anatomy of the Muscular System

Anatomical Terms 176
Muscle Actions 177
175

176

Muscles by Region 180

Anatomy of a Skeletal Muscle 196
Anatomy of a Skeletal Muscle Cell 197
5.4 Physiology of the Muscular System 199
©AAGAMIA/The Image Physiological Characteristics of Muscle Tissue 199
Bank/Getty Images
Neuromuscular Junction 200
Muscle Contraction at the Molecular Level 201
Types of Muscle Contractions 201
Motor Units and Recruitment 204
Isotonic and Isometric Contractions 205
Levers 205
Muscle Metabolism 206
Fatigue 208
Comparison of Muscle Tissues 209
Nutritional Requirements of Muscle Tissue 210
Functions of the Muscular System 211
5.5 Effects of Aging on the Muscular System 212

5.6 Diagnostic Test for Muscular System Disorders 213

5.7 Muscular System Disorders 213

Hernias 213
Cramps 213
Muscular Dystrophy 214

CONTENTS vii
 Sprains 214
Muscle Strain 215
Myalgia 215
Fibromyalgia 215
Tendinitis 215
Atrophy 216
Shin Splints 216
Putting the Pieces Together–The Muscular System 218

6 The Nervous System 222

6.1 Word Roots and Combining Forms
6.2 Overview 223

6.3 Anatomy of the Nervous System Cells

Anatomy of a Neuron 224
Neuroglia 228
223

224

6.4 Anatomy of the Central Nervous System 231

Meninges 231
©Ingram Publishing Cerebrospinal Fluid 232
Brain 234
Spinal Cord 242
6.5 Anatomy of the Peripheral Nervous System 245
Anatomy of a Nerve 245
Cranial Nerves 246
Spinal Nerves 247
Autonomic Nervous System 250
6.6 Physiology of the Nervous System 253
Nerve Impulses 253
Reflexes 256
Memory 259
Language 259
Pathways 260
Nutritional Requirements of the Nervous System 261
6.7 Effects of Aging on the Nervous System 261

6.8 Diagnostic Tests for Nervous System Disorders 262

6.9 Nervous System Disorders 262

Cerebrovascular Accident 262
Alzheimer’s Disease 262
Huntington’s Disease 263
Parkinson’s Disease 263
Multiple Sclerosis 263
Paralysis 264
Hydrocephalus 264
Epilepsy 265
Cerebral Palsy 265
Putting the Pieces Together–The Nervous System 266

viii CONTENTS
7 The Nervous System—Senses 270
7.1 Word Roots and Combining Forms
7.2 Overview
7.3 General Senses
271

271
Anatomy of Receptors in the Skin 271
271

Physiology of General Senses in the Skin 272

7.4 Taste 275
Anatomy of Receptors for Taste 276
Physiology of Taste   277
7.5 Smell 278
©Jae Rew/Getty Images Anatomy of Receptors for Smell 278
Physiology of Smell 279
7.6 Hearing 279
Anatomy of the Ear 280
Physiology of Hearing 282
7.7 Equilibrium 285
Anatomy of the Vestibular Apparatus 285
Physiology of Equilibrium 287
7.8 Vision 289
Anatomy of the Eye 290
Physiology of Vision 295
7.9 Effects of Aging on the Senses 298
Changes in the General Senses 298
Changes in Taste 298
Changes in Smell 298
Changes in Hearing 299
Changes in Equilibrium 299
Changes in Vision 299
7.10 Diagnostic Tests for Disorders of the Senses 299

7.11 Disorders of the Senses 300

Hearing Loss 300
Cataracts 301

8 The Endocrine System 305

8.1 Word Roots and Combining Forms
8.2 Overview 306
8.3 Anatomy of the Endocrine System
Glands 307
Hormones 315
306

307

Target Tissues 316

8.4 Physiology of the Endocrine System 318
Regulation of Hormone Secretion and Distribution 318
Receptor Regulation 320
©Hero Images/Getty Images Hormone Elimination 321
Functions: Four Scenarios 322
8.5 Effects of Aging on the Endocrine System 326
8.6 Diagnostic Tests for Endocrine System Disorders 327

CONTENTS ix
 8.7 Endocrine System Disorders 328
Diabetes Mellitus 328
Diabetes Insipidus 329
Growth Disorders 329
Goiters 331
Hypothyroidism 332
Cushing’s Syndrome 332
Putting the Pieces Together–The Endocrine System 334

9
The Cardiovascular System—Blood 337
9.1 Word Roots and Combining Forms 338

9.2 Overview 338

9.3 Anatomy of Blood 338

Plasma 339
Formed Elements 340
9.4 Physiology of Blood 344
Hemopoiesis 344
Hemoglobin 348
Nutritional Requirements for Erythropoiesis 349
Life Cycle of a Red Blood Cell 350
Hemostasis 351
Pathways of Blood Clotting 353
Elimination of Blood Clots 354
Preventing Inappropriate Clotting 354
Blood Typing 354
Functions of Blood 358
9.5 Diagnostic Tests for Blood Disorders 359

9.6 Blood Disorders 361

Leukemia 361
Polycythemia 362
Anemia 364
Clotting Disorders 364

10
The Cardiovascular System—Heart
and Vessels 370
10.1 Word Roots and Combining Forms 371

10.2 Overview 371

10.3 Heart Anatomy 371

Pericardium 371
Heart Wall 373
Chambers and Valves 375
Cardiac Muscle Tissue 378
10.4 Heart Physiology 379
Blood Flow through the Heart 379
©Mark Andersen/Getty Images Cardiac Conduction System 382

x CONTENTS
 Cardiac Cycle 383
Electrocardiogram 387
Cardiac Output 389
Heart Regulation 390
10.5 Vessel Anatomy 392
Arteries 395
Capillaries 397
Veins 397
10.6 Vessel Physiology 397
Circulatory Routes 398
Venous Return 402
Blood Pressure, Resistance, and Flow 402
Regulation of Blood Pressure and Flow 404
Effects of Exercise on Cardiac Output 407
10.7 Effects of Aging on the Cardiovascular System 408
10.8 Diagnostic Tests for Heart and Vessel Disorders 408
10.9 Disorders of the Heart and Vessels 410
Valve Disorders 410
Vessel Disorders 410
Myocardial Disorders 414
Congenital Heart Defects 414
Putting the Pieces Together–The Cardiovascular System 419

11 The Lymphatic System 423

11.1 Word Roots and Combining Forms
11.2 Overview 424
11.3 Anatomy of the Lymphatic System 424
Lymph and Lymph Vessels 424
Cells of the Lymphatic System 428
424

Lymphoid Tissues and Organs 429

11.4 Physiology of the Lymphatic System 435
Three Lines of Defense 435
Nonspecific Resistance versus Specific Immunity 436
Nonspecific Defenses 436
Specific Immunity 439
©Terry Vine/Blend Humoral (Antibody-Mediated) Immunity 440
Images/Getty Images
Cellular (Cell-Mediated) Immunity 442
Forms of Acquired Immunity 443
Importance of Thelper Cells in Nonspecific Resistance and Specific Immunity 445
Functions of the Lymphatic System 446
11.5 Effects of Aging on the Lymphatic System 447
11.6 Diagnostic Tests for Lymphatic System Disorders 447
11.7 Lymphatic System Disorders 448
Lymphoma 448
Multiple Myeloma 449
Splenomegaly 449
Allergies 449

CONTENTS xi
 Autoimmune Disorders 450
Immunodeficiency Disorders 451
Putting the Pieces Together–The Lymphatic System 453

12 The Respiratory System 457

12.1 Word Roots and Combining Forms
12.2 Overview

Nose 460
458

12.3 Anatomy of the Respiratory System

Nasal Cavity 460

458

458

Pharynx 462
Larynx 463
Trachea 464
Lungs and the Bronchial Tree 466
Alveoli 469
12.4 Physiology of the Respiratory System 470
©Stephen Marks/
Stone/Getty Imagses Mechanics of Taking a Breath 470
Measurements of Pulmonary Function 474
Composition of Air 476
Gas Exchange 476
Comparison of Inspired and Expired Air 478
Factors That Influence Gas Exchange 478
Gas Transport 482
Regulation of Respiration 485
Functions of the Respiratory System 487
12.5 Effects of Aging on the Respiratory System 488

12.6 Diagnostic Tests for Respiratory System Disorders 489

12.7 Respiratory System Disorders 490

Respiratory Infections 490
Chronic Obstructive Pulmonary Disorders 492
Respiratory Distress Syndrome 493
Cancers of the Respiratory System 493
Putting the Pieces Together–The Respiratory System 497

13 The Digestive System 501

13.1 Word Roots and Combining Forms
13.2 Overview 502
502

13.3 Anatomy and Physiology of the Digestive System

Anatomy in the Mouth 504
Physiology of Digestion in the Mouth 507
504

Anatomy from the Mouth to the Stomach 508

Physiology of Digestion from the Mouth to the Stomach 509
Anatomy of the Stomach 510
©Westend61/Getty Images Physiology of Digestion in the Stomach 513
Anatomy of Digestive Accessory Structures 514

xii CONTENTS
 Anatomy of the Small Intestine 518
Physiology of Digestion in the Small Intestine 520
Absorption of Nutrients in the Small Intestine 522
Anatomy of the Large Intestine 522
Physiology of Digestion in the Large Intestine 524
Types of Absorbed Nutrients 526
Circulation of Absorbed Nutrients 526
Control of Digestion 527
Functions of the Digestive System 527
13.4 Effects of Aging on the Digestive System 528
13.5 Diagnostic Tests for Digestive System Disorders 529
13.6 Digestive System Disorders 530
Leukoplakia 530
Gastroenteritis 530
Diverticular Disease 530
Abdominal Hernias 531
Irritable Bowel Syndrome 531
Crohn’s Disease 531
Peptic Ulcers 531
Intussusception 532
Cirrhosis 532
Hepatitis 533
Vomiting 534
Food Poisoning 534
Parasites 535
Malabsorption 536
Putting the Pieces Together–The Digestive System 538

14 The Excretory/Urinary System 542

14.1 Word Roots and Combining Forms
14.2 Overview 543
Sources of Nitrogenous Wastes 544
Overview of Kidney Function
14.3 Anatomy of the Kidney 545
544
543

Anatomy of a Nephron 547

Flow of Urine Components through a Nephron 549
Blood Flow to a Nephron 550
14.4 Physiology of Urine Production 551
Filtration 551
Reabsorption 552
Secretion 552
14.5 Water Conservation 555
©didi/Getty Images
Water in the Body 555
14.6 Regulation of Urine Volume and Concentration 556
Hormonal Mechanisms of Control 557
Nervous System Mechanisms of Control 560
Diuretics 561

CONTENTS xiii
 14.7 Anatomy of Ureters, Urinary Bladder, and Male and Female Urethras 561
Ureters 561
Urinary Bladder 562
Urethra 563
14.8 Physiology of the Passing of Urine 564

14.9 Functions of the Excretory System 565

14.10 Effects of Aging on the Excretory System 566

14.11 Diagnostic Tests for Excretory System Disorders 566

14.12 Disorders of the Excretory System 567

Urinary Tract Infections 567
Hydronephrosis 568
Polycystic Kidney Disease 568
Kidney Stones 569
Glomerulonephritis 569
Renal Failure 570
Cancers of the Excretory System 570
Putting the Pieces Together–The Excretory/Urinary System 572

15
The Male Reproductive System 576
15.1 Word Roots and Combining Forms 577

15.2 Overview 577

15.3 Male Reproductive Anatomy 578

Testes 578
Secondary Sex Organs and Structures 580
Anatomy of a Sperm 586
15.4 Physiology of the Male Reproductive System 586
Hormonal Control at Puberty 587
Sperm Production 587
Spermatogenesis and Spermiogenesis 589
Hormonal Control in the Adult Male 592
©Image Source/Getty Images Pathway for Sperm 594
Sexual Response in the Male 594
15.5 Effects of Aging on the Male Reproductive System 596

15.6 Diagnostic Tests for Male Reproductive System Disorders 597

15.7 Male Reproductive System Disorders 597

Prostate Cancer 597
Testicular Cancer 598
Hypospadias 599
Hydrocele 599
Epididymitis 599
Phimosis 599
Sexually Transmitted Diseases 599
Putting the Pieces Together–The Reproductive Systems 602

xiv CONTENTS
16
The Female Reproductive System 605
16.1 Word Roots and Combining Forms 606

16.2 Overview 606

16.3 Female Reproductive Anatomy 606

Ovaries 606
Secondary Female Reproductive Organs and Structures 608
16.4 Physiology of the Female Reproductive System 613
Hormonal Control at Puberty 613
Oogenesis 614
Hormonal Control in the Adult Female 617
The Female Sexual Response 621
16.5 Effects of Aging on the Female Reproductive System 623

16.6 Diagnostic Tests for Female Reproductive System Disorders 624

©Mango Productions/ 16.7 Disorders of the Female Reproductive System 625

Corbis/Getty Images Breast Cancer 625
Ovarian Cancer 626
Cervical Cancer 626
Fibroids 626
Endometriosis 627
Sexually Transmitted Diseases 628
16.8 Pregnancy 628
Pathway for Sperm to Meet an Egg 629
Fertilization to Implantation 629
Hormonal Control of Pregnancy 632
A Woman’s Adjustment to Pregnancy 633
Nutritional Requirements for a Pregnancy 634
Initiating the Birth Process 635
The Birth Process 636
Lactation 637
Disorders of Pregnancy 639
Putting the Pieces Together–The Reproductive Systems 642

Appendices
A The Metric System A-1
B Nutrition Table A-3
C Spot Check Answers A-5
D Prefixes, Suffixes, and Additional Word Roots A-11

Endnotes A-13

Glossary G-1

Index I-1

CONTENTS xv
 About the Authors

Deborah Roiger
M.A. Education, St. Mary’s University of Minnesota; B.S. Biology
and Earth Science, St. Cloud State University
Deborah Roiger has 17 years of teaching experience,
the last 12 of which were in the Minnesota State Col-
leges and University (MNSCU) system of 32 state-
sponsored technical colleges, community colleges,
and universities. She was voted instructor of the
year in 2007 by the students at St. Cloud Technical
College, received five awards for excellence by
MNSCU for projects she developed, and was named
educator of the year in 2009 by the MNSCU board of ©Champa Studios
trustees. Deborah’s development of digital resources
for teaching anatomy and physiology online also earned an Innovation of the Year
award in 2009 from the League for Innovation in the Community College. She has
presented her work in the development of anatomy and physiology resources at four
national conferences. Deborah is the author of Anatomy & Physiology: Foundations
for the Health Professions and its accompanying workbook. She is a member of
the Human Anatomy and Physiology Society (HAPS), American Academy for the
Advancement of Science (AAAS), and National Science Teachers’ Association.

Nia Joyner Bullock

Ph.D. Comparative Biomedical Sciences, North Carolina State
University; B.S. Biology, North Carolina Agricultural & Technical
State University; RMA American Medical Technologist
Dr. Nia Joyner Bullock has 18 years of teaching
experience in private career colleges and universi-
ties. During her tenure at Miller-Motte College, she
served in various professional capacities, includ-
ing Academic Dean and Medical Assisting Pro-
gram Director. She also teaches a variety of courses
within the curriculum. Dr. Bullock has developed
courses for the online division of the college and was
instrumental in the implementation and use of vari-
ous virtual training tools for allied health programs.
She has made scholarly presentations at a number
©Picture People
of scientific conferences and published articles and
abstracts on maternal diabetes and its effects on
embryonic heart development. She is a member of American Medical Technologists.
Dr. Bullock lives in Wake Forest, North Carolina, with her husband and three sons.

xvi
 Preface
The structure of the human body is fascinating. The study of human anatomy and physi-
ology is vital knowledge for all students, and just as significant is an understanding of
the abnormal functions of the body. Students seeking careers in the health care field can
be doubly motivated when taking an anatomy, physiology, and pathology course, as the
personally relevant content also prepares them for their chosen careers.
As instructors, we look for a text that is, first and foremost, accurate; is written at
an appropriate level for our students—neither too high nor too low; can be customized
to accommodate the organization of our individual courses; and will be interesting and
appealing to our students.
This text has been designed specifically for college students taking an anatomy and
physiology course or an anatomy, physiology, and pathology course.
∙∙ Reading-level assessments ensure the text is accessible to students.
∙∙ Thorough reviewing and meticulous checking of all text and illustrations ensure
accuracy.
∙∙ All of the textbook and digital learning and assessment content has been mapped
to specific learning outcomes, allowing instructors the option of building their
course around specific outcomes and related content.
∙∙ The authors’ illustration program has been expertly executed in full color and
amazing detail by talented and precise medical illustrators.

Three Key Principles

The pedagogical approach of this text and its learning and assessment program is
founded on three key principles:
1. Tell students what we are going to teach them. Each chapter in this text begins
with a list of specific learning outcomes.
2. Teach students what we outlined in the learning outcomes. Everything in
this text and all ancillary materials directly relates to the learning outcomes out-
lined in each chapter. Real-life situations, analogies, and a commonsense, direct
approach are used to teach anatomy, physiology, and pathology concepts.
3. Test students on what they have been taught. All assignments, activities,
discussion questions, review questions, and test questions in this text and in the
Workbook for Use with Anatomy, Physiology, and Disease by Roiger/Bullock
directly assess only the learning outcomes stated in each chapter.
This pedagogical approach warrants there will be no surprises for the student. If
the learning outcomes are stressed through lecture and assignments, students quickly
find comfort in having a guideline to follow in learning the content.

Changes to the Second Edition

This second edition features many macro-level changes that overlay each chapter of
the book. The universal changes to the second edition include the following:

xvii
 ∙∙ A reorganization of chapters helps to better integrate pathology throughout the
text. Chapter 1 (The Basics) and Chapter 3 (Introduction of Pathology) have
merged and are now all incorporated into Chapter 1. Chapter 1 now introduces
anatomy, physiology, and pathology to the student. All of the systems chapters
follow Chapter 1, in the same sequence as in the first edition.
∙∙ The illustration program in the second edition has been completely revised to include
more detailed, vibrant line art and many new photos. In addition, many figures have
been revised to include content changes; those figures are included in the chapter-
specific lists that follow, and the most significant new photos are noted as well.
∙∙ Learning outcomes now immediately follow relevant A or B heads.
∙∙ Twenty percent more Spot Check questions have been added throughout the text.
∙∙ Pronunciations now appear immediately after first use of the terms within text.
∙∙ The word “Homeostasis” is highlighted in bold, red lettering as important
homeostasis concepts are introduced throughout the chapters.
∙∙ Chapter summaries have been expanded to include greater detail.
∙∙ Key terms lists are added to the end of each chapter.
∙∙ Warning boxes have been changed to “Common Misconception” boxes.
∙∙ Epidemiology Point boxes were removed from the chapters.

Chapter 1
∙∙ Merged Chapters 1 and 3 to cover introduction to anatomy, physiology, and
pathology in the new Chapter 1
∙∙ Coverage added on communicable and noncommunicable disease, infectious and
noninfectious disease, introduction to disease, predisposing factors, signs and
symptoms of disease, classification of disease, diagnosing disease, treatment of
diseases, and epidemiology
∙∙ Revised coverage included on the topics of hypersensitivities, cancer (shortened
in Chapter 1, expanded in Chapter 2), and therapeutic treatment
∙∙ New Clinical Point boxes on pain scale and determining a diagnosis
∙∙ Updated Table 1.6 Most Prominent Chronic Diseases in the United States
∙∙ New photos in Figure 1.7(a)–(d) Anatomical planes

Chapter 2
∙∙ New section added: Modes of Tissue Growth, Change, Shrinkage, and Death
(includes expanded coverage on cancer)
∙∙ Expanded coverage on hydrogen bonding
∙∙ Revised Figure 2.13 Generic cell cut to reveal its organelles
∙∙ Revised Figure 2.20 Protein synthesis: Transcription
∙∙ Revised Figure 2.21 Protein synthesis (continued): Translation
∙∙ Revised Figure 2.22 What happens after Translation
∙∙ Revised Figure 2.45(b): new cadaver heart photo

Chapter 3
∙∙ New Clinical Point on onychomycosis
∙∙ Updated Table 3.3 Skin Diseases and Disorders
∙∙ Eleven new photos throughout the chapter

xviii PREFACE
Chapter 4
∙∙ Revised Figure 4.38(b) Histology of bone tissue
∙∙ Fourteen new photos throughout the chapter

Chapter 5
∙∙ Table 5.1 revised to include zygomaticus major
∙∙ Table 5.6 revised the function of tensor fasciae latae
∙∙ New Clinical Point on RICE acronym for muscle sprains
∙∙ Revised section on Effects of Aging on the Muscular System
∙∙ Revised text on Sprains and Muscle Strain in Disorders section
∙∙ Revised Figure 5.10 Muscles: full figure anterior view
∙∙ Revised Figure 5.11 Muscles: full figure posterior view
∙∙ Revised Figure 5.12(a) and (b) Muscles of the head and neck
∙∙ Revised Figure 5.26 Sliding filament theory of muscle contraction
∙∙ New photo in Figure 5.16(c) Muscles of the forearm, cadaver view
∙∙ New photo in Figure 5.17(c) Carpal tunnel syndrome, cadaver view

Chapter 6
∙∙ Overview is revised
∙∙ Expanded synapse and neurotransmitters coverage in Anatomy of a Neuron/Body
section
∙∙ New Clinical Point on neurotransmitter imbalance and mental disorders
∙∙ Revised description of Wernicke’s area, Huntington’s disease, and Parkinson’s
disease
∙∙ Revised Figure 6.22(a) Resting membrane potential
∙∙ New Figure 6.22(b) Sodium/potassium pump
∙∙ Updated Table 6.6 Summary of Diseases and Disorders of the Nervous System

Chapter 7
∙∙ Revised text includes: anatomy of receptors for smell, cataract description, and
physiology of taste
∙∙ Definition of proprioceptor was added to Chapter 7
∙∙ New Clinical Point box on age-related macular degeneration was added to Chapter 7
∙∙ Updated Table 7.3 Summary of Diseases and Disorders of the Senses in the
Nervous System
∙∙ Revised Figure 7.8 The anatomy of the external ear, middle ear, and inner ear
∙∙ Revised Figure 7.10 Anatomy of the cochlea unwound
∙∙ Revised Figure 7.12 The effects of sound waves on the cochlea
∙∙ Revised Figure 7.13 Frequency response of the basilar membrane in the cochlea

Chapter 8
∙∙ Revised text on parathyroid glands
∙∙ New Clinical Point box on prediabetes

PREFACE xix
 ∙∙ New Clinical Point box on blood tests for hormone changes associated with
menopause
∙∙ Revised Figure 8.4 Hypothalamus–anterior pituitary target-tissue relationship
∙∙ Revised Figure 8.5(a)–(c) Hypothalamus-pituitary relationship
∙∙ New photo in Figure 8.17 Acromegaly
∙∙ New photo in Figure 8.19 Endemic goiter resulting from an iodine deficiency
∙∙ New photo in Disease Point box on myxedema
∙∙ New photo in Figure 8.20(a) Cushing’s syndrome

Chapter 9
∙∙ New Clinical Point box on carbon monoxide added
∙∙ Reorganized Blood Disorders section
∙∙ Updated Table 9.4 Summary of Diseases and Disorders of the Blood
∙∙ New photo in Figure 9.12(c) Agglutinated blood

Chapter 10
∙∙ Expanded section on Chambers and Valves to cover fossa ovalis
∙∙ Expanded section on Blood Flow through the Heart to include fetal heart blood flow
∙∙ Revised section on Heart Failure
∙∙ New Clinical Point box on defibrillation
∙∙ Coverage on fetal heart incorporated into chapter text (from Clinical Point box)
∙∙ Revised Figure 10.2 The position of the heart in the thorax (a, b, and c)
∙∙ Revised Figure 10.3 The pericardium and the heart wall
∙∙ New photo in Figure 10.5(c) External cadaver heart anterior view
∙∙ Revised Figure 10.9 General diagram of the pulmonary and systemic circuits
∙∙ New photo in Clinical Point box on defibrillators
∙∙ New photo in Figure 10.22(c) Polymer cast of coronary arteries
∙∙ New photo in Figure 10.31(b) Varicose veins

Chapter 11
∙∙ Revised section on Lymph and Lymph Vessels
∙∙ New Clinical Point box on organ transplantation and immunosuppressant drugs
∙∙ New Clinical Point box on biologic DMARDs
∙∙ Revised Figure 11.3(b) Valves in lymphatic vessels
∙∙ Revised Figure 11.14 Graph of a fever
∙∙ Revised Figure 11.18 Cellular immunity
∙∙ New photo for Disease Point box on elephantiasis
∙∙ New photo for Disease Point box on anaphylaxis
∙∙ New photo for Figure 11.24 Kaposi sarcoma

Chapter 12
∙∙ New photo in Figure 12.9 Lining of trachea
∙∙ New photo in Figure 12.13 Histology of the lung

xx PREFACE
∙∙ Revised Figure 12.15 A respiratory cycle of inspiration, expiration, and rest
∙∙ Revised Figure 12.17 Graphs of pulmonary volumes and capacities
∙∙ Revised Figure 12.22 Ventilation-perfusion coupling
∙∙ Revised Figure 12.23 Systemic gas exchange and transport
∙∙ Revised Figure 12.24 Alveolar gas exchange and transport
∙∙ New photo in Figure 12.28 Lung X-ray showing tuberculosis
∙∙ New photo in Figure 12.31 Lung cancer

Chapter 13
∙∙ Revised Figure 13.16 Gross anatomy of the small intestine showing the circular
folds of the lining
∙∙ Revised Figure 13.17(b) Intestinal villi
∙∙ New photo in Disease Point box on gallstones

Chapter 14
∙∙ Angiotensinogen added to Aldosterone section
∙∙ New section added on Sources of Nitrogenous Wastes
∙∙ New photo added in Figure 14.5(b) Coronal section of cadaver kidney

Chapter 15
∙∙ New Clinical Point box added on anabolic steroids
∙∙ New photo in Figure 15.10(a) Mature spermatozoon
∙∙ New photo in Figure 15.14(a) Histology of a testis, seminiferous tubule
∙∙ Revised Figure 15.16 The male sexual response
∙∙ New photo in Figure 15.19 Hydrocele

Chapter 16
∙∙ New Clinical Point box added on birth control
∙∙ Revised Figure 16.13 The female sexual response
∙∙ Revised Figure 16.19 The process of fertilization
∙∙ Revised Figure 16.22 Initiating the birth process
∙∙ New photo in Figure 16.7(c) The female breast
∙∙ New photo in Figure 16.11 Ovulation in a human (endoscopic view)
∙∙ New photo in Figure 16.16 Removal of uterine fibroid

End matter
∙∙ Appendix B Nutrition table updated with the most current version (2015–2020)
∙∙ Appendix C updated to include answers to new Spot Check questions
∙∙ Appendix D: Prefixes, Suffixes, and Additional Word Roots is added to the
Appendix section
∙∙ New terms added to the Glossary, and a number of terms and definitions are
updated

PREFACE xxi
Pedagogical Features
The following tools are built into this text to facilitate student learning.

Specific Learning Outcomes Histology of the Skeletal System

Specific learning outcomes give clear expectations
and direct student learning. Every piece of content, Learning Outcomes
including the text, figures, and tables in each chap- 5. Describe the cells, fibers, and matrix of bone tissue.
6. Compare and contrast the histology of compact and cancellous bone.
ter, directly relates to specified learning outcomes. 7. Compare and contrast the histology of hyaline, elastic, and fibrocartilage
connective tissues.

Now that you have a better understanding of the bones of the skeletal system, you are
ready to explore the skeletal system at the microscopic level. At this level, you will
need to look at bone, hyaline cartilage, elastic cartilage, and fibrocartilage connective
A Chapter Summary tissues. You have already identified these tissues in “Chapter 2: Levels of Organiza-
section, located at the end of tion of the Human Body.” In this chapter, you will study the cells, fibers, and matrix of
these tissues more completely to see how they function in the skeletal system.
each chapter, provides relevant Summary
bullet points to summarize 14.5 Water Conservation
9.1 Word Roots and Combining Forms
Water conservation Boneby theConnective Bone is dynamic
Tissue Approximately
kidney is truly remarkable. 1.5 L of urine tissue.
is It changes daily. You will learn
each text section. ∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the cardiovascular system.
excreted per day. This whyis and the same how it changes
amount shortly,
as three-fourths of a 2but firstof you
L bottle need to understand the cells, fibers, and
your favorite
9.2soda. Think about this: This amount represents only 1% of the water filtered out of the blood
Overview matrixtheinvolved.
∙ at thecardiovascular
The glomeruli because rest wasofreabsorbed.
system is composed If there
the heart, blood were
vessels, andnoblood.
reabsorption, 150 L of
urine (75 2 L bottles) would Osteoblasts
be produced per and osteoclasts
day, assuming you would are types
have theof timebone
to takecells. Osteoblasts build bone tissue,
9.3 Anatomy
in that of
much water.whileJustBlood
where is the water in
osteoclasts the body,it.
destroy andBoth
where types
does it come from?are necessary for the skeletal system to
of cells
∙ Blood is a connective tissue of formed elements in a matrix of plasma.
Water in thefunction Body properly. Osteoblasts build new bone by forming a soft matrix of protein and
Plasma carbohydrate molecules with collagen fibers. The osteoblasts then allow hard mineral
∙ Plasma is 91% water; 7% protein; and 2% ions, nutrients, waste products, gases, and regulatory substances.
Learning
∙ Plasma crystals
Outcome
is a solution, to be deposited
and its concentration is important for inhomeostasis.
the matrix. The mineral crystals are mostly hydroxyapatite,
10. Describe theafluid calcium
compartments phosphate
of the bodymineral
and how water salt.moves
Thebetweenhydroxyapatite
them. crystals make the matrix hard.
Formed Elements
∙ The formed elements The collagen
of the fibers give
blood are erythrocytes, the matrix
leukocytes, some flexibility. This process is somewhat similar
and thrombocytes.
∙ Your body isareapproximately
Erythrocytes to that
biconcave in50%
disks with to
no 75%
adeposit nuclei.water.
sidewalk They Men tend
orcontain
bridge to havethat
decking:
hemoglobin slightly more
hasCement
iron water
to carry makes
oxygen. Inthe sidewalk
addition, red or decking hard,
than
bloodwomen because
cells carry womenand
carbon dioxide hydrogenmoreions.fat, which does not contain much water.
∙ Body water
There are fiveistypesbut
located steel
in two rods
of leukocytes major embedded
fluid
that must in the to besidewalk
compartments—intracellular
be stained in order seen. Each type or
and bridge
hasextracel- decking
its own function. give
These leuko-it flexibility that rein-
lular. Sixty-five
cytes are neutrophils,forces
percent ofit.body
basophils, So,waterwithout
eosinophils, is in the
monocytes,sufficient
cytoplasm hydroxyapatite,
of your cells (intracellu-
and lymphocytes. bones become soft. Without collagen
∙ lar). The otheralso
Thrombocytes, 35% of water
called is outside
platelets, your cells
are fragments of cells(extracellular),
that have many as tissue fluid, blood
functions.
fibers, bones become brittle. You
plasma, lymph, CSF, synovial fluid, fluids of the eye (humors), bile, and serous fluid. can see this at home if you soak a chicken bone in
9.4 Physiology
Water movesvinegar of Blood for two a fewfluiddays. The acid of the traveling
vinegareasily will dissolve the hard mineral crystals
Anatomy, Physiology, and Hemopoiesis
across membranes
between
intoproduction.
equalize
the
the
chicken the concentration
bone,
compartments
of solutes
leaving
by osmosis,
theon flexible
both sides and maintainfibers. You may even be able to tie
collagen
∙ homeostasis.
Hemopoiesis is Osmosis
blood Therequickly
are threetoforms: erythropoiesis, leukopoiesis, and thrombopoiesis.
Disease in Context ∙ gradients
Thrombopoiesis thein
starts
of solutes from
occurs very
bone toinmaintain
a knot
a hemocytoblast
order
thrombopoietin when there is a need for more platelets.
minimize
if red
enough
inhomeostasis.
the bone marrow.
the formation
mineral
Most Thethe
of liver
of concentration
crystals in thehave
and kidneys
solutes start thebeen
fluids processdissolved.
by producing

∙
are electrolytes, such as sodium in the extracellular fluids and potassium in the intra-
Leukopoiesis starts from a hemocytoblast in the red bone marrow. Lymphocytes and macrophages produce CSFs when
Physiology concepts are emphasized and cellular
there is afluids. Fluid
challenge and
to the electrolyte
immune system.balance
There is are therefore
a different CSFtied together.
for each type ofFigure
leukocyte 14.11
production.
∙ shows the movement of awater between in thethemajor fluid compartments.
put in context with real-world examples. Erythropoiesis starts from hemocytoblast red bone marrow. The kidneys start the process by releasing EPO in

The normal and abnormal functions of each

In Figure
situations
This
of hypoxemia.
Disease P int
14.11 youHypoxemia
can see that canwater
result enters the body
from disease, highthrough theincreased
elevation,
is the major source of water for the body, but not the only one. You may remem-
monoxide.
fluids you drink.blood loss, and carbon
exercise,

∙ ber
Iron,that
folicwater is alsoB12formed
acid, vitamin , copper,in andthe cellsCthrough
vitamin are neededcellular respiration (C6H12O6 +
for erythropoiesis.
system are explained in the context of a spe- 6O2 → 6CO2 + 6H2O Osteogenesis imperfecta,
+ energy). This additional source iscommonly
considered to called
be metabolicbrittle bones, is a congenital defect
Hemoglobin
cific individual, and interconnections are water because it is derivedin whichfromthe a chemical
bones process
lack that occurs in
collagen the cells.
fibers. With this
∙ The cytoplasm of erythrocytes contains hemoglobin, which is a red, complex protein made of four amino acid chains
As you can see in Figure 14.12, the body’s daily intake and output of water should
defect, the bones are very brittle
made between new concepts and content in called globins.
be equal to maintain and break easily.
homeostasis. Although Until
most this
of condition
the water you istake
accurately
∙ Each globin chain contains a heme group with an iron at its center, which binds one oxygen molecule.
in is from diagnosed, affected children may
previous chapters. ∙ drinks, foodofand
The function metabolic
appear
hemoglobin water
is to to bedo make
transport oxygensignificant
victims andof as acontributions
actabuse bufferbecause to of
to resist pH water balance.
their
change large number of broken bones.
in blood.
At the same time, urine output is the major way the body rids itself of water, while
Rickets is a childhood disorder in which an inadequate amount of mineral crystals
Homeostasis, indicated throughout sweat, water
Nutritional evaporated
Requirements for from the skin, expired air, and feces also make significant
Erythropoiesis
∙ is deposited
Iron is required for erythropoiesis; the RDAinforthe
iron bone. The
is 18 mg/day for bones are27 therefore
leg bones may not
a female and too soft.
mg/day for a pregnant The
woman.
the text in red lettering, is discussed in ∙ Other nutrients required for erythropoiesis are folic acid, copper, and vitamin C.
be able to completely support the weight of the body. As a result, the legs become
context with relevant chapter topics and Life Cycle of a Red Blood Cell
bowed and deformed as they develop.
emphasizes the interdependent relation- ∙
∙
Red blood cells are produced in the red bone marrow.
Red blood cells carry oxygen and carbon dioxide through the bloodstream for 110 to 120 days before wearing out.
ship between homeostasis and acid–base ∙ The liver and spleen remove old, worn-out blood cells.
Intracellular fluid
∙ Hemoglobin is broken down to heme and globin.
balance, fluid and electrolytes, and nutri- ∙ Heme is further broken down to iron, which is recycled, and bilirubin, a waste product. The liver puts bilirubin in bile,
tion. These concepts are covered in the which eventually leaves the body in feces. The spleen secretes bilirubin into the blood, where it is removed by the kidneys
and excreted with urine. There are two types of bone tissue: compact bone and cancellous bone. Compact
context of the body systems, not isolated ∙ bone
Globin is broken down isliver
by the very dense
and spleen and
to free highly
amino organized.
acids, which are recycled.Cancellous bone is spongy in appearance,

in separate chapters. characterized by delicate slivers and plates of bone with spaces between.
367
Digestive tract
Compact bone This type of bone is found in the shafts of long bones and the sur-
faces of flat bones. CompactInterstitial
Bloodstream bonefluid
tissue is arranged in a series of
Lymph osteons (Haversian
Bloodstream

FIGURE 14.11 movement ofthat

systems)
The waterappear as targets.
between major See Figure 4.38b and c. The central osteonic or
fluid compartments.

14.5 Water Conservation 555

4.3 Anatomy of the Skeletal System

xxii PREFACE
 Putting the Pieces Together,
found at the end of each system
chapter, ties the covered system Putting the Pieces Together
to the other 10 systems of the
human body.
The Nervous System
Integumentary system Lymphatic system
Has receptors for the general Microglia serve as immune system
senses. cells to fight pathogens in the CNS.

Innervates smooth muscle of blood

vessels for vasoconstriction and Respiratory system
vasodilation to help regulate
Provides O2 to nervous tissue
temperature.
and removes CO2.

Skeletal system Medulla oblongata regulates

respiratory rate.
Provides protection for the brain
Primary motor and spinal cord. General sensory area
area for touch,
Digestive systempain, heat,
Proprioceptors sense movement
of joints and body position. cold,
Provides pressure, and
nutrients for nervous

movement
system tissues.

Premotor Muscular system

Parasympathetic division
area Muscles carry out movements innervates digestive organs.
initiated in the central nervous
system. Association area for
Broca’s Excretory/urinary system
touch, pain, heat,
area Stimulates muscle contractions.
cold, pressure,
Kidneys dispose and
of wastes and
maintain electrolyte balance
Endocrine system movement
needed by neurons.

Hormones regulate blood glucose Micturition reflex and higher brain

Prefrontal and electrolyte levels needed for centers regulate urine elimination.
cortex neuron function.

Hypothalamus secretes releasing

Wernicke’s area
Reproductive system
hormones and sends nerve signals
General sensory (leak) into theto stimulate
heart chamber. Untreated endocarditis can lead to congestive heart
the pituitary gland. Reproductive hormones affect
area for taste failure, arrhythmias, or the formation of emboli from pieces of vegetation thatthemight production of hypothalamus

and smell have broken Cardiovascular

off and are traveling systemin the blood vessels. releasing hormones.
Association area
Provides nutrients and removes
wastes.
for
Nervevision
impulses innervate
muscles involved in erection,
Association area Chambers Innervates
and Valvessmooth muscle of
ejaculation, and childbirth.

for smell The human heart blood is divided

vessels into four chambers, which can be seen externally
for vasoconstriction
General in sensory
and vasodilation to regulate blood
Figure 10.5. Thepressuretwo superior
and flow; medulla chambers—the right and left atria (A-tree-uh)— area for vision
receive blood oblongata
for theregulates
heart,heartwhile
rate. the two inferior chambers—the right and left
Association area ventricles—pump blood out of the heart. Figure 10.5 also shows the atria’s small,
for hearing hollow, earlike flaps called auricles (AW-ri-kulz), which slightly increase General the atria’s sensory
volume. Sulci are depressions on the surface of the heart and mark the division area for of hearing
the chambers
FIGUREexternally.
6.29 Putting Thethe coronary marks System:
sulcus Nervous
Pieces Together—The the separation
connectionsofbetween
the atria from system and
the nervous
the body’s other systems.
the ventricles. The anterior interventricular sulcus and posterior interventricular
sulcus mark
266the separation of the right and left
CHAPTER ventricles.
6 The Nervous System
Vibrant, accurate illustrations
are frequently paired with striking
Superior
vena cava
Superior
cadaver photos. Students entering vena cava
Aorta
Right
pulmonary
health sciences careers will
FIGURE 6.9ulti-
Functional regions ofRight
the cerebral cortex. Pulmonary
Left
pulmonary
artery

mately be working with real bodies, auricle trunk artery Right

pulmonary

and cadaver photos help to prepare

veins
•sulcusTemporal lobe. The temporal lobe is responsible for the senseLeftofatriumhearing.
Coronary
Left auricle

students for later experiences in Wernicke’s area (WUR-ni-kehz),Anterior another

interventricular
Left
pulmonary
important area for language, is located
their careers.
Right
here.
ventricle It is discussed later in the
sulcus chapter. veins Right
atrium

•
Inferior Occipital lobe. The occipital lobe is responsible for vision. It is remarkable vena cava to con-
Inferior

sider that the receptors for vision are located at the front of the head (in the eye) but
vena cava Left ventricle

the input received is interpreted Apex

at the back of the brain. You will learn how this is
of the heart
(a) done in the nervous system chapter on senses.(b)
• Insula. This small lobe is located deep in the cerebrum, and it can be seen only
when part of the cerebrum (temporal lobe) is retracted. Not much is known about
the function of this lobe.
In addition to having five lobes, the cerebrum contains large parts of the limbic
system. There is no defined anterior boundary for the ring of structures in the limbic
system, as they make up parts of several of the lobes. The limbic system includes
structures important for memory and learning (hippocampus)
Left ventricle
and others for emotions
(amygdala). See Figure 6.10. Parts of the limbic sulcussystem also involve the diencepha-
Interventricular

lon, the subdivision of the brain you will study next.

Right ventricle
(c)

Diencephalon
FIGURE The
10.5 Surface anatomy diencephalon
of the heart: (a) anterior viewhas two major
, (b) posterior viewcomponents, theof athalamus
, (c) anterior view cadaver heart. and the
(c) ©McGraw-Hill Education/Christine Eckel
hypothalamus. The description of each follows and is shown in Figure 6.8e.

Study Hint boxes contain Study Hint

10.3 Heart Anatomy 375

useful tips and mnemonics for When you are looking at a midsagittal view of the brain, such as Figure 6.8e, the
remembering structures and diencephalon looks like the head of a duck. Upon closer inspection, seeing that the
learning concepts. diencephalon has two components, imagine that the thalamus is the head of the duck
and the hypothalamus is its beak.

PREFACE
238 CHAPTER 6 The Nervous System
xxiii
 Physiological processes Oval window
1 2 3
Stapes Sound waves cause The malleus, incus, The oval window
are broken down into detailed, Incus the tympanic and stapes vibrate and vibrates.
numbered steps to help build Malleus
membrane to vibrate. amplify the vibrations.
Cochlear
understanding. Relevant nerve

figures are correlated to Tympanic

3 TABLE 5.5 Muscles of the Forearm Vestibular
membrane
2
Anatomy & Physiology membrane
4
Muscle 5 Origin Tectorial
Insertion Function
membrane
REVEALED, where 1 Extensor carpi radialis Lateral epicondyle of humerus Metacarpals Extends an
6
students may locate additional Round 7
Spiral organ wrist

pertinent illustrations and window Extensor carpi ulnaris Lateral epicondyle of humerus Basilar
Carpals and
membrane
Extends an
cadaver images. metacarpals
Cochlear
wrist

Palmaris longus Medial epicondyle of humerus ductaponeurosis

Palmar (contains Flexes wris
endolymph)
Flexor carpi radialis Medial epicondyle of humerus Metacarpals
Perilymph Flexes and
4 5 6 7
Vibrations of the oval The wave pushes
Flexoron the
carpi ulnaris WavesMedial
in the endolymph Hair cells release
epicondyle of humerus neurotransmitters
Metacarpals Flexes and
window create waves vestibular membrane, which cause the basilar to bipolar neurons of the cochlear
in the perilymph that causes a waveExtensor
in the endolymph
digitorum membrane to vibrate,
Lateral branch and then
epicondyle of humerus the wave
Posterior pushes
phalanges Extends fin
cannot be compressed. of the cochlear(DIJ-ih-TOR-um)
duct. which bends hair cells. against the round window.

FIGURE 7.12 The effects of sound waves Flexor

on the digitorum
cochlea. Ulna Phalanges Flexes finge

Clinical Point boxes make the connection between

Base Apex • Disease Point boxes are placed near descriptions of normal
Palmaris longus duct(pahlm-AIR-is)
(5). Vibrationsisinthe
theonly muscle ofcause
endolymph the forearm withmem-
the basilar a tendon
anatomy and physiology concepts and applications
(near oval window) in anatomy and physiology, allowing students to make a direct com-
(near end of that is superficial
cochlear duct)
braneto to
thevibrate.
carpalThe
ligament
basilar(braceletlike
membrane isligament at the
flexible and canwrist).
bend All
(highest-pitched sounds) (lowest-pitched sounds)
health professions. parison
other between andnormal
tendons, nerves, and abnormal
and vessels
vibrate, unlike travel
the deep tostructure
tectorial ofand
this ligament.
membrane function.
the spiral organ,
1,500 which is stiff. The hair cells are pushed against the tectorial
3,000
Hz
membrane and bend each time the basilar membrane vibrates
Hz
Clinical P int 600
Hz Disease P int
(6). Hair cells are mechanoreceptors, so each time a hair cell is
Nucleic Acids These organic molecules are composed of carbon,
bent, it releases hydro-
a neurotransmitter to the bipolar neuron at its
Blocked coronary arteries can be treated through angioplasty or coronary bypass Prolonged The
repetitive motions of the
gen, oxygen,
20,000 nitrogen, and phosphorus.
200 a vessel in
building
base to blocks for fingers
start a local nucleic and hands, such as typing Aon a computer
potential. Eventually, Tthe vibrations reach
surgery. Angioplasty involves threading a balloon-tipped catheter through
acids areHznucleotides. Nucleotides
Hz 800 are composed
keyboard theofround
or regularly a sugar,
working a phosphate
with
window, hand tools,
where thecan cause ends
process inflammation
G(7). C
of the tendons
the leg to the blocked coronary artery. The balloon is inflated within the blockage to
group, and a nitrogenous base. Nucleotides
Hz are strung
traveling under together
the carpal in a twisted,
ligament. See Figure 5.17. Swelling is a characteristic
open the vessel lumen. A stent may be used as part of the balloon The frequency of the vibrations determines which hair cell of
doublesystem
strandto(double
hold the helix), as in deoxyribonucleic C G
inflammation.
4,000 Because acid
the (DNA),
sheath or in superficial
(fascia) a to the tendons doesbend
not stretch
vessel open after the catheter is withdrawn. 1,000 of the spiral organ is bent. High-frequency sounds hair
single strand, as in Hz ribonucleic acid (RNA).
Hz The nitrogenous
to accommodatecells theclose
bases caused
in DNA by A T

(T).toInthe ovalura-
window. Low-frequency sounds bend
Coronary bypass surgery involves harvesting a vessel andare inserting swelling
7,000 Hzits ends
guanine (G), before
cytosine (C), adenine (A), and thymine RNA,
and after the obstruction to effectively bypass the blockage.cilSeveral
(U) isvessels
substituted
can befor thymine. hair cells
inflammation, pressure farther away
increases
5,000 HzThe double helix of DNA resembles a
from the oval window. So the pitch of
on nerves
twisted
used, like the great saphenous vein of the leg or a collateral branchladder with nitrogenous traveling
of a mammary deep base
bases forming the the
to sound
pairs, is determined
carpal
the ligament.
rungs by
of theThethe hair cell that is bent. How much
artery. But, as you will remember, the anatomy of the walls ofladder.
arteriesGuanine always
differs from added
that pairs with pressure
cytosine (G-C), the
may and hair
cause cells
adenine bend
tingling
always determines
or pain in the
pairs the volume of the sound. See
with thymine (A-T). See Figurepalm,
of veins in regard to how much pressure the vessels can withstand. 2.11. and this may Figure
radiate7.13.
to the shoulder. This
Your DNA contains all ofcondition the genetic information
is carpal that is you.
tunnel syndrome. It can It be
is not written in English; it is written
treatedinwith
DNA language called
anti-inflammatory the geneticand/
medications
Collapsed Dilated code. Spot Check
or surgery to remove part of the tendon sheath.
Describe where perilymph and
balloon catheter balloon catheter Stent
and stent and stent English uses 26 letters combined in many different
deployed ways toare
endolymph form words
found in the ear ©Tetra
and explain why they are
Images/Shutterstock
of various lengths. The words are separated by spaces, and thoughts
necessary are sep-
for hearing.
7,000 Hz 1,000 Hz 200 Hz
arated by punctuation to (low-frequency
(high-frequency give them meaning. You must read the letters in
sounds)correct order to make sense of what is written. ForSpot
sounds) example,Checktar has a veryIt is possible to have arthritis in the joints
different meaning than rat. between
FIGURE 7.13DNA Frequency response of Muscles
the basilar of the Thigh Nowossicles.
that youHowhavemight that affect
reviewed hearing?of the arm and upper
the muscles
language is much simpler. The genetic code has just four letters,
membranethe in the cochlea. bases of thebody,
nitrogenous you are ready
nucleotides (G, C,toA, study
T), the
thatbody’s lower limbs, focusing first on the thigh muscles.
are always
read three nucleotides at a time See (called
Figuresa 5.18 and If
codon). youTable
5.19. know5.6 outlines
always to the names, origins, insertions, and func-
Pathway
read three letters at a time, tions
for Hearing
thereofis the
no thigh
The pathway
need muscles,
for spaces. the for
andPunctuation hearing
following begins with
is list provides
Thymine the bipolar
(T)additional neurons
Adenine at
details: (A)
the base of the hair cells. Their axons form the cochlear nerve
Guanine (G) that joins withCytosine
the ves-(C)
not necessary. Certain codons tell
reading the DNA. Yourtibular DNA nerve
The
has
you •wheremajor
psoas to begin
to form the auditory
approximately
and where
(SO-ahz)
3thebillion nerve
base
to stop high on the posterior abdominal
originates
(CN VIII).
pairs of The auditory nerve delivers the wall
(T12–L5), while iliacus (ill-EE-ah-kuss) originates on and colliculi of line
appears to
nucleotides to record allsensory messagesand
the information
the ilium.
to the pons. From
directions
Both muscles on how
run
there,
your
deep
the
body messages
toofthe
FIGURE go 2.11
to theDNA inferior
structure:
and insert
the midbrain, where the ___location of the source inguinal
the sound
nucleotidesis ligament
perceived.
pairing The
to form the DNA on the
sensory
works. A gene is the sequence oflesser DNAtrochanter
that must be of read to give When
the femur. you thethey pass deep to the inguinal ligament,
molecule.
Plaque directions to make one specific protein. Your DNA contains about 35,000
they merge to form the iliopsoas.
genes. RNA is used to process the DNA genetic information, as you will
284
learn later in this chapter.
CHAPTER
•
The rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius
7 The Nervous
make up the group System—Senses
of muscles called the quadriceps femoris (KWAD-rih-seps

Applied Genetics
Thrombophlebitis boxes (THROM-boh-fleh-BY-tis)
Thrombophlebitis focus on is inflammation
of a vein, caused by thrombosis (formation of a blood clot in a blood vessel). There
genetic applications to anatomy and Applied Genetics
are many causes of thrombosis, including surgery, immobility, and pathological condi- 5.3 Anatomy of the4,000
Muscular
Up to this point of the chapter, approximately wordsSystem
involving the use of
physiology.
tions that cause the blood to clot abnormally. The two types of thrombophlebitis are
16,000 letters (A to Z) were used to convey the information on the pages. The gene
• deep
An venous
effects of aging
thrombosis, section
which affects is and that contains the directions on how to make a single chloride channel protein on a
deep veins;
included
• superficialinthrombophlebitis,
each systemwhich chapter to close tocell
affects veins themembrane uses approximately 250,000 base pairs of nucleotides (G, C, T, A) to
skin’s surface.
helpSymptoms
students understandinclude
of thrombophlebitis ever- ofconvey
theinflammation the information. Cystic fibrosis, a genetic disorder that reduces life expec-
the body part with the
tancy to approximately 35 years, results when just 3 of the 250,000 base pairs
affected vein, pain, redness, and tenderness over the inflamed vein. See Figure 10.30.
increasing geriatric patient population.
Thrombophlebitis is diagnosed using tests that allow physicians of nucleotides are missing.
to visualize the This results in the loss of 1 amino acid from the chain of
Asuch
vein, diagnostic testandtable
as ultrasound precedes
venography. the superficial thrombophlebitis
Although 1,480 that are needed to make this chloride channel protein.1
does not usually cause any major health issue, deep venous thrombosis canAsresult you will see later in this chapter, this small mistake in directions
disorders section in each system chap-
in chronic pain and swelling and pulmonary embolism (a blood clot that has trav-in an amino acid sequence that is slightly off, causing the shape
results
ter.
eled This tableTreatment
to the lungs). explains thecontrolling
involves common the pain with analgesics, treating
of the resulting protein to be slightly off too. Because the shape is not
any infection that might be present, controlling the inflammation with nonsteroidal
tests and screenings that health care pro- exactly what it is supposed to be, the chloride channel protein does not
anti-inflammatory drugs, using anticoagulants to thin the blood, and administering
function properly. Cystic fibrosis is the result.
viders use to
thrombolytic determine
drugs designed toadissolve
patient’s diag-clot. If severe, the
the blood vein can be
©MOLEKUUL/SPL/age fotostock
surgically removed.
nosis relevant to the particular system.
Varicose Veins Varicose veins are veins in which the valves that prevent the back-
flow of blood are not working properly. The dysfunctional valves allow the blood to pool,
Spot Check
xxiv PREFACEyour answer.
What type of organic molecule is C6H12O6? Use Table 2.2 to derive

CHAPTER 10 The Cardiovascular System—Heart and Vessels

 Table 5.12 summarizes all of the muscle diseases and disorders described throughout
the chapter.

Disorders common to
TABLE 5.12 Summary of Diseases and Disorders of the Muscular System
each system are included
in each system chapter to Disease/Disorder Description

help students understand Atrophy A wasting away of muscle tissue

the relationship of abnormal •

Carpal tunnelDuring the
contraction
syndrome Inflammationphase, myosin
of tendons under thepulls
carpal(power
ligament,stroke).
caused byThe muscle
repetitive cell shortens.
movement

anatomy and physiology to • During the relaxation

Compartment syndrome
Cramps
phase, myosin lets go. The muscle goes back to shape
Inflammation of muscles within a compartment due to overactivity or trauma
A painful muscle spasm
pathology. because it is elastic (elasticity).
Fibromyalgia A condition characterized by myalgia, fatigue, problems with sleep, and tenderness
Hernias • During the refractory the viscerathe
Protrusion ofphase, calcium
through is actively
the muscular wall transported back to the sar-
Muscle straincoplasmic reticulum and the
A tear in muscle tissuemuscle
or tendonsproduces acetylcholinesterase to remove the
acetylcholine from
Muscular dystrophy A groupthe receptors.
of genetic The
disorders that muscle still appears
result in progressive to be
weakening and relaxed.
degeneration of
muscle tissue and its replacement with fibrous scar tissue
(b)
Myalgia Each muscle twitch has the four phases shown in the graph. However, your hand
Muscle pain
is likely
Myasthenia gravis not goingAnthrough
autoimmune a disorder
series that
of affects
twitches
muscle(contractions
contractions and relaxations) as you
hold a pencil to take
Shin splints Pain notes.
along theYour
tibia of flexor
the lowerdigitorum muscles
leg due to an increase are inchange
or sudden a sustained
in activity contrac-
Sprain tion to flex your fingers
A tear into hold your pencil. So how is this done? It is controlled by the
a ligament

frequency of the nerve

Tendinitis impulses.
Inflammation If more and more nerve impulses come and complete
of a tendon

their latent phases before the muscle cell can even begin to enter the relaxation phase
from
5.7 Muscular the first
System nerve impulse, the effect is a sustained contraction called tetany. 217
Disorders It is the
frequency of the nerve impulses that determines the occurrence either of a series of
twitches with relaxation between nerve impulses or of sustained contractions with no
• The increasing
relaxation betweenamounts of estrogen
nerve impulses. See secreted
Figureby5.28.the follicle target the anterior pitu-
itary to inhibit FSH production, so FSH levels go down (day 5). A follicle is already
Spot Checks are interspersed developing, so no further stimulation by FSH is needed. This is a negative feedback
throughout each chapter to give Spot Checkthat helps
mechanism Whatmaintain
happenshomeostasis.
to the calciumEstrogen
releaseddoes
fromnot
the inhibit
sarcoplasmic
the ante-
the student an opportunity to check rior pituitary’s
reticulum if there production
is tetany? of LH, so LH levels continue to rise. A peak of estrogen
for understanding before moving causes LH levels to reach a peak at day 14. FSH levels also rise slightly at this time.
on. The answers to these questions • The estrogen secreted by the follicle also targets the uterine lining, causing it to
are found in Appendix C.
Disease P int
thicken. This is the proliferative phase (days 5 to 14) of the menstrual cycle.

When muscle contractions are not carried out normally, the body may be dealing with
Common Misconception Common Misconception
an autoimmune disorder, such as myasthenia gravis. Myasthenia gravis usually affects
boxes alert the student to possible women between the ages of 20 and 40. The immune system produces antibodies that
The length of a woman’s reproductive cycle up to the events on day 14 is highly
mistakes and misconceptions. Most normally fight foreign pathogens, but in people with myasthenia gravis the antibodies
variable. It can be days or even weeks longer than 14 days. Nutri-
students come to the course with attack the acetylcholine receptors in the neuromuscular junctions. This leaves the
tion, activity levels, stress, illness, and many other variables can
preconceived notions of how the muscle
cause thewith fewerofreceptors,
length this portionsoofit the
is less sensitive cycle
reproductive to acetylcholine. Muscle weakness
body works. These warnings help results
to be variable. This makes it difficult for a woman to the
because the muscle cannot fully respond to pre-nerve impulses.
dispel common misconceptions. dict when she will ovulate. In a typical cycle, ovulation
occurs on day 14. However, once ovulation happens, the
remaining length of the cycle does not usually vary from
another 14 days. Muscle Twitch ©Tom Grill/Getty Images Te

Latent Contraction Relaxation Refractory

Figure 16.10 also shows
phase phasewhat happens
phase during phase
Keythe rest are
words of adefined
woman’sinreproductive
context in the chapters.
cycle, begin- The glossary defines key words
Amount of Contraction

Amount of Contraction

in the context
ning with day 14. Again, follow along with the prior knowledge.
they were used in the chapters to activate
A pronunciation key for
figure while reading the difficult terms is located immediately following the first
explanation:
occurrence of the
• The peakvocabulary
of estrogenword in thewith
combined text.a peak of
LH causes the mature follicle to listed
Word roots specific to the system are ruptureat and
the beginning of each system chap-
ter, and common prefixes and suffixes are listed in
release its egg (ovulation) on day 14. The egg, Appendix D.
the cells immediately surrounding it (cumulus
oophorus), and the follicular fluid are released
Workbook from the ovary. See Figure 16.11. Currents cre-
ated by the movement of the fimbriae of the
A full-color workbook, written by the authors, is available for purchase to reinforce
uterine tubes draw the egg toward the tube’s
the lessons infundibulum.
that students learn
If the in each
egg chapter
reaches the of the ittext. Workbook features include a
tube,
Time T
coloring booksticks to it and ciliated cells in the lining of key
section, lab exercises and activities, the word concept maps, and review
FIGURE
questions, all 5.27
correlated
uterine Graph
with
tube start of a
thethemuscle twitch:
Learning
egg muscle
Outcomes
on its 3-day contraction
journeyof this text. FIGURE 5.28 Graph of a m
over time divided into latent, contraction, relaxation, andFIGURE 16.11 Ovulationshowing tetany.
in a human (endosco
to the uterus. If the egg does not reach the tube,
refractory phases. is a bump on the ovary that oozes follicular fluid
it is eventually reabsorbed somewhere in the
the follicle. Ovulation takes 2 to 3 minutes.
pelvic cavity. The egg must be fertilized in the ©Petit Format/Science Source
PREFACE uterine tube within 24 hours of ovulation if it is xxv
to remain viable.
5.4 Physiology of the Muscular System
• Another effect of these ovulation-initiating hormones is the thinning of the mucus
Acknowledgments
Thank you to the Product Development staff at McGraw-Hill—Donna Nemmers, Amy Reed, and Michael Ivanov—for
their guidance on the revision; to Vicki Krug, who skillfully guided the many details of the production process; and to
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trator at MPS, for his talents and patience in both guiding and working on the gorgeously updated illustration program;
and to Egzon Shaqiri for his assistance with the revision of the illustration program, interior design, and cover. Thanks
to Jeanne Patterson for her expert copyediting skills and to Debbie Trilk and David Heath for their attention to detail
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cal eye and constructive suggestions contributed significantly to this revision. Finally, a special thanks to our families
whose never-ending support, patience, and encouragement make all things possible.
Deborah Roiger
Nia Bullock

Reviewers Myriam Feldman Narine B. Mirijanian

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xxvi
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 1 The Basics
Welcome to the start of your edu-
cation on the structures and func-
tions of the human body. Whether
you are pursuing a health career
or reading this book for personal
interest, no subject will be
more relevant to you than
your own body and how it
functions. Take a moment
to consider what happens
when the structures of
the human body fail to
function normally. You
may have a cold you
can’t shake, or a loved
one may have been diag-
nosed with cancer. The
topic of disease and how it
can affect your body is also
relevant to your everyday life.
Knowing the body’s structures and
functions provides greater under-
standing of what happens when the
body doesn’t function normally.
©Stuart Gregory/Getty Images

Module 1: Body Orientation

1
 1.1 Overview

Learning Outcome
1. Define anatomy, physiology, and pathology.

Anatomy is the study of body structures, including structures of all sizes, from micro-
scopic red blood cells to the heart, which is the size of a fist. Physiology is the study
of exactly how all of these structures function. For example, why are red blood cells
thinner in the middle than they are along the edge? What do red blood cells actually do,
and how does their shape aid in the way they work? What causes your heart to speed up
or slow down, and why does it have four chambers?
These important questions of anatomy and physiology give us an idea of how inter-
connected structure and function are. You will need a fundamental knowledge of the
human body and how it works under normal circumstances before you can begin to
understand abnormal functioning, the study of which is pathology.
In order to develop a foundation for that knowledge, we must first learn the basic
terms of anatomy.

1.2 Terms of Anatomy

Learning Outcome
2. D
 escribe the ___location of structures in the human body using anatomical terms
of direction, regions, planes, positions, and cavities.

As a student pursuing a career in allied health, part of the essential knowledge you need to
learn at the start is the vocabulary of anatomy. To describe the ___location of various struc-
tures, you need to be able to effectively use anatomical terms of direction, regions, planes,
positions, and cavities.
Picture the body in the standard anatomical position before you begin to ­identify
and describe the ___location of a structure. A body in the standard anatomical position looks
like this: The body is upright; the legs are close together; the feet are flat on the floor; the
arms are close to the sides; and the head, toes, and palms of the hands are facing forward.
See Figure 1.1.

Anatomical Terms of Direction

Once the standard anatomical position has been considered, anatomical terms of
direction are used to describe the following: the ___location of a particular structure in
the body, the ___location of a structure relative to another structure, or the ­___location of
something within a s­ tructure. See Table 1.1 and F
­ igures 1.2 through 1.4.

Anatomical Regions
In addition to being described by its ___location within the body, a structure may also be
described by identifying the specific region in which it is located. The two major regions
of the body are the axial region (head, neck, and trunk) and the appendicular region
(arms and legs). These regions are further subdivided. See Table 1.2 and Figure 1.5.
The abdominal region can be divided in either of two ways: into four quadrants or
into nine regions similar to a tic-tac-toe grid. See Figure 1.6. By mentally dividing
FIGURE 1.1 Standard this region, you can communicate about it and the structures within it more quickly
anatomical position. Head,
toes, and palms of the hands
and accurately. For example, when dealing with abdominal pain, you can use either
are facing forward. method to describe the ___location of the pain. The four quadrants are the right upper
©McGraw-Hill Education/Joe quadrant, left upper quadrant, right lower quadrant, and left lower quadrant. The
De Grandis nine regions of the abdomen are the right hypochondriac region, epigastric region,

2 CHAPTER 1 The Basics

 TABLE 1.1 Anatomical Terms of Direction
Term of Direction Definition Example
Anterior or ventral Front or belly side The trachea is anterior to the esophagus.
Posterior or dorsal Back side The esophagus is posterior to the trachea.
Superior Closer to the top of the head (used for head, The lungs are superior to the diaphragm.
neck, and trunk)
Inferior Farther from the top of the head (used for head, The stomach is inferior to the diaphragm.
neck, and trunk)
Medial Toward the midline of the body The heart is medial to the lungs.
Lateral Away from the midline of the body The lungs are lateral to the heart.
Bilateral Relating to or affecting two sides She had bilateral ovarian tumors.
Proximal Closer to the connection to the body The elbow is proximal to the wrist.
Distal Farther from the connection to the body Fingernails are at the distal end of the fingers.
Superficial Closer to the surface (used for layered structures) The epidermis is superficial to the dermis
of the skin.
Deep Farther from the surface (used for layered The hypodermis is deep to the dermis
structures) of the skin.
Right On the body’s right side (not the viewer’s right side) The liver is on the right side of the body.
Left On the body’s left side (not the viewer’s left side) The stomach is on the left side of the body.

Spot Check How would you describe the ___location of your nose using at least
three anatomical terms?

Esophagus Esophagus

Trachea Trachea

(a) (b)

FIGURE 1.2 Sagittal view of the head: (a) the trachea anterior to the esophagus,
(b) a cadaver head.
(b) ©McGraw-Hill Education/Rebecca Gray

1.2 Terms of Anatomy 3

 Midline

Lung

Heart

Liver Diaphragm

Stomach

FIGURE 1.3 Chest and abdominal organs. The lungs are lateral to the heart. The stomach
is inferior to the diaphragm.

Epidermis

Dermis

Hypodermis
(subcutaneous
tissue)

FIGURE 1.4 Layers of the skin. The epidermis is superficial to the dermis. The hypodermis
is deep to the dermis.

4 CHAPTER 1 The Basics

 TABLE 1.2 Anatomical Regions
Region Definition Example
Axial Head, neck, and trunk The ribs are in the axial region.
Abdominal Belly She had a measles rash on her abdomen.
Axillary Armpit Many people apply deodorant in the axillary region.
Cephalic or cranial Head The brain is located in the cranial region.
Cervical Neck He wore a cervical collar after the car accident.
Facial Face The maxilla is a facial bone.
Inguinal Groin He had an inguinal hernia.
Pelvic Lower end of the trunk The urinary bladder is located in the pelvic region.
Thoracic Chest The breasts are in the thoracic region.
Umbilical Navel She developed an umbilical hernia during her pregnancy.
Appendicular Arms and legs The elbow is in the appendicular region.
Brachial Arm The nurse administered the vaccine to his brachial region.
Carpal Wrist She had pain in the carpal region from a wrist sprain.
Cubital Elbow The phlebotomist drew blood from the anterior cubital region.
Femoral Thigh He had a large bruise on his femoral region.
Palmar Palms of the hands He had blisters on his palmar surface from raking.
Patellar Knee She was ticklish in her patellar region.
Plantar Soles of the feet She had her plantar warts removed.
Tarsal Ankle He had pain in his tarsal region from an ankle sprain.

Cephalic r. (head)
Facial r. (face)

Cervical r. (neck)

Axillary r. (armpit) Thoracic r. (chest)

Brachial r. (arm)
Cubital r. (elbow) Umbilical r.

Abdominal r.
Inguinal r. (groin)
Carpal r. (wrist) Pelvic r.

Palmar r. (palm)

Femoral r. (thigh)

Patellar r. (knee)

Tarsal r. (ankle)

Plantar surface
(sole)

FIGURE 1.5 Anatomical regions: anterior (ventral) view.

©McGraw-Hill Education/Joe De Grandis

1.2 Terms of Anatomy 5

 Right Left
hypochondriac Epigastric hypochondriac
region region region
Right upper Left upper
quadrant quadrant

Right Left
Umbilical
lumbar lumbar
region
region region
Right lower Left lower
quadrant quadrant Right Left
inguinal Hypogastric inguinal
region region region

FIGURE 1.6 Abdominal quadrants and nine regions of the abdomen.

left hypochondriac region, right lumbar region, umbilical region, left lumbar region,
right inguinal region, hypogastric region, and left inguinal region.

Spot Check Describe the ___location of liver pain by specific abdominal region in
two different ways.

Anatomical Planes
In order to view the ___location of structures from different angles, the body may be cut
along anatomical planes. Table 1.3 lists the three anatomical planes and their defini-
tions. See Figure 1.7 for examples.

TABLE 1.3 Anatomical Planes

Plane Definition
Sagittal (SAJ-ih-tal) Separates right from left. If the plane is exactly down the
midline of the body, it is midsagittal.

Transverse or horizontal Separates top from bottom; commonly called a cross

section.

Frontal or coronal Separates anterior from posterior (front from back).

Anatomical Positions
Anatomical terms may also be used to describe body position, such as standard ana-
tomical position, which appears earlier in this chapter. Prone and supine are terms
that may be used to describe the position of either the entire body or individual parts

6 CHAPTER 1 The Basics

 Frontal, or
coronal, plane

Sagittal plane

Transverse, or
horizontal, plane

Brain

(a)

Stomach Liver
Nasal
cavity Large
intestine

Spleen

Spinal Vertebra
cord
Tongue
Vertebral Kidney
Pharynx
column
(throat)
Kidney
Trachea
Spinal
cord
(b) (c)

Skin

Fat

Scapula
Arm
muscle

Humerus
(arm
Thigh
bone)
muscles

(d)

FIGURE 1.7 Anatomical planes: (a) full figure showing planes, (b) sagittal section of the head, (c) transverse section through the
abdomen, (d) frontal section through the right shoulder.
(a) ©McGraw-Hill Education/Joe De Grandis; (b) ©McGraw-Hill Education/Rebecca Gray; (c) ©McGraw-Hill Education/Rebecca Gray; (bottom left) ©McGraw-Hill
Education/Joe De Grandis; (d) ©Medical Media Images/SPL/Science Source

1.2 Terms of Anatomy 7

 of the body such as the hands. For example, your hands would be in a supine position
if you held them out in front of you, palms facing up. See Table 1.4.

TABLE 1.4 Anatomical Positions

Position Definition
Supine Anterior surface facing up

Prone Anterior surface facing down

Anatomical Cavities
Most of the body’s organs are located in cavities, which are pocketlike spaces
of ­various sizes. There are three general cavities—the dorsal cavity, the tho-
racic cavity, and the abdominopelvic cavity—that can be further subdivided. See
Table 1.5 for a specific breakdown of cavities, their associated organs, and the
lining membranes.

TABLE 1.5 Anatomical Cavities

Cavity Associated Organs Lining Membranes
Dorsal:
Cranial cavity Brain Meninges
Vertebral cavity Spinal cord Meninges

Thoracic:
Pleural cavities (2) Lungs Pleurae
Pericardial cavity Heart Pericardium

Abdominopelvic:
Abdominal cavity Digestive organs, spleen Peritoneum
Pelvic cavity Urinary bladder, rectum, Peritoneum
reproductive organs

As you can see in Figure 1.8, there is no wall dividing the cranial and vertebral
cavities. There is also no wall separating the pleural and pericardial cavities or
the abdominal from the pelvic cavity. The diaphragm, however, serves as a wall
separating the thoracic cavity from the abdominopelvic cavity. The space between
the pleural cavities that contains the heart, esophagus, trachea, thymus, and major
vessels is called the mediastinum (MEE-dee-ass-TIE-num). Again, see Figure 1.8
for the locations of these cavities in the body.
Now that you know where the cavities are in relation to the organs they house,
it is important to note that these cavities are lined with membranes. The cranial
and vertebral cavities are lined by the meninges (meh-NIN-jeez)—three layers of
membrane surrounding the brain and spinal cord. You will learn more about the
meninges in the nervous system chapter. The thoracic and abdominopelvic cavities
contain fluid-filled serous membranes (SEER-us), which line the cavities and sur-
round the organs.

8 CHAPTER 1 The Basics

 Cranial
cavity

Dorsal
cavity
Vertebral
cavity

Thoracic cavity

Diaphragm

Abdominal
cavity
Abdominopelvic
cavity
Pelvic cavity

(a)

Mediastinum
Right pleural
cavity Thoracic
Thoracic Left pleural
Pericardial cavity
cavity cavity
cavity

Abdominal
cavity

Abdominopelvic
cavity

Pelvic cavity

(b)

FIGURE 1.8 Body cavities: (a) lateral view, (b) anterior view.

Spot Check Name the specific cavities that are located in the axial region of the
human body.

1.2 Terms of Anatomy 9

 Serous Membranes

Learning Outcome
3. Locate serous membranes by their individual names and relative ___location to organs.

Serous membranes are double-layered membranes that contain fluid between the
two layers. A good analogy for a serous membrane is a very soft water balloon.
You slowly push your fist into the balloon so that it does not break. Part of the
water balloon will be in direct contact with your fist, and part of the balloon will
not. Water exists between the two layers. Your fist represents the individual organ,
while the layers of the water balloon represent the layers of the serous membrane.
See Figure 1.9.
A serous membrane called the pleura surrounds each of the lungs in the thoracic
cavity just as the water balloon surrounds your fist. The part of the pleural membrane
in direct contact with the lung is called the visceral pleura (VISS-er-al PLUR-ah). The
part of the pleural membrane not in direct contact with the lung is the parietal pleura
(pah-RYE-eh-tal PLUR-ah). Pleural fluid fills the space between the two layers. The
heart is surrounded by a similar serous membrane called the pericardium. The peri-
cardium has two layers: the visceral pericardium (in contact with the heart) and the
parietal pericardium (not in contact with the heart). Pericardial fluid fills the space
between these two layers. See Figure 1.10.
The abdominopelvic cavity contains another serous membrane called the
­peritoneum. This double-layered serous membrane has many abdominal organs
pushed into it from the posterior wall of the abdominopelvic cavity. The parietal
portion of the peritoneum lines the anterior wall of the abdominopelvic cavity,
while the visceral portion of the peritoneum covers several, but not all, of the organs
in the abdominal cavity. The kidneys and most of the pancreas are retroperitoneal,
meaning they are between the parietal peritoneum and the posterior abdominal
wall. See Figure 1.11.
In Figure 1.11, look closely at the peritoneum surrounding a section of the small
intestine. The membrane starts at the posterior abdominal wall, extends out and
surrounds the section of small intestine (this part of the membrane is the visceral
­peritoneum), and then returns parallel to itself to the posterior wall before extending
out again to surround the next organ. This membrane repeatedly extends from the

Outer balloon wall

(parietal serous membrane)
not in contact with the fist
Inner balloon wall
(visceral serous membrane)
in contact with the fist
Cavity
Fist (organ)

FIGURE 1.9 Water balloon. A fist (representing an organ) is slowly pushed into the
water balloon (representing a serous membrane).

10 CHAPTER 1 The Basics

 Parietal
pericardium
Lung
Pericardial
fluid

Visceral
pericardium

Heart
Parietal
Diaphragm pleura

Pleural
fluid

Visceral
pleura
(a) (b)

FIGURE 1.10 Pericardial and pleural membranes: (a) pericardium, (b) pleurae.

Common Misconception
Although there appears to be significant space between the organs in Figure 1.11, there
is actually no extra space in the abdominopelvic cavity. The diagram has been drawn
with extra space to highlight the peritoneal membrane.

FIGURE 1.11 Peritoneal

membrane.
Liver

Pancreas

Stomach

Duodenum
Parietal peritoneum

Transverse
colon Greater omentum

Mesentery

Small
intestine Visceral peritoneum

Urinary
bladder
Peritoneal fluid

Rectum

1.2 Terms of Anatomy 11

 posterior wall to surround individual organs. The membrane then returns parallel to
itself before finally becoming the parietal peritoneum that lines the anterior abdomi-
nal wall. The peritoneal fluid is found between the parietal peritoneum (lining the
anterior wall) and the visceral peritoneum (surrounding each organ). The sections
of the membrane where the peritoneum comes back parallel to itself are called the
mesenteries (MESS-en-ter-reez). The mesenteries do not involve any fluid because
they are outside the water balloon–like serous membrane. Blood vessels and nerves,
going out to individual organs, can be found neatly arranged in the mesenteries. See
Figure 1.12.
The visceral peritoneum (shown in Figure 1.11) has two extensions. See F
­ igure 1.13.
The greater omentum looks like a fatty apron lying over all the abdominal viscera; it
extends from the inferior margin of the stomach. The lesser omentum is smaller and
extends from the superior edge of the stomach to the liver.

Spot Check What specific serous membrane is attached to the inferior surface
of the diaphragm? What specific serous membrane(s) is (are) attached to the superior
surface of the diaphragm?

Lung

Diaphragm

Transverse colon

Gallbladder
Small intestine

Mesenteric
arteries and veins

Mesentery

Descending colon
Cecum

Sigmoid colon

FIGURE 1.12 Anterior view of the abdominopelvic organs. Mesenteries are shown with
arteries and veins neatly arranged.
©McGraw-Hill Education/Rebecca Gray

12 CHAPTER 1 The Basics

 Greater
omentum

Liver
Stomach

Gallbladder Lesser
omentum Transverse
colon

Greater
Descending
omentum
colon
Ascending
colon
Mesentery

Small Sigmoid
Small
intestine colon
intestine

(a) (b)

FIGURE 1.13 Anterior view of omentums and mesenteries: (a) the greater omentum covering the abdominopelvic organs,
and the lesser omentum; (b) the greater omentum and small intestines retracted to show the mesenteries and the mesenteric
blood vessels neatly arranged within.

1.3 Terms of Physiology

Now that you have become familiar with basic anatomical terms, let’s look at the
basic terms of physiology that will be used throughout this book. These terms include
homeostasis, negative feedback, and positive feedback.

Homeostasis

Learning Outcomes
4. D
 efine homeostasis and explain why it is so important in human physiology.
5. D efine negative feedback and positive feedback and explain their importance
to homeostasis.

Homeostasis (ho-mee-oh-STAY-sis) is an important unifying concept in physiology.

All structures function together in the human body to maintain a steady internal envi-
ronment. Think of homeostasis as a series of ranges—a range of blood pressure, tem-
perature, blood oxygen levels, and blood calcium levels that the body must maintain
for normal functioning. If these levels move outside the homeostasis range (too high
or too low), the body will usually attempt to bring the levels back to the optimal range.
If the body detects a movement outside the homeostasis range, it may use either
of two feedback mechanisms in response. Negative feedback is the process the body
uses to reverse the direction of movement away from homeostasis. Positive feedback
is the process the body uses to increase the movement away from homeostasis. It is
important to understand that the terms negative and positive in this context are not
value judgments indicating good or bad. They simply describe the direction of move-
ment. If the body detects a change outside its normal homeostasis range (either too
high or too low) and it works to reach its homeostasis range by reversing the direction

1.3 Terms of Physiology 13

 of movement, that is negative feedback. If the body detects a change and works to
make the levels move even farther away from homeostasis, that is positive feedback.
Examples follow for each type of feedback.

Negative Feedback Jen takes a break from studying and goes to the vending
machines for a soda and a candy bar. Her digestive system digests the soda and the
candy bar and absorbs the digested sugar into her bloodstream, causing her blood
sugar level to rise above normal. Her pancreas recognizes the increased blood sugar
level and, in response to that stimulus, releases the hormone insulin. The insulin then
travels to most cells in her body, telling these cells to take in sugar from the blood.
Through this process, her blood sugar level is lowered back to homeostasis. This sce-
nario is an example of negative feedback. The blood sugar level became too high from
the soda and candy, and the body brought the level back down to normal.
Now consider another example of negative feedback: Paul has not eaten for a
long time, so his blood sugar level has fallen below normal. His pancreas detects the
decreased blood sugar level and, in response to this stimulus, releases the hormone
glucagon. Glucagon then travels to his liver, telling it to release glucose (sugar) into his
bloodstream. This raises his blood sugar level to homeostasis. The blood sugar level
became too low, and his body brought the level back up to normal. See Figure 1.14.

Pancreas releases insulin

telling cells to take in glucose
from the blood.

Blood glucose Blood glucose level

level rises. returns to normal.

Blood glucose Blood glucose level

level falls. returns to normal.

Normal blood glucose level

Pancreas releases glucagon

telling the liver to release
glucose into the blood.

FIGURE 1.14 Negative feedback mechanisms for blood sugar regulation.

Black balance scale: ©Don Farrall/Getty Images

Positive Feedback The next scenario is an example of positive feedback as it

relates to the concept of homeostasis. A woman is at the end of her pregnancy. In
homeostasis, the uterus does not contract during pregnancy. As the fetus reaches full
term, its head pushes on the neck of the uterus (the cervix). The increased pressure on
the cervix causes the cervix to release chemicals (prostaglandins) that cause the uterus
to contract, moving away from homeostasis. The contractions cause the fetal head to

14 CHAPTER 1 The Basics

push harder on the cervix, and this increases the pressure. The cervix responds by
making more prostaglandins, leading to more contractions and further increasing the
fetal head’s pressure on the cervix. As you can see, this has a “runaway-train effect,”
creating more and more contractions until the baby is finally born.
Homeostasis as a unifying concept is covered in all the chapters in this book. You
will see homeostasis in color when important homeostasis topics such as acid–base
balance, fluid and electrolyte balance, and nutrition are covered.

Spot Check It is 90ºF and sunny. You are wearing your cap and gown for
graduation. You want to look your best for the outdoor graduation photos, but you are
sweating profusely. Is the production of sweat a negative or positive feedback mechanism?

1.4 Terms of Pathology

Now that we have looked at the basic terms of physiology, let’s discuss basic terms of
pathology. Pathology is the study of disease.

Introduction to Disease

Learning Outcome
6. Define disease and describe the relationship between disease and homeostasis.

So what exactly is disease? Disease can be defined as abnormally functioning organs or

organ systems resulting from a disruption in homeostasis. Diseases can be categorized
as acute—having rapid onset, severe symptoms, and a short duration—or chronic—
having slow progression and long duration. The body’s internal balance can be dis-
rupted by a variety of factors.

Predisposing Factors of Disease

Learning Outcome
7. D
 efine predisposing factors of disease and explain how specific predisposing factors
affect disease.

Predisposing factors are risk factors or activities that people participate in that play
a large role in a person’s overall health status. These include factors that cannot be
controlled, such as age, heredity, and gender, as well as factors that can be controlled,
such as lifestyle and the environment. All of these risk factors can collectively influ-
ence a person’s ability to either recover from disease or avoid certain pathological
conditions altogether.

Age A person’s age can affect his or her overall health. Due to the gradual effects
of the aging process, age can be a contributing factor to disease. For example, as the
body gets older, organ systems can become less efficient, and they do not work as
well. There are a number of ways to help slow the aging process and prevent disease:
getting regular exercise, maintaining healthy eating habits, and keeping current with
your health care provider’s recommended screenings (prostate exams, mammograms,
pap smears, blood pressure checks for hypertension, and blood cholesterol checks).
Certain age recommendations accompany these screenings, and this ensures that
clinicians keep a good check on the overall health status of each patient. When con-
sidering specific age ranges in relation to disease, keep in mind that children and the
elderly are more susceptible to disease than young adults.

1.4 Terms of Pathology 15

 Children Various categories of disease can affect children.
Children can suffer from infections, congenital disorders,
genetic disorders, or developmental disorders, which are
explained in the following list:
• Infections are diseases caused by microorganisms.
Babies are born with only partially developed immune
systems. The immune system is responsible for helping
fight disease throughout a person’s lifetime. A child’s
immune system continues to mature throughout childhood
(discussed in more detail in the lymphatic system chapter).
For this reason, children are often more vulnerable to infec-
tions caused by a microorganism such as a bacterium or
virus. Before vaccinations for chicken pox were developed,
FIGURE 1.15 A child suffering with chicken pox. chicken pox was considered a common childhood disease
©Mieke Dalle/Getty Images (see Figure 1.15). You may recall your parents being very
cautious because this disease spreads quite easily from per-
son to person, especially among children.
• Congenital disorders(kon-JEN-ih-tal) are those present at birth. For example,
Figure 1.16 shows a child with a congenital disorder called a cleft lip. A cleft
lip is a birth defect that results in failure of the upper lip to properly fuse together.
A cleft lip occurs as the child is developing inside the mother’s womb, and it is
present when the child is born.
• Genetic disorders are diseases caused by inherited genes, which are passed to
children by their parents.
• Developmental disorders are caused by an event that may occur while the child
is developing in the womb, at birth, or after the child is born. This type of disorder
may interrupt normal development, either in a single area of development or several
different areas of development. For example, cerebral palsy is a disorder caused by
damage to the parts of the brain that control movement and coordination. The damage
to the brain may have occurred prenatally (before birth), perinatally (during birth),
or postnatally (after birth) and may have been a result of injury or infection.

Cleft lip

(a) (b)

FIGURE 1.16 A child with a cleft lip.

(b) ©Medicshots/Alamy Stock Photo

16 CHAPTER 1 The Basics

 Applied Genetics
Familial combined hyperlipidemia (HIGH-per-li-pi-DEE-me-ah) is a genetic disorder that
causes high cholesterol and increased fat levels in the blood. The disease is inherited, or
passed down, from family members. The increased fat and cholesterol within the blood
can cause early heart disease, heart attack, and stroke. Early diagnosis, medical treatment,
and avoidance of lifestyle risk factors that can contribute to heart attacks are essential to
controlling this disease.
©MOLEKUUL/SPL/age fotostock

With today’s technology, congenital defects can often be detected before a child is
born. Some of these defects can even be fixed while the child is still inside the womb. It is
important to realize that the potential for a person to have a particular disease or disorder
may be present at birth or during childhood but the actual signs and symptoms of the dis-
ease may not present themselves until later in life. Diseases that affect children can be more
difficult to treat due to the constant changes that occur as a child is developing. Numerous
diagnostic tools are used throughout pregnancy to determine whether a child may have a
congenital defect. Genetic testing can help determine the probability of the presence of a
genetic defect. Close monitoring of infants and children by a pediatrician, along with the
administering of vaccines and immunizations as shown in Figure 1.17, can help identify
potential developmental disorders and decrease the instance of infectious diseases.

The elderly The elderly face a different set of circumstances that make them more
susceptible to disease. Aging causes changes in normal body function. As the body ages,
there is a general reduction in function at the cellular and organ levels. This reduction of
function is accompanied by the inability of certain organs such as the brain and heart to
regenerate, which leaves the aging individual potentially open to pathological conditions.
Other factors, such as an individual’s genetic makeup and overall health status, also play
a role in how a person ages. Throughout this text, you will explore how aging affects each
body system and will learn about the common pathologies associated with the changes.
People are generally living longer, and society is rapidly moving toward expanding the
health care industry for the elderly. So, as a health care provider, you must consider all
aspects of normal body structure and function and of related pathologies and must recog-
nize the differences that exist between children, young adults, and the elderly population.

Gender Another predisposing factor for disease is gender, which refers to the sex of
an individual—male or female. Some diseases affect only males or females due to the
differences in anatomy: Men and women are built differently;
they have different reproductive organ systems and different
mechanisms that control the function of their bodies. There-
fore, some diseases are more prevalent in one gender than in
the other. For example, women are more prone to develop
osteoporosis than men, while men are more prone to develop
Parkinson’s disease than women.

Lifestyle Lifestyle contributors to disease include habits

that can have a negative effect on a person’s overall health.
For instance, cigarette smoking, abuse of drugs or alcohol,
lack of exercise, poor diet, multiple sex partners, risky sex-
ual behavior—all can have detrimental effects on a person’s
health. The good thing is that this category of risk factors can
be controlled and altered by the individual. Choosing not to
participate in these and other risky behaviors has a beneficial FIGURE 1.17 A child receiving a vaccination.
impact on a person’s overall health status. ©Jill Braaten

1.4 Terms of Pathology 17

 Environment The environment can also be a predisposing factor for disease. For
example, researchers have shown that certain cancers and pulmonary diseases are more
prevalent in people who are exposed to polluted air or water. Other environmental
stressors that can contribute to poor health include chronic stress, loud noise, poor and
unsanitary living conditions, and contaminated food.

Heredity A person’s heredity is a combination of the genetic material from both par-
ents, and it, too, is a major predisposing factor for disease. The genetic material inherited
from one’s parents may come with links to certain diseases and pathological conditions.
Researchers are constantly uncovering genetic links to diseases, thereby showing that there
is potential for parents to pass these links to their children. While people cannot control what
genetic material they inherit, there are many instances where a person’s genetic makeup in
combination with the presence of certain lifestyle risk factors makes a person more prone
to a particular disease or condition. It is important to be mindful of the fact that although
a person may have a genetic predisposition for a disease, good lifestyle choices can be the
determining factor in whether that person actually inherits the particular condition.
When considering a person’s lifestyle, you cannot ignore the fact that many of
the risk factors that increase a person’s susceptibility to diseases can be controlled
by the individual. You can make healthy lifestyle choices that will help support good
health. Eating a balanced diet, getting regular exercise, having routine health screen-
ings, and avoiding behaviors such as smoking, alcohol abuse, and drug abuse are
ways you can reduce your chances of getting various pathological conditions. There
is a big move in society toward preventive health care. This supports the idea that
there are actions individuals can take to avoid being sick and unhealthy. Studies have
shown that if more time, effort, and resources are invested in making sure patients
are taking their overall health into consideration, less time and fewer resources are
spent on treating disease.

Spot Check How do predisposing factors play a role in your health?

Signs and Symptoms of Disease

Learning Outcomes
8. Differentiate between signs and symptoms of disease and give an example of each.
9. Explain the function of pain and inflammation.

Now that you are aware of the predisposing factors that can lead to disease, how do
you recognize disease? When you are coming down with a cold or the flu, how do you
know that you are sick? There are a few things to consider when determining whether
disease is present.
The signals of disease fall into two categories: objective signals, or signs, of
­disease and subjective signals, or symptoms, of disease.
Signs are objective signals that can be measured. For example, a fever is a sign
of a potential pathological condition. Your average normal body temperature is
98.6°F (37°C). Body temperature can rise when you have been exposed to infectious
agents such as bacteria or viruses. In some cases, extreme heat exhaustion, cancers,
inflammatory conditions, medications, or immunizations can cause a fever. A person
is considered to have a fever if the body temperature is above 98.6°F (37°C). Body
­temperature can be measured using a thermometer.
On the other hand, symptoms are subjective signals relative to the patient that indi-
cate that something is wrong, but this “something” cannot be measured. Examples of
symptoms are headache and nausea. There is really no way to measure a headache or
nausea. You can attempt to have the patient describe the degree to which she feels the
headache or nausea, but you cannot apply a normal range or measure these symptoms

18 CHAPTER 1 The Basics

with any definitive tool. Signs and symptoms that may appear—such as a fever, head-
ache, nausea, and malaise (mah-LAZE), a feeling of general discomfort or ­uneasiness—
can indicate the presence of disease. Let’s look at other signs and symptoms.

Spot Check Bobby had a terrible episode of vertigo (dizziness) that caused
him to visit the doctor. Was his vertigo a sign or a symptom, and what is the rationale
of your answer?

Two very important signals of disease in the human body are pain and inflammation.
Recall that the definition of disease is a disruption in the normal state of the body’s inter-
nal environment. Pain and inflammation are warnings of a disruption in normal function.

Pain Pain is a symptom indicating physical suffering or distress due to injury or illness.
The physiology, or function, of pain serves as a defense mechanism to warn the person
that there is a problem. Because everyone’s pain threshold is different, an exact measure-
ment of pain is not possible. If you fracture a bone, you will experience pain. This pain
will not disappear by itself and may be so severe that you are unable to use the fractured
body part as you did before the injury. Continued use of the injured body part may cause
further damage. So pain acts in a protective manner, alerting your attention to the prob-
lem and forcing you to take extra care or seek medical attention. The absence of pain can
also be an indication that disease is present. For example, patients with diabetes mellitus
(which will be discussed further in the ­endocrine ­chapter) can experience numbness or a
lack of feeling in their extremities due to nerve damage associated with the disease. The
inability to feel pain in that area may alert clinicians that the nerve damage is present. So
pain (or the lack of pain in certain instances) acts in a protective manner, alerting atten-
tion to the problem and forcing you to take extra care or seek medical attention.

Clinical P int
Pain is a subjective symptom that cannot be measured. Often, health care professionals attempt to have patients rank their
degree of pain on a pain scale. However, note that even this ranking is relevant to the specific patient and his or her own
individual pain threshold.

©1983, Wong-Baker FACES Foundation, www.WongBakerFACES.org. Used with permission. Originally published in Whaley &
Wong’s Nursing Care of Infants and Children. ©Elsevier Inc.

Inflammation Another symptom of disease is inflammation. Inflammation is the

body’s normal immune response to injury and disease. Sometimes injury to the skin
allows bacteria and other pathogens to enter underlying tissues. The body’s response to
the invasion is inflammation. Symptoms such as redness, heat, swelling, and pain are
indicators of inflammation. Consider the example of a splinter, shown in Figure 1.18.
The splinter damages tissue of the dermis and pushes bacteria into the wound.

1.4 Terms of Pathology 19

 Splinter

Epithelium

Bacteria

Blood vessel

FIGURE 1.18 Splinter in the skin damages tissues and promotes an inflammatory
response.

The damaged tissues produce chemicals that cause any blood vessels they meet to
dilate. This brings more blood flow to the area. The increased blood flow accounts
for the redness and heat. Blood vessels become more permeable (leaky) when they
dilate. Fluid from the blood leaks out into the surrounding damaged tissue, causing it
to swell. This extra fluid increases pressure on the nerve endings, creating the pain.
Inflammation is discussed more fully in the lymphatic system chapter.

Common Misconception
It is important to understand that fluid, not red blood cells, can leave the dilated blood
vessels. Redness is not caused by the red blood cells out in the tissues. Instead, it is
simply small vessels becoming bigger in diameter, bringing more blood flow to the area
within the vessels.

Pain and swelling are certainly not desirable, so why does the body have an inflam-
matory response? Because the pain will cause you to notice and pay attention to the
inflammation. The increased blood brings more nutrients to the area and carries more
wastes away. This speeds the healing process. Also, the increased heat discourages
bacteria growth. In essence, inflammation is the body’s way of fixing a problem.

Clinical P int
Some medications are anti-inflammatory agents, which help reduce pain and swelling.
Common mediators of inflammation produced by damaged tissues are histamines
and prostaglandins. Antihistamines block the effects of histamines, and aspirin blocks
the production of prostaglandins.

20 CHAPTER 1 The Basics

 Spot Check What is the purpose of inflammation?

Classification of Disease

Learning Outcome
10. Explain the two classifications of disease and the subcategories of each.

Just as signs and symptoms can be categorized, so can types of disease. Diseases can
be classified as infectious diseases and noninfectious diseases, with subcategories
under each. First, let’s look at infectious diseases.

Infectious Diseases Infectious diseases are those caused by pathogens, which are
disease-causing agents. Infectious disease includes a broad category of pathological
conditions, which can have different sources of infection, modes of transmission, and
pathological agents responsible for the diseases. Disease-causing organisms—bacteria,
viruses, parasites, and fungi—can grow and multiply within the body and cause disease.
They do so either by damaging local tissue or by producing substances that are toxic to
the infected individual. Specific examples of pathogens and how they attack the body,
resulting in disease, are discussed in the various system chapters throughout the text.
Infectious diseases can be further classified into communicable and noncommuni-
cable diseases.

Communicable diseases Communicable diseases are infectious diseases that are

contagious (spread from person to person). An example of a communicable disease
is the flu. The flu is a highly contagious virus that is easily spread from person to per-
son by direct or indirect contact. You will learn more about the flu in the respiratory
system chapter.

Noncommunicable diseases Noncommunicable diseases are infectious diseases

that are caused by pathogens but are not contagious. For example, food poisoning is
caused by either a bacteria present in food or by toxins produced by that bacteria. In
either case, a pathogen is the cause of the infectious disease, but food poisoning is not
contagious and therefore noncommunicable. Food poisoning is discussed further in
the digestive system chapter.

Noninfectious Diseases Noninfectious diseases can be classified as cancers,

immune disorders, genetic disorders, mental disorders, or conditions caused by trauma
or injury. Each category is explained in succeeding paragraphs.

Cancers Cancers are a class of disease characterized by uncontrollable cell growth

and proliferation. These cells form tumors, which compete with healthy tissue for
nutrients. The cancer cells function solely to grow and divide, and they cause disrup-
tions in tissue and organ structure and function. The tumors can block passageways;
break through organ and vessel walls, causing hemorrhaging; and reduce the body’s
ability to fight infection. These tumors and types of cancers will be further defined in
“2.5 Tissue Level” in the next chapter.

Immune disorders Immune disorders are a class of diseases that result from the
inability of the body’s immune system to effectively protect and defend itself. As you
will learn in the lymphatic system chapter, the function of the immune system is to
recognize self from nonself and destroy what is considered nonself. For example, your
immune system should be able to recognize that a particular bacterium, capable of
causing an infectious disease, is not one of your cells. The immune system sees this

1.4 Terms of Pathology 21

 cell as foreign, and this will cause an immune reaction. That reaction involves the
destruction of the bacterial cell, thereby protecting you from the infectious disease.
Three general categories of immune disorders are described in the following list:
• Hypersensitivities (allergies) involve an overreaction of the immune system to an
allergen. An allergen is a substance such as pollen or pet dander that causes the
immune system to overreact. This overreaction results in a variety of symptoms,
ranging from hives or congestion to more severe symptoms that can even result in
death. We will learn more about these reactions in the lymphatic system chapter.
• Immunodeficiency disorders are characterized by a deficiency in the immune
system’s ability to defend the body. Various types of immunodeficiencies can affect
different parts of the immune system. For example, acquired immune deficiency
syndrome (AIDS) is a disorder caused by HIV. This virus causes the immune sys-
tem to be deficient, leaving the body open to pathological conditions that can result
from a variety of causes. You will read more about HIV and AIDS in the lymphatic
system chapter.
• Autoimmune disorders are characterized as an inability of the immune system
to distinguish between its own tissues (self) and foreign tissue or cells (nonself).
Because the immune system cannot distinguish between self and nonself, an
attack on normal body cells, tissues, and organs can result. For example, type 1
diabetes is considered an autoimmune disease. In a healthy individual, the islet
cells of the pancreas secrete insulin to control blood glucose levels. In type 1
diabetes, the body’s immune system sees the islet cells of the pancreas as foreign
and attacks them. The attack on these cells causes them to stop functioning. These
cells can no longer secrete the insulin needed to control blood glucose levels,
resulting in type 1 diabetes. This disorder is further explained in the endocrine
system chapter.

Genetic disorders Genetic disorders are a class of diseases characterized as abnor-

malities caused by changes in genetic material. The changes in genetic material can
be inherited, occur spontaneously, or be a result of exposure to a mutagen (MYU-
tah-jen), an agent capable of causing a mutation (genetic change). For example,
research has shown that the UV rays produced by the sun have the ability to alter
genetic material within a cell’s nucleus. This alteration of genetic material in skin
cells can cause cancerous cells to develop. In this particular example, the UV rays are
considered a mutagen.
Now that you have a good idea of how genes can be altered and result in disease,
it’s time to move forward and explore the next category of disease, mental disorders.

Mental disorders Mental disorders are a class of condi-

tions of the mind and include disorders associated with
behavior or psychological well-being. Mental disorders are a
very broad category of disease with various etiologies (EE-
tee-OL-oh-jeez) (causes), some of which are still a mystery.
It is important to consider mental disorders with the same
urgency as that with physical disorders, since mental disor-
ders can impair function and cause disability and pain just as
any other illness can.

Trauma/injury Trauma can be defined as a wound

or shock (sudden loss of blood pressure) produced by
an injury. Figure 1.19 shows a man who has fallen and
FIGURE 1.19 Trauma to the leg obtained by a sports injured himself while playing a sport. Recall that a dis-
injury. ease is the body functioning in an abnormal way. With
©Terje Rakke/Getty Images a trauma, the wound can cause the body to function

22 CHAPTER 1 The Basics

improperly. The man in Figure 1.19 has clearly hurt his knee, and his injury could
have an effect on the function of that body part. If the body part functions abnor-
mally following the injury, the result is a pathological condition. Trauma can result
in a pathological condition of a specific system or the body as a whole. Trauma
has a wide variety of causes, including burns, physical abuse, accidents, drowning,
wounds inflicted by foreign objects, and exposure to toxic agents. When dealing
with trauma, the patient’s condition must be properly assessed and the circum-
stances that threaten the patient’s life must be managed. Often, this will involve
controlling massive bleeding, preventing or managing shock, and preventing infec-
tion from resulting injuries.

Diagnosing Disease

Learning Outcomes
11. D
 efine diagnosis and list the steps involved in diagnosing diseases.
12. D efine differential diagnosis and explain when it may be used.

When an individual determines that he or she needs a medical evaluation from a health
care provider, the clinician determines what steps need to be taken in order to diagnose
the problem.
Diagnosis is the process of determining by examination the nature and circum-
stances of a diseased condition. Determining a diagnosis is a step-by-step process
that involves collecting a patient history, performing an examination, and utilizing
diagnostic screening tools and tests. Once the information has been obtained and
reviewed by the clinician, a diagnosis, treatment plan, and prognosis—predicted
patient ­outcome—can be determined.

Clinical P int
This flowchart shows the order of steps a clinician uses to determine a diagnosis.

Patient has routine Patient experiences signs and

health screenings. symptoms that cause concern.

Patient seeks the advice of a medical professional.

Obtain medical history and chief complaint.

Diagnostic test/
Medical examination
laboratory screenings

Compare results with normal findings and interpret.

Determine the diagnosis, treatment, and prognosis.

1.4 Terms of Pathology 23

 Differential Diagnosis In some cases, the signs, symptoms, and results of the diag-
nostic examination do not yield enough information to diagnose the patient with a
specific disease. In cases like this, a differential diagnosis may be determined. This
is used when there is more than one disease that might be responsible for the patient’s
condition. Determining a differential diagnosis involves a process of elimination per-
formed by the clinician. The physician first creates a list of possible diagnoses and
ranks them from most severe to least severe. Once the list of diseases has been estab-
lished, the physician either rules out or confirms the diagnosis of each on the basis
of the patient’s signs, symptoms, and diagnostic test results. The use of a differential
diagnosis encourages a physician to leave no stone unturned. Physicians must consider
every possible related diagnosis until it can be ruled out. This attention to detail not
only helps ensure safety for the patient but also allows for a more comprehensive treat-
ment plan and prognosis.

Diagnostic Tests and Screenings A variety of diagnostic tests and procedures

are available to help physicians determine the appropriate diagnosis for a patient. A
biopsy is an example of a diagnostic test that involves the removal of a piece of tis-
sue or a sample of cells from the body so that it can be examined in the laboratory.
Depending on the results, this test may indicate the presence of disease. Screenings
are also an important diagnostic tool. For example, it is suggested that at a certain
age, women receive an annual mammogram to screen for breast tissue abnormali-
ties. This type of routine screening can give health care providers a normal baseline
of what the tissue looks like, which can make it easier to determine any abnor-
mal changes that may occur in future screenings. See Figure 1.20. After you have
investigated the anatomy and physiology of each system, the table of diagnostic
tests will help you understand how these procedures relate to the diseases covered
in the specific system.

Common Diagnostic Tests Used for

Integumentary System Disorders
Diagnostic test or screening Description
Skin biopsy The removal of a piece of tissue or a
sample of cells from a body so that it
can be analyzed in a laboratory.
Skin scraping The taking of scrapings of skin cells
so that the cells can be viewed under
a microscope.
Wood’s light The use of a black light to view
pigment changes in the skin.

FIGURE 1.20 Sample of a diagnostic test table.

Treatment of the Disease

Learning Outcome
13. Summarize four types of treatment plans.

Once the diagnosis has been established, a treatment plan can be developed. Treatment
plans can have different goals, as described in the following list:

24 CHAPTER 1 The Basics

• Palliative treatment (PAL-ee-ah-tiv) is used at any stage
of the disease process. The goal of this type of treatment
is to make a patient more comfortable and improve the
quality of life. For example, a palliative treatment plan
may be introduced to treat the side effects of anti-cancer
drugs. During the terminal stages of disease, palliative
treatment may be the only treatment option available to a
patient. See Figure 1.21.
• Curative treatment is a treatment regimen designed to
cure the patient of the disease.
• Therapeutic treatment may involve a long-term care
plan designed to restore a patient’s normal body func-
tion. An example of therapeutic treatment is a consis-
tent physical therapy plan, as shown in Figure 1.22. FIGURE 1.21 Home health care for a terminally ill
patient.
This plan is designed to restore function to an injured ©McGraw-Hill Education/Rick Brady
limb.  
Another example of therapeutic treatment is
occupational therapy. Occupational therapy is designed
to help people develop, recover, or maintain the skills
necessary for daily living. A person recovering from
an illness may need occupational therapy to help him
or her to live more independently. Both physical and
occupational therapy treatment plans help patients
restore body functions, reduce the risk of a reoc-
curring injury, and allow a patient to become more
self-sufficient.
• Preventive treatment is an increasingly significant
approach in health care today. The idea that steps can
be taken to prevent disease from happening is becom-
ing more accepted. Some insurance agencies have added
incentives for health care maintenance. This cuts down
on the cost of health care overall and allows individuals FIGURE 1.22 Patient receiving physical therapy.
to live a longer, healthier life. ©Erproductions Ltd/Blend Images

Spot Check Mary has been diagnosed with a terminal form of cancer.
Physicians have tried all treatment options, and there is nothing they can do to cure
her cancer. She has been given 6 months to live. What kind of treatment could Mary
benefit from at this point?

Epidemiology

Learning Outcome
14. Define epidemiology and explain how epidemiology affects health care.

Up to this point, you have explored the definition of disease and various dis-
ease classifications. You have also examined what goes into developing a diag-
nosis and the different kinds of treatment plans. Now you will take a brief look
at e­ pidemiology (EP-ih-DEE-mee-OL-oh-jee), which is the study of how disease
affects the overall health and well-being of a population. Studies in epidemiology
involve collecting various types of data on specific diseases that presently affect
the population.

1.4 Terms of Pathology 25

 In epidemiology, the incidence of disease refers to the
number of new cases of a particular disease in the popula-
tion. The prevalence of disease refers to the total number of
cases of a disease in a population.
Consider the Spanish flu of 1918 as an example. The
Spanish flu pandemic claimed the lives of over 50 million
people worldwide and infected an estimated one-third of
the world’s population. See Figure 1.23. This historical
event has undergone analysis to determine how, when, and
where the effects of the Spanish flu were seen. Research-
ers considered various time lines and maps that showed
the progression of the disease from one place to another
(prevalence). They also looked at the numbers of deaths
and infected persons that occurred in a given area at a
given time (incidence). Both incidence and prevalence
must be taken into account when discussing what effect a
FIGURE 1.23 Patients suffering from the Spanish flu
pandemic of 1918. disease may have on a particular population. Considering
©Science Source these factors allows public health researchers and govern-
ment officials to devise plans to deal with the presence
of a disease within a population. If a link can be made between the statistical data
associated with the disease and risk factors that cause the disease, health care pro-
viders can properly educate their patients. This can include warning and educating
the public about methods of transmission, identifying risk factors associated with
the disease, educating patients on how to avoid associated risk factors, and explain-
ing methods of treatment associated with the disease. Epidemiological information
helps health care workers properly assess and advise their patients.

Spot Check What are some epidemics that affect society today?

Clinical P int
The Centers for Disease Control and Prevention recommend that people receive
the yearly flu vaccine between September and March. By tracking the prevalence
and incidence of the flu, the CDC can make recommendations as to when patients
should receive the flu vaccine. Studies show that flu outbreaks can begin in October
and continue well past January in some cases. This research is also used to create
the flu vaccine that is administered. Scientific research, along with data collected by
public health officials, will show which strains of influenza could potentially be prob-
lematic in the upcoming flu season. The vaccine for a given year will contain influ-
enza strains that are predicted to be most virulent to the population. The study and
practice of epidemiology enable health care providers to use the data collected to
serve the health care needs of the community and prevent or attempt to control
various disease outbreaks.

Epidemiology has a huge impact on health care. The trends in epidemiology

that are present in a population at any given time determine not only the direction
of pharmaceutical research but also the direction of treatment by health care profes-
sionals. Therefore, health care providers must stay abreast of the trends in epide-
miology affecting their patients. Diseases seen in patients could be associated with
various risk factors determined through epidemiology. Clinicians are responsible for

26 CHAPTER 1 The Basics

not only treating disease but also helping patients remain healthy by educating them
on preventive measures.
Table 1.6 presents data on the epidemiological trends of certain chronic diseases.
This information can be utilized by health care providers to aid in the prevention of
such diseases.

TABLE 1.6 Most Prominent Chronic Diseases in the United States

Disease Epidemiological Trend
Heart disease These two chronic diseases together account for more than 48% of all deaths in the United States.a
and cancer
Diabetes This is the leading cause of kidney failure, lower-extremity amputations other than those caused
by injury, and blindness each year among adults (20–74 years of age) in the United States.b
Arthritis This is the most common disability, limiting activity for more than 22 million adults in the
United States.c
Obesity One in every three adults is obese, and nearly one in every five young people (ages 2–19)
is obese.d

Source: aCenters for Disease Control and Prevention. Death and Mortality. NCHS FastStats. www.cdc.gov. Accessed December 20, 2013.
b
Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. www.cdc.gov. Accessed December 20, 2013.
c
Barbour KE, Helmick CG, Theis KA, et al. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010–2012.
MMWR. 2013;62(14):869–73. www.cdc.gov. Accessed March 13, 2014.
d
Centers for Disease Control and Prevention. NCHS Obesity Data. www.cdc.gov. Accessed December 20, 2013.

Summary
1.1 Overview
∙∙ A
 natomy is the study of structures, physiology is the study of how structures function, and pathology is the study
of disease.

1.2 Terms of Anatomy

∙∙ The standard anatomical position is standing with arms at the sides and palms and head facing forward.

Anatomical Terms of Direction

∙∙ Anterior or ventral means front or belly side.
∙∙ Posterior or dorsal means back side.
∙∙ Superior is closer to the top of the head and is used for the axial region only.
∙∙ Inferior is farther away from the top of the head and is used for the axial region only.
∙∙ Medial is toward the midline of the body.
∙∙ Lateral is away from the midline of the body.
∙∙ Proximal is closer to the connection to the body and is used for the appendicular region only.
∙∙ Distal is farther from the connection to the body and is used for the appendicular region only.
∙∙ Superficial is closer to the surface.
∙∙ Deep is farther from the surface.
∙∙ Right is on the body’s right side.
∙∙ Left is on the body’s left side.

27
Anatomical Regions
∙∙ Axial is head, neck, and trunk.
∙∙ Abdominal is belly.
∙∙ Axillary is armpit.
∙∙ Cranial or cephalic is head.
∙∙ Cervical is neck.
∙∙ Facial is face.
∙∙ Inguinal is groin.
∙∙ Pelvic is lower trunk.
∙∙ Thoracic is chest.
∙∙ Umbilical is navel.
∙∙ Appendicular is arms and legs.
∙∙ Brachial is arm.
∙∙ Carpal is wrist.
∙∙ Cubital is elbow.
∙∙ Femoral is thigh.
∙∙ Palmar is palms of the hands.
∙∙ Patellar is knee.
∙∙ Plantar is soles of the feet.
∙∙ Tarsal is ankle.

Anatomical Planes
∙∙ The sagittal plane separates right from left.
∙∙ The transverse or horizontal plane separates top from bottom.
∙∙ The frontal or coronal plane separates front from back.

Anatomical Positions
∙∙ Supine is anterior surface facing up.
∙∙ Prone is anterior surface facing down.

Anatomical Cavities
∙∙ The dorsal cavity contains the cranial and vertebral cavities, which are lined by the meninges.
∙∙ The thoracic cavity contains two pleural cavities lined by pleural membranes, the pericardial cavity lined by the pericardial
membranes, and the mediastinum.
∙∙ The abdominopelvic cavity contains the abdominal cavity and the pelvic cavity, together lined by the peritoneum.

Serous Membranes
∙∙ Serous membranes form two layers when surrounding an organ, similar to a water balloon surrounding a fist.
∙∙ The pericardial membranes surround the heart.
∙∙ The pleural membranes surround the lungs.
∙∙ The peritoneal membranes surround many of the abdominopelvic organs.
∙∙ The portion of the serous membrane in contact with the organ is the visceral pericardium, visceral pleura, or visceral
peritoneum.
∙∙ The portion of the serous membrane not in contact with the organ is the parietal pericardium, parietal pleura, or parietal
peritoneum.
∙∙ The mesenteries are sections of the peritoneum that neatly arrange blood vessels and nerves to organs.
∙∙ The greater and lesser omentums are extensions of the peritoneal membrane.

1.3 Terms of Physiology

Homeostasis
∙∙ H
 omeostasis is a steady internal environment in which the body works best. If the body detects a change away from
homeostasis, it will use either of two feedback mechanisms.
∙∙ Negative feedback is the process the body uses to reverse the direction of movement away from homeostasis.
∙∙ Positive feedback is the process the body uses to increase the movement away from homeostasis.

28
1.4 Terms of Pathology
Introduction to Disease
∙∙ P
 athology is the study of disease, and disease is the disruption of the body’s homeostatic environment as a result of
abnormally functioning organs and organ systems.

Predisposing Factors of Disease

∙∙ P redisposing factors are risk factors or activities that can affect a person’s health such as age, gender, lifestyle,
environment, and heredity.
∙∙ Age can affect the health of both children and the elderly.
∙∙ A person’s gender, whether male or female, can affect his or her health.
∙∙ A person’s lifestyle, including his or her negative habits, can have an effect on that person’s overall health.
∙∙ Environmental stressors such as chronic stress, loud noise, poor and unsanitary living conditions, and contaminated food
can affect a person’s overall health.
∙∙ Heredity or the combination of genetic material from a person’s parents can affect the health of that individual.

Signs and Symptoms of Disease

∙∙ T he signals of disease fall into two categories: signs of disease, which are objective and can be measured, and symptoms
of disease, which are subjective and cannot be measured.
∙∙ The symptom of pain is the physical suffering or distress due to injury or illness that serves as a protective mechanism to
alert a person that something may be wrong.
∙∙ Inflammation is the body’s normal immune response to injury and disease.

Classification of Disease
∙∙ Diseases can be classified as infectious diseases and noninfectious diseases, with subcategories under each class.
∙∙ Infectious diseases are those caused by pathogens and can be further classified into communicable and noncommu-
nicable diseases.
∙∙ Noninfectious diseases are not caused by pathogens and can be classified as cancers, immune disorders, genetic disorders,
mental disorders, or conditions caused by trauma or injury.

Diagnosing Disease
∙∙ D iagnosis is the process of determining by examination the nature and circumstances of a diseased condition, involving a
step-by-step process that includes collecting a patient history, performing an examination, and utilizing diagnostic screen-
ing tools and tests.
∙∙ A differential diagnosis is used when there is more than one disease that may be responsible for the patient’s condition,
and it involves a comprehensive process of elimination performed by the clinician.
∙∙ A variety of diagnostic tests and procedures are available to help physicians determine the appropriate diagnosis for
a patient.

Treatment of the Disease

∙∙ P
 alliative treatment is used at any stage of the disease process. The goal of this type of treatment is to make a patient more
comfortable and improve his or her quality of life.
∙∙ Curative treatment is a treatment regimen designed to cure the patient of the disease.
∙∙ Therapeutic treatment may involve a long-term care plan designed to restore a patient’s normal body function.
∙∙ Preventive treatment involves the idea that steps can be taken to prevent disease from happening.

Epidemiology
∙∙ E
 pidemiology is the study of how disease affects the overall health and well-being of a population, taking into account the
incidence and prevalence of disease in an effort to predict the impact of that disease on the population.

29
Key Words for Review
The following terms are defined in the glossary.

abdominal homeostasis pelvic

acute hypersensitivity peritoneum
anatomy immunodeficiency physiology
appendicular incidence pleura
axial inflammation positive feedback
chronic malaise prevalence
communicable diseases meninges prognosis
cranial mesentery proximal
diagnosis negative feedback serous membrane
disease noncommunicable diseases signs
epidemiology palliative symptoms
etiologies parietal thoracic
greater omentum pathogens visceral
heredity pathology

30
 Levels of

2 Organization of
the Human Body
Now that you have completed the
chapter on the basics, you have
started to see the connection
between anatomy and physiology
and to understand how the structures
of the body work and relate to the
bigger picture of normal functioning.
In this chapter, you will learn how
the body’s structures and functions
are organized, and this
will further clarify
precisely how
human anatomy
and physiology are
so interrelated.
©Fuse/Corbis/Getty Images

Module 2: Cells and Chemistry

31
 2.1 Overview

Learning Outcome
1. List the levels of organization of the human body from simplest to most complex.

As you can see in Figure 2.1, our bodies are organized in a hierarchy, from simplest
to most complex.
The chemical level—the simplest level—deals with the body’s chemistry and
involves individual atoms and molecules. At the organelle level, molecules work
together as organelles to perform specific functions. Mitochondria, ribosomes, and
Golgi complexes are examples of organelles. At the cellular level, the organelles work
together to perform specific functions for a cell (the basic unit of life). The body is com-
posed of trillions of cells that work together to complete specific functions at the tissue
level. Different tissues work together to perform particular functions at the organ level.
The stomach, liver, and lungs are all organs. The organs work together at the systems
level to perform functions like digestion and respiration. All the body systems must
work together to accomplish the entire organism’s functions. In this case,
the organism is a human. The organism level is the most complex.
This chapter covers the essential information about
each level of this hierarchy up through an introduc-
tion to the systems. The individual systems are
covered later in their own chapters. Let’s start
at the chemical level.

Organism
Organ system
Organ

Tissue

Molecule (DNA)

Cell

Organelle
Atoms

Chemical

FIGURE 2.1 Levels of organization in the human body.

©Fuse/Corbis/Getty Images

32 CHAPTER 2 Levels of Organization of the Human Body

2.2 Chemical Level
The chemical level of organization includes many chemistry concepts: atoms and how
they bond to form molecules, water and how it is the basis for solutions in the body,
acids and bases and how they are measured by pH, organic molecules and their impor-
tance in the body, and chemical reactions, such as cellular respiration. We begin our
exploration with the basics.

Atoms and Isotopes

Learning Outcome
2. Define the terms matter, element, atom, and isotope.

All solids, liquids, and gases are composed of matter. Matter is defined as anything
that takes up space and has mass. The chair you are sitting on as you read this, the
beverage you may have at your side, and the air you breathe are all composed of
matter. The simplest chemical component of matter is an element. An element has
a unique set of chemical properties and cannot be separated by chemical methods.
The elements are listed in the Periodic Table of the Elements by their composition
and by their chemical properties. See Figure 2.2. The most common elements in the
human body are listed in Table 2.1.
The smallest piece of an element still exhibiting the element’s unique set of chemi-
cal properties is an atom. Atoms are composed of protons, electrons, and neutrons.
For an example, see the diagram of a carbon atom in Figure 2.3.
The number of protons for each element is fixed and is indicated by the atomic
number. For carbon (C), the number of protons in each atom is six. The number of
electrons equals the number of protons. The atomic mass is the combined number

TABLE 2.1 Major Elements of the Human Body

Element, by Weight Symbol Percentage of Body Weight
Oxygen O 65.00%

Carbon C 18.00

Hydrogen H 10.00

Nitrogen N 3.00

Calcium Ca 1.50

Phosphorus P 1.00

Sulfur S 0.25

Potassium K 0.20

2.2 Chemical Level 33

 Representative Representative
Elements ( s Series) Elements ( p Series)
Key
IA VIIIA
1Atomic number
1 Name
Hydrogen 2
1 Hydrogen
H H Symbol Helium
He
IIA 1.0079 Atomic mass IIIA IVA VA VIA VIIA
1.0079 4.0026
3 4 5 6 7 8 9 10
Lithium Beryllium
2 Boron Carbon Nitrogen Oxygen Fluorine Neon
Li Be B C N O F Ne
6.941 9.0122 10.811 12.0112 14.0067 15.9994 18.9984 20.179
11 12 Transition Metals ( d Series of Transition Elements)
13 14 15 16 17 18
Sodium Magnesium Aluminum Silicon Phosphorous Sulfur Chlorine Argon
3 VIIIB
Na Mg IIIB IVB VB VIB VIIB IB IIB
Al Si P S Cl Ar
22.989 24.305 26.9815 28.086 30.9738 32.064 35.453 39.948
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
Period

Potassium Calcium Scandium Titanium Vanadium Chromium Manganese Iron Cobalt Nickel Copper Zinc Gallium Germanium Arsenic Selenium Bromine Krypton
4
K Ca Sc Ti V Cr Mn Fe Co Ni Cu Zn Ga Ge As Se Br Kr
39.098 40.08 44.956 47.90 50.942 51.996 54.938 55.847 58.933 58.71 63.546 65.38 69.723 72.59 74.922 78.96 79.904 83.80
37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Rubidium Strontium Yttrium Zirconium Niobium Molybdenum Technetium Ruthenium Rhodium Palladium Silver Cadmium Indium Tin Antimony Tellurium Iodine Xenon
5
Rb Sr Y Zr Nb Mo Tc Ru Rh Pd Ag Cd In Sn Sb Te I Xe
85.468 87.62 88.905 91.22 92.906 95.94 (99) 101.07 102.905 106.4 107.868 112.40 114.82 118.69 121.75 127.60 126.904 131.30
55 56 *57 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86
Cesium Barium Lanthanum Hafnium Tantalum Tungsten Rhenium Osmium Iridium Platinum Gold Mercury Thallium Lead Bismuth Polonium Astatine Radon
6
Cs Ba La Hf Ta W Re Os Ir Pt Au Hg Tl Pb Bi Po At Rn
132.905 137.34 138.91 178.49 180.948 183.85 186.2 190.2 192.2 195.09 196.967 200.59 204.37 207.19 208.980 (209) (210) (222)
87 88 **89 104 105 106 107 108 109
Francium Radium Actinium Rutherfordium Hahnium Seaborgium Neilsbohrium Hassium Meitnerium
7
Fr Ra Ac Rf Ha Sg Ns Hs Mt
(223) (226) (227) (261) (262) (263) (261) (265) (266)

Inner Transition Elements (f Series)

58 59 60 61 62 63 64 65 66 67 68 69 70 71
4f Cerium Praseodymium Neodymium Promethium Samarium Europium Gadolinium Terbium Dysprosium Holmium Erbium Thulium Ytterbium Lutetium
* Lanthanides Ce Pr Nd Pm Sm Eu Gd Tb Dy Ho Er Tm Yb Lu
140.12 140.907 144.24 144.913 150.35 151.96 157.25 158.925 162.50 164.930 167.26 168.934 173.04 174.97
90 91 92 93 94 95 96 97 98 99 100 101 102 103
** Actinides 5f Thorium Protactinium Uranium Neptunium Plutonium Americium Curium Berkelium Californium Einsteinium Fermium Mendelevium Nobelium Lawrencium
Th Pa U Np Pu Am Cm Bk Cf Es Fm Md No Lr
232.038 (231) 238.03 (237) 244.064 (243) (247) (247) 242.058 (254) 257.095 258.10 259.101 260.105

FIGURE 2.2 Periodic Table of the Elements.

of protons and neutrons. The atomic mass of carbon is 12.0112. Therefore, one atom
of carbon contains six protons and six neutrons. Notice that the atomic mass listed in
Figure 2.3 is not a whole number. The number of neutrons may vary for atoms of the
same element. The atomic mass listed is the average
mass for an atom of carbon.
Isotopes of an element are atoms that have the
same number of protons as every other atom of that
6
element but have a different number of neutrons. The
Carbon (C) 6p+, 6n0 atomic mass listed in the Periodic Table is an average
Carbon
Atomic number = 6
C
Atomic mass = 12 taken of all the atoms and isotopes for that element.
12.0112
The protons in an atom are positively charged, and
the electrons are negatively charged. Neutrons have no
charge—they are electrically neutral. Because the num-
ber of positive protons is equal to the number of negative
= Proton = Neutron = Electron electrons, atoms are also electrically neutral. Electrons
travel in orbits or shells around the centrally located pro-
FIGURE 2.3 Carbon atom diagram. Periodic Table information tons and neutrons. See Figure 2.3. Each shell has a set
for a carbon atom and a model of a carbon atom. limit as to how many electrons it can hold.

34 CHAPTER 2 Levels of Organization of the Human Body

 Clinical P int
Some isotopes are unstable and freely emit particles to get to a more stable form.
If they do, they are called radioisotopes and their decay, called radioactivity,
can be very useful in medicine for diagnosis and treatment. For example, the thyroid
gland (located in the cervical region) is soft tissue and therefore does not show up
well on an X-ray. It is also one of the few parts of the body that
requires the element iodine, which it uses to make thyroid hormone.
(You will learn more about this in the endocrine system chapter.) A
physician can inject a small amount of the iodine radioisotope into
a patient. The patient’s thyroid gland quickly takes in the radioiso-
tope of iodine, and the radiation given off by the isotope causes
the thyroid to be visible on an X-ray. This gives the physician more Thyroid
diagnostic information. For treatment, other radioisotopes in differ- gland
ent strengths may be administered as radioactive seeds to tumor
sites. These seeds can deliver radiation directly to the tumor site to
kill cancerous cells.

Spot Check How many protons, electrons, and neutrons are in a typical
potassium (K) atom? Use the Periodic Table in Figure 2.2 to derive your answer.

Bonding to Form Molecules

Learning Outcome
3. Define molecule and describe three methods of bonding that may form molecules.

Atoms will bind with other atoms to form molecules in order to fill their outer shells
with electrons. This makes them more stable. The definition of a molecule is two or
more atoms bonded together. A very stable bond called a covalent bond, which is often
formed by carbon atoms, occurs when two or more atoms share electrons to fill their
outer shells. Another type of bond is an ionic bond. Here, two or more atoms bind to
form a molecule by giving up or receiving electrons from each other to fill their outer
shells. The transfer of electrons means each of the individual atoms is no longer electri-
cally neutral. Sodium (Na) and chlorine (Cl) atoms typically form an ionic bond. The
sodium atom, which gives up an electron, becomes positively charged, while the chlo-
rine atom, which receives an electron, becomes negatively charged. Atoms with a charge
are called ions. Ions are attracted to each other because of their opposite charges, so they
form a bond resulting in an electrically neutral molecule. The molecule, sodium chloride
(NaCl), is table salt. See Figure 2.4.
When placed in water, ionically bonded molecules separate into their individual
ions. These ions in solution, called electrolytes, are capable of conducting elec-
tricity. You will study electrolytes more thoroughly in the muscular and nervous
system chapters.
Some examples of electrolytes are sodium (Na+), potassium (K+), calcium
(Ca2+), and chloride ions (Cl−). Electrolyte balance is a very important concept
in homeostasis, as it can mean life or death. For example, diarrhea is a major
concern in infants because of the loss of electrolytes in the runny stool. For this
reason, a physician may prescribe a commercial electrolyte solution to restore
electrolyte balance.

2.2 Chemical Level 35

FIGURE 2.4 Bonding: Oxygen atom Carbon atom Oxygen atom
(a) covalent bonding for carbon
dioxide (CO2), in which atoms
share electrons; (b) ionic
8p+ 6p+ 8p+
bonding for sodium chloride 8n0 8n0
6n0
(NaCl), in which atoms gain
and lose electrons to form
ions.
O C O
Carbon dioxide molecule (CO2)

= Proton = Neutron = Electron

(a)

–
– –
– –
–
– –
– –
–
–
11p+ 17p+
0
12n – 18n0 –
–
– –
–
– –

– – – –
– –

Sodium atom (Na) Chlorine atom (Cl)

Separate atoms
If a sodium atom loses an electron to a chlorine atom, the sodium
atom becomes a sodium ion (Na+) and the chlorine atom becomes
a chlorine ion (Cl – ).

– – –
– –
–
– –
– –
–
–
–
11p+ – 17p+
12n0 18n0
– – –
–
– –
– –
– – –
–

Sodium ion (Na+) Chlorine ion (Cl – )

Sodium chloride (NaCl)

Bonded ions
These oppositely charged particles attract electrically and join by an
ionic bond.

= Proton = Neutron = Electron

(b)

Another type of bond that is important to physiology is a hydrogen bond. A hydro-

gen bond is a weak bond that occurs between a positively charged hydrogen atom and a
negatively charged oxygen or nitrogen atom. Hydrogen bonds are responsible for holding
water molecules together. You will cover the key functions of water in the human body
in the next section. Hydrogen bonds are also found in protein and in deoxyribonucleic
acid (DNA). Hydrogen bonds cause these molecules to bend, fold, and coil in a way that
creates a specific three-dimensional shape, which is important to their function. You will
learn more about the structure and function of protein and DNA later in the chapter. Now
let’s discuss the key functions of water in the human body.

36 CHAPTER 2 Levels of Organization of the Human Body

Water

Learning Outcome
4. S
 ummarize the five functions of water in the human body and give an explanation or
example of each.

Water serves key functions in the body. You have just seen one of them—it can
separate ionically bonded atoms into ions to create electrolytes. The human body is
approximately 50%–75% water (H2O). As the main component of many body fluids,
water carries out the following five functions for the body:
• Water chemically separates ionically bonded molecules into individual ions called
electrolytes.
• Water works as a lubricant in tears and the fluid of joints.
• Water aids in chemical reactions, as in saliva during digestion.
• Water is used to transport nutrients and wastes in blood plasma.
• Water is used for temperature regulation. It has a high heat capacity to maintain
body temperature and can also be used to cool the body when it evaporates from
the surface as sweat.

Solutions

Learning Outcome
5. Compare solutions based on tonicity.

Body fluids, like tears, sweat, saliva, and plasma, are not pure water. They are solutions.
Every solution is composed of two basic parts: one or more solutes and a solvent.
Consider, for example, a salt solution: If you add a tablespoon of salt to a beaker
of water, the salt settles to the bottom of the beaker. If you stir the contents of the
beaker, the salt disappears as it dissolves. You now have a salt solution. This solution
is composed of a solute (the salt) dissolved in a solvent (the water). Solutes may be
solids, liquids, or gases. Examples are salt, alcohol, and carbon dioxide, respectively.
Water is a common solvent in the body. Concentration refers to the amount of solute
present in a solution relative to the amount of solvent. To create a more concen-
trated salt solution than the one in our example, you would add more salt to the same
amount of water.
The term tonicity is used when comparing solutions. A solution may be hyper-
tonic, isotonic, or hypotonic when compared to another solution. If a solution is
hypertonic, it is more concentrated with solutes than the other solution. If a solution
is isotonic, it has the same concentration of solutes as the other solution. If a solution
is hypotonic, it is less concentrated with solutes than the other solution. This basic
information on solutions will be important for our discussion of transport across cell
membranes later in this chapter. See Figure 2.5.

Acids, Bases, and pH

Learning Outcome
6. D
 etermine whether a substance is an acid or a base and its relative strength if given
its pH.

At first glance, the terms acids, bases, and pH may look familiar. You take an antacid
to relieve excess stomach acid, many household cleaners you use are bases, and your

2.2 Chemical Level 37

FIGURE 2.5 Tonicity.
The beaker with the hypotonic
solution has fewer solutes than
solution A. The beaker with the
isotonic solution has the same
amount of solutes as solution A.
The beaker with the hypertonic
solution has more solutes than
solution A.
Solution A

Hypotonic Isotonic Hypertonic

shampoo is often pH-balanced. However, you will need to know these terms chemi-
cally to understand their importance in human physiology.
An acid is a molecule that releases a hydrogen ion (H+) when added to water. A
base is a molecule that will accept the hydrogen ion, often by releasing a hydroxide
ion (OH−) when added to water. You can measure the strength of acids and bases by
using a pH (potential of hydrogen) scale. This scale is a number range from 0 to 14. See
Figure 2.6. A molecule with a pH of 7 is considered neutral because it is composed of
equal amounts of hydrogen and hydroxide ions (H+ and OH−). Water (H2O or HOH) is a
good example of a molecule with a pH of 7. Acids have a pH less than 7. Bases have a pH
greater than 7. Each one-number difference in pH indicates 10 times more ions released.
Consider three substances, A, B, and C. Substance A has a pH of 3. Substance B
has a pH of 4. Both substances are acids because their pHs are less than 7. Substance A

Relative 7.4
amounts human 8.4
of H+ (red) Acidic H+ 6.6 blood sodium
and OH– cow’s bicarbonate
5.3 milk
(blue)
cabbage
4.2
tomato
3.0 juice
apple
juice 11.5
household
10.5 ammonia
2.0 milk of
gastric magnesia
juice 8.0
egg white
7.0
distilled Basic OH–
6.0 water
corn
pH
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Basic
Acidic H+ concentration increases Neutral OH– concentration increases
(alkaline)

FIGURE 2.6 pH scale. This scale shows the pH of many common substances.

38 CHAPTER 2 Levels of Organization of the Human Body

 C A B FIGURE 2.7 pH comparison.
Substance A has a pH of 3.
Substance B has a pH of 4.
Substance C has a pH of 2.

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Basic
Acidic H+ concentration increases Neutral OH– concentration increases
(alkaline)

is a stronger acid because its pH is farther away from neutral than is substance B’s pH.
Both substances release H+ when placed in water because they are acids. Substance
A releases 10 times more H+ than substance B because A’s pH is one number lower
than B’s. If substance C has a pH of 2, it too is an acid and it releases H+ when placed
in water. Substance C would release 10 times more H+ than substance A because its
pH is one number lower than A’s. Substance C would release 100 times more H+ than
substance B because substance C’s pH is two numbers lower than B’s pH (10 times
10). The lower than 7 the pH is, the more hydrogen ions the substance has to release;
this makes it more acidic. The same relationship exists for bases. The higher than 7
the pH is, the more hydroxide ions (OH−) the substance has to release; this makes it
more basic (alkaline). See Figure 2.7.
The acid–base balance is very important to the body’s homeostasis. For example,
the pH of human blood needs to be within the very narrow pH range of 7.35 to 7.45.
A blood pH lower than 7.35 is considered acidosis, and a blood pH higher than 7.45 is
considered alkalosis. Either condition can be fatal. In the system chapters of this book,
you will investigate how the body’s acid–base balance is maintained in many body fluids.
This investigation will include how the body regulates blood pH, what may cause an
acid–base imbalance in the blood, and what disorders may result from that imbalance.

Spot Check Liquid X has a pH of 8. Liquid Y has a pH of 11. Are these liquids
acids or bases? Which ion will each liquid release (H+ or OH−) when placed in water?
Which liquid is stronger and will release more ions when placed in water? How many
times more ion will be released by the stronger liquid?

Organic Molecules

Learning Outcome
7. D
 escribe the four types of major organic molecules in the body by giving the elements
present in each, their building blocks, an example of each, the ___location of each example
in the body, and the function of each example.

In common usage, the term organic refers to something that is healthy, free of pesti-
cides, and naturally grown. The meaning in chemistry is very different. In chemistry,
organic molecules come from life and must contain atoms of the elements carbon
and hydrogen. You may know that you are 50%–75% water (H2O) and that you exhale
carbon dioxide (CO2). These molecules are certainly involved in life, but CO2 contains
carbon but not hydrogen and H2O contains hydrogen but not carbon. Therefore, these
molecules are not organic molecules. They are inorganic molecules. The four major
types of organic molecules are carbohydrates, lipids, proteins, and nucleic acids.
See Table 2.2. These organic molecules are discussed in the paragraphs that follow.
As shown in Table 2.2, building blocks are subunits of complex molecules, and
each organic molecule has a unique building block. Following, we take a closer look at
the building blocks for each of these molecules.

2.2 Chemical Level 39

 TABLE 2.2 Major Organic Molecules
Organic Location of Example Function of Example
Molecule Elements Building Blocks Examples in the Body in the Body
Carbo­hydrate C, H, O in Monosaccharides 1. Glucose 1. Glucose is a sugar 1. Main energy source
a ratio of (simple sugars) 2. Glycogen found in blood. for cells
1:2:1 2. Glycogen is a starch 2. S
 tored energy
found in muscles source (glucose
and the liver. is converted to
glycogen for storage)

Lipid C, H, O Fatty acids and 1. Fats 1. Adipose tissue 1. Stored energy

not in a glycerol 2. Steroids 2. Hormones found in 2. Regulate the body
ratio of blood
3. Phospholipids 3. Give structure to cell
1:2:1
3. Cell membranes and regulate what
goes in and out
of the cell

Protein C, H, O, N Amino acids 1. Keratin and 1. Skin 1. Give strength

(20 different collagen 2. Blood 2. Regulate the body
amino acids) 2. Hormones 3. Blood 3. Transport other
3. T
 ransport 4. Everywhere molecules
proteins 4. Aid in chemical
5. Blood
4. Enzymes reactions
6. Muscles
5. Antibodies 5. F
 ight foreign invaders
7. Cell membranes
6. Muscle proteins 6. Allow for contraction
7. Binding and of muscles
receptor proteins 7. Hold cells together

Nucleic C, H, O, Nucleotides 1. Deoxyribonucleic 1. Nucleus of a cell 1. DNA is the genetic

acid N, P acid (DNA) 2. Many places in a cell information.
2. Ribonucleic acid 2. RNA processes the
(RNA) genetic information.

Carbohydrates These organic molecules contain atoms of carbon, hydrogen,

and oxygen in a ratio of 1:2:1. Monosaccharides (MON-oh-SACK-ah-rides)
(simple sugars)—the simplest form of a carbohydrate—are the building blocks
of carbohydrates. Glucose is an example of a monosaccharide. If you combine
two monosaccharides to form a single molecule, you have a disaccharide. If you
string many monosaccharides together like beads in a necklace to form a single
molecule, you have a polysaccharide. See Figure 2.8. Glycogen (a starch) is an
O O O
O

(a) Monosaccharide (glucose) (b) Disaccharide O

O O
O O
O
O O
O O CH
O O 2
O O O O
O O
O O O O
O O O
O O
O O
O O
O O
O O
CH2 O O
O O
O O O
O O
O
O O

(c) Polysaccharide

FIGURE 2.8 Carbohydrates: (a) a monosaccharide, (b) two monosaccharides combined to form a disaccharide, (c) monosaccharides
strung together to form a polysaccharide like glycogen.

40 CHAPTER 2 Levels of Organization of the Human Body

 H O H H H H H H H H H H H H H H H FIGURE 2.9 Triglyceride (fat)
H C O C C C C C C C C C C C C C C C C H
synthesis. A glycerol molecule
combines with three fatty
H H H H H H H H H H H H H H H acid molecules to form
a triglyceride (fat).
O H H H H H H H H H H H H H H H H

H C O + C C C C C C C C C C C C C C C C C

H H H H H H H H H H H H H H H H

O H H H H H H H H H H H H H
H C O C C C C C C C C C C C C C C H
H H H H H H H H H H H H

H O H H H H H H H H H H H H H H H

H C O C C C C C C C C C C C C C C C C H

H H H H H H H H H H H H H H H

O H H H H H H H H H H H H H H H H H

H C O C C C C C C C C C C C C C C C C C C H

H H H H H H H H H H H H H H H H H

O H H H H H H H H H H H H H
H C O C C C C C C C C C C C C C C H
H H H H H H H H H H H H

Glycerol Fatty acid

portion portions

example of a polysaccharide. Carbohydrates are an energy source for the cell. You
will learn how they are used for energy later in this chapter when you explore
cellular respiration.
Lipids These organic molecules contain atoms of the same elements as those in car-
bohydrates (carbon, hydrogen, and oxygen) but not in the 1:2:1 ratio. The building
blocks of lipids are fatty acids and glycerol. See Figure 2.9. The three types of lipids
you will focus on in later chapters are fats, steroids, and phospholipids.

Proteins These organic molecules contain nitrogen in addition to carbon, hydro-

gen, and oxygen. The building blocks for proteins are the 20 different amino
acids. It is very important that you understand that proteins function in many ways
according to their shape. This shape is determined by the order of the protein’s
amino acids. Parts of amino acids may be attracted to segments of other amino
acids. This attraction causes the amino acid chain to bend, fold, and pleat, which
results in a very unique shape.
Consider this comparison: Think about the keys on your key ring. One key opens
the front door to your home, another opens the lock for your bike, a third key unlocks
your car. Although your keys are all basically made from the same metal, they do not
open the same locks. A tiny variation in shape makes a huge difference as to whether
or not the key works. The same is true for proteins. You will investigate how proteins
are made later in this chapter and how proteins are used in the body in every following
chapter. See Figure 2.10 for an example of protein structure.

2.2 Chemical Level 41

FIGURE 2.10 Protein Amino acids
structure. This diagram shows
First level—
the four levels of protein Amino acids are
structure. Each protein is a string bonded together
of amino acids that coils, sheets, to form a chain.
and folds and may assemble
with additional chains to form
the protein’s unique shape.

C C R
H H H
H N C O C
C N R
C O H N H
C
H H H HO H
C C R
Second level— R R
N C
Attraction of some N H O C
R
N C C
O
amino acids in the O C N H C H
R R H H O
chain to other amino C C
R
H
C
acids causes parts H N
H H
C O
N C
C N
of the chain to pleat O H R
C O H N
as a ribbon or coil as HO
C
H H H H
a rod. R
C C
R
R
N C
N H O C N C
R C O
C H
O C N H
H H OR
R R
C H
C C N
H H C
H N C O C N
O H
Pleated C O H N Coiled O
structure H H structure
C C

Third level—The
pleated ribbons and
coiled rods fold into a
three-dimensional
structure defining the
protein's unique shape.

Three-dimensional
folding

Fourth level—Two or
more uniquely shaped
proteins may be
connected to form a
single protein molecule.

42 CHAPTER 2 Levels of Organization of the Human Body

Nucleic Acids These organic molecules are composed of carbon, hydro-
gen, oxygen, nitrogen, and phosphorus. The building blocks for nucleic T A
acids are nucleotides. Nucleotides are composed of a sugar, a phosphate G C
group, and a nitrogenous base. Nucleotides are strung together in a twisted,
C G
double strand (double helix), as in deoxyribonucleic acid (DNA), or in a
single strand, as in ribonucleic acid (RNA). The nitrogenous bases in DNA A T

are guanine (G), cytosine (C), adenine (A), and thymine (T). In RNA, ura-
cil (U) is substituted for thymine. The double helix of DNA resembles a
twisted ladder with nitrogenous bases forming base pairs, the rungs of the
ladder. Guanine always pairs with cytosine (G-C), and adenine always pairs
with thymine (A-T). See Figure 2.11.
Your DNA contains all of the genetic information that is you. It
is not written in English; it is written in DNA language called the genetic
code.
English uses 26 letters combined in many different ways to form words
of various lengths. The words are separated by spaces, and thoughts are sep-
arated by punctuation to give them meaning. You must read the letters in
correct order to make sense of what is written. For example, tar has a very
different meaning than rat.
DNA language is much simpler. The genetic code has just four letters,
the nitrogenous bases of the nucleotides (G, C, A, T), that are always
read three nucleotides at a time (called a codon). If you know always to
Thymine (T) Adenine (A)
read three letters at a time, there is no need for spaces. Punctuation is
Guanine (G) Cytosine (C)
not necessary. Certain codons tell you where to begin and where to stop
reading the DNA. Your DNA has approximately 3 billion base pairs of
nucleotides to record all the information and directions on how your body FIGURE 2.11 DNA structure:
nucleotides pairing to form the DNA
works. A gene is the sequence of DNA that must be read to give you the
molecule.
directions to make one specific protein. Your DNA contains about 35,000
genes. RNA is used to process the DNA genetic information, as you will
learn later in this chapter.

Applied Genetics
Up to this point of the chapter, approximately 4,000 words involving the use of
16,000 letters (A to Z) were used to convey the information on the pages. The gene
that contains the directions on how to make a single chloride channel protein on a
cell membrane uses approximately 250,000 base pairs of nucleotides (G, C, T, A) to
convey the information. Cystic fibrosis, a genetic disorder that reduces life expec-
tancy to approximately 35 years, results when just 3 of the 250,000 base pairs
of nucleotides are missing. This results in the loss of 1 amino acid from the chain of
1,480 that are needed to make this chloride channel protein.1
As you will see later in this chapter, this small mistake in directions
results in an amino acid sequence that is slightly off, causing the shape
of the resulting protein to be slightly off too. Because the shape is not
exactly what it is supposed to be, the chloride channel protein does not
function properly. Cystic fibrosis is the result.
©MOLEKUUL/SPL/age fotostock

Spot Check What type of organic molecule is C6H12O6? Use Table 2.2 to derive
your answer.

2.2 Chemical Level 43

 Chemical Reactions

Learning Outcomes
8. Explain three factors governing the speed of chemical reactions.
9. Write the equation for cellular respiration using chemical symbols, and describe it in
words.
10. Explain the importance of ATP in terms of energy use in the cell.

Now that we have discussed atoms and molecules, we can look at what happens when
they are combined. Some molecules will react with others in what is called a chemi-
cal reaction. The sum total of all the chemical reactions that take place in the human
body is called metabolism. In any reaction, you start with reactants and end with
products:
Reactants → Products  or  Products ← Reactants
Read the arrow as “yield,” and know that it always points to the products. It does
not matter in what order the reaction is written, as long as you remember that you
always end with the products.

Speed of Reactions You must bring molecules together for them to react with one
another. Imagine a playland ball pit where children are playing. The children represent
reactants/molecules. You need to have children collide for them to interact. So what
can you do to get them to come together more quickly?
1. Increase the concentration of the reactants. Add more kids to the ball pit. More
children playing increases the likelihood that two or more will come together.
2. Increase the speed of the reactants. Giving all the kids caffeine and energy
bars makes them move faster and therefore more likely to come together.
Just as caffeine and energy bars speed up kids, heat speeds up the motion of
molecules.
3. Use a catalyst. Have an adult (the catalyst) step into the pit, grab one child with
one hand and another child with the other hand, and then bring them together. A
catalyst is any molecule that speeds up a reaction without becoming chemically
involved. Enzymes (one of the protein examples) often act as catalysts to speed
up chemical reactions. They facilitate the reaction without becoming chemically
involved.

Spot Check How does putting leftovers in the refrigerator relate to bacteria
metabolism?

Cellular Respiration Some reactions require that energy be added for them to occur.
Other reactions release the energy held in the chemical bonds between the atoms in a
molecule. Cellular respiration is such a reaction, and it is one of the most important
chemical reactions in the body. Chemical reactions are written using a shorthand of
chemical symbols and numbers. Here is the cellular respiration reaction, followed by
the meaning of the symbols and numbers:
C6H12O6 + O2 → CO2 + H2O
Glucose + Oxygen yields Carbon dioxide and Water
A law in nature states that matter can neither be created nor destroyed. So there
must be an equal number of atoms of each element on both sides of the sample reac-
tion shown. A subscript number indicates the number of atoms present for the element
just before it. No subscript is understood as 1. For example, the molecule CO2 (carbon
dioxide) contains 1 atom of carbon and 2 atoms of oxygen.

44 CHAPTER 2 Levels of Organization of the Human Body

 Count the atoms on each side of the reaction:

C6H12O6 + O2 CO2 + H2O

Reactant side Product side
Carbon 6 Carbon 1
Hydrogen 12 Hydrogen 2
Oxygen 8 Oxygen 3

As you can see, an unequal number of atoms for each element exists on each side
of this reaction. To balance the equation, numbers are placed in front of the molecules:
• If you have H2O, you have 1 molecule of water having 2 hydrogen atoms and 1
oxygen atom.
• If you have 3H2O, you have 3 molecules of water, each molecule having 2 hydro-
gen atoms and 1 oxygen atom. Three molecules of water have a total of 6 hydrogen
atoms and 3 oxygen atoms.
Now count the number of atoms for each element on each side of the reaction:

C6H12O6 + 6O2 6CO2 + 6H2O

Reactant side Product side
Carbon 6 Carbon 6
Hydrogen 12 Hydrogen 12
Oxygen 18 Oxygen 18
So the correct, balanced formula for this equation is:
C6H12O6 + 6O2 → 6CO2 + 6H2O
Glucose + Oxygen yields Carbon dioxide and Water
But, hold on, you are not finished just yet. Cellular respiration is performed in
cells. It is the reason you eat—to deliver glucose to cells. It is one of the reasons you
breathe—to deliver oxygen to your cells. But why is cellular respiration important? So
that you can produce carbon dioxide and water? Surely this cannot be the reason. Car-
bon dioxide is a waste product you get rid of by exhaling. And producing water is not
the reason either, as you can easily add water to your body by drinking. The reason our
cells perform cellular respiration is to release the energy within the bonds of the glu-
cose molecule. You will learn much more about this in the muscular system chapter.
The final, complete version of this chemical reaction is the one you must
remember:
C6H12O6 + 6O2 → 6CO2 + 6H2O + Energy
Glucose + Oxygen yields Carbon dioxide + Water + Energy

ATP The energy released from the glucose molecule in cellular respiration must be
converted to a usable form. A helpful analogy is that energy is like money. You may
have a job for which you earn money (or energy, in this example), which may be issued
as a paper check. There is monetary value in the check just as there is chemical energy
within the bonds of the glucose molecule. However, you cannot take your paycheck to
the vending machine to buy a soda. Although the check has monetary value, it is not
in a usable form. So the check must first be converted to cash before it can be used.
The same idea can be applied to your body cells. These cells cannot use the energy
contained in the chemical bonds of a glucose molecule until this energy has been

2.2 Chemical Level 45

FIGURE 2.12 Formation of
ATP. ADP combines with P P P Phosphate P P
to form ATP, a high-energy Yields
Energy A P A
molecule.
P
High-energy bond
Adenosine diphosphate Adenosine triphosphate

released through cellular respiration and converted to a usable form. This involves
another chemical reaction that requires the addition of energy:
Energy + ADP + P → ATP
Energy + Adenosine diphosphate + Phosphate → Adenosine triphosphate
Adenosine triphosphate (ATP) contains the usable form of energy for the cell.
This energy is released from a glucose molecule’s chemical bonds via cellular respira-
tion, and then it helps to form a chemical bond between adenosine diphosphate and a
third phosphate. See Figure 2.12. Cells can easily break the bond between the third
phosphate and adenosine, releasing the energy as needed. The usable form of energy
for the cell contained in the ATP molecule is like the cash in your pocket for the soda
in that vending machine.
You have now finished the basic concepts of chemistry in the chemical level of the
human body’s organization. You will need this understanding for the upcoming levels,
including the system levels in chapters that follow. It is vital that you see each level
not as an end point but, instead, as part of a building process in which the levels build
upon and support each other. In the section that follows, for example, you will see how
molecules function together as organelles in the next level of organization.

2.3 Organelle Level

Learning Outcome
11. Describe cell organelles and structures and explain their functions.

Molecules of different types come together to form organelles. Organelles are special-
ized, membrane-bound structures of cells. Each organelle has its own function, and
together they carry out the necessary cellular functions. Descriptions of organelles and
their functions are listed in Table 2.3. Not all cells have the same organelles. The type
and number of organelles in each cell depend upon the cell’s function.

The organelles are suspended within the cell in a fluid called cytoplasm, which
is a solution. Cytoplasm contains electrolytes, nutrients, wastes, and gases (such as
oxygen and carbon dioxide) as the solutes and water as the solvent. A cytoskeleton of
protein fibers organizes the organelles within the cytoplasm. See Figure 2.13.
Here are some specific examples of cell types and the organelles they need to per-
form their functions. Cells of the pancreas produce the protein insulin for export out

46 CHAPTER 2 Levels of Organization of the Human Body

 TABLE 2.3 Cell Structures and Organelles
Organelle Description and Location Function
Cell membrane Phospholipid bilayer Gives structure to cell, defining
(plasma membrane) what is intracellular (inside the
Found in all cells
cell) and what is extracellular
(outside the cell); regulates
what may enter or leave the cell

Cilia (SILL-ee-ah) Hairlike extensions of cell membrane Move in wavelike motion to

move materials past the cell
Found in cells needing to move materials outside
themselves (cells lining trachea, moving inhaled dust out of
the trachea)

Microvilli Hairlike extensions of cell membrane Provide extra surface area for
the cell
Found in cells requiring extra surface area (cells lining the
intestines, absorbing nutrients)

Nucleus Enclosed by a membrane Houses DNA

Found in all cells except red blood cells

Mitochondria Rod shaped; enclosed by a membrane Carry out cellular respiration

and process the energy
Found in large numbers in cells with high energy demands
released to form ATP

Ribosomes Large and small subunits Assemble amino acids into

proteins
Found in large numbers in cells that produce proteins

Endoplasmic Sheets of membrane extending from nuclear membrane

reticulum (ER)
1. Has ribosomes on its surface 1. Site of protein production
1. Rough ER Extensive in cells producing proteins
2. Smooth ER 2. Does not have ribosomes on its surface 2. Site of lipid production
Extensive in cells producing lipids

Golgi complex Membrane-enclosed folds usually close to the ER Receives and modifies proteins
(GOAL-jee) and lipids produced in the cell
Extensive in cells involved in protein and lipid production

Secretory vesicles Membrane packages bubbled off the Golgi complex that Carry materials from the Golgi
contain the inspected and modified products of the Golgi complex to the cell membrane
complex for export outside the cell
Found in large numbers in cells that produce proteins for
export out of the cell
Lysosomes Membrane-bound packages of enzymes Store and isolate enzymes
often used for intracellular
Found in large numbers in cells required to destroy
digestion until they are needed
materials (white blood cells destroy bacteria)

of the cell. On the basis of the organelle functions listed in Table 2.3, you may predict
that pancreas cells need the following:
• Well-developed, rough endoplasmic reticulum (site of protein production)
• Many ribosomes (to assemble proteins)
• Many Golgi complexes (to receive and modify proteins produced)
• Many secretory vesicles (to serve as packages for export out of the cell)

2.3 Organelle Level 47

 Nucleus
Ribosomes
Rough
endoplasmic Cell membrane
reticulum
with ribosomes

Smooth Mitochondrion
endoplasmic
reticulum

Microvilli

Secretory
vesicles
Cilia
Golgi
complex

Cytoskeleton
fibers

Lysosomes

FIGURE 2.13 Generic cell cut to reveal its organelles.

On the other hand, white blood cells that phagocytize (FAG-oh-sit-ize) (eat and
destroy) bacteria do not need the same relative amounts of organelles. White blood
cells need many lysosomes containing digestive enzymes to destroy the bacteria.

Common Misconception
Figure 2.13 may lead to a misconception, as it depicts a generic cell showing the differ-
ent possible types of organelles. Each type of cell is unique on the basis of its structure
and function. Each cell has its own unique set and number of organelles to carry out
that function. See Table 2.3.

Spot Check Predict the relative amounts of organelles needed for a cell in a
testicle that produces the steroid hormone testosterone. Use Table 2.3 to derive your
answer.

Cell Membrane
By studying the cell membrane, another important cell structure, you will see how
different organic molecules work together.

48 CHAPTER 2 Levels of Organization of the Human Body

 Common Misconception
Be careful of the terminology for this structure, as it is a cell membrane, not a cell wall.
Cell walls are not found in human (animal) cells; they are found in bacteria and plant
cells. Cell walls in plants are made of a carbohydrate called cellulose, which is indigest-
ible for humans. In nutrition, cellulose is commonly called fiber. Nutrition and its role
in maintaining homeostasis will be covered in many of the system chapters. But we
return here to our discussion of the cell membrane.

The cell membrane is designed to define the cell by separating the extracellular fluid
(fluid outside the cell) from the intracellular fluid (fluid inside the cell). Both fluids are
primarily water. Phospholipids, the primary component of a cell membrane, are com-
posed of a hydrophilic (water-loving) glycerol head and two fatty acid hydrophobic
(water-fearing) chains. The phospholipids arrange themselves in a bilayer. This means
that the glycerol heads face the extracellular and intracellular fluids and that the fatty acid
chains face toward each other (away from the fluids). The phospholipids are not rigidly
connected; they float side by side in what is called a fluid mosaic. Cholesterol molecules
(an example of a steroid lipid) may be found between the fatty acid chains of the phos-
pholipids. Their presence may cause a stiffening of the cell membrane. See Figure 2.14.
In addition to containing phospholipids and steroids, the cell membrane may also
contain a variety of embedded proteins. Some of these proteins serve as receptors. Their
unique shape on the extracellular side of the cell membrane can make them sensitive to
specific chemicals, such as hormones. Other proteins serve as channels to allow materi-
als (like those unable to travel through the phospholipid bilayer) to enter the cell. You
will read more about membrane transport shortly. Still other proteins have a carbohy-
drate on their extracellular surface. These glycoproteins serve as an identifying tag that
enables the immune system to tell what is self from what is foreign. You will explore
glycoproteins more fully in the cardiovascular and lymphatic system chapters.

Extracellular side
Carbohydrate of membrane

Glycoprotein

Glycerol
Bilayer of head
phospholipid
molecules Phospholipids
Fatty acid
chains
(a)
Receptor
protein

Glycolipid

Channel Cholesterol
protein molecules Intracellular side
of the membrane

(b)

FIGURE 2.14 Cell membrane (plasma membrane): (a) phospholipids, (b) cell membrane.

2.3 Organelle Level 49

 All of these organic molecules come together to carry out the functions of the cell
membrane. These functions are the following:
• To give structure to the cell
• To define what is intracellular (inside the cell) and what is extracellular (outside the cell)
• To regulate what may enter or leave the cell by a process called membrane transport
Now that you understand the organelle level, you are ready to explore how the
organelles (listed in Table 2.3) work together to complete the functions of the next
level of your body’s organization.

2.4 Cellular Level

By now you should be familiar with the anatomy of cells, which are defined by a cell
membrane and contain various organelles depending upon the cell’s function. Protein
fibers suspend the organelles in a solution called cytoplasm, and together the organ-
elles carry out the cell’s functions. We discuss below the cellular functions of mem-
brane transport, protein synthesis, and cell division.

Membrane Transport

Learning Outcomes
12. C
 ompare four methods of passive transport and active transport across a cell membrane
in terms of materials moved, direction of movement, and the amount of energy required.
13. Describe bulk transport, including endocytosis and exocytosis.

Movement of ions and molecules across the cell membrane can happen in either of two
general ways: passively (requiring no energy) or actively (requiring energy). Materials
can also be moved across the cell membrane in bulk.

Passive Transport Passive transport can move materials across the cell membrane
in either direction—into or out of the cell. It is important to remember that with each of
the four following methods, no energy is required for this type of movement to happen.
1. Filtration. Filtration is a passive-transport method that moves materials across a
cell membrane using force but no energy. An analogy for this is a coffee maker.
The membrane is the coffee filter. You place coffee grounds in the filter. The filter
allows materials to pass through according to the size of its pores. It allows water
and the coffee’s essence through, but not the grounds. The coffee maker uses the
force of gravity to move the water and the coffee’s essence through the filter. An
example of this method of transport in the body occurs in the kidneys. Water and
some wastes are removed from the blood in the kidney to form urine. The filter in
this case is the cell membranes of the blood vessel walls. It is not gravity, however,
that allows the wastes to cross the vessel walls in the kidney (you can still produce
urine standing on your head). Instead, the blood pressure forces wastes out of the

50 CHAPTER 2 Levels of Organization of the Human Body

 bloodstream to form urine in the kidney.
No energy is required.
2. Simple diffusion. All atoms and mole-
cules maintain a constant state of motion.
Even the molecules in the paper of a
book are moving while you are reading.
Although they do not move very far from
each other because the paper is a solid,
they do in fact move. Molecules in liq-
uids and gases move more freely. You can
see evidence of this movement if you add
a drop of food coloring to a stationary FIGURE 2.15 Simple
diffusion. A drop of red dye
container of water. At first you can see exactly the position of the food-coloring
is placed in a cup of water
drop in the water. But, as time goes on, the food coloring disperses equally
and soon diffuses throughout
throughout the container’s contents. In simple diffusion, as in all diffusion the cup.
methods, materials (like the molecules in the drop of food coloring) move from ©Deborah Ann Roiger
areas of high concentration to areas of low concentration until the concentrations
become equal. See Figure 2.15.
Of course, not all materials can pass through the cell membrane by simple dif-
fusion. In fact, the cell membrane is selectively permeable, which means that only
select molecules can pass through it by simple diffusion. Oxygen is an example of
a molecule that can pass through the phospholipid bilayer on its own.
The following factors govern the speed of simple diffusion:
• Temperature. Heat causes molecules to move faster; increased temperature
increases the speed of simple diffusion.

• Molecular weight. Heavy proteins move slower than lighter, smaller molecules
like electrolytes, and gases diffuse faster.

• Concentration gradient. This is the amount of difference in concentration on

either side of the membrane; the greater the difference, the faster the diffusion.
Materials are said to move down a concentration gradient (from areas of high
concentration to areas of low concentration) until they are equal on both sides of
the membrane.

• Membrane surface area. The speed of diffusion is increased with greater

surface area, so there is more membrane for this to occur.
3. Facilitated diffusion. This passive-transport method is used for molecules that
cannot diffuse through the selectively permeable membrane on their own (like
glucose), so they need help getting through a channel protein. Consider again
homeostasis and the negative feedback example in “Chapter 1, The Basics.” If
Jen consumes the soda and candy bar she bought from the vending machine on
her study break, her digestive system digests the soda and candy bar and absorbs
the sugar into her bloodstream. This causes her blood sugar (glucose) level to rise
above normal. Her pancreas recognizes the increased glucose level and responds
by releasing the hormone insulin, which travels to most cells. Insulin binds to a
protein receptor (shaped specifically for insulin) on the cell’s surface. When insu-
lin is bound to this receptor, a gated channel protein opens. This allows glucose to
diffuse into the cell from an area of high concentration to an area of low concen-
tration until the concentrations on the outside and inside of the cell are equal. The
transport of glucose across the cell membrane fits the description of diffusion, but
it requires insulin fitting into the receptor before it can happen. The cell’s glucose
uptake lowers the blood glucose level, restoring homeostasis. This is negative
feedback. See Figure 2.16.

2.4 Cellular Level 51

FIGURE 2.16 Examples of
membrane proteins during
transport. In facilitated diffusion,
insulin binds to a protein
receptor (a) based on shape. Glucose
This causes a gated channel for Insulin molecules
glucose (b) to open, allowing
glucose to diffuse into the cell.
A channel protein (c) that is not
for glucose remains closed.

(a) Receptor (b) Glucose (c) Channel

protein channel protein

4. Osmosis (oz-Mo-sis). An important homeostasis concept is fluid and electrolyte

balance. Cell membranes are selectively permeable. As you have seen, some mol-
ecules can move across the membrane by filtration, some by simple diffusion, and
others by facilitated diffusion. Some molecules, however, cannot move across the
cell membrane to equalize their concentration by any passive means. In the human
body, the intracellular fluid (cytoplasm) and the extracellular fluid are both solutions.
If the solutes cannot move across the membrane, water will move across the cell
membrane by a process called osmosis to equalize the concentration of both solu-
tions. Water moves to the more concentrated solution to dilute it. See Figure 2.17.
An example of osmosis can be seen in the blood. Blood is composed of blood cells
traveling in plasma. The cytoplasm inside the blood cells and the plasma on the outside
are both solutions separated by the selectively permeable cell membrane. If the plasma
is isotonic (has the same concentration of solutes relative to the cytoplasm of the blood
cells), no movement of water by osmosis takes place. If the plasma is hypotonic (less
concentrated with solutes than the cytoplasm of the blood cells), water from the plasma
will move across the cell membrane by osmosis to reduce the concentration of solutes in
the cytoplasm of the blood cells. The blood cells swell to accommodate the extra water.

FIGURE 2.17 Osmosis. Selectively

A selectively permeable permeable membrane
membrane separates
this container into two
compartments. At the start, A
shown in part (a), side A
contains water and many large A B
protein molecules. Side B
contains water and fewer large B
protein molecules (hypotonic).
The protein molecules cannot
move across the selectively
permeable membrane. So,
in part (b), water moves from
side B to side A to try to
equalize the concentrations. Time

Protein molecule Water molecule

(a) (b)

52 CHAPTER 2 Levels of Organization of the Human Body

 FIGURE 2.18 Red blood cells
in three solutions: (a) hypotonic,
(b) isotonic, (c) hypertonic.
©David M. Phillips/Science Source

(a) (b) (c)

If the concentration gradient is too great, the blood cells may lyse (burst). If the plasma is
hypertonic (more concentrated with solutes than the cytoplasm of the blood cells), water
from the cytoplasm will move across the membrane by osmosis to reduce the concentra-
tion of solutes in the plasma. The blood cells may crenate (shrivel and appear spiky)
from the water loss. Fluid balance is an important concept in several upcoming chapters.
See Figure 2.18.

Spot Check It is possible to chemically remove just the shell from a raw egg.
You are then left with a membrane enclosing a highly concentrated solution: the egg
white. The egg’s membrane is selectively permeable and will not let the solutes inside
the egg cross this membrane. Predict what will happen to the egg’s weight if the egg is
placed in a beaker of water. What membrane transport process will be responsible for
the change, if any?

Active Transport Active transport moves materials across the cell membrane from areas
of low concentration to areas of high concentration. This involves moving materials up a
concentration gradient against the natural trend of diffusion. It requires the cell’s usable
form of energy contained in ATP molecules. An analogy for this is a flood. The ceiling,
walls, windows, and doors of a basement apartment are like a cell membrane, regulating
what can enter or exit the apartment. In a flood, water enters the apartment through the
somewhat leaky walls, windows, and doors from an area of high concentration (outside
the apartment) to an area of low concentration (inside the apartment) until the levels are
equal. This is simple diffusion, a passive process. The apartment resident, however, will
want to make the water move in the opposite direction, from an area of low concentration
(the apartment) to an area of high concentration (outside) to keep the apartment dry. This
requires the work of a pump that needs energy to run. This is active transport.
An example of this type of membrane transport in the body is a sodium-potassium
pump. This series of channels on the cell membrane regulates the concentration of
sodium and potassium ions on both sides of the cell membrane. This is vital for neurons
(cells of the nervous system that carry electrical messages). Ions are charged atoms.
Electricity is the flow of charged particles. The sodium-potassium pump controls the
flow of electricity by controlling the concentration of these ions and their movement
across the cell membrane. About half of the energy you use each day is used to run the
sodium-potassium pump. This is another example of homeostasis and fluid and electro-
lyte balance. Without the sodium-potassium pump regulating the concentration of ions
on either side of the cell membrane, the normal physiology of the nerve cell will be dis-
rupted. You will learn more about how this works in the nervous system chapter.

Spot Check What high-energy molecule will the sodium-potassium pump need?

2.4 Cellular Level 53

 Particle
Bulk Transport This form of membrane transport moves
large quantities of materials—not individual ions and
1 molecules—across a cell membrane at one time. The two forms
White blood cell
approaches foreign of bulk transport—depending upon the direction materials are
particle. Nucleus transported—are explained here:
1. Endocytosis moves materials into the cell in bulk. For
example, a white blood cell moves close to a foreign par-
ticle such as a bacterium, engulfs it by surrounding it with
2
its cell membrane, and then pinches the membrane off,
White blood cell
engulfs particle.
creating a membrane-enclosed vesicle (packet) of the bac-
terium inside the cell. Here, in essence, the white blood
cell has phagocytized (eaten) the bacterium. A lysosome,
Lysosome containing digesting enzymes, can then merge its mem-
brane with the membrane enclosing the bacterium. The
3
Vesicle is formed
Vesicle with enzymes from the lysosome digest the bacterium, making
foreign matter
containing the it harmless.
particle (endocytosis).
2. Exocytosis moves materials out of the cell in bulk. Con-
tinuing the previous example, the membrane-enclosed
packet of the digested bacterium moves to the inside of
the cell membrane, merges with it, and then opens to the
4 outside, expelling its contents (the digested bacterium) in
Lysosome merges
bulk. See Figure 2.19.
with the vesicle.

Protein Synthesis

5 Learning Outcomes
Enzymes from the
lysosome digest the 14. D
 escribe the processes of transcription and translation in
foreign particle. protein synthesis in terms of ___location and the relevant nucleic
acids involved.
15. Describe what happens to a protein after translation.
16. Explain the possible consequences of mistakes in protein
6 synthesis.
The vesicle
merges with the
cell membrane.
Making proteins, a process called protein synthesis, is another
major function for many different cells. The production process
from cell to cell is the same. However, the directions and the
assembly of the amino acid building blocks can result in very
7
Residue different proteins. The directions for assembling the amino acids
The contents of the into a protein are written in the DNA, housed in the nucleus.
vesicle are expelled It is the ribosome (floating free in the cytoplasm or located on
(exocytosis).
the rough ER) that actually assembles the amino acid building
blocks in the correct order to produce a functioning protein. Pro-
tein synthesis is a two-stage process involving transcription
FIGURE 2.19 Endocytosis and exocytosis. Steps 1
through 3 show endocytosis. Steps 4 through 7 show
and translation.
exocytosis.
Transcription Transcription must happen first, and it occurs
in the nucleus. The DNA contains all the information on cre-
ating a protein, but it cannot leave the nucleus. Somehow, the information con-
tained in the DNA must be converted to a form that can be transported to where it
needs to be used. This is similar to taking notes from a book on reserve in a library.
You need the information where you will write your paper, but you cannot take
the book from the library. In transcription, the double-stranded DNA is opened
at the section containing the directions for making the protein. Free nucleotides
bind to one side of the open DNA (C’s bind to G’s and U’s bind to A’s) to form a

54 CHAPTER 2 Levels of Organization of the Human Body

single-stranded messenger RNA (mRNA) molecule. Uracil (U) replaces thymine
(T) in RNA language. The mRNA, carrying the DNA directions in a usable form,
leaves the nucleus and travels to the ribosome. See Figure 2.20.

DNA
double helix Inside nucleus Cytoplasm

T A
G C Messenger U A
A T RNA C G
C G
(blue) C G
G G C
A T A T
C G DNA T U A C G
A T opens G G C
G A T DNA
C G G G C
C G C A T strand
T CG (orange)
C C G
A T C U A
C G G C G
G C C C G
T A A 1 G C
CG
A T A A T
C A T
AC TG C G
C G G
G
G C 2
G C mRNA
A T C C G
C G (messenger RNA)
G C A T
T A G C
A T To the
AC G
C GT C G ribosome
A TG A T
C

FIGURE 2.20 Protein synthesis: Transcription. Steps 1 and 2 show transcription. (1) The
DNA molecule is opened, and the DNA information is copied, or transcribed, into mRNA;
(2) mRNA leaves the nucleus to attach to a ribosome.

Translation Translation happens at the ribosome. The ribosome, free or on the

rough ER, must use the directions contained in the mRNA to assemble amino acids
into a functioning protein. There are 20 individual and unique amino acids. The spe-
cific amino acids used and their sequence are vital to the protein’s eventual shape.
These amino acids must be transported to the ribosome on the rough ER for assembly.
The process of translation is similar to automobile production. A car is made of
auto parts. Each type of auto part is unique just as amino acids differ from one to
another. Trucking companies transport and deliver the auto parts, which eventually
end up in an assembly line at the assembly plant for the autoworkers. Different truck-
ing companies deliver different parts. One delivers spark plugs; another delivers wind-
shields. The placement of these auto parts—engine, tires, seat belts—must be specific
if the car is to work properly. For example, a engine cannot be installed in place of a
muffler, and a tire will not work in place of a steering wheel.
In translation, the ribosome reads the directions (on how to make a protein) three
nucleotides (a codon) at a time on the mRNA. A transfer RNA (tRNA) molecule
delivers a specific amino acid to the ribosome by matching its three nucleotides (anti-
codon) to the codon on the mRNA (C’s match to G’s and U’s match to A’s). Transfer
RNA is the truck delivering a specific auto part (amino acid) to the plant for assembly.
The ribosome “reads” the next codon on the mRNA. The tRNA that has the correct
anticodon to match with it brings its specific amino acid to the ribosome. The amino
acids are joined together at the ribosome, and the first tRNA falls away to pick up
another of its specific amino acids from the cytoplasm (for later use). This process
continues until the complete amino acid chain (like a complete car) is assembled.
See Figure 2.21.

2.4 Cellular Level 55

FIGURE 2.21 Protein
synthesis (continued):
Translation. Steps 3 and 4 3
show translation. (3) Translation 1
Growing 2
begins as tRNA molecules 3
polypeptide 4
with anticodons that match to 5 6 Next
chain
mRNA codons bring specific amino acid
Anticodon Transfer
amino acids to the ribosome;
(4) translation continues as the RNA
UGCCG U
ribosome moves along the
A U G G G C UC C GC A ACGGC A G GC A AGC GU
mRNA and more amino acids
are added. (5) The ribosome Messenger
releases the assembled protein 1 2 3 4 5 6 7 RNA
shown here with the mRNA that
Codons Peptide
was used for its assembly.
1 bond
2 4
Growing 3
polypeptide 4 Next
5 6
chain amino acid
Anticodon Transfer
RNA
U GC CGU
A U G G G C U C C GC A A CGGCA G GC A A GC GU

Messenger
1 2 3 4 5 6 7 RNA
Codons
1
2 3 4 Next
5 7
6 amino acid
Transfer
RNA
UGC C CG
CG U
A U G G G C U C C GC A AC G GC A G GC A A G C G U

Messenger
1 2 3 4 5 6 7 RNA

Ribosome
1
2 3 4
5 Next
6 7 amino acid
Transfer
RNA
C GU CCG
A U G G G C U C C GC A A CGGCA GGC A AGCG U

Messenger
1 2 3 4 5 6 7 RNA

Amino acids represented

5
Metheonine Serine Threonine Glycine

Glycine Alanine Alanine

Codon: 1 2 3 4 5 6 7

AUGGGCUCCGCAACGGCAGGC

56 CHAPTER 2 Levels of Organization of the Human Body

 Nuclear pore 1
Protein gene is
transcribed to form
mRNA.

2
mRNA leaves the
nucleus to go to the
ribosome.

3
Milk mRNA is translated
protein to form the protein.
mRNA

4
The Golgi complex
receives and modifies
Milk protein the protein.
in Golgi vesicle

5
Protein exits the
Golgi complex in a
secretory vesicle.

FIGURE 2.22 What happens after translation. Steps 1, 2, and 3 show transcription and
translation. In step 4, the resulting chain of amino acids is received by the Golgi complex and
modified. In step 5, the protein exits the Golgi complex in a secretory vesicle to be exported
out of the cell.

Once the amino acid chain has been formed, the Golgi complex receives it and pos-
sibly modifies it chemically. The cell may use the modified protein directly from the
Golgi complex, or the Golgi complex can package the protein in a secretory vesicle that
carries the protein to the cell membrane to be exocytosed from the cell. See Figure 2.22.

Spot Check If the third codon on the DNA strand in the nucleus coding for a
particular protein was GCC, what corresponding codon would be formed for the mRNA
during transcription? What would have to be the anticodon of the tRNA used
to match this mRNA codon during translation?

Mistakes in Protein Synthesis Although the preceding examples above may give
the impression that protein synthesis is always a smooth and successful process, mis-
takes can happen. Such mistakes may be catastrophic or of little consequence. Transfer
RNA has a three-nucleotide anticodon on one end and uses the other end to transport
one of 20 different amino acids. Four possible nucleotides can be combined to form
the three-nucleotide anticodon on a tRNA molecule. There are more possible combi-
nations for anticodons than there are different amino acids. As a result, some amino
acids may be transported by more than one tRNA. If a mistake in transcription results
in a faulty mRNA molecule, either of two outcomes may result:
1. The ribosome reading the faulty mRNA calls for a tRNA that brings an amino acid
that is wrong.

2.4 Cellular Level 57

 2. The ribosome reading the faulty mRNA calls for a tRNA that just happens to be a
tRNA that brings the correct amino acid.
In the first case, a different protein is made, with possible drastic consequences. In
the second case, the correct protein is made and there are no consequences.

Cell Division

Learning Outcomes
17. D escribe the process of mitosis, including a comparison of the chromosomes in a
parent cell to the chromosomes in the daughter cells.
18. Explain the possible consequences of mistakes in replication.

Cell division is another key cellular function. Meiosis and mitosis are the two types
of cell division. Meiosis (my-OH-sis) is involved only in sperm and egg production;
it is discussed in the reproductive system chapters (Chapters 15 and 16). Mitosis (my-
TOE-sis) is the process all other cells use to divide, and it is necessary for the develop-
ment of the human anatomy, which is composed of 40 trillion cells.
In mitosis, a single cell, the parent cell, divides to become two daughter cells.
Once the division has taken place, the parent cell no longer exists. The two daughter
cells are identical to each other and to the parent cell that came before them.

Common Misconception
Do not be confused by the terminology of mitosis. The terms parent cell and daughter
cells have nothing to do with sexual reproduction or gender; they are simply used to
refer to generations, as in parents come before daughters.

During most of a cell’s life cycle, the DNA in the nucleus is loosely spread out in an
arrangement called chromatin (KROH-ma-tin). This arrangement allows information
contained in the DNA to be used more easily. Think of the way you arrange your books
and notes when studying. By spreading these materials out in front of you—books
open, notes visible—you have immediate access to the information. When you have
finished studying, you will need to pack these materials in your backpack to take with
you. At that point, it would no longer be an advantage to have everything spread out.
Back to the cell: To divide, the cell packages the chromatin into tight, compact
bundles called chromosomes. There are 46 chromosomes in all human cells other
than sperm and eggs (sperm and eggs each contain 23 chromosomes). In a typical
cell, the chromosomes are arranged in 23 pairs: Half of each pair is from the indi-
vidual’s mother; the other half is from the individual’s father.

Clinical P int
The exception to this is red blood cells, which do not have nuclei and, hence, have
no DNA. Forensic scientists use the DNA from white blood cells to test and establish
identity or paternity.

All cells in an individual have the same DNA. Skin cells producing the skin pig-
ment melanin have the same DNA as pancreas cells producing insulin. Salivary gland
cells producing saliva have the same DNA as stomach cells producing stomach acid.
Muscle cells have the same DNA as bone cells. They all contain the complete set of
information, all 3 billion base pairs. Each type of cell uses only the part of the DNA
that is relevant to its specific function.
The reason that every cell has the same complete set of human DNA is further
explained here: A fully developed human is composed of approximately 40 trillion

58 CHAPTER 2 Levels of Organization of the Human Body

cells. These cells begin from one fertilized egg (a zygote). The zygote received
half of its DNA from the father’s sperm and the other half from the mother’s
egg. The zygote has 46 chromosomes when it begins its first division by mito-
sis. It becomes two identical daughter cells when mitosis is complete. It seems
reasonable to conclude that when a cell with 46 chromosomes divides into two
equal parts, the resulting two cells will each have 23 chromosomes. But this is not
the case. The parent cell, the zygote in this case, makes an identical copy of the
DNA before dividing so that each daughter cell gets a complete set that is identi-
cal to the DNA set of the other daughter cell and identical to the DNA set of the
parent cell. This copying, called replication, ensures that every cell (other than
the exceptions mentioned earlier) has a full identical set of DNA. The process of
mitosis continues over and over until the fetus is fully developed. Even after birth,
mitosis is important for the growth of organs and tissues, the repair of damaged
cells, and the replacement of dead cells. Therefore, mitosis is a multistage process,
as you can see in Figure 2.23, and its basic concept is relatively simple, as shown
in Figure 2.24.

Early interphase
of daughter cells—
a time of normal cell 1
growth and function P
Prophase

4 2
T
Telophase M
Metaphase

3
A
Anaphase

FIGURE 2.23 Mitosis. The series of micrographs shows the stages of mitosis in whitefish eggs. The diagram depicts a
hypothetical cell with two chromosome pairs. Human cells contain 23 pairs of chromosomes. The stages are (1) prophase:
chromatin condenses to form chromosomes, and the nuclear membrane breaks down; (2) metaphase: chromosomes align along
the midline of the cell; (3) anaphase: chromosomes move to opposite poles; (4) telophase: chromosomes decondense to form
chromatin, the nuclear membrane forms, and the cell finishes division.
©Ed Reschke

2.4 Cellular Level 59

FIGURE 2.24 Mitosis
simplified. One parent cell with Parent Cell
46 chromosomes replicates
and divides to form two
daughter cells each having 46
chromosomes. The daughter
cells’ DNA sets are identical to 46 chromosomes
23 pairs
each other and to the parent
cell’s DNA, which no longer
exists once mitosis has taken
place.

Replication

Daughter Cell Daughter Cell

46 chromosomes 46 chromosomes
23 pairs 23 pairs

Spot Check How does the DNA of a brain cell compare to the DNA of a bone
cell? How does the DNA of a brain cell differ from the DNA of a sperm cell?

Replicating 3 billion base pairs of human DNA each time a cell divides is an
amazing feat. Each cell has special enzymes to check for accuracy during the rep-
lication process, but nothing is perfect. Mistakes happen. Even if the enzymes
mistake only a few base pairs of nucleotides, there may be consequences. If the
mistake in replication (mutation) occurs in the part of the DNA that the cell does
not use, there are no consequences. If it occurs in a section of DNA the cell does
use, the cell will be affected. This mutation may or may not be of benefit to the cell.
Regardless of the benefit or harm the mistake causes for the cell, the mutation will
be carried on to the next daughter cells when the cell divides.

Effect of Aging on Cells

Learning Outcome
19. Describe the effects of aging on cell division.

A human cell can divide for only so long. One possible explanation involves telo-
meres. Telomeres are sequences of nucleotides that provide a protective cap on the
ends of chromosomes. Although they do not code for the production of proteins, they
are believed to stabilize the chromosome by keeping it from unraveling and preventing
it from sticking to other chromosomes. The cell cannot replicate the very ends of the
chromosome. So each time the cell divides, a fraction of the telomeres is lost. Once all
of the telomeres are lost, the protective cap no longer exists and vital protein-coding
nucleotide sequences are then at the ends of the chromosome. The cell still cannot
replicate the ends of the chromosomes, and with vital nucleotides at these ends, more
and more mistakes in replication are bound to happen. As a result, the cell’s chances of

60 CHAPTER 2 Levels of Organization of the Human Body

producing more and more dysfunctional proteins increase with age. Eventually the cell
becomes nonfunctional and dies. See Figure 2.25.

Clinical P int
Cancer cells have an active enzyme that is absent in normal cells. This enzyme, telomerase,
repairs the telomere damage during replication, making the cancer cell immortal.

You now have a better understanding of cellular functions and the effects of aging
on cells. In the next section, you will see how cells function together at the tissue level.
FIGURE 2.25 Telomeres:
micrograph of human
2.5 Tissue Level chromosomes with telomeres
highlighted.
©Dr. Hesed M. Padilla-Nash, Ph.D.,
Learning Outcome National Cancer Institute/National
Institutes of Health
20. Describe the four classifications of tissues in the human body.

Histology is the study of tissues. The four basic classifications of tissues are epithelial,
connective, muscle, and nervous. Following you will find a basic explanation of each of
these tissue classes. Specific tissues are covered in the relevant system chapters.

Epithelial Tissues
These tissues cover and line all body surfaces. Epithelial tissues cover organs, ves-
sels, and ducts and line hollow organs, vessels, and ducts. As a result, all epithelial
cells have a free edge that borders an open area on the outside surface or as a lining of
an inside surface. Epithelial tissues are named, first, for the shape of their cells and,
second, for the amount of layering of the cells.
It is important to know that cells are three-dimensional objects—with a width,
height, and depth—that can have different shapes. Epithelial cells can be squamous
(SKWAY-mus) (flat and thin), cuboidal (cube-shaped), or columnar (tall column-
shaped). A basement membrane separates epithelial tissue from other tissues.
Tissue layering is described in three ways: Simple epithelial tissue has a single
layer of epithelial cells; stratified epithelial tissue is composed of stacked layers
of epithelial cells; and pseudostratified epithelial tissue appears to be layered,
but all cells have contact with the basement membrane, so it is a false (pseudo)
layering. See Figure 2.26.
The following are some examples of epithelial tissue:
• Simple squamous epithelial tissue lining the alveoli (air sacs) of the lung. See
Figure 2.27.
• Simple cuboidal epithelial tissue that lines the tubules in the kidneys. See
Figure 2.28.
• Stratified squamous epithelial tissue lining the mouth and esophagus. See
Figure 2.29.
• Simple columnar epithelial tissue that lines the small intestines. See Figure 2.30.

2.5 Tissue Level 61

 • Pseudostratified ciliated columnar epithelial tissue that lines much of the respi-
ratory tract. In addition to its ciliated columnar cells that move debris in the
respiratory tract, this tissue contains goblet cells that function to produce mucus.
See Figure 2.31.
An exception to the naming of epithelial tissue is transitional epithelial tissue.
This epithelium is stratified (layered), but its cell shape is difficult to describe because
it is so changeable. Transitional epithelial tissue is designed to stretch, and it lines
structures like the urinary bladder. If stretched, the cells appear to be more squamous.
If not stretched, they appear to be more cuboidal. See Figure 2.32.

FIGURE 2.26 Epithelial cell

shapes and layering.

Cell shapes

Squamous Cuboidal Columnar

Layering of
epithelium

Basement
membrane
Basement
membrane
Simple Stratified Pseudostratified
(simple columnar (stratified squamous (pseudostratified ciliated
epithelium) epithelium) columnar epithelium)

Free surface

Nucleus

Basement
membrane

Simple squamous
epithelial cell

FIGURE 2.27 Simple squamous epithelial tissue, showing a single layer of squamous cells (nuclei of epithelial cells appear
as dark circles), the free edge (free surface) bordering the lumen (open space), and the basement membrane separating the
epithelial tissue from other tissue. Micrograph: simple squamous epithelial tissue lining the alveoli (air sacs) of the lung.
©Ed Reschke

62 CHAPTER 2 Levels of Organization of the Human Body

 Free surface

Nucleus

Simple cuboidal
epithelial cell

Basement
membrane

FIGURE 2.28 Simple cuboidal epithelial tissue, showing a single layer of cuboidal (cube-shaped) cells (nuclei of epithelial
cells appear as dark circles), the free edge bordering the lumen (open space), and the basement membrane separating the
epithelial tissue from other tissue. Micrograph: simple cuboidal tissue lining kidney tubules.
©Victor Eroschenko

Free surface

Stratified
squamous
epithelial cell

Nuclei

Basement
membrane

LM 286x

FIGURE 2.29 Stratified squamous epithelial tissue, showing stratified squamous cells, the free edge bordering an open
area, and a basement membrane separating the epithelial tissue from other tissue. Micrograph: stratified squamous epithelial
tissue of the skin.
©Victor Eroschenko

2.5 Tissue Level 63

 Lining of
small
intestines

Free surface

Goblet cell
containing mucus

Nucleus

Simple columnar
epithelial cell

Basement LM 640x
membrane

FIGURE 2.30 Simple columnar epithelial tissue, showing a single layer of columnar-shaped cells, the free edge bordering the
lumen, goblet cells that produce mucus, and a basement membrane separating the epithelial tissue from the connective tissue.
Micrograph: simple columnar epithelial tissue lining the small intestines.
©Victor Eroschenko

Cilia

Free surface

Goblet cell
containing mucus

Pseudostratified
ciliated columnar
epithelial cell

Nucleus

Basement
LM 413x
membrane

FIGURE 2.31 Ciliated pseudostratified columnar epithelial tissue, showing a pseudostratified layer of ciliated columnar-
shaped cells, the free edge bordering the lumen, goblet cells that produce mucus, and a basement membrane separating the
epithelial tissue from the connective tissue. Micrograph: ciliated pseudostratified columnar epithelial tissue lining much of the
respiratory tract.
©Victor Eroschenko

64 CHAPTER 2 Levels of Organization of the Human Body

 Free surface

Transitional
epithelial cell

Nucleus

LM 413x

Basement
membrane

(a) Tissue not stretched

Free surface

Transitional
epithelial cell

Nucleus LM 413x

Basement
(b) Tissue stretched membrane

FIGURE 2.32 Transitional epithelial tissue, showing the free edge, the transitional epithelial cells, and the basement
membrane separating the epithelial tissue from other tissue. Notice that part (a) shows this tissue when not stretched and
part (b) shows this tissue stretched. Micrographs: transitional epithelial tissue lining the urinary bladder.
Photos: ©Victor Eroschenko

Connective Tissues
Connective tissues all have cells and fibers in a matrix (background substance). The
density of the matrix and the type of cells and fibers determine the type of connective
tissue. The density of the matrix is highly variable; it can be very fluid, as in blood, or
as dense and hard as concrete, as in bone.
Types of connective tissue include the following:
1. Loose/areolar connective tissue has a loose arrangement of fibers in a matrix
with a thick fluid consistency. A variety of cells are able to move through the
matrix. It is found, for example, in the middle layer of the skin (dermis) and
between the serous layers of the mesenteries. See Figure 2.33.
2. Dense regular connective tissue has mostly dense bundles of collagen (pro-
tein) fibers that run parallel to each other. Fiber-making cells (fibroblasts) are

2.5 Tissue Level 65

 Dermis

Collagen
fiber
Fibroblast

Ground
substance

Elastic
fiber

FIGURE 2.33 Loose/areolar connective tissue, showing cells that produce fibers (fibroblasts) in a loose weave of collagen and
elastic fibers suspended in the ground substance (matrix). Micrograph: loose/areolar connective tissue of the dermis.
©McGraw-Hill Education/Dennis Strete

occasionally interspersed between fibers. The cells in this tissue are not able to
move (immobile). This arrangement of fibers gives strength and resistance to pull-
ing forces for the tendons and ligaments composed of this tissue. See Figure 2.34.
3. Dense irregular connective tissue has an interwoven pattern to its many com-
posing fibers. It can be found supporting the skin’s middle layer, and the weave of
its fibers is much denser than that of loose/areolar connective tissue.
4. Adipose connective tissue is composed of lipid-storing fat cells. These cells are
so full of lipids that the nucleus and other organelles seem to be pushed aside to
allow room for the lipid droplet they contain. They are active cells that convert

Tendon

Fibroblasts

Collagen
fibers

FIGURE 2.34 Dense regular connective tissue, showing cells that produce fibers (fibroblasts) and a dense arrangement
of parallel collagen fibers in a ground substance (matrix). Micrograph: dense regular connective tissue in a tendon.
©McGraw-Hill Education/Dennis Strete

66 CHAPTER 2 Levels of Organization of the Human Body

 Adipose tissue

Fat droplet

Cell
membrane

Nucleus

FIGURE 2.35 Adipose connective tissue, showing cells filled with lipids (adipocytes) with their nuclei pushed off to the side.
Micrograph: adipose connective tissue in the deepest layer of the skin.
©McGraw-Hill Education/Dennis Strete

carbohydrates to fats. Adipose tissue can be found in the deepest layer of the skin,
where it serves as insulation; in the breast; around organs; and in the greater omen-
tum. See Figure 2.35.
5. Blood connective tissue is composed of red and white blood cells and platelets
in a very fluid matrix called plasma. This tissue is covered extensively in the car-
diovascular system chapter on blood. See Figure 2.36.
6. Cartilage connective tissue is of three types: hyaline, elastic, and fibrocartilage.
The fibers involved determine their type. All three types of cartilage have cells

Aorta

White blood
cell

Red blood
cells

Plasma
(extracellular
matrix of blood)

Platelets

FIGURE 2.36 Blood connective tissue, showing blood cells and platelets in a fluid matrix called plasma. The white blood cell
(dark purple) is stained to make it more visible. Red blood cells are the most numerous. Platelets are cell fragments. Micrograph:
blood connective tissue obtained from any blood vessel.
©McGraw-Hill Education/Al Telser

2.5 Tissue Level 67

 Costal
cartilage

Nucleus

Lacuna

Chondrocyte

Extracellular
matrix

FIGURE 2.37 Hyaline cartilage connective tissue, showing cartilage cells (chondrocytes) in spaces (lacunae) within the matrix.
Micrograph: hyaline cartilage connective tissue in the costal cartilages that connect the ribs to the sternum.
©McGraw-Hill Education/Al Telser

surrounded by a very durable gel-like matrix. These tissues are covered exten-
sively in the skeletal system chapter.
• Hyaline cartilage connective tissue (HIGH-ah-lin) has a very smooth, glassy
appearance. Its collagen fibers are so fine that they are virtually invisible. This
cartilage is found at the ends of long bones, the larynx, the nose, bronchi, and
the cartilages between the ribs and sternum. See Figure 2.37.
• Elastic cartilage connective tissue has elastic fibers running in all directions.
These fibers allow this cartilage to snap back to shape if bent. Elastic cartilage
can be found in the ear and the epiglottis. See Figure 2.38.
• Fibrocartilage connective tissue has dense bundles of collagen fibers all
running in the same direction. These fibers allow this cartilage to function as
a shock absorber. Fibrocartilage connective tissue can be found in the disks
between vertebrae and in the meniscus of the knee. See Figure 2.39.
7. Bone connective tissue has bone cells isolated by a dense, concretelike matrix
that makes bone very hard. Collagen fibers in the matrix allow a little bit of flex

Elastic fibers

Nucleus

Lacuna

Chondrocyte

Extracellular
matrix

FIGURE 2.38 Elastic cartilage connective tissue, showing cartilage cells (chondrocytes) in spaces (lacunae) within the matrix
and elastic fibers running in all directions. Micrograph: elastic cartilage connective tissue of the ear.
©McGraw-Hill Education/Al Telser

68 CHAPTER 2 Levels of Organization of the Human Body

 Intervertebral
disk

Lacuna
Chondrocyte

Nucleus

Collagen
fiber

Extracellular
matrix

FIGURE 2.39 Fibrocartilage connective tissue, showing cartilage cells (chondrocytes) in spaces (lacunae) within the matrix
and bands of parallel collagen fibers running in one direction. Micrograph: fibrocartilage connective tissue in an intervertebral
disk.
©McGraw-Hill Education/Al Telser

Osteocyte
in lacuna

Osteon

Lamella

FIGURE 2.40 Bone connective tissue, showing an organized targetlike arrangement (osteon), lacunae that house bone
cells (osteocytes), and layers of hard matrix (lamellae) in bone. Micrograph: bone connective tissue found in the compact bone
of a bone shaft.
©McGraw-Hill Education/Dennis Strete

so that the bone is not brittle. This tissue is covered extensively in the skeletal
system chapter. See Figure 2.40.

Muscle Tissues
The three types of muscle tissue are skeletal muscle, smooth muscle, and cardiac mus-
cle. All of these are composed of cells with a high concentration of proteins. The pro-
teins and their arrangement allow muscle cells to contract. These tissues are covered
extensively in “Chapter 5, The Muscular System.”
1. Skeletal muscle tissue makes up the skeletal muscles that move the body and
control body openings. Skeletal muscle cells are cylindrical, appear striated
(striped), and have multiple nuclei pushed off to the side. See Figure 2.41.

2.5 Tissue Level 69

 Muscle

Nucleus
(near periphery of cell)

Skeletal
muscle
fiber

Striations LM 800x

FIGURE 2.41 Skeletal muscle tissue, showing parallel, cylindrical muscle cells (muscle fibers) that have striations and multiple
nuclei pushed off to the side. Micrograph: skeletal muscle tissue of the biceps brachii muscle in the arm.
©Ed Reschke

2. Smooth muscle tissue can be found in the walls of hollow organs, veins, and
arteries. This tissue allows hollow organs to move materials through them and
allows vessels to change their diameter. Smooth muscle cells are spindle-shaped
(taper at the ends), do not appear striated, and have one nucleus per cell. See
Figure 2.42.
3. Cardiac muscle tissue is found in the walls of the heart and is specially adapted
to not fatigue. Cardiac muscle cells branch, appear striated, and have one nucleus
per cell. Specialized junctions between cells (intercalated disks) allow for fast
transmission of electrical impulses. See Figure 2.43.

Wall of stomach

Nucleus

Smooth
LM 800x
muscle cell

FIGURE 2.42 Smooth muscle tissue, showing tapered, nonstriated muscle cells with one nucleus per cell.
Micrograph: smooth muscle tissue in the wall of the stomach.
©Victor Eroschenko

70 CHAPTER 2 Levels of Organization of the Human Body

 Cardiac muscle

Nucleus (central)

Cardiac
muscle cell

Intercalated disks
(special junctions
between cells)

Striations
LM 800x

FIGURE 2.43 Cardiac muscle tissue, showing branching, striated muscle cells with one nucleus per cell, and intercalated
disks between cells. Micrograph: cardiac muscle of the heart.
©Ed Reschke

Nervous Tissue
The body uses nervous tissue for communication through electrical and chemical sig-
nals. This tissue is composed of nerve cells called neurons and many more support
cells called neuroglia that protect and assist neurons in their function. Neurons can
vary greatly in size and shape. Nervous tissue is covered extensively in the nervous
system chapter. See Figure 2.44.

Spot Check Name the four basic classifications of tissues and give an example
of each.

Dendrite

Cell body
of neuron

Nucleus
of neuron

Nuclei of
neuroglial
Brain cells

Spinal
cord Neuroglial
cells LM 240x

Spinal
nerves
Axon

FIGURE 2.44 A neuron and surrounding neuroglial cells of nervous tissue. The neuron has a long axon and many dendrites
radiating from the cell body. Micrograph: a neuron surrounded by neuroglial support cells.
©Trent Stephens

2.5 Tissue Level 71

 Modes of Tissue Growth, Change, Shrinkage, and Death

Learning Outcome
21. Describe the modes of tissue growth, change, shrinkage, and death.

The tissues you just covered are not stagnant. In fact, they can grow, change, shrink,
and die. Let’s look at what can happen to tissues.

Tissue Growth Tissues grow normally in either of two ways: hypertrophy or

hyperplasia. In hypertrophy, tissues grow because the existing individual cells grow
bigger. An example of hypertrophy is seen in skeletal muscle tissue in adult body
builders. Body builders can greatly increase the size of their muscles, not by increasing
the number of muscle cells but by enlarging their existing cells through training. This
accounts for the apparent muscle tissue growth.
In hyperplasia (high-per-PLAY-zee-ah), tissues grow because more cells are
produced. Hyperplasia is the mode of growth during childhood. Skeletal muscles,
organs, vessels, and other structures grow during childhood because more cells are
produced.
On the other hand, neoplasia is the uncontrolled growth and proliferation of cells
of abnormal or nonfunctional tissue. This kind of growth results in a neoplasm also
known as a tumor. Tumors compete with healthy tissue for nutrients, often causing
angiogenesis (AN-jee-oh-JEN-eh-sis) (blood vessel growth) to feed the tumor cells.
There are two major types of tumors, malignant and benign. Malignant (mah-LIG-
nant) tumors are considered cancerous because they have cells that break off and
travel to other parts of the body where they continue to produce more abnormal
cells. This migration is called metastasis. Because malignant cells have the ability
to spread to other areas of the body (metastasize), they can cause tissue and organ
damage in various locations, not just where the malignant cells originated. Benign
tumors tend to be encapsulated, remain local, and are considered noncancerous.
Although they are not considered cancerous, benign tumors can be deadly because
they compete for space that healthy tissues would normally occupy. An example of
this would be a benign tumor in the brain. Although it remains local and does not
have the ability to spread to other parts of the body, it competes with normal, healthy
brain tissue for space, putting pressure on the brain that could lead to death.
Cancer has many causes, but most cancers are the result of mutations. For example,
mutations can stem from mistakes made in DNA replication or from environmental
factors called carcinogens (kar-SIN-oh-jens) that affect the DNA. Radiation from
ultraviolet (UV) light, chemicals like nitrites in bacon and lunch meat, and viruses
like the human papillomavirus (HPV) are all carcinogens. The mutations may turn on
oncogenes, which are genes that code for uncontrolled production of cellular growth
factors stimulating mitosis or the receptors for the growth factors. Either way, the cells
grow and divide uncontrollably. The mutations may also damage tumor suppressor
genes. Healthy tumor suppressor genes inhibit oncogenes. If the tumor suppressor gene
is damaged through mutation, there is little to keep the oncogene from expressing itself.
Cancers are named for their tissue of origin:
• Carcinomas originate in epithelial tissues.
• Sarcomas originate in connective tissues or muscle.
• Lymphomas originate in lymphoid tissue (discussed in the lymphatic system
chapter).
• Leukemias originate in blood-forming tissues in the red bone marrow (discussed
in the cardiovascular system chapter on blood).

72 CHAPTER 2 Levels of Organization of the Human Body

 Now that we have discussed the different ways that tissues grow, let’s take a look at
how tissues can change over time.

Tissue Change Tissue type is not absolute. Some types of tissue may change over
a lifetime. The change of a tissue from one type to another is called metaplasia. An
example of this can be seen in the normal development of the lining of the vagina.
As a child, a girl’s vagina is lined by simple cuboidal epithelial tissue. At puberty,
due to the influence of hormones, the lining changes from simple cuboidal epithelial
tissue to stratified squamous epithelial tissue. The stratified squamous epithelium is
a more durable lining, better adapted for intercourse and childbirth. Environmental
factors may also cause metaplasia. An example is seen in the ciliated pseudostrati-
fied columnar epithelium lining the bronchi of a heavy smoker. The ciliated cells
function to move debris (such as dust and smoke particles) out of the bronchi to the
throat to be swallowed. Due to the constant irritation to the respiratory lining caused
by the heavy smoking, the lining changes from ciliated pseudostratified columnar
epithelium to stratified squamous epithelium, a much stronger tissue. The loss of cili-
ated cells reduces the lining’s capacity to remove debris normally. The heavy smoker
then must cough up what the lining can no longer remove. This is commonly called
“smoker’s hack.”

Tissue Shrinkage and Death Atrophy (AT-roh-fee) is the shrinkage of tissue due
to a decrease in cell size or number. It can be caused by aging or lack of use. Anyone
who has had a cast on a broken arm or leg has experienced muscle atrophy. The mus-
cles of the broken arm or leg have atrophied beneath the cast from lack of use. Normal
appearance and function can be achieved through exercise.
Necrosis (neh-KROH-sis) is the premature death of tissue, caused by disease,
infection, toxins, or trauma. Gangrene is tissue necrosis resulting from an insuf-
ficient blood supply, often associated with an infection. Infarction is the sudden
death of tissue, which often results from a loss of blood supply. An example is a
myocardial infarction (sudden death of heart muscle) due to a blocked coronary
artery.
Apoptosis (AP-op-TOE-sis) is programmed cell death. This mode of death
removes cells that have fulfilled their function and are no longer needed. Examples of
this type of death can be seen in the developing fetus. The fingers and toes are origi-
nally webbed, but the cells of the webbing die by apoptosis before birth. The fetus also
produces more neurons in early development than will be needed. The neurons that
make connections survive, while any unnecessary neurons die by apoptosis. The cells
that die by apoptosis are quickly consumed by macrophages (large, infection-fighting
cells) that clear them away.

2.6 Organ Level

Learning Outcome
22. Identify the human body systems and their major organs.

Different tissue types work together in organs, the next level in the human body’s
hierarchy of organization. For example, the heart is an organ composed of cardiac
muscle tissue that allows its chambers to forcefully contract to expel blood. It also has
a fibrous skeleton of elastic fibers. This allows the heart chambers to return to shape
after a contraction so that they can fill with blood again. Each of the chambers is lined
with epithelial tissue. The epithelial tissue extends between chambers to cover the
heart valves, which regulate blood flow. Coronary blood vessels with smooth muscle

2.6 Organ Level 73

 in their walls are located in the heart to feed the cardiac muscle tissue. All of these dif-
ferent types of tissue work together to form the heart, a functioning pump for blood.
See Figure 2.45.

FIGURE 2.45 Heart:

(a) diagram of heart chambers
(atria and ventricles) and valves,
(b) portion of a cadaver heart
showing the ventricles and a
valve.
(b): ©Oktay Ortakcioglu/Getty Images

Aortic valve
Left
atrium
Right atrium

Left AV valve
Left
Right AV valve ventricle

Right ventricle

(a)

Left
atrium

Left
AV valve
Right
atrium
Right
AV valve Left
ventricle
Right ventricle

(b)

74 CHAPTER 2 Levels of Organization of the Human Body

 Because the major function of the heart is to pump and circulate blood, the heart
belongs to the cardiovascular system. Like many other organs, however, the heart plays
a minor role in other systems. For example, the heart produces a hormone that helps
regulate urine production in the excretory system. You will cover all of the organs in
their relevant system chapters. See Table 2.4.

TABLE 2.4 Human Body Systems

Major Organs
System and Structures Accessory Structures Function
Integumentary Skin, hair, nails, cutaneous Protection, vitamin D
glands production, temperature
regulation, water retention,
sensation, nonverbal
communication

Skeletal Bones Ligaments, cartilages Support, movement, protection,

acid–base balance, electrolyte
balance, blood formation

Muscular Muscles Tendons Movement, stability, control of

body openings and passages,
communication, heat
production

Nervous Brain, spinal cord, nerves Meninges, sympathetic chain of Communication, motor control,
ganglia sensation

Endocrine Pineal gland, hypothalamus, Communication, hormone

pituitary gland, thyroid production
gland, adrenal glands,
pancreas, testes,
ovaries

Cardio­vascular Heart, aorta, superior and Arteries, veins, capillaries Transportation, protection
inferior venae cavae by fighting foreign invaders
and clotting to prevent its
own loss, acid–base balance,
fluid and electrolyte balance,
temperature regulation

Lymphatic Thymus gland, spleen, Thoracic duct, right lymphatic Fluid balance, immunity, lipid
tonsils duct, lymph nodes, lymph absorption, defense against
vessels, MALT, Peyer’s disease
patches

Respiratory Nose, pharynx, larynx, Diaphragm, sinuses, nasal Gas exchange, acid–base
trachea, bronchi, lungs cavity balance, speech, sense of
smell, creation of pressure
gradients necessary to circulate
blood and lymph

2.6 Organ Level 75

 TABLE 2.4 Human Body Systems (continued)
Major Organs
System and Structures Accessory Structures Function
Digestive Esophagus, Liver, pancreas, gallbladder, Ingestion, digestion, absorption,
stomach, small cecum, teeth, salivary glands defecation
intestine, large
intestine

Excretory/urinary Kidneys, ureters, Lungs, skin, liver Removal of metabolic wastes,

urinary bladder, fluid and electrolyte balance,
urethra acid–base balance, blood
pressure regulation

Male reproductive Testes Scrotum, spermatic ducts Production and delivery

(epididymis, ductus deferens), of sperm, secretion of sex
accessory glands (seminal hormones
vesicles, prostate gland,
bulbourethral glands),
penis

Female Ovaries Uterus, uterine tubes, vagina, Production of an egg, housing

reproductive vulva, breasts of the fetus, birth, lactation,
secretion of sex hormones

2.7 System Level

Organs and other structures work together to carry out the system function. The
body systems are the integumentary system, the skeletal system, the muscular
system, the nervous system, the endocrine system, the cardiovascular system, the
lymphatic system, the respiratory system, the digestive system, the excretory/
urinary system, the male reproductive system, and the female reproductive
system. This is the last level of the organization hierarchy to be covered in this text.
Each system of the human body will be covered in individual chapters later in this
text. For an overview, see Table 2.4 and Figure 2.46, which summarize the organ
systems, their major components, and their functions.

Spot Check Name the systems that make up the human body.

76 CHAPTER 2 Levels of Organization of the Human Body

 Integumentary System Muscular System
Major Organs and Structures: Major Organs and Structures:
skin, hair, nails, cutaneous glands muscles
Functions: Accessory Structures:
protection, vitamin D production, tendons
temperature regulation, water
Functions:
retention, sensation, nonverbal
movement, stability, control of
communication
body openings and passages,
communication, heat production

Skeletal System
Major Organs and Structures:
bones
Accessory Structures:
ligaments, cartilages
Functions:
support, movement, protection,
acid–base balance, electrolyte
balance, blood formation

(a) (b) (c)

Nervous System Endocrine System

Major Organs and Structures: Major Organs and Structures:
brain, spinal cord, nerves pineal gland, hypothalamus,
Accessory Structures: pituitary gland, thyroid gland,
meninges, sympathetic chain of adrenal glands, pancreas, testes,
ganglia ovaries

Functions: Functions:
communication, motor control, communication, hormone
sensation production

Cardiovascular System
Major Organs and Structures:
heart, aorta, superior and inferior
venae cavae
Accessory Structures:
arteries, veins, capillaries
Functions:
transportation, protection by fighting
foreign invaders and clotting to
prevent its own loss, acid–base
balance, fluid and electrolyte balance,
temperature regulation

(d) (e) (f)

FIGURE 2.46 Human body systems: (a) integumentary system, (b) skeletal system, (c) muscular system, (d) nervous system,
(e) endocrine system, (f) cardiovascular system, (g) lymphatic system, (h) respiratory system, (i) digestive system, ( j) excretory/
urinary system, (k) male reproductive system, (l) female reproductive system.

2.7 System Level 77

 Lymphatic System
Major Organs and Structures:
thymus gland, spleen, tonsils
Accessory Structures:
thoracic duct, right lymphatic duct,
lymph nodes, lymph vessels,
MALT, Peyer’s patches
Functions:
fluid balance, immunity, lipid
absorption, defense against
disease

Respiratory System
Digestive System
Major Organs and Structures:
nose, pharynx, larynx, trachea, Major Organs and Structures:
bronchi, lungs esophagus, stomach, small
intestine, large intestine
Accessory Structures:
diaphragm, sinuses, nasal cavity Accessory Structures:
liver, pancreas, gallbladder,
Functions: cecum, teeth, salivary glands
gas exchange, acid–base balance,
speech, sense of smell, creation Functions:
of pressure gradients necessary ingestion, digestion, absorption,
to circulate blood and lymph defecation

(g) (h) (i)

Male Reproductive System

Major Organs and Structures:
testes
Accessory Structures:
scrotum, spermatic ducts
(epididymis, ductus deferens),
accessory glands (seminal
vesicles, prostate gland,
bulbourethral glands), penis
Functions:
production and delivery of sperm,
secretion of sex hormones

Excretory/Urinary System Female Reproductive System

Major Organs and Structures: Major Organs and Structures:
kidneys, ureters, urinary bladder, ovaries
urethra
Accessory Structures:
Accessory Structures: uterus, uterine tubes, vagina,
lungs, skin, liver vulva, breasts
Functions: Functions:
removal of metabolic wastes, fluid production of an egg, housing of
and electrolyte balance, acid–base the fetus, birth, lactation, secretion
balance, blood pressure regulation of sex hormones

(j) (k) (l)

FIGURE 2.46 Human body systems (continued).

78 CHAPTER 2 Levels of Organization of the Human Body

Summary
2.1 Overview
∙∙ There is a hierarchy of organization to the body:

chemical → organelle → cell → tissue → organ → system → organism

2.2 Chemical Level

∙∙ All solids, liquids, and gases are composed of matter. The purest form of matter is an element.

Atoms and Isotopes

∙∙ A
 toms contain protons, neutrons, and electrons. Atoms bond to form molecules. Isotopes of an element are atoms with
the same number of protons but a different number of neutrons.

Bonding to Form Molecules

∙∙ A
 toms share electrons to form a covalent bond. Atoms give up and receive electrons in an ionic bond. Ioni-
cally bonded molecules separate to become ions in water. Ions in solution are electrolytes. A hydrogen bond
is a weak bond that occurs between a positively charged hydrogen atom and a negatively charged oxygen or
nitrogen atom.

Water
∙∙ W
 ater carries out five vital functions in the body: (1) It allows for ions in solution. (2) It works as a lubricant. (3) It aids in
chemical reactions. (4) It helps with transportation. (5) It is used for temperature regulation.

Solutions
∙∙ A
 solution is composed of a solute dissolved in a solvent. Concentration refers to the amount of solute relative to the
amount of solvent. In comparing solutions, a hypertonic solution is more concentrated, an isotonic solution is the same
concentration, and a hypotonic solution is less concentrated.

Acids, Bases, and pH

∙∙ A
 cids are hydrogen ion donors. Bases accept hydrogen ions. The pH scale is used to measure acidity and alkalinity; every
one-number difference is a tenfold difference in the amount of H+ or OH−.

Organic Molecules
∙∙ T
 he four major types of organic molecules are carbohydrates, lipids, proteins, and nucleic acids. All organic molecules
must contain carbon and hydrogen. Organic molecules are composed of building blocks.

Chemical Reactions
∙∙ M
 olecules must come together to react. Metabolism is the total of all the chemical reactions in the body. Reactions hap-
pen faster if (1) the concentration of the reactants is increased, (2) the speed of the reactants is increased by adding heat,
and (3) a catalyst is used.
∙∙ Cellular respiration is one of the most important chemical reactions in the body.
C6H12O6 + 6O2 → 6CO2 + 6H2O + Energy
Glucose + Oxygen yields Carbon dioxide + Water + Energy
∙∙ The molecule ATP contains the usable form of energy for the cell.

2.3 Organelle Level

∙∙ Organelles are suspended within the cell in a fluid called cytoplasm. The organelles follow:
1. Nucleus: the part of the cell that houses the DNA.
2. Mitochondria: organelles that perform cellular respiration and process the energy to ATP.

79
 3. Ribosomes: organelles that assemble proteins.
4. Endoplasmic reticulum: an extension of the nuclear membrane. Rough ER is the site of protein synthesis.
Smooth ER is the site of lipid synthesis.
5. Golgi complexes: membrane-enclosed folds that receive and modify proteins and lipids produced in the cell.
6. Secretory vesicles: membrane packages that carry materials from the Golgi complex to the cell membrane for
export from the cell.
7. Lysosomes: membrane-bound packages of digestive enzymes.

Cell Membrane
∙∙ T
 he cell membrane is a phospholipid bilayer that gives structure to the cell and regulates what may enter and leave
the cell.

2.4 Cellular Level

Membrane Transport
∙∙ M aterials can be moved across the selectively permeable cell membrane through passive, active, or bulk transport.
∙∙ Passive transport moves materials from areas of high concentration to areas of low concentration with no energy required.
Methods of passive transport include filtration, simple diffusion, facilitated diffusion, and osmosis.
∙∙ Active transport moves materials across a cell membrane from areas of low concentration to areas of high concentration
(against a concentration gradient). Active transport requires energy.
∙∙ Bulk transport moves large quantities of materials, not individual molecules, across a cell membrane. Materials are
moved out of the cell through exocytosis. Materials are moved into the cell through endocytosis.

Protein Synthesis
∙∙ P rotein synthesis is a two-step process. Transcription happens in the nucleus. It produces mRNA, which carries
the instructions written in the DNA to the ribosome on the rough endoplasmic reticulum. Translation happens at
the ribosome. The tRNAs transport specific amino acids to the ribosome for assembly based on the information
in the mRNA.
∙∙ The amino acid sequence that was assembled through translation is received and modified by the Golgi complex.
∙∙ Mistakes in protein synthesis may or may not have any consequences.

Cell Division
∙∙ H uman DNA is spread out for use as chromatin. Before dividing, the DNA is tightly packaged into 46 chromosomes.
∙∙ Mitosis is the method of cell division used by all cells other than those producing sperm and eggs.
∙∙ A parent cell replicates its 46 chromosomes before dividing to become two daughter cells. Each daughter has a complete
set of 46 chromosomes that is identical to the other daughter’s set and to the parent cell’s set, which no longer exists once
cell division is complete.
∙∙ Mistakes in replication may or may not have any consequences.

Effect of Aging on Cells

∙∙ T
 elomeres are noncoding strings of nucleotides at the ends of chromosomes. Their purpose is believed to be
protection of the chromosome ends. Part of the telomere is lost with each cell division. When all of the telomeres
are lost, more and more mistakes in replication may occur. Therefore, more mistakes potentially affecting cellular
function occur with age.

2.5 Tissue Level

∙∙ There are four basic classifications of tissues.

Epithelial Tissues
∙∙ E
 pithelial tissue covers or lines all of the body’s surfaces. The various types are named for the cell shape and amount of
layering.

Connective Tissues
∙∙ C
 onnective tissue has cells and fibers in a matrix. The matrix may be very fluid, as in blood, or very hard and dense as
in bone.

80
Muscle Tissues
∙∙ Muscle tissue has a high concentration of proteins; this arrangement allows the tissues to contract.

Nervous Tissue
∙∙ N
 ervous tissue is composed of neurons and support cells called neuroglia. The function of nervous tissue is communi-
cation through electrical and chemical signals.

Modes of Tissue Growth, Change, Shrinkage, and Death

∙∙  issues grow normally through hyperplasia (making more cells) or hypertrophy (making existing cells bigger).
T
∙∙ Tissues grow abnormally to form neoplasms (tumors). Neoplasms may be benign or malignant.
∙∙ Metaplasia is the change of tissue from one type to another.
∙∙ Atrophy is the shrinkage of tissue due to age or disuse.
∙∙ Necrosis is the premature death of tissue. If the death is sudden, it is called an infarction. Gangrene is the death of tissue
due to an insufficient blood supply, usually associated with an infection.
∙∙ Apoptosis is programmed cell death.
∙∙ Neoplasia is the uncontrolled growth and proliferation of cells of abnormal or nonfunctional tissue. Neoplasia results in
malignant (cancerous) tumors that metastasize or benign tumors that are encapsulated and remain local. Tumors compete
with healthy tissue for space and nutrients.
∙∙ Most cancers are caused by mutations through mistakes in replication or through environmental factors called carcinogens.
∙∙ Cancers are named for their tissue of origin. Carcinomas originate in epithelial tissues; sarcomas originate in connective
tissues or muscle; lymphomas originate in lymphoid tissue; and leukemias originate in blood-forming tissues in the red
bone marrow.

2.6 Organ Level

∙∙ Many different types of tissue function collectively as organs to carry out functions in the various systems.

2.7 System Level

∙∙ T
 here are 11 systems in the human body: integumentary, skeletal, muscular, nervous, endocrine, cardiovascular,
lymphatic, respiratory, digestive, excretory/urinary, and reproductive.

Key Words for Review

The following terms are defined in the glossary.

acid histology oncogenes

angiogenesis integumentary system organelles
atom malignant organic molecules
base membrane transport osmosis
benign metabolism protein synthesis
carcinogens metastasize reactants
cellular respiration mitosis replication
chemical reaction molecule solution
epithelial tissues mutation

81
 The

3 Integumentary
System
Although you might associate the
word organ with the heart or one of
the lungs or kidneys, the skin is in
fact the largest organ in the human
body. The skin plays an enormous
role in the integumentary system,
which is made up of skin, hair,
nails, and cutaneous glands. See
Figure 3.1. By its very nature and
___location, this system is the most
visible of all the body systems, and
its structures are constantly chang-
ing and growing.
©liza5450/Getty Images

Module 4: Integumentary System

82
3.1 Word Roots and Combining
Forms Integumentary System
Major Organs and Structures:
skin, hair, nails, cutaneous glands
Learning Outcome Functions:
1. Use medical terminology related to the integumentary system. protection, vitamin D production,
temperature regulation, water
retention, sensation, nonverbal
communication
cutane/o: skin kerat/o: hard
cyan/o: blue melan/o: black
derm/o: skin onych/o: nail
dermat/o: skin seb/o: oil

3.2 Overview
In this chapter, you will become familiar with the anatomy
and physiology of the integumentary system. Note that the
skin’s physiology is explained in the context of going out for a
morning run. You will also learn how skin responds to injury,
burns, the effects of aging, diagnostic tests relevant to skin
disorders, and common disorders that affect the skin, as well
as how skin repairs itself.

3.3 Anatomy of the Skin, Hair,

and Nails FIGURE 3.1 Integumentary system.

Learning Outcome
2. Describe the histology of the epidermis, dermis, and hypodermis.

As the body’s largest organ, the skin makes up approximately 15% of the body’s total
weight. It consists of two layers, the epidermis and the dermis. The epidermis is the
skin’s most superficial layer, composed of stratified squamous epithelial tissue. Deep
to the epidermis is the dermis, which is composed of loose/areolar connective tissue
over dense irregular connective tissue. The cutaneous glands, the hair follicles, and
most of the skin’s nerve endings can be found in the dermis.
Deep to the dermis is the hypodermis or subcutaneous layer (subcutaneous tis-
sue). Although it is technically not part of the skin, this layer attaches the skin to
the rest of the body. Mainly composed of adipose connective tissue, the hypodermis
serves as an insulating layer, a cushioning layer, and an energy source. This layer is
generally thicker in women than in men. See Figure 3.2.

Clinical P int
The hypodermis is an ideal site for subcutaneous drug injections (which are done with
a hypodermic needle) because it has numerous blood vessels and can absorb the
drugs easily. See Figure 3.3.

Epidermis

Learning Outcome
3. Describe the cells of the epidermis and their function.

3.3 Anatomy of the Skin, Hair, and Nails 83

Epidermis

Dermis

Hypodermis
(subcutaneous
tissue)

FIGURE 3.2 The skin. Three layers are shown: the epidermis, FIGURE 3.3 Hypodermic needle.
the dermis, and the hypodermis (subcutaneous tissue). ©Photodisc Collection/Getty Images

The epidermis (the superficial layer of the skin) is subdivided into four or five
general layers called strata. These strata can be seen in Figure 3.4. The deepest
layer is the stratum basale (ba-SAL-eh), which contains a single layer of cuboi-
dal cells. It is the only stratum of the epidermis with cells that actively grow and
divide to produce new epidermis. The stratum basale dips into the dermis of the
skin to form the hair follicles. Superficial to the stratum basale are the stratum
spinosum and the stratum granulosum. The stratum lucidum (loo-SEE-dum) is
found only in thick skin. It is not found in thin skin. The stratum corneum is
the most superficial stratum. It may have as many as 20 layers of cells. It is com-
posed of tough, waterproof dead cells that eventually flake off (exfoliate). The
human body sheds thousands of these dead stratum corneum cells every day. The
exfoliated cells make up the majority of all the dust you find on your floor and
furniture when cleaning.

Common Misconception
Whether skin is “thick” or “thin” does not have to do
with the depth of the skin or the number of cell layers.
It has to do with the presence of the stratum lucidum,
which is present only in thick skin. Thick skin is found
on the lips, on the palms of the hands, and on the
plantar surface of the feet. Thick skin has no hair,
while thin skin does. ©Stockbyte/Getty Images

84 CHAPTER 3 The Integumentary System

 Direction Superficial
of cell
movement Exfoliating
cells
5
Stratum Intercellular
corneum lipids

Keratin
4
Stratum
lucidum

3
Stratum
granulosum

2
Stratum
spinosum

1
Stratum Nucleus
basale
Basement
Deep membrane

FIGURE 3.4 Strata of the epidermis. This is epidermis of thick skin. Stratum lucidum is
present, and there is no hair.

Spot Check How does the anatomy of the epidermis of your forearm compare
to the anatomy of the epidermis of your lips?

Cells of the Epidermis Several different types of cells that serve specific func-
tions can be found in the epidermis. These cells are defined in the list below. See
Figure 3.5.
• Keratinocytes (ke-RAT-in-oh-sites) begin in the stratum basale and make up the
majority of epidermal cells. Their purpose is to grow and divide. As they divide,
they push the older cells up toward the surface. The keratinocytes produce and
fill themselves with keratin (a hard, waterproof protein) as they move toward the
surface. By the time they reach the stratum corneum, the keratinocytes have com-
pletely filled with keratin and died. This process is called cornification. These cells
form a very durable stratum corneum at the surface. See Figures 3.4 and 3.5.
• Melanocytes produce skin pigments called melanin. These cells stay in the stra-
tum basale, but they have projections to more superficial layers. The keratinocytes
take in the melanin produced by pinching off bits of the melanocyte extensions that
contain melanin-filled vesicles called melanosomes. This is an example of endocy-
tosis (covered in “Chapter 2, Levels of Organization of the Human Body”). See the
inset in Figure 3.5. Melanocytes may not be evenly distributed across the skin, and
denser patches of these cells account for freckles and moles.

3.3 Anatomy of the Skin, Hair, and Nails 85

FIGURE 3.5 Cells of the Epithelial cell
epidermis: keratinocytes,
melanocytes, tactile cells, and
dendritic cells.
Melanosomes

Melanocyte

Nucleus

Golgi apparatus

Exfoliating
keratinocytes
Dead
keratinocytes
Stratum corneum

Living
keratinocytes Stratum lucidum

Stratum granulosum

Dendritic cell

Tactile cell Stratum spinosum

Melanocyte

Stratum basale
Dermal
papilla

Tactile
nerve fiber

Dermis
Dermal
blood vessels

Common Misconception
The idea that people with dark skin have more melanocytes than people with light skin
is a misconception, as both types of skin contain the same number. Although the mela-
nocytes function the same, the difference is the amount of melanin they produce. This
amount is genetically determined. See Figure 3.6.

• Tactile cells serve as receptors for fine touch only. Although they are found in the
stratum basale, they are associated with nerve cells in the underlying dermis.
• Dendritic cells are immune system cells found in the stratum spinosum and the
stratum granulosum. They alert the body’s immune system to the invasion of
pathogens (disease-causing foreign invaders) that could make it through the stra-
tum corneum.

86 CHAPTER 3 The Integumentary System

 Stratum
corneum

Epidermis

Melanized
cells of
stratum
basale
Dermis

(a) (b)

FIGURE 3.6 Variations in skin color. (a) There are heavy deposits of melanin in the stratum basale in dark skin.
(b) There is little to no visible melanin in the stratum basale of light skin.
(a) ©McGraw-Hill Education/Dennis Strete; ©Thomas Northcut/Getty Images (inset); (b) ©McGraw-Hill Education/Dennis Strete;
©Creatas/PunchStock/Getty Images (inset)

Dermis

Learning Outcomes
4. Describe the structures of the dermis and their functions.
5. Compare and contrast the glands of the skin in terms of their structure, products, and
functions.
6. Describe the histology of a hair and hair follicle.

The dermis is sometimes called the “true skin.” Blood vessels, fibers, nerve end-
ings, hair follicles, and cutaneous glands are found in the dermis. See Figure 3.7. We
explain this layer and its related structures in the paragraphs that follow.

Papillae The superficial edge of the dermis has bumps called papillae, which are in
direct contact with the epidermis. These papillae, arranged in a random pattern over
most of the body, form individual-specific patterns of ridges on the palmar and plantar
surfaces. This unique arrangement creates fingerprints. The papillae’s numerous small
blood vessels provide nearby stratum basale cells with nutrients they need to grow and
divide. The stratum basale cells are fed by diffusion. Because blood vessels do not extend
into the epidermis, the risk of blood loss if the epidermis becomes injured is reduced.

Spot Check How deep into layers of the skin would a cut have to be in order to
cause bleeding?

Fibers The dermis changes from loose/areolar tissue to dense irregular connective
tissue with depth. Both of these tissue types are characterized by cells and fibers in
a matrix, but they lack a neat dividing line between them. The cells (fibroblasts) of
both tissues produce two types of protein fibers: collagen and elastin. Collagen fibers
give the skin strength. Elastin fibers provide elasticity, which allows the skin to come
back to shape if stretched. The number of fibers increases with depth in the dermis.

3.3 Anatomy of the Skin, Hair, and Nails 87

 Pore
Hairs

Papillae

Tactile corpuscle
Epidermis
Sebaceous
gland

Collagen and
elastin fibers

Sweat gland duct

Nerve ending

Dermis Lamellar corpuscle

Hair follicle

Nerve

Vein

Artery
Subcutaneous
tissue
(hypodermis) Sensory
nerve fiber

Adipose tissue

Sweat gland

FIGURE 3.7 The dermis and its structures: papillae, hair follicles, sebaceous glands, sweat glands, nerve endings, vessels,
and fibers.

Common Misconception
Be careful of the word elastic as it does not mean “the ability to be stretched.” (That
is the definition of extensibility, which is covered in the muscular system chapter.)
Elasticity is the ability to come back to shape if something has first been stretched,
like a rubber band. For example, think of an elastic waistband on an old pair of
sweatpants. This waistband is no longer elastic if you stretch out the waistband, let
go, and the pants fall off.

Vitamin A and vitamin C are important for healthy skin because they are necessary
for collagen production. You can get vitamin A (which is also important in the main-
tenance of epithelial tissues) by eating green and yellow vegetables, dairy products,

88 CHAPTER 3 The Integumentary System

and liver. You can boost your vitamin C intake by consuming plenty of fruits and
green vegetables. Proper nutrition in this particular case allows the body to maintain
homeostasis resulting in healthy skin.

Nerve Endings Nerve cells have endings in the dermis that serve as receptors
(receiving devices). These receptors include warm receptors, cold receptors, pain
receptors, and pressure receptors. For example, the lamellar and tactile corpuscles
shown in Figure 3.7 are nerve receptors. There are also receptors associated with hair
follicles located in the dermis that can detect the movement of a single hair. The dis-
tribution of receptors varies by region. All of the skin’s nerve endings are explained in
more detail in the nervous system chapter on senses.

Cutaneous Glands The skin’s cutaneous glands—which are considered exocrine

glands (EK-soh-krin)—are located throughout the dermis. Exocrine glands produce
and secrete products that are delivered to the appropriate locations through ducts.
There are two basic types of cutaneous glands: sebaceous glands (se-BAY-shus) and
sweat glands. See Figure 3.7.

Sebaceous glands As you can see in Figure 3.7, sebaceous glands are associated
with a hair follicle. The sebaceous gland duct leads to the hair follicle surrounding
the hair root. Sebum, a very oily, lipid-rich substance, is produced by the sebaceous
gland to moisturize the skin and hair. Sebum exits the hair follicle to the skin’s sur-
face with the emerging hair. You can remove sebum from your skin by washing with
soap. Once your skin is clean, you can then replenish its moisture balance by replac-
ing the removed sebum with a lanolin-containing lotion. Lanolin is sebum produced
by sheep.
The hormones estrogen and testosterone increase the amount of sebum
produced. The levels of these hormones greatly increase at puberty, which
causes the sebaceous glands to become much more active, producing
more and more sebum. In this case, the short ducts delivering sebum to
the hair follicle can become plugged with the excess sebum and cells shed
from the sebaceous gland. The gland continues to produce more sebum
even though the duct is plugged. The plug prevents the sebum from reach-
ing the surface, which results in a comedo (KOM-ee-doh) (a whitehead
or blackhead). It appears as a blackhead if the plug reaches the surface.
In addition, because P. acnes bacteria normally live on the skin, oil and
excess cells of the plug allow these bacteria to grow in the plugged fol-
licles. This causes inflammation that may result in the breakdown in the
hair follicle wall. If the inflammation continues, pus may form, resulting
in a pimple. This condition is called acne. See Figure 3.8. Estrogen levels
fluctuate for a woman both during her menstrual cycle and during preg-
nancy, making acne more prevalent for her on certain days of her cycle FIGURE 3.8 Male teen with acne.
and during pregnancy. ©Camerique/ClassicStock/Getty Images

Clinical P int
Methods of treating acne are based on the disorder’s specific anatomy and physiology.
Antibiotics kill the bacteria. Other drug therapies include the following treatments:
● Salicylic acid helps reduce the shedding of cells that line the sebaceous gland and
hair follicles.
● Benzoyl peroxide destroys P. acnes and may reduce sebum production.
● Vitamin A derivatives called retinoids unplug comedones (plural of comedo) to
allow other topical medicines to enter the follicle.

3.3 Anatomy of the Skin, Hair, and Nails 89

 TABLE 3.1 Sweat Glands
Gland Location Product Function
Merocrine sweat This is the most numerous type Watery sweat composed Helps cool the body
gland of sweat gland. Merocrine glands of 99% water, lactic acid, through evaporation.
deliver their sweat to the surface nitrogenous waste called
of the skin through a duct whose urea, and some salt.
opening is called a pore. They are
located all over the body and are
highly concentrated in the palmar
and plantar regions.

Apocrine sweat This type of sweat gland delivers Lipid-rich sweat that Serves as scent to
gland its sweat through a duct leading to bacteria feed on. It is not influence the behavior
a hair follicle. Apocrine glands are the sweat itself but the of others.
associated with axillary hair, pubic waste from the bacteria
hair, and the beard. They begin to feeding on the sweat that
produce their sweat at puberty. creates body odor.

Ceruminous gland This is a modified sweat gland. Cerumen (earwax). Keeps the eardrum flexible,
Ceruminous glands (seh-ROO- waterproofs the ear canal,
min-us) are found only in the ear kills bacteria, and protects
canal. the ear canal from foreign
debris.

Mammary gland This is a modified sweat gland Breast milk, which is Nourishes an infant.
found in the breast. Mammary composed of water,
glands begin to develop at carbohydrates, lipids,
puberty and fully develop during proteins, and minerals.
pregnancy. They deliver their
product to ducts that end at the
nipple.

Sweat glands There are several types of sweat glands present in the dermis, and
these glands differ in ___location, product, and function. See Table 3.1 and Figure 3.7.
For an example of how these glands work, consider the merocrine sweat glands—
the most numerous sweat glands in your body—described in Table 3.1. The presence
of lactic acid in merocrine sweat (secreted from the merocrine gland) causes the pH
range of merocrine sweat to be 4 to 6. This forms an acid mantle on the skin that
reduces the growth of bacteria. This is an example of homeostasis and how the main-
tenance of the appropriate pH of the skin can help maintain overall skin health.

Hair Follicles As you have already seen, hair follicles play an important role in the
healthy functioning of the integumentary system. Let’s take a closer look at precisely
how the many hair follicles do their job. See Figure 3.9. The stratum basale dips down
to form the hair follicles in the thin skin’s dermis. Each hair follicle is positioned at an
angle in the dermis with a dermal papilla at its base. The dermal papilla has a blood
vessel, which feeds the keratinocytes and melanocytes contained in the hair follicle.
The keratinocytes produce the hair, while the melanocytes produce the hair’s pigment
(color). Active keratinocytes form the hair matrix just above the dermal papilla. The
dermal papilla is the hair’s growth center, and it contains important nerves and blood
vessels that provide amino acids for keratin production.
Associated with the hair follicle is a smooth muscle called an arrector pili muscle
(a-REK-tor PYE-lye). This muscle attaches the hair follicle’s base to the epidermis
at an angle. See Figure 3.9. When this muscle contracts, it pulls on the hair follicle’s

90 CHAPTER 3 The Integumentary System

Hair shaft
(above skin
surface)

Medulla

Cortex
Hair
Hair root
(below skin Cuticle
surface)

Arrector pili
Stratum (smooth muscle)
basale

Sebaceous
gland

Hair bulb Matrix

(base of
hair root) Dermal papilla

(a) (b) 0.5 mm

FIGURE 3.9 Hair follicle: (a) structure of a hair and its follicle, (b) micrograph of the base of a hair follicle.
(b) ©Michael Abbey/Science Source

base, making the hair stand perpendicular (in an upright position) to the skin’s surface.
For furry animals, this makes a thicker layer of fur insulation to help keep the skin
warm. For humans, the visible effect is “goose bumps.”

Hair

Learning Outcome
7. Explain how a hair grows and is lost.

Under normal circumstances, hair is present wherever there is thin skin on the body.
There are three types of hair on every human body. They are the following:
• Lanugo hair, which is very fine and unpigmented (colorless), forms on a fetus dur-
ing the last 3 months of its development. This hair is usually replaced by birth.
• Vellus hair, which is also unpigmented and very fine, replaces lanugo hair around
the time of birth. An example of vellus hair is the body hair on most women and
children.
• Terminal hair, which is thick, coarse, and heavily pigmented, forms the eyebrows,
eyelashes, and hair on the scalp. At puberty, terminal hair forms in the axillary and
pubic regions of both sexes. It also forms on the face and possibly on the trunk and
limbs of men.

3.3 Anatomy of the Skin, Hair, and Nails 91

 All types of human hair can be divided into three sections (shown in Figure 3.9):
• The bulb is a thickening of the hair at the end of the hair follicle.
• The root extends from the bulb to the skin’s surface.
• The shaft is the section of the hair extending out from the skin’s surface.
A cross section of a hair shows three layers: an inner medulla composed of soft
keratin, a middle cortex composed of hard keratin, and an outer cuticle that appears
as interlocking scaly plates of dead keratinocytes. The direction of the cuticle plates
resists the follicle’s cells, so the hair cannot be easily pulled from the follicle. The hair
is easy to manage if the plates of the cuticle are lying smooth on the hair and not stick-
ing out along the length of the shaft. Conditioners can be used to encourage the cuticle
to lay flat.
The hair texture depends on the shaft’s cross-sectional shape. Straight hair has a
round shaft, wavy hair has an oval shaft, and curly hair has a flatter shaft. Rates of
growth within the follicle matter too. Straight hair grows evenly within the follicle.
Wavy and curly hair may grow alternately faster on one side of the follicle than on the
other.
Hair color depends on the amount and type of melanin produced by the hair folli-
cle’s melanocytes. Gray to white hair results from a lack of melanin in the hair’s cortex
and from the possible presence of air in the medulla. See Figure 3.10.
As with most living things, hair has a life cycle. There is a growing stage, a resting
stage, and then a dying stage, when the hair finally falls out. However, not all of the
hairs on the head cycle on the same schedule. Each hair grows about a half inch per
month, and its growth stage lasts for approximately 3 years. Each hair then goes into
a 1 to 2 year resting stage, and then it falls out. If all the hairs on your head were on
the same schedule, you would go bald every 4 to 5 years. Instead, roughly 90% of the

Eumelanin Pheomelanin

Medula

Cortex

Cuticle

(a) Black, straight (b) Blond, straight

Air space

(c) Red, wavy (d) Gray, wavy

FIGURE 3.10 Hair color and texture. Hair colors are shown with the corresponding type of melanin and textures with the
corresponding shape of hair-shaft cross section. All three layers of the hair shaft are shown.
Photos: ©McGraw-Hill Education/Joe DeGrandis

92 CHAPTER 3 The Integumentary System

hairs on your head are somewhere in the growing stage at any given time. In fact, it is
perfectly normal to lose about 100 hairs from your scalp every day. You probably notice
this routine hair loss all the time, as your fallen hair accumulates in the tub or sink
drain, on the bathroom floor, and in your brush when you wash, style, and blow-dry
your hair. Eyelashes go through a similar cycle. They grow for about 30 days, rest for
105 days, and then fall out.

Disease P int
Alopecia, or baldness, is characterized by an excessive
loss of hair. This disorder affects both men and women
and is caused by various factors such as heredity,
infection, or use of certain medications. Alopecia is
diagnosed when you have significantly more than
100 hairs entering the resting stage at one time. ©wasansos1/Getty Images

Spot Check Describe what eyelashes would look like if they had the same
growth cycle as scalp hair.

Nails

Learning Outcome
8. Describe the structure and function of a nail.

Nails form on the distal end (away from the attachment point) of the fingers and toes.
As you can see in Figure 3.11, the structure of the nail includes the skin-covered nail
root and the visible nail plate. The free edge of the nail and the nail body make up
the nail plate. The nail body lies over the nail bed. The nail bed appears pink because
of the dermis’s numerous blood vessels. Laterally, the skin rises to form a nail fold
over the nail’s lateral edge. Here the nail fits into a nail groove. An eponychium (ep-
uh-NIK-ee-um), or cuticle, at the proximal edge of the nail body, is composed of stra-
tum corneum cells extending onto the nail bed. The nail matrix (the nail’s growth
center) at the root of the nail is composed of active keratinocytes in the stratum basale.
The nail is translucent, although a lunula or lunule (LOON-yule) (white crescent)

Cuticle Nail root Nail

(under matrix
Nail plate the skin)

Nail body
Free edge

Nail bed
Bone
Epidermis
Nail groove
Nail fold
Nail root Cuticle Lunula

FIGURE 3.11 Anatomy of a nail.

3.3 Anatomy of the Skin, Hair, and Nails 93

 may be visible under the nail especially on the thumbs. This is where the nail
matrix is thick enough to hide the blood vessels of the dermis deep to it. Again, see
Figure 3.11.
Composed of stratum corneum cells with hard keratin, nails grow distally through-
out life and, unlike hair, do not have a resting stage. Fingernails grow faster than toe-
nails. Nails protect the ends of the fingers and toes, aid in grasping small objects, and
are used for scratching.

Clinical P int
It is important to note that nails can be a good indicator of health. Respiratory diseases
that result in chronic low blood oxygen levels can cause clubbed fingertips and cyano-
sis. With clubbed fingertips, the fingertips widen and the nails become more convex. In
cyanosis (a bluish skin condition), the nail beds may appear blue if there is low blood
oxygen circulating to the nail bed.

3.4 Physiology of the Integumentary System

Learning Outcome
9. E
 xplain how the layers and structures of the skin work together to carry out the
functions of the system.

Now find a pen and draw four dots on the posterior surface of your hand to represent
the corners of a square inch. This 1 square inch of skin you have on your own hand is
typically composed of
• 20 blood vessels
• 65 hairs and arrector pili muscles
• 78 nerve endings for heat
• 13 nerve endings for cold
• 160 to 165 sensors for pressure
• 100 sebaceous glands
• 650 sweat glands
• 19,500,000 cells1
All of these structures work together to accomplish the functions outlined in the
following paragraphs. To see how they do this, let’s look at Nick and Kate as they go
for a run on a cool, sunny morning. See Figure 3.12.

Functions of Skin
Your skin has several necessary and important functions. These functions include
• Protection
• Vitamin D production
• Temperature regulation
• Sensation
• Nonverbal communication
• Water retention

94 CHAPTER 3 The Integumentary System

 FIGURE 3.12 Nick and Kate
on a morning run.
©Image Source/Getty Images

Protection Skin is the body’s first line of defense against the foreign pathogens Nick
and Kate will encounter on their run. Anything they come in contact with may be a
source of potential pathogens. Luckily, the dead, cornified stratum corneum of their
skin makes entry for bacteria difficult. The skin’s surface is also dry, with an acidic
pH, making it an unfriendly place for bacteria to grow. Dendritic cells of the epidermis
stand guard if any pathogens try to make it past the stratum corneum.

Spot Check How might the histology of the dermis hamper the movement of
bacteria as they go deeper into the skin?

Remember that the skin protects the body in other ways too. The sun’s ultraviolet
(UV) rays can damage the skin cells’ DNA. Some stratum basale cells are actively
going through mitosis every day to make new epidermis. Any damage to the DNA
of those cells would be carried to future generations of cells. The stratum basale’s
melanocytes react to UV exposure by producing more melanin. This melanin is then
carried toward the skin’s surface by the keratinocytes. Melanin protects underlying
cells from the potential damage of UV light. The skin exposed to the sun will begin
to darken.

Vitamin D Production Despite the potential dangers of overexposure to the sun’s

UV rays, minimal exposure to these rays does have a benefit. UV light encourages
skin to produce vitamin D, as it activates a precursor molecule in the skin. The liver
and kidney then modify this molecule to become active vitamin D. If you live in a
four-season climate, your exposure to UV light may be greatly reduced during the
winter months. Not only is the sun less intense, but you are more likely to cover most
of your skin with clothing to stay warm, therefore reducing your UV exposure. It is for
this reason that vitamin D is added to most dairy products. Getting enough vitamin D
through proper nutrition is important for homeostasis.
Vitamin D is important for the absorption of calcium from the diet into the blood-
stream. Calcium is needed for bone development and maintenance. You will revisit
this topic in the skeletal system chapter.

3.4 Physiology of the Integumentary System 95

 Temperature Regulation Let’s get back to Nick and Kate’s workout. They are
outside running on a cool, sunny morning. If it is very cool out, their skin may get
paler as the dermal blood vessels constrict to preserve heat for the body’s core. As
they continue to run, their muscles generate heat and they will notice that their skin
is becoming redder. The dermal blood vessels are now dilating and increasing blood
flow to the skin, which gives it more color. The increased blood flow radiates off
some of the excess heat to keep the body’s core from getting too warm. If this effort
is not sufficient to remove the excess heat, the brain will trigger sweating. In sweat-
ing, fluid (not blood cells) leaks from the dilated blood vessels. Sweat glands take in
this fluid, process it, and deliver it to the skin’s surface as sweat to start evaporative
cooling. This further reduces body temperature.
The scenario just described is an important homeostasis example of negative
feedback temperature regulation. The body becomes too warm, so blood vessels
dilate and sweat glands produce sweat to cool the body down to a normal tem-
perature. Another example of negative feedback concerning core body temperature
occurs in freezing conditions. In this case, you may see the skin first redden as blood
vessels dilate in the dermis to warm the skin and prevent it from freezing. If, how-
ever, this process draws too much heat from the body’s core (heart, lungs, and other
organs), the dermal blood vessels will constrict to preserve the heat for the core and
thus preserve life. Frostbite of the skin may then occur.

Sensation During the run, the nerve endings in the stratum basale and dermis of the
skin constantly send the brain messages. Nick and Kate will sense the cool tempera-
ture from the cold receptors in their dermis. They will feel the sun on their faces from
the heat receptors and feel the presence of their clothing and shoes from the pressure
sensors. Nick will even detect the ant crawling on his leg as it disturbs his leg hair, acti-
vating the sensors wrapped around his hair follicles. If Kate stumbles and falls, pain
receptors will alert her to any skin injury.

Nonverbal Communication Aside from the skin’s fluctuating temperature or

any minor injury sustained from a fall while out running, it is crucial to note that
the condition of their skin and their hair sends nonverbal messages to anyone see-
ing them. Nick may blush if he is embarrassed by something he has done, or Kate’s
face may become pale if she is frightened. Even the color, texture, silkiness, and
other qualities of the skin and hair can all be indicative of overall health. Billion-
dollar industries in hair care, skin care, and cosmetics have been developed to help
convey positive messages to one’s self and others to ensure social acceptance. So
it is quite likely that Nick and Kate will want to freshen up their appearance after
their run.

Water Retention Taking a bath after the run brings us to the last of the skin’s func-
tions: water retention. In this case, let’s assume Kate is going to have a bath. As you
know, her body is made up of trillions of cells. You learned in Chapter 2 that a cell will
swell through osmosis if placed in a hypotonic solution. Yet nothing happens to Kate’s
cells when she immerses her body in a tub of bathwater (a hypotonic solution). As she
relaxes in the tub, her body does not swell and her cells do not gain weight. The skin’s
epidermis waterproofs the body by keeping water from the environment out and body
fluids in. (One of the major dangers in severe burns is fluid loss when the epidermis is
completely destroyed.) If Kate stays in the bathwater long enough, she may notice that
the skin on her fingers and toes becomes wrinkly, like a raisin. Why? Her fingers and
toes are the areas of the skin most likely to have abrasions to the epidermis through
everyday activities. The abrasions allow some water to pass through the epidermis,
causing swelling in the underlying tissues. The wrinkling she sees while bathing is the
swelling of these underlying cells going through osmosis.

96 CHAPTER 3 The Integumentary System

3.5 Injuries to the Skin

Learning Outcome
10. Explain how the skin responds to injury and repairs itself.

Skin can be damaged by all sorts of injuries, including cuts, punctures, and burns.
These injuries can happen in everyday life and are not necessarily from a disease pro-
cess. Let’s look at how the physiology of the skin works so the skin can repair itself.

Regeneration versus Fibrosis

Wounds to the skin can heal by regeneration or fibrosis. In regeneration, the wound
is healed with the same tissue that was damaged and normal function is returned. In
fibrosis, the wound is healed with scar tissue and normal function is not returned.
Consider a cut to the skin that goes into the dermis, as shown in Figure 3.13. What
happens to heal the wound?
1. Cutting into the dermis means severing blood vessels, so the wound bleeds and
then clots.
2. A scab forms and pulls the edges of the wound closer together as it dries. This is
called wound contracture.
3. A race begins between the dermis’s fibroblasts and the stratum basale’s keratino-
cytes. The fibroblasts’ collagen fibers produce granulation tissue to fill in the
wound’s clot. In the meantime, stratum basale cells are actively dividing. They
normally divide and push the older cells toward the surface to form epidermis.
But if they are not in contact with other stratum basale cells, the keratinocytes will
divide and push cells laterally toward other stratum basale cells until the edges
of stratum basale come in contact with each other again. This is called contact
inhibition. Once these edges are joined, the keratinocytes resume the cornification
process described earlier to form new epidermis. The type of healing is determined
by who wins the race.
4. It all depends on whether the keratinocytes reach contact inhibition before the
fibroblasts can fill the wound with so much collagen that keratinocytes are pre-
vented from meeting. If the stratum basale wins, the wound heals by regeneration
and normal function results from the new epidermis. If the fibroblasts win, the
wound heals by fibrosis. The scar tissue cannot accomplish the same functions as
normal epidermis. A key factor in who wins the race is how far apart the edges
are. See Figure 3.13.

Disease P int
A possible complication of wound healing can be keloid formation. A keloid is a raised scar
that extends beyond the margins of the wound. Keloids are generally hyperpigmented
or pink in color. A keloid is formed by an overgrowth of scar tissue. Keloid formation
is more common in African Americans. There are a
variety of treatments for keloids, such as corticosteroid
injections, surgical excision, laser treatment, cryotherapy
(freezing the keloid with liquid nitrogen), and radiation.
These treatments may not completely remove the
keloid but can improve the appearance of the keloid by
flattening it and changing the color. ©Biophoto Associates/Science Source

3.5 Injuries to the Skin 97

 Scab New epidermis
growing into wound
Blood
clot

Epidermis

Blood
vessel

Dermis

Subcutaneous
fat

Macrophages
migrating to Fibroblasts migrating
wound site to wound site

1 2
A cut goes through the epidermis into the After approximately a week, a scab has formed and
dermis and damages a blood vessel. It bleeds new epidermis is growing into the wound from the
and a clot forms. stratum basale.

New Scab Freshly healed

epidermis epidermis

Epidermis

Subcutaneous
fat

Granulation tissue Granulation tissue being

(fibroblasts proliferating) replaced with dermis

3 4
After approximately 10–14 days, the epidermis has A month after the injury, the scab has sloughed off, the
grown completely into the wound and the stratum wound is closed, new epidermis has formed from the
basale has reached contact inhibition. Granulation stratum basale, and the granulation tissue has been
tissue has formed. replaced by dermis.

FIGURE 3.13 Wound healing showing regeneration. Stratum basale cells reached contact inhibition before fibroblasts filled
the area with a fibrosis (scar).

Spot Check How would the anatomy and physiology of scar tissue formed
during fibrosis differ from the anatomy and physiology of normal epidermis formed
through regeneration?

98 CHAPTER 3 The Integumentary System

Burns

Learning Outcomes
1 1. C
 ompare and contrast three degrees of burns in terms of symptoms, layers of the skin
affected, and method used by the body for healing.
12. Describe the extent of a burn using the “rule of nines.”

Burns are a common skin injury. Just think how easy it is to burn a finger while lighting
a candle or how quickly you can lose track of time while out in the summer sun with-
out sunscreen. Burns can be categorized in three degrees by the skin layers involved.
These categories are described here and shown in Figure 3.14.
• First-degree burns are the most common burns. Sunburns are often first-degree
burns. They involve only the skin’s epidermis. Symptoms are redness, pain, and
swelling. New epidermis will be made by the stratum basale.
• Second-degree burns, sometimes called partial-thickness burns, involve the
epidermis and dermis. Symptoms are redness, pain, swelling, and blisters. New
epidermis will be made from the stratum basale cells at the burn’s edges and the
stratum basale of the hair follicles growing toward each other until contact inhibi-
tion is achieved. Normal epidermis production then proceeds.
• Third-degree burns, sometimes called full-thickness burns, are the most serious burns.
They involve the epidermis, dermis, and hypodermis. The symptoms are charring and
no pain. There is no pain at the site of a third-degree burn because all of the nerve
endings have been destroyed in the dermis. However, there is pain in the second- and
Partial Full
thickness thickness

First Second Third

degree degree degree

Epidermis

Dermis

Hypodermis

FIGURE 3.14 Three degrees of burns.

Photos: (Left) ©Dmitrii Kotin/Alamy Stock Photo; (Middle and Right) ©John Radcliffe/Science Source

3.5 Injuries to the Skin 99

 first-degree burns that typically surround the third-degree burn. The size of this type of
burn is crucial to healing. Because the dermis has been completely destroyed, the third-
degree burn site has no hair follicles. Therefore, there is no additional stratum basale
of the hair follicles available to help heal the burn. The only stratum basale left is at the
burn’s edges. Skin grafting may be necessary if the stratum basale’s edges are too far
apart. The danger with a third-degree burn is infection and fluid loss. See Figure 3.14.

Clinical P int
The treatment options and chance for recovery may be determined by the severity and
extent of a burn. You have just read about the severity of burns categorized by degree. The
extent of a burn can be determined by applying the “rule of nines”: The body is divided
into 11 areas, each of which represents approximately 9% of the body’s surface area—with
the exception of the genital area, which is 1% of the body’s surface area. See Figure 3.15.

FIGURE 3.15 The rule of

nines. The body is divided into
4.5% 4.5%
11 areas, each with 9% of the
body’s surface area—with the
exception of the genital area,
which is 1% of the body’s
surface area.

18% 18%

4.5% 4.5% 4.5%

1%

9% 9% 9% 9%

Spot Check Hailey went snow skiing in February on a bright, sunny day. It
was cold and she was adequately dressed. She got a sunburn on her face, which was
exposed. She did not have any blisters. Classify the severity and extent of her burn.

3.6 Effects of Aging on the Integumentary System

Learning Outcome
13. Summarize the effects of aging on the integumentary system.

Skin changes with age. The epidermis becomes dry due to the loss of some of the seba-
ceous and sweat glands in the dermis. Also, reductions in estrogen and testosterone
slow the production of sebum from the existing sebaceous glands. Some melanocytes

100 CHAPTER 3 The Integumentary System

in the epidermis are also lost, while others begin to overproduce melanin. The result
is uneven tanning and age spots. Age spots are flat, brown spots produced by melano-
cytes, sometimes called “liver spots.” They have nothing to do with the liver, but they
are colored like the liver. They typically occur on sun-exposed skin surfaces.
Over time, the dermis thins and the number of collagen and elastic fibers is reduced.
This, together with gravity, causes the skin to sag and wrinkle. Blood vessels become
more fragile and respond less quickly to temperature regulation. Combined with the
decrease in dermis sweat glands and the reduction in hypodermis adipose tissue, all of
this makes temperature regulation much more difficult.
The thinning of the hypodermis also reduces the cushioning layer between the skin
and underlying tissues. Bumps resulting in bruises become more frequent and appar-
ent. In elderly persons, the skin over bony prominences may become necrotic (the
tissue dies) if the individuals remain in the same position for too long. This can cause
pressure ulcers or bedsores.
Nails are also affected by aging. The nail plate and nail matrix thin with age. The
thinning of the nail matrix is visible with the loss of the lunule. Nail fractures become
more common as the nail body thins. Toenails may thicken and yellow due to fungal
infections, which the body is less prepared to fight.

Disease P int
Onychomycosis (tinea unguium) is a fungal infection of the nails. Onychomycosis
causes nails to thicken and become discolored. While anyone can develop
onychomycosis, this condition often affects elderly
people due to reduced blood flow and slower-
growing nails. Onychomycosis is usually treated by
oral antifungal drugs, medicated nail polish, or an
antifungal nail cream. These medications can be used
in combination with each other to relieve the symptoms
of the infection. Even if onychomycosis is successfully
treated, it is common for a repeat infection to occur. ©Dr P. Marazzi/Science Source

Hair, too, is affected by aging. Terminal hairs on the ears, nose, and chin become
coarser. The loss of hair follicle melanocytes causes hair to go gray. Because hair does
not replace itself as rapidly in later years, the hair on the scalp becomes thinner. It also
becomes drier, as the hair follicle has a reduced number of sebaceous glands.

Spot Check What could be done to minimize specific effects of aging on the
skin, hair, or nails?

3.7 Diagnostic Tests for Integumentary

System Disorders

Learning Outcome
14. D
 escribe a diagnostic test commonly used when diagnosing integumentary system
disorders.

Before you explore the various types of skin disorders, look at Table 3.2. This table
describes some of the common diagnostic tests and procedures for integumentary sys-
tem disorders.
In the following section, you will explore some of the integumentary disorders that
use these diagnostic tests and procedures.

3.7 Diagnostic Tests for Integumentary System Disorders 101

 TABLE 3.2Common Diagnostic Tests Used for Skin
Disorders
Diagnostic Test Description
Skin biopsy The removal of a piece of tissue or a sample of cells from
a body so that it can be analyzed in a laboratory

Skin scraping The taking of skin cell scrapings so that the cells can be
viewed under a microscope

Wood’s light The use of a black light to view pigment changes in the skin

3.8 Integumentary System Disorders

Skin disorders may or may not have anything to do with aging. There are many types
of skin disorders, and in the following paragraphs you will learn about two: skin can-
cers and skin infections.

Skin Cancer

Learning Outcome
15. D
 escribe three forms of skin cancer in terms of the body area most affected,
appearance, and ability to metastasize.

Skin cancer is the most common type of cancer. Although cancer has many causes,
skin cancer is usually associated with sun exposure and it is more common in older,
light-skinned people. The amount of exposure is cumulative with age. Light-skinned
people have less melanin present to protect them from the sun’s UV rays. The follow-
ing list explains the three forms of skin cancer and will help you see how they differ.
• Basal cell carcinoma is the most common form of skin cancer. It starts in stratum
basale cells and first appears as a small, shiny bump on the face, hands, ears, and
neck. As it progresses, it develops a central depression and a pearly edge. It rarely
metastasizes. See Figure 3.16a.
• Squamous cell carcinoma starts from keratinocytes in the stratum spinosum. First
appearing as a red, scaly patch that develops a central crust, it commonly forms on
the face, hands, ears, and neck. If detected early, it can be surgically removed. Unlike
basal cell carcinoma, this form of skin cancer can metastasize. See Figure 3.16b.
• Malignant melanoma is the rarest but deadliest form of skin cancer. It metastasizes
easily and can occur anywhere on the body. It starts with melanocytes, usually in a pre-
existing mole. Malignant melanoma may be seen as a dark spot under a nail or as a mole
that is asymmetrical and has uneven color and scalloped borders. See Figure 3.16c.

Clinical P int
A change in the number, size, or shape of moles or other highly pigmented areas of the
skin can be evaluated through the ABCDEs of skin cancer:
● Asymmetry. One half does not match the other half.
● Border irregularity. The edges are ragged or blurred.
● Color. More than one color is present, and the color is uneven.
● Diameter. The growth of a mole is in excess of 6 millimeters.
● Evolving. The mole looks different from other moles or is changing in size, shape,
and color.2

102 CHAPTER 3 The Integumentary System

 (a)
(a)

(a) (b)
(b)

FIGURE 3.16 Skin cancer: (a) basal cell carcinoma,

(b) squamous cell carcinoma, (c) malignant melanoma.
(b) (c) ©Dr P. Marazzi/Science Source; (b) ©Biophoto Associates/
(a)
(c) Science Source; (c) ©James Stevenson/SPL/Science Source

Clinical P int
A biopsy is often used to diagnose skin cancers. This common diagnostic procedure
involves excising or removing an area of skin that the health care provider may suspect
is cancerous or that may appear suspicious. The excised skin is viewed under a micro-
scope to determine whether cancer is present.

(c)

Clinical P int
In the 1930s, Dr. Fredrick Mohs developed what is now known as Mohs micrographic
surgery for the treatment of skin cancer. Treatment of skin cancer involves excising the
cancerous tissue. With Mohs micrographic surgery, the surgeon removes thin layers
of tissue and looks at them under a microscope. Each layer is examined for cancerous
cells. When the surgeon obtains a layer that is free of cancerous cells, the excision is
complete. The advantages of Mohs micrographic surgery are preservation of healthy
tissue and precise removal of all cancerous tissue, even malignant cells that cannot be
seen with the naked eye.

Spot Check What common diagnostic test(s) used for skin disorders may be
used to diagnose skin cancer?

3.8 Integumentary System Disorders 103

 Skin Infections

Learning Outcome
16. D
 escribe a common integumentary disorder other than skin cancer and relate
abnormal function to the pathology.

Unlike skin cancers, skin infections can stem from an assortment of bacterial, viral,
and fungal infections. In the following paragraphs, we discuss one or more representa-
tives of each type of skin infection.

Bacterial Skin Infections Several common bacterial infections are described in the
following list:
• Impetigo is an infectious skin disease caused by the bacterium Staphylococcus or
Streptococcus. Impetigo appears as a cluster of vesicles, which are fluid-filled blis-
ters that burst and crust over. Pain and itching may be associated with the vesicles,
and scratching them will cause them to spread to other areas of the skin. Risk fac-
tors involved in contracting impetigo include a possible break in the skin, moist
environment of the skin, poor hygiene, and the existence of the Staphylococcus
bacterium in the nose. Impetigo is usually treated with either oral or topical antibi-
otics or a combination of both.
• Cellulitis is an infection of the skin’s dermis or hypodermis and is frequently caused
by Streptococcus or Staphylococcus bacteria. Cellulitis commonly occurs on the
face and lower legs, characterized by redness and swelling of an area of the skin
that increases in size rapidly. See Figure 3.17. The infected area has a tight, glossy
appearance and is tender or painful. Cellulitis is also accompanied by other signs
of infection, like fever, chills, and muscle aches. Cellulitis can be serious and even
deadly. It is treated with antibiotics.

Viral Skin Infections These infections, including several types of herpes viral infec-
tions, are described in the following list:
• Warts are growths caused by an infection of the skin produced by the human papil-
lomavirus (HPV). Types of warts include common warts (found most often on
the fingers), plantar warts (found on the soles of the feet), genital warts (which
are sexually transmitted), and flat warts (found on frequently shaved surfaces).

FIGURE 3.17 Cellulitis caused

by streptococcal bacteria.
Source: CDC

104 CHAPTER 3 The Integumentary System

 Warts that appear in children often go away as the immune system develops to
fight them, but they may also be removed by freezing.
• Herpes simplex virus (HSV) has two forms: HSV-1 and HSV-2. This virus is
characterized by small, painful blisters that appear on the skin and on the mucous
membranes of the mouth or genitals. Although these blisters eventually subside,
the virus remains dormant in the body for life. HSV-1 causes viral herpes infec-
tions seen on the lips or mouth, while HSV-2 causes viral herpes infection on the
genitals. Both HSV-1 and HSV-2 are extremely contagious and can be spread
through direct contact of the infected area, even when there is no active infection
present. There is no cure for HSV, but antiviral therapy can help slow the duration
and the frequency of the outbreaks.
• Herpes varicella-zoster virus, another type of herpes infection, causes chicken
pox in children and shingles in adults:
∘ chicken pox is a common childhood disorder characterized by red, itchy, fluid-
filled vesicles or pox that appear on the skin. The rash is also accompanied by
fever, headache, and malaise. Chicken pox is contagious and can be contracted
through direct or indirect contact. The chicken pox vaccine helps prevent or
lessen the severity of the illness. It is recommended that children receive this
vaccine at 1 year of age. There is no cure for chicken pox; most treatments are
geared toward making the patient comfortable.
∘ shingles occurs in adults and is similar in appearance to
chicken pox. It is characterized by small, painful vesicles
that usually follow a path along an area of skin supplied
by a spinal nerve. See Figure 3.18. Shingles usually
occurs in the elderly or in immunocompromised patients.
With shingles, the herpes virus has remained dormant in
the patient’s body from the time that the person first con-
tracted it. Shingles occurs in adults who have had chicken
pox in the past. When a patient presents with shingles,
the herpes virus has been reactivated. Although there is
no treatment for shingles, pain medications are often used
to treat the severe pain associated with the disease and
antiviral medications can be helpful in speeding up the
recovery process.
FIGURE 3.18 Shingles.
Fungal Skin Infections Now you will explore a common fun- ©N.M. Hauprich/Science Source
gal infection of the skin:
• Tinea infections are caused by a fungus. Contact with an
infected person, damp surfaces like shower floors or pool decks,
or even pets can transmit the fungus. Examples of tinea fun-
gal infections include ringworm, athlete’s foot, and jock itch.
Ringworm is a circular rash that clears from the center, giving it
a ringlike appearance. See Figure 3.19. It is a fungal infection
and has nothing to do with worms. Athlete’s foot causes burn-
ing, itching, and cracking of the skin between the toes. Jock itch
causes an itchy, burning rash in the groin region. Tinea infec-
tions are treated with fungicides.

Parasitic Skin Infections Following is a description of a para-

sitic skin infection:
• Scabies
 is a parasitic infection of the skin caused by an
infestation of mites. Scabies causes small red bumps on the FIGURE 3.19 Ringworm.
skin that itch severely. See Figure 3.20. The rash and itching ©John Hadfield/Science Source

3.8 Integumentary System Disorders 105

FIGURE 3.20 Scabies:
(a) mite that causes scabies,
(b) scabies skin infection.
(a) ©Eye of Science/Science Source;
(b) ©Dr. P. Marazzi/Science Source

(a) (b)

result from the burrowing of the mite into the skin, and the deposit and hatching
of eggs, which causes an allergic reaction. Scabies is very contagious and can
spread from direct or indirect contact. A topical ointment can be applied to the
skin to kill the mites.

Clinical P int
Skin scrapings can be performed to diagnose fungal infections and scabies infestations.
See Figure 3.21. For fungal infections, the borders of the infection are scraped, and the
cells are placed on a microscope slide for viewing. If a fungal infection is present, the
health care provider should be able to see hyphae (filaments characteristic of fungi)
and budding yeast, which is an indication of fungal reproduction. Skin scrapings can
also be used to view the areas where burrowing from a scabies infection is suspected.
If scabies is present, the health care provider should see the mites that have burrowed
into the skin and the eggs they have deposited.

Other Common Skin Disorders

In addition to understanding the skin disorders you have already reviewed in this chap-
ter, you should be familiar with some of the other common skin disorders that you
will likely encounter as a health care provider. These skin disorders include psoriasis,
dermatitis, decubitus ulcers, hives, and scleroderma.

Psoriasis This is a common skin disease characterized by the overgrowth of skin

cells and improper keratinization of the epidermis and nails. Psoriasis is a hereditary
autoimmune disorder that runs in families. The immune system is triggered to cause
an inflammatory response in the epidermis and dermis, accompanied by overproduc-
tion of keratinocytes. Psoriasis causes red, irritated skin that appears thick and flaky.
Scales (silvery white patches) can also be seen on the skin. See Figure 3.22. The
nails may appear to have white spots, pitting, ridges, and scaling as well. A variety of
treatments can be used to help with the symptoms associated with psoriasis, such as
topical creams and immunosuppressive drugs. Antibiotics can also be used to treat any
secondary skin infections that might occur.

Dermatitis Dermatitis is characterized by inflammation of the skin and may also

show symptoms of redness, swelling, oozing, crusting, scaling, pimples or vesicles,

106 CHAPTER 3 The Integumentary System

FIGURE 3.21 Skin scraping. FIGURE 3.22 Psoriasis.
©Dr. P. Marazzi/Science Source ©Biophoto Associates/Science Source

and itching. There are various types of dermatitis, but the two most common types are
contact dermatitis and atopic dermatitis (eczema):
• Contact dermatitis is inflammation of the skin caused by direct contact with a
substance that can be categorized as either a skin irritant or one that causes an
allergic reaction. These substances can vary greatly. The contact causes the skin to
become inflamed, red, and itchy; these symptoms are localized to a specific area.
The most important factor in treating contact dermatitis is to have the patient avoid
contact with the substance that causes the reaction.
• Atopic dermatitis, also known as atopic eczema, is an allergic reaction that
causes an infection. Atopic dermatitis or eczema can show the same symptoms as
contact dermatitis and can also cause the skin to have a leathery appearance and be
discolored, as shown in Figure 3.23. Atopic dermatitis is most common in children
and is typically outgrown by the teenage years. Treatment for atopic dermatitis
includes avoiding anything that makes the symptoms worse. This could include
detergents, soaps, and lotions or even various foods. Over-the-counter antihista-
mines can help with the itching. If the disease is severe enough, the health care
provider may prescribe corticosteroids to help with inflammation, antibiotics to
help with infection, and allergy shots to minimize the reaction to the allergen.

Decubitus Ulcers Another common skin disorder is decubitus ulcers, also known
as pressure ulcers or bedsores. They are areas of necrotic or ulcerated tissue caused by
the pressure of a bony prominence in the body and another
surface. Although these ulcers are usually seen in people
with limited mobility, other risk factors such as age, poor
or inadequate nutrition, and existing diseases also play a
role. Each body system is affected by aging, which causes
a thinning of the hypodermis and decreased blood flow.
This, combined with limited mobility, can cause com-
pressed tissues to die off or become necrotic. Once the
skin has been damaged, further effects of aging, such as
a decrease in the ability of the immune system to assist
in healing, can make recovery very difficult. Treatment of
decubitus ulcers includes reduction of pressure to the site
of the ulcer, wound care, management of any pain or infec-
tion associated with the ulcer, and sometimes surgery.

Hives This skin condition, also known as urticaria, is a FIGURE 3.23 Atopic dermatitis.
skin reaction that can be caused by insect bites or by contact ©CNRI/Science Source

3.8 Integumentary System Disorders 107

 FIGURE 3.24 Hives.
©SPL/Science Source

with substances that cause an allergic reaction, such as certain foods or drugs. Symptoms
of hives include raised areas of the skin, redness, and itching. See Figure 3.24. Hives usu-
ally resolves without any treatment, but in some cases antihistamines and corticosteroids
may be recommended to reduce itching and swelling.

Scleroderma This disease involves the accumulation of excess connective tissue

in the skin and various organs. It is characterized by increased collagen production
in these connective tissues. The excess collagen works to harden the skin and organs,
decreasing their elasticity and therefore decreasing their ability to function. Sclero-
derma can be caused by exposure to certain chemicals or can be associated with auto-
immune diseases such as lupus and polymyositis. Signs and symptoms of scleroderma
can include skin discoloration, skin thickening and hardening, hair loss, ulcers on fin-
gertips and toes, and tight skin on the face. See Figure 3.25. Additional symptoms can
occur if the disease is systemic, affecting internal organs as well as the skin. Although
there is currently no treatment for the disease, certain medications—like NSAIDs,
corticosteroids, or immunosuppressants—are used to treat its signs and symptoms.

Spot Check Categorize the following skin infections based on their cause:
cellulitis, tinea infection, warts, scabies, herpes, and impetigo.

108 CHAPTER 3 The Integumentary System

FIGURE 3.25 Scleroderma.
©Dr. P. Marazzi/Science Source

Table 3.3 summarizes all the skin diseases and disorders described throughout this
chapter.

TABLE 3.3 Skin Diseases and Disorders

Disease/Disorder Description
Acne Inflammation of sebaceous glands caused by oil, excess cells, and bacteria found on the skin

Alopecia Baldness or excessive loss of hair

Burns Damage to tissues caused by heat, chemicals, sunlight, radiation, or electricity

Cellulitis An infection of the skin’s dermis or hypodermis, which is frequently caused by Streptococcus or
Staphylococcus bacteria

Decubitus ulcers Areas of necrotic or ulcerated tissue caused by the pressure of a bony prominence in the body
and another surface

Dermatitis Inflammation of the skin

Herpes Viral infections of the skin, including the oral and genital areas

Hives A reaction of the skin that can be caused by insect bites or by contact with substances that cause
an allergic reaction, such as certain foods or drugs

Impetigo An infectious disease of the skin caused by the Staphylococcus or Streptococcus bacteria

Onychomycosis A fungal infection of the nails

Psoriasis Skin condition of the nails and epidermis characterized by an overgrowth of skin cells and
improper keratinization

Scabies An infection of the skin caused by an infestation of mites

Scleroderma Increased collagen production in the skin and organs

Tinea infections Fungal infections of the skin

Warts Growths caused by an infection of the skin produced by the human papillomavirus (HPV)

3.8 Integumentary System Disorders 109

Putting the Pieces Together

The Integumentary System

Skeletal system Lymphatic system
Supports skin in cranial and facial Sends white blood cells to fight
regions where bone is close to the pathogens.
surface.
Has dendritic cells to guard against
Vitamin D production enables pathogens; protects against fluid
calcium absorption for bone loss.
deposition.

Muscular system
Respiratory system
Provides heat to warm skin;
Allows for the exchange of O2 and arrector pili muscles move hair.
CO2.
Radiates excess heat generated
Has guard hairs in the nose to trap by muscles; vitamin D production
debris. enables calcium absorption
needed for muscle contractions.

Nervous system Digestive system

Innervates smooth muscle of blood Provides nutrients for tissues of
vessels for vasoconstriction and the integumentary system.
vasodilation to help regulate
temperature. Vitamin D production in the skin
enables calcium absorption in
Has receptors for the general the small intestines.
senses.

Excretory/urinary system
Endocrine system
Disposes of wastes; maintains
Reproductive hormones affect hair fluid and electrolyte balance.
growth for secondary sex
characteristics. Removes some nitrogenous waste
in sweat.
Provides the precursor molecule
for calcitriol (vitamin D).
Reproductive system

Cardiovascular system Reproductive hormones promote

sebum production.
Delivers fluids for sweat
production, provides nutrients, Apocrine glands secrete
and removes wastes. pheromones to attract the
opposite sex; mammary glands
Helps radiate heat of the blood secrete milk to nourish an infant.
for temperature regulation.

FIGURE 3.26 Putting the Pieces Together—The Integumentary System: connections between the integumentary system
and the body’s other systems.

110 CHAPTER 3 The Integumentary System

Summary
3.1 Word Roots and Combining Forms
∙∙ See this heading at the beginning of the chapter to learn the medical terminology that relates to the integumentary system.

3.2 Overview
∙∙ The integumentary system is composed of the skin, hair, nails, and cutaneous glands.

3.3 Anatomy of the Skin, Hair, and Nails

∙∙ The skin is the largest organ of the body.
∙∙ It is composed of two layers: the epidermis and the dermis.
∙∙ The epidermis is stratified squamous epithelial tissue.
∙∙ The dermis is loose/areolar connective tissue over dense irregular connective tissue.
∙∙ The hypodermis is adipose connective tissue; it is not part of the skin, but it attaches the skin to the body.

Epidermis
∙∙  he stratum basale is composed of keratinocytes and melanocytes. This stratum actively divides to make new epidermis.
T
∙∙ The stratum corneum is composed of dead, keratin-filled cells.
∙∙ The stratum lucidum is found only in thick skin.
∙∙ Other cells of the epidermis include tactile cells and dendritic cells.

Dermis
∙∙ The dermis contains papillae, fibers, nerve endings, cutaneous glands, and hair follicles.
∙∙ There are two main types of cutaneous glands: sebaceous glands and sweat glands.
∙∙ Sebaceous glands produce sebum and are associated with a hair follicle.
∙∙ Sweat glands include merocrine glands, apocrine glands, ceruminous glands, and mammary glands.
∙∙ Hair follicles are formed by the stratum basale, which is the center for hair growth.

Hair
∙∙ The three types of hair are lanugo, vellus, and terminal.
∙∙ A hair can be divided into three sections: the bulb, the root, and the shaft.
∙∙ There are three layers to a hair: the inner medulla, the cortex, and the cuticle.
∙∙ Hair goes through a growing stage and a resting stage, and then it falls out.

Nails
∙∙ Nails protect the ends of the fingers and toes, aid in grasping objects, and are used for scratching.
∙∙ They are composed of hard keratin.
∙∙ They are formed by stratum basale cells in the nail matrix.

3.4 Physiology of the Integumentary System

Functions of Skin
∙∙ T
 he functions of the integumentary system include protection from pathogens and UV light, vitamin D production,
temperature regulation, water retention, sensation, and nonverbal communication.

3.5 Injuries to the Skin

Regeneration versus Fibrosis
∙∙ Skin can heal by regeneration or fibrosis.
∙∙ In regeneration, normal function returns.
∙∙ In fibrosis, normal functioning tissue is replaced by scar tissue.

Burns
∙∙ Burns can be classified by degree.
∙∙ First-degree burns involve only the epidermis. Symptoms are redness, pain, and swelling.

111
∙∙ Second-degree burns involve the epidermis and dermis. Symptoms include redness, pain, swelling, and blisters.
∙∙ Third-degree burns involve the epidermis, dermis, and hypodermis. Symptoms include charring and no pain at the
burn site.
∙∙ The “rule of nines” is used to determine the extent of a burn.

3.6 Effects of Aging on the Integumentary System

∙∙ All parts of the integumentary system are affected by aging.
∙∙ The epidermis becomes drier, with uneven tanning and age spots.
∙∙ The dermis thins and produces less collagen and elastic fibers; this, along with gravity, causes sagging and wrinkling of
the skin.
∙∙ The hypodermis thins, providing less cushioning and less insulation.
∙∙ Nails become thinner and more susceptible to fracture.
∙∙ Hair thins and turns gray.

3.7 Diagnostic Tests for Integumentary System Disorders

∙∙ C
 ommon diagnostic tests for integumentary system disorders include skin biopsy, skin scraping, and Wood’s light skin
examination.

3.8 Integumentary System Disorders

Skin Cancer
∙∙ Skin cancer is the most common cancer, and it is associated with sun exposure.
∙∙ Basal cell carcinoma is the most common skin cancer, and it tends not to metastasize.
∙∙ Squamous cell carcinoma can metastasize.
∙∙ Malignant melanoma is the rarest form of skin cancer, but it is also the most deadly because it metastasizes easily.

Skin Infections
∙∙ Skin can be infected by a type of bacteria, a virus, or a fungus.
∙∙ Impetigo and cellulitis are examples of bacterial skin infections.
∙∙ Human papillomavirus, herpes simplex virus, and herpes varicella-zoster virus are examples of viral infections that
affect the skin.
∙∙ Tinea infections of the skin and nails are caused by a fungus.
∙∙ Scabies is a parasitic infection of the skin caused by an infestation of mites.

Other Common Skin Disorders

∙∙ Other common skin disorders include psoriasis, dermatitis, decubitus ulcers, hives, and scleroderma.

Key Words for Review

The following terms are defined in the glossary.

acne first-degree burn subcutaneous layer

contact inhibition keratin sweat glands
cornification melanocytes thin skin
cutaneous papillae urticaria
dermatitis regeneration vesicles
epidermis scales wound contracture
exocrine glands sebum
fibrosis stratum basale

112
 4 The Skeletal
System
Imagine life without bones. How
would you move your feet, point
your finger, practice a yoga
posture, or chew an apple? How
would you communicate with
your friends? Would you
be able to hold a phone to
your ear or text a message?
Your skeletal system makes
it possible for you to do all of
these things, as it allows you
to function as a human being.
See Figure 4.1.
©Juice Images/Getty Images

Module 5: Skeletal System

113
 4.1 Word Roots and Combining Forms

Learning Outcome
1. Use medical terminology related to the skeletal system.

ankyl/o: bent, crooked humer/o: humerus, bone patell/o: patella, kneecap

arthr/o: joint of the upper arm phalang/o: phalanges,
burs/o: sac ili/o: ilium, bone of bones of the fingers
the hip and toes
carp/o: wrist
ischi/o: ischium, bone pub/o: pubis, bone
chondr/o: cartilage of the hip of the hip
condyl/o: condyle lumb/o: lower back stern/o: sternum,
cost/o: rib maxill/o: maxilla, upper breastbone
crani/o: head, skull jaw synov/i: synovial fluid,
femor/o: femur, bone of myel/o: bone marrow, joint, or membrane
the thigh spinal cord tars/o: tarsals, foot
fibul/o: fibula, lateral orth/o: straight tibi/o: tibia, medial bone
bone of the lower leg oste/o: bone of the lower leg

4.2 Overview
No one could deny that your skeletal system makes it pos-
Skeletal System sible for you to move your body from one place to another
Major Organs and Structures: and to communicate with friends using a cell phone or a
bones
friendly wave of the hand. But your skeletal system does
Accessory Structures: so much more than just give your body support and allow
ligaments, cartilages
Functions: for movement. It protects your organs, produces blood cells,
support, movement, protection, and helps maintain your electrolyte and acid–base balance.
acid–base balance, electrolyte
balance, blood formation This chapter covers these functions in the context of every-
day activities.
In this chapter, you will also learn about the anatomy of
the skeletal system, which includes the bones, cartilage, and
ligaments of the body. See Figure 4.1. You will find that bone
is dynamic tissue, changing daily, and that what you do can
affect the changes. You will need to start at the cellular and
tissue levels to understand how the structures of this system
change. But first, you should become familiar with the differ-
ent bones of the body.

4.3 Anatomy of the Skeletal System

Learning Outcome
2. Distinguish between the axial skeleton and the appendicular skeleton.

The human skeleton is divided into two major divisions: the axial skeleton and the
appendicular skeleton. The axial skeleton consists of the bones of the head, neck, and
FIGURE 4.1 Skeletal system. trunk. The appendicular skeleton includes the bones of the arms, legs, and girdles
(the bones that attach the arms and legs to the trunk). See Figure 4.2.

114 CHAPTER 4 The Skeletal System

 Cranium
Skull
Face

Clavicle
Hyoid
Scapula

Sternum Vertebral
column
Humerus
Vertebral
column
Ribs Sacrum

Pelvic girdle
Carpals Coccyx

Radius

Ulna

Femur
Metacarpals Phalanges
Patella

Tibia

Fibula

Tarsals

Metatarsals

Phalanges

(a) (b)

FIGURE 4.2 The axial and appendicular skeletons: (a) anterior, (b) posterior. The axial skeleton is shown in blue, and the
appendicular skeleton is shown in gold.

Classification of Bones

Learning Outcome
3. Describe five types of bones classified by shape.

Bones are classified by their shape, and each bone fits into one of five classes:
• Long bones
• Short bones

4.3 Anatomy of the Skeletal System 115

 • Flat bones
• Irregular bones
• Sesamoid bones

Long Bones A bone is considered to be a long bone if it is longer than it is wide and
it has clubby ends. The bones of the arms, legs, fingers, and toes are long bones. The
most distal finger bone is not very long, but it fits the definition of a long bone because
it is longer than it is wide and it has clubby ends. See Figure 4.3. You will learn about
the anatomy of a long bone and how it develops and changes later in this chapter.

Short Bones Short bones are not longer than they are wide. These bones, which
include wrist bones and proximal foot bones, are more cube-shaped. See Figure 4.3.

Flat Bones Flat bones are just that—flat. They look like a sheet of modeling clay
that has been molded over an object. The sternum (breastbone), the cranial bones of
the skull, and the ribs are all flat bones. See Figure 4.4. We discuss the anatomy and
development of a flat bone later in this chapter.

Irregular Bones Irregular bones are also self-explanatory: They do not fit into any
of the other categories. Irregular bones have processes, spines, and ridges that stick
out and serve as attachment points for tendons and ligaments. Tendons attach muscle
to bone, and ligaments attach bone to bone. The vertebrae are good examples of this
classification. See Figure 4.5.

Long
bones

Sternum

Ribs

Short
bones

FIGURE 4.3 Long bones of the hand and short bones

of the wrist. FIGURE 4.4 Flat bones—sternum and ribs.
©McGraw-Hill Education/Christine Eckel ©McGraw-Hill Education/Christine Eckel

116 CHAPTER 4 The Skeletal System

 Common Misconception
It is very easy to mistakenly think ribs are long bones because they are longer than they
are wide. However, ribs do not have clubby ends, so they are considered flat bones.

Sesamoid Bones Sesamoid bones look like ses-

ame seeds. They grow in tendons where there is a lot
of friction. Their presence helps protect the tendon
from wear and tear as the tendon slides over a bony
prominence. The body has at least two sesamoid
bones, which are the patellas, otherwise known as
the kneecaps. Granted, these bones would be very
huge sesame seeds, but they are seed-shaped none-
theless. Each patella protects the patellar tendon
that goes across the anterior surface of the knee. (a) (b)
See Figure 4.6.
The human body contains about 206 bones. This FIGURE 4.5 Irregular bone—typical vertebra: (a) superior view,
is an approximate figure because each human body (b) lateral view.
may have a slightly different number of sesamoid ©McGraw-Hill Education/Christine Eckel
bones. The two patellas are part of the 206 bones.
Many people, however, may develop additional,
smaller sesamoid bones in the tendons of their
fingers and in the joints of their toes. You would
need an X-ray of a body to know exactly how many
bones it contains.

You have now viewed the skeleton as a whole,

and you know that the bones of both parts—axial
and appendicular—can be classified by their shape.
In the next sections, you will look more closely at (a) (b)
the individual bones and structures of the axial and
appendicular skeletons. FIGURE 4.6 Sesamoid bone—the patella: (a) posterior,
(b) anterior.

Axial Skeleton

Learning Outcome
4. Identify bones, markings, and structures of the axial skeleton and appendicular
skeleton.

The axial skeleton includes the bones of the head, neck, and trunk. You can further
break it down into the following specific bone types: cranial bones, facial bones, spi-
nal column, sternum and ribs, and the hyoid bone. We start with the cranial and facial
bones of the head.
The skull is composed of 8 cranial bones and 14 facial bones. The cranial bones
form a cavity to house the brain. The facial bones provide structure, and they are the
attachments for the facial expression muscles. See Figures 4.7 to 4.12.

Cranial Bones Cranial bones include the frontal bone, occipital bone, two temporal
bones, and two parietal bones, which all happen to be flat bones. Learning the ___location
of these bones is crucial for any student pursuing a career in allied health. When you
study the brain in the nervous system chapter (Chapter 6), you will find that each lobe of
the cerebrum is named for the bone it lies under. See Figures 4.7, 4.8, and 4.12.

4.3 Anatomy of the Skeletal System 117

 Parietal
bone
Frontal
bone

Lacrimal
bone
Ethmoid Nasal
bone bone

Sphenoid Sphenoid
bone bone
Temporal Middle
bone nasal
Perpendicular concha
plate of the Zygomatic
ethmoid bone bone

Vomer Inferior
nasal
concha
Mandible
Maxilla

(a)

(b)

FIGURE 4.7 Anterior view of the skull: (a) colored image, (b) natural skull.
(b) ©McGraw-Hill Education/Christine Eckel

118 CHAPTER 4 The Skeletal System

 Frontal
bone
Parietal Sphenoid
bone bone
Ethmoid
bone
Lacrimal
bone
Occipital
bone Nasal
bone
Temporal
bone Zygomatic
bone

Maxilla

Mandible
(a)

(b)

FIGURE 4.8 Lateral view of the skull: (a) colored image, (b) natural skull.
(b) ©McGraw-Hill Education/Christine Eckel

If you look closely at Figure 4.10, you will see many holes or openings in the skull.
These openings are called foramina (plural of foramen), and they allow the passage of
blood vessels and nerves. The occipital bone contains a large opening called the foramen
magnum (fo-RAY-men), which allows the spinal cord to exit the cranial cavity.
The external occipital protuberance is located on the occipital bone’s posterior
surface. See Figure 4.10. This protuberance is typically larger in males, and—like all
other structures that stick out from a bone—it is the attachment point for a tendon to
connect a muscle to the bone. More information about this particular muscle appears
in “Chapter 5, The Muscular System.”
The ethmoid and sphenoid (SFEE-noyd) bones are irregular bones, and they
form the majority of the cranial cavity floor. The ethmoid bone includes a structure

4.3 Anatomy of the Skeletal System 119

 Frontal bone
Temporal bone
Sphenoid bone

Parietal bone
Frontal sinus
Occipital bone
Nasal bone
Sella turcica

Cribriform plate Sphenoidal sinus

Ethmoid Perpendicular plate
bone (nasal septum) Vomer

Inferior nasal
concha
Palatine bone
Maxilla

Mandible

FIGURE 4.9 Medial view of the skull.

Maxilla
Zygomatic
bone
Frontal
bone
Palatine
Sphenoid bone
bone
Zygomatic
arch

Vomer

Temporal
bone
Foramen
magnum

External Occipital
occipital bone
protuberance

(a) (b)

FIGURE 4.10 Inferior view of the skull: (a) colored image, (b) natural skull.
(b) ©McGraw-Hill Education/Christine Eckel

120 CHAPTER 4 The Skeletal System

 Cribriform plate of
the ethmoid bone

Frontal
bone
Sphenoid
bone
Sella turcica

Temporal
bone

Parietal bone

Foramen
magnum

Occipital
bone
(a) (b)

FIGURE 4.11 Cranial floor of the skull: (a) colored image, (b) natural skull.
(b) ©McGraw-Hill Education/Christine Eckel

FIGURE 4.12 Superior view

Anterior of the skull: (a) colored image,
(b) natural skull.
(b) ©McGraw-Hill Education/Christine
Eckel
Frontal bone
Coronal suture

Parietal bone

Sagittal suture

Occipital bone

(a) Posterior (b)

called the cribriform plate. See Figures 4.11 and 4.13a. This plate consists of two
depressions in the cranial cavity’s anterior floor. The cribriform plate is perforated
with many holes. These holes allow nerve endings from the first cranial nerve to have
access to the nasal cavity for the sense of smell. The ethmoid bone also forms lateral
bony ridges called conchae (KON-kee) (plural of concha) in the nasal cavity. The
sphenoid bone appears butterfly-shaped, and it is visible from outside the skull next to
the temporal bone. Inside the skull, the sphenoid bone forms another important struc-
ture called the sella turcica (SELL-ah TUR-sih-kah) (“Turkish saddle”). The pituitary
gland sits in this bony saddle, and the saddle’s broad bar helps protect the pituitary
gland by surrounding it in bone. See Figures 4.11 and 4.13b.

4.3 Anatomy of the Skeletal System 121

 Common Misconception
Like all bones, the ethmoid and sphenoid bones are three-dimensional. They are difficult
to identify because they appear differently depending on the view of the skull. Together,
both bones form the cranial vault floor, and both are found in the eye socket. The eth-
moid bone forms structures in the nasal cavity, while the sphenoid bone can be seen on
the exterior skull. It is important to look at bones from several angles to understand their
___location with respect to other bones.

Facial Bones The following bones make up your facial bones: two nasal, two
lacrimal, two zygomatic, two inferior nasal concha, two maxilla, two palatine, one
mandible, and one vomer. As you can tell from so many different kinds of bones, the
facial part of the skull is quite complicated. Notice that in Figure 4.7 it takes seven
Cribriform plate bones (palatine bone is obscured by the
maxilla) to form the eye socket. If you feel
the bridge of your nose, you will notice a
Superior change about halfway down. That is where
nasal concha the nasal bones end and plates of nasal car-
tilage begin. The vomer forms the inferior
part of the nasal septum, which divides the
nostrils into right and left. The ethmoid
bone forms the superior part of the septum.
(a) The inferior nasal concha forms the infe-
Middle nasal
rior lateral ridge in the nasal cavity, while
concha the ethmoid bone forms the superior and
middle lateral ridges. The zygomatic bone
Perpendicular is the cheekbone. Notice how it arches out
plate to perfectly form an arch with the temporal
bone. Muscles pass deep to this arch.
Again, it is important to realize these are
three-dimensional bones. The maxilla forms
the upper jaw, but it also forms the anterior
hard palate in the roof of the mouth cavity.
The mandible is the lower jaw. In fact, the
only movable joint in your entire skull—
the temporal mandibular joint—is where
the mandible meets the temporal bone.
The frontal bone, ethmoid bone, sphe-
(b) Sella turcica noid bone, and maxilla (a facial bone)
Superior view
have cavities within the bones themselves.
These spaces are the sinuses. Each sinus
is named for the bone that contains it. The
sinuses are lined by mucous membranes
and filled with air, and they help warm and
moisten inspired air and give resonance to
the voice. See Figure 4.14.

Spinal Column In an adult, the spinal

column is composed of 26 bones. It con-
tains three types of vertebrae, the sacrum
(SAY-crum), and the coccyx. There are
Posterior view 7 cervical vertebrae, 12 thoracic verte-
FIGURE 4.13 The ethmoid and sphenoid bones: (a) ethmoid , brae, 5 lumbar vertebrae, 1 sacrum, and 1
(b) sphenoid . coccyx. See Figure 4.15.

122 CHAPTER 4 The Skeletal System

 Sphenoid
sinus

Frontal
sinus

Ethmoid
sinus

Maxillary
sinus

FIGURE 4.14 Sinuses.

(left) ©Ryan McVay/Getty Images

In Figure 4.15, you will notice that the spinal column forms a straight line when
viewed from an anterior or posterior perspective. But when viewed laterally, as in
Figure 4.16, the spinal column has an elongated S-shaped curve. The S curvature

C1
Atlas (C1)
Axis (C2)
Cervical Cervical
vertebrae curvature

C7
C7
T1
T1

Thoracic Thoracic
vertebrae curvature

T12
L1
T12
L1

Lumbar Lumbar
vertebrae curvature
L5
L5
S1
S1
Sacrum Sacral
curvature
S5
Coccyx Lateral view
Posterior view
FIGURE 4.16 Adult spinal
FIGURE 4.15 Spinal column. column curvatures.

4.3 Anatomy of the Skeletal System 123

 develops over time. The spinal column of a newborn has a C-shaped curvature. This
C-shaped curvature quickly develops the cervical curvature as the infant begins to
crawl and raise its head to look forward. The lumbar curvature starts as the toddler
begins to walk.

Disease P int
Abnormal spinal curvatures can result from congenital defects (present at birth),
disease, aging, obesity, and pregnancy. The most common abnormal curvature is
scoliosis. See Figure 4.17a. It is characterized by a lateral curvature of the spinal
column, often in the thoracic region. During the screening process, the individual
bends over at the waist. The screener looks to see if the shoulders appear to be level
and the spine is straight. If this is not the case, a follow-up X-ray is taken to look for the
lateral curvature. If diagnosed before the spinal column has fully developed, scoliosis
can be treated with a back brace or surgery. It is important to treat scoliosis to ensure
ample room for organs. In addition to scoliosis, other abnormal spinal curvatures
include kyphosis and lordosis.
Kyphosis, commonly called “hunchback,” is an exaggerated abnormal curvature
of the thoracic vertebrae. It is associated with aging and osteoporosis. Lordosis,
commonly called “swayback,” is an exaggerated curvature of the lumbar vertebrae,
often associated with obesity and pregnancy. See Figure 4.17b and c.

(a) (b) (c)

= Normal = Pathological

FIGURE 4.17 Abnormal curvatures of the spinal column: (a) scoliosis, (b) kyphosis, (c) lordosis.

124 CHAPTER 4 The Skeletal System

 Each vertebra is an irregular bone. Look closely at the lumbar vertebra shown
in Figure 4.18a. It has a body, a vertebral foramen, a spinous process, and two
transverse processes. The body of the vertebra supports the weight of the body. The
spinous and transverse processes are attachment points for tendons and ligaments.
The vertebral foramen (VER-teh-bral) allows the spinal cord to pass through the
vertebra. Spinal nerves exit the spinal cord between vertebrae.
Between each of the vertebrae is an intervertebral disk of softer matrix surrounded
by fibrocartilage. The disks support the body weight and act as shock absorbers, cush-
ioning the vertebrae from the impact of each footstep. See Figure 4.18b.

Disease P int
Improper heavy lifting compresses the intervertebral disks. The pressure of extra
weight may cause one of these disks to bulge out laterally. This bulge may allow the
softer matrix to ooze out. This condition is called a herniated disk. In common usage,
this is often referred to as a ruptured or slipped disk. Depending on the direction
of the bulge, a herniated disk can put pressure on the spinal cord or spinal nerves,
causing severe pain. See Figure 4.18c.

FIGURE 4.18 A vertebra:

Posterior (a) second lumbar vertebra (L2),
(b) intervertebral disk,
(c) herniated disk.
Spinous
process

Transverse
process
Fibrocartilage

Vertebral
foramen

Body

Anterior Soft matrix

(a) (b)

Spinal cord

Herniation with soft Spinal nerve

matrix oozing out

Soft matrix

Fibrocartilage

(c)

4.3 Anatomy of the Skeletal System 125

 Odontoid
process, dens
Transverse
foramen Transverse
foramen
Vertebral
foramen Vertebral
foramen

(a) (b) (c)

FIGURE 4.19 Cervical vertebrae: (a) typical cervical vertebra , (b) atlas (C1) , (c) axis (C2) .
©McGraw-Hill Education/Christine Eckel

Cervical vertebrae Look closely at the typical cervical vertebra in Figure 4.19a.
Notice that the seven cervical vertebrae have foramina in the transverse processes.
The vertebral arteries pass through these openings on their way to the head. You
will learn more about these in the cardiovascular system chapter on the heart and
vessels (Chapter 10). The cervical vertebrae are the only vertebrae with transverse
foramina. The first two cervical vertebrae—the atlas and the axis—are unique. The
first is the atlas (Figure 4.19b), which has a very little body and a very large verte-
bral foramen for the spinal cord. Second comes the axis (Figure 4.19c), which has
a peglike structure called the odontoid process or dens. It sticks through the large
vertebral foramen of the atlas and provides a pivot point so that the atlas can rotate
on the axis. This allows you to turn your head to the right or left.

Study Hint
Here is an easy hint for remembering which of these vertebrae comes first: They are in
alphabetical order—atlas comes before axis.

Thoracic vertebrae The 12 thoracic vertebrae are distinctive because they are the
only vertebrae in the body that have smooth surfaces called costal facets. Ribs attach
to the facets on the bodies and transverse processes of these vertebrae. They are num-
bered T1 through T12. T1 is the most superior. See Figure 4.20a.

Costal facets
Costal facet on the body
on transverse
process

(a) (b)

FIGURE 4.20 Thoracic and lumbar vertebrae: (a) thoracic vertebra with costal facets , (b) lumbar vertebra with no costal
facets .
©McGraw-Hill Education/Christine Eckel

126 CHAPTER 4 The Skeletal System

Lumbar vertebrae The five lumbar
vertebrae are the most massive because
they support the weight of the body. There
may be little difference in mass between
T12 and L1, which are located right next
to each other. T12, however, has facets for Sacrum
ribs to attach, whereas L1 does not. See
Figure 4.20b.

Sacrum and coccyx The sacrum and

the coccyx, which are still part of the axial
skeleton, complete the inferior end of the
spinal column. The sacrum is composed Coccyx
of five separate bones in a fetus that fuse (a) (b)
to become one bone in an adult. The coc- FIGURE 4.21 Sacrum and coccyx: (a) anterior view, (b) posterior view.
cyx is composed of four to five bones ©McGraw-Hill Education/Christine Eckel
in a fetus that fuse to become one bone
in an adult. Therefore, there are 33 to
34 bones in a fetal spinal column and just
26 bones in an adult spinal column. See
Figure 4.21. 1st rib
Manubrium
Sternum The sternum is a flat bone
composed of three parts: the manu-
Body of
brium, the body, and the xiphoid sternum
process (ZIE-foyd). Together, they serve
as a protective plate for the heart and as Costal cartilage
an attachment site for the ribs encasing
the thorax. The manubrium is the attach- Xiphoid process
7th rib
ment point for the pectoral girdle. You
will read more about this shortly in regard False floating
to the appendicular skeleton. The xiphoid ribs
process is the most inferior part of the False ribs
sternum. See Figure 4.22.

FIGURE 4.22 The sternum and ribs: anterior view.

©McGraw-Hill Education/Christine Eckel

Clinical P int
Before you administer CPR, care must be taken to locate
the xiphoid process. During CPR, you must apply pressure
to the sternum superior to the xiphoid process to ensure
the xiphoid process does not break.

©Stockbyte Platinum/Alamy Stock Photo

4.3 Anatomy of the Skeletal System 127

 Inferior costal Transverse
facet of T5 costal facet
for rib 6

Vertebral
body T5
Rib 6
Rib 6
Intervertebral
disk
Vertebral
body T6 Superior
costal
facet T6
Superior costal for rib 6
facet of T6
(a) (b)

FIGURE 4.23 Rib 6 attachment to T5 and T6: (a) anterior view, (b) superior view.

Ribs As you can see in Figure 4.22,

Styloid process there are 12 pairs of ribs in the human
body. They provide protection for the
lungs in the thoracic cavity. The supe-
rior 7 pairs of ribs are connected to
Hyoid bone the sternum by their individual costal
cartilages. These pairs are considered
Hyoid bone
Larynx
true ribs. Pairs 8 through 12 are con-
sidered false ribs because they do not
have individual costal cartilages con-
necting them to the sternum. Of the
false ribs, pairs 8 through 10 share a
costal cartilage to connect to the ster-
num. Pairs 11 and 12 are considered to
FIGURE 4.24 Hyoid bone. be false floating ribs because they are
not connected to the sternum. The costal cartilages are composed of hyaline cartilage
connective tissue. The ribs attach posteriorly to the thoracic vertebrae at the vertebral
bodies and transverse processes. See Figure 4.23.

Hyoid Bone The hyoid bone is a U-shaped bone found in the body’s anterior cervi-
cal region between the mandible and the larynx. This bone is unique because it is not
attached to another bone. Muscles attach to the hyoid bone to form the angle between
the chin and the neck. See Figure 4.24.

Clinical P int
Forensic pathologists look for fractures of the hyoid bone as an indication of
strangulation.

Spot Check Name three flat bones of the axial skeleton.

Spot Check Name two irregular bones of the axial skeleton.

128 CHAPTER 4 The Skeletal System

Appendicular Skeleton
The appendicular skeleton is composed of the bones of the limbs
and the bones (called girdles) that attach each limb to the axial
skeleton. The pectoral girdle bones attach the arm bones to the
axial skeleton. The pelvic girdle bones attach the leg bones to (a)
the axial skeleton. We begin our discussion with the bones of the
pectoral girdle and the upper limb.

Pectoral Girdle In the pectoral girdle, the clavicle and scapula

connect the arm to the axial skeleton. The clavicle, commonly
called the collarbone, is slightly S-shaped. It holds the shoulder (b)
out from the body laterally, preventing the chest muscles from
pulling the shoulder medially. See Figure 4.25. FIGURE 4.25 Right clavicle: (a) superior view,
The scapula is the shoulder blade. It has a smooth anterior sur- (b) inferior view.
face that allows it to slide over the ribs, while its posterior surface ©McGraw-Hill Education
has a prominent spine for the attachment of muscles by tendons.
The scapula contains the following three prominent lateral features: the acromion
process (ah-CROW-mee-on) articulates (joins together) with the clavicle; the cora-
coid process (KOR-ah-koyd) is an attachment point for muscles (see the muscular
system chapter) by tendons; and the glenoid cavity is a smooth surface that articulates
with the upper arm bone called the humerus. See Figure 4.26.

Clinical P int
The only bone-to-bone connection of the arm and
scapula to the axial skeleton is at the point where
the clavicle and the manubrium of the sternum meet.
The clavicle is a commonly fractured bone because
of the stress placed on it when people reach out
with an arm to break a fall. If a clavicle is broken, it
is very important to immobilize the arm to the body.
This will relieve the stress on the fracture from the
weight of the arm.

Coracoid FIGURE 4.26 Scapula:

process (a) posterior view, (b) anterior
view.
Acromion
process

Spine

Glenoid
cavity

(a) (b)

4.3 Anatomy of the Skeletal System 129

Greater Head Greater
tubercle tubercle

Lesser
tubercle

Deltoid
tuberosity

Olecranon
fossa

Lateral Medial Lateral

epicondyle epicondyle epicondyle

Capitulum Trochlea

(a) (b) (c)

Humerus

Lateral Medial
epicondyle Humerus
epicondyle

Medial
epicondyle Lateral
Capitulum
Olecranon epicondyle

Trochlea Radius

Ulna
Radius
Ulna

(d) (e)

FIGURE 4.27 Humerus: (a) anterior view; (b) posterior view ; (c) natural humerus, anterior view; (d) anterior elbow;
(e) posterior elbow .
(c, d, e) ©McGraw-Hill Education/Christine Eckel

Bones of the Upper Limb The bones of the upper limb include the humerus, radius,
ulna, carpals, metacarpals, and phalanges.

Humerus The humerus is the proximal long bone of the arm, and its many features
(shown in Figure 4.27) include the following:
• Head. The head is located at the proximal end of the humerus. It articulates with
the glenoid cavity of the scapula.
• Greater and lesser tubercles. These are attachment points for muscles by tendons.

130 CHAPTER 4 The Skeletal System

• Deltoid tuberosity. Tuberosities are rough areas on Olecranon
a bone that serve as attachment points of muscles by Trochlear
tendons. This tuberosity is an attachment point for the notch
deltoid muscle.
Head
• Capitulum. The capitulum (ka-PIT-you-lum) is a rounded
smooth surface on the distal end of the bone. It articulates
with the radius, which you will read about shortly.
• Trochlea. The trochlea (TROHK-lee-ah) is a pulley-
shaped smooth surface on the distal end of the humerus.
It articulates with the ulna, which you will also read about
shortly.
• Lateral and medial epicondyles. Condyles (KON-dilz) Ulna
are smooth bone surfaces that articulate with another bone
at a joint. Head, capitulum, and trochlea are specific names
for the humerus’s condyles. Epicondyles are rough bumps
usually to the side of the condyles that work as attachment
points for muscles by tendons. You will need to be able to Radius
determine medial from lateral epicondyles, as this will be Interosseous
membrane
very relevant when you study muscles in the muscular sys-
tem chapter.
• Olecranon fossa. A fossa is a depression in a bone. The
olecranon fossa (oh-LEK-kra-nun) is a depression on the
posterior surface of the humerus’s distal end. The olecra-
non, a feature of the ulna, fits into this depression. You will
learn about the ulna shortly. Again, see Figure 4.27.
Styloid Styloid
process process
Radius The radius is a long bone of the forearm. See
Figure 4.28. Special features of this bone include the following:
• Head. The head is at the proximal end of the radius. It artic- FIGURE 4.28 Radius and ulna: anterior view.
ulates with the capitulum of the humerus.
• Styloid process. Styloid means pointy, while a process is something that
sticks out. So the styloid process is a pointed process at the radius’s dis-
tal end. It helps frame the lateral carpal bones of the wrist (thumb side). See
Figure 4.28.

Study Hint
If someone were to show you a humerus, would you be able to tell if it belonged to
the right or left side of the body? You will have a very good understanding of the fea-
tures of this bone when you can accomplish that task. Think about what you already
know that may be helpful. You know that the head articulates with the glenoid cavity
of the scapula. So the head has to face medially—it cannot face laterally away from
the body. You also know that the olecranon fossa is on the posterior surface of the
bone. Knowing the head is medial and the olecranon fossa is posterior is enough to
allow you to determine right from left. It also is enough to help you determine the
medial epicondyle from the lateral epicondyle, as long as you keep in mind the stan-
dard anatomical position.

4.3 Anatomy of the Skeletal System 131

 Ulna The ulna is another long bone of the forearm. Its special features include the
following:
• Olecranon. The olecranon is a hook at the proximal end of the ulna; it fits into the
olecranon fossa of the humerus.
• Trochlear notch. The trochlear notch is a smooth surface at the ulna’s proximal
end. It articulates with the trochlea of the humerus.
• Styloid process. The styloid process of the ulna frames the medial carpal bones of
the wrist.
There is also an interosseous membrane that connects the radius and ulna along
the length of the two bones. This is actually a ligament connecting bone to bone.
See Figure 4.28. It helps distribute the pressure put on either bone equally to both
bones and thus helps prevent wear and tear at the elbow joint. You will learn more
about this membrane later in this chapter when you investigate joints.

Carpal bones There are eight short bones in the wrist that are collectively called
the carpal bones. They form two rows of cubelike bones that allow movement from
side to side and front to back. The proximal row of bones (starting from the thumb
side) is made up of the scaphoid, lunate, triquetrum (tri-KWE-trum), and pisiform
(PIS-ih-form). The distal row of bones (starting on the thumb side) is made up of the
trapezium, trapezoid, capitate, and hamate. See Figure 4.29.

Study Hint
There is a mnemonic device that will help you remember the names of the carpal
bones. The saying uses the first letter of each bone in order, and it goes like this: “Small
little trains pull tiny train cars home.”

Metacarpals The five metacarpal bones are long bones. They make up the palm
of the hand. The metacarpals are numbered, with 1 being proximal to the thumb and
5 being proximal to the little finger. See Figure 4.29.

Phalanges The 14 phalanges (fah-LAN-jeez) are long bones that make up the fin-
gers. They are named by their position as proximal, middle, or distal and by the finger in
which they reside. The thumb is 1 and the little finger is 5. People often wear a wedding
ring on the left proximal phalanx (FAY-lanks) 4. See Figure 4.29.

Common Misconception
On an X-ray, the metacarpal bones appear to be part of the fingers. For this reason, it is
easy to confuse metacarpal bone 1 with proximal phalanx 1. Take a look at your thumb.
There are only two phalanges in the thumb. All other fingers contain three phalanges.
See Figure 4.30.

Now that you have covered the bones of the pectoral girdle and upper limb, it is
time to examine the bones of the pelvic girdle and lower limb.

Pelvic Girdle The right and left pelvic girdles attach the lower limbs to the axial
skeleton at the sacrum. Each of the pelvic girdles is composed of three bones: the ilium
(ILL-ee-um), the ischium (ISS-kee-um), and the pubis. These three bones are fused

132 CHAPTER 4 The Skeletal System

Radius Capitate FIGURE 4.29 Left wrist and
hand: anterior view.

Ulna Trapezoid

Scaphoid Trapezium

Lunate

Carpals
Pisiform

Triquetrum

1
Metacarpals
Hamate
5
2
4 3

Proximal
phalanx

Middle
phalanx Phalanges

Distal
phalanx

together, and they are sometimes referred to collectively as the ossa

coxae (OS-sah COCK-see) or hip bone. See Figure 4.31.
The ilium is the most superior bone of a pelvic girdle, and the
ischium is the most inferior. The third bone of the pelvic girdle, the Sesamoid
bone
pubis, is the most anterior bone. Together these three bones form a
lateral feature called the acetabulum (as-eh-TAB-you-lum). This is
the smooth hip socket that articulates with the thigh bone (femur). It
is remarkable to think that three bones developed together to form a
socket that would perfectly fit a fourth bone.
The right and left pelvic girdles along with the sacrum and coccyx
form the pelvis. The joint between the ilium and the sacrum is called FIGURE 4.30 X-ray of a hand, including a
the sacroiliac (say-kroh-ILL-ee-ak) joint. This knowledge will help sesamoid bone.
you determine the right and left pelvic girdles. The ilium has a rough ©RNHRD NHS Trust/Getty Images

4.3 Anatomy of the Skeletal System 133

 Ilium
Ilium

Location of
sacroiliac
joint
Acetabulum
Ischium
Pubis
Ischium Location
Pubis of pubic
symphysis

(a) (b) (c) (d)

FIGURE 4.31 Pelvic girdle: (a) lateral view; (b) natural bone, lateral view; (c) medial view; (d) natural bone, medial view.
(b, d) ©McGraw-Hill Education/Christine Eckel

Sacroiliac area that must be medial to form the sacroiliac joint

joint
with the sacrum. The right and left pelvic girdles are
connected anteriorly by fibrocartilage at a joint called
Ilium the pubic symphysis (SIM-feh-sis). See Figure 4.32.
The male and female pelvises have specific differ-
ences, but, mainly, it is important for you to know the
Sacrum following: The female pelvis is wider and shallower,
Acetabulum has a more rounded pelvic brim, and has a larger pelvic
inlet or opening than the male pelvis. All of these dif-
Pubis
ferences are accommodations for pregnancy and birth.
Pubic Ischium See Figure 4.33.
symphysis

Bones of the Lower Limb The bones of the lower

FIGURE 4.32 Pelvis: anterosuperior view. limb include the femur, tibia, and fibula and the tarsals,
metatarsals, and phalanges of the foot.

Femur The femur is the proximal long bone of the leg. Its special features (shown in
Figure 4.34) include:
• Head. The head of the femur is a round ball-like structure at the proximal end of
the femur. It articulates with the acetabulum of the pelvic girdle.
• Neck. The neck of the femur connects the head to the bone’s shaft.
• Greater and lesser trochanters. The greater and lesser trochanters (troh-KAN-
terz) are similar to the tubercles found on the humerus of the arm. The trochanters

Flared ilium

Pelvic brim

Pelvic inlet

Pubic arch

(a) (b)

FIGURE 4.33 Female and male pelvises: (a) female pelvis , (b) male pelvis .

134 CHAPTER 4 The Skeletal System

 are more massive than the tubercles. Like the tubercles, the trochanters are attach-
ment points for muscles by tendons.
• Medial and lateral condyles. The condyles are smooth surfaces at the distal end
of the femur. They articulate with the tibia, which you will read about shortly. The
condyles bulge and are more prominent posteriorly.
• Medial and lateral epicondyles. The epicondyles at the distal end of the femur
are similar to the medial and lateral epicondyles of the humerus. They are rough
prominences at the side of the condyles and serve as attachment sites for muscles
by tendons. See Figure 4.34.

Patella The patella is a sesamoid bone in the patellar ligament. It protects the patel-
lar ligament from wear and tear as it glides over the femur and tibia at the knee joint.
See Figure 4.34.

Tibia The tibia is the more massive long bone of the lower leg. It articulates with
the femur at the knee. Special features of the tibia (shown in Figure 4.35) include the
following:
• Medial and lateral condyles. The medial and lateral condyles of the tibia articu-
late with the medial and lateral condyles of the femur at the knee.
• Tibial tuberosity. The tibial tuberosity is similar to the deltoid tuberosity of the
humerus. It is a roughened area for the attachment of muscles by tendons.

Greater
FIGURE 4.34 Femur and
Head patella: (a) anterior view;
trochanter
(b) posterior view; (c) natural femur,
anterior view; (d) patella.
Neck Lesser (c) ©McGraw-Hill Education/Christine
trochanter Eckel

Medial
Patellar condyle
surface
Medial
Lateral
Lateral epicondyle
condyle
epicondyle

(a) (b) (c)

(d) Posterior Anterior

4.3 Anatomy of the Skeletal System 135

 • Anterior crest. The anterior crest of the tibia is a sharp ridge running along the anterior
shaft of the bone. It is very close to the surface and is commonly referred to as the shin.
• Medial malleolus. The medial malleolus (mal-LEE-oh-lus) is a specific name
for a prominent medial epicondyle. It forms the knob of the medial ankle and is an
attachment site for muscles by tendons. See Figure 4.35.

Fibula The fibula is the less massive long bone of the lower leg. See Figure 4.35.
It is lateral to the tibia, and it does not articulate with the femur at the knee. The head
at the proximal end of the fibula articulates with the tibia. The lateral malleolus at
the fibula’s distal end forms the lateral knob of the ankle. It is an attachment point for
muscles by tendons. It also anchors the ankle to prevent it from turning laterally.
Similar to the membrane located between the radius and the ulna, there is another
interosseous membrane that runs between the shafts of the tibia and fibula. You will
examine this further when you learn about joints.

Tarsal bones The tarsal bones are short bones of the ankle and foot. There are seven
tarsal bones, which are described here and shown in Figure 4.36.
• Talus. The talus articulates with the distal end of the tibia.
• Calcaneus. The calcaneus (kal-KAY-knee-us) is the heel bone. The calcaneal
(Achilles) tendon attaches the calf muscles to the calcaneus.
• Navicular. The navicular is a large, wedge-shaped bone.
• Cuneiforms and cuboid. The three cuneiforms (KYU-ni-formz) and the cuboid
bone make up the distal row of tarsals in the foot. The cuboid is the most lateral.
See Figure 4.36.

Lateral Medial
condyle condyle
Tibial
Head of tuberosity
fibula

Anterior
Lateral crest
surface

Fibula
Tibia

Interosseous
membrane

Medial
Lateral malleolus
malleolus
(a) (b) (c)

FIGURE 4.35 Right tibia and fibula: (a) anterior view; (b) natural tibia, anterior view;
(c) natural fibula, anterior view.
(b, c) ©McGraw-Hill Education/Christine Eckel

136 CHAPTER 4 The Skeletal System

Calcaneus

Talus

Navicular

Tarsals
Cuboid

Lateral
cuneiform

Intermediate
cuneiform

Medial
cuneiform 5
4
3
Metatarsals
2 1
Proximal
phalanx

Middle
phalanx

Phalanges
Distal
phalanx

(a) (b)

FIGURE 4.36 The foot: (a) superior view of right foot; (b) natural foot, superior view of right foot.
(b) ©McGraw-Hill Education/Christine Eckel

Metatarsals There are five metatarsal bones in the foot, which are proximal to
the toes and distal to the tarsals. Like the metacarpals of the hand, they are num-
bered 1 through 5. The metatarsal proximal to the great (big) toe is metatarsal 1. See
Figure 4.36.

Phalanges The 14 phalanges are long bones that make up the toes. They are named
by their position as proximal, middle, or distal and by the toe in which they reside. The
great toe is 1 and the little toe is 5. See Figure 4.36.
The tarsals and metatarsals of the foot form a longitudinal arch and a transverse
arch to the sole of the foot. You can see this when viewing a footprint. Not all of the
plantar surface comes in contact with the ground, as the arches are supported by strong
ligaments that attach the bones to each other. See Figure 4.37.

Spot Check What bones make up the acetabulum?

Spot Check Where does the pelvic girdle join the axial skeleton?

4.3 Anatomy of the Skeletal System 137

FIGURE 4.37 Arches of the
foot: (a) inferior (medial) view;
(b) X-ray of right foot, medial
view.
(b) ©Scott Camazine/Science Source

Medial
longitudinal
arch

Transverse
Lateral arch
longitudinal
arch

Phalanges Metatarsal bones Tarsal bones

(a)

Cuboid Cuneiform Calcaneus Fibula

Proximal
phalanx I Metatarsal I Navicular Talus Tibia

(b)

Clinical P int
Congenital weakness, obesity, or repetitive stress can cause
the foot ligaments to stretch, leading to a condition called flat
feet or fallen arches. Here, the foot’s entire plantar surface
comes in contact with the ground when standing. People
with this condition may be less tolerant to prolonged stand-
ing and walking.

138 CHAPTER 4 The Skeletal System

Histology of the Skeletal System

Learning Outcomes
5. Describe the cells, fibers, and matrix of bone tissue.
6. Compare and contrast the histology of compact and cancellous bone.
7. Compare and contrast the histology of hyaline, elastic, and fibrocartilage
connective tissues.

Now that you have a better understanding of the bones of the skeletal system, you are
ready to explore the skeletal system at the microscopic level. At this level, you will
need to look at bone, hyaline cartilage, elastic cartilage, and fibrocartilage connective
tissues. You have already identified these tissues in “Chapter 2, Levels of Organiza-
tion of the Human Body.” In this chapter, you will study the cells, fibers, and matrix of
these tissues more completely to see how they function in the skeletal system.

Bone Connective Tissue Bone is dynamic tissue. It changes daily. You will learn
why and how it changes shortly, but first you need to understand the cells, fibers, and
matrix involved.
Osteoblasts and osteoclasts are types of bone cells. Osteoblasts build bone tissue,
while osteoclasts destroy it. Both types of cells are necessary for the skeletal system to
function properly. Osteoblasts build new bone by forming a soft matrix of protein and
carbohydrate molecules with collagen fibers. The osteoblasts then allow hard mineral
crystals to be deposited in the matrix. The mineral crystals are mostly hydroxyapatite,
a calcium phosphate mineral salt. The hydroxyapatite crystals make the matrix hard.
The collagen fibers give the matrix some flexibility. This process is somewhat similar
to that in a sidewalk or bridge decking: Cement makes the sidewalk or decking hard,
but steel rods embedded in the sidewalk or bridge decking give it flexibility that rein-
forces it. So, without sufficient hydroxyapatite, bones become soft. Without collagen
fibers, bones become brittle. You can see this at home if you soak a chicken bone in
vinegar for a few days. The acid of the vinegar will dissolve the hard mineral crystals
in the chicken bone, leaving the flexible collagen fibers. You may even be able to tie
the bone in a knot if enough mineral crystals have been dissolved.

Disease P int
Osteogenesis imperfecta, commonly called brittle bones, is a congenital defect
in which the bones lack collagen fibers. With this defect, the bones are very brittle
and break easily. Until this condition is accurately diagnosed, affected children may
appear to be victims of abuse because of their large number of broken bones.
Rickets is a childhood disorder in which an inadequate amount of mineral crystals
is deposited in the bone. The bones are therefore too soft. The leg bones may not
be able to completely support the weight of the body. As a result, the legs become
bowed and deformed as they develop.

There are two types of bone tissue: compact bone and cancellous bone. Compact
bone is very dense and highly organized. Cancellous bone is spongy in appearance,
characterized by delicate slivers and plates of bone with spaces between.

Compact bone This type of bone is found in the shafts of long bones and the sur-
faces of flat bones. Compact bone tissue is arranged in a series of osteons (Haversian
systems) that appear as targets. See Figure 4.38b and c. The central osteonic or

4.3 Anatomy of the Skeletal System 139

 Head of femur

Central canal
Cancellous bone containing blood
vessels and a nerve
Osteon
Compact bone
Co
m
bo pa
ne ct
Canaliculi

Ca
Periosteum n
bo cell
ne ou
s

(a)

Endosteum Central Perforating

canal canal Nerve Blood Nerve
vessels
Nerve Trabeculae

Blood
vessels

Compact
bone
Lamellae

Central canal

Lacuna

(b) (c) Canaliculus

FIGURE 4.38 Histology of bone tissue: (a) compact and cancellous bone in a frontal section of a femur, (b) three-dimensional
illustration of an osteon, (c) microscopic view of an osteon.
(a) ©Science Stock Photography/Science Source; (c) ©Steve Gschmeissner/Science Source

140 CHAPTER 4 The Skeletal System

Haversian canal contains blood vessels and a nerve. Matrix is formed around the
canal in concentric layers called lamellae. Osteocytes are mature osteoblasts that
are found in spaces called lacunae arranged in circles around the central canal.
They have boxed themselves in the lacunae by depositing matrix around them-
selves. Tiny cracks called canaliculi (kan-ah-LIK-you-lie) in the matrix allow the
osteocytes to reach out to each other and to the central canal for nutrients. It is
important to realize that canaliculi are microscopic. The one osteon you see in
Figure 4.38c has been highly magnified. It represents a very small sliver of bone
on the microscope slide.
It is also important to realize that bone cells have a very good supply of nutrients
through the blood supply to the central (Haversian) canals and the canaliculi. Bone
cells need these features because the matrix is very dense. Diffusion does not work (to
supply osteocytes with the nutrients they need for survival or to remove their wastes)
across this dense mineral crystal matrix.

Cancellous bone This type of bone is found in the end of long bones and in the
middle of flat and irregular bones. If you cut through a flat bone, it would look like
a cancellous bone sandwich: It would have a thin layer of compact bone on the sur-
faces as the bread, and the filling would be cancellous bone. Cancellous bone is not as
organized as compact bone, and it does not have Haversian systems. Here, the matrix
is arranged in delicate slivers and plates called trabeculae (tra-BECK-you-lee). The
spaces between the interlocking trabeculae give cancellous bone a spongy appearance.
See Figure 4.38a.
You have now explored the cells, fibers, and matrix of bone tissue and compared
the histology of two types of bone: compact bone and cancellous bone. Cartilage—
previously mentioned in regard to the bones and structures of the axial and appen-
dicular skeletons—also plays an important role in this system. We now explain the
histology of cartilage connective tissue in detail.

Cartilage Connective Tissue There are three types of cartilage in this system: hya-
line, elastic, and fibrocartilage. All three types of cartilage have the same cells, fibers, and
matrix. How the fibers are arranged is what makes the difference.
In cartilage connective tissue, the cells are called chondrocytes. They produce a
matrix of proteoglycans and water. A proteoglycan is basically a protein molecule
with a carbohydrate added to it. When viewed through a microscope, the matrix
looks like clear gelatin containing bubbles. That is not a bad analogy, as gelatin is
basically protein, sugar (a carbohydrate), and water, just like the matrix. The bubbles
are lacunae—spaces similar to the lacunae of compact bone. Chondrocytes have
deposited the matrix in every direction, trapping themselves in the lacunae. The
fibers of cartilage are made of collagen. See Figure 4.39.
It is important to notice that this type of tissue lacks a blood supply. Unlike bone,
cartilage does not have blood vessels feeding the chondrocytes. The reason for the
difference is seen in the matrices: The matrix of cartilage is like gelatin, whereas the
matrix of bone is like cement. If you put a drop of ink on the surface of a cube of each
matrix, the ink would be able to diffuse across the cartilage matrix but it would not be
able to diffuse across the mineral matrix of bone. Chondrocytes are therefore fed and
have their wastes removed by diffusion across the matrix. They do not need a direct
blood supply. Diffusion through the matrix is a slower process than having a direct
blood supply.

Hyaline cartilage connective tissue This type of cartilage is found covering the
ends of long bones, in the costal cartilages of the ribs, and in the nasal cartilages of the
nose. The matrix looks like gelatin, smooth and clear. The lacunae are prominent, with
chondrocytes visible within them. Whatever collagen fibers are present are so fine that
they are barely visible. See Figure 4.39a.

4.3 Anatomy of the Skeletal System 141

 Elastic cartilage connective tissue This cartilage is found in the pinna of the ear
(outer ear flap) and in the epiglottis in the throat. It has the same chondrocytes, matrix,
and lacunae as the other cartilages. The difference is the direction of the fibers. In
elastic cartilage the fibers run in all directions, giving the cartilage elasticity. A good
example is the outer ear flap. You can bend it over and let go, and it immediately goes
back to shape. See Figure 4.39b.

Fibrocartilage connective tissue This type of cartilage is found in the interverte-

bral disks, the pubic symphysis, and the meniscus of the knee. Fibrocartilage has the
same matrix and chondrocytes in lacunae as the other types of cartilage. The differ-
ence is that the collagen fibers are very visible and run in only one direction in fibro-
cartilage. This arrangement of fibers allows fibrocartilage to serve as a shock absorber.
The knee’s meniscus is a prime example. Each footstep causes the femur to pound
against the tibia. The meniscus (made of fibrocartilage) lies between the femur and the
tibia in the knee joint. It absorbs the shock of the impact and prevents wear and tear on
the joint. See Figure 4.39c.

Spot Check How does the matrix of compact bone differ from that of cancellous
bone? How are the matrices of the three types of cartilage similar?

Spot Check How do the matrices of bone and cartilage differ in terms
of how cells are fed and have their wastes removed?

Anatomy of a Long Bone

Learning Outcomes
8. Describe the anatomy of a long bone.
9. Distinguish between two types of bone marrow in terms of ___location and function.

Now that you have looked at the bones and the histology of the skeletal system, it is
time to look at the anatomy of a long bone. This will bring the gross anatomy and the
histology together. See Figure 4.40.
The epiphyses are the clubby ends of a long bone. Each epiphysis is covered by
articular cartilage, which is composed of hyaline cartilage connective tissue. The
articular cartilage provides a smooth surface for the end of the long bone to articu-
late with another bone. Articular cartilage is firmly attached to the bone. Cancellous
bone is found in the epiphyses. Red bone marrow fills the spaces between the cancel-
lous bone’s trabeculae.

Common Misconception
Many students mistake articular cartilage for bone when dissecting a specimen. It
appears to be the hard, white, smooth end of the bone. But articular cartilage can be
sliced with a scalpel, and bone cannot.

The diaphysis (die-AF-ih-sis) is the shaft of the long bone. It is composed of com-
pact bone, but it is not solid bone. The diaphysis is a hollow tube of compact bone
filled with yellow bone marrow in what is called a marrow (medullary) cavity. Why
is the diaphysis hollow? After all, wouldn’t a solid rod of bone be stronger than a pipe
of bone? Yes, it would, but it would also be much heavier. The presence of the marrow
cavity reduces the bone’s weight.

142 CHAPTER 4 The Skeletal System

 Lacuna

Chondrocyte

Matrix

Articular cartilage Epiphyseal plates

(a)
Cancellous bone
Proximal
Spaces containing
epiphysis
red marrow

Endosteum

Marrow cavity
Elastic fibers
Nutrient artery

Yellow marrow

Lacuna Compact bone

Chondrocyte
Periosteum

(b) Diaphysis

Chondrocyte

Lacuna

Collagenous
fiber

Distal
Articular cartilage epiphysis

(c)
Femur
FIGURE 4.39 Cartilage connective tissue: (a) hyaline cartilage
, (b) elastic cartilage , (c) fibrocartilage . FIGURE 4.40 Anatomy of a long bone.

4.3 Anatomy of the Skeletal System 143

 The diaphysis has a fibrous covering called the periosteum. It starts where the
articular cartilage ends (at the proximal epiphysis) and goes to where the articular car-
tilage begins (at the distal epiphysis). The periosteum encircles the diaphysis, and it is
a source of osteoblasts. The marrow cavity inside the diaphysis is lined by endosteum,
which is a source of osteoclasts. A nutrient artery enters the bone through a foramen
in the diaphysis. This artery branches to form the blood vessels in the many Haversian
canals in the compact bone.

Spot Check If the shaft of the humerus were broken, would the bone bleed?
Explain.

Red bone marrow is found in the spaces of cancellous bone. This includes flat
bones like the sternum, irregular bones like the vertebrae, and the epiphyses of long
bones. Red bone marrow is composed of stem cells, which produce both red and white
blood cells and platelets. You will learn more about blood cell production in the car-
diovascular system chapter discussing blood.
Yellow bone marrow is found in the marrow cavity of mature long bones. The
marrow cavity in a developing long bone originally contains red marrow. By the time
the bone matures, the marrow has become yellow marrow composed mostly of fatty
tissue. Yellow marrow reduces the bone’s weight because fat is less dense than bone.
Yellow bone marrow does not produce blood cells, but it can convert back to red bone
marrow in cases of extreme anemia. You can see yellow bone marrow in the meat
department of a grocery store. The round bone seen in a thick slice of ham or a thin
beef roast is a transverse section of the diaphysis of a long bone. The bone is compact
bone. The fatty substance in the center of the bone is yellow bone marrow.
Now you understand the anatomy of a long bone, including the articular cartilage
that covers the ends of the bone. This cartilage provides a smooth surface where two or
more long bones meet. Following, you will learn about other ways bones meet.

Joints

Learning Outcomes
10. Describe three major structural classes of joints and the types of joints in each class.
11. Differentiate between rheumatoid arthritis and osteoarthritis.

When two or more bones meet, they form a joint or an articulation. Joints can be
classified by their anatomy or by the amount of motion they allow. By their anatomy,
joints can be classified as fibrous, cartilaginous, or synovial. There are subdivisions
called types within each class.

Fibrous Joints Fibrous joints have fibrous tissue between the bones. There are three
types of joints in this class (see Table 4.1):
• Sutures. A suture (SOO-chur) has a fibrous membrane between bones until the
suture is completely closed. It can be found between cranial bones of the skull.
Sutures are immovable joints.
• Gomphoses. A gomphosis (gom-FOE-sis) is formed by fibrous ligaments hold-
ing a tooth in its socket. Gomphoses are immovable joints.
• Syndesmoses. A syndesmosis (sin-dez-MOH-sis) is formed by an interosseous
membrane. It can be found between the radius and the ulna and between the tibia
and the fibula. Syndesmoses may allow some movement, as in rotating a hand.

144 CHAPTER 4 The Skeletal System

 TABLE 4.1 Joints
Class Type Description Movement Location
Fibrous Fibrous tissue
connecting bones
together
Suture Membrane of the skull Immovable Between flat
connecting bones bones of the skull
together
Suture

Gomphosis Ligament connecting Immovable Tooth in socket

bones together

Syndesmosis Formed by interosseous Partly movable Between tibia

ligament connecting and fibula;
bones together between radius
and ulna

Cartilaginous Cartilage connecting

bones together

Symphysis Fibrocartilage Very little Between

connecting bones movement vertebrae of the
spinal column;
between pubic
bones

Synchondrosis Hyaline cartilage Partly movable Between the ribs

connecting bones and sternum
Immovable Between
epiphysis and
diaphysis of a
developing long
bone

4.3 Anatomy of the Skeletal System 145

 TABLE 4.1 Joints (continued)
Class Type Description Movement Location
Synovial Bones capped with Freely movable
cartilage articulate
within a fluid-filled cavity
Hinge C-shaped surface of Very movable Elbow, knee,
one bone swings about in one interphalangeal
the rounded surface of direction, like a joints
another bone door hinge

Ball and socket Ball of one bone fits Very movable Hip (head
into a socket of another in all directions of femur to
acetabulum);
shoulder (head
of humerus in
glenoid cavity)

Saddle Concave surfaces of All movements Carpometacarpal

two bones articulate possible, but joint of the thumb
with one another rotation limited

Gliding Two opposed flat Up-and-down Carpal bones

surfaces of bone glide wave of the
past one another hand at the
wrist

Ellipsoid Reduced ball and All movements, Carpal bones;

socket but rotation joint between
severely metacarpals and
limited: side- phalanges
to-side wave
of the hand at
the wrist and
spreading apart
of the fingers
Pivot Ring of bone articulates Rotation Atlas on the
with a post of bone odontoid process/
dens of the axis

146 CHAPTER 4 The Skeletal System

Cartilaginous Joints Cartilaginous joints
Bursa (extension
have cartilage between the bones. There are Synovial
of joint cavity)
membrane
two types of joints in this class (see Table 4.1): Joint
Fibrous
• Symphyses. The pubic symphysis has
capsule
capsule
fibrocartilage between the two pubic
bones. This joint becomes more elastic and Bone
slightly movable during the birth process.
• Synchondroses. Synchondroses can be Joint cavity
found in the long bones of children. A (filled with
synovial fluid)
synchondrosis (sin-kon-DROH-sis) is the
cartilage joint between an epiphysis and
Articular
the diaphysis of a long bone. This is an cartilage
immovable joint. Tendon
sheath
Synovial Joints Look at the anatomy of a Tendon
synovial joint (si-NOH-vee-al) in Figure 4.41. Bone
Synovial joints have a joint cavity. This joint Periosteum
space is formed by a joint capsule that sur-
rounds and seals the joint space. The capsule
is composed of fibrous connective tissue con-
tinuous with the periosteum of the articulating
FIGURE 4.41 Anatomy of a synovial joint. The joint space is lined by a
bones. The joint space is lined by a synovial synovial membrane and filled with synovial fluid.
membrane, which produces a very slippery
synovial fluid. This fluid lubricates the joint,
reducing the heat of friction as the bones articulate. The synovial fluid also feeds and
removes wastes from the articular cartilage that covers the bones’ surfaces in the joint
space. The synovial membrane may extend at the joint to form a pocket called a bursa.
The bursa acts as a cushion for tendons rubbing against the bone.

Disease P int
Bursitis is inflammation of the bursa. Bursitis causes pain, tenderness, and
swelling, especially with movement or pressure on the affected body part.
Trauma or repetitive movement can cause bursitis. Athletes—like
tennis players and baseball pitchers—who participate in sports Swollen
requiring them to repetitively use the same motion may be bursa
prone to bursitis. Areas of the body commonly affected by
bursitis are the knee, elbow, shoulder, and hip. Treatment
includes rest and nonsteroidal anti-inflammatory drugs. If
the condition is severe, immobilization of the affected joint
may be recommended.

The knee is a prime example of a synovial joint. The femur, tibia, and patella form
the knee joint. See Figure 4.42. The knee is a relatively unstable joint because the distal
end of the femur articulates with the rather flat-surfaced tibia at the knee. In comparison,
the hip is a more stable joint because the head of the femur fits into a deep, bony socket
called the acetabulum. Five ligaments connect the bones to help support the knee:
• Medial and lateral collateral ligaments attach the epicondyles of the femur to the
epicondyles of the tibia and fibula. They prevent side-to-side movement at the knee.
• Anterior and posterior cruciate ligaments attach the femur to the tibia. They cross
to form an X between the femur’s condyles, and they are named for their attachment
relative to the tibia: The anterior cruciate ligament attaches to the tibia’s anterior,

4.3 Anatomy of the Skeletal System 147

 Patellar surface Lateral
of femur condyle

Posterior cruciate
ligament Fibular
(lateral)
collateral
ligament
Medial condyle

Anterior cruciate
ligament
Lateral
meniscus

Medial meniscus

Tendon (cut)
Tibial (medial)
collateral ligament

Tibia Fibula

(a)

Femur

Lateral condyle

Medial condyle
Fibular (lateral)
collateral
ligament
Anterior cruciate
ligament

Lateral
meniscus
Medial meniscus

Posterior
cruciate Tibial (medial)
ligament collateral ligament

Fibula Tibia

(b)

FIGURE 4.42 The knee: (a) right knee, anterior view with the knee flexed and the patella
and patellar ligament removed; (b) right knee, posterior view; (c) left knee, midsagittal cut with
patella in place; (d) left tibia and menisci, superior view.

148 CHAPTER 4 The Skeletal System

 FIGURE 4.42 The knee
Synovial
membrane (continued).

Bursa Femur

Patellar
tendon

Patella
Joint cavity

Bursa
Articular
cartilage

Patellar
ligament
Bursa
Menisci
Joint
capsule

Tibia

(c)

Tibial
tuberosity
Anterior
cruciate
ligament

Synovial
membrane
Medial
meniscus
Lateral
condyle
of tibia
Medial
condyle
of tibia
Lateral
meniscus
Posterior
cruciate
(d) ligament

and the posterior cruciate ligament attaches to the tibia’s posterior side. These liga-
ments prevent the femur from sliding forward or backward relative to the tibia.
• The patellar ligament, sometimes called the patellar tendon, attaches the patella
to the tibia. It also attaches the quadriceps muscles of the anterior thigh to the tibia
at the tibial tuberosity. It qualifies as a tendon and a ligament because it attaches
muscle to bone and bone to bone.
There are two C-shaped fibrocartilage pads—the menisci—between the femur and
the tibia. Each meniscus acts as a shock absorber for a femoral condyle and prevents it
from sliding from side to side. See Figure 4.42d. You can also see in Figure 4.42c the
many bursae that cushion the knee joint.

4.3 Anatomy of the Skeletal System 149

 The human body contains six types of synovial joints (shown in Table 4.1):
• Hinge. A hinge joint is very movable in one direction, like a door hinge. Example:
elbow.
• Ball and socket. The ball of one bone fits into a socket of another bone. This type
of synovial joint is very movable in all directions. Example: hip.
• Saddle. Concave surfaces of the bones articulate with one another. All move-
ments are possible, but rotation is limited. Example: carpometacarpal joint of
the thumb.
• Gliding. Flat surfaces of the bones glide past one another. Example: carpal bones,
where this joint produces an up-and-down wave of the hand.
• Ellipsoid. This is a reduced ball and socket. Example: carpal bones, where this
joint produces a side-to-side wave of the hand. Another example: metacarpopha-
langeal joints, which enable the fingers to be spread apart.
• Pivot. A ring of bone articulates with a post of bone. Example: atlas on the odon-
toid process of the axis, which enables rotation of the head.

Spot Check What kind (class and type) of joint is formed by an interosseous
ligament?

Disease P int
Because we use our joints daily, normal wear and tear can eventually lead to joint
problems, such as arthritis. Arthritis is an inflammation of a joint. There are more than 100
types of arthritis, and some of them can affect other tissues beyond the joints. According
to the Centers for Disease Control and Prevention (CDC), arthritis is the most common
cause of disability in the United States, with over 19 million adults affected.1 All forms of
arthritis involve stiff or painful joint movement. With this constant pain comes fatigue.
There are two different forms of the disorder: osteoarthritis and rheumatoid arthritis.
Osteoarthritis is the most common form of arthritis. It usually occurs in people
over the age of 40, and 85% of people over the age of 70 show some signs of this
condition. It is caused by the normal wear and tear of a joint or injury to the joint as the
articular cartilage wears with age and becomes rough. Crepitus is the creaking sound
that may be heard during the movement of osteoarthritic joints. This form of arthritis
usually occurs in joints of the fingers, hips, knees, and vertebrae. Osteoarthritis is
often treated with anti-inflammatory drugs to relieve the symptoms and physical
therapy to improve function.
Rheumatoid arthritis (RA) is an autoimmune disease that can happen to anyone
at any age. Children may develop juvenile RA. In rheumatoid arthritis, the body’s own
immune system attacks the structures of the joint. Antibodies (produced by the body’s
immune system) mistakenly attack a joint’s synovial membranes, causing inflammation.
As the synovial membranes thicken, enzymes produced by inflammatory cells erode
the articular cartilage. The cartilage can be eaten away to the point that the articulating
bones fuse with one another. This is called ankylosis. See Figure 4.43. Rheumatoid
arthritis tends to have periods of remission, and then it flares up again. Joint damage,
however, is progressive. Management of the disease is important to minimize long-
term joint damage. A range of treatment options exists, from anti-inflammatory and
immunosuppressant drugs to joint replacement surgery.

150 CHAPTER 4 The Skeletal System

 Joint replacement surgery is an option for badly damaged joints. Here, the
articulating bone surfaces are replaced with a metal alloy, and joint sockets are lined
with plastic. See Figure 4.44. Porous surfaces on the metal components (where they
attach to the bone) allow osteoblasts to deposit bone into the component surface to
ensure a tight bond. Joint replacement can be very successful in restoring mobility.
The majority of artificial knees last more than 20 years.

(a)

Tibia
Tibia Femur
Femur

(a) (b)

FIGURE 4.43 Rheumatoid arthritis: (a) a severe case showing ankylosis of the joints, (b) X-ray of a severe case.
(a) ©Southern Illinois University/Science Source; (b) ©CNRI/Science Photo Library/Science Source

(a) (a)

Artificial
Artificial Artificial
Artificial
femoral
femoral headhead acetabulum
acetabulum

Tibia Femur

(b)

(a) (b) (b) (c) (c)

FIGURE
Artificial 4.44 Joint replacement:
Artificial (a) total knee replacement showing the femoral and tibial components as well as the
plastic
femoralinsert
head for the meniscus,
acetabulum (b) femoral component for a hip replacement, (c) X-ray of a hip replacement.
(a) ©Antonia Reeve/Science Source; (b) ©TEK Image/SPL/Getty Images; (c) ©Mehau Kulyk/SPL/Science Source

4.3 Anatomy of the Skeletal System 151

 4.4 Physiology of the Skeletal
System
Up to this point, you have covered all of the skeletal system’s
anatomy. You have looked at bones, cartilages, and joints.
Now it is time to understand how all of the anatomy functions.
As you know, bone is dynamic tissue that changes daily. To
show you how the structures of this system develop, grow,
and continue to change throughout life, we discuss their phys-
iology in the context of Maria and her soon-to-be-born baby,
Chloe. See Figure 4.45.

FIGURE 4.45 Maria.

©Brand X Pictures/Jupiterimages/ Mineral Deposition
Getty Images

Learning Outcome
12. Explain how minerals are deposited in bone.

To understand how your bones develop, first you need to learn how bone matrix is
formed. Osteoblasts produce the collagen fibers of bone, but they do not produce
bone’s hydroxyapatite crystals. They simply allow hydroxyapatite to be deposited.
Calcium phosphate is dissolved in body fluids and blood. If it is highly concentrated,
it will settle out of solution and form crystals. Most body tissues make a chemical that
prevents calcium phosphate crystals from forming. This prevents tissues like those in
the muscles, liver, and eyes from calcifying.
Osteoblasts produce a chemical that allows the dissolved calcium phosphate to
crystallize. This process begins with a single “seed” crystal, and eventually more and
more calcium phosphate crystallizes on this seed crystal. This is a homeostasis posi-
tive feedback mechanism of mineral deposition. More and more crystals continue to
form until they are out of the osteoblasts’ range.

Bone Development

Learning Outcome
13. Compare and contrast endochondral and intramembranous ossification.

Now that you know how osteoblasts deposit matrix in general, you are ready to see
how flat bones and long bones are formed in a fetus. The processes involved follow
and are summarized in Table 4.2.

Intramembranous Ossification The flat bones of baby Chloe’s skull are forming
through a process called intramembranous ossification. Osteoblasts start by deposit-
ing bone in the skull membrane. The membrane will eventually be replaced by the flat
cranial bones. Look at the top of Chloe’s skull in Figure 4.46a. Osteoblasts deposit
bone at several sites in the membrane of the head to form the center of the parietal,
frontal, and occipital bones. The deposition proceeds outward until the bones eventu-
ally fuse. This will not happen, however, by the time Chloe is born. At birth, there
will be fontanelles (membranous areas) between the bones of the skull. Chloe’s mom
may refer to the larger fontanelle between the frontal and parietal bones as the baby’s
“soft spot.” Once the bones meet, they form a joint called a suture. The flat bones will
cease to grow any bigger once the sutures have completely closed in adulthood. Until
that time, the membranes continue to grow as the osteoblasts continue to deposit more
bone. This allows the skull to continue to grow larger. Imagine if this were not the

152 CHAPTER 4 The Skeletal System

 TABLE 4.2 Types of Ossification
Intramembranous Ossification Endochondral Ossification
1. This process forms flat bones of the skull of the 1. This process forms long bones, vertebrae, ribs, sternum,
developing fetus. scapula, pelvis, and bones of the limbs of the developing fetus.
2. Osteoblasts deposit bones in membranes. 2. Osteoblasts deposit bone in hyaline cartilage models.
3. Site of ossification is the center of the future bone. 3. Primary site of ossification is the diaphysis, with deposition
toward the epiphyses. Secondary sites of ossification are in
each epiphysis, depositing toward the diaphysis.
4. Membranes continue to grow as bone is being 4. Cartilage of the model continues to grow as bone is being
deposited. deposited.
5. Existing membrane, not yet bone, present at birth is 5. Existing cartilage between the epiphyses and the diaphysis
called a fontanelle. is called an epiphyseal plate.
6. Continued membrane growth allows bones of the skull 6. Epiphyseal plate continues to grow, allowing bones to
to get bigger as the child grows. increase in length.
7. Development is finished when sutures are completely 7. Development is finished when the epiphyseal plates are
closed. completely closed.

case, and the sutures closed prematurely. How would you look with a head the size of
a newborn on your body? See Figure 4.46b.

Endochondral Ossification The long bones of Chloe’s appendicular skeleton

are formed through a different process. They form while Chloe is a fetus through
endochondral ossification. From the term endochondral, you should understand that

AnteriorAnterior

Frontal Frontal

Fontanelle
Fontanelle

Parietal Parietal Parietal Parietal

OccipitalOccipital

PosteriorPosterior
(a) (a) (b) (b)

FIGURE 4.46 Intramembranous ossification of the skull: (a) fetal skull, superior view;
(b) natural baby skull (showing a fontanelle) and a natural adult skull of comparable size.
b(i) ©Science Stock Photography/Science Source; b(ii) ©McGraw-Hill Education/Christine Eckel

4.4 Physiology of the Skeletal System 153

 Articular
Remnants of
cartilage
Secondary epiphyseal
ossification plates
Cartilaginous Developing Compact bone center
model periosteum developing Cancellous
bone
Epiphyseal Marrow
plates cavity
Compact
bone
Marrow
Blood cavity
vessel

Epiphyseal Remnant of
plate epiphyseal
Calcified Primary Cancellous plate
cartilage ossification Secondary bone
center ossification
center
(a) (b) (c) (d) (e) (f)
Articular
cartilage

FIGURE 4.47 Endochondral ossification of a long bone: (a) hyaline cartilage model, (b) cartilage begins to
calcify, (c) a primary ossification center and a nutrient artery develop, (d) secondary ossification centers develop
at the epiphyses and a marrow cavity begins to form, (e) epiphyseal plates can be seen between the diaphysis and
epiphyses, (f) mature bone.

this form of bone development happens inside cartilage. It starts with a small hyaline
cartilage model of the long bone. See Figure 4.47. Osteoblasts begin depositing bone
around the diaphysis of the model, forming a bony collar. This blocks the chondro-
cytes’ blood supply in the diaphysis of the model, so they die. The lacunae merge
to form the marrow cavity. A blood vessel penetrates through the beginning bone of
the fetus and establishes stem cells in the marrow cavity. This creates red bone mar-
row. Secondary ossification centers begin in each epiphysis. A blood vessel penetrates
through the beginning bone here also to establish the stem cells of red bone mar-
row between the trabeculae. Osteoblasts deposit bone in all directions. In the mean-
time, the chondrocytes between the epiphyses and the diaphysis continue to produce
more cartilage, extending the length of the developing bone. This zone of cartilage is
called the epiphyseal plate (eh-PIF-ih-see-al), and the chondrocytes will continue to
expand it. Osteoblasts will continue to deposit bone in the epiphyseal plate until all
long bone growth is finished. You will learn about this type of growth shortly. Other
bones formed through endochondral ossification include the vertebrae, ribs, sternum,
scapula, and pelvic bones.

Spot Check What type of ossification would form a humerus in Chloe as

a fetus?

Bone Growth

Learning Outcome
14. Compare and contrast endochondral and appositional bone growth.

Intramembranous and endochondral ossification are processes of bone development in

the fetus. After birth, the bones grow through two processes: endochondral growth and
appositional growth.

154 CHAPTER 4 The Skeletal System

Endochondral Growth As you can see in Figure 4.48, Chloe is a happy, healthy
baby girl. Her skeletal system is continuing to grow. The osteoblasts are continuing to
deposit bone in the epiphyseal plates of her long bones while the chondrocytes con-
tinue to expand the plates with cartilage. See Figure 4.49. It is a race between the two
types of cells, which will be in the race until Chloe reaches puberty. At puberty, the
hormone estrogen will speed up the osteoblasts, which will deposit more bone than the
chondrocytes can produce cartilage. The osteocytes will eventually close the epiphyseal
plates, and endochondral growth will have stopped. Chloe’s long bones will not get any
longer. All that will remain of the growth plate is an epiphyseal line indicating where the
epiphyseal plate was located. If Chloe had been a boy, it would have been the hormone
testosterone at puberty that would have caused the osteoblasts to deposit bone faster.

Appositional Bone Growth Appositional bone growth occurs in all types of

bone. In long bones, it does not make the bone longer, but it makes it more mas-
sive. Osteoblasts of the periosteum deposit more bone on the bone’s shaft. Osteo-
blasts of the cancellous bone’s trabeculae in the epiphyses deposit more bone
along the bone’s lines of stress. This makes the bone stronger to handle the stress.
See Figure 4.50.
Chloe is now already able to sit. She will continue to develop her muscles as she
learns to crawl and walk. This will cause more stress on her bones at the epicondyles
where the muscles are attached by tendons. The tubercles of the humerus and trochan-
ters of the femur will continue to enlarge through appositional bone growth as more
stress is applied. This is also true of her other epicondyles and the spines and processes
of other bones like the vertebrae.
Maria, Chloe’s mother, is also experiencing appositional growth as long as she
supplies her osteoblasts with sufficient calcium and continues to put stress on her
bones with exercise. It is important to note that Maria is relatively young. Appositional
growth becomes more difficult with age. You will learn more about this shortly.
Again, bone is dynamic tissue. You have seen
how it develops and how it continues to grow. But
bone can also be lost. The next section explains why
and how this happens.

Diaphysis

Epiphyses

Epiphyseal
plate

Metacarpal
bone

Epiphyseal
plate

FIGURE 4.49 X-ray of a child’s hand. The long bones of the

hand have only one epiphyseal plate. The epiphyseal plates are still
evident in the long bones of this hand. When endochondral growth
FIGURE 4.48 Chloe. is complete, they will no longer be visible.
©Blend Images/Getty Images ©Steven Needell/Science Source

4.4 Physiology of the Skeletal System 155

 Greater Bone Remodeling
trochanter

Learning Outcome
Head 15. Explain how bone is remodeled by reabsorption.

Trabeculae of Calcium is used by many systems in your body. Muscles

cancellous bone
require calcium to contract. Blood requires calcium to clot.
Compact bone The skeletal, muscular, and cardiovascular systems take
the calcium they need from the blood. If the blood con-
Lines of stress tains sufficient calcium, bone will be maintained. If there
is more calcium than necessary in the blood, appositional
Shaft (diaphysis) bone growth will take place. If there is insufficient cal-
cium in the blood, calcium will be taken from the bone to
bring blood calcium levels back to normal. It is the job of
osteoclasts to reabsorb calcium by producing hydrochloric
acid. The acid dissolves the calcium phosphate crystals into
FIGURE 4.50 Appositional bone growth. Bone
solution, which then allows the calcium and phosphate ions
deposition increases along lines of stress indicated by the to return to the blood. This is an example of homeostasis
red and purple arrows. and how the proper electrolyte balance in the blood is
©Biophoto Associates/Science Source achieved and maintained.

Common Misconception
The following three terms are often misused by students: deposition, absorption, and
reabsorption. Deposition is the process of putting calcium phosphate crystals into the
bone. Absorption is the process of putting calcium into the blood for the first time. This
occurs through the diet. Reabsorption is the process of putting calcium into the blood
again, not the first time. To clarify, reabsorption involves dissolving calcium phosphate
crystals from the bone and putting the calcium back into the blood again.

Bone therefore serves as a reservoir for calcium. While Chloe was a fetus, her
osteoblasts took calcium from Maria’s blood. This reduced Maria’s blood calcium lev-
els. If Maria did not absorb sufficient calcium from her diet, her osteoclasts would
have reabsorbed calcium from her bones to keep her blood calcium levels normal.

Disease P int
Pregnant women often need to take calcium supplements to ensure sufficient calcium
levels in their blood. The condition osteomalacia is a softening of the bones due to
reabsorption of calcium to meet the needs of pregnancy. See Figure 4.51.

Spot Check What happens if there is insufficient calcium in the blood?

Bone remodeling happens daily depending on the calcium levels in the blood
and the stress applied to the bone. Both sufficient calcium and stress on the bone
FIGURE 4.51 Calcium are required to ensure healthy bone. This can be seen in astronauts returning from
supplements. extended stays in a weightless environment. The lack of gravity reduces the bone
©Brand X Pictures/Jupiterimages/ stress. They may also have bone loss through remodeling even though their diets may
Getty Images be rich in calcium and vitamin D.

156 CHAPTER 4 The Skeletal System

Nutritional Requirements of the Skeletal System

Learning Outcome
16. Explain the nutritional requirements of the skeletal system.

As you can see in Figure 4.52, dairy products are a major source of
calcium in the diet. Calcium is not in the fat portion of the dairy
product, so removing some of the fat does not affect the calcium
content. Active vitamin D, also called calcitriol (kal-sih-TRY-ol),
is required for the small intestines to absorb calcium from the
diet. As you may remember from the integumentary system chapter,
vitamin D is produced in the skin and modified by the liver and kid- FIGURE 4.52 Sources of
ney to become calcitriol. The calcium of the diet moves through the digestive system calcium in the diet.
without ever being absorbed into the blood if calcitriol is not present. For that reason, ©C Squared Studios/Getty Images
vitamin D is added to most dairy products. Calcium can also be found in green leafy
vegetables, such as broccoli, collards, kale, turnip greens, and bok choy. Again, see
Figure 4.52. The phosphorus for phosphates is found in dairy products and meats. It is
readily absorbed by the small intestines and does not require vitamin D. Proper nutri-
tion can help support homeostasis and allow for the development of healthy bone.

Spot Check What specifically can be done to ensure strong, healthy bones in
adulthood? Explain.

Hormonal Regulation of Bone Deposition

and Reabsorption

Learning Outcome
17. Describe the negative feedback mechanisms affecting bone deposition and reabsorption
by identifying the relevant glands, hormones, target tissues, and hormone functions.

How do the osteoblasts and osteoclasts know when to deposit or reabsorb bone? They do
so because their work is regulated by hormones. You have already covered the hormones
estrogen and testosterone. These hormones speed up the work of osteoblasts at puberty to
encourage the epiphyseal plates to begin closing. Testosterone has less of an effect than
estrogen in speeding up the work of osteoblasts. As a result, it takes the epiphyseal plates
in men longer to completely close. Men have a longer growth period and are therefore
typically taller than women. Estrogen is produced by the ovaries in women. Testosterone
is primarily produced by the testes in men. Both estrogen and testosterone also serve as
a lock on calcium in the bone, making it more difficult for osteoclasts to reabsorb bone.
Two other hormones—from the thyroid gland and the parathyroid glands—regulate
bone deposition and reabsorption based on the level of calcium in the blood through
negative feedback mechanisms. The thyroid gland produces the hormone calcitonin
when blood calcium levels are high. Calcitonin travels through the blood. Although it
comes in contact with many cells, it works only on osteoblasts and osteoclasts because
they have receptors for the hormone. Calcitonin tells osteoblasts to deposit calcium in
the bone, and it prevents osteoclasts from reabsorbing calcium. The net effect of calci-
tonin’s action is bone deposition to reduce blood calcium levels.
The parathyroid glands look like small buttons on the posterior side of the thy-
roid gland. See Figure 4.53. They produce parathyroid hormone (PTH) when blood
calcium levels are low. PTH travels through the blood and has three target tissues. It
tells osteoclasts to reabsorb bone, increasing blood calcium levels. It tells the kidney to
reabsorb any calcium that may be contained in the urine (this does not increase blood

4.4 Physiology of the Skeletal System 157

FIGURE 4.53 Parathyroid
glands on the posterior side of
the thyroid gland.

Pharynx

Thyroid
gland

Parathyroid
glands

Esophagus

Trachea

Posterior view

calcium, but it maintains the current levels by preventing the loss of calcium in the
urine). Last, PTH targets the small intestine, telling it to absorb any calcium present in
the small intestine from digestion. See Figures 4.53 and 4.54 and Table 4.3.
You have now covered the anatomy and the physiology of your skeletal system.
Next, you will see how they work together to carry out the system’s functions.

FIGURE 4.54 Homeostasis

Thyroid gland releases calcitonin,
of calcium. telling osteoblasts to deposit calcium
©Don Farrall/Getty Images in bone and inhibiting osteoclasts
from reabsorbing bone.

Blood calcium Blood calcium level

level rises. returns to normal.

Blood calcium Blood calcium level

level falls. returns to normal.

Normal blood calcium level

Parathyroid glands release PTH,

telling osteoclasts to reabsorb bone,
the kidney to reabsorb calcium from
urine, and the small intestines
to absorb calcium.

158 CHAPTER 4 The Skeletal System

 TABLE 4.3 Hormonal Regulation of Bone Deposition and Reabsorption
Gland Hormone Target Tissue Function of Hormone
Thyroid gland Calcitonin 1. Osteoblasts 1. Tells osteoblasts to deposit bone, reducing blood calcium levels
2. Inhibits osteoclasts from reabsorbing bone
2. Osteoclasts
Parathyroid Parathyroid 1. Osteoclasts 1. Tells osteoclasts to reabsorb bone, increasing blood calcium levels
glands hormone 2. Tells kidneys to reabsorb calcium, maintaining blood calcium levels
2. Kidneys 3. Tells small intestine to absorb calcium, increasing blood calcium
levels (Vitamin D is required for this to work.)
3. Small intestine
Ovaries Estrogen Osteoblasts Tells osteoblasts to work faster; serves as a lock on bone by
inhibiting osteoclasts
Testes Testosterone Osteoblasts Tells osteoblasts to work faster; serves as a lock on bone by inhibiting
osteoclasts (Testosterone has less of an effect than does estrogen.)

Functions of the Skeletal System

Learning Outcome
18. S
 ummarize the six functions of the skeletal system and give an example
or explanation of each.

The skeletal system serves six important functions for the human body. It provides
support, allows for movement, provides protection for organs, aids in acid–base bal-
ance, aids in electrolyte balance, and is responsible for blood formation. We discuss
each of these functions in the following sections.

Support Chloe’s spinal column was C-shaped at birth. As she developed, she
learned to crawl and then walk. Her spinal column developed an S shape to support her
weight as she became more upright. The lumbar vertebrae became the most massive to
support the majority of her weight. Her femurs and tibias also became more massive
through appositional growth to support her weight.

Movement The arrangement of bones is very important in this function. Each of

Chloe’s little hands at birth contained 14 phalanges, so she could grasp Maria’s finger.
She would not be able to grasp anything if her fingers did not have multiple bones and
joints. Chloe’s spine would be nice and straight if it were a single bone, but her adult
spinal column will have 26 bones. The joint between each bone allows slight motion.
Added together, the motions of all the joints between vertebrae will allow Chloe to
touch her toes when standing. If you held your arm straight out to the side, would you
be able to then touch the tip of your nose with your index finger if you did not have a
shoulder, an elbow, a wrist, and finger joints?

Protection Chloe’s flat bones underwent intramembranous ossification to form her

skull’s cranial bones, which provide protection for her brain. Her ribs and sternum
developed to protect her lungs and heart. Her vertebrae developed the central vertebral
foramen to protect her spinal cord. Even within the skull, the sella turcica developed to
give added protection to her pituitary gland.

Acid–Base Balance Maintaining normal blood pH (7.35 to 7.45) is very important

for maintaining homeostasis. Acidosis results if the blood pH is too low. Acidosis is char-
acterized by too many free hydrogen ions in the blood. Calcium phosphate is an ionically

4.4 Physiology of the Skeletal System 159

 bonded molecule that forms calcium ions and phosphate ions in solution. If the pH of the
blood is too low, the phosphate ions will bind to excess free hydrogen ions, causing the
pH to rise. So phosphate ions act as a buffer, resisting a change in normal blood pH.

Electrolyte Balance Bone serves as a reservoir for the electrolyte calcium, which is
important for maintaining homeostasis. Suppose Maria has a glass of milk for break-
fast, a grilled cheese sandwich for lunch, and vegetables with a chicken breast for dinner.
During the course of this particular day, Maria has consumed calcium in her diet. The
calcium will be absorbed into her bloodstream as long as she has sufficient calcitriol. If
this process raises her blood calcium levels above normal, the calcium will be deposited
in her bones. If she had not consumed the calcium and her blood calcium levels fell
below normal, calcium would have been reabsorbed from the bone to bring her blood
calcium levels to homeostasis.

Blood Formation Red blood cells, white blood cells, and platelets are produced by
stem cells in the red bone marrow. You will learn about this in detail when you study
the cardiovascular system.
You have looked at how the skeletal system functions as a whole in the human body.
But what are the effects of aging on this system? Does it continue to function normally?

Clinical P int
Red bone marrow may be harvested to give to another person who is a close match.
It can even be harvested to give back to the donor. Some cancer treatments include
chemotherapy so strong that it kills all fast-growing tissues like bone marrow along with
the cancer cells. In this case, bone marrow can be harvested before treatment and the
harvested bone marrow can be given back to the patient after the chemotherapy is over.

4.5 Effects of Aging on the Skeletal System

Learning Outcome
19. Summarize the effects of aging on the skeletal system.

The ratio of deposition and reabsorption changes as we age. In general,

● Deposition > Reabsorption Birth to age 25 Increasing bone mass and density
● Deposition = Reabsorption Ages 25 to 45 Maintaining bone mass and density
● Deposition < Reabsorption Age 45 and over Decreasing bone mass and density

A major reason for this is that the levels of estrogen and testosterone decrease with
age. Both of these hormones serve as a lock on calcium in the bone. It is much easier
for osteoclasts to reabsorb bone when the levels of these hormones are decreased. This
has a greater impact on women, as their production of estrogen ceases after meno-
pause. Men’s production of testosterone diminishes as they age but not to the extent of
women’s production of estrogen.
The effects of the decreased bone mass and density with age are many:
• Each vertebra becomes thinner. The spinal column becomes more curved and com-
pressed, resulting in a shorter trunk and a more stooped posture. The neck may also
become tilted. Compression fractures of the vertebrae become more common.
• The change in posture affects the gait and balance. This makes elderly people more
prone to falls. The decreased bone mass and density result in fractures from falls.

160 CHAPTER 4 The Skeletal System

• Long bones lose mass but not length. The arms and legs appear longer in relation
to the trunk.
• Scapulae thin and become more porous. On an X-ray, they may appear to have holes.
• Joints stiffen and become less flexible as osteoarthritis sets in. The amount of
synovial fluid may decrease.
• Minerals may deposit in the joints, especially the shoulder.
• Phalangeal joints lose cartilage, and the bones may thicken slightly.
Age-related changes occur in the system’s cartilage too. You have already read that
articular cartilage erodes in osteoarthritis. The intervertebral disks become thinner
from the effect of gravity over the years. This, along with the vertebrae compressing,
accounts for the way we seem to get shorter as we age.
The effects of aging can be minimized but not eliminated. The best way to ensure
good bone health for life is to build strong bones while deposition exceeds reabsorp-
tion. Proper nutrition with ample calcium and vitamin D, along with exercise, through-
out life can reduce the effects of aging.
Now that you are familiar with what normally happens to structures in this system
over the years, it is time to consider what can happen when things are not quite normal,
as in the case of fractures and bone disorders.

4.6 Fractures

Learning Outcome
20. Classify fractures using descriptive terms.

A fracture is a break in a bone. It can result from injury

or trauma, like a fall, or it can result from a disease pro-
cess that has weakened the bone. Fractures may produce
a simple crack, a dent, or a bone that is shattered in many
pieces. X-rays can be used to view fractured bones, as you
can see in Figure 4.55.

Types of Fractures
There are several descriptive terms used to classify frac-
(a) (b) (c)
tures, and they include the following:
• Closed. A closed fracture (formerly called a simple
fracture) does not cause a break in the skin. A shat-
tered bone may not break through the skin, but it
hardly seems appropriate to refer to it as simple.
• Open. An open fracture (formerly called a compound
fracture) breaks through the skin.
• Complete. The bone is in two or more pieces.
• Displaced. The bone is no longer in proper alignment.
• Nondisplaced. The bone is in proper alignment.
• Hairline. There is a crack in the bone.
•(a) Greenstick. The bone has broken
(b)
through one side but
(c) (d)

not completely through the other side. FIGURE 4.55 X-rays of fractures: (a) nondisplaced,
(b) displaced, (c) comminuted, (d) greenstick.
• Depressed. The bone has been dented. This fracture is (a) ©Scott Camazine/Science Source; (b) ©Howard Kingsnorth/Getty Images;
found where there is cancellous bone, as in skull fractures. (c) ©Lester V. Bergman/Corbis; (d) ©Biophoto Associates/Science Source

4.6 Fractures 161

 • Transverse. The bone is broken perpendicular to its length.
• Oblique. The break in the bone is at an angle.
• Spiral. The break in the bone spirals up the bone. This type of break often results
from twisting the bone. This may occur when children fall while kneeling on a
chair at the table with their feet sticking through the chair’s spokes.
• Epiphyseal. The break occurs at the epiphyseal plate in a child.
• Comminuted. The bone is broken into three or more pieces (commonly referred to
as shattered).
• Compression. Cancellous bone has been compressed. This type of fracture may
occur in the vertebrae.

Spot Check What terms would be used to describe a fracture that broke the
shaft of a humerus at an angle into two separate pieces, with one of the pieces sticking
out of the skin?

Clinical P int
The integumentary system chapter covered injuries to the skin. As you read in that
chapter, it is important to bring the edges of a cut together as much as possible for
proper healing or a primary union. It is just as important to bring the edges of a frac-
tured bone together as close as possible with the proper alignment to ensure the best
healing. A closed reduction sets the edges of the fracture in proper alignment by
manipulating the bone without surgery. An open reduction sets the bones in proper
alignment through surgery. Plates, pins, and screws may be used in an open reduction
to ensure that the bone fragments stay in proper alignment. It is important to immo-
bilize the break once either type of reduction is performed to give the body the best
chance of healing the fracture properly. See Figure 4.56.

Fracture Healing

Learning Outcome
21. Explain how a fracture heals.

The body uses several processes, in steps, to heal a complete transverse fracture of a
long bone (see Figure 4.57):
1. A bone bleeds when broken. Not only is the bone broken, but so are the blood ves-
sels in all of the Haversian canals. Blood clots once it is out of the vessels, and a
hematoma is formed.
2. Stem cells from the periosteum deposit collagen and fibrocartilage in the break to
form a soft callus. The callus is thicker than the original bone.
3. Osteoblasts deposit bone in the soft callus, forming a hard callus. Bone deposition
extends into the marrow cavity.
4. Osteoblasts continue forming compact bone in the break while osteoclasts
FIGURE 4.56 Open reduction from the endosteum remodel the bone to reestablish the marrow cavity. The
of a fractured tibia. remnant of the hard callus can be seen as a thickening of the bone after the
©feellife/E+/Getty Images bone has healed.

162 CHAPTER 4 The Skeletal System

Compact
bone

Medullary
cavity

Fibrocartilage

Cancellous bone
Hematoma

New blood
vessels

1 2
A break in the bone also breaks Stem cells from the periosteum deposit
blood vessels within bone. Blood collagen and fibrocartilage in the break.
clots and a hematoma is formed.

Compact bone

Medullary cavity

Periosteum
Bony callus

Endosteum

3 4
Osteoblasts deposit bone in the soft Osteoblasts continue to deposit bone
fibrocartilage to form a bony callus. while osteoclasts from the endosteum
remodel the bone to reestablish the
marrow cavity.

FIGURE 4.57 The healing of a bone fracture. (1) Bone breaks and a hematoma is formed. (2) Fibrocartilage is deposited in
the break. (3) A bony callus is formed. (4) Bone is remodeled restoring bone structure.

4.6 Fractures 163

 4.7 Diagnostic Tests for Skeletal System Disorders

Learning Outcome
22. D
 escribe a diagnostic test commonly used when diagnosing skeletal
system disorders.

Before you explore the other disorders in this chapter, look at Table 4.4, which
describes common diagnostic tests and procedures for skeletal system disorders.

TABLE 4.4 Common Diagnostic Tests for Skeletal

System Disorders
Diagnostic Test or Screening Description
DEXA (dual-energy X-ray The use of low-dose radiation to measure bone
absorptiometry) scan density in the hip and vertebrae
X-ray The use of electromagnetic radiation that sends
photons through the body to create a visual
image of dense structures such as bone

Spot Check What diagnostic tool can be used to view a bone fracture?

4.8 Skeletal System Disorders

Learning Outcome
23. Describe skeletal system disorders and relate abnormal function to the pathology.

You have already studied several bone disorders in the context of the anatomy and
physiology of the skeletal system, but there are a few more that need to be included in
your understanding of skeletal system disorders. They include osteoporosis, osteomy-
elitis, some cancers, and other conditions.

Osteoporosis
Osteoporosis (OS-tee-oh-poh-ROE-sis) is a severe lack of bone density. It affects
all bone but is more evident in cancellous bone. A diet deficient in calcium and
vitamin D, lack of exercise, and diminished estrogen and testosterone due to aging
are the major causes of osteoporosis. The presence of this disorder may not be
apparent until a fracture occurs. A comparison between healthy cancellous bone
and bone from a person with osteoporosis, shown in Figure 4.58a, shows decreased
bone density in bone with osteoporosis. Figure 4.58b and c show the effect that this
disorder can have on the shape of the vertebral column. Oftentimes, patients with
osteoporosis suffer from kyphosis, as shown in Figure 4.58c. Diagnostic tools such
as X-rays, bone scans, and bone density tests can help diagnose osteoporosis and
determine its severity.

Spot Check Which abnormal curvature of the spine is often associated with
osteoporosis?

164 CHAPTER 4 The Skeletal System

(a) (b) (c)

FIGURE 4.58 Osteoporosis: (a) comparison of healthy cancellous bone and bone showing osteoporosis, (b) X-ray
of lumbar vertebrae showing osteoporosis, (c) kyphosis due to osteoporosis.
(a) ©Michael Klein/Getty Images; (b) ©Dr. P. Marazzi/Science Source; (c) ©Dr. P. Marazzi/SPL/Getty Images

Clinical P int
A DEXA (dual-energy X-ray absorptiometry) scan uses low-dose radiation to measure
bone density in the hip and vertebrae. It can be performed on a yearly basis to detect a
decrease in bone density before osteoporosis progresses to the point of causing fractures.
Treatment for osteoporosis includes improving nutrition, increasing exercise, preventing
falls, and using therapeutic medications. Bisphosphonates are a class of drugs that inhibit
the reabsorption of bone by osteoclasts. Drugs in this class include Fosamax, Actonel, and
Boniva. Other medications for this disorder include calcitonin and estrogen therapy.

Osteomyelitis
Osteomyelitis is a bone infection that can reach the bone from the blood, from sur-
rounding tissues, or from trauma that exposes the bone to a pathogen (such as a bac-
terium or fungus). This type of trauma is typical of an open fracture or a break in the
shin’s skin because the anterior surface of the tibia is very superficial. The infection
may be acute (lasting several months or less), or it may be chronic (lasting several
months to years). Treatment may include antibiotics and/or surgery to drain the area
and remove damaged bone.

Cancers Affecting the Skeletal System

As you will recall from the levels of organization chapter, sarcomas are cancers of
connective tissues. Following, you will explore two different kinds of sarcomas that
affect bone and cartilage: osteosarcomas and chondrosarcomas.
Osteosarcomas are malignant bone tumors that occur in immature bone at any
age, although they tend to be more common in people between the ages of 10 and 25.
These bone tumors often occur near the knee or in other long bones in the body. Treat-
ment usually involves chemotherapy and surgery.
Chondrosarcomas are cancerous tumors that occur in cartilage. Most chondro-
sarcomas are primary tumors, which means that they originate in cartilage, not from a
tumor located in another organ or tissue within the body. These tumors may also occur
in patients who have osteosarcomas. Treatment for chondrosarcomas involves surgical
removal of the tumor.

Spot Check What type of cancer causes malignant tumors in immature bone?

4.8 Skeletal System Disorders 165

 Gout
Gout is characterized by the deposit of monosodium urate crystals in the tissues and
joints throughout the body. Hyperuricemia, or excess uric acid in the blood, can cause
this deposition of crystals in tissues and joints. A decrease in uric acid secretion by the
kidneys, an increase in the production of urate in the body, or an increase in intake of
high-protein foods can all lead to hyperuricemia. The excess urate in the blood pre-
cipitates as crystals and collects in tissues, especially the larger joints of the body. The
collection of the crystals in the joints can cause acute or chronic arthritis, described
as gouty arthritis. Usually, this affects the first metatarsophalangeal joint or the big
toe. See Figure 4.59. The symptoms of gout include pain, redness, tenderness, and
inflammation. Gout is commonly treated with anti-inflammatory drugs and cholchi-
cine, which helps relieve the arthritis symptoms. If necessary, health care professionals
may also prescribe medications that help treat hyperuricemia.

Cleft Palate
Cleft palate is a common craniofacial congenital defect characterized by the failure of
the hard or soft palate to fuse during gestation. Many factors can potentially lead to a
cleft palate, including environmental or genetic factors. There is some evidence that
mothers who use alcohol or tobacco while pregnant may be more at risk for having a
baby with a cleft palate. It has also been shown that increasing folic acid intake before
and during pregnancy can decrease the risk of a cleft palate. This is one reason that
prenatal vitamins are highly recommended for women who are pregnant. A cleft palate
can vary in severity, affecting either the hard or soft palate in the roof of the mouth or
both. There are instances where the cleft also affects the lip, as shown in Figure 4.60.
This defect can interfere with the ability of the infant to feed, affect speech in later

Swollen and
inflamed joint

Uric acid
crystals

Masses of
uric acid

(a) (b) (c)

FIGURE 4.59 Gout: (a) deposit of uric acid crystals in the metatarsophalangeal joint, (b) X-ray of gout in the metatarsophalangeal
joint, (c) foot showing inflammation caused by gout in the metatarsophalangeal joint.
(b) ©Du Cane Medical Imaging Ltd./Science Source; (c) ©Dr. P. Marazzi/Science Source

166 CHAPTER 4 The Skeletal System

 (a)

(a) (b)

FIGURE 4.60 Cleft palate: (a) drawing of a cleft palate, (b) infant with cleft palate.
(b) ©Biophoto Associates/Science Source

years, and possibly increase the instance of ear infections. Treatment of a cleft palate
involves surgical repair to close the palate and restore normal function.

Mastoiditis
Mastoiditis is an infection of the mastoid process of the temporal bone in the skull.
This condition is usually caused by an untreated middle-ear infection that has spread
to the mastoid process. Symptoms of mastoiditis include pain, fever, redness, tender-
ness, and swelling near the mastoid process. See Figure 4.61. The patient may also
have pus or discharge from the ear. The infection is usually treated with antibiotics
intravenously. If the infection has caused an abscess or a pus-filled cavity to form
within
(b) the mastoid process, surgery may be required to drain the infection.

Infection

Mastoid

Swollen Ear turned

(a) area forward (b)

FIGURE 4.61 Mastoiditis: (a) infection of the mastoid process of the temporal bone,
(b) child with inflamed mastoid process of the temporal bone due to mastoiditis.
(b) ©Mediscan/Alamy Stock Photo

4.8 Skeletal System Disorders 167

 Table 4.5 summarizes the skeletal diseases and disorders described throughout
the chapter.

TABLE 4.5 Summary of Diseases and Disorders of the Skeletal System

Type of Disease/Disorder Disease/Disorder Description
Bone softening Osteoporosis Severe lack of bone density
Osteomalacia Bone loss due to reabsorption of calcium to meet the
demands of pregnancy
Rickets Lack of bone deposition in children
Brittle bones Osteogenesis Lack of collagen fibers in bone
imperfecta
Abnormal spinal curvatures Kyphosis Exaggerated thoracic curvature
Lordosis Exaggerated lumbar curvature
Scoliosis Lateral curvature of vertebral column
Joint inflammation Bursitis Inflammation of the bursa
Gout Excessive buildup of uric acid crystals within the joints
and soft tissues
Osteoarthritis Wear and tear on a joint
Rheumatoid Autoimmune disease
arthritis
Infection Mastoiditis Inflammation of the mastoid process caused by infection
Osteomyelitis Acute or chronic infection usually from bacteria or fungi
Cancers Chondrosarcoma Malignant tumor found in cartilage
Osteosarcoma Malignant bone tumor
Other disorders of the Cleft palate A congenital defect resulting in failure of the hard and/or
skeletal system soft palate to fuse
Fractures A break in the bone
Herniated disk The lateral bulge of an intervertebral disk

Spot Check Compare and contrast the disorders of the skeletal system that
specifically affect the joints.

168 CHAPTER 4 The Skeletal System

Putting the Pieces Together

The Skeletal System

Integumentary system Lymphatic system
Vitamin D production enables Sends white blood cells to fight
calcium absorption for bone pathogens.
deposition.

Red bone marrow produces white

Supports skin in cranial and facial
blood cells.
regions where bone is close to the
surface.
Respiratory system

Muscular system Allows for the exchange of O2

and CO2.
Works with bones to move the
body in lever systems; applies Ribs protect the lungs; bone gives
stress to bone for appositional structure to nasal passages to warm
bone growth. and moisturize inspired air; sinuses
give resonance to the voice.
Provides calcium needed for
muscle contractions.
Digestive system
Provides nutrients for tissues of
Nervous system the skeletal system.
Proprioceptors sense movement of
joints and body position. Provides protection for some
digestive organs.
Provides protection for the brain
and spinal cord.
Excretory/urinary system
Kidneys activate vitamin D for
Endocrine system calcium absorption, dispose of
wastes, and help maintain fluid
Hormones affect bone deposition and electrolyte balance.
and remodeling.

Ribs protect the kidneys.

Sella turcica protects the
pituitary gland.
Reproductive system
Cardiovascular system Reproductive hormones promote
endochondral bone growth and
Provides nutrients and removes serve as a lock on calcium in the
wastes. bone.

Red bone marrow produces Bones of the pelvis protect some

blood cells and platelets. reproductive organs.

FIGURE 4.62 Putting the Pieces Together—The Skeletal System: connections between the skeletal system
and the body’s other systems.

4.8 Skeletal System Disorders 169

Summary
4.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the skeletal system.

4.2 Overview
∙∙ The skeletal system is composed of bones, cartilages, and ligaments. It is a dynamic system that changes daily.

4.3 Anatomy of the Skeletal System

∙∙ The skeleton can be divided into two parts: the axial skeleton and the appendicular skeleton.

Classification of Bones
Bones can be classified by shape:
∙∙ Long bones are longer than they are wide and have clubby ends. Example: tibia.
∙∙ Short bones are cubelike. Example: carpal bones.
∙∙ Flat bones look like they are a sheet of clay that has been molded. Example: parietal bone.
∙∙ Irregular bones have many projections and spines. Example: vertebrae.
∙∙ Sesamoid bones grow in tendons where there is a lot of friction. Example: patella.

Axial Skeleton
The axial skeleton contains the following bones:
∙∙ Cranial bones: frontal, occipital, temporal, parietal.
∙∙ Ethmoid and sphenoid.
∙∙ Facial bones: nasal, lacrimal, zygomatic, inferior nasal concha, maxilla, palatine, mandible, vomer.
∙∙ Spinal column: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, sacrum, coccyx.
∙∙ Sternum.
∙∙ Ribs: 12 pairs. Of these, 7 pairs are true ribs with individual costal cartilages and 5 pairs are false ribs. Of the 5 pairs of
false ribs, 2 pairs are floating because they do not have or share a costal cartilage.
∙∙ Hyoid bone.

Appendicular Skeleton
The appendicular skeleton is composed of the bones of the limbs and the bones of the girdles that connect the limbs to the
axial skeleton.
∙∙ Pectoral girdle: clavicle and scapula.
∙∙ Bones of the upper limb: humerus, radius, ulna, carpal bones, metacarpals, phalanges.
∙∙ Pelvic girdle: ilium, ischium, pubis.
∙∙ Bones of the lower limb: femur, patella, tibia, fibula, tarsal bones, metatarsals, phalanges.

Histology of the Skeletal System

The skeletal system contains bone connective tissue and cartilage connective tissue.

Bone connective tissue:

∙∙ Osteoblasts build bone tissue by making matrix with collagen fibers and allowing hydroxyapatite (calcium phosphate
crystals) to deposit.
∙∙ Collagen fibers give bone some flexibility.
∙∙ Calcium phosphate crystals make bone hard.
∙∙ Osteoclasts destroy bone.
∙∙ Compact bone is well organized into osteons (Haversian systems).
∙∙ Cancellous bone is loosely organized as trabeculae.

Cartilage connective tissue:

∙∙ Chondrocytes produce a matrix composed of proteoglycans and water.
∙∙ Hyaline cartilage matrix is smooth and clear. It is found as nasal cartilages, costal cartilages, and articular cartilages
covering the ends of long bones.

170
∙∙ F ibrocartilage matrix has fibers going in one direction to act as a shock absorber. It is found in the intervertebral disks, the
menisci of the knee, and the pubic symphysis.
∙∙ Elastic cartilage matrix has fibers going in all directions so as to be elastic. It is found in the pinna of the ear and the
epiglottis.

Anatomy of a Long Bone

∙∙ Epiphyses are the clubby ends of the bone. They are composed of cancellous bone.
∙∙ The diaphysis is the shaft of the bone. It is composed of compact bone.
∙∙ The periosteum covers the diaphysis of the bone. The endosteum lines the marrow cavity.
∙∙ Red bone marrow is found in the epiphyses.
∙∙ The marrow cavity in the diaphysis is filled with yellow marrow.

Joints
Joints can be classified on the basis of their anatomy:
∙∙ Fibrous joints have fibrous tissue between bones.
∙ Suture. This is formed by the membranes of intramembranous ossification.
∙ Gomphosis. This is formed by ligaments holding the tooth in its socket.
∙ Syndesmosis. This is formed by an interosseous membrane.
∙∙ Cartilaginous joints have cartilage between the bones.
∙ Symphysis. This is formed by fibrocartilage between the pubic bones.
∙ Synchondrosis. This is formed by hyaline cartilage between the diaphysis and the epiphyses of bones in children.
∙∙ Synovial joints are lined by a synovial membrane and have synovial fluid in the joint space.
∙∙ The knee is a relatively unstable joint held together by five ligaments: the medial and lateral collateral ligaments, the
anterior and posterior cruciate ligaments, and the patellar ligament. It also contains fibrocartilage pads called menisci that
act as a shock absorber.
∙∙ There are six types of synovial joints: hinge, ball and socket, saddle, gliding, ellipsoid, pivot.
∙∙ Osteoarthritis is wear and tear on a joint. Most people develop osteoarthritis as they age.
∙∙ Rheumatoid arthritis is an autoimmune disease. Anyone, including children, can develop rheumatoid arthritis.

4.4 Physiology of the Skeletal System

Mineral Deposition
∙∙ O
 steoblasts produce a chemical that allows calcium phosphate crystals to be deposited. This is a positive feedback
mechanism starting with a seed crystal.

Bone Development
∙∙ Flat bones are formed through intramembranous ossification.
∙∙ Long bones are formed through endochondral ossification.

Bone Growth
∙∙ Long bones continue to grow longer after birth through endochondral growth until the epiphyseal plates are closed.
∙∙ Appositional growth makes bones more massive. It occurs along lines of stress.

Bone Remodeling
∙∙ B
 one remodeling is done by osteoclasts. They remove bone by producing hydrochloric acid, which dissolves the calcium
phosphate crystals.
∙∙ Bones act as a reservoir for calcium.

Nutritional Requirements of the Skeletal System

∙∙ C
 alcium can be found in dairy products and in green leafy vegetables such as broccoli, collards, kale, turnip greens, and
bok choy.
∙∙ Phosphorus for phosphates is found in dairy products and meats.
∙∙ Vitamin D is needed for calcium absorption.

171
Hormonal Regulation of Bone Deposition and Reabsorption
∙∙ Bone deposition and reabsorption are regulated by hormones on the basis of blood calcium levels.
∙∙ If blood levels of calcium are too high, calcitonin tells osteoblasts to deposit bone.
∙∙ If blood levels of calcium are too low, PTH tells osteoclasts to reabsorb bone.
∙∙ Estrogen and testosterone speed up deposition at puberty and serve as a lock on calcium in the bone.

Functions of the Skeletal System

∙∙ Support. Vertebral column allows the body to be erect.
∙∙ Movement. The arrangement of bones and joints allows a range of movements.
∙∙ Protection. The cranial bones protect the brain. The sternum and rib cage protect the lungs and heart.
∙∙ Acid–base balance. Phosphate ions can bind to excess hydrogen ions to buffer the pH of the blood.
∙∙ Electrolyte balance. Bones serve as a reservoir for calcium.
∙∙ Blood formation. Red blood cells, white blood cells, and platelets are produced in the red bone marrow.

4.5 Effects of Aging on the Skeletal System

∙∙ The ratio of deposition to reabsorption changes as we age.
∙∙ Decreases in estrogen and testosterone levels are responsible for the change.
∙∙ More reabsorption decreases the bone mass and density.
∙∙ Vertebrae thin, and the spinal column becomes more curved and compressed.
∙∙ The elderly are more prone to falls, resulting in fractures.
∙∙ Joints stiffen and become less flexible.
∙∙ Minerals may deposit in joints.
∙∙ The best way to ensure good bone health in later life is to build strong bones when deposition exceeds reabsorption.
∙∙ Exercise and good nutrition, including calcium and vitamin D, can minimize the effects of aging.

4.6 Fractures
Types of Fractures
∙∙ Fractures can be classified by using descriptive terms.
∙∙ Fractured bones can be set back into proper alignment by closed or open reduction.

Fracture Healing
∙∙ The healing of a fracture starts with stem cells forming a soft callus in a hematoma.
∙∙ Osteoblasts deposit bone in the soft callus to form a hard callus.
∙∙ Osteoclasts finish the healing of the fracture by remodeling the hard callus to reestablish the marrow cavity.

4.7 Diagnostic Tests for Skeletal System Disorders

∙∙ Common diagnostic tests for skeletal system disorders include dual-energy X-ray absorptiometry and X-ray.

4.8 Skeletal System Disorders

∙∙ Bone-softening disorders include osteoporosis, rickets, and osteomalacia.
∙∙ Brittle bones is another name for osteogenesis imperfecta.
∙∙ Abnormal spinal curvatures include scoliosis, kyphosis, and lordosis.
∙∙ Joint inflammations include osteoarthritis and rheumatoid arthritis.
∙∙ Osteoporosis is a severe lack of bone density.
∙∙ Osteomyelitis is a bone infection.
∙∙ Two different kinds of sarcomas affect bone and cartilage: Osteosarcomas are malignant bone tumors that occur in
immature bone, and chondrosarcomas are cancerous tumors that occur in cartilage.
∙∙ Gout is characterized by the deposit of monosodium urate crystals in the tissues and joints throughout the body.
∙∙ Cleft palate is a common craniofacial congenital defect characterized by the failure of the hard or soft palate to fuse
during gestation.
∙∙ Mastoiditis is an infection of the mastoid process of the temporal bone.

172
Key Words for Review
The following terms are defined in the glossary.

absorption compact bone hyperuricemia

appendicular skeleton deposition mastoiditis
appositional bone growth diaphysis meniscus
axial skeleton endochondral ossification metatarsophalangeal joint
cancellous bone epiphyseal plate osteon (Haversian system)
chondrocyte fontanelle reabsorption
cleft palate foramen magnum synovial membrane
comminuted hydroxyapatite trabeculae

173
 5 The Muscular
System
When you open your text to
Chapter 5 or start your computer to
access this chapter online, muscle
action is required. Even the expres-
sion on your face as you read the
learning outcomes puts your mus-
cles to use. While you are reading,
you are breathing and your heart
is pumping. Your muscles contract
to give you control over areas that,
on first thought, you might not
associate with muscles, such as
your bladder and bowels. In fact,
muscles have many functions. See
Figure 5.1. They are even respon-
sible for much of your body heat.
©AAGAMIA/The Image Bank/Getty Images

Module 6: Muscular System

174
5.1 Word Roots and Combining Forms
Learning Outcome
1. Use medical terminology related to the muscle system.

muscul/o: muscle sarc/o: flesh

my/o: muscle sthen/o: strength

5.2 Overview
Skeletal muscles are the primary structures in the muscular system. Each skeletal
muscle contains muscle fibers that contract, connective tissues that focus the force
of the contraction, and nerves that control the contraction. These muscles contract
to move most of the bones you learned about in the skeletal system chapter in a
variety of motions. This chapter covers prominent skeletal muscles by region and
the motions they cause in the body. It also covers skeletal muscle cell anatomy
and metabolism to help you learn precisely how a muscle cell contracts at the
molecular level and how it produces the energy needed for the contractions to
happen.
Although skeletal muscles are the primary structures in the muscular system,
there are actually three types of muscle tissue in this system: skeletal, cardiac, and

FIGURE 5.1 The muscular

system.
Muscular System
Major Organs and Structures:
muscles
Accessory Structures:
tendons
Functions: movement, stability,
control of body openings and
passages, communication,
heat production

5.2 Overview 175

 smooth muscle tissue. This chapter compares the different types of muscle tissue
in terms of appearance, ___location, and the kind of metabolism used by each to pro-
cess energy.
Once you have become familiar with the different types of muscle tissue, you can
then combine this knowledge to see how the functions of this system are accomplished.
This chapter ends with information about the effects of aging on the muscular system
and muscular system disorders.

5.3 Anatomy of the Muscular System

To explore the skeletal muscles of the human body, you must first understand
the definitions of muscle terms and of the different muscle actions. You will need
to effectively use these terms when describing the muscles of the body and their
actions.

Anatomical Terms

Learning Outcome
2. D
 efine terms concerning muscle attachments and the ways muscles work in groups to
aid, oppose, or modify each other’s actions.

Definitions follow for terms of muscle attachment and terms that indicate the interre-
lated actions of muscles.

Terms of Muscle Attachment

• Origin: the attachment of a muscle to a bone or structure that does not move when
the muscle contracts. A muscle has an attachment to a bone or another structure at
each end. One attachment must be anchored for the muscle to be able to pull at the
other end. The origin is the site of the anchored end.
• Insertion: the attachment of a muscle to a bone or structure that does move when the
muscle contracts.
• Intrinsic muscle: a muscle that has its origin and insertion located in the
same body region. Example: The temporalis muscle is intrinsic to the head
because its origin and insertion are both in the head. (To see this, look ahead at
Figure 5.10.)
• Extrinsic muscle: a muscle that has its origin located in a body region different
from that of its insertion. Example: The sternocleidomastoid muscle is extrinsic to
the head because its origin is in the head but its insertion is in the thorax. (Again,
turn to Figure 5.10.)

Terms That Indicate the Interrelated Actions of Muscles The following terms
classify muscles according to how they work together to aid, oppose, or modify each
other’s actions. Examples of how these terms are used are provided in the descriptions
of the muscles later in the chapter.
• Fixator: a muscle that holds an origin stable for another muscle.
• Synergists: muscles that have the same action.
• Prime mover: the main muscle that performs the action, helped by synergists.
• Antagonist: a muscle that has an opposing action.

176 CHAPTER 5 The Muscular System

Muscle Actions

Learning Outcome
3. Demonstrate actions caused by muscles.

Muscle actions are the motions caused by the muscle contraction. Figures 5.2 to 5.9
show the following common actions:
• Flexion: action that bends a part of the body anteriorly, such as flexing
the elbow. To flex the arm is to bring the entire arm anteriorly, as in using
your entire arm to point at something ahead of you. The exception is the
knee. Flexion of the knee moves the lower leg posteriorly. See Figure 5.2a
and b.
• Extension: action that bends a part of the body posteriorly, such as straightening
the arm at the elbow. As with flexion, the exception is the knee. Extending the
knee straightens the lower leg. See Figure 5.2a and b.
• Abduction: movement of a part of
the body away from the midline.
See Figure 5.3a. Flexion

• Adduction: movement of a part

of the body toward the midline.
See Figure 5.3b. Doing “jumping
Extension
jacks” is to alternately abduct and
adduct the arms and legs.
• Protraction: movement that brings
part of the body forward. See (a)
Figure 5.4a.
• Retraction: movement that brings
part of the body backward. For
example, a chicken protracts and
retracts its head as it walks. See
Figure 5.4b.
• Lateral excursion: movement of Hip
the jaw laterally to either side. See flexion
Figure 5.4c.
• Medial excursion: movement of
the jaw back to the midline. See
Figure 5.4d.
• Dorsiflexion: position of standing
Knee
on the heels with the toes pointing flexion
up off the floor. See Figure 5.5a.
• Plantar flexion: position of stand-
ing on tiptoes with the heels off the Extension
floor. See Figure 5.5a.
• Inversion: position in which the (b)
soles of the feet are together, facing
each other. See Figure 5.5b. FIGURE 5.2 Flexion and extension:
(a) flexion and extension of the elbow,
• Eversion: position in which the (b) flexion and extension of the knee
soles of the feet point away from and hip.
each other. See Figure 5.5c. ©McGraw-Hill Education/Timothy L. Vacula

5.3 Anatomy of the Muscular System 177

(a) (b)

FIGURE 5.3 Abduction and adduction: (a) abduction, (b) adduction.

©McGraw-Hill Education/Timothy L. Vacula

(a) (b) (c) (d)

FIGURE 5.4 Protraction, retraction, lateral excursion, and medial excursion: (a) protraction, (b) retraction, (c) lateral
excursion, (d) medial excursion.
©McGraw-Hill Education/Timothy L. Vacula

Dorsiflexion

Zero
position

Plantar flexion

(a) (b) (c)

FIGURE 5.5 Dorsiflexion, plantar flexion, inversion, and eversion: (a) dorsiflexion and plantar
flexion, (b) inversion, (c) eversion.
©McGraw-Hill Education/Timothy L. Vacula

178 CHAPTER 5 The Muscular System

• Rotation: the act of spinning on an axis. Pointing your toes to the side involves
lateral rotation of the leg. See Figure 5.6a and b.
• Circumduction: the act of making a circle with part of the body. A baseball or
softball pitch involves circumduction at the shoulder. See Figure 5.6c.
• Supination: rotation that turns the palms up. You could hold soup in the palm of
your hand when your palm is supinated. See Figure 5.7a.
• Pronation: rotation that turns the palms down. You would pour soup from your
hand during pronation. See Figure 5.7b.

(a) (b)

(a) (b) (c)

FIGURE 5.6 Rotation and circumduction: (a) medial rotation, (b) lateral rotation, (c) circumduction.
©McGraw-Hill Education/Timothy L. Vacula

FIGURE 5.7 Supination

and pronation: (a) supination,
(b) pronation.
©McGraw-Hill Education/Timothy L.
Vacula

(c)

(a) (b)

5.3 Anatomy of the Muscular System 179

 (a) (b)

FIGURE 5.8 Opposition. FIGURE 5.9 Elevation and depression: (a) elevation, (b) depression.
©McGraw-Hill Education/Timothy L. Vacula ©McGraw-Hill Education/Timothy L. Vacula

• Opposition: the act of bringing the thumb to the palm. See Figure 5.8.
• Reposition: the act of taking the thumb away from the palm.
• Elevation: the act of closing the jaw or raising the shoulders. See Figure 5.9a.
• Depression: the act of opening the jaw or lowering the shoulders. See Figure 5.9b.

Study Hint
Studying this system can be difficult because there are so many muscles with names
that are difficult to pronounce. Remember, you have a complete set of muscles with you
at all times in your own body.
A good study technique is to find a muscle on your body and contract it. Point to
the muscle’s origin and insertion and feel the action while saying the name aloud. If
you can hear yourself say the name, you will have an easier time spelling it.

Spot Check Give an example of the body performing the following muscle
actions: opposition, eversion, flexion, abduction.

Figures 5.10 and 5.11 show the superficial muscles of the entire body. The next sec-
tion of the chapter focuses on the muscles by region. Closer views of muscles are shown
in each body region.

Muscles by Region

Learning Outcome
4. Identify muscles, giving the origin, insertion, and action.

Muscles of the Head and Neck While larger, more obviously visible
muscles might come to mind when you hear the word muscles, even the head
and neck muscles, no matter their size, are crucial to the body’s functioning.

180 CHAPTER 5 The Muscular System

Epicranial aponeurosis

Temporalis Frontalis

Orbicularis
Masseter oculi Facial
muscles
Sternocleidomastoid Orbicularis
oris

Platysma

Deltoid
Pectoralis major

Serratus anterior

Biceps brachii

Rectus abdominis
Linea alba
External abdominal
oblique

Flexors of wrist Brachioradialis

and fingers

Flexor carpi
radialis

Carpal ligament

Pectineus
Tensor fasciae latae
Adductor
longus
Vastus lateralis
Rectus femoris
Gracilis
Vastus intermedius (deep
Quadriceps
Sartorius to the rectus femoris and
femoris
not visible in figure)

Vastus medialis

Gastrocnemius Tibialis anterior

Fibularis

Soleus

FIGURE 5.10 Muscles: full figure, anterior view.

5.3 Anatomy of the Muscular System 181

Epicranial
aponeurosis
Temporalis
muscle
Occipitalis

Trapezius

Deltoid

Triceps brachii
Latissimus dorsi

Extensors
of the wrist
and fingers
External abdominal
oblique

Gluteus medius

Gluteus maximus

Gracilis Semitendinosus
Biceps femoris Hamstring
muscles
Semimembranosus

Gastrocnemius

Soleus

Calcaneal tendon Fibularis

(Achilles tendon)

FIGURE 5.11 Muscles: full figure, posterior view.

182 CHAPTER 5 The Muscular System

Epicranial
aponeurosis
Epicranial
aponeurosis
Temporalis Frontalis

Orbicularis
oculi
Occipitalis
Zygomaticus
major

Buccinator Buccinator
Masseter
Masseter
Orbicularis
oris
Sternocleidomastoid

Trapezius

Platysma

(a) (b)

Frontalis

Orbicularis
oculi

Orbicularis
oris

Masseter

Platysma
(c)

FIGURE 5.12 Muscles of the head and neck: (a) lateral view, (b) anterior view, (c) lateral view of a cadaver.
(c) ©McGraw-Hill Education/Rebecca Gray

See Figure 5.12. The names, origins, insertions, and functions of the muscles of
the head and neck are outlined in Table 5.1 and explained in the following list:
• The orbicularis oris (or-BIK-you-LAIR-is OR-is) is an example of a muscle that
does not have a bone as an origin or insertion. The insertion is the lips, and the
origin is a complex cord at the corner of the mouth.
• The frontalis (fron-TAY-lis) muscle originates on the epicranial aponeurosis (a mem-
branous sheath that rides and can slide back and forth slightly over the top of the skull).
The occipitalis (ock-SIP-ih-TAY-lis) contracts when the frontalis raises the eyebrows.
In this case, the occipitalis acts as a fixator holding the origin for the frontalis steady.
• The buccinator (BUCK-sih-NAY-tor) is often called the “trumpeter’s muscle,” but
do not be confused and think that this muscle causes a kissing motion of the lips. That
is not how a trumpet is played. The buccinator flattens and compresses the cheeks.
• The temporalis (tem-poh-RAHL-is) and masseter (MASS-eh-ter) muscles are
synergists because they have the same action. When you look at the insertion for

5.3 Anatomy of the Muscular System 183

 TABLE 5.1 Muscles of the Head and Neck
Muscle Origin Insertion Function
Orbicularis oris Complex cord at the corner Lips Closes and protrudes lips, as in
of the mouth kissing

Orbicularis oculi Medial eye orbit Eyelids Closes eye

(or-BIK-you-LAIR-is
OCK-you-lie)

Frontalis Sheath of fibrous tissue over Skin of forehead Raises eyebrows and wrinkles the
the top of the skull, called skin of the forehead
the epicranial aponeurosis

Occipitalis Temporal bone Epicranial Fixes epicranial aponeurosis as an

aponeurosis origin for the frontalis muscle

Temporalis Temporal bone Mandible Elevates, retracts, and causes

medial and lateral excursion of the
mandible

Buccinator Maxilla and mandible Orbicularis oris Compresses cheeks

Masseter Zygomatic arch Mandible Elevates mandible

Platysma Fascia of the deltoid and Mandible Depresses mandible and draws
pectoralis major muscles the corner of the mouth and lower
lip downward

Sternocleidomastoid Manubrium of the sternum Mastoid process of Individually, each muscle rotates
and medial portion of the the temporal bone the head. Together, the muscles
clavicle bring the head forward and down

Zygomaticus major Zygomatic bone Muscles at angle of Draws the mouth’s angle upward
mouth and outward

each on the mandible, the masseter has a much broader connection. It is the prime
mover.
• The masseter and platysma (plah-TIZ-ma) have opposite functions as far as the ele-
vation and depression of the mandible are concerned. They are therefore antagonists.
• Each sternocleidomastoid (STIR-noh-KLIDE-oh-MASS-toyd) muscle rotates
the head.

Spot Check If you put one finger on the origin of the right sternocleidomastoid
(the mastoid process posterior to your right earlobe) and another finger on the insertion of
the right sternocleidomastoid (the manubrium at the base of the neck), you can determine
which direction the right sternocleidomastoid rotates the head. Muscles can shorten only
when they contract. First turn your head right, and then turn your head left. Which direction
caused your fingers to come closer together, indicating that the muscle shortened?

Muscles of the Thorax and Abdomen The muscles of the thorax and abdomen are
shown in Figure 5.13. The names, origins, insertions, and functions of these muscles
are outlined in Table 5.2 and explained in the following list:
• The pectoralis minor (pek-tor-AL-is) is deep to the pectoralis major.
• The serratus anterior (seh-RAY-tus) has a serrated or jagged edge like that of a
serrated knife.

184 CHAPTER 5 The Muscular System

• The diaphragm is a dome-shaped skeletal muscle composed of skeletal muscle
tissue. It divides the thorax from the abdomen. A central tendon at the center of the
dome serves as the insertion. The diaphragm is the prime mover for breathing and
flattens as it contracts, increasing the size of the thoracic cavity.
• The rectus abdominis is the “six-pack muscle” you see on abdomens of people
who are very physically fit. Whenever you see the word rectus, think straight up
and down. A fibrous sheath—formed by the tendons of the internal and external
abdominal oblique muscles—encloses the rectus abdominis.

FIGURE 5.13 Muscles

of the thorax and abdomen:
Pectoralis (a) superficial and deep muscles,
major anterior view; (b) deep muscles,
Pectoralis minor anterior view; (c) abdominal
muscles of a cadaver.
Latissimus
dorsi

Serratus
anterior Rectus sheath

Linea alba

Rectus abdominis
(sheath removed)
Umbilicus
External abdominal
oblique
External
abdominal
oblique Internal abdominal
oblique

Transverse
(a) abdominal

1
External 2
intercostals 3 Internal
intercostals
4
5
Central tendon
of diaphragm
6

7
Diaphragm
8
9

10

(b)

5.3 Anatomy of the Muscular System 185

FIGURE 5.13 Muscles of
the thorax and abdomen
(continued).
(c) ©Christine Eckel

Rectus External
sheath abdominal
oblique
External
abdominal Internal
oblique abdominal
oblique
Transverse
abdominal
Umbilicus
Rectus
Linea alba abdominis

(c)

TABLE 5.2 Muscles of the Thorax and Abdomen

Muscle Origin Insertion Function

Pectoralis major Clavicle and costal Humerus Flexes and adducts humerus
cartilages
Pectoralis minor Ribs Coracoid process Depresses and protracts shoulder
of scapula

Serratus anterior Anterior ribs Scapula Protracts shoulder

Diaphragm Xyphoid process, Central tendon of Prime mover for breathing

costal cartilages, and diaphragm
lumbar vertebrae
External intercostals Inferior margins of Superior margin of Expand the thoracic cavity during
ribs next-lower rib inspiration
Internal intercostals Superior margins Inferior margin of Compress the thoracic cavity during
of ribs next-higher rib forced expiration
External abdominal Ribs Iliac crest Compresses abdomen, flexes spine,
oblique and allows rotation at the waist
Internal abdominal Iliac crest Ribs Compresses abdomen, flexes spine,
oblique and allows rotation at the waist

Rectus abdominis Pubis Xyphoid process Flexes spine

and costal cartilages
Transverse abdominal Inguinal ligament, Linea alba and pubis Compresses abdomen
iliac crest, and
costal cartilages

186 CHAPTER 5 The Muscular System

• The abdominal wall on either side of the rectus abdominis has three layers. The
most superficial layer is the external abdominal oblique. Oblique means that it
runs at an angle. Deep to this layer is the internal abdominal oblique. The deep-
est layer is the transverse abdominal. Its cells run on the transverse plane.
• The rectus abdominis and the external and internal abdominal obliques are syn-
ergists for flexing the spine, but only the external and internal abdominal obliques
are synergists with the transverse abdominal for compressing the abdomen.

Muscles of the Back On the opposite side of the body’s abdominal and thoracic
muscles are the muscles of the back, which also include the neck and buttocks muscles.
See Figure 5.14. The names, origins, insertions, and functions of the back muscles are
outlined in Table 5.3. Further detail about these muscles follows:
• The trapezius (trah-PEE-zee-us) is a diamond-shaped muscle that can have multiple
origins, insertions, and actions depending on the way it is used. If its attachment to the

FIGURE 5.14 Muscles of the

Superficial Deep
neck, back, and buttocks:
(a) superficial muscles and deep
muscles (b) back muscles of a
cadaver, with superficial muscles
Epicranial aponeurosis
and deep muscles.

Sternocleidomastoid

Trapezius

Deltoid

Erector
spinae

Latissimus
dorsi

External abdominal
oblique

Gluteus medius

Gluteus maximus

(a)

5.3 Anatomy of the Muscular System 187

FIGURE 5.14 Muscles of
the neck, back, and buttocks
(continued).
(b) ©McGraw-Hill Education/Rebecca
Gray
Trapezius
Ribs

External
intercostals

Erector spinae

Latissimus dorsi

(b)

TABLE 5.3 Muscles of the Neck, Back, and Buttocks

Muscle Origin Insertion Function

Trapezius Scapula External occipital Extends head

protuberance

Latissimus dorsi Lumbar vertebrae Intertubercular groove Extends, adducts, and medially
of humerus rotates the humerus

Erector spinae Ribs, vertebrae, and ilium Ribs and vertebrae Holds spine erect for posture
and extends spine

Gluteus maximus Ilium, sacrum, and coccyx Femur Extends and laterally rotates hip

Gluteus medius Ilium Greater trochanter Abducts and medially rotates hip
of femur

scapula is held steady (fixated), the external occipital protuberance becomes the inser-
tion and the action is extension of the head. If the head is held steady as the origin, the
scapula then becomes the insertion and the action is elevation of the shoulders.
• The latissimus dorsi (lah-TISS-ih-muss DOOR-sigh) is a very broad back mus-
cle that comes around the body to insert on the groove between the greater and
lesser tubercles of the humerus. Its job is to extend, adduct, and medially rotate the
humerus. The arm motion of the butterfly stroke in swimming is a good example
of how these three movements are performed together by this muscle.
• The erector spinae (ee-REK-tor SPY-nee) is a whole group of muscles that runs
straight up and down, deep in the back. Its function is to hold the spine erect for
posture and further extension of the spine.

188 CHAPTER 5 The Muscular System

• The gluteus maximus is the largest muscle of the buttocks. It extends the leg and
laterally rotates the hip.
• The gluteus medius is also located in the buttocks. It is an antagonist to the
gluteus maximus in regard to hip rotation, as it medially rotates the hip.

Muscles of the Arm The muscles of the arm are shown in Figure 5.15. Their names,
origins, insertions, and functions are outlined in Table 5.4, and the following item pro-
vides additional details:
• The biceps brachii (BYE-sepz BRAY-kee-eye), brachialis (BRAY-kee-al-is),
and brachioradialis (BRAY-kee-oh-RAY-dee-al-is) are synergists for flexing the
elbow. The brachialis muscle is the prime mover. The antagonist to this group is
the triceps brachii (TRY-sepz BRAY-kee-eye).

Acromion

Clavicle
Spine of
scapula

Deltoid

Pectoralis
major

Triceps Deltoid
Biceps
brachii
brachii

Pectoralis
major
Brachialis
Biceps
brachii

Serratus
anterior
Brachioradialis
External
abdominal
oblique
(a) (b)

FIGURE 5.15 Pectoral and brachial muscles: (a) lateral view, (b) anterior view of a cadaver.
(b) ©McGraw-Hill Education/Rebecca Gray

TABLE 5.4 Muscles of the Arm

Muscle Origin Insertion Function

Deltoid Clavicle and Deltoid tuberosity Abducts

scapula of humerus humerus

Biceps brachii Scapula Radius Flexes elbow

Triceps brachii Humerus and Olecranon of ulna Extends elbow

scapula

Brachialis Humerus Ulna Flexes elbow

Brachioradialis Humerus Radius Flexes elbow

5.3 Anatomy of the Muscular System 189

 Muscles of the Forearm Connected to the muscles of the arm are the muscles of the
forearm. See Figure 5.16. The names, origins, insertions, and functions of the muscles
of the forearm are outlined in Table 5.5. Further detail about these muscles follows:
• The forearm has many muscles. It is important to pay attention to their origins
because the origins help with understanding the actions of these muscles. For
example, all flexors originate at the medial epicondyle of the humerus, while all
extensors originate at the lateral epicondyle of the humerus.
• Carpi radialis and carpi ulnaris muscles have long and short versions called longus
and brevis components. The longus or brevis components may also be called carpi
radialis or carpi ulnaris.
• Flexor carpi ulnaris (FLEK-sor KAR-pee ul-NAR-is) and extensor carpi ulna-
ris muscles have different origins, but both run along the ulna. They are antago-
nists to each other for wrist flexion and extension, but they are synergists for wrist
adduction.
• Flexor carpi radialis (FLEK-sor KAR-pee RAY-dee-al-is) and extensor carpi
radialis muscles have different origins, but both run along the radius. They are
antagonists to each other for wrist flexion and extension, but they are synergists for
wrist abduction.

Biceps
brachii Triceps Triceps
brachii brachii
Triceps
brachii Brachioradialis
Brachialis

Brachioradialis
Extensor
Palmaris Flexor carpi
Extensor Flexor
longus carpi radialis
carpi radialis carpi
ulnaris ulnaris
Flexor Extensor
carpi carpi radialis
radialis longus Extensor
Extensor digitorum
Flexor carpi
carpi ulnaris
ulnaris

Extensor
digitorum Extensor
Carpal
ligament carpi radialis
brevis
Carpal
ligament

(a) (b) (c)

FIGURE 5.16 Muscles of the forearm: (a) superficial flexors, anterior view ; (b) superficial extensors, posterior
view ; (c) superficial muscles of a cadaver, posterior view.
(c) ©McGraw-Hill Education/Christine Eckel

190 CHAPTER 5 The Muscular System

 TABLE 5.5 Muscles of the Forearm
Muscle Origin Insertion Function
Extensor carpi radialis Lateral epicondyle of humerus Metacarpals Extends and abducts
wrist

Extensor carpi ulnaris Lateral epicondyle of humerus Carpals and Extends and adducts
metacarpals wrist

Palmaris longus Medial epicondyle of humerus Palmar aponeurosis Flexes wrist

Flexor carpi radialis Medial epicondyle of humerus Metacarpals Flexes and abducts wrist

Flexor carpi ulnaris Medial epicondyle of humerus Metacarpals Flexes and adducts wrist

Extensor digitorum Lateral epicondyle of humerus Posterior phalanges Extends fingers

(DIJ-ih-TOR-um)

Flexor digitorum Ulna Phalanges Flexes fingers

• Palmaris longus (pahlm-AIR-is) is the only muscle of the forearm with a tendon
that is superficial to the carpal ligament (braceletlike ligament at the wrist). All
other tendons, nerves, and vessels travel deep to this ligament.

Disease P int
Prolonged repetitive motions of the fingers and hands, such as typing on a computer
keyboard or regularly working with hand tools, can cause inflammation of the tendons
traveling under the carpal ligament. See Figure 5.17. Swelling is a characteristic of
inflammation. Because the sheath (fascia) superficial to the tendons does not stretch
to accommodate the swelling caused by
inflammation, pressure increases on nerves
traveling deep to the carpal ligament. The
added pressure may cause tingling or pain in the
palm, and this may radiate to the shoulder. This
condition is carpal tunnel syndrome. It can be
treated with anti-inflammatory medications and/
or surgery to remove part of the tendon sheath.
©Tetra Images/Shutterstock

Muscles of the Thigh Now that you have reviewed the muscles of the arm and upper
body, you are ready to study the body’s lower limbs, focusing first on the thigh muscles.
See Figures 5.18 and 5.19. Table 5.6 outlines the names, origins, insertions, and func-
tions of the thigh muscles, and the following list provides additional details:
• The psoas major (SO-ahz) originates high on the posterior abdominal wall
(T12–L5), while the iliacus (ill-EE-ah-kuss) originates on and appears to line
the ilium. Both muscles run deep to the inguinal ligament and insert on the
lesser trochanter of the femur. When they pass deep to the inguinal ligament,
they merge to form the iliopsoas.
• The rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius
make up the group of muscles called the quadriceps femoris (KWAD-rih-seps

5.3 Anatomy of the Muscular System 191

FIGURE 5.17 Carpal tunnel Palmaris longus Flexor tendons
syndrome: (a) anterior view tendon (cut)
of tendons and ligaments of
the wrist, (b) cross section of Palmar carpal
the wrist, (c) anterior view of a ligament (cut) Ulnar artery
cadaver wrist.
(c) ©Robert Chase/Science Source Median nerve Sheath covering the
carpal tunnel
Radial artery
Ulnar nerve
Trapezium
bone

(a)

Carpal tunnel
Ulnar artery Palmaris longus tendon

Ulnar nerve Sheath covering

the carpal tunnel
Muscle
Flexor tendons

Median nerve

Carpal bones Radial artery

Extensor tendons

(b)

Instrument travels
through the
carpal tunnel.

Carpal
ligament

Ulnar artery

Flexor tendons

(c)

192 CHAPTER 5 The Muscular System

 Lateral Medial

Psoas major

Iliacus Tensor fasciae

latae Femoral
Tensor fasciae latae vein
Iliopsoas Femoral
Iliopsoas artery
Sartorius Pectineus
Inguinal ligament

Pectineus
Adductor
Adductor longus longus
Gracilis
Sartorius Quadriceps femoris: Gracilis
Rectus femoris
Rectus femoris
Vastus intermedius Vastus lateralis
(deep to rectus
femoris and not Quadriceps
visible in figure) femoris
Vastus medialis
Vastus medialis
Vastus lateralis
Patellar tendon Patellar tendon
Patella
Patella
Patellar ligament

(a) (b)

FIGURE 5.18 Anterior muscles of the thigh: (a) anterior view, (b) superficial muscles of a cadaver.
(b) ©McGraw-Hill Education/Rebecca Gray

FEM-or-is). They are synergists for knee extension. Note that they all have
the same origin except for the rectus femoris, which originates above the hip
at the ilium. Due to its origin, the rectus femoris is solely responsible for hip
flexion.
• The biceps femoris, semitendinosus (sem-ee-TEN-dih-NOH-sis), and semimem-
branosus (sem-ee-MEM-bran-OH-sis) make up the group called the hamstrings,
which are synergists for knee flexion. The hamstrings are antagonists to the quad-
riceps. The biceps femoris has its origin above the hip at the ischium, so it is also
responsible for hip extension.
• The gracilis (GRASS-ih-lis), adductor longus, and pectineus (pek-TIN-ee-us)
are synergists for hip adduction.

Study Hint
A study tip for remembering the gracilis, adductor longus, and pectineus muscles
involves the first letter of each muscle. Going medial to lateral with the first letter of
each, you have GAP. These muscles are in that order, and they close the gap between
the legs (adduction).

5.3 Anatomy of the Muscular System 193

FIGURE 5.19 Posterior
muscles of the thigh:
(a) posterior thigh muscles,
Gluteus
(b) posterior muscles of a
maxiumus
cadaver.
(b) ©McGraw-Hill Education/Christine
Eckel

Biceps femoris
Semitendinosus
Semitendinosus
Biceps femoris

Hamstrings
Semimembranosus

Semimembranosus

Tibia Fibula

Posterior view
(a) (b)

TABLE 5.6 Muscles of the Thigh

Muscle Origin Insertion Function
Tensor fasciae latae Ilium Tibia Abducts and medially rotates hip
(TEN-sor FASH-ee-ee LAY-tee)
Gracilis Pubis Tibia Flexes knee and adducts hip
Adductor longus Pubis Femur Adducts hip
Pectineus Pubis Femur Adducts and flexes hip

Iliacus Ilium Lesser trochanter of femur Flexes hip

Iliopsoas Ilium and vertebrae Lesser trochanter of femur Flexes hip

Psoas major Vertebrae Lesser trochanter of femur Flexes hip

Sartorius Ilium Tibia Flexes knee and flexes hip

Rectus femoris Ilium Tibial tuberosity Extends knee and flexes hip

Vastus lateralis Greater trochanter of femur Tibial tuberosity Extends knee

Vastus medialis Femur Tibial tuberosity Extends knee
Vastus intermedius Femur Tibial tuberosity Extends knee

Biceps femoris Ischium Fibula Flexes knee and extends hip

Semitendinosus Ischium Tibia Flexes knee

Semimembranosus Ischium Tibia Flexes knee

194 CHAPTER 5 The Muscular System

 Spot Check Which muscles are synergists for hip flexion? Which muscles are
antagonists to hip flexors?

Muscles of the Leg Figure 5.20 shows the muscles of the leg, and Table 5.7 out-
lines their names, origins, insertions, and functions. Additional information follows:
• The gastrocnemius (gas-trok-NEE-me-us) and soleus (SO-lee-us) are synergists
for plantar flexion. They are antagonists to the tibialis anterior, (tih-bee-AH-lis),
which is responsible for dorsiflexion. The gastrocnemius and soleus share the
calcaneal (Achilles) tendon for their insertion.
• The peroneus muscles may also be called fibularis (FIB-you-LAH-ris) muscles.

TABLE 5.7 Muscles of the Leg

Muscle Origin Insertion Function
Gastrocnemius Femur Calcaneus Plantar-flexes foot

Soleus Fibula and tibia Calcaneus Plantar-flexes foot

Peroneus, or fibularis Fibula Metatarsal Everts foot

Tibialis anterior Tibia Metatarsal Dorsiflexes and inverts foot

Patella

Patellar Patella
ligament Head of
fibula
Tibia

Gastrocnemius
Peroneus
(Fibularis) Gastrocnemius
Tibialis
Soleus anterior
Soleus
Tibialis
anterior Peroneus
(Fibularis)

Soleus
Calcaneal tendon
(Achilles tendon)

Lateral malleolus

(a) (b) (c)

FIGURE 5.20 Muscles of the leg: (a) anterior view , (b) posterior view , (c) lateral view of a cadaver.
(c) ©McGraw-Hill Education/Rebecca Gray

5.3 Anatomy of the Muscular System 195

 Anatomy of a Skeletal Muscle

Learning Outcome
5. Describe the structural components of a muscle, including the connective tissues.

Now that you have looked at the prominent muscles by region, it is time to con-
sider the anatomy of a single muscle and its connective tissues, starting with the
smallest structure in Figure 5.21a. (Follow along with the diagram while reading
this section.)
An individual muscle cell (muscle fiber) is surrounded by connective tissue
called the endomysium (EN-doh-MISS-ee-um). Muscle fibers are grouped together
to form a fascicle (FAS-ih-kull), which is surrounded by connective tissue called the
perimysium. The fascicles are grouped
together to form the muscle. The entire
muscle is surrounded by a connec-
tive tissue called the epimysium. It
is important to understand that all of
these connective tissues run through
the entire length of the muscle. The
endomysium between muscle fibers,
the perimysium surrounding each fasci-
Tendon cle, and the epimysium surrounding the
entire muscle merge at the ends of the
muscle to form the tendon that attaches
the muscle to the bone. A tendon is not
just a piece of fibrous connective tissue
attached to each end of the muscle. Its
Muscle components are an integral part of the
Epimysium entire muscle, not just the ends.
Perimysium

Endomysium
Fascicle

Neuron

Blood
vessels

Muscle fiber Myofibril Filaments

Nucleus

Cell membrane
(sarcolemma)

Sarcoplasmic
reticulum

(a)

FIGURE 5.21 Connective tissues and structural components of a muscle: (a) structural
components of a muscle and attachment of muscle to the humerus, (b) cross section of the
lower leg showing the relationship of individual muscles and fasciae.

196 CHAPTER 5 The Muscular System

 FIGURE 5.21 Connective
tissues and structural
components of a muscle
(continued).

Posterior
compartment

Superficial posterior Deep posterior

compartment compartment

Fibula

Lateral
compartment

Tibia

Fasciae

Nerves Anterior
(b) and vessels compartment

A fourth connective tissue, called fascia (FASH-ee-ah), is shown in Figure 5.21b.

Fascia is a tough, fibrous tissue that does not allow for expansion. It surrounds several
muscles of an area, forming muscle compartments, and it separates muscle from the
hypodermis.

Disease P int
Overactivity or trauma may cause the muscles of a compartment to become inflamed
and swell. Because the fascia does not stretch enough to accommodate the swelling,
pressure builds within the compartment. The increased pressure hampers blood flow
and muscle activity. This is called compartment syndrome. It may require cutting the
fascia of the compartment to relieve the pressure and reestablish blood flow.

Anatomy of a Skeletal Muscle Cell

Learning Outcome
6. Describe the structural components of a skeletal muscle fiber, including the major proteins.

Figure 5.22 shows the anatomy of a single muscle fiber (muscle cell). Muscle fibers
have specialized names for many of their organelles. The cell membrane is called the

5.3 Anatomy of the Muscular System 197

 Mitochondria

Skeletal muscle fiber

Sarcolemma
Thick (myosin)
filaments
Sarcoplasmic Thin (actin)
reticulum filaments

Myofibril

Sarcomere

Z line Z line

(a) (b)

FIGURE 5.22 Structure of a muscle fiber: (a) the structures of a muscle fiber (cell), (b) two
sarcomeres.

sarcolemma. The smooth endoplasmic reticulum of

the cell is called the sarcoplasmic reticulum (shown in
orange). Its function is to store calcium ions until they
are needed. Notice that a muscle fiber is a bundle of
myofibrils, but there is no connective tissue surround-
ing each of the myofibrils.
Myofibrils are composed of a series of repeated
functional units called sarcomeres running end to end.
(a) See Figure 5.22. Z lines form the ends of a sarcomere,
Sarcomere which is composed of thick and thin filaments (myofila-
ments) made of protein. Only the thin myofilaments are
attached at the Z lines. The thick and thin myofilaments
overlap in two areas near the center of the sarcomere.
These sections of the sarcomere (where thick and thin
myofilaments overlap) appear darker. This accounts for
the striated appearance of skeletal muscle tissue when
seen on a microscope slide. See Figure 5.23.
Thick myofilaments are made of several hundred pro-
tein molecules called myosins. A myosin molecule looks
like a golf club with a pincherlike head (cross-bridge),
which can grab and bend. See Figure 5.24. As shown
in the figure, the myosin molecules are grouped with the
Z line Z line cross-bridges pointing toward the two ends of the thick
myofilament.
Thin myofilaments are composed of three different
Thin filaments Thick filaments protein molecules—actin, tropomyosin, and troponin.
(b)
Actin looks like a double chain of beads twisted together.
FIGURE 5.23 Muscle fiber (cell) striations and sarcomeres: Tropomyosin resembles a thread running through the
(a) micrograph showing striations, (b) the overlapping of thick actin chain. It covers spots called active sites on actin
and thin myofilaments responsible for the striations. where myosin molecules could grab hold. Troponin is a
(a) ©Don W. Fawcett/Science Source small protein attached to tropomyosin. See Figure 5.24.

198 CHAPTER 5 The Muscular System

 Cross-bridges Thin filament FIGURE 5.24 Protein
structure of thick and thin
myofilaments. Active sites are
shown as blue dots on actin
that are covered by
tropomyosin.

Troponin Tropomyosin Myosin Thick Actin Active site

molecule filament molecule on actin
covered by
tropomyosin

This information about the proteins of the myofilaments will be used later in the
chapter to explain how a muscle fiber contracts at a molecular level.

Spot Check Put the following in order of size from smallest to largest: muscle
fiber, myofilament, fascicle, muscle, myofibril.

5.4 Physiology of the Muscular System

You have become familiar with the prominent skeletal muscles of this system, the
anatomy of a muscle, and the anatomy of a skeletal muscle cell down to its molecular
level. How exactly does that anatomy work to carry out a muscle contraction? To
answer that question, you first need to understand the physiological characteristics
shown by all muscle tissues.

Physiological Characteristics of Muscle Tissue

Learning Outcome
7. Explain the five physiological characteristics of all muscle tissue.

All muscle tissues display five physiological characteristics. These characteristics and
their meanings are as follows:
1. Excitability. A muscle cell can be stimulated by a nerve to contract.
2. Conductivity. The stimulation from the nerve moves quickly along the length of the
muscle cell.
3. Contractility. A muscle cell can shorten with force. Muscles can only pull; they
cannot push.
4. Extensibility. A muscle cell can be stretched. If the biceps brachii contracts to flex
the arm, the triceps brachii needs to stretch to accommodate the motion. Muscles
are stretched by the contraction of other muscles.
5. Elasticity. If a muscle cell is stretched, it will return to its original shape.
Look for excitability, conductivity, contractility, and elasticity as you study how a
muscle contracts. Extensibility is not included in a description of a muscle contraction

5.4 Physiology of the Muscular System 199

 because it is not a characteristic shown by the contracting muscle. The ability to stretch
would be characteristic of the muscle opposing the contraction.

Neuromuscular Junction

Learning Outcome
8. Explain how a nerve stimulates a muscle cell at a neuromuscular junction.

To see how a muscle cell shows excitability, you begin by studying a neuromuscu-
lar junction. See Figure 5.25. There is an indentation in the muscle cell that forms
a gap (synapse, also called a synaptic cleft) where the nerve ending meets the
muscle cell. The nerve ending and muscle cell do not actually touch. Instead, recep-
tors with a very specific shape are located on the muscle cell in the space formed
by the neuromuscular junction. These receptors work to communicate information
between the nerve ending and the muscle cell.
Stimulating the muscle cell begins with an electrical signal traveling down the
nerve cell (neuron). This signal triggers the release of a chemical (neurotransmitter)
from the synaptic knob at the nerve end. The neurotransmitter is designed to fit into
the receptors on the muscle cell on the basis of its unique shape, like a key fitting into
a lock. Acetylcholine (ACh) (AS-eh-til-KOH-leen), a protein, is the neurotransmitter
released for skeletal muscle tissue. The presence of acetylcholine in the receptors is
the signal for the muscle cell to contract.
There is a minimum amount, called the threshold, of acetylcholine that is neces-
sary in receptors for the muscle to react. The muscle cell will not respond if there is
less acetylcholine fitting into receptors than the threshold amount. A muscle’s response
to nerve stimulation is all or nothing, based on a threshold amount of acetylcholine
fitting into receptors. Adding more acetylcholine than the threshold will not give a
bigger response. Once the threshold is reached, the stimulation is conducted down the
length of the entire muscle cell (conductivity).

Secretory
vesicles

Neuron Mitochondria

Acetylcholine Synaptic
cleft

Muscle fiber Nerve ending Myofibril of

nucleus (synaptic knob) muscle fiber
Muscle
fiber

Neuromuscular
junction

(a) (b)

FIGURE 5.25 A neuromuscular junction: (a) anatomy of a neuromuscular junction, (b) micrograph of a neuromuscular junction.
(b) ©Dr. Thomas Caceci, Virginia-Maryland Regional College of Veterinary Medicine

200 CHAPTER 5 The Muscular System

Muscle Contraction at the Molecular Level

Learning Outcome
9. Describe a muscle contraction at the molecular level.

A skeletal muscle cell also shows contractility. The sliding filament theory of muscle
contraction involves thick myofilaments grabbing thin myofilaments and pulling them
toward the center of the sarcomere. The thin myofilaments are attached to the Z lines,
which are then drawn closer together as the thick myofilaments pull on the thin. As all
of the sarcomeres are shortened, so too is the muscle cell.
To see how the proteins in the muscle cell work together to shorten the sarcomere,
look at the steps of a contraction at the molecular level. Follow along with the diagram
in Figure 5.26 as you read through the following steps, which describe this process. Pay
close attention to where energy is required. Remember, the usable form of energy for
the cell is contained in an ATP molecule.
1. An electrical impulse travels down the neuron. Acetylcholine is released from the
synaptic knob of the neuron and fits into the receptors on the relaxed muscle cell
(the neuromuscular junction is not shown in the figure).
2. This triggers the sarcoplasmic reticulum (specialized smooth ER) to release cal-
cium ions. The released calcium ions bind to troponin automatically. This causes
tropomyosin to be pulled aside, uncovering active sites on actin. The active sites are
like handles for myosin to grab hold.
3. The myosin cross-bridges have already been energized (“cocked”) with ATP in
a previous contraction. This allows the myosin cross-bridges to grab hold of the
active sites on actin as soon as they are exposed. At this point, the thick myofila-
ment has grabbed the thin myofilament.
4. Myosin pulls on actin. This is called a power stroke, which draws the Z lines toward
the center, shortening the sarcomere. An ADP and a P are released from myosin.
5. A new ATP molecule binds to myosin, causing it to let go of the active site on actin.
6. The ATP molecule bound to myosin splits. This provides the energy to “cock” the
myosin cross-bridge for the next power stroke. (See steps 3 and 4.)
7. Several things must happen for the contraction to be over and the muscle to relax.
The calcium must be put back in the sarcoplasmic reticulum so that tropomyosin
can again cover the active sites on actin. If this does not occur, myosin will again
grab the exposed active sites. It requires ATP to return the calcium ions back to the
sarcoplasmic reticulum by active transport.
8. The acetylcholine must also be removed from the receptors at the neuromuscular junc-
tion to keep the calcium in the sarcoplasmic reticulum. As long as acetylcholine is in
the receptors, the sarcoplasmic reticulum will allow calcium ions to diffuse out and
myosin will grab hold of the active sites on actin. The muscle cell removes the acetyl-
choline by producing an enzyme called acetylcholinesterase. This enzyme removes the
acetylcholine from the receptors. (This step is not shown in Figure 5.26.)

Spot Check How much acetylcholine was necessary for the contraction to happen?

Types of Muscle Contractions

Learning Outcome
10. C
 ompare and contrast a muscle twitch and tetany with regard to the steps of a muscle
contraction at the molecular level.

5.4 Physiology of the Muscular System 201

 Nerve impulse
1
Nerve impulse Tropomyosin
arrives at muscle. Troponin Actin
filament
Actin molecules (thin)
ADP + P ADP + P
Myosin filament (thick)
2
Calcium is released
Ca+2
from the sarcoplasmic Ca+2
reticulum, binds to 7
troponin exposing ATP is required
active sites on actin. to put calcium
back in the
ATP sarcoplasmic
Ca+2 binds Tropomyosin reticulum.
to troponin pulled aside Binding sites on
actin filament
exposed

Ca+2 Ca+2 Ca+2

ADP + P ADP + P ADP + P ADP + P

6
ATP on myosin
splits to prepare
3 myosin for next
Myosin grabs power stroke.
hold of the
active sites.

ADP + P ADP + P
ATP ATP ATP

5
ATP binds to
ATP myosin, which
Direction of pull
4 ADP + P causes it to let
Myosin pulls (power go of the active
stroke) and sarcomere site on actin.
shortens, ADP + P
released. ADP ADP
P P

FIGURE 5.26 Sliding filament theory of muscle contraction. (1) A nerve impulse arrives at a muscle; (2) calcium is released
from the sarcoplasmic reticulum, binds to troponin exposing active sites on actin; (3) myosin grabs hold of active sites; (4) myosin
pulls (power stroke) and sarcomere shortens, ADP + P released; (5) ATP binds to myosin, which causes it to let go of the active
site on actin; (6) ATP on myosin splits, preparing it for the next power stroke; and (7) ATP is required to put calcium back in the
sarcoplasmic reticulum.

What has just been described is a muscle twitch—the contraction of one muscle cell
due to one nerve impulse. A graph of the contraction broken down into phases is shown
in Figure 5.27. These phases are explained in detail in the following list:
• During the latent phase, the nerve impulse comes down the neuron; acetylcholine
is released and fits into the receptors on the muscle cell; the sarcoplasmic reticu-
lum releases calcium; the calcium binds to troponin; tropomyosin shifts position
to expose the active sites; and myosin grabs hold of actin. The muscle cell has not
shortened during this phase.

202 CHAPTER 5 The Muscular System

 • During the contraction phase, myosin pulls (power stroke). The muscle cell shortens.
• During the relaxation phase, myosin lets go. The muscle goes back to shape
because it is elastic (elasticity).
• During the refractory phase, the calcium is actively transported back to the sar-
coplasmic reticulum and the muscle produces acetylcholinesterase to remove the
acetylcholine from the receptors. The muscle still appears to be relaxed.
Each muscle twitch has the four phases shown in the graph. However, your hand
is likely not going through a series of twitches (contractions and relaxations) as you
hold a pencil to take notes. Your flexor digitorum muscles are in a sustained contrac-
tion to flex your fingers to hold your pencil. So how is this done? It is controlled by the
frequency of the nerve impulses. If more and more nerve impulses come and complete
their latent phases before the muscle cell can even begin to enter the relaxation phase
from the first nerve impulse, the effect is a sustained contraction called tetany. It is the
frequency of the nerve impulses that determines the occurrence either of a series of
twitches with relaxation between nerve impulses or of sustained contractions with no
relaxation between nerve impulses. See Figure 5.28.

Spot Check What happens to the calcium released from the sarcoplasmic
reticulum if there is tetany?

Disease P int
When muscle contractions are not carried out normally, the body may be dealing with
an autoimmune disorder, such as myasthenia gravis. Myasthenia gravis usually affects
women between the ages of 20 and 40. The immune system produces antibodies that
normally fight foreign pathogens, but in people with myasthenia gravis the antibodies
attack the acetylcholine receptors in the neuromuscular junctions. This leaves the
muscle with fewer receptors, so it is less sensitive to acetylcholine. Muscle weakness
results because the muscle cannot fully respond to the nerve impulses.

Muscle Twitch Tetany

Latent Contraction Relaxation Refractory

phase phase phase phase
Amount of Contraction

Amount of Contraction

Time Time
FIGURE 5.27 Graph of a muscle twitch: muscle contraction FIGURE 5.28 Graph of a muscle contraction over time
over time divided into latent, contraction, relaxation, and showing tetany.
refractory phases.

5.4 Physiology of the Muscular System 203

 Clinical P int
Electromyography (EMG) is a diagnostic test that can be used to determine the
health of a muscle and its nerve supply. The test involves inserting a needle, which
contains an electrode, into the muscle. The electrode is able to measure the activity
of the nerve supplying the muscle. With a disorder like myasthenia gravis, the lack of
nerve transmission to the muscle caused by this disease could be determined using
electromyography.

Common Misconception
Be careful not to confuse tetany with the disorder tetanus (sometimes commonly
referred to as lockjaw). Tetany is a purposeful, sustained contraction caused by nerve
impulses coming in rapid succession. Tetanus is a disorder caused by a powerful
neurotoxin produced by the bacterium Clostridium tetani. Tetanus produces painful,
unwanted, sustained muscle contractions that often begin in the masseter muscle.

You now have a good idea of the difference (and its cause) between a single muscle
twitch and tetany (a sustained contraction for a muscle cell). But what determines how
much a muscle as a whole moves? Imagine a boxer’s punch. His fist is clenched, involv-
ing flexion of the fingers in a sustained contraction (tetany). But his arm is first pulled
back and then rapidly pushed forward to deliver the punch. There must be a difference
in the use of his muscles, whether he is stopping halfway or going the full extent. To
understand just how much an entire muscle actually moves, you need to look at motor
units and recruitment.

Motor Units and Recruitment

Learning Outcome
11. Define motor unit and explain the effect of recruitment.

A motor unit is defined as a single nerve cell and all the muscle cells it stimulates.
A nerve cell can have more than one nerve ending. For example, it may have just a
few nerve endings stimulating a few muscle cells, or it may have hundreds of nerve
endings stimulating hundreds of muscle cells. A single nerve cell stimulates all of
the muscle cells in its motor unit at the same time. If the size of the motor unit is
small (a few muscle cells per nerve cell), there is a small motion. If the motor unit is
large (a hundred muscle cells per nerve cell), there is a large motion. You need to be
able to do fine, precise motions with your hands. Therefore, you need small motor
units in the flexors and extensors of the fingers and wrist. However, you do not need
to do fine, precise motions using your hamstrings and quadriceps muscles to flex and
extend your knee, so the motor units are large in these muscles.
Consider again the boxer’s punch, which involves getting more and more motor
units involved during the punch. This is called recruitment. Even though motor units
are small—for muscles moving the arm, wrist, and fingers—the boxer can get a big-
ger motion by stimulating more and more motor units. So there is rapid recruitment in
muscles of the shoulder and arm during his punch.

Spot Check What causes the difference between gently holding an egg in your
fist and crushing an egg in your fist?

204 CHAPTER 5 The Muscular System

Isotonic and Isometric Contractions

Learning Outcome
12. Compare and contrast isotonic and isometric contractions.

Another way of looking at muscle contractions is based on whether the muscle caused
movement or just increased the tension within the muscle. The boxer displayed an
isotonic contraction when moving his arm during the punch. In this type of contrac-
tion, the tension in his muscles remained constant, and motion was the result. He may
have displayed an isometric contraction if he increased the tension of his muscles
without moving his arm. In this type of contraction, his muscles would have bulged
with the increased tension, but movement would not have resulted. Bodybuilders often
demonstrate isometric contractions when posing to show off their musculature.

Spot Check Put the palms of your hands together at your chest. Now push
your palms together equally as hard as you can. Was pushing your palms together
an isotonic or isometric contraction?

Levers

Learning Outcome
13. D
 escribe an example of a lever system in the human body, giving the resistance,
effort, and fulcrum.

Most isotonic contractions result in the movement of a bone by a muscle using a lever
system. You may have studied lever systems in a physics course. A lever is a rigid
object that can be used to lift something. For example, you open a can of soup with a
can opener. You then use the tip of a knife to pry under the sharp edge of the lid to lift
it so that it can be removed from the can without your cutting your finger. In this case,
the knife was used as a lever. In the human body, bones act as levers. A basic lever
system has three parts:
1. Resistance is a weight to be lifted.
2. Effort is the force applied to lift the weight. In a muscle system, the effort is the
insertion of the muscle.
3. Fulcrum is a pivot point on the lever that does not move. In muscle lever systems,
the fulcrum is a joint.
The order of the resistance (R), effort (E), and fulcrum (F) determines the class of
lever used. Figure 5.29 shows examples of the three classes of levers. Look closely
at Figure 5.29c, the third-class lever, which is the most common lever system used
in the body. The diagram shows the biceps brachii muscle flexing the elbow. Try this
motion yourself. In this lever system, the radius is the lever. The weight being lifted is
the hand (R). The effort is the insertion of the muscle on the radius (E). Notice that it
is very close to the fulcrum, the elbow joint (F). The elbow is the pivot point for the
radius. The radius does not move at the elbow; it pivots there. All third-class lever
systems have the effort between the resistance and the fulcrum.
Having the effort so close to the fulcrum is a disadvantage mechanically because
it limits how much you can lift. For example, try holding down one end (F) of a meter
stick (the lever) and placing a book (R) on the opposite end. Now try lifting the book
by pulling on the lever close to the end you are holding down (F), and then try again
close to the book (R). It is much easier to lift the weight if the effort (E) is closer to
the resistance than to the fulcrum. Why then is the insertion for the biceps brachii so

5.4 Physiology of the Muscular System 205

 Fulcrum Resistance Effort

E
R
R
E
F F
F E
E
R R R

F E R

E F

(a) F
(b)

F
E

R FIGURE 5.29 Lever systems

showing the resistance (R), the
F
effort (E), and the fulcrum (F):
E (a) first-class lever—the trapezius
muscle extends the head to lift the
R chin, (b) second-class lever—the
E gastrocnemius muscle does plantar
flexion to lift the body (centered over
F
the base of the tibia), (c) third-class
lever—the biceps brachii muscle
(c) flexes the elbow to lift the hand.

close to the elbow and not closer to the hand? Imagine what the arm would look like if
the biceps brachii’s insertion were closer to the hand. Would you be able to straighten
your arm? If so, imagine how the triceps brachii, the antagonist, would look and work.
Although having the insertion of a muscle so close to the fulcrum is a disadvantage
mechanically, it does allow for a greater range of motion.
You have now covered how a muscle cell is stimulated and how it contracts at a
molecular level. You have looked at different types of contractions and how they work.
Energy was used during all of the contractions to move the thin myofilaments and to
actively transport calcium ions back to the sarcoplasmic reticulum. Next, you will see
how the muscle cell processes energy.

Muscle Metabolism

Learning Outcome
14. C
 ompare aerobic and anaerobic respiration in terms of amount of ATP produced,
speed, and duration.

Muscle metabolism can be defined as the chemical reactions a muscle cell uses to pro-
cess energy. To better comprehend this process, let’s first review what you studied in
“Chapter 2, Levels of Organization of the Human Body.” Mitochondria produce energy
for a cell through cellular respiration: C6H12O6 + 6O2 → 6CO2 + 6H2O + Energy.

206 CHAPTER 5 The Muscular System

The energy produced in this reaction is used to form an ATP molecule: Energy +
ADP + P → ATP. The third phosphate bond of the ATP molecule holds the usable
energy for the cell.
The mitochondria of muscle cells can use two different forms of cellular respiration—
aerobic respiration or anaerobic respiration—to obtain the energy needed to form
ATP. The difference between the two is in the use of oxygen, the products produced, and
the amount of energy made available to generate ATP. Figure 5.30 and Table 5.8 com-
pare the two methods of respiration, and a discussion of each method follows.

Aerobic Respiration Aerobic respiration begins with a glucose molecule. The first
step is to produce pyruvic acid from the glucose. This step, called glycolysis, produces
enough energy to form two ATP molecules. The dashed line in Figure 5.30a indicates
several further steps in aerobic respiration, beyond glycolysis, that release additional

Aerobic Respiration Anaerobic Respiration

Glucose Glucose

Glycolysis Glycolysis

2 ATPs 2 ATPs
Pyruvic acid Pyruvic acid

Oxygen 0 ATPs
34 ATPs

Carbon dioxide Lactic acid

and water
Total of 36 ATPs Total of 2 ATPs
per glucose per glucose
molecule molecule

(a) (b)

FIGURE 5.30 Muscle metabolism: (a) aerobic respiration requiring oxygen, with the dashed
black line representing many steps; (b) anaerobic respiration, which does not require oxygen.

TABLE 5.8 Comparison of Aerobic and Anaerobic Respiration

Aerobic Respiration Anaerobic Respiration
Number of ATPs produced per glucose molecule 36 2

Oxygen required Yes No

Speed of the process Slower (more steps) Faster (fewer steps)

Products other than energy Carbon dioxide and water Lactic acid

Duration Long duration (hours) Few minutes

5.4 Physiology of the Muscular System 207

 energy. As you can see in the figure, aerobic respiration is a multistep process that
requires the addition of oxygen, results in carbon dioxide and water, and produces
enough energy to form 36 ATP molecules. As long as sufficient oxygen is available,
aerobic respiration can continue for long periods of time. For example, you may be
able to go on a leisurely walk for hours.
Mitochondria perform aerobic respiration whether or not there is an immedi-
ate need for energy. As you already know, ATP is the usable form of energy for
a cell, but you also need to know that ATP is an unstable molecule. ATP can
waste the energy it contains by releasing the energy when the energy is not needed.
Therefore, mitochondria convert ATP to a more stable molecule called creatine
phosphate (CP) when energy is not immediately needed. Mitochondria do this by
adding creatine to ATP. Creatine phosphate is a storage molecule only. It must be
converted back to ATP for the energy to be used.

Anaerobic Respiration As Figure 5.30b shows, anaerobic respiration also begins

with a glucose molecule. The first step is glycolysis, which produces enough energy to
form two ATPs. Notice that this step is the same in both aerobic and anaerobic respira-
tion. In anaerobic respiration, however, there is insufficient oxygen to add to the process
after glycolysis is completed. Pyruvic acid is then changed to lactic acid, a waste product
that must be removed. Anaerobic respiration involves fewer steps than aerobic respira-
tion, does not require oxygen, and produces enough energy to form just two ATP mol-
ecules. Why does the body go through the process of anaerobic respiration if it produces
less energy and a waste product that must be removed? It does so because this process
is faster (has fewer steps) and still provides energy to form ATP molecules when the
supply of oxygen is insufficient to perform aerobic respiration. If sufficient oxygen is
available, the body will perform aerobic respiration because it is more efficient. The
buildup of lactic acid limits the length of time anaerobic respiration can be done. For
example, a long-distance runner may run aerobically for a long time. But if insufficient
oxygen is supplied during a sprint at the end of her run, during which she runs as fast as
she can, her muscles will have to use anaerobic respiration, and this can last only for a
few minutes.

Fatigue

Learning Outcome
15. Explain the basis of muscle fatigue and soreness.

The runner in the previous example needs to time her sprint at the end of her run care-
fully to avoid fatigue. The anaerobic sprint lasts only a few minutes due to the buildup
of lactic acid. As the levels of lactic acid in the muscle build, the muscle cells become
less and less able to respond to nerve stimuli. Muscle fatigue is the inability to fully
respond to a nerve impulse; eventually, the muscle may weaken to the point of not
being able to respond at all. Physiological contracture is complete fatigue in which
the muscle appears to be stuck. It can no longer contract or relax.
Lactic acid must be removed from the muscles because it is a waste product
bathing the muscle in acid. It is responsible for the muscle soreness felt during
the sprint. Oxygen must be added to the lactic acid to remove it. This is partly
the reason you breathe harder during and after exercise. The amount of oxygen
needed to remove the lactic acid is called the oxygen debt. When the debt has
been paid and sufficient oxygen is present to do aerobic respiration again, the
fatigue is over. Other causes of fatigue include insufficient acetylcholine from
the nerve cell or insufficient glucose supplied to the muscle. In either case, the
muscle cannot fully respond.
On the other hand, some skeletal muscle fibers are specially adapted to stay aero-
bic, so they are less likely to fatigue. These muscle fibers are called slow-twitch fibers

208 CHAPTER 5 The Muscular System

(aerobic respiration is a slower process). They have extra mitochondria, a better blood
supply to deliver oxygen and glucose, glycogen stores within the muscle cell that can
be converted to glucose, and a protein called myoglobin to store oxygen until it is
needed. Other skeletal muscle fibers called fast-twitch fibers excel at anaerobic respi-
ration. Each skeletal muscle in your body has cells of each type. The ratio of slow- to
fast-twitch fibers is genetically determined. You can train to increase the efficiency of
the fibers you have, but you cannot train to change their type.

Spot Check Jessica and Jennifer are twins but not identical. They are both
going out for track at their high school. They live together, have similar diets, and train
together. Explain why Jessica is better than Jennifer at running the 100-meter dash and
why Jennifer is better than Jessica at the 1,600-meter run. What other events or activities
may show similar results?

Comparison of Muscle Tissues

Learning Outcome
16. C
 ompare and contrast skeletal, cardiac, and smooth muscle tissue in terms of
appearance, structure, type of nerve stimulation, type of respiration, and ___location.

You have looked at the anatomy and physiology of skeletal muscle tissue. Now you
will see how skeletal muscle tissue compares to the two other types of muscle tissue
in this system. See Table 5.9.

TABLE 5.9 Comparison of Skeletal, Cardiac, and Smooth Muscle Tissues

Skeletal Muscle Tissue Cardiac Muscle Tissue Smooth Muscle Tissue
Appearance

Long, striated cells with Branched, striated cells with a Spindle-shaped cells with no
many nuclei per cell single nucleus and junctions striations and a single nucleus
pushed off to the side between cells called
intercalated disks (covered
in the cardiovascular system
chapter on heart and vessels)

Type of nerve Voluntary, under Autorhythmic, i.e., self- Involuntary, not under
stimulus conscious control stimulating (No nerve conscious control
stimulus is needed for cardiac
muscle cells to contract.
Nerve stimuli may modify the
frequency of contractions.)

Type of Aerobic and anaerobic Aerobic Aerobic

respiration

Location Associated with the bones Heart Hollow organs and blood
and skin and with circular vessel walls
muscles called sphincters
that control body openings

5.4 Physiology of the Muscular System 209

 All three types of muscle tissue—skeletal, cardiac, and smooth—are primarily
composed of protein molecules. As you saw with skeletal muscle, muscle cells use
these proteins to contract. To maintain the proteins necessary for contractions, these
muscle tissues must carry out protein synthesis. The next section, therefore, focuses on
the nutritional requirements of muscle tissue.

Nutritional Requirements of Muscle Tissue

Learning Outcome
17. Explain the nutritional requirements of the muscular system.

As you read in Chapter 2, the building blocks of proteins are the 20 amino acids. All
20 amino acids must be present in the cell during protein synthesis to ensure the pro-
duction of a functioning protein with exactly the right shape. A nonfunctional protein
may be produced if just one amino acid is missing. The body can make 11 amino
acids, which are called nonessential amino acids. See Table 5.10. The nine other
amino acids—essential amino acids—must come from the diet.
The dietary recommended daily allowance (RDA) of protein for an adult of
average weight is 46 to 56 grams (g). This protein may come from a variety of
sources. Given that the nine essential amino acids must come directly from your
diet, it is important to note that complete proteins have all the amino acids neces-
sary for the human body. Meat, eggs, and dairy products are good sources of com-
plete proteins. Incomplete proteins are those that are missing one or more of the
needed amino acids. For example, legumes like beans are low in methionine, and
cereals like rice are low in lysine. But having a vegetarian meal of beans and rice
supplies all of the amino acids.
In addition to both nonessential and essential amino acids, the minerals calcium
and potassium are also necessary for muscle cells to function properly. The RDA
for calcium is 1,000 milligrams (mg). Dairy products, fish, shellfish, and green
leafy vegetables are good sources of calcium. As mentioned in the integumentary
system and skeletal system chapters, vitamin D is necessary for calcium absorp-
tion. The RDA for potassium is 4,700 mg. Red meat, poultry, fish, cereals, spinach,
and bananas are good sources of potassium. Good nutrition is essential to main-
tain homeostasis and support muscle development. See Appendix B for dietary
guidelines.

TABLE 5.10 Amino Acids

Nonessential Essential
Alanine Histidine
Arginine Isoleucine
Asparagine Leucine
Aspartic acid Lysine
Cysteine Methionine
Glutamic acid Phenylalanine
Glutamine Threonine
Glycine Tryptophan
Proline Valine
Serine
Tyrosine

210 CHAPTER 5 The Muscular System

 Spot Check Which type of diet, vegetarian or nonvegetarian, requires more
planning to meet the needs of the muscular system? Explain.

Study Hint
In the previous paragraphs, the amounts for the muscu-
lar system’s required nutrients are expressed in grams.
As a health care professional, you will need to effec-
tively use the metric system for measurements of
weight (grams), volume (liters), and length (meters).
It may help you associate known quantities to their
equivalents in the metric system. For example, you
already know that a large bottle of soda contains
2 liters (L) of liquid. The burger of the quarter-pound
burger (4 ounces precooked) you may have had for
lunch weighs approximately 113 grams. You can even
use your body as a measurement tool. In ­Appendix A,
you will find metric conversion tables and a ruler
marked in inches and centimeters. Measure the
length and width of your thumb and the maximum
distance you can spread your thumb and index finger
apart in both inches and centimeters. Knowing these
Soda: ©McGraw-Hill Education
measurements will help you visualize the metric lengths Hamburger: ©Ryan McVay/Getty
used in future chapters. Images

Functions of the Muscular System

Learning Outcome
18. S
 ummarize the five functions of the muscular system and give an example or
explanation of each.

You have now covered all the anatomy, physiology, and requirements of this system.
It is time to put all of that information together to see how the functions of the
muscular system are carried out.
The muscular system carries out five important functions in the human body:
movement, stability, control of body openings and passages, communication, and
heat production. Consider the role of each of these functions in Sam’s body as he is
drinking his tea (see Figure 5.31):
1. Movement. The flexor digitorum muscles of Sam’s right arm are in tetany
to hold his cup while his right biceps brachii, brachioradialis, and brachialis
muscles are working as synergists to flex his elbow in an isotonic contrac-
tion. This allows Sam to bring his cup to his mouth. A gradual recruitment of
additional motor units makes a smooth contraction going the full distance to
his mouth.
FIGURE 5.31 Sam
2. Stability. Sam is sitting upright with his head stable. Some of the motor units in demonstrating the functions of
his trapezius muscle are taking turns in isometric contractions to maintain the the muscular system.
stability of his head. This is called muscle tone. Your posture is the result of ©John Lund/Marc Romanelli/Blend
muscle tone. Images

5.4 Physiology of the Muscular System 211

 3. Control of body openings and passages. As skeletal muscles, Sam’s uri-
nary and anal sphincters are under his voluntary control. He will decide when
he wants them to relax so that he can pass urine and defecate.
4. Communication. It may be the sunny day, the tea, the company, or just a pleas-
ant thought, but something has prompted Sam to use his facial muscles to com-
municate through his smile that he is pleased. Of course, Sam may also use
his muscles in his throat, jaw, tongue, and diaphragm to communicate through
speech.
5. Heat production. Sam is sitting at his computer wearing a lightweight cotton
shirt. He does not need to find an outside heat source to maintain his body tem-
perature, as his muscles provide body heat. Sam’s muscle cells are performing
cellular respiration to supply the energy for his muscular system, but not all of the
energy is used efficiently. Some energy is lost as heat in the process. This is similar
to a car burning gasoline. The energy (in the bonds of the gasoline molecules) is
released in the engine to move the drivetrain of a car, but the engine is not totally
efficient. Some energy is lost as heat during the process. The heat can be felt on
the hot hood of the car.
In the photo, you can see that Sam is no longer a young man. We focus next on
the effects of aging on this system.

5.5 Effects of Aging on the Muscular System

Learning Outcome
19. Summarize the effects of aging on the muscular system.

Lean muscle mass decreases with age due to atrophy. Fat is deposited in muscle, the
muscle fibers shrink, and some of the muscle tissue is replaced by fibrous tissue.
Muscle changes begin in the 20s for men and in the 40s for women. The rate and
extent of muscle loss is genetically determined. The decrease of muscle mass in
weight-bearing muscles is fiber-type specific. Fast-twitch fibers are more affected
than slow-twitch fibers.
Changes in the muscle tissue, along with the effects of aging on the nervous system
(covered in the nervous system chapter), have several effects:
• Strength is decreased.
• Fatigue occurs more quickly.
• Reduced muscle tone limits stability.
• Movement slows and becomes more limited.
• The gait shortens and is slower.
• Muscle tremors become more common.
These effects result in decreased mobility and therefore ultimately a decrease in
independence.
Exercise is one of the best ways to limit the effects of aging on the muscular sys-
tem. Resistance exercises, such as weight lifting, increase strength by increasing muscle
mass through hypertrophy. Exercises that increase cardiovascular function, such as brisk
walking or jogging, increase the supply of oxygen and other nutrients to the muscle tis-
sue, so muscles work more efficiently.

Spot Check What would be the effect of reduced muscle tone on posture?

212 CHAPTER 5 The Muscular System

5.6 Diagnostic Test for Muscular System Disorders

Learning Outcome
20. D
 escribe a common diagnostic test used to diagnose disorders of the muscular
system.

Before you explore the other disorders in this chapter, look at Table 5.11, which
describes a common diagnostic test for disorders in the muscular system. Earlier in the
chapter, you saw how this test is used in the diagnosis of myasthenia gravis. Electromy-
ography can be used in various ways to determine pathological conditions associated
with muscular dysfunction.

TABLE 5.11 Common Diagnostic Test Used for

Muscular System Disorders
Diagnostic Test or Screening Description
Electromyography (EMG) A procedure that assesses the health
of the muscles by testing how a muscle
responds to electric stimuli

Spot Check Explain how electromyography works.

5.7 Muscular System Disorders

Learning Outcome
21. Describe muscle disorders and relate abnormal function to pathology.

You have already read about carpal tunnel syndrome, compartment syndrome, and
myasthenia gravis in Disease Point boxes earlier in this chapter. In this section, you
will learn about other disorders of the muscular system, which include hernias, cramps,
muscular dystrophy, sprains, muscle strain, myalgia, fibromyalgia, tendinitis, atrophy,
and shin splints.

Hernias
A hernia occurs when any part of the viscera protrudes through the muscle of the
abdominal wall. An inguinal hernia involves a loop of the intestine protruding through
the inguinal canal (an opening in the muscle of the abdominal wall for blood ves-
sels to reach the testes), as shown in Figure 5.32. This type of hernia can occur if a
man improperly lifts heavy weights. A hiatal hernia involves the stomach protruding
through the diaphragm. This type of hernia is most common in obese people over the
age of 40.

Cramps
A cramp is a painful muscle spasm. Heavy exercise, dehydration, electrolyte imbal-
ance, extreme cold, low blood glucose levels, or lack of blood flow can cause painful
muscle spasms.

5.7 Muscular System Disorders 213

 Common Misconception
A cramp should not be confused with a charley horse, which is often an athletic injury
involving a painful tear, stiffness, and blood clotting in a muscle.

FIGURE 5.32 Inguinal hernia.

A loop of small intestine has
pushed through the inguinal
canal.
Inguinal
ligament Defective
inguinal
Inguinal canal
canal
Herniated
loop of
intestine

Muscular Dystrophy
The term muscular dystrophy is used for a group of genetic disorders that result in
progressive weakening and degeneration of muscle tissue and its replacement with
fibrous scar tissue. There are different forms of muscular dystrophy that vary in onset
of the disease and the kind of symptoms the patient experiences. Some forms of mus-
cular dystrophy affect infants and children, while other forms do not affect a person
until later in adult life. As muscular dystrophy progresses, patients grow weaker and
sometimes become disabled. Symptoms of muscular dystrophy include muscle weak-
ness that worsens over time. The increase in muscle weakness can eventually lead to
drooling, ptosis (drooping eyelids), increased falls, difficulty walking, and a decrease
in muscle coordination. There is no cure for muscular dystrophy. Current treatments of
the disease are targeted at treating the symptoms. Health care professionals may recom-
mend physical and speech therapy, devices that aid in walking, medications, and, in
some cases, surgery.

Sprains
As you read earlier in this chapter, ligaments are a type of connective tissue responsible
for attaching bone to bone. A sprain is a tear in a ligament, usually caused by trauma.
The treatment for a sprain is based on the severity of the injury. The recommended
treatment for a typical sprain includes rest, ice, compression, and elevation. With severe
sprains, immobilization or surgery may also be necessary to treat and repair the injury.

Applied Genetics
Duchenne muscular dystrophy is a type of muscular dystrophy that has a very rapid
progression. It is caused by a defect in the gene that produces dystrophin, a protein
needed for muscle contractions. Males are more likely to have the disease than females.
Symptoms include muscle weakness and fatigue that progress to severe disability by
age 10 or 12.
©MOLEKUUL/SPL/age fotostock

214 CHAPTER 5 The Muscular System

Muscle Strain
Muscle strain is characterized by a tear in a muscle or a tendon. Be careful not to get
strains confused with sprains. A sprain involves a stretch or tear in a ligament. Strains
can occur from injury or from overuse of a particular group of muscles. The treatment
for a strain is very similar to that for a sprain. If the strain is severe, medications to con-
trol inflammation and physical therapy may also be recommended.

Clinical P int
Health care providers will often use the acronym RICE to describe the treatment recom-
mended for muscle sprains and strain:
R–rest
I–ice
C–compression
E–elevation

Myalgia
Myalgia is the term used for muscle pain. Myalgia can have various causes, such as the
overuse of muscles, injury, tension, or exercise. Some infections or diseases can also
cause myalgia. For example, a person with the flu may experience muscle aches. In
general, rest, gentle exercise, and reduction of stress can help reduce myalgia. Medica-
tions or physical therapy may also be suggested for more severe forms of myalgia. If
myalgia is associated with a particular disease, treatment of that disease should help
relieve the muscle pain.

Fibromyalgia
Fibromyalgia is a disorder characterized by myalgia, fatigue, and pain in soft
tissues, tendons, and ligaments. People with fibromyalgia may also experience
tenderness when certain areas of the body are touched. Figure 5.33 shows the trig-
ger points where people with fibromyalgia commonly experience tenderness and
discomfort. The cause of fibromyalgia is unknown, but health care professionals
have found a link between certain conditions and fibromyalgia. Poor sleeping hab-
its, repeated muscle injuries such as strains and sprains, and a high level of stress
or the inability to deal with stress may all be contributing factors to this disorder.
There is also evidence that certain medical conditions can cause fibromyalgia,
such as lupus or rheumatoid arthritis. Treatment for fibromyalgia includes activi-
ties that counteract the contributing factors. Health care providers may suggest
that patients reduce the stress in their lives, develop better sleeping habits, and
exercise to improve the body’s condition.

Tendinitis
Tendinitis is a condition of the tendon characterized by inflammation. Tendinitis
can result from injury, overuse, or aging. Similar to other disorders discussed in this
chapter and in the skeletal system chapter, tendinitis can be a common occurrence in
athletes, as a lot of their movements are repetitive and can cause wear and tear on the
muscles, joints, ligaments, and tendons. Tennis players and golfers suffer from tendini-
tis of the elbow, or “tennis elbow.” Symptoms of tendinitis include pain and tenderness
in the affected tendon. This pain usually worsens with movement of the affected area.
Treatment for tendinitis includes rest, immobilization, nonsteroidal anti-inflammatory
drugs, and physical therapy. There are instances when prolonged tendinitis can result
in the rupture or tear of the tendon. In this case, surgery may be recommended to
repair the damage.

5.7 Muscular System Disorders 215

FIGURE 5.33 Trigger points
for fibromyalgia sufferers. Anterior Posterior

Atrophy
Atrophy is defined as a decrease in muscle size due to a decrease in muscle tissue. If a per-
son wore a cast on a broken limb for an extended period of time, the muscle could atrophy
due to the decrease in use of the injured limb. Once the cast is removed, you may notice the
injured limb is smaller than it was before the injury. Figure 5.34 shows another cause for
muscle atrophy—loss of nerve stimulation to the leg muscles of a man with a neural disease.
Atrophy can occur from decreased muscle use or a loss in the muscle’s nerve stimulation.

Shin Splints
Shin splints are characterized by pain in the front of the lower leg. The pain usually
runs along the tibia toward the inside of the lower leg. Shin splints commonly occur
during physical activity. As the level of physical activity increases or changes, such as
increasing the mileage of a run or running up a hill instead of on a flat surface, shin
splints can result. Shin splints are caused by inflammation of the posterior and ante-
rior tibialis muscles, tendons, and the periosteum covering the tibia. Treatment involves
resting and possibly changing the activity to avoid recurrence.

Spot Check What is the difference between a sprain and a strain?

216 CHAPTER 5 The Muscular System

 (a)

Decrease in
gastrocnemius
muscle due to
muscle atrophy

Normal
gastrocnemius
muscle

(a) (b)

FIGURE 5.34 Muscle atrophy: (a) atrophy of the gastrocnemius muscle, (b) atrophy of a male patient’s leg muscles
due to neural disease.
(b) ©DrRave/iStock/Getty Images

Spot Check What disorders of the muscular system are common to athletes?
Why do you think these disorders affect athletes?

Table 5.12 summarizes all of the muscle diseases and disorders described throughout
the chapter.

TABLE 5.12 Summary of Diseases and Disorders of the Muscular System

Disease/Disorder Description
Atrophy A wasting away of muscle tissue
Carpal tunnel syndrome Inflammation of tendons under the carpal ligament, caused by repetitive movement
Compartment syndrome Inflammation of muscles within a compartment due to overactivity or trauma
Cramps A painful muscle spasm
Fibromyalgia A condition characterized by myalgia, fatigue, problems with sleep, and tenderness
Hernias Protrusion of the viscera through the muscular wall
Muscle strain A tear in muscle tissue or tendons
Muscular dystrophy A group of genetic disorders that result in progressive weakening and degeneration of
muscle tissue and its replacement with fibrous scar tissue
(b)
Myalgia Muscle pain
Myasthenia gravis An autoimmune disorder that affects muscle contractions
Shin splints Pain along the tibia of the lower leg due to an increase or sudden change in activity
Sprain A tear in a ligament
Tendinitis Inflammation of a tendon

5.7 Muscular System Disorders 217

Putting the Pieces Together
The Muscular System
Integumentary system Lymphatic system
Radiates excess heat generated by Sends white blood cells to fight
muscles; vitamin D production pathogens.
enables calcium absorption needed
for muscle contractions. Moves lymph through lymph
vessels so it can be returned to
Provides heat to warm skin; the cardiovascular system.
arrector pili muscles move hair.

Respiratory system
Skeletal system
Provides O2 to muscle tissue and
Provides calcium needed for removes CO2 produced through
muscle contractions. aerobic respiration.

Works with bones to move the Skeletal muscle contractions are

body in lever systems; applies responsible for inspiration and
stress to bone for appositional forced expiration.
bone growth.

Digestive system
Nervous system
Provides nutrients for tissues of
Stimulates muscle contractions. the muscular system.

Muscles carry out movements Skeletal muscles are used for

initiated in the central nervous chewing and swallowing; muscles
system. provide protection for some
digestive organs.

Endocrine system
Excretory/urinary system
Hormones regulate blood calcium
Kidneys dispose of wastes and
and glucose levels needed for
maintain electrolyte balance
muscle contractions.
needed by muscles.
Skeletal muscles protect some
endocrine glands, such as the Skeletal muscles control the
adrenal glands. passing of urine.

Cardiovascular system Reproductive system

Reproductive hormones promote
Provides nutrients and removes
muscle growth and development.
wastes.

Moves blood through veins so it Muscle contractions are involved

can return to the heart. in ejaculation and childbirth.

FIGURE 5.35 Putting the Pieces Together—The Muscular System: connections between the muscular system and the body’s
other systems.

218 CHAPTER 5 The Muscular System

Summary
5.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the muscular system.

5.2 Overview
∙∙ Skeletal muscles are primary structures in the muscular system.

5.3 Anatomy of the Muscular System

Anatomical Terms
∙∙ Terms such as origin and insertion are used to indicate muscle attachments.

Muscle Actions
∙∙ Muscle actions are the motions produced by muscles.

Muscles by Region
∙∙ M uscles of the head and neck include orbicularis oris, orbicularis oculi, frontalis, occipitalis, temporalis, buccinator, mas-
seter, platysma, sternocleidomastoid, and zygomaticus major.
∙∙ Muscles of the thorax and abdomen include pectoralis major, pectoralis minor, serratus anterior, diaphragm, external
intercostals, internal intercostals, external abdominal obliques, internal abdominal obliques, rectus abdominis, and trans-
verse abdominal.
∙∙ Muscles of the back and buttocks include trapezius, latissimus dorsi, erector spinae, gluteus maximus, and gluteus medius.
∙∙ Muscles of the arm include deltoid, biceps brachii, triceps brachii, brachialis, brachioradialis.
∙∙ Muscles of the forearm include extensor carpi radialis, extensor carpi ulnaris, palmaris longus, flexor carpi radialis,
flexor carpi ulnaris, extensor digitorum, and flexor digitorum.
∙∙ Muscles of the thigh include tensor fasciae latae, gracilus, adductor longus, pectineus, iliacus, iliopsoas, psoas major,
sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedius, biceps femoris, semitendinosus, and
semimembranosus.
∙∙ Muscles of the leg include gastrocnemius, soleus, peroneus/fibularis, and tibialis anterior.

Anatomy of a Skeletal Muscle

∙∙ A muscle has a fibrous covering called the epimysium.
∙∙ A muscle is composed of a bundle of fascicles.
∙∙ Each fascicle is surrounded by perimysium.
∙∙ A fascicle is composed of muscle cells (muscle fibers) surrounded by endomysium.
∙∙ The connective tissues of the muscle come together at the end of the muscle cell, or fiber, to form a tendon.

Anatomy of a Skeletal Muscle Cell

∙∙ A muscle cell is composed of myofibrils.
∙∙ Each myofibril is composed of thick and thin myofilaments arranged in sarcomeres.
∙∙ Thick and thin myofilaments are composed of protein molecules.

5.4 Physiology of the Muscular System

Physiological Characteristics of Muscle Tissue
∙∙ A
 ll muscle tissues display five physiological characteristics: excitability, conductivity, contractility, extensibility, and
elasticity.

Neuromuscular Junction
∙∙ Stimulation of a muscle cell by a nerve happens at a neuromuscular junction.
∙∙ An electrical stimulation along the nerve cell results in the release of acetylcholine.
∙∙ Acetylcholine fits into receptors on the muscle cell to stimulate it to contract.
∙∙ A minimal amount of stimulus called a threshold is needed for the muscle to respond.
∙∙ As long as the threshold is reached, the muscle cell will contract in an all-or-nothing manner.

219
Muscle Contraction at the Molecular Level
∙∙ T he sliding filament theory of muscle contraction involves thick myofilaments grabbing thin myofilaments and pulling
them toward the center of the sarcomere.
∙∙ As all of the sarcomeres are shortened, so too is the muscle cell.
∙∙ Energy contained in ATP is needed for the contraction to happen and to actively transport calcium ions back to the sarco-
plasmic reticulum so that the muscle can relax.

Types of Muscle Contractions

∙∙ A twitch is a contraction of a muscle cell in response to a single nerve stimulus.
∙∙ A twitch has a latent phase, contraction phase, relaxation phase, and refractory phase.
∙∙ Tetany is a sustained contraction due to repetitive nerve signals.
∙∙ The frequency of the nerve impulses determines whether the contraction will be a twitch or tetany.

Motor Units and Recruitment

∙∙ A motor unit is a single nerve cell and all of the muscle cells it stimulates.
∙∙ Small motor units are needed for fine, precise movements.
∙∙ Getting more motor units involved is recruitment.
∙∙ More and more motor units can be recruited to achieve a larger motion.

Isotonic and Isometric Contractions

∙∙ In an isotonic contraction, tension in the muscle remains constant as the muscle shortens.
∙∙ In an isometric contraction, tension in the muscle increases, but there is no shortening of the muscle.

Levers
∙∙ Muscles move bones in lever systems.
∙∙ There are three parts to a lever system: the resistance (the weight to be moved), the effort (the force applied at the inser-
tion of the muscle), and the fulcrum (the pivot point for the lever, always a joint).
∙∙ Lever systems are classified as first, second, or third class on the basis of the ___location of the fulcrum, effort, and resistance.
∙∙ Most levers in the human body are third-class levers.

Muscle Metabolism
∙∙ Muscle cells can do either aerobic or anaerobic respiration to process energy.
∙∙ Aerobic respiration is a many-step process that produces enough energy to generate 36 ATP molecules for every glucose
molecule but requires the addition of oxygen.
∙∙ Anaerobic respiration is a shorter process that produces enough energy to generate 2 ATP molecules per glucose mol-
ecule and does not require oxygen.
∙∙ Anaerobic respiration results in lactic acid, which must be removed by adding oxygen.
∙∙ Aerobic respiration can be done for long periods of time, while anaerobic respiration can be done only for short periods
of time.

Fatigue
∙∙ Fatigue is the inability of a muscle to fully respond to a nerve stimulus.
∙∙ Fatigue can result from the buildup of lactic acid, the lack of acetylcholine, or the lack of glucose.
∙∙ Fast-twitch fibers are specialized for anaerobic respiration and therefore fatigue quickly.
∙∙ Slow-twitch fibers are specialized for aerobic respiration, so they do not fatigue quickly.

Comparison of Muscle Tissues

∙∙ S keletal muscle tissue is composed of long, striated cells with multiple nuclei pushed off to the side. The cells are under
voluntary control, rely on aerobic or anaerobic respiration for energy production, and are associated with bones, skin, and
body openings.
∙∙ Cardiac muscle tissue is composed of branched, striated cells with a single nucleus and junctions between cells called
intercalated disks. The cells are autorhythmic, rely on aerobic respiration for energy production, and are located in
the heart.
∙∙ Smooth muscle tissue is composed of spindle-shaped cells with a single nucleus. The cells are not under voluntary con-
trol, rely on aerobic respiration for energy production, and are located in the walls of blood vessels and hollow organs.

220
Nutritional Requirements of Muscle Tissue
∙∙ M
 uscle tissue must maintain the proteins needed for contraction. Therefore, amino acids, the building blocks of proteins,
must be included in the diet.
∙∙ The body can make nonessential amino acids.
∙∙ Essential amino acids must be supplied through the diet.
∙∙ The mineral potassium is also needed for proper muscle function.

Functions of the Muscular System

∙∙ T
 he muscular system carries out five important functions in the human body: movement, stability, control of body open-
ings and passages, communication, and heat production.

5.5 Effects of Aging on the Muscular System

∙∙ Lean muscle mass decreases with age.
∙∙ The amount of loss is genetically determined.
∙∙ Fast-twitch fibers are more affected than slow-twitch fibers.
∙∙ The effects of decreased muscle mass include the following: Strength is decreased, fatigue occurs more quickly, stability
is reduced, movement slows and becomes more limited, and the gait shortens.
∙∙ Exercise is the best way to limit the effects of aging.

5.6 Diagnostic Test for Muscular System Disorders

∙∙ A common diagnostic test for muscular system disorders is electromyography.

5.7 Muscular System Disorders

∙∙ A hernia is the protrusion of viscera through the muscle of the abdominal wall.
∙∙ A cramp is a painful muscle spasm that may have many causes.
∙∙ Muscular dystrophy is a term for a group of hereditary disorders that result in the progressive degeneration of muscle
tissue.
∙∙ A sprain is a tear in a ligament.
∙∙ A muscle strain is a tear in muscle tissue or tendons.
∙∙ Myalgia is muscle pain.
∙∙ Fibromyalgia is a condition characterized by myalgia, fatigue, problems with sleep, and tenderness.
∙∙ Tendinitis is inflammation of a tendon.
∙∙ Atrophy is a wasting away of muscle tissue.
∙∙ Shin splints are pain along the tibia of the lower leg due to an increase or sudden change in activity.

Key Words for Review

The following terms are defined in the glossary.

acetylcholine (ACh) flexion origin

aerobic respiration insertion recruitment
anaerobic respiration isometric sarcomere
antagonist isotonic sliding filament theory
extension lever synergists
fascicle motor unit tetany
fatigue muscle twitch

221
 6 The Nervous
System
Whether it is smiling while day-
dreaming on a sunny day, speeding
up the heart when frightened by a
stranger, or squinting in response
to a bright light, the human body’s
nervous system is all about com-
munication, motor control, and
sensation. See Figure 6.1. It is a
fast, highly efficient way for one
part of the body to communicate
with another.
©Ingram Publishing

Module 7: Nervous System

222
6.1 Word Roots and Combining Forms

Learning Outcome
1. Use medical terminology related to the nervous system.

cephal/o: head encephal/o: brain mening/o: meninges

cerebell/o: cerebellum gangli/o: ganglion myel/o: spinal cord
cerebr/o: cerebrum gli/o: glue neur/o: nerve
dur/o: tough medull/o: medulla poli/o: gray matter

6.2 Overview

Learning Outcome
2. Describe the organization of the nervous system in regard to structure and function.

The nervous system is all about communication. It controls homeostasis by monitor-

ing what is happening in the body and the outside environment, analyzing the informa-
tion, and initiating a response if one is needed. To do that, the nervous system uses
neurons (nervous system cells) and nerves (bundles of neurons) for communication.
The nervous system has two main divisions. One of these divisions is the central
­nervous system (CNS), which is composed of the brain and spinal cord and serves
as the central processing center. The other main division is the peripheral nervous
­system (PNS), a network of all the nerves in the body that
sends messages to and from the central processing center.

Study Hint Nervous System

Major Organs and Structures:
As you read through this chapter, you may find it helpful to brain, spinal cord, nerves
refer to Figure 6.2 to refresh your mind on the organiza- Accessory Structures:
tion of this complex system. meninges, sympathetic chain of ganglia
Functions:
communication, motor control,
sensation
This chapter will follow the organization of the nervous
system that is shown in ­Figure 6.2, starting with the central
nervous system (CNS), shown on the left. You will begin
your study of the CNS with the four subdivisions of the
brain. These four subdivisions are the ­cerebrum and its
lobes; the diencephalon, composed of the hypothalamus
and thalamus; the brainstem, composed of the medulla
oblongata, pons, midbrain, and reticular formation; and
the cerebellum. You will also learn about the anatomy of
the spinal cord and its functions. After you become famil-
iar with the brain and the spinal cord, you will then move
on to study the divisions within the peripheral nervous sys-
tem (PNS), shown on the right in Figure 6.2.
As you can see in Figure 6.2, the PNS is composed
of nerves carrying messages in two directions. Sensory
neurons carry afferent (incoming) messages to the brain
or spinal cord. Motor neurons carry efferent (outgoing)
messages away from the brain and spinal cord.
Some of the efferent messages travel on motor neu-
rons to stimulate skeletal muscles to move the body, so
they belong to the somatomotor (soma means “body,” FIGURE 6.1 The nervous system.

6.2 Overview 223

 NERVOUS SYSTEM

Central Nervous Peripheral Nervous

System (CNS) System (PNS)

Brain Spinal cord Afferent Efferent

(incoming) (outgoing)

Cerebrum Diencephalon Brainstem Cerebellum Somatomotor Autonomic

Frontal lobe Hypothalamus Medulla

oblongata
Parasympathetic
Temporal Thalamus
lobe Pons
Sympathetic

Parietal Midbrain
lobe

Reticular
Occipital formation
lobe

Insula

FIGURE 6.2 Organization of the nervous system into two divisions: the central nervous system (CNS) and the peripheral
nervous system (PNS).

motor means “movement”) division. Other efferent messages go to glands, the car-
diac muscle of the heart, or the smooth muscle of hollow organs and blood vessels.
These messages make up the autonomic division. (Again, see Figure 6.2.)
The autonomic division has two subdivisions: ­parasympathetic and sympathetic.
The parasympathetic division sends electrical messages to carry out functions for veg-
etative activities such as digestion, defecation, and urination. The sympathetic division
sends electrical messages to prepare the body for physical activity, often referred to as
fight or flight. You will become familiar with the differences in anatomy of these two
subdivisions and learn more about their functions later in the chapter.

6.3 Anatomy of the Nervous System Cells

To understand the divisions of this system, you must first take a look at the
anatomy of a neuron (nerve cell) and the neuroglia (nyu-roh-GLEE-ah) that aid
neurons in their function.

Anatomy of a Neuron

Learning Outcomes
3. Describe the anatomy of a neuron.
4. Differentiate multipolar, bipolar, and unipolar neurons in terms of anatomy, ___location, and
direction of nerve impulses.

A single neuron can be very long (measuring a meter or more), as it may start at the tip
of your finger and end at your spinal cord. A neuron has three basic parts: one or more

224 CHAPTER 6 The Nervous System

dendrites that receive information; a body containing the nucleus and organelles for
protein synthesis; and an axon that carries the nerve impulse along its length to the
synaptic knobs at the end of the neuron. The basic parts of a neuron are shown in
Figure 6.3 and discussed here:
• Dendrites. A neuron may have anywhere from 1 to 1,000 dendrites. The more den-
drites the neuron has, the more information it can process. The dendrites branch to
make multiple connections and form precise pathways. Incoming messages travel
from the dendrites toward the body of the neuron.

FIGURE 6.3 Anatomy of

a generic neuron, showing
dendrites, a neuron cell body,
Dendrites myelinated axons, and terminal
arborization.

Neuron
Mitochondrion cell
body
Nucleus
Golgi
complex

Trigger zone:
axon hillock Axon

Schwann cell
Myelin sheath

Nucleus
Direction of
signal transmission

Collateral axon

Node of Ranvier

Terminal
arborization

Synaptic knobs

6.3 Anatomy of the Nervous System Cells 225

 • Body. The body contains the nucleus and organelles for protein synthesis. In the
previous chapter, you learned that protein neurotransmitters were released from
the knobs at the end of a nerve cell to stimulate a muscle cell to contract. In the
case of skeletal muscle, the neurotransmitter is acetylcholine, but there are other
neurotransmitters. The nervous system uses about 50 neurotransmitters for com-
munication and proper brain function. Neurotransmitters are made in the body of
the neuron through protein synthesis. The Golgi complex then packages the neu-
rotransmitter in secretory vesicles called synaptic vesicles. These vesicles carry
the neurotransmitter down the next part of the neuron (the axon) to the synaptic
knob at the end. This is called axonal transport.

Clinical P int
An imbalance in specific neurotransmitters can result in mental disorders. For exam-
ple, depression is a mental disorder that affects a person’s mood by altering the way
someone feels, thinks, sleeps, eats, and works. Research has shown a relationship
between depression and the increase or decrease of certain neurotransmitters. Treat-
ment of depression often involves a combination of psychotherapy and medication.
Antidepressant medications are prescribed to help balance the abnormal levels of neu-
rotransmitters in these patients.

Disease P int
Axonal transport, in the direction from the body to the synaptic knob, is relatively fast.
The empty synaptic vesicles are carried in the opposite direction (back to the body) for
reuse in what is called retrograde axonal transport. Viruses, such as the rabies virus,
can hitch a ride with either type of transport. A bite on the hand or arm from a rabies-
infected animal may damage a neuron. When the neuron is damaged, the virus gains
entry into the neuron and travels by axonal and/or retrograde axonal transport to move
from one neuron to another and finally reach the brain. Once the virus has reached the
brain, it causes rapid inflammation.

• Axon. The axon leaves the neuron body at the axon hillock, also called the trigger
zone. Electrical messages travel away from the body down to the axon’s end, which
branches in the terminal arborization (arbor means “tree”). A synaptic knob at
the end of each branch forms a synapse (junction) with another cell. This allows
for the neuron to communicate with the other cell. The synapse may be with a
muscle cell, a gland cell, or the dendrite of another nerve cell. As you read in the
muscular system chapter, a motor unit is defined as a single neuron and all of the
muscle fibers it stimulates. By having the terminal arborization and multiple syn-
aptic knobs, one neuron can potentially stimulate hundreds of muscle fibers in a
large motor unit. Each synaptic knob meets a muscle cell at a neuromuscular junc-
tion (a synapse). Here, the synaptic vesicles release acetylcholine by exocytosis to
stimulate the muscle cell.
It is important to note in Figure 6.3 that the axon is only intermittently covered
with a myelin sheath (MY-eh-lin). Myelin does not cover the body or dendrites of
a neuron, just the axons. Very short axons may not need this covering at all. Myelin
is lipid-rich, and it insulates the axons much like the wire coating insulates the
wires of electrical appliances in your home. But unlike the coating on wires, the
myelin on an axon has gaps. These gaps, called nodes of Ranvier (rahn-vee-AY),

226 CHAPTER 6 The Nervous System

are very important in the conduction of nerve impulses. Later in this chapter you
will read more about their role. It is also important to note that myelin is white
in color. So it makes sense that white matter, in the brain and spinal cord, is a
concentration of myelinated axons. Gray matter, in the brain and spinal cord, is a
concentration of dendrites, cell bodies, and unmyelinated axons. Peripheral nerves
have myelinated axons.

Types of Neurons There are three basic types of neurons: multipolar, bipolar, and
unipolar. Table 6.1 compares their anatomy, their ___location, the types of messages they
carry, and the direction these messages are sent. These neuron types and their func-
tions are further described in the following list:
• Multipolar neurons look like the neuron shown in Figure 6.3. They have mul-
tiple dendrites and an axon that may or may not have a collateral branch. This
is the most common type of neuron in the brain and spinal cord. Motor neurons
are multipolar. They carry electrical messages away from (efferent) the brain and
spinal cord.
• Bipolar neurons have one dendrite and one axon. They can be found in the nasal
cavity, the retina of the eye, and the inner ear. They are sensory neurons, so the
electrical messages they carry travel toward (afferent) the brain.
• Unipolar neurons seem to have one process that serves as dendrite and axon with
the cell body pushed off to the side. They are sensory neurons in the body, located
in areas such as the skin, organs, and other areas where bipolar neurons are not
present. Since they are sensory, the electrical messages carried by these neurons

TABLE 6.1 Comparison of Basic Neuron Types

TYPE OF NEURON
Multipolar Bipolar Unipolar
Appearance
Dendrites

Cell body Dendrite Dendrites

Cell body

Cell body

Axon Axon
Axon

Location CNS and PNS Nasal cavity, retina, inner ear Skin, organs, etc.

Type of message Motor (for many multipolar Sensory Sensory

neurons)

Direction of Efferent (if they are motor Afferent Afferent

message neurons)

6.3 Anatomy of the Nervous System Cells 227

 are afferent. The cell bodies of many unipolar neurons are grouped together to
form ganglia. You will learn more about this when you study how nerves connect
to the spinal cord.

Spot Check Which type of neuron would make up the somatomotor division
of the PNS?

In total, the body contains billions of neurons of these three types, but these neu-
rons cannot function alone. There are many times more support cells, which are col-
lectively called neuroglia. The term neuroglia literally means “nerve glue.”

Neuroglia

Learning Outcome
5. Describe neuroglia and state their function.

There are six types of neuroglia in the human body: oligodendrocytes (OL-ih-
goh-DEN-droh-sitz), ependymal cells (ep-EN-dih-mahl), astrocytes, microglia,
Schwann cells (SHWANN), and satellite cells. We discuss the appearance, ___location,
and function of these cells below. See Table 6.2 for a comparison.
As you can see in Figure 6.4, four of the six types of neuroglia are located solely
in the brain and spinal cord:
• Oligodendrocytes resemble octopi that reach out with tentacles to tightly wrap
around the axons of neurons in the CNS. These cells form the myelin in the CNS.
Imagine a piece of tape. It would have a top and a sticky bottom surface. If you
wrapped the tape around your finger several times, you would have several lay-
ers of tape. The part of the oligodendrocyte that wraps around the axon is very
thin (like the tape), but the top and bottom surfaces are cell membranes composed
mostly of phospholipids. The oligodendrocytes wrap around a section of an axon
several times, just as you imagined the tape around your finger. So there are many
layers of phospholipids of the oligodendrocyte cell membrane wrapped around the
axon. This explains why myelin is very lipid-rich. As you can see in Figure 6.4, an
oligodendrocyte can reach out and form myelin on more than one axon at a time.
• Ependymal cells line fluid-filled cavities and spaces in the CNS. They produce
cerebrospinal fluid (CSF). Cilia on the ependymal cells are responsible in part
for the circulation of the fluid. You will learn more about cerebrospinal fluid
shortly.

TABLE 6.2 Comparison of Neuroglia

Type of Neuroglia Location Function
Oligodendrocytes CNS Form myelin in the CNS

Ependymal cells CNS Produce cerebrospinal fluid

Astrocytes CNS Form the blood-brain barrier, regulate composition of CSF, and form scar tissue

Microglia CNS Provide protection by seeking and removing damaged cells, debris, and pathogens

Schwann cells PNS Form myelin in the PNS and help damaged myelinated axons regenerate

Satellite cells PNS Regulate the chemical environment of ganglia in the PNS

228 CHAPTER 6 The Nervous System

 Fluid-filled cavity of FIGURE 6.4 Neuroglia of
Ependymal cell the brain or spinal cord Neuron the CNS: ependymal cells,
microglia, astrocytes, and
oligodendrocytes.

Astrocyte

Node of
Ranvier
Microglial cell

Axon

Myelin
sheath (cut)
Axon

Capillary
Oligodendrocyte

• Astrocytes are the most numerous neuroglia in the CNS. They have a somewhat
star-shaped appearance and have several functions. Astrocytes cover the nonmyelin
portions of neurons and blood vessels in the CNS, forming a blood-brain barrier.
This barrier allows astrocytes to regulate what can leave the bloodstream to enter
the CNS, protecting the CNS from potentially toxic chemicals. Astrocytes also
regulate the contents of the cerebrospinal fluid by absorbing excess neurotransmit-
ters and potassium ions. If a neuron in the CNS becomes damaged, astrocytes fill
the space with scar tissue. This process is called sclerosis.
• Microglia are small macrophages in the CNS that look for cell damage, debris, and
pathogens. If these items are found, it is the microglia’s responsibility to remove
them. They constantly wander through the CNS as an important line of defense.

Disease P int
Even though neurons have little capacity for mitosis past puberty, neoplasms (tumors)
may develop in the CNS. It is often neuroglia that divide out of control to form the
tumor. These tumors (gliomas) tend to be malignant and grow rapidly, competing with
the brain for space in the cranial cavity. Because the blood-brain barrier formed by
the astrocytes prevents many chemotherapies from reaching the tumor cells, these
tumors often need to be treated with radiation and/or surgery.

6.3 Anatomy of the Nervous System Cells 229

 The last two types of neuroglia are found only in the PNS:
• Schwann cells form the myelin in the PNS. Unlike oligodendrocytes of the CNS,
each Schwann cell forms one piece of myelin on one axon of one neuron. See
­Figure 6.5. Like the oligodendrocytes, they wrap their cell membrane around the
axon several times to form the lipid-rich myelin insulation for the axon. The out-
ermost layer of a Schwann cell is called the neurolemma. Along with forming
myelin, Schwann cells are important in the PNS if the axon of a myelinated neuron
becomes severed. If the body of the neuron is damaged, the cell dies. However, if a
myelinated axon of a neuron in the PNS is severed, the Schwann cell past the break
is responsible for helping the axon regenerate by secreting growth factors. The
growth factors stimulate the axon to grow toward the sleeve created by the neuro-
lemma of the Schwann cells. An analogy will help you understand this concept.
You may have seen someone take a cutting from an ivy plant and place it in a jar
of water so that the cutting can develop roots. After a couple of weeks, extensions
can be seen branching in many directions from the cutting’s severed end. Just like
the ivy cutting, a severed axon will develop extensions growing out of the severed
end, but only the growth in the direction of the neurolemma sleeve is stimulated to
continue to grow by growth factors released by the Schwann cell. All of the other
extensions stop growing. In this way, the axon regenerates in the proper ___location.
• Satellite cells surround neuron cell bodies in the ganglia of the PNS. They help
regulate the chemical environment of the neurons.

Spot Check Encephalitis is often caused by an infection in the brain. It is difficult

to treat with medication. Which neuroglia make it difficult to treat encephalitis with
drugs? Which neuroglia will fight the pathogen causing the infection?

Now that you have covered the primary and support cells of this system, you can
focus on the anatomy of the CNS and PNS.

Node of Ranvier
Schwann cell 1 (no myelin
sheath)

Nucleus

Cytoplasm

Axon

Sch Myelin sheath

wan
n ce
ll 2 Neurolemma

FIGURE 6.5 Anatomy of Schwann cells wrapped around the axon of a neuron.

230 CHAPTER 6 The Nervous System

6.4 Anatomy of the Central Nervous System
Meninges

Learning Outcome
6. Describe the meninges covering the brain and spinal cord.

In exploring the anatomy of the CNS, we begin with the role of the ­meninges. The
brain and spinal cord are covered by meninges, which are three membranes that
line the cranial and vertebral cavities. The most superficial layer of the meninges is
the dura mater (DYU-rah MAY-ter) (“tough mother”). Deep to it is a very delicate,
weblike layer called the arachnoid mater (“spider-like mother”). Tight to the brain
and spinal cord is the pia mater (“affectionate mother”). See Figure 6.6. Each of

FIGURE 6.6 The meninges:

(a) meninges covering the brain,
Skull (b) meninges covering the
spinal cord, (c) transverse
Dura mater section of the spinal cord
between vertebrae, showing
the meninges and epidural
Arachnoid mater space.

Vessels in
subarachnoid space
Pia mater
(directly attached to brain
surface and not removable)

Cerebrum

(a)

Spinal cord

Pia mater
Ventral root
Dorsal root
Spinal nerve ganglion

Dorsal root Subarachnoid

space

Arachnoid mater
Epidural
Dura mater space
Spinal
nerve
Epidural
space
Thoracic
vertebra

Body of
vertebra

(b) (c)

6.4 Anatomy of the Central Nervous System 231

 the meninges forms a continuous covering over the brain and spinal cord. Between
the vertebrae and the dura mater surrounding the spinal cord is the epidural space,
which contains blood vessels, adipose tissue, and loose connective tissue. Anesthet-
ics can be administered into this space during surgeries and childbirth. The space
between the arachnoid mater and pia mater is the subarachnoid space. It contains
cerebrospinal fluid.

Cerebrospinal Fluid

Learning Outcome
7. E
 xplain the importance of cerebrospinal fluid, including its production, circulation,
and function.

Cerebrospinal fluid is made by ependymal cells lining cavities in the brain called
ventricles. See Figure 6.7. A bed of capillaries (small blood vessels), called a choroid
plexus, exists in the walls of the ventricles. Ependymal cells cover the capillaries and
take what they need to make CSF from capillary blood. CSF is a clear, colorless fluid
that circulates between the ventricles and the subarachnoid space to bathe the brain
and spinal cord. The cilia of the ependymal cells, gravity, and the pulsation of arter-
ies in the brain are responsible for the CSF’s circulation. See Figure 6.7c. Approxi-
mately 500 milliliters (mL) of CSF are produced daily. The same amount of CSF is
absorbed through arachnoid villi back into the bloodstream every day. So there are
only approximately 100 to 160 mL of CSF present at any one time. The CSF has sev-
eral important functions:
1. Provides buoyancy. The floor of the cranial cavity is bone with various ridges.
The CSF allows the brain to float in the cranial cavity. Without the CSF, nervous
tissue would be damaged by the sheer weight of the brain against the bony floor.
2. Provides protection. The CSF cushions the brain from impact. The following
Clinical Point puts this important job of the CSF into perspective.

Clinical P int
If you are traveling 50 miles per hour (mph) in your car, the car is traveling at 50 mph,
you are traveling at 50 mph, and your brain is traveling at 50 mph. If the car hits a pole,
it is now going 0 mph but you and your brain are still moving at 50 mph. If you are not
wearing a seat belt, the window will slow down your head but the brain is still going
50 mph. The brain is going to slam into the anterior skull before it bounces back to hit
the posterior skull. CSF limits the amount of the impact. The resulting condition due to
the impact is a concussion. Concussions often come in pairs because of the bounce-
back effect.

3. Facilitates chemical stability. The CSF rinses metabolic wastes from the brain
and spinal cord and helps regulate the chemical environment. One way it does
this is by removing excess hydrogen ions, which is an example of maintaining
homeostasis through acid–base balance.
4. Provides nutrients. The CSF provides CNS tissues with some nutrients—like
glucose.

Spot Check What will happen to pH if the CSF removes excess hydrogen ions?

232 CHAPTER 6 The Nervous System

 Lateral
ventricle Lateral
ventricle

Third ventricle

Fourth
ventricle

To central
canal of
spinal cord
(a) (b)

Arachnoid villi

Blood-filled
dural sinus
Choroid plexuses
of third ventricle

Pia mater

Third ventricle
Subarachnoid space
Arachnoid mater
Fourth ventricle
Dura mater

Choroid plexus of
fourth ventricle

Central canal of spinal cord

Pia mater

Subarachnoid space

Arachnoid mater

FIGURE 6.7 Ventricles of

Dura mater the brain: (a) lateral view;
(b) anterior view; (c) circulation
of CSF around the brain and
spinal cord represented by
black arrows, circulation
of blood to the dural sinus
represented by white
(c) arrows.

6.4 Anatomy of the Central Nervous System 233

 You have studied the meninges and the cerebrospinal fluid surrounding the brain.
You are now ready to study the anatomy of the brain itself.

Brain

Learning Outcome
8. Describe the major landmarks and subdivisions of the brain and state their functions.

As mentioned earlier in this chapter, the brain can be divided into four subdivisions:
the cerebrum, the diencephalon, the brainstem, and the cerebellum. See Figure 6.8
and Table 6.3.
Cerebrum The cerebrum is characterized by a series of grooves and folds on its
surface. The grooves are called sulci (SUL-sye) (sulcus, singular). The folds are called

Cerebral hemispheres Central Parietal

sulcus lobe
Gyrus

Sulcus
Frontal lobe

Frontal
Central sulcus lobe Occipital
lobe
Lateral
sulcus Cerebellum
Parietal lobe
Temporal
lobe
Brainstem
Occipital lobe
Spinal
(a) Longitudinal fissure (b) cord

Anterior

Frontal Anterior Posterior

lobes
Frontal lobe
Central
sulcus Parietal lobe
Central
sulcus
Longitudinal Occipital
Lateral
fissure lobe
sulcus
Parietal
lobes Temporal lobe

Pons
Cerebellum
Occipital Medulla
lobes oblongata
Spinal cord
(c) Posterior (d)

FIGURE 6.8 The brain: (a) superior view, (b) lateral view, (c) superior view of a cadaver brain, (d) lateral view
of a cadaver brain, (e) midsagittal view, (f) midsagittal view of a cadaver brain.
(c, d, f ) ©McGraw-Hill Education/Christine Eckel

234 CHAPTER 6 The Nervous System

FIGURE 6.8 The brain (continued).
Skull
Frontal Parietal lobe
lobe

Meninges Central sulcus

Cerebrum
Occipital lobe
Thalamus
Diencephalon
Hypothalamus
Corpus callosum

Pituitary gland
Midbrain

Pons Fourth ventricle

Brainstem
Medulla
oblongata Cerebellum

Spinal cord
(e)

Hypothalamus Central
sulcus

Frontal Parietal
lobe lobe
Corpus
callosum

Occipital
Midbrain lobe

Temporal
lobe
Cerebellum
Pons

Medulla Thalamus
oblongata

(f)

gyri (JI-rye) (gyrus, singular). The purpose of gyri is to give extra surface area. There
is a l­ongitudinal fissure that separates the cerebrum into right and left hemispheres.
A white fibrous band called the corpus callosum is deep to the fissure and keeps the
right and left hemispheres connected. The corpus callosum appears white because it
is composed of myelinated axons carrying messages back and forth between the two
hemispheres, allowing them to communicate with each other. The superficial part of
the cerebrum, the cortex, is composed of gray matter. Most of the brain’s dendrites
and cell bodies are located here. Conscious thought and voluntary actions arise in the
cortex. The rest of the cerebrum is composed of white matter: myelinated axons carry-
ing messages. See Figure 6.8.
The cerebrum can be divided into four major lobes, named for the cranial bone
they lie beneath, and a fifth lobe, called the insula, that lies deep to the lateral sulcus.
Many of the lobes are responsible for analyzing sensory information. In each of these
lobes, there is a general sensory area to identify sensory messages coming in and an

6.4 Anatomy of the Central Nervous System 235

 TABLE 6.3 Subdivisions of the Brain
Cerebrum Largest subdivision, divided into two hemispheres.
Characterized by gyri and sulci.
Divided into lobes.

Frontal lobe Contains premotor and primary motor areas.

Motivation and aggression are located here.
Contains Broca’s area for language.
Parietal lobe Sense of touch is located here.
Higher-level processes for math and problem solving are also located here.
Temporal lobe Sense of hearing is located here.
Contains Wernicke’s area for language.
Occipital lobe Sense of vision is located here.
Insula Not much is known.
Diencephalon Located deep to the cerebrum.

Thalamus Switching station for incoming sensory messages.

Sends message to appropriate lobe of the cerebrum.
Hypothalamus Monitoring station for maintaining homeostasis.
Regulates temperature.
Performs autonomic and endocrine functions.
Brainstem Located in the cranial cavity inferior to the diencephalon and anterior to the cerebellum.
All parts include tracts (bundles of nerve fibers) of neurons traveling to and from the
spinal cord.

Midbrain Appears as a hook.

Has colliculi for vision and hearing.

236 CHAPTER 6 The Nervous System

 TABLE 6.3 Subdivisions of the Brain (continued)
Pons Appears as a bulge between the midbrain and the cerebellum.
Serves as a bridge to the cerebellum for efferent motor messages.

Medulla oblongata Most inferior part of the brainstem.

Motor messages cross sides at the pyramids.
Contains centers to regulate heart rate, blood pressure, respiratory rate, and blood vessel
diameter.

Reticular formation Groups of cell bodies located throughout the brainstem.

Determines if sensory messages will be consciously perceived by the cerebrum.
Responsible for sleep-wake cycle.

Cerebellum Receives input of body-part ___location.

Uses that information in fine-tuning efferent motor messages to maintain coordination,
balance, and smooth motions.

association area to interpret the message by comparing it to what has come before.
For detailed information about each of the lobes, see Figure 6.9 and review the fol-
lowing list:

• Frontal lobe. The frontal lobe has two motor areas: a premotor area that plans
efferent skeletal muscle messages and a primary motor area that then sends out
the planned, voluntary skeletal muscle messages. This lobe is also responsible for
motivation, judgment, and aggression. Broca’s area, an important area concerning
language, is also located in the frontal lobe. It is discussed later in the chapter.

• Parietal lobe. The parietal lobe is responsible for the general senses, like touch.
(The general senses and other senses are discussed in the nervous system chapter
on senses.)

6.4 Anatomy of the Central Nervous System 237

Primary motor General sensory area
area for touch, pain, heat,
cold, pressure, and
movement
Premotor
area
Association area for
Broca’s touch, pain, heat,
area cold, pressure, and
movement

Prefrontal
cortex
Wernicke’s area
General sensory
area for taste
and smell Association area
for vision
Association area
for smell General sensory
area for vision
Association area
for hearing General sensory
area for hearing

FIGURE 6.9 Functional regions of the cerebral cortex.

• Temporal lobe. The temporal lobe is responsible for the sense of hearing.
­Wernicke’s area (WUR-ni-kehz), another important area for language, is located
here. It is discussed later in the chapter.
• Occipital lobe. The occipital lobe is responsible for vision. It is remarkable to con-
sider that the receptors for vision are located at the front of the head (in the eye) but
the input received is interpreted at the back of the brain. You will learn how this is
done in the nervous system chapter on senses.
• Insula. This small lobe is located deep in the cerebrum, and it can be seen only
when part of the cerebrum (temporal lobe) is retracted. Not much is known about
the function of this lobe.
In addition to having five lobes, the cerebrum contains large parts of the limbic
­system. There is no defined anterior boundary for the ring of structures in the limbic
­system, as they make up parts of several of the lobes. The limbic system includes
structures important for memory and learning (hippocampus) and others for emotions
(amygdala). See Figure 6.10. Parts of the limbic system also involve the diencepha-
lon, the subdivision of the brain you will study next.

Diencephalon The diencephalon has two major components, the thalamus and the
hypothalamus. The description of each follows and is shown in Figure 6.8e.

Study Hint
When you are looking at a midsagittal view of the brain, such as Figure 6.8e, the
diencephalon looks like the head of a duck. Upon closer inspection, seeing that the
diencephalon has two components, imagine that the thalamus is the head of the duck
and the hypothalamus is its beak.

238 CHAPTER 6 The Nervous System

• Thalamus. The thalamus serves FIGURE 6.10 The limbic
as a switching station for incom- system, shown in purple.
ing sensory ­ messages except
those for smell. It directs the sen-
sory messages to the appropriate
lobe of the cerebrum so they can
be identified and interpreted.
Corpus
• Hypothalamus. The hypothala- callosum
mus is very important in main-
taining homeostasis. It monitors
the internal environment and
has several functions, including
the following:
∘ Temperature regulation.
The hypothalamus monitors Amygdala
body temperature, and it may
­stimulate an increase in sweat Hippocampus
production to cool the body Temporal lobe
or promote muscle action
(shivering) to produce heat
to warm the body. These are
two more examples of how homeostasis is achieved using negative feedback
mechanisms.
∘ Autonomic functions. The hypothalamus helps control heart rate and blood
vessel diameter as well as the release of urine from the bladder. The main cen-
ters for heart rate and vessel diameter are located in the medulla oblongata.
∘ Endocrine functions. The hypothalamus produces the hormones ADH and
oxytocin as well as several releasing hormones that regulate hormone produc-
tion of the pituitary gland (covered in the endocrine system chapter).
∘ Food and water intake. The hypothalamus monitors blood glucose and amino
acid levels, and it is responsible for the sensation of hunger if the levels are
below homeostasis. The hypothalamus also monitors the concentration of sol-
utes and blood cells in the blood, and it is responsible for the sensation of thirst
in cases of dehydration. These are examples of homeostasis being maintained
through fluid and electrolyte balance.
∘ Sexual development. The hypothalamus stimulates sexual development and
arousal.
Neurons connect the hypothalamus to the posterior pituitary through the infundib-
ulum, a stalk extending from the tip of the hypothalamus. You will learn more about
this in the endocrine system chapter.

Spot Check List the different ways the hypothalamus functions to maintain
homeostasis.

Brainstem The brainstem is composed of four parts: the medulla oblongata, pons,
midbrain, and reticular formation. See Figures 6.8e and 6.11.

• Medulla oblongata. The medulla oblongata is the most inferior section of the
brainstem. All ascending sensory messages pass through the medulla oblongata on
their way from the spinal cord to the thalamus. All descending motor messages also
travel through the medulla oblongata on their way from the primary motor area in
the frontal lobe of the cerebrum to the spinal cord and ultimately out to the skeletal

6.4 Anatomy of the Central Nervous System 239

 Optic nerve Superior
colliculus Thalamus
Pituitary gland
Optic tract
Midbrain Pineal gland
Inferior
Pons colliculus

Fourth
Pyramidal ventricle
tract
Medulla
oblongata

Medulla
oblongata

(a) (b)

FIGURE 6.11 The brainstem: (a) anterior view, (b) posterior view.

muscles. The efferent motor messages pass through two anterior raised areas on
the medulla oblongata, called the pyramids. The motor messages cross sides at the
pyramids, so messages coming from the right frontal lobe go to muscles on the left
side of the body and motor messages sent by the left frontal lobe go to muscles on
the right side of the body. The medulla oblongata also contains centers to regulate
heart rate, respiratory rate, and blood vessel diameter. Even the emetic center that
controls vomiting is located in the medulla oblongata. You will continue to learn
more about this section of the brainstem as it becomes relevant in other systems.

Common Misconception
It is important to realize that all of the brainstem is located in the cranial cavity; the
brainstem does not extend beyond the cranial cavity into the neck.

Clinical P int
Encephalitis can cause swelling of the brain, which is located in a bony cavity with no
room for expansion. If the swelling is severe enough, the medulla oblongata (the most
inferior part of the brainstem) will be pressed toward the foramen magnum (an open-
ing in the skull that cannot stretch). The medulla oblongata is wider than the foramen
magnum. Given that the medulla oblongata contains the centers for heart rate, respira-
tory rate, and vessel diameter, you can see why this may be a lethal situation if these
centers are damaged from the pressure caused by the swelling. Medication and/or
removal of part of the skull may be necessary to reduce the swelling or give temporary
room for expansion.

• Pons. The pons appears as a large bulge on the anterior surface of the brainstem
between the medulla oblongata and the midbrain. Like the medulla oblongata, the
pons has ascending tracts of neurons carrying sensory messages to the thalamus
and descending motor tracts from the cerebrum. The pons serves as a bridge for
motor tracts to the cerebellum, where they are fine-tuned before continuing on
their way to the medulla oblongata and spinal cord.

240 CHAPTER 6 The Nervous System

• Midbrain. When viewed in a sagittal section, the midbrain appears as a hook at
the superior end of the brainstem. See Figure 6.8e. The midbrain has four bulges,
called colliculi, on its posterior surface. The two superior colliculi are important
for visual reflexes, as in tracking the movement of an object or focusing on some-
thing seen off to the side. The two inferior colliculi are important for auditory
reflexes, such as turning your head toward a sound or jumping at the sound of a
loud noise. Colliculi direct the sensory messages on to the thalamus.
• Reticular formation. The reticular formation is composed of groups of cell bodies
(called nuclei in the CNS, ganglia in the PNS) scattered throughout the brainstem.
The reticular formation is important for arousal, as it determines whether sensory
messages will be consciously noticed by the cerebrum. It is also responsible for
sleep-wake cycles. If the reticular formation is not working, a coma results.

Clinical P int
Many drugs such as barbiturates, benzodiazepines, and opiates depress
the CNS by affecting the reticular formation. The effects can range from
mild calming to sleep (sedation) to loss of sensory sensitivity (­anesthesia).
On the other hand, smelling salts stimulate the reticular formation.

Cerebellum The cerebellum is the last subdivision of the brain that

you need to cover before moving on to the spinal cord. The cerebellum
is located posteriorly in the brain, inferior to the occipital lobes of the
cerebrum. As you can see in Figure 6.12, the cerebellum has tracts
of white matter, called the arbor vitae, which branch like a tree. The
cerebellum receives sensory messages concerning the position of limbs,
muscles, and joints. It uses this information to fine-tune efferent skel- ©Stockbyte/Getty Images
etal muscle messages to coordinate position, balance, and movement. The
effect is smooth, coordinated movement, such as touching the end of your nose with
your finger while your eyes are closed. People who are proficient at keyboarding—
either typing or playing piano—have reflexive memory. When they were first learn-
ing to keyboard, it may have been necessary for them to watch their fingers move
to each key, but by now their cerebellum has fine-tuned messages so often that key-
boarding seems effortless.

Clinical P int
The normally smooth, coordinated movements for which the cere-
bellum is responsible are affected by alcohol consumption. Alcohol
can impair cerebellar function. A sobriety test may include walking a
straight line, alternately touching the right and left index finger to the
nose while the eyes are closed, or standing on one foot. All of these
activities are difficult to perform smoothly if the cerebellum is impaired.

At this point, you have finished a very basic overview of the

human brain. It is important to know that research is constantly
being done to broaden understanding of this very complicated
structure. We focus next on the other division of the central ner- ©Dynamic Graphics/Jupiterimages/
Getty Images
vous system, the spinal cord.

6.4 Anatomy of the Central Nervous System 241

FIGURE 6.12 The anatomy Superior
White matter
of the cerebellum: midsagittal colliculus
(arbor vitae)
view. Inferior
colliculus Gray matter

Midbrain

Fourth
ventricle

Pons

Medulla Cerebellum
oblongata

Spinal Cord

Learning Outcome
9. Describe the spinal cord.

The spinal cord is a solid cylindrical structure in the vertebral cavity that extends from
the foramen magnum to the inferior margin of the first lumbar vertebra. From there,
a bundle of nerve roots called the cauda equina (“horse’s tail”) extends from L1 to
S5 in the vertebral cavity. See Figure 6.13. The spinal cord is enlarged in the cervical
and lumbar regions to accommodate the number of nerve fibers going to and from the
limbs. Thirty-one pairs of spinal nerves attach to the spinal cord between vertebrae.
You will learn more about these nerves when you cover the peripheral nervous system.

Clinical P int
Meningitis is a serious inflammation of the meninges caused by viruses or bac-
teria often acquired through a respiratory, throat, or ear infection. A test, called a
lumbar puncture, can be done to look for the presence of a pathogen
in the CSF. This test involves inserting a needle through
the dura mater and arachnoid mater to access the CSF
in the subarachnoid space. The test is performed in the
lumbar region below the end of the cord to reduce the
risk of accidental damage to the cord. The strands of
the cauda equina in this region are bathed in CSF. Imag-
ine trying to stab a single piece of wet spaghetti with a
fork. Because the spaghetti is wet and slippery, it tends to
slide away as the fork approaches. The intent is not to stab
the spinal cord or nerves in a lumbar puncture. However, if the
needle does go too far, the strands of the cauda equina (bathed
in CSF) tend to move out of the way, reducing the risk of injury.

As you can see in Figure 6.14, a cross section of the cord shows both gray and
white matter. The gray matter is in the center of the cord and arranged in an “H,” the
points of which are called horns. The gray matter is composed of dendrites, cell bod-
ies, and short unmyelinated neurons (interneurons). These interneurons synapse with

242 CHAPTER 6 The Nervous System

 Posterior
view
C1
C2
Cervical C3
enlargement C4 Cervical
C5 nerves
C6
C7
C8
T1
T2
Subarachnoid T3
space T4
T5
T6 Thoracic
T7 nerves
T8
T9
Spinal cord
T10
Lumbar
enlargement T11 Vertebra (cut)
T12 Spinal nerve
End of solid
cord L1

L2 Spinal nerve
Lumbar rootlets
L3 nerves
Cauda equina Subarachnoid
L4
space
L5
Epidural space
S1
S2
S3 Sacral
S4
S5 nerves
Arachnoid
Co Coccygeal mater
nerve
Dura mater

(a) (b)

FIGURE 6.13 The spinal cord: (a) posterior view, (b) close-up view.

other neurons in the spinal cord to carry a message from the cord up to the brain or out
to the body. You will see them again later when you study reflexes. The white matter
of the spinal cord contains myelinated axons of neurons arranged in columns. Axons
in ascending columns carry messages to the brain, while axons in descending columns
carry messages away from the brain. The axons are grouped together in tracts with simi-
lar functions. For instance, Figure 6.15a shows how a sensory (primary) neuron from
the skin goes to the spinal cord. There, it synapses with an interneuron, so its message
can be eventually carried to the brain on myelinated axons in the lateral column on the
left side of the cord. Descending tracts from the cerebral cortex carry motor messages
on myelinated axons in the anterior and lateral columns of the cord. See Figure 6.15b.
Now that you have studied the organization of the central nervous system, you are
ready to explore the nerves of the peripheral nervous system. The PNS nerves carry
messages to and from the CNS. To tackle this system, you can begin with the basic
anatomy of a nerve.

6.4 Anatomy of the Central Nervous System 243

Dorsal root Central canal

Dorsal root White matter:

ganglion Dorsal (posterior)
column
Ventral root
Ventral (anterior)
column
Gray matter:
Posterior (dorsal) Lateral column
horn
Spinal
Lateral horn nerve

Anterior (ventral)
horn

FIGURE 6.14 Spinal cord cross section.

General sensory

M
area of cerebrum

oto
rc
ort
Cerebrum

ex
Tertiary
Cerebrum neuron

Thalamus

Midbrain

Secondary Upper motor

neuron neurons

Pons

Pyramid Medulla
Dorsal root ganglion oblongata
Medulla
Primary neuron oblongata
cell body Descending
tract in lateral Crossing
column over at the
Primary Ascending pyramids
neuron tract of lateral
column
Free nerve Descending
endings in skin Interneuron tract in anterior
column
Spinal cord
Neuromuscular
Interneuron Spinal cord
junction
Lower motor
(a) (b)
neurons

FIGURE 6.15 Ascending and descending tracts: (a) A primary (sensory) neuron with free nerve endings in the skin carries
messages to an interneuron in the spinal cord, which synapses with another neuron to carry the messages up the cord in ascending
tracts to the thalamus and then the general sensory area of the cerebral cortex. (b) Motor messages are carried from the motor cortex
of the cerebrum to the pyramids of the medulla oblongata where they cross over before continuing on descending tracts through the
cord to another interneuron in the gray matter of the spinal cord that synapses with a motor neuron going out to a muscle.

244 CHAPTER 6 The Nervous System

 Spot Check What short, unmyelinated neurons located in the spinal cord
synapse with other neurons traveling to and from the brain?

6.5 Anatomy of the Peripheral Nervous System

Anatomy of a Nerve

Learning Outcome
10. Describe the anatomy of a nerve and its connective tissues.

A nerve is a bundle of nerve fibers with an arrangement and connective tissues simi-
­ ndoneurium is the
lar to those of the muscle fibers of a muscle. See Figure 6.16. E
FIGURE 6.16 The anatomy of
a nerve: a nerve with sensory
and motor neurons. Arrows
show the direction of nerve
signals.

Peripheral nerve

Epineurium

Perineurium
Fascicle

Endoneurium

Schwann cell
Axon
Node of Ranvier

Motor neuron Myelin sheath

ending (synaptic
knob)

Free nerve endings

of sensory neuron in
the skin (dendrites)

6.5 Anatomy of the Peripheral Nervous System 245

 connective tissue surrounding an axon of an individual neuron. Axons are arranged in
bundles called fascicles that are surrounded by perineurium. The fascicles are bundled
to form a nerve, which is surrounded by epineurium. An individual nerve may contain
all afferent axons and be called sensory, all efferent axons and be called motor, or both
sensory and motor neuron axons carrying messages in both directions. Two categories of
nerves based on their connection to the CNS are the cranial nerves and the spinal nerves.

Cranial Nerves

Learning Outcome
11. L
 ist the cranial nerves in order, stating their function and whether they are sensory,
motor, or both.

Cranial nerves connect directly to the brain. Their messages do not go through the spinal
cord. The 12 pairs of cranial nerves are numbered in the order that they come off the
inferior surface of the brain. See Figure 6.17 and Table 6.4.

Study Hint
Mnemonic devices can help you remember the cranial nerves. Here is one for remem-
bering the names in order: Look at the first letter of each name—­OOOTTAFAGVAH.
Imagine the three O’s as pills. The rest of the letters then represent “Take Three ­Aspirin
For A Giant, Very Awful, Headache.” Here is one for the type of message carried by
nerves, in order, given S = sensory, M = motor, and B = both: “Some Say Marry Money,
But My Brother Says, Bad Business Marry Money.”

FIGURE 6.17 Cranial

nerves: Inferior view of a
cadaver brain showing cranial
nerves.
©McGraw-Hill Education/Christine Olfactory
Eckel nerve (CN I)

Optic nerve (CN II)

Oculomotor nerve (CN III)

Trochlear nerve (CN IV)

Trigeminal nerve (CN V)

Abducens nerve (CN VI)

Facial nerve (CN VII)

Auditory (vestibulocochlear)
nerve (CN VIII)
Glossopharyngeal nerve
(CN IX)

Vagus nerve (CN X)

Accessory nerve (CN XI)

Hypoglossal nerve (CN XII)

246 CHAPTER 6 The Nervous System

 TABLE 6.4 Cranial Nerves
Type of Messages:
Name Function
Sensory, Motor, or Both
I. Olfactory nerve S Sensory for smell

II. Optic nerve S Sensory for vision

III. Oculomotor nerve M Motor for eye movement

IV. Trochlear nerve M Motor for eye movement

V. Trigeminal nerve B Sensory for pain, touch, and temperature for the
eye and lower and upper jaws
Motor for muscles for chewing

VI. Abducens nerve M Motor for eye movement

VII. Facial nerve B Sensory for taste

Motor for facial expression

VIII. Auditory (vestibulocochlear) S Sensory for hearing and equilibrium

nerve

IX. Glossopharyngeal nerve B Sensory for taste

Motor for swallowing

X. Vagus nerve B Sensory and motor for organs in the thoracic

and abdominal cavities
Motor for larynx

XI. Accessory nerve M Motor for the trapezius, sternocleidomastoid,

and muscles of the larynx

XII. Hypoglossal nerve M Motor for the tongue

Spot Check Which cranial nerve could be assessed by each of the following:
asking the patient to smile, asking the patient to stick out her tongue, and asking the
patient to move her head from side to side?

Spot Check Which cranial nerves would contain bipolar neurons?

Spinal Nerves

Learning Outcome
12. Describe the attachment of nerves to the spinal cord.

 here are 31 pairs of spinal nerves that connect to the spinal cord. These nerves
T
are numbered according to where they attach to the cord on the vertebral column:
C1–8, T1–12, L1–5, S1–5, and Co (coccygeal nerve). See Figure 6.18. All spinal
nerves carry sensory and motor messages, so they are composed of both unipolar

6.5 Anatomy of the Peripheral Nervous System 247

 C1
C2
C3
C4
C5
C6
C7
Phrenic nerve C8
T1
T2
Musculocutaneous T3
nerve
T4
T5
Axillary nerve
T6
Radial nerve
T7
Median nerve Intercostal
T8
Ulnar nerve nerves
T9
T10

T11
T12

L1

Cauda equina L2

L3
L4
Femoral nerve
L5
S1
Obturator nerve S2
S3
S4
S5
Co
Sciatic nerve

(a) Posterior view

Dorsal root
ganglion
Sensory
nerve fibers
Sensory (unipolar)
neuron cell bodies
Direction
of signal Spinal cord Dorsal Spinal nerve
transmission root
Dorsal root
ganglion

Sensory pathway

Ventral Blood vessels

root
Ventral root Epineurium
Motor nerve fibers
(b) Spinal nerve (c)
Motor pathway

FIGURE 6.18 Spinal nerves: (a) spinal nerves, (b) attachment of spinal nerves to the spinal cord, (c) close-up of dorsal and
ventral roots.

248 CHAPTER 6 The Nervous System

and multipolar neuron axons (bipolar neuron axons are found only in some cranial
nerves). Each spinal nerve splits into two nerve roots as it approaches the cord: a
dorsal root and a ventral root. Notice in Figure 6.18b that the dorsal root has a bulge
whereas the ventral root does not. The bulge is a ganglion (group of cell bodies) of
the unipolar neurons. As you may recall from earlier in the chapter, unipolar neurons
have their cell bodies pushed off to the side. So the dorsal root carries afferent (sen-
sory) messages, while the ventral root is composed of multipolar neuron axons that
carry efferent (motor) messages.

Study Hint
How can you keep the direction of messages in the roots straight? Think of naming the
spinal cord DAVE (“Dorsal is Afferent; Ventral is Efferent”).

Each sensory nerve is responsible in part for carrying messages from specific areas
of the skin. These areas are mapped in dermatomes. See Figure 6.19. Numbness in
any given dermatome indicates which spinal nerve is involved.

C2
C3
C2 C4 FIGURE 6.19 Dermatomes:
C5
C3 C6
(a) anterior, (b) posterior.
C4 C7
C5
T1 T1 C8

C6

T1
T12 L1

T12 L5
S1
L1 S2
S2 L2 S3
C6 S3 S4
C7 L3 S5
L1 C0

L2
L4
C8
L3

L5

S1
L4
L5

(a) (b)

6.5 Anatomy of the Peripheral Nervous System 249

 Autonomic Nervous System

Learning Outcome
13. C
 ompare the parasympathetic and sympathetic divisions of the autonomic nervous
system in terms of anatomy and function.

As you may recall from the organizational chart in the beginning of the chapter (­see
Figure 6.2), the autonomic nervous system carries efferent messages. These messages
go out primarily to thoracic and abdominal viscera as well as the smooth muscle of
blood vessel walls. These messages are involuntary, meaning they are not under con-
scious control.
The autonomic nervous system is further divided into two parts—the sympathetic
and parasympathetic divisions—based on anatomy and function. In both divisions,
two neurons are involved in carrying the efferent message from the spinal cord—a
preganglionic neuron and a postganglionic neuron. The anatomical differences in
these divisions are where they exit the CNS and the ___location of the ganglia. Each
division uses different neurotransmitters to target the same tissue. For example, the
parasympathetic division may slow down the heart rate by using acetylcholine as a
neurotransmitter, while the sympathetic division may speed up the heart rate by using
norepinephrine as a neurotransmitter.

Sympathetic Division The sympathetic division carries messages to prepare the

body for physical activity, sometimes called fight or flight. Efferent messages cause
blood vessels to the heart and skeletal muscles to dilate to increase blood flow. The
heart is signaled to beat faster. Meanwhile, this division sends other messages to
decrease blood flow in blood vessels that deliver blood to the digestive organs. If you
are preparing for fight or flight, it is more important to send blood to the heart and
skeletal muscles than to the stomach and intestines.
In the sympathetic division, there is a chain of ganglia just outside and lateral to the
vertebral column. A short preganglionic neuron leaves the spinal cord from the thoracic
and lumbar regions. It synapses with the postganglionic neuron at the sympathetic chain
of ganglia just outside the vertebral column. As you can see in Figure 6.20, the pregan-
glionic neuron is very short and the postganglionic neuron is quite long, ending at the
structure it stimulates.
Prolonged activation of the sympathetic division during times of stress can lead to
various diseases. For example, heart disease from increased blood pressure (hyperten-
sion) or digestive ulcers due to changes in digestive secretions and motility (amount of
movement) may result. The sympathetic division can even weaken the body’s immune
system (as another effect) by stimulating the production of hormones from the adrenal
gland (glucocorticoids) so that more glucose and amino acids can be released for the
fight-or-flight response. You will learn more about these hormones in the endocrine
system chapter.

Spot Check What parts of the preganglionic and postganglionic neurons form
the synapse at the ganglia?

Parasympathetic Division The parasympathetic division carries messages for

everyday body maintenance functions such as digestion and elimination of waste. It
has a calming effect on the body. You might think of this as a rest-and-veg effect. The
­parasympathetic division slows down the heart rate and increases blood flow to the
digestive organs.
There is no neat chain of ganglia in the parasympathetic division as there is in
the sympathetic division. In the parasympathetic division, the preganglionic neurons

250 CHAPTER 6 The Nervous System

Lacrimal gland

Eye

Parotid gland,
submandibular
and sublingual
glands

Blood vessels

Heart

Skin

Trachea

Superior
Lungs mesenteric
ganglion

Liver Celiac
ganglion
Stomach Fibers to skin,
blood vessels,
and adipose
tissue
Gallbladder
Pancreas

Small
intestine

Large
intestine

Adrenal Inferior
gland mesenteric Spinal
ganglion cord
Kidney Sympathetic
chain ganglia

Urinary
bladder
Preganglionic Postganglionic
neuron neuron
Ovary
Scrotum
Uterus
Penis
FIGURE 6.20 The sympathetic division of the autonomic nervous system, showing
preganglionic neurons leaving the thoracic and lumbar regions of the spinal cord and
synapsing with postganglionic neurons in the sympathetic chain of ganglia outside of the
spinal column. Notice that all of the ganglia for this part of the autonomic nervous system are
in the sympathetic chain of ganglia except the three that send messages via postganglionic
neurons to the digestive organs, the adrenal gland, the kidney, the urinary bladder, and the
reproductive organs.

6.5 Anatomy of the Peripheral Nervous System 251

 Sphenopalatine
Lacrimal gland
ganglion
Eye Ciliary ganglion Cranial
nerve III
Submandibular and
Cranial
sublingual glands Submandibular
nerve
ganglion
Parotid gland VII

Otic ganglion
Cranial
nerve IX
Heart
Cranial nerve X
(Vagus)

Trachea
Lung

Liver
Stomach

Gallbladder
Pancreas Spleen

Small intestine

Large intestine Preganglionic

neurons Spinal
cord

Kidney

Pelvic
Urinary nerves
bladder Postganglionic
neurons

Ovary
Preganglionic Postganglionic
Uterus Penis Scrotum neuron neuron

FIGURE 6.21 The parasympathetic division of the autonomic nervous system, showing
preganglionic neurons leaving the brainstem and sacral regions of the spinal cord and
synapsing with postganglionic neurons in ganglia near the organ they enervate.

come off the brain and the sacral region of the spinal cord and synapse with postgan-
glionic neurons in ganglia close to the structure they stimulate. See Figure 6.21.

Spot Check Compare the length of the preganglionic and postganglionic

neurons in the sympathetic and parasympathetic divisions.

You have covered all of the anatomy of the central and peripheral nervous systems.
It is time to see how these structures carry out their functions. You will start with a
basic nerve impulse.

252 CHAPTER 6 The Nervous System

6.6 Physiology of the Nervous System
Nerve Impulses

Learning Outcomes
14. Describe a resting membrane potential.
15. Compare and contrast a local potential and an action potential.

As you already know from studying a muscle contraction at the molecular level, a
nerve impulse starts as an electrical impulse that travels down a neuron and results in
the release of a chemical neurotransmitter at the synaptic knob. To understand how an
electrical impulse happens, you need to look at the membrane of a neuron at rest. See
Figure 6.22a.
In the figure, you see the phospholipid bilayer of the neuron membrane. This small
section includes two channel proteins: one for sodium ions (Na+) and one for potas-
sium ions (K+). ECF stands for “extracellular fluid” on the outside of the neuron.
ICF stands for “intracellular fluid” (cytoplasm) inside the neuron. Notice that most
of the Na+ is on the outside of the membrane and most of the K+ is on the inside of
the cell. Na+ cannot freely move across the membrane by simple diffusion. It needs

ECF
FIGURE 6.22 Resting
membrane potential:
(a) resting membrane potential,
Na+ (b) the sodium-potassium pump
restores resting membrane
potential by actively transporting
Na+ out of the cell.
Na+
Channel
K+
Channel

K+

Large negative
ions that cannot
ICF escape the cell
(a)

ECF

Na+

ATP
ADP + P
K+

ICF

(b)

6.6 Physiology of the Nervous System 253

 an open channel to allow it to cross through facilitated diffusion. Na+ would naturally
diffuse across the membrane from an area of high concentration (outside the cell)
to an area of low concentration (inside the cell) if it could, but it cannot because the
channel for Na+ is closed. K+ is mostly on the inside of the cell. It is attracted to
the large negative ions inside the cell that cannot cross the membrane by any means.
The presence of many large negative ions inside the cell and many positive sodium
ions outside the cell creates a difference in charge across the cell membrane. The
outside is positive and the inside is negative, so the membrane is polarized. This situ-
ation is called a resting membrane potential. Electricity is the flow of charges, and
there is a potential for a flow of charges with a resting membrane potential. Once
the Na+ channel is opened, the Na+ can diffuse across the membrane into the cell.
This occurs by facilitated diffusion, from an area of high concentration outside the
cell to an area of low concentration inside the cell, until the concentrations are equal.
This flow of charged ions is electricity. When the positive Na+ flows into the cell, the
difference in charge across the membrane changes. The membrane is depolarized.
An opening of K+ channels follows at a slightly slower rate to allow the flow of K+
ions to the ECF, which then repolarizes the membrane.
The sodium-potassium pump is responsible for reestablishing and maintaining the
resting membrane potential by pumping Na+ out of the cell again through active trans-
port (requiring energy). Running the sodium-potassium pump uses 70% of the energy
needed by the nervous system. Once the resting membrane potential is restored, the
neuron is ready to begin again with another nerve impulse. See Figure 6.22b.
What causes the Na+ channel to open? The process begins at the dendrite of a
neuron.

Local Potential A local potential is the flow of electricity begun by stimulating the
dendrite of a neuron. It starts with the opening of an Na+ channel on the membrane of
a dendrite. A chemical, heat, light, or mechanical disturbance may cause the Na+ chan-
nel to open. For example, light stimulates sensory neurons in the eye, heat stimulates
sensory neurons in the skin, a chemical (like perfume) may stimulate the neurons in
the nose, and pressure (caused by touching a table) may stimulate a sensory neuron for
touch in the skin of your finger by opening the Na+ channel on a dendrite.
When that gate opens, Na+ rushes in and spreads in all directions. Some of it may
flow on the inside of the membrane to the next Na+ channel and open it from the
inside. Na+ rushes into that open channel too. Some of that Na+ may flow on the inside
of the neuron to the next Na+ channel and open it, and so on, and so on. K+ channels
open following the Na+ channels for repolarization. Meanwhile, the sodium-potassium
pump actively transports the previous Na+ out of the cell again to restore a resting
membrane potential. In effect, this creates a wave of Na+ moving in and out of the
cell, along the dendrite toward the cell body, and on to the trigger zone of the
neuron. See Figure 6.23.
Local potentials have definite characteristics, which are outlined as follows:
1. The amount of stimulation in a local potential matters. It determines how much
Na+ enters the cell and how many Na+ channels get opened. Therefore, a local
potential is graded.
2. The effects of a local potential decrease with distance. Therefore, a local potential
is also decremental.
3. Local potentials are also reversible, meaning that if the stimulation is stopped, the
resting membrane potential is quickly restored.
4. In addition, local potentials can be excitatory, meaning they cause the neuron to
send a signal, or they can be inhibitory, meaning they prevent a neuron from send-
ing a s­ignal. For example, a needle used for an injection mechanically disturbs
the dendrite of a neuron of a pain receptor. This is excitatory because it results in

254 CHAPTER 6 The Nervous System

 FIGURE 6.23 Local
potential: conduction of a nerve
Dendrites impulse along a dendrite.
Signal

Cell body
Axon
Trigger zone

Local potential Sodium-potassium pump restoring Resting membrane

in progress resting membrane potential potential

a message being sent to the brain, and as a result you experience the pain of the
needle stick. The chemicals in topical anesthetics are inhibitory. They bind to the
dendrite of a pain receptor neuron but prevent a pain signal from being sent.
So far you have looked only at a nerve impulse traveling from a dendrite to the
body of a neuron and possibly reaching the trigger zone. If adequate stimulation
occurs so that enough channels are opened and the wave of depolarization goes all
the way to the trigger zone of the neuron, then an action potential may or may not
happen.

Action Potential An action potential is the flow of electricity along an axon of a

neuron in one direction—from the trigger zone to the synaptic knob. It differs from a
local potential in several ways, including the following:
1. An action potential is not graded. It has a threshold. If that minimal amount of
stimulation is present at the trigger zone, the action potential happens. This is an
all-or-nothing effect. A stronger stimulus at the trigger zone has no more effect
than the threshold amount. If the local potential is subthreshold at the trigger zone,
no action potential happens.
2. An action potential is not decremental. It does not decrease with distance. The action
potential begun at the trigger zone of a motor neuron located in the spinal cord will
be just as strong at the synaptic knob as it was at the trigger zone. This holds true even
if the synaptic knob is at a flexor digitorum muscle 2 feet away.
3. An action potential is also not reversible. Once the threshold is met at the trigger
zone, the action potential happens and it goes the full extent of the axon.

6.6 Physiology of the Nervous System 255

 Trigger zone is a good term because action potentials are similar to shooting a gun. To
shoot a gun, you need a minimal amount of pressure (threshold stimulus) on the trigger. It
is an all-or-nothing effect. Unless you press hard enough, the gun does not fire. If you press
the trigger harder than necessary, the gun fires the same as it would if you pressed just hard
enough (all-or-nothing). If the gun fires, you cannot call the bullet back (irreversible).
Myelination of an axon allows the action potential to travel very quickly. The change
in charge (depolarization followed by repolarization) across the membrane needs to hap-
pen only at the unmyelinated nodes of Ranvier. So the action potential can jump from
node to node. See Figure 6.24. Neurons with long axons are myelinated. Short inter-
neurons found in the gray matter of the spinal cord do not need to be myelinated because
of their length.

Spot Check Sound waves cause vibrations in the ear that mechanically disturb
bipolar neurons. In terms of local and action potentials, why might you be able to hear a
sound that your friend standing next to you cannot?

Now that you have covered the anatomy of the nervous system and the physiology
of a nerve impulse, you are ready to see how they are used together in the body in
reflexes, memory, and language in carrying out the functions of this system.

Reflexes

Learning Outcome
16. Describe a specific reflex and list the components of its reflex arc.

A reflex is an involuntary, predictable, motor response to a stimulus without conscious

thought. It is a very fast response, used often as a protective device. A reflex occurs in
what is called a reflex arc that involves the following anatomy, in order:
1. Receptor: the dendrite of a neuron receiving the stimulus (a chemical, heat, light,
or mechanical disturbance).
2. Afferent neuron (sensory): a neuron that has an action potential carrying the sig-
nal to the CNS.
3. Integrating center: either the brain or spinal cord, where the signal is received
from the afferent neuron and conducted to a motor neuron. This may or may not
require an interneuron.
4. Efferent neuron (motor): a neuron that has an action potential carrying a signal
away from the CNS.
5. Effector: the structure causing the effect. If this structure is skeletal muscle, it is
called a somatic reflex. If the effector is a gland or smooth muscle, it is called an
­autonomic reflex.

Clinical P int
Testing reflexes is an important diagnostic tool for evaluating the condition of the ner-
vous system. Exaggerated, decreased, or absent responses indicate damage to the
nervous system from disease or injury. For example, if the spinal cord is damaged, test-
ing reflexes may help determine on what level of the cord the damage occurred. Reflex
motor responses above the damage may be normal, while the reflex motor responses
below the damage may be decreased or absent.

©Ingram Publishing/SuperStock

256 CHAPTER 6 The Nervous System

 Signal

(a)

Na+ inflow at node ++

+ ––––
– +
– – Na+ travels along inside ++
+
+
– Na+ diffuses along of axon and opens Na+
inside of axon channel at next node

++
–– ––––
++
++ ++
––

+ +–
+ – –
–
– + + +
– –
+ –
+

– –+
++ +
–– ++
–– ––
+ +

– –+
+ + +
– + + –
– – –
+ –
+

++ ++
– ––
– –
– –– + +
++

Action potential Sodium-potassium pump restoring Resting membrane

in progress resting membrane potential potential
(b)

FIGURE 6.24 Action potential: (a) movement of Na+ along an axon, (b) conduction of a nerve impulse along a
myelinated axon.

6.6 Physiology of the Nervous System 257

 Cell body of sensory neuron

Axon of sensory neuron

Direction
of impulse Interneuron

Spinal cord
Effector (flexor Axon of
muscle contracts motor neuron Cell body of
and withdraws part motor neuron
being stimulated)
Dendrite of
sensory
neuron
Pain
receptor
in skin
Tack

FIGURE 6.25 A reflex arc for a withdrawal reflex.

An example of a somatic reflex is shown in Figure 6.25. In this case, the reflex arc
begins with the mechanical disturbance of the dendrite of a pain receptor in the skin of
the foot. A local potential is generated along the afferent neuron. Notice that this is a
unipolar neuron whose body is in the dorsal root ganglion of the spinal cord. An action
potential carries the signal to the gray area of the spinal cord (integrating center). Here,
the synaptic knob of the afferent neuron synapses with a dendrite of a short, unmyelin-
ated interneuron. A local potential is generated by the neurotransmitter released by the
synaptic knob stimulating the dendrite of the interneuron. The local potential travels to
the trigger zone of the interneuron and stimulates an action potential to run the short
length of the axon. The synaptic knob of the interneuron synapses with the dendrite of
an efferent motor neuron and releases a neurotransmitter. A local potential and then an
action potential are generated in the motor neuron to carry the electrical impulse out
the ventral root to the effector, which, in this case, is flexor muscles in the thigh. The
involuntary, predictable, motor response to stepping on a tack is flexion resulting in
the withdrawal of the foot and leg.
Not all reflexes use the spinal cord as the integration center. An example of an
autonomic reflex is the involuntary, predictable contraction of the iris constricting
the size of the pupil within the eye in response to a bright light. In this case, the recep-
tor (dendrite) in the eye is stimulated by light. The afferent neuron is part of a cranial
nerve, the integration center is the brain, and the efferent neuron is part of another
cranial nerve. This is an autonomic reflex because the effector, the iris, is smooth
muscle.

Spot Check What nerve would contain the afferent neuron in a pupillary light
reflex?

You have become familiar with reflexes, which are unconscious responses. Next,
you will read about memory, which involves conscious thought.

258 CHAPTER 6 The Nervous System

Memory

Learning Outcome
17. Explain the difference between short-term memory and long-term memory.

An anatomy and physiology student needs to be able to recall enormous amounts of

data stored, hopefully, in long-term memory. How does this work? There are three
basic types of memory: immediate memory, short-term memory, and long-term mem-
ory. Let’s look at each type individually.

Immediate Memory Immediate memory lasts for a few seconds. One example is
keeping track of the beginning words in a sentence long enough to finish the sentence
to get the full meaning. Another example is what it felt like to put on your shoe this
morning. Unless there was something significant about it, memory of this sensation is
gone in a few seconds.

Short-Term Memory Short-term memory lasts a few seconds to a few hours. It may
be lost if you are distracted by something else, and it is somewhat limited to a few bits
of information. Phone companies base the length of phone numbers on this. You may
have looked up a phone number, repeated it several times, and still forgotten it by the
time you found your phone to enter the number.

Long-Term Memory Long-term memory may last a lifetime and is not limited as
to the amount of information it can hold. Each time a dendrite is stimulated, a local
potential is generated. But a chemical change takes place inside the neuron as well.
If the chemical change takes place often enough, the dendrite is stimulated to grow
and make new and broader connections. As mentioned earlier, the more dendrites
a neuron has, the more information it can process. The added connections form the
memory. So a chemical change at the molecular level causes a physical change in the
size and shape of the neuron.

Spot Check On the basis of how memories are formed, what is the best way to
study for an exam on the nervous system?

Language

Learning Outcome
18. D
 ifferentiate between Broca’s area and Wernicke’s area in regard to their ___location and
function in speech.

Just as memory is an important part of human communication, so is language,

especially in regard to the ability to retain and recall information that has been
communicated verbally and/or in writing. The cerebrum plays a crucial role in both
the interpretation of and the ability to produce language. As mentioned earlier in
the discussion of the anatomy of the cerebrum, there are two areas in the cerebrum
concerned with language: Wernicke’s area in the temporal lobe and Broca’s area in
the frontal lobe. Aphasia (ah-FAY-zee-ah) is any language deficit resulting from
damage to either Wernicke’s or Broca’s area.

Wernicke’s Area This area is used to interpret incoming language by sorting out
what the incoming sounds are. People who have had damage to this area may speak
clearly but are unable to understand the language directed to them.

6.6 Physiology of the Nervous System 259

 Broca’s Area This area is used to find the words for outgoing language. If brain
damage has occurred in this area, a person is perfectly capable of understanding
incoming language but may not be able to find the words to respond.

Pathways

Learning Outcome
19. E
 xplain the function of the nervous system by writing a pathway for a sensory message
sent to the brain to be processed for a motor response.

The function of the nervous system is fast, efficient communication of one body part
with another. You have seen how this works for a muscle contraction, and you have
seen how this works with a reflex. Now you will put more of the parts of the nervous
system together by writing a pathway of nerve impulses that involves a sense and a
reaction.
As you can see in Figure 6.26, Miriam is adding an ice cube to her glass of water.
You can write a pathway for Miriam’s touching the ice cube and saying “cold.” You
will start with the type of neuron receiving the stimulus and end the pathway with
skeletal muscle messages being sent out from the cerebrum:

The pathway begins with a unipolar (sensory) neuron in Miriam’s finger

that carries the message to her spinal cord.

From the spinal cord, the message travels to the medulla oblongata,

to the pons,

to the midbrain,

to the thalamus, which acts as a switching station, and

to the parietal lobe for touch (first the general sensory area and then the
association area).

FIGURE 6.26 Miriam adds an Miriam now knows the ice feels cold, but her nerve impulses have to go to
ice cube to her glass of water. Broca’s area in the frontal lobe to find the word cold.
©McGraw-Hill Education/Suzie Ross

From Broca’s area the message goes to the premotor area in the frontal lobe to
plan the skeletal muscle messages to be sent.

Finally, the messages travel from her premotor area to her primary motor area,
which actually sends the skeletal muscle messages to say the word cold.

So the pathway involving multiple neurons is unipolar neuron → spinal

cord → medulla oblongata → pons → midbrain → thalamus → parietal lobe (general

260 CHAPTER 6 The Nervous System

sensory area, association area) → frontal lobe (Broca’s area, premotor area, primary
motor area). This demonstrates how complicated, yet how fast and efficient, the ner-
vous system is at communication.

Spot Check Why does the pathway not include Wernicke’s area in the
temporal lobe?

Nutritional Requirements of the Nervous System

Learning Outcome
20. Explain the nutritional requirements of the nervous system.

For the body to maintain homeostasis, proper nutrition is essential. For the nutritional
requirements of the nervous system to be met, it is important throughout life to have
adequate sodium and potassium in the diet. This helps maintain resting membrane
potentials. Sodium is found in table salt (NaCl) and most processed foods. The RDA
for sodium is 2,300 mg for an adult. Having enough sodium in the diet is usually not a
problem, as a typical American diet contains much more sodium than is needed. Too
much sodium can lead to hypertension, which is discussed in the cardiovascular sys-
tem chapter on heart and vessels. The RDA for potassium is 4,700 mg. Good sources
of potassium include red meat, poultry, fish, cereals, spinach, bananas, and apricots. It
is also important that children have fat in their diet for proper myelination of develop-
ing neurons. See Appendix B for dietary guidelines.

Spot Check Why is it important for the function of the nervous system to have
an adequate amount of sodium and potassium in the diet?

6.7 Effects of Aging on the Nervous System

Learning Outcome
21. Explain the effects of aging on the nervous system.

Cognitive function—the ability to think and reason—increases rapidly in the young,

remains relatively stable in adulthood, and declines with old age. The definition of old
age varies from person to person, due to health, lifestyle, and genetics, but in general
the following holds true:
• Short-term memory is affected relatively early.
• Verbal skills and vocabulary usually begin to decline around age 70.
• Intellectual performance may slow but remain high until about age 80.
• Reaction time slows due to a decrease in neuron efficiency.
Overall, the number of neurons in the brain decreases with age. This does not have to
have a drastic effect because the brain has more neurons than it needs to function. You
have also become aware that existing neurons can grow to make more and broader con-
nections. Exercising the brain through reading and problem-solving activities can help
minimize the effects of aging. Having a healthy lifestyle that ensures good cardiovascular
health also helps brain function by making sure the brain has an adequate blood supply.
This can be accomplished by maintaining a healthy diet, exercising, and not smoking.
We now focus on nervous system disorders that may or may not have a connection
to the effects of aging.

6.7 Effects of Aging on the Nervous System 261

 6.8 Diagnostic Tests for Nervous System Disorders

Learning Outcome
22. Describe common diagnostic tests used to diagnose disorders of the nervous system.

Before you explore the disorders in this chapter, look at Table 6.5, which describes com-
mon diagnostic tests and procedures for disorders in the nervous system. You are already
familiar with lumbar puncture, which can be used to diagnose meningitis. Other disorders
we cover may use nerve conduction studies (NCS) as a part of the diagnostic procedure.

Common Diagnostic Tests for Nervous

TABLE 6.5
System Disorders
Diagnostic Test or Screening Description
Lumbar puncture (spinal tap) A procedure used to collect and analyze cerebrospinal
fluid (CSF) surrounding the brain and spinal cord

Nerve conduction study (NCS) A procedure that assesses the conduction of nerve
impulses along peripheral nerves by using electrodes
to stimulate the nerve while reading the conduction
of the impulse as it reaches its end point

Spot Check How is a nerve conduction study used to diagnose disorders of

the nervous system?

6.9 Nervous System Disorders

Learning Outcome
23. Describe nervous system disorders and relate abnormal function to the pathology.

Cerebrovascular Accident
A cerebrovascular accident (CVA), commonly called a stroke, happens when part of
the brain dies due to a lack of blood supply. This is commonly the result of a blocked
artery, but it can also result from the rupture of an artery feeding part of the brain. The
part of the brain past the rupture does not receive blood due to the bleed. The symptoms
of a stroke occur suddenly and may include muscle weakness, paralysis, loss in sensa-
tion on one side of the body, confusion, vision problems, and difficulty with speech. It is
important to determine the cause of the CVA before treating it. Medications to dissolve
clots are desirable if the cause is a blockage, but they can be very harmful if the cause is
a ruptured vessel in the brain.

Alzheimer’s Disease
Alzheimer’s disease is another disorder involving the nervous system. It is a progres-
sive, irreversible disease of the brain that is characterized by dementia. Dementia
is the loss of cognitive function such as thinking, remembering, and reasoning. The
symptoms of Alzheimer’s disease usually first appear after age 60, but the disease
process may have started 10 to 20 years earlier. The exact cause of Alzheimer’s disease
is unknown. It results in tangles of insoluble proteins within nerve cells and clumps
of dead nerve cells, called plaques. Parts of the brain degenerate, causing the death of
some neurons and reducing the responsiveness of other neurons to neurotransmitters.

262 CHAPTER 6 The Nervous System

An exact diagnosis is not possible until an autopsy is completed upon death. An alter-
native explanation for the dementia is always considered first before an Alzheimer’s
disease diagnosis is made. At this time there is no definitive treatment for Alzheimer’s.
However, medications to increase neuron sensitivity to neurotransmitters can help
alleviate the severity of the symptoms to a point.

Huntington’s Disease
Huntington’s disease is a genetic disease caused by a defective gene—passed down
from either the mother or the father—that destroys cells in the brain. Although a per-
son is born with the defective gene, the symptoms tend to appear during middle age,
between the ages of 35 and 50. Huntington’s disease is characterized by degeneration
of cells in the brain. As part of the brain degenerates, patients experience uncoordi-
nated, jerky movements and deterioration of their mental abilities. Nerve conduction
studies can be performed to help diagnose this disease by determining the ability of
nerves to send signals to muscles for movement. There is no cure for Huntington’s
disease, so treatments are aimed at relieving the symptoms.

Parkinson’s Disease
Parkinson’s disease is another degenerative brain disorder. Here, nerve cells in the
basal ganglia of the brain degenerate. These cells are located on the underside of the
brain and produce a neurotransmitter called dopamine, which functions to help control
muscle movement and coordination. When these cells degenerate, dopamine levels
decrease, resulting in tremors and slow, uncoordinated movements. Although research-
ers have not identified a cause of Parkinson’s disease, there appears to be a genetic
component, as some patients who have the disease have also had family members
with the disease. Nerve conduction studies can be used in the diagnosis of Parkinson’s
disease. Because there is no cure for Parkinson’s disease, treatment concentrates on
relieving the symptoms. Treatment of symptoms originating in the brain can be diffi-
cult due to the protective nature of the blood-brain barrier. The disease is progressive,
and those who suffer from Parkinson’s disease will eventually be severely disabled.

Clinical P int
Current research suggests that the use of stem cells may help improve the condition
of a person with Parkinson’s disease. Stem cells are undifferentiated cells that have the
ability to differentiate into healthy tissue. Once these cells differentiate into healthy ner-
vous tissue, they are able to produce neurotransmitters such as dopamine. Stem cell
research targeted at treating Parkinson’s disease is showing promise as researchers
are able to replace affected brain cells with new ones using this technique. Replacing
the affected cells would increase dopamine production and cause a decrease in the
severity of the symptoms associated with the disease.

Multiple Sclerosis
Multiple sclerosis (MS) is a disease characterized by demyelination of the axon. As
you learned in this chapter, myelin covers the axons of the nerve and helps with con-
duction of the nerve impulse. With multiple sclerosis, portions of the myelin sheath
are destroyed; this damage can extend to affect the axon of the nerve as well. There
is no known cause of MS, but the disease may be hereditary. Evidence indicates that
people affected by the disease may have a family member who is also affected. Evi-
dence also indicates that MS is an autoimmune disease.
As you may recall from “Chapter 1, The Basics,” autoimmune disorders are a type of
immune disorder in which the body cannot distinguish self from nonself. With MS, the
body launches an immune response that results in the destruction of the myelin sheath
and damage to the axon. The severity of symptoms varies from person to person. Due to

6.9 Nervous System Disorders 263

 the destruction of the myelin sheath, conduction of the nerve
impulse is altered, resulting in a loss of sensation or motor
control. Earlier, you saw that myelin coated the nerve axon
like the covering of an electric cord to an appliance. This cov-
ering, or insulation, allows the electricity to travel only down
the wire within the cord from the plug in the wall. If the wire
had no insulation, the direction of the electric impulse would
be difficult to control. Myelin serves the same function with
our nerves. When the insulation, or myelin, of the nerve is
damaged, the direction of the nervous impulse cannot be con-
trolled. The inability to properly direct the nervous impulse
results in problems with sensation or touch, movement, and
vision and in severe cases can cause dementia. Treatment
for MS differs from person to person. Generally, treatment is
geared toward suppressing the immune system to stop or slow
the progression of nerve damage. Health care professionals
may also prescribe drugs to treat the various symptoms that
accompany the disease.

Paralysis
Paralysis is the loss of muscle function due to an interrup-
tion in the pathway between the brain and muscles. Paraly-
sis can be caused by injury to the spinal cord, and various
diseases could possibly result in nerve damage that causes
paralysis. There are many different types of paralysis that
affect different parts of the body; a few are explained here:

FIGURE 6.27 Hydrocephalus: transverse section of normal •  Hemiplegia is paralysis that affects one side of the body.
brain, and transverse section of brain with hydrocephalus.
©McGraw-Hill Education
• Quadriplegia is paralysis that affects the arms and legs.
• Paraplegia is paralysis that affects the lower half of the
body.

Hydrocephalus
Hydrocephalus is a condition resulting in the buildup of excess cerebrospinal fluid
in the brain. As you learned earlier in this chapter, cerebrospinal fluid functions to
support and cushion the brain and spinal cord. When there is too much cerebrospinal
fluid, this puts pressure on the brain that can be harmful. Two types of hydrocephalus
are congenital and acquired:
• Congenital hydrocephalus is present at birth. In this case, the fetus developed
abnormally, resulting in excess cerebrospinal fluid in the brain. See Figure 6.27.
• Acquired hydrocephalus occurs at any age. This can result from a trauma to the
brain caused by an injury, a stroke, or a tumor.

Clinical P int
If not treated, hydrocephalus can cause damage to
the brain that results in mental retardation and abnor-
mal physical development. Treatment of hydrocepha-
lus involves surgery to insert a shunt into the ventricle
of the brain. The shunt is a tube designed to move
the excess fluid from the brain to the abdominal cavity,
where it will be absorbed by the bloodstream.

264 CHAPTER 6 The Nervous System

Epilepsy
Epilepsy is a condition that is characterized by recurring
seizures caused by a misfiring of electrical signals in the
brain. Seizures can cause abnormal behavior in an individ-
ual, such as convulsions or loss of consciousness. There is
no cure for epilepsy, but health care providers can prescribe
medications that control the seizures.

Cerebral Palsy
Cerebral palsy is characterized by a group of symptoms
that occur following an injury to the brain in children before
the age of 5 years old. The injury can occur either prenatally
(before birth), perinatally (during birth), or postnatally (after
birth). Cerebral palsy can be caused by infection or illness FIGURE 6.28 Young child with cerebral palsy.
during fetal development or lack of oxygen to the fetus at ©Will & Deni McIntyre/Science Source
any given time, by an injury during birth, or by an injury
after birth. Symptoms of cerebral palsy vary greatly but do not progress as the child
develops. They can be mild and almost hard to notice, or they can be severe enough to
include spastic movements, mental retardation, and seizures. With cerebral palsy, the
brain damage is permanent, and there is no treatment. See Figure 6.28.
Table 6.6 summarizes all of the nervous system diseases and disorders described
throughout the chapter.

TABLE 6.6 Summary of Diseases and Disorders of the Nervous System

Disease/Disorder Description
Alzheimer’s disease A progressive, irreversible disease of the brain that is characterized by dementia.
Cerebral palsy A group of symptoms that occur following injury to the brain prenatally, perinatally, or
postnatally.
Cerebrovascular Death of brain tissue due to a lack of blood supply.
accident (CVA)
Concussion Injury of the brain resulting from impact.
Depression A mental disorder caused by an imbalance of neurotransmitters that affects a person’s
mood by altering the way he or she feels, thinks, sleeps, eats, and works.
Encephalitis Swelling of the brain that is usually caused by a bacterial or viral infection.
Epilepsy A condition that is characterized by recurring seizures.
Gliomas Tumor cells formed by neuroglia.
Huntington’s disease A genetic disease that destroys brain cells responsible for movement and coordination.
Hydrocephalus A condition resulting from excess cerebrospinal fluid buildup in the brain.
Meningitis Inflammation of the membranes surrounding the brain and spinal cord.
Multiple sclerosis (MS) A disease characterized by demyelination of the axon.
Paralysis A loss of muscle function due to an interruption in the pathway between the brain and muscles.
Parkinson’s disease A degenerative disorder of the brain characterized by tremors and slow, uncoordinated
movements.
Rabies virus A virus transmitted by infected animals to humans. The virus causes acute encephalitis.

Spot Check Compare and contrast Alzheimer’s disease, Huntington’s

disease, and Parkinson’s disease.

6.9 Nervous System Disorders 265

Putting the Pieces Together

The Nervous System

Integumentary system Lymphatic system
Has receptors for the general Microglia serve as immune system
senses. cells to fight pathogens in the CNS.

Innervates smooth muscle of blood

vessels for vasoconstriction and Respiratory system
vasodilation to help regulate
Provides O2 to nervous tissue
temperature.
and removes CO2.

Skeletal system Medulla oblongata regulates

respiratory rate.
Provides protection for the brain
and spinal cord.
Digestive system
Proprioceptors sense movement
of joints and body position. Provides nutrients for nervous
system tissues.
Muscular system
Parasympathetic division
Muscles carry out movements innervates digestive organs.
initiated in the central nervous
system.
Excretory/urinary system
Stimulates muscle contractions.
Kidneys dispose of wastes and
maintain electrolyte balance
Endocrine system needed by neurons.

Hormones regulate blood glucose Micturition reflex and higher brain

and electrolyte levels needed for centers regulate urine elimination.
neuron function.

Hypothalamus secretes releasing

Reproductive system
hormones and sends nerve signals
to stimulate the pituitary gland. Reproductive hormones affect
the production of hypothalamus
Cardiovascular system releasing hormones.

Provides nutrients and removes Nerve impulses innervate

wastes. muscles involved in erection,
ejaculation, and childbirth.
Innervates smooth muscle of
blood vessels for vasoconstriction
and vasodilation to regulate blood
pressure and flow; medulla
oblongata regulates heart rate.

FIGURE 6.29 Putting the Pieces Together—The Nervous System: connections between the nervous system and
the body’s other systems.

266 CHAPTER 6 The Nervous System

Summary
6.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the nervous system.

6.2 Overview
∙∙ The nervous system uses neurons and nerves for communication.
∙∙ It monitors what is happening in and outside of the body, analyzes the information, and initiates a response if necessary.
∙∙ The nervous system is divided into two parts: the central nervous system, consisting of the brain and spinal cord, and the
peripheral nervous system, consisting of all the nerves of the body.

6.3 Anatomy of the Nervous System Cells

Anatomy of a Neuron
∙∙ N
 eurons have basically three parts: dendrites that receive information, cell bodies that are involved in protein synthesis,
and axons that transmit electrical impulses.
∙∙ Axons may or may not have a myelin sheath.
∙∙ Neurons may be multipolar, bipolar, or unipolar, depending on anatomy.

Neuroglia
There are six types of neuroglia that aid in neuron function:
∙∙ Oligodendrocytes form myelin in the CNS.
∙∙ Ependymal cells produce cerebrospinal fluid in the CNS.
∙∙ Astrocytes form the blood-brain barrier in the CNS.
∙∙ Microglia seek out and fight pathogens in the CNS.
∙∙ Schwann cells form myelin in the PNS.
∙∙ Satellite cells control the environment for ganglia in the PNS.

6.4 Anatomy of the Central Nervous System

Meninges
∙∙ The brain and spinal cord are covered with three membranes called meninges.

Cerebrospinal Fluid
∙∙ The brain and spinal cord are bathed in CSF found in the ventricles and subarachnoid space.

Brain
∙∙ T he cerebrum is characterized by gyri and sulci. It is divided into hemispheres that are further divided into four main
lobes. Each lobe has a general sensory area and an association area for senses.
∙∙ The diencephalon contains the thalamus, which acts as a switching station for incoming sensory messages, and the hypo-
thalamus, which monitors the internal environment and helps regulate homeostasis.
∙∙ The brainstem is composed of the medulla oblongata, pons, midbrain, and reticular formation.
∙∙ The cerebellum is important for fine-tuning skeletal muscle messages.

Spinal Cord
∙∙ The spinal cord is a solid structure from the foramen magnum to L1.
∙∙ The cauda equina extends from the inferior end of the spinal cord.
∙∙ The spinal cord has gray matter in the form of an “H” and white matter arranged in columns.

6.5 Anatomy of the Peripheral Nervous System

Anatomy of a Nerve
∙∙ A nerve is arranged similarly to a muscle, with fascicles and connective tissues.

Cranial Nerves
∙∙ Twelve pairs of cranial nerves attach directly to the brain. They can be classified as sensory, motor, or both.

267
Spinal Nerves
∙∙ Thirty-one pairs of spinal nerves attach to the spinal cord by dorsal and ventral roots.

Autonomic Nervous System

∙∙ T he autonomic division of the PNS is subdivided into the sympathetic and parasympathetic divisions on the basis of
anatomy and function.
∙∙ The sympathetic division has a chain of ganglia and prepares the body for physical activity (fight or flight).
∙∙ The parasympathetic division has ganglia close to the structure affected and prepares the body for vegetative functions
(rest and veg).

6.6 Physiology of the Nervous System

Nerve Impulses
∙∙ A resting membrane potential is the basis for a nerve impulse and therefore must be maintained.
∙∙ Local potentials start at a dendrite and travel toward the trigger zone. They are graded, decremental, and reversible, and
may be excitatory or inhibitory.
∙∙ Action potentials travel from the trigger zone to the synaptic knob. They require a threshold stimulus and have an all-or-
nothing effect. They are not graded, decremental, or reversible.
∙∙ Myelination allows for the speed of an action potential.
Reflexes
∙∙ A reflex is an involuntary, predictable motor response to a stimulus without conscious thought.
∙∙ A reflex occurs in a reflex arc that involves a receptor, an afferent sensory neuron, an integration center in the CNS, an
efferent motor neuron, and an effector.
Memory
∙∙ T here are three types of memory: immediate, short term, and long term.
∙∙ Long-term memory results from chemical changes in the neuron. This results in cellular changes, including the growth of
dendrites and the formation of new connections.
Language
∙∙ W ernicke’s area is located in the temporal lobe. It is used to interpret incoming language.
∙∙ Broca’s area is located in the frontal lobe. It is used to find the words for outgoing language.
Pathways
∙∙ T he function of the nervous system is fast, efficient communication of one part of the body with another part, using
action potentials.
∙∙ The function can be demonstrated through identifying pathways.

Nutritional Requirements of the Nervous System

∙∙ S odium and potassium are needed throughout life to maintain resting membrane potentials.
∙∙ Fat is necessary in the diet, especially for children, to ensure the proper myelination of developing neurons.

6.7 Effects of Aging on the Nervous System

∙∙  ognitive ability increases in the young, remains stable in adulthood, and declines in old age.
C
∙∙ The definition of old age differs for each individual.
∙∙ Short-term memory is affected early.
∙∙ Verbal skills decline around age 70.
∙∙ Intellectual performance may remain high until around age 80.
∙∙ Reaction times slow as neurons become less efficient.
∙∙ The number of neurons in the brain decreases with age.

6.8 Diagnostic Tests for Nervous System Disorders

∙∙ Common diagnostic tests for nervous system disorders include lumbar puncture and nerve conduction studies.

268
6.9 Nervous System Disorders
∙∙ A cerebrovascular accident (CVA), commonly called a stroke, happens when part of the brain dies due to a lack of blood
supply.
∙∙ Alzheimer’s disease is a progressive, irreversible disease of the brain that is characterized by dementia.
∙∙ Huntington’s disease is a genetic disease that destroys brain cells responsible for movement and coordination.
∙∙ Parkinson’s disease is a degenerative disorder of the brain characterized by tremors and slow, uncoordinated movements.
∙∙ Multiple sclerosis (MS) is a disease characterized by demyelination of the axon.
∙∙ Paralysis is the loss of muscle function due to an interruption in the pathway between the brain and muscles.
∙∙ Hydrocephalus is a condition resulting in the buildup of excess cerebrospinal fluid in the brain.
∙∙ Epilepsy is a condition that is characterized by recurring seizures caused by a misfiring of electrical signals in the brain.
∙∙ Cerebral palsy is characterized by a group of symptoms that occur following an injury to the brain in children before the
age of 5 years old.

Key Words for Review

The following terms are defined in the glossary.

action potential dendrite reflex

afferent depolarize repolarize
autonomic efferent resting membrane potential
axon multipolar neuron sympathetic
bipolar neuron myelin synapse
cerebrospinal fluid (CSF) neuroglia unipolar neuron
decremental parasympathetic

269
 7 The Nervous
System—Senses
It is Saturday morning. Although it
is chilly outside, it is warm in the
coffee shop you just entered. You
can smell the fresh coffee brew-
ing and see the warm cinnamon
rolls displayed on the counter. You
cannot wait to taste them. Your
favorite music even happens to be
playing in the background. How
sweet it is! This is truly a feast for
the senses. At this very moment,
sensory neurons are sending all
sorts of messages to the brain and
spinal cord where they are being
processed, contributing
to the functions
of the nervous
system. See
Figure 7.1.
©Jae Rew/Getty Images

Module 7: Nervous System

270
7.1 Word Roots and Combining Forms
Learning Outcome
1. Use medical terminology related to the senses of the nervous system.

audi/o: hearing lith/o: stone presby/o: old age

aur/o: ear ocul/o: eye propri/o: own
cochle/o: cochlea ophthalm/o: eye retin/o: retina
corne/o: cornea opt/o: eye, vision scler/o: sclera
lacrim/o: tears ot/o: ear tympan/o: eardrum

7.2 Overview

Learning Outcome
2. Classify the senses in terms of what is sensed and where the receptors are located.

The senses can be classified into two categories: general senses and
Nervous System
special senses. Various types of simple receptors in the skin, mus-
Major Organs and Structures:
cles, joints, tendons, and organs are used for general senses. These brain, spinal cord, nerves
receptors—located all over the body—detect touch, pressure, stretch, Accessory Structures:
heat, cold, and pain. Special senses involve complex sense organs meninges, sympathetic chain of
ganglia
located only in the head, such as the eye and ear. The special-sense
Functions:
organs are used for taste, smell, hearing, equilibrium, and vision. communication, motor control,
This chapter covers the general and special senses. You will study sensation
the anatomy of the receptors and how the sense is detected. You will
also continue your study of the nervous system by exploring the path-
way for each sense to the brain. Your study begins with the general
senses detected by receptors in the skin.

7.3 General Senses

Learning Outcome
3. Describe the sensory receptors for the general senses in the skin.

There are many ways to classify receptors for the general senses. One
way is by the type of stimulus detected:
• Thermoreceptors detect heat and cold.
• Mechanoreceptors detect touch, vibration, stretch, and pres-
sure. They are stimulated by mechanically disturbing the dendrite
of the neuron. FIGURE 7.1 The nervous system.

• Nociceptors (NO-sih-SEP-torz) are pain receptors that detect tissue injury or

potential tissue injury. These receptors may be stimulated by a chemical, tempera-
ture, or mechanical disturbance.
Following, you will explore the anatomy of receptors in the skin and then examine
the physiology of how they work.

Anatomy of Receptors in the Skin

The skin contains a variety of receptors that vary by anatomy, ___location, and function.
See Figure 7.2 and Table 7.1.

7.3 General Senses 271

FIGURE 7.2 Three skin
receptors: tactile corpuscle,
lamellar corpuscle, and hair
receptors.

Epidermis

Tactile corpuscle

Hair receptors Dermis

Sensory nerve fiber

Hypodermis

Nerve

Adipose tissue Lamellar corpuscle

Spot Check In what layer of the skin are most of the general-sense receptors
located?

Spot Check In the nervous system chapter, you learned about four things that
could stimulate a dendrite of a neuron. Which of the four is not used for general senses?

Physiology of General Senses in the Skin

Learning Outcomes
4. Explain the types of information transmitted by sensory receptors in the skin.
5. Describe the pathway for pain.

The four kinds of information—type of sensation, ___location, intensity, and duration—

transmitted to the brain from the receptors of the general senses are described here:
1. Type of sensation. The brain knows the function of the neuron sending the signal
by the pathway the neuron used. For example, the end point of a pathway for a
bulbous corpuscle detecting pressure is different from that of a free nerve ending
detecting cold.
2. Location. Each neuron in the skin is responsible for detecting a stimulus in a given
area called a receptive field. A single sensory neuron on the back has a much
larger receptive field than the combined fields of many neurons on the fingertip.
Stimulating the neuron anywhere in the receptive field sends the same signal to
the brain. The brain does not differentiate where in the field the stimulus happened
but knows just that it happened in that particular field. So the brain is better able

272 CHAPTER 7 The Nervous System—Senses

 TABLE 7.1 Receptors in the Skin
Name Anatomy Location Function
Free nerve endings Bare dendrites with no Widespread throughout Thermoreceptors for heat
associated connective the skin and mucous and cold
tissue membranes Nociceptors for pain

Tactile corpuscles Two or three nerve fibers Dermal papillae of the skin; Mechanoreceptors for light
among flattened Schwann highly concentrated in the touch and texture
cells, forming a pearlike fingertips and palmar skin
structure

Hair receptors Bare dendrites with no Wrapped around the base Mechanoreceptors for
associated connective of a hair follicle any light touch that bends
tissue a hair

Lamellar corpuscles Single dendrites Deep in the dermis Mechanoreceptors for

surrounded by flattened (especially on the hands, deep pressure, stretch,
Schwann cells that in breasts, and genitals) and vibration
turn are surrounded by
fibroblasts, giving a layered
appearance like tree rings

Bulbous (Ruffini) Long, flattened capsules Dermis of the skin Mechanoreceptors for
corpuscles with a few nerve fibers heavy touch, pressure,
and stretching of the skin

Tactile disks Flattened nerve endings Stratum basale of Mechanoreceptors for

the epidermis next to light touch
specialized tactile cells

7.3 General Senses 273

FIGURE 7.3 Receptive fields:
a two-point discrimination test.
(a) Touching the back with two
points in the same receptive
field is perceived by the brain as
one touch even though the 1 2 3
points are relatively far apart.
(b) Touching the fingertip with Neuron Neuron 1 Neuron 2 Neuron 3
two points the same distance
apart is perceived by the brain
as two touches because it
involves two different receptive
fields (field for Neuron 1 and
field for Neuron 3).

(a) (b)

to distinguish a specific ___location of a stimulus from the fingertips because of the

many neurons with very small fields. See Figure 7.3.
3. Intensity. As explained in “Chapter 6, The Nervous System,” an action potential is
an all-or-nothing effect. Yet sensory neurons do transmit information on the inten-
sity of the stimulus. They do this in three ways:
∙∙ Some receptors are more sensitive than others. If less sensitive receptors are
also sending signals, the stimulus must be intense.
∙∙ The number of signals matters. Therefore, the more receptors stimulated, the
more intense the sensation.
∙∙ The frequency at which the signals are sent makes a difference; the more frequent
the nerve impulses, the more intense the sensation. (You may recall from the
muscular system chapter that this is applicable for motor neurons in the muscular
system as well. The more frequent the nerve impulse, the larger the contraction.)
4. Duration. Some receptors send a burst of signals when first stimulated but then
adapt quickly and slow the frequency of their transmissions. Hair receptors are
good examples of this. You may notice the sensation of your shirt on your back
when you first put it on, but it quickly becomes insignificant. Other receptors such
as lamellar corpuscles are slow to adapt, so you would continue to be aware of a
vibration for a longer period of time.

Pathway for Pain It is time to investigate how a nociceptor for pain works. Pain may
be undesirable, but it is necessary to alert us that something wrong in the body needs
to be addressed. Damaged tissues secrete chemicals, such as bradykinin, prostaglan-
dins, and histamine. These chemicals stimulate a local potential on the dendrites of
nociceptors. Even K+ and ATP released from ruptured cells can stimulate a nociceptor.
If the nociceptor is in the head, cranial nerve V, VII, IX, or X will carry the sensory
message to the brain. If the nociceptor is below the neck, the relevant spinal nerve will
carry the message to the spinal cord. Once at the cord, the signal can take either of two
pathways to ultimately reach the cortex of the parietal lobe. See Figure 7.4. These two
pathway options are the following:
1. The pathway can be the same as any other sensory input from the skin:
Unipolar neuron → spinal cord → medulla oblongata → pons → midbrain
→ thalamus → parietal lobe

274 CHAPTER 7 The Nervous System—Senses

 Parietal lobe FIGURE 7.4 Pathways for
pain. One pathway leads to the
parietal lobe. The other pathway
leads to the hypothalamus and
limbic system.
Thalamus

Hypothalamus and
limbic system

Reticular
formation

Spinal cord

Nociceptor

2. The signal may take a different pathway:

Unipolar neuron → spinal cord → reticular formation → hypothalamus and limbic system

parietal lobe
In the second pathway, the signal travels from the spinal cord to the reticular forma-
tion in the brainstem. The reticular formation filters the sensory signals it receives and
passes on only important messages—like pain signals—to the cerebrum. The reticular
formation sends the pain signal to the parietal lobe directly and to the hypothalamus
and limbic system, where the signal may promote physical and emotional responses
such as nausea and fear.

Spot Check Compare the two pathways for pain as to the destination and type
of response.

Now that you have explored the general senses of the skin, you can move on to the
body’s special senses, starting with taste.

7.4 Taste

Learning Outcome
6. Describe the sensory receptors for taste.

7.4 Taste 275

 Gustation is the term for taste. There are approximately 10,000 taste buds in the human
mouth. Most of the taste buds are on the tongue, but some are found lining the cheeks
and on the soft palate, larynx, and epiglottis. Following, we focus on the anatomy of a
taste bud and the receptors for taste and then explore the physiology of how they work.

Anatomy of Receptors for Taste

The surface of the tongue is covered with bumps called lingual papillae. Many of
them contain multiple taste buds, which are composed of several types of cells. See
Figure 7.5. These cell types include the following:
• Taste cells are banana-shaped and have hairlike microvilli (taste hairs) on their
surface. Taste hairs are exposed to molecules taken into the mouth through a taste
pore of the taste bud. The microvilli are the chemoreceptors for taste. Taste cells are

Papillae

Epiglottis
Taste
Lingual buds
tonsils

Palatine (b)
tonsil

Epithelium
of tongue

Taste cell
Synaptic
vesicles
Taste hair
Basal
cell
(a) Supporting
cell Connective
tissue

Sensory
nerve
Taste fibers
pore

(c)

FIGURE 7.5 The tongue: (a) tongue , (b) lingual papillae , (c) structure of a taste bud.

276 CHAPTER 7 The Nervous System—Senses

 not neurons. They are epithelial cells with sensory neurons at their base. When stim-
ulated by a chemical binding to a receptor on the taste hairs, the taste cell secretes a
neurotransmitter to stimulate the sensory neuron. Taste cells live for about 10 days.
• Basal cells are stem cells in the taste bud that develop to replace taste cells as they die.
• Support cells physically support the 50 to 150 taste cells in the taste bud. They do
not have a sensory role.

Physiology of Taste

Learning Outcomes
7. Describe the different tastes and explain how flavor is perceived.
8. Describe the pathway for taste.

Molecules taken into the mouth must first dissolve in saliva to enter the taste pore and
come in contact with the taste hairs. Five primary tastes are recognized by the taste
cells. Each of the primary tastes can be detected by taste cells throughout the mouth.
The five primary tastes are outlined in the following list:
• Salt. This taste sensation is caused by ions from salts binding to the taste hairs. An
example is table salt (NaCl), discussed in “Chapter 2, Levels of Organization of the
Human Body.” NaCl is an ionically bonded molecule that forms Na+ and Cl– when
dissolved in the water of saliva.
• Sweet. This taste sensation is caused by sugars.
• Sour. This taste sensation is associated with acids.
• Bitter. This taste is associated with alkaloids such as caffeine, nicotine, and quinine
found in tonic water. It is also associated with spoiled food.
• Umami (oo-MOM-ee). This meaty taste is derived from some amino acids binding
to the taste hairs. An example of umami is the taste of beef or chicken broth.
Sensation is the result of a sensory signal sent to the brain. Perception is the way
the brain interprets the sensory information. You know from your own experience that
there is more to tasting food than these five tastes. The immense variety is not simply a
combination effect of mixing the five primary tastes. Other sensory inputs such as tex-
ture, smell, temperature, and even pain (for some peppers) are perceived by the brain
along with taste to produce flavors.

Pathway for Taste Three cranial nerves—the facial nerve, the glossopharyngeal
nerve, and the vagus nerve—carry the sensory messages for taste. The facial nerve
(CN VII) carries sensory messages from taste buds in the anterior two-thirds of the
tongue. The glossopharyngeal nerve (CN IX) carries sensory messages from taste
buds on the posterior one-third of the tongue. The vagus nerve (CN X) carries sensory
messages for taste from the other taste buds in the mouth. The pathway for taste ulti-
mately ends in the association area of the parietal lobe near the lateral sulcus.
Cranial nerve → medulla oblongata → hypothalamus and amygdala
pons → midbrain → thalamus → parietal lobe
The sensory message that takes the path to the hypothalamus and amygdala may
trigger salivation, gagging, and emotional responses to taste.

Spot Check Would the list of cranial nerves used for taste differ from the list of
cranial nerves used for flavors? Explain.

7.4 Taste 277

 7.5 Smell

Learning Outcome
9. Describe the sensory receptors for smell.

The sense of smell is called olfaction. As you have just read, olfaction and taste are
often paired to produce the flavors you experience in foods. Even though the human
body has about 12 million olfactory receptor cells, a human’s olfactory ability is poor
compared to that of most mammals.
Receptors for olfaction are located in the mucous membranes of the roof of the
nasal cavity, called olfactory mucosa. The rest of the mucous membrane lining the
nasal cavity, called respiratory mucosa, has no sensory function. Olfactory cells access
the mucosa through foramen in the cribriform plate of the ethmoid bone (discussed in
the skeletal system chapter).

Anatomy of Receptors for Smell

The 12 million olfactory cells are bipolar neurons. These clublike cells have cilia
called olfactory hairs that have binding sites for odor molecules. The cilia of the
olfactory cell are spread out in the olfactory mucosa. Once odor molecules have initi-
ated a nerve impulse, the messages are carried from the cilia to the bipolar neuron’s
cell body, through the cribriform plate to the olfactory bulb of the olfactory nerve
(CN I). See Figure 7.6. Olfactory cells live for approximately 60 days. Nearby basal
cells develop to replace olfactory cells as they die.

Cribriform
plate
Olfactory
bulb Olfactory area of
nasal cavity
Olfactory
nerve
Nasal
cavity

(a)
Nerve fibers
within the
olfactory bulb

Odor
molecules
Olfactory
Airflow cell
Mucus

Cribriform Cilia Olfactory Columnar

plate receptor epithelial
(b) cells cells

(c) Cilia

FIGURE 7.6 Olfactory receptors: (a) view of the olfactory bulb, cribriform plate, and nasal cavity; (b) close-up view showing the
olfactory bulb and cribriform plate; (c) olfactory cell.

278 CHAPTER 7 The Nervous System—Senses

Physiology of Smell

Learning Outcomes
10. Explain how odors are perceived.
11. Describe the pathway for smell.

Each olfactory cell has one type of receptor to detect one particular odor. The binding
of an odor molecule to the receptor initiates a local potential. If there is a threshold
stimulus at the trigger zone of the olfactory cell, an action potential is generated that
will be passed on to a synapse within the olfactory bulb of CN I.

Spot Check How might a cold affect your ability to taste your food?

Spot Check Some people cannot smell garlic. How does their anatomy differ
from those who can smell garlic?

Pathway for Olfaction The pathway for olfaction is the only special-sense pathway
that does not go through the thalamus on its way to a general sensory area. The gen-
eral sensory area for olfaction is the temporal lobe, while the association area is in the
frontal lobe. It is in the association area that the brain compares the message to what
has come before and identifies the odor.
Bipolar neuron → CN I → temporal lobe (general sensory area) → frontal lobe (association area)

hypothalamus and amygdala

Like other special-sense pathways, the pathway for olfaction splits to carry sen-
sory messages to the hypothalamus and amygdala. Physical reactions initiated by the
hypothalamus include coughing or sneezing, while the amygdala is responsible for
emotional reactions to odors.

7.6 Hearing

Learning Outcome
12. Describe the anatomy of the ear.

Hearing is the interpretation of sound waves traveling in air. To understand hearing,

you first need to understand the characteristics of sound. Sound travels in waves of
air molecules. When a wave of molecules hits a solid object, it causes the solid object
to vibrate. The frequency of waves (how often the waves are coming) determines the
pitch of the sound. Pitch is measured in cycles per second, called hertz (Hz). A sound
whose waves are coming very frequently has a high pitch (treble). A sound whose
waves come at a slower frequency has a low pitch (bass). The most sensitive people
can hear frequencies of 20 to 20,000 Hz, or up to 20,000 vibrations per second. The
average person can hear frequencies of 1,500 to 5,000 Hz, which includes the normal
range for language.
Volume is determined by the size of the sound wave and therefore the size of
the vibration of the solid object. So the bigger the vibration, the louder the volume.
Volume is measured in decibels (dB). Humans can typically hear from 0 to 120 dB.
See Figure 7.7.
The ear is an elaborate sensory organ for hearing. It is also the sensory organ for
equilibrium. You will investigate that special sense later in the chapter. First, consider
the structures of the ear, which are relevant to hearing.

7.6 Hearing 279

FIGURE 7.7 A graph of Threshold
the range of human hearing of pain
in terms of loudness and 120
frequency.
100

Volume (decibels)
Music
80

60 Language

40

20
Any sound
Threshold
0 of hearing

20 50 100 200 500 1,000 2,000 5,000 10,000 20,000

Frequency (hertz)

Anatomy of the Ear

As you can see in Figure 7.8, the anatomy of the ear can be divided into three sections: the
external (outer) ear, the middle ear, and the inner ear. The outer ear consists of the pinna
and the auditory canal. The pinna is an external ear flap composed of elastic cartilage.
It directs sound waves into the ear. The auditory canal leads from an opening in the

Inner ear Middle ear External ear

Tympanic
membrane Temporal
bone

Semicircular
canals
Auditory
canal Pinna
Oval window

Vestibular branch

Auditory nerve

Elastic
Cochlear branch cartilage
Vestibule
Cochlea

Round window

Auditory tube

Stapes Incus Malleus External

auditory
Ossicles of the meatus
middle ear

FIGURE 7.8 The anatomy of the external ear, middle ear, and inner ear.

280 CHAPTER 7 The Nervous System—Senses

temporal bone, called the external auditory meatus, to the tympanic membrane, com-
monly known as the eardrum. The auditory canal is lined with skin and has ceruminous
glands (specialized sweat glands), which produce cerumen (earwax). The sticky ceru-
men coats guard hairs in the canal to deter insects from traveling any farther into the ear.
Cerumen also has lysozymes and a low pH to deter bacteria. The tympanic membrane
separates the outer ear from the middle ear.

Disease P int
An infection anywhere in the outer ear is called otitis externa, better known as
swimmer’s ear. It is usually associated with repeated exposure of the ear to water,
as in swimming. It is typically a bacterial or
fungal infection. An infection in the outer ear
can usually be distinguished from an infection
of the middle ear by pulling on the earlobe. If
the pain increases when the earlobe is pulled,
it is typically an outer-ear infection. If the pain
is still present but does not increase when the
lobe is pulled, it is most likely a middle-ear
infection. ©Corbis/Getty Images

The middle ear contains three tiny bones called ossicles—the malleus, the incus,
and the stapes. Again, see Figure 7.8. The malleus is attached to the tympanic mem-
brane, and it forms a synovial joint with the incus. The incus also forms a synovial
joint with the stapes, the last of the three ossicles. The stapes comes in contact with
a membranous oval window located at the beginning of the inner ear. The auditory
tube, also called the eustachian tube, leads from the middle ear to the nasopharynx.
It is normally flattened and closed, but it opens during yawning or swallowing to
allow air to enter the middle ear. This allows pressure to equalize on both sides of the
tympanic membrane. If you have traveled in an airplane or a fast elevator, you may
be familiar with the feeling of your ears “popping” from the sudden pressure change
experienced when a plane rises or an elevator quickly climbs several stories. Pain can
occur if there is too great a pressure difference between the outer ear and the middle
ear. Swallowing or yawning equalizes the pressure and alleviates the pain.

Disease P int
Otitis media is an infection of the middle ear. Bacteria can gain entry into this space
by way of the auditory tube. The growth of bacteria and the buildup of fluid and pus
from the immune system fighting the infection can increase the pressure in the middle
ear, causing pain. Tubes may be surgically implanted through the tympanic membrane
to drain the fluid and pus from the middle ear. See Figure 7.9. However, care must be
taken when bathing or swimming to avoid getting water in the ear if tubes have been
implanted because this would open an additional gateway for bacteria to enter the
middle ear. Otitis media is usually treated with antibiotics.

The inner ear is a complicated mass of fluid-filled semicircular canals and a spiral
tube embedded in a bony labyrinth (labyrinth means “maze”) of the temporal bone. FIGURE 7.9 A tube inserted
Notice in Figure 7.8 that the auditory nerve (CN VIII) separates into two branches in the tympanic membrane to
in the inner ear. The cochlear branch is for hearing. The vestibular branch is for drain fluid.

7.6 Hearing 281

Oval window

Stapes Unwound cochlea

Incus

Malleus Cochlear
nerve

Tympanic Vestibular
membrane membrane

Auditory Tectorial
canal membrane

Round Spiral organ

window
Basilar
Auditory membrane
tube
Cochlear
duct (contains
endolymph)
Perilymph

FIGURE 7.10 Anatomy of the cochlea unwound.

equilibrium. As you can also see in Figure 7.8, there are semicircular canals in the
inner ear. These canals are not involved with hearing. You will read more about them
later in regard to the sense of equilibrium.
The stapes of the middle ear comes in contact with the vestibule at a membrane
called the oval window. The oval window separates the stapes from a fluid-filled
tube that coils to form a snail-like structure called the cochlea, embedded in the
bony labyrinth. The cochlea is 2½ twists of the fluid-filled tube, which then ends at
the round window of the vestibule. Figure 7.10 shows how this would look if the
cochlea were unwound.
The fluid in the tube (perilymph) is shown in blue in Figure 7.10. This tube
begins at the oval window and extends out for some distance before making a U-turn.
It ends at the round window. Also notice in Figure 7.10 that the tube surrounds another
tube, called the cochlear duct, which is filled with endolymph (shown in pink in
Figure 7.10). The cochlear duct contains hair cells, called such because of stiff micro-
villi on their surface. Hair cells are not neurons, but they have bipolar neurons at their
base much like taste cells have neurons at their base. The hair cells are arranged on the
basilar membrane of the cochlear duct with a stiff tectorial membrane suspended
over them. This arrangement of structures in the cochlear duct is called the spiral
organ or organ of Corti. See Figure 7.11.
Now that you have covered the complex anatomy of the ear for hearing, you are
ready to explore how hearing works.

Physiology of Hearing

Learning Outcomes
13. Explain how sound is perceived.
14. Describe the pathway for hearing.

The physiology of hearing involves converting sound waves outside the head into
action potentials in the bipolar neurons of the cochlear nerve. To understand what that
means, follow the numbered steps in Figure 7.12, which again presents the cochlea
unwound, as you read the explanation here. Sound waves are directed into the auditory

282 CHAPTER 7 The Nervous System—Senses

 Perilymph
Vestibular membrane
Tectorial membrane

Cochlear duct
(filled with
endolymph)
Semicircular
canals Basilar membrane
Cochlear
branch
Perilymph

Vestibule Cochlear ganglion

Oval window (b)

Cochlea

Round window
(a)

Cochlear duct

Vestibular membrane

Tectorial membrane

Microvilli
Cochlear nerve

Supporting
cells
Outer hair Spiral Basilar
Hair cell cells organ membrane
Inner hair
(c) cell
Nerve endings
of cochlear nerve
(d)

FIGURE 7.11 Anatomy of the cochlea: (a) cross section of the cochlea, with perilymph in blue and endolymph of the
cochlear duct in pink; (b) detail of one cross section of the cochlear duct; (c) detail of the spiral organ; (d) detail of a hair cell
and nerve endings of the cochlear branch of the auditory nerve.

canal by the pinna. The waves of air molecules hit the tympanic membrane and cause
it to vibrate (1). Because the malleus is connected to the tympanic membrane, it
too begins to vibrate. That causes the incus and then the stapes to vibrate as well
(2). Vibrations of the stapes are transferred to the oval window of the inner ear (3). So
far, the sound waves outside the head have been converted to mechanical vibrations in
the middle ear and are now being transferred to the inner ear. (But why, then, is a mid-
dle ear even needed? Why not have the oval window serve as the tympanic membrane?
The middle ear is needed because the bones of the middle ear amplify the vibration of
the tympanic membrane 20 times.)
Vibrations of the oval window create waves within the perilymph of the cochlear
tube (4). Each time the stapes pushes in on the oval window, a wave of perilymph starts
on its way around the tube. This eventually causes the round window to bulge, like a
soft water balloon. The perilymph cannot be compressed, so if you push in one side of
the tube, it must bulge out somewhere else. The wave can make it all the way around
the tube if the frequency is slow enough. If the frequency is faster, the wave pushes
on the vestibular membrane, which causes vibrations in the endolymph of the cochlear

7.6 Hearing 283

Oval window
1 2 3
Stapes Sound waves cause The malleus, incus, The oval window
Incus the tympanic and stapes vibrate and vibrates.
membrane to vibrate. amplify the vibrations.
Malleus Cochlear
nerve
3 Vestibular
Tympanic membrane
2
membrane
4 Tectorial
5
membrane
1 6
Spiral organ
Round 7
window Basilar
membrane
Cochlear
duct (contains
endolymph)
Perilymph
4 5 6 7
Vibrations of the oval The wave pushes on the Waves in the endolymph Hair cells release neurotransmitters
window create waves vestibular membrane, which cause the basilar to bipolar neurons of the cochlear
in the perilymph that causes a wave in the endolymph membrane to vibrate, branch and then the wave pushes
cannot be compressed. of the cochlear duct. which bends hair cells. against the round window.

FIGURE 7.12 The effects of sound waves on the cochlea.

Base Apex duct (5). Vibrations in the endolymph cause the basilar mem-
(near oval window) (near end of cochlear duct)
(highest-pitched sounds) (lowest-pitched sounds)
brane to vibrate. The basilar membrane is flexible and can bend
and vibrate, unlike the tectorial membrane of the spiral organ,
1,500 3,000 which is stiff. The hair cells are pushed against the tectorial
Hz
600
Hz membrane and bend each time the basilar membrane vibrates
Hz (6). Hair cells are mechanoreceptors, so each time a hair cell is
bent, it releases a neurotransmitter to the bipolar neuron at its
20,000 200 base to start a local potential. Eventually, the vibrations reach
Hz Hz 800 the round window, where the process ends (7).
Hz
The frequency of the vibrations determines which hair cell
1,000 4,000 of the spiral organ is bent. High-frequency sounds bend hair
Hz Hz
7,000 Hz
cells close to the oval window. Low-frequency sounds bend
5,000 Hz
hair cells farther away from the oval window. So the pitch of
the sound is determined by the hair cell that is bent. How much
the hair cells bend determines the volume of the sound. See
Figure 7.13.

Spot Check Describe where perilymph and

endolymph are found in the ear and explain why they are
7,000 Hz 1,000 Hz 200 Hz
necessary for hearing.
(high-frequency (low-frequency
sounds) sounds) Spot Check It is possible to have arthritis in the joints
FIGURE 7.13 Frequency response of the basilar between ossicles. How might that affect hearing?
membrane in the cochlea.

Pathway for Hearing The pathway for hearing begins with the bipolar neurons at
the base of the hair cells. Their axons form the cochlear nerve that joins with the ves-
tibular nerve to form the auditory nerve (CN VIII). The auditory nerve delivers the
sensory messages to the pons. From there, the messages go to the inferior colliculi of
the midbrain, where the ___location of the source of the sound is perceived. The sensory

284 CHAPTER 7 The Nervous System—Senses

messages then travel to the thalamus, which directs them to the temporal-lobe general
sensory area and association area for hearing.
Bipolar neurons of CN VIII → pons → midbrain (inferior colliculi) → thalamus
→ temporal lobe
The ear is also the sensory organ for equilibrium. We focus next on how equilib-
rium is perceived.

7.7 Equilibrium
Learning Outcome
15. Describe the anatomy of the vestibular apparatus.

The sense of equilibrium is based on the brain knowing where in space the head is
located and how it may be moving. There are two kinds of equilibrium: static equilib-
rium and dynamic equilibrium. Static equilibrium is perceived when the head is sta-
tionary or moving in a straight line. Holding your head still as you are reading, or while
you are accelerating in your car, involves static equilibrium. Dynamic equilibrium is
perceived when the head is rotating. The rotation would be in the transverse plane if
you were spinning in a chair, the coronal plane if you were doing a cartwheel, or the
sagittal plane if you were doing a somersault (forward tuck and roll). See Figure 7.14.
The receptors for both types of equilibrium are located in the vestibular apparatus.

Anatomy of the Vestibular Apparatus

The saccule (SACK-yule) and utricle (YOU-trih-kel) in the vestibule of the inner ear
are used to perceive static equilibrium. The saccule is used to perceive vertical move-
ment of the head, as in going up and down in an elevator. The utricle is used for

(b)

(a) (c)

FIGURE 7.14 Dynamic equilibrium: rotation in the (a) transverse plane, (b) coronal plane, (c) sagittal plane.

7.7 Equilibrium 285

 horizontal movement of the head, as in acceleration in a car. Each of these structures
contains a patch of hair cells called a macule that has a gel-like structure called an
otolithic membrane over the top of the hair cells. See Figure 7.15. Calcium carbon-
ate and protein granules called otoliths (oto means “ear” and liths means “stones”)
are suspended in the gel. As you can see in Figure 7.16, gravity, during a tilt of the
head, causes the otoliths to move in the direction of the force of gravity, which bends
the hair cells. The hair cells are again mechanoreceptors, which, when bent, release a

Vestibule

Utricular Utricle Saccule

macula

Vestibular branch of
the auditory nerve

Saccular
macula

Otoliths
(a)
Otolithic
membrane

Microvilli

Hair cell

Nerve fibers
of vestibular
branch of the
auditory nerve
Hair Supporting
cell cells
(c)
(b) Part of macula

FIGURE 7.15 The saccule and utricle: (a) ___location of the saccule and utricle of the inner ear; (b) anatomy of the macula of the
utricle, with otoliths suspended in an otolithic membrane over hair cells that release neurotransmitters when bent to stimulate
neurons of the vestibular branch of the auditory nerve; (c) a hair cell.

286 CHAPTER 7 The Nervous System—Senses

 Endolymph
in utricle

Force of
gravity

(b)

Vestibular Otolithic Hair cell Supporting

nerve fibers membrane cell

(a) Macula

FIGURE 7.16 The effect of gravity on the macula. (a) In an upright position, the otoliths press equally on the hair cells.
(b) When the head is tilted, the force of gravity causes the otoliths to bend the hair cells of the macula, which then release
neurotransmitters to stimulate neurons of the vestibular branch of the auditory nerve.
(a) ©Hero Images/Getty Images; (b) ©Peter Dressel/Blend Images/Getty Images

neurotransmitter to initiate a local potential in the bipolar neurons at their base. The
axons of these neurons form the vestibular branch of the auditory nerve.
Dynamic equilibrium is perceived from information transmitted by neurons associ-
ated with the semicircular canals. See Figure 7.17. The three semicircular canals are
oriented in different planes to give the brain sensory input concerning rotation of the
head in the transverse, coronal, and/or sagittal planes. Each semicircular canal has a
patch of hair cells called the crista ampullaris located in the bulge at its base, called
the ampulla. The crista ampullaris has a gel cap called the cupula. Each semicircular
canal is filled with fluid called endolymph. When the head rotates, the endolymph
starts flowing in the semicircular canal oriented in that plane. This bends the hair
cells of the crista ampullaris. The hair cells respond by releasing a neurotransmitter
to stimulate a local potential in the bipolar neurons at their base. The axons of these
neurons also form the vestibular nerve.

Physiology of Equilibrium

Learning Outcomes
16. Explain how equilibrium is perceived.
17. Describe the pathway for equilibrium.

The sense of equilibrium is somewhat more complicated than these structures in the
inner ear can sense alone. To create a sense of equilibrium, the brain uses additional
input, such as sight from the eyes and body position from proprioceptors (nerve
endings in muscles, joints, and tendons) and combines it with input from the inner
ear. Many people pay to experience a challenge to the brain’s sense of equilibrium
by buying a ticket for a roller coaster or some other amusement park ride.

7.7 Equilibrium 287

Semicircular
canals
Ampullae
Vestibular
branch

Auditory
nerve
Cupula
Cochlear
branch

(a)

Endolymph in semicircular
canal causes movement
Microvilli of the cupula
Cupula

Cupula

Hair
Crista
cell
ampullaris Hair cell

Crista ampullaris

Nerve fibers
to vestibular
branch of
auditory nerve Movement of semicircular
(b) (c) canal with body movement

(d)

FIGURE 7.17 Semicircular canals: (a) structure of the semicircular canals; (b) detail of the crista ampullaris and hair cell;
(c) action of the endolymph on the crista ampullaris and cupula during rotation shown in (d): as the body moves during rotation,
the semicircular canals move but the endolymph remains stationary (red arrow) in relation to the direction of movement
(blue arrow); (d) rotation in the sagittal plane.
(d) ©Jerry Wachter/Science Source

288 CHAPTER 7 The Nervous System—Senses

 Spot Check What type of equilibrium is involved if a roller coaster has a complete
vertical loop? What anatomy is used to sense the equilibrium while you are making the loop?

Clinical P int
Motion sickness may result if the brain cannot accurately interpret the information it is
receiving. This may happen when you are aboard a boat, in a car, or even in the weight-
less environment of space. Giving the brain additional input, such as staring at the hori-
zon while in the boat or sitting in the front seat of the car to see where you are going,
can help alleviate the symptoms associated with motion sickness, such as nausea.

Pathway for Equilibrium The pathway for sensory messages for equilibrium has
more than one target. It begins with bipolar neurons in the vestibular nerve, which then
merges with the neurons of the cochlear nerve to become the auditory nerve, which
then synapses with other neurons within the medulla oblongata. The four destinations
for these messages are the following:

• Spinal cord, which initiates reflexes if the position of the head changes abruptly.
• Cerebellum, which uses the information to determine the position of the head for
coordination and posture.
• Neurons in cranial nerves III, IV, and VI, which coordinate eye movements. They
can compensate (balance) the movement of the eyes based on the position of the
head and how it may be moving.
• Thalamus, which directs the sensory messages of equilibrium to the frontal and
parietal lobes.

Bipolar neurons of CN VIII → medulla oblongata → pons → cerebellum

→ pons → midbrain → thalamus → frontal lobe

parietal lobe

cranial nerves III, IV, VI

spinal cord

7.8 Vision
The eye is a complicated sensory organ for vision. Unlike any of the other senses,
it uses light to stimulate the receptors for vision, called photoreceptors. To under-
stand the anatomy and physiology of vision, you first need to explore some charac-
teristics of light. Light is emitted from a source (e.g., the light bulb in your room).
The light travels in all directions and is reflected (bounced) off objects in straight
lines. You can “see” only the straight lines of light that enter your eye. It is impor-
tant to understand that light travels in straight lines but can be bent as it passes
through materials of different densities. This phenomenon is called refraction. You
can demonstrate this by putting a pencil in a glass half full of water. Light from the
source reflects off the portion of the pencil in the water differently than it reflects
off the portion of the pencil out of the water, surrounded by air. Water is denser than
air, so the light is refracted and the pencil appears bent. As you explore the anatomy
of the eye, you will see how all of this works.

7.8 Vision 289

 Anatomy of the Eye
Pupil
Learning Outcome
Eyebrow
Upper 18. Describe the anatomy of the eye.
eyelid

Iris
The Orbital Region The eyes are protected
Eyelashes by the eyebrows, eyelids, and eyelashes. The
Sclera eyebrows shade the eyes from the glare of
the sun and help prevent sweat from entering
Tarsal plate the eyes. The eyelids blink periodically to dis-
Lower
eyelid tribute moisture across the surface of the eyes.
Each eyelid contains tarsal glands along its edge
(tarsal plate), which secrete an oil that helps
FIGURE 7.18 Orbital region. lubricate the eye. See Figures 7.18 and 7.20. The
©McGraw-Hill Education/Joe DeGrandis eyelids are also involved in reflexes that prevent foreign matter, like dust or particles
of debris, from entering the eye. The eyelashes, too, help keep debris from entering
the eye.
A lacrimal gland is located deep to the skin, lateral and superior to each eye. See
Figure 7.19. Its function is to produce tears. Tears contain mostly water, to cleanse the
eye, and lysozymes to destroy bacteria in order to prevent an eye infection. The tears are
secreted through ducts, wash over the eye, and are drained through an opening called
the lacrimal punctum at the medial, inferior corner of the eye. From there, they are
drained through a lacrimal canal to the lacrimal sac to the nasolacrimal duct to the
nose. See Figure 7.19.

Spot Check Which would be the best place to administer eyedrops to a patient
to treat an eye infection: the lateral corner of the eye, the middle of the eye, or the
medial corner of the eye?

Spot Check Why does your nose run when you cry?

FIGURE 7.19 Lacrimal gland

and ducts.

Lacrimal gland

Ducts
Lacrimal
canals

Lacrimal sac

Nasolacrimal
duct
Lacrimal
punctum

Nostril

290 CHAPTER 7 The Nervous System—Senses

 FIGURE 7.20 Accessory
Frontal bone
structures of the eye.

Orbicularis oculi muscle

Superior rectus muscle

Tarsal plate

Tarsal glands

Cornea

Conjunctiva

Lateral rectus muscle

Inferior rectus muscle

Figure 7.20 shows another important accessory structure of the eye, the conjunctiva
(kon-junk-TIE-vah). The conjunctiva is a thin, transparent membrane that lines the
eyelids and covers the white, exposed surface of the eye. Its purpose is to secrete a
mucous film to prevent the eye from drying.

Disease P int
Inflammation of the conjunctiva—conjunctivitis—results in redness and pain. A common
form of conjunctivitis is called pink eye. It is a highly contagious bacterial infection
that is treated with antibiotic drops. Two
other forms of conjunctivitis can occur with
newborns delivered through an infected
birth canal. They are neonatal gonorrheal
conjunctivitis and neonatal chlamydial
conjunctivitis. Both of these forms of
conjunctivitis can cause blindness in the
newborn. So all newborns are typically
treated with silver nitrate and antibiotic
drops in the eyes immediately after birth to
prevent either form of conjunctivitis. ©Dr. P. Marazzi/Science Source

Muscles of the Eye Just as there are muscles of the shoulders, neck, and head and
all throughout the body, there are also muscles connected to the eye. Figure 7.21a
shows the muscles that are attached to the eyeball. The muscles are termed rectus if

7.8 Vision 291

FIGURE 7.21 Muscles
of the eye: (a) lateral view, Trochlea
(b) anterior view showing which Superior oblique
cranial nerve controls each eye
Superior rectus
muscle.
Lateral rectus
Inferior rectus

Inferior oblique

(a)

Superior Superior
Trochlear oblique
nerve (IV) rectus
muscle muscle

Lateral Medial rectus

Abducens muscle
rectus
nerve (VI) Oculomotor
muscle
Inferior rectus nerve (III)
muscle

Inferior
oblique
(b) muscle

they directly approach the front of the eye in a straight line, and they are oblique if they
approach the eye at an angle to the front of the eye. The muscles control the movement
of the eyeball. Figure 7.21b shows which cranial nerve controls each muscle.

Spot Check The muscles of the eye and the cranial nerves that stimulate these
muscles can be tested by having the subject move the eye in an “H” pattern. Which eye
muscles move the eye in a transverse, side-to-side motion for the bar of the “H”? Which
cranial nerves stimulate each of these muscles?

The Eyeball The anatomy of the eyeball is shown in Figure 7.22. Refer to the figure
as you read the following text. The wall of the eye is composed of three layers:
• Sclera. The sclera is the outermost layer. It is a tough, fibrous layer that does not
stretch. It can be seen as the white of the eye. The anterior part of the sclera is
transparent. This section is called the cornea. It needs to be transparent to allow
light to enter the eye.
• Uvea. The uvea is the middle layer of the eye’s wall. It consists of three regions:
the choroid layer (KOR-oid), the ciliary body, and the iris. The choroid layer is
dark and has many blood vessels to feed the neurons located on the inner layer of
the eye. It is highly pigmented and dark so that light is absorbed and not reflected
inside the eye. The ciliary body is composed of smooth muscle and forms a ring
around the lens. Suspensory ligaments extend from the ciliary body and suspend
the lens in a capsule. The ciliary body, the suspensory ligaments, and the cap-
sule enclosing the lens form a wall within the eye. The ciliary body also produces
a thin, watery fluid called aqueous humor found in the anterior and posterior
chambers of the eye. Because this fluid is constantly produced, it must constantly

292 CHAPTER 7 The Nervous System—Senses

 Conjunctiva
Vitreous chamber
(filled with vitreous
humor) Cornea

Anterior
Central retinal chamber Both filled
artery and with aqueous
vein Posterior humor
chamber

Pupil
Optic nerve
Lens
Vitreous
humor
Iris

Retina
Suspensory
ligaments

Choroid Ciliary body

layer

Sclera

FIGURE 7.22 Sagittal view of the anatomy of the eye.

be reabsorbed into the blood through a blood vessel called the canal of Schlemm
(not shown in the figure). The iris of the eye is seen as the colored part of the eye.
It is smooth muscle that regulates the size of the pupil, the central opening that
allows light to pass to the lens.
• Retina. The retina is the innermost layer of the eye’s wall. It lines the vitreous
chamber that is filled with vitreous humor, a transparent, gel-like fluid. The
retina contains the photoreceptors and associated neurons important for vision.
The axons of the bipolar neurons come together to leave the retina of the eye to
form the optic nerve.

Disease P int
It is vitally important that the drainage of aqueous humor keeps up with its production.
If more aqueous humor is produced than is drained, pressure builds up in the anterior
portion of the eye. The sclera does not stretch to accommodate the added pressure.
The increased pressure instead pushes on the lens, which pushes on the vitreous
humor, which pushes on the fragile neurons of the retina and compresses the
blood vessels feeding the retina. Without a good blood supply, the neurons on the
retina die. This condition is called glaucoma, and it is a major cause of blindness. A
tonometer can be used in a routine eye exam to determine the intraocular pressure
(pressure inside the eye). Early detection can stop the progression of glaucoma, but
damaged neurons cannot be restored.

7.8 Vision 293

 There are two types of photorecep-
tors in the retina of the eye: rods and
cones. Rods are photoreceptors used for
Choroid gray-scale (noncolor vision) and low-
light conditions. They contain a chemi-
cal called rhodopsin that reacts to light
to initiate a local potential. Cones are
Cone cell
photoreceptors used for color vision
Rod cell and are responsible for the best visual
acuity (sharpest vision). They contain
the chemical iodopsin that reacts to
Bipolar
cell
light to initiate a local potential. Cones
Sensory require more light than rods to function.
retina Cones primarily respond to one color,
either green, red, or blue. However, each
cone will have a mild response to the
Ganglion other two colors.
cell
The rods and cones are deep in the
Nerve fibers Fibers to retina close to the choroid layer. They
optic nerve synapse with bipolar connecting neu-
Impulses to Vitreous humor rons, which synapse with still another
optic nerve
layer of neurons called ganglion cells.
The axons of these cells form the optic
nerve. Light must pass through the lay-
ers of neurons to reach the rod and cone
Light waves photoreceptors. See Figure 7.23.
FIGURE 7.23 Neurons of the retina.

Applied Genetics
Color blindness is a genetic disorder that affects the cones in the retina, resulting in an
inability to see color. Color blindness is an X-linked (sex-linked) trait, meaning that the
defective gene for color blindness is carried on the X chromosome. Because the defec-
tive gene is on the X chromosome, the disorder occurs mostly in males. You will learn
more about sex-linked traits in the cardiovascular system chapter on blood.
©MOLEKUUL/SPL/age fotostock

Clinical P int
Color blindness can be diagnosed using a series of
colored plates called the Ishihara test. Shown here is
an example of an Ishihara test plate. If a person looks
at the series of color plates and cannot identify the
numbers, that may be an indication of color blindness.

©Steve Allen/Getty Images

There is a difference in the amount and distribution of rods and cones in the retina.
More specifically, there are approximately 120 million rods, or 10 to 20 times more
rods than cones, in the retina. If you use an ophthalmoscope to look at the retina at

294 CHAPTER 7 The Nervous System—Senses

 FIGURE 7.24 The
retina as seen through an
Artery ophthalmoscope. (a) A direct
ophthalmoscope shines a fine
Veins beam of light into the eye, so
Macula
lutea
the examiner sees a magnified
Optic image of the retina where the
disc Fovea
centralis beam falls; (b) diagram of the
retina.
(a) ©Steve Allen/Getty Images

(a) (b)

the back of the eye as shown in Figure 7.24, you can see three distinct areas: the optic
disc, the macula lutea, and the fovea centralis.
• Optic disc. The optic disc is the area where blood vessels enter the eye and the
axons forming the optic nerve leave the eye. It is located medially on the retina.
There are no receptor cells at the optic disc, so it is a functional blind spot.
• Macula lutea. The macula lutea is located on the retina directly posterior to the
center of the lens. The macula lutea has more cones than rods.
• Fovea centralis. The fovea centralis appears as a small depression in the center of
the macula lutea. It contains only cones, so it is the area of sharpest vision. As you
read this, you are now moving your eyes across the page to make sure the letters
are focused on the fovea centralis in each of your eyes.
The rest of the retina contains a mixture of rods and cones, which allows you to see
the color of objects focused anywhere in your field of vision whether you are looking
directly at the object or not.

Spot Check You are sitting outside in the evening as it is getting dark. Predict
what would be easier: determining the shape of a car driving by or determining whether
the color of the car is dark blue or black. Explain in terms of the photoreceptors involved.

You have covered the anatomy of the eye and the photoreceptors involved. Next, you
will see how the anatomy and photoreceptors work together to provide a sense of vision.

Physiology of Vision

Learning Outcomes
19. Explain how vision is perceived.
20. Describe the pathway for vision.

To understand how the physiology of vision works, look at the two examples in
Figure 7.25. In Figure 7.25a, a stop sign is shown at a distance (indicated by the bro-
ken lines). Light reflected off the top of the stop sign strikes the cornea and is refracted
because the cornea is a different density than the air. The light passes through the
aqueous humor and then through the lens, where it is again refracted. The light passes
through the vitreous humor and is projected low on the retina. At the same time, light
reflected from the bottom of the stop sign travels in a straight line too. It hits the cornea
and is also refracted. This light then passes through the aqueous humor and is refracted
by the lens as it passes through the vitreous humor to be projected high on the retina.
As you can see in Figure 7.25a, the image of the stop sign on the retina is clear and
focused but upside down. All images are projected on the retina upside down, which is

7.8 Vision 295

FIGURE 7.25 Focus and Distant vision
accommodation by the eye:
(a) distant vision, (b) near vision. Ciliary muscles in the
ciliary body are relaxed

Tension in suspensory
ligaments is high

FP

Lens flattened

(a)
Near vision

Ciliary muscles in the

ciliary body contract, moving
ciliary body toward lens

Tension in suspensory
ligaments is low

FP

Lens thickened

(b)

okay because the retina is not actually interpreting the information. It is the association
area in the occipital lobe that interprets the visual signals.
In this case, the smooth curve of the cornea and the smooth curve of the lens have
refracted the light to perfectly focus it on the retina. If the cornea and lens focused the
image ahead of the retina, the condition is called myopia (nearsightedness). If the cornea
and lens focused the image behind the retina, the condition is called hyperopia (farsight-
edness). Either condition can be corrected with artificial lenses or refractive surgery to
reshape the cornea to act as a lens. If the cornea or the lens is not a perfectly smooth curve,
the light rays will not refract correctly to produce a clearly focused image on the retina.
This condition is called an astigmatism. It too can be corrected with artificial lenses.

Clinical P int
Distance vision can be measured during a routine eye exam
using a vision test called the Snellen test. The Snellen chart
shown here tests how well one can see (visual acuity) at a
distance of 20 feet.

©Creatas/PunchStock/Getty Images

296 CHAPTER 7 The Nervous System—Senses

 Now compare the near-vision example in Figure 7.25b with the example you just
reviewed for distant vision. Notice that the image of the “A” in the near-vision example
is clear, focused, and upside down on the retina. It is larger for near vision because the
object is closer. The eye has to accommodate for the change in distance to keep the
image in focus on the retina. It does that by changing the shape of the lens. For distant
vision, the ring of ciliary muscles around the lens is relaxed (Figure 7.25a). This cre-
ates tension in the suspensory ligaments that hold the lens in place. The tension pulls
on the lens from all sides, causing it to become thinner. But in the near-vision example
(Figure 7.25b), the ciliary muscles contract to take tension off the suspensory liga-
ments, allowing the lens to become thicker. Thus, the eye is able to change its focus
so that the image of the “A” is perfectly focused on the retina whether it is near or far.
This ability is called accommodation.
You have now seen the “A,” but how do you locate it in space? Humans have two
eyes to view objects. This is called binocular vision. As you can see in Figure 7.26,
the occipital lobe has two sets of sensory messages coming in from different angles,
one set from the right eye and one set from the left eye. Binocular vision allows the
brain to have depth perception, knowing where the object is located in space. You
can witness this by holding a small tube in front of someone and having that person
quickly insert his or her pencil in the tube, first with both eyes open and then with one
eye closed. It is much easier to insert the pencil into the small opening if both eyes are
open because of binocular vision and depth perception.

FIGURE 7.26 Pathway for

binocular vision from both
eyes to the visual cortex of the
occipital lobe.

Eye
Optic
nerve Fibers from
medial half
of each retina
crossing over
Optic
chiasma
Optic tract

Thalamus

Visual cortex of
occipital lobe

7.8 Vision 297

 Spot Check You have injured your eye and now need to wear a patch over it
while it heals. What activities should you avoid while wearing the patch because of the
loss of vision in that eye?

By studying the anatomy of the eye and properties of light, you know that light
enters the eye, is refracted by the different mediums it passes through, and is projected
on the retina. The light penetrates the retina to activate the rods and cones to start local
potentials. The rods work in low-light conditions, and the cones detect color if there
is sufficient light. The rods and cones stimulate connecting neurons, which further
stimulate other neurons whose axons leave the eye to form the optic nerve. Following,
we look at the pathway from this point.

Pathway for Vision Notice in Figure 7.26 that the two optic nerves (CN II) come
together at the optic chiasm (KYE-asm) (or chiasma) inferior to the hypothalamus.
At the optic chiasm, some of the nerve fibers from each nerve cross to the other side to
form optic tracts. Therefore, each optic tract contains neurons carrying messages from
both eyes. The optic tracts continue to the thalamus before going on to the occipital
lobe’s general sensory and association areas for vision. Some of the neurons carry
sensory messages to the superior colliculi of the midbrain, where visual reflexes are
controlled.
Optic nerve → optic chiasm → optic tracts → thalamus → occipital lobe
superior colliculi of midbrain

7.9 Effects of Aging on the Senses

Learning Outcome
21. Describe the effects of aging on the senses.

As you age, the general and special senses are affected, causing a gradual change in
the way you experience the various senses. It is not always readily apparent if aging
itself or lifestyle choices and disease are the cause of the changes.

Changes in the General Senses

In terms of noticeable differences in the general senses, there may be a changed sensation
of pain, vibration, cold, heat, pressure, and touch. Pain sensitivity is reduced usually after
age 50. An individual may be aware of the sensation, but it does not bother her as much
as it would have at an earlier age. Elderly individuals may not be able to differentiate
between cool and cold or warm and hot as easily as when they were younger. Light-touch
sensitivity, however, may be increased due to the thinning of the skin.

Changes in Taste
The number and size of taste buds decrease beginning about age 50. A decrease in
the sensitivity to taste usually occurs about age 60. With this decreased sensation, the
interest in food may diminish as well. Lifestyle choices such as smoking and diseases
such as diabetes may be the cause of the changes in taste perception.

Changes in Smell
The number of nerve endings in the human nose typically decreases by age 70. This
may further decrease the perception of flavors of food. Again, environmental, lifestyle,

298 CHAPTER 7 The Nervous System—Senses

and/or disease factors may be as responsible as aging, or even more responsible, for
the decrease in sensitivity of this sense.

Changes in Hearing
Hearing is affected by aging. It is estimated that 30% of people over age 65 have sig-
nificant hearing loss.1 The loss most often involves high-frequency sounds. Repeated
exposure to loud noise over a lifetime may account for the loss. Hearing acuity (or
sharpness in hearing) typically starts to diminish at about age 50. The tympanic mem-
brane thickens with age and becomes less flexible, which diminishes the conduction
of vibrations. Tinnitus (ti-NAHY-tuhs), a persistent abnormal ear ringing or roaring
noise, is common in older people due to mild hearing loss.

Changes in Equilibrium
The brain uses many sensory clues to sense body position, and an aging effect on any
of these sensory clues affects equilibrium. As you age, it becomes more difficult for
the brain to adapt to the changing input. For example, age-related changes in the inner
ear and the vestibular nerve can affect the sense of equilibrium. This makes walking
more difficult, which is why falls are more common among the elderly. It is also why
roller coasters affect us more as we age.

Changes in Vision
Vision is affected by aging. Fewer tears are produced, making the eyes drier and more
uncomfortable. The lens becomes less flexible and cloudy, making the sun’s glare or
bright lights more of a problem. The iris is not as fast at changing the size of the pupil
in response to changes in the amount of light. Insoluble proteins called floaters may
form in the fluid of the eye. The ciliary muscles and suspensory ligaments are less able
to accommodate the shape of the lens with age, creating a condition called presbyopia.
The onset of this decreased ability to accommodate is dramatic at about age 40. Dis-
tance vision is not affected with presbyopia, but corrective lenses (reading glasses) may
be required for near vision.

Disease P int
Age-related macular degeneration (AMD) is a disease of the eye in which the cells
of the central portion of the retina (macula lutea) degenerate, eventually causing
vision loss. Age-related macular degeneration is the leading cause of vision loss in
people ages 50 and older. The most common symptom of AMD is a blurred area of
vision near the center of the visual field. As the disease progresses, the blurred area
grows larger, objects are not as bright as they once were, and blank spots may appear
in the central vision. There is no cure for AMD, and age and heredity are major risk
factors for the disease. However, there are lifestyle choices such as avoiding smoking,
regular exercise, proper diet, and control of blood pressure and cholesterol that can
reduce a person’s risk of developing AMD or slow its progression.

7.10 Diagnostic Tests for Disorders of the Senses

Learning Outcome
22. Describe common diagnostic tests used to diagnose disorders of the senses.

Before you explore the disorders in this chapter, look at Table 7.2, which describes com-
mon diagnostic tests and procedures for disorders of the senses of the nervous system.

7.10 Diagnostic Tests for Disorders of the Senses 299

 Common Diagnostic Tests for Disorders
TABLE 7.2
of Senses of the Nervous System
Diagnostic Test or Screening Description
Ishihara test A test for color blindness

Rinne test Procedures in which a tuning fork is used to test for

Weber test hearing loss

Snellen test An eye chart used to measure visual acuity

Tonometry A procedure that measures the pressure inside the eye

You have already learned about tonometry, which is used to detect glaucoma; the
Ishihara test, which tests for color blindness; and the Snellen test, which is used to
assess visual acuity. These tests and other common diagnostic procedures for this
system are listed in Table 7.2.

7.11 Disorders of the Senses

Learning Outcome
23. Describe disorders of the senses and relate abnormal function to the pathology.

Hearing Loss
The two types of hearing loss—conductive and sensorineural—are dependent on the
___location of the problem.
• Conductive hearing loss. Conductive hearing loss is caused by a lesion in the
external (outer) or middle ear, preventing the proper conduction of vibrations
to the inner ear. This could be anything from a thickened or ruptured tympanic
membrane, to impacted cerumen against the tympanic membrane, to arthritis in
the joints of the ossicles of the middle ear.
• Sensorineural hearing loss. Sensorineural hearing loss is caused by a problem
with the organ of Corti or the auditory nerve.
Conductive and sensorineural hearing loss can be determined by testing hear-
ing by air and bone conduction. A tuning fork is used in both tests. The Rinne test
involves placing a vibrating tuning fork close to the ear. Sound waves produced
by the fork are normally received by the ear through the air to the outer ear, and
then the vibrations should be conducted to the middle ear. The Weber test involves
placing the base of a vibrating tuning fork on the bone of the skull behind the
ear, causing the inner ear to vibrate directly. If the person cannot hear the sound
produced by the tuning fork through the air but can hear it when the tuning fork is
placed on bone, the problem is not with the organ of Corti or the auditory nerve.
Instead, this result indicates a conduction problem and conductive hearing loss. If
the subject cannot hear in either case, the problem is sensorineural and possibly
conductive hearing loss.

Spot Check Explain the differences in how a Rinne test and a Weber test are
performed. What do the results of these tests indicate?

300 CHAPTER 7 The Nervous System—Senses

 FIGURE 7.27 Cataract.
©Dr. P. Marazzi/Science Source

Cataracts
A cataract is a clouding of the lens of the eye that causes a progressive, painless loss
of vision. See Figure 7.27. It can occur at any age but is most commonly associated
with getting older. Cataracts may be caused by aging, exposure to X-rays, infection,
diabetes mellitus, and even some medications. Surgery may be used to remove the
clouded lens and replace it with an artificial lens.
Table 7.3 summarizes all of the diseases and disorders described throughout the
chapter.

TABLE 7.3Summary of Diseases and Disorders of the Senses

in the Nervous System
Disease/Disorder Description
Age-related macular A disease of the eye in which the cells of the central portion of the retina (macula lutea)
degeneration (AMD) degenerate, eventually causing vision loss
Cataract A progressive loss of vision due to the clouding of the lens of the eye
Color blindness A genetic disorder that results in the inability to see certain colors
Conductive hearing loss Hearing loss caused by a lesion in the outer or middle ear that prevents the proper
conduction of vibrations to the inner ear
Conjunctivitis Inflammation of the conjunctiva
Glaucoma Increased intraocular pressure
Myopia/hyperopia/ Various shapes of the eye that affect vision
astigmatism
Presbyopia An inability of the eye to accommodate for near and far vision that occurs with aging
Otitis externa Infection of the outer ear (swimmer’s ear)
Otitis media Infection of the middle ear
Sensorineural hearing Hearing loss caused by a problem with the organ of Corti or the auditory nerve
loss

Spot Check Compare and contrast hyperopia and presbyopia.

7.11 Disorders of the Senses 301

Summary
7.1 Word Roots and Combining Forms
∙∙ S
 ee the heading at the beginning of the chapter to learn the medical terminology that relates to the nervous
system senses.

7.2 Overview
∙∙ G
 eneral senses are touch, pressure, stretch, heat, cold, and pain. Receptors for general senses are located throughout
the body.
∙∙ Special senses are taste, smell, hearing, equilibrium, and vision. Special sense organs are located in the head.

7.3 General Senses

Anatomy of Receptors in the Skin
∙∙ General senses are detected by thermoreceptors, mechanoreceptors, and nociceptors.

Physiology of General Senses in the Skin

∙∙ The neurons for general senses send messages on the type, ___location, intensity, and duration of the sensation.
∙∙ The pathway includes cranial nerves if the general sense is located in the head. The pathway includes the spinal
nerves and spinal cord if the general sense is located below the head.
∙∙ Messages sent to the hypothalamus and amygdala may initiate visceral and emotional responses.

7.4 Taste
Anatomy of Receptors for Taste
∙∙ T he special sense organ for taste is the taste bud. Taste buds are located mostly on the tongue.
∙∙ Taste cells have taste hairs that are chemoreceptors.

Physiology of Taste
∙∙ T here are five primary tastes: salt, sweet, sour, bitter, and umami.
∙∙ Other sensory inputs are used to produce the sensations of flavors.
∙∙ The pathway for taste uses three cranial nerves and ends in the parietal lobe.

7.5 Smell
Anatomy of Receptors for Smell
∙∙ O lfactory cells are bipolar neurons.
∙∙ Olfactory cells access the olfactory mucosa of the roof of the nasal cavity through the foramen of the
cribriform plate.
∙∙ Olfactory hairs are chemoreceptors.

Physiology of Smell
∙∙ T
 he pathway for smell involves the olfactory nerve and does not go through the thalamus on its way to the
frontal lobe.

7.6 Hearing
Anatomy of the Ear
∙∙ F requency of sound waves, measured in hertz, determines pitch.
∙∙ Volume is measured in decibels.
∙∙ The ear can be divided into three sections: the external (outer) ear, the middle ear, and the inner ear.

Physiology of Hearing
∙∙ S ound waves are directed into the auditory canal and cause the tympanic membrane to vibrate.
∙∙ The tympanic membrane causes the ossicles of the middle ear to vibrate.

302
∙∙ T he stapes causes the oval window to vibrate.
∙∙ Waves of perilymph, caused by the vibrations of the oval window, cause the basilar membrane to vibrate.
∙∙ The vibrating basilar membrane pushes hair cells against the tectorial membrane of the organ of Corti, initiating a
local potential.
∙∙ Pitch is determined by which hair cell is bent.
∙∙ Volume is determined by how much hair cells are bent.
∙∙ The pathway for hearing starts with the auditory nerve and ends in the temporal lobe.

7.7 Equilibrium
Anatomy of the Vestibular Apparatus
∙∙ T he receptors for equilibrium are housed in the vestibular apparatus of the inner ear.
∙∙ Mechanoreceptors in the saccule and utricle detect static equilibrium.
∙∙ Mechanoreceptors in the semicircular canals detect dynamic equilibrium.

Physiology of Equilibrium
∙∙ The pathway for equilibrium has many destinations.

7.8 Vision
Anatomy of the Eye
∙∙  he eye uses photoreceptors to detect light.
T
∙∙ Rectus and oblique muscles stimulated by CN III, IV, and VI move the eye.
∙∙ The wall of the eye has three layers: the sclera, the uvea, and the retina.
∙∙ There are two types of photoreceptors in the eye: rods and cones.
∙∙ Rods function well in low light and do not detect color.
∙∙ Cones require more light and detect color. They offer the sharpest vision.
∙∙ There are more rods than cones on the retina.
∙∙ The rods and cones are not evenly distributed. The fovea centralis has only cones.

Physiology of Vision
∙∙  ight travels in straight lines and is refracted as it passes through materials of different densities.
L
∙∙ Objects are projected upside down on the retina.
∙∙ Binocular vision allows for depth perception.
∙∙ The pathway for vision starts with the optic nerve and ends with the occipital lobe.

7.9 Effects of Aging on the Senses

In general, the senses are affected by aging, but it is not always clear if it is aging itself or lifestyle choices, environmen-
tal exposures, and/or diseases that are actually responsible. Most sensory ability decreases with age, with some senses
being more affected than others.

7.10 Diagnostic Tests for Disorders of the Senses

∙∙ C
 ommon diagnostic tests for nervous system disorders of the senses include the Ishihara test, the Rinne and Weber
tests, the Snellen test, and tonometry.

7.11 Disorders of the Senses

∙∙ C onductive hearing loss is caused by a lesion in the outer or middle ear that prevents the proper conduction
of vibrations to the inner ear.
∙∙ Sensorineural hearing loss is a problem with the organ of Corti or the auditory nerve.
∙∙ A cataract is a clouding of the lens of the eye that causes a progressive, painless loss of vision.

303
Key Words for Review
The following terms are defined in the glossary.

accommodation myopia refraction

dynamic equilibrium nociceptor sensorineural
gustation olfactory static equilibrium
humor otoliths umami
hyperopia perilymph vestibular apparatus
lacrimal presbyopia visual acuity
lingual receptive field

304
 8 The Endocrine
System
You may have heard about the
“raging hormones” of teenagers or
a woman “acting hormonal” after a
pregnancy, but hormones produced
by the endocrine system affect the
homeostasis of the body in many
different ways on a daily basis
throughout life for both sexes.
See Figure 8.1.
©Hero Images/Getty Images

Module 8: Endocrine System

305
 8.1 Word Roots and Combining Forms
Learning Outcome
1. Use medical terminology related to the endocrine system.

aden/o: gland crin/o: secrete hormon/o: hormone

adren/o: adrenal glands dips/o: thirst pancreat/o: pancreas
adrenal/o: adrenal glands gluc/o: sugar ster/o: steroid
andr/o: male glyc/o: sugar thyr/o: thyroid gland
cortic/o: cortex gonad/o: sex glands

Endocrine System
8.2 Overview
Major Organs and Structures:
pineal gland, hypothalamus,
pituitary gland, thyroid gland, Learning Outcome
adrenal glands, pancreas,
testes, ovaries 2. C
 ompare and contrast the endocrine and nervous systems in terms
Functions: communication, of type, specificity, speed, and duration of communication.
hormone production

Like the nervous system, the endocrine system is all about communi-
cation. It involves one part of the body communicating with another
part of the body to maintain homeostasis. There are similarities and
differences between the two systems. See Figure 8.2. Both systems use
chemicals as messengers; the nervous system uses chemical neurotrans-
mitters, and the endocrine system uses chemicals called hormones to
carry messages. As you will remember, the nervous system responds
to a stimulus with very fast, electrical action potentials that result in
the release of neurotransmitters. Also, the nervous system can be very
specific by targeting just a few cells of a muscle. The effects of this
communication can be stopped immediately if the nervous system stops
sending nerve impulses. In contrast, the endocrine system responds to
a stimulus by producing a chemical hormone and secreting it outside
the gland that produced it. The blood carries this hormone throughout
the body. The hormone will work not just on a few cells but on all of the
FIGURE 8.1 The endocrine cells that have a receptor for it. The effects of the hormone will continue
system.
until it has been cleared from the target tissue. Communication through

FIGURE 8.2 Neurotransmitter

Communication of the
nervous and endocrine
systems. (a) A neuron Nerve impulse
communicates by using
action potentials to Target cells
deliver neurotransmitters
to the specific target
tissue. (b) Endocrine (a)
cells secrete a hormone Endocrine cells Target cells Hormone in
that is taken up into bloodstream
the bloodstream
through capillaries
and delivered to a
general target tissue,
where the hormone
leaves the capillaries
(b)
to fit into receptors.

306 CHAPTER 8 The Endocrine System

the endocrine system is much slower to start, is less specific as to its target, and takes
longer to end than communication by the nervous system.
In this chapter, you will investigate the anatomy of the endocrine system includ-
ing the major glands, hormones, and target tissues. You will study how hormones
are regulated, distributed, and eliminated from the body. You will also learn how
target tissues regulate their sensitivity to hormones. This chapter explores four sce-
narios that will help you understand and see the interaction of glands and their hor-
mones as it relates to their function. Finally, you will cover the effects of aging on
the endocrine system and a few endocrine system disorders.
Your study begins with the anatomy of the endocrine system.

8.3 Anatomy of the Endocrine System

Learning Outcome
3. Define gland, hormone, and target tissue.

The anatomy of the endocrine system is fairly simple. The system is composed of
glands that make chemicals called hormones that travel to target tissues to tell them to
do something. A gland may be a separate structure, or it may be made up of groups
of cells within an organ that function together to produce hormones. The hormones
produced by the gland are secreted outside the cells that produce them. There are no
special ducts to carry the hormones to their destinations. Instead, the bloodstream is
the transportation system. Once secreted by the gland, the hormones are picked up by
the blood and travel everywhere the blood travels—to the liver, the eye, even the big
toe. Although a hormone travels everywhere, it has an effect only on its target tissue
because the cells of the target tissue have receptors for that specific hormone.

Spot Check The hormone insulin targets most tissues in the body. What do all
of the target cells for insulin have in common?

Spot Check Can the pancreas target specific cells to respond to insulin?

Glands

Learning Outcomes
4. L
 ist the major hormones—along with their target tissues and functions—of each of the
endocrine system glands.
5. Locate and identify endocrine system glands.

The glands of the endocrine system are shown in Figure 8.3. For a list of the glands
and their hormones, target tissues, and functions, see Table 8.1.

Pineal Gland This gland is named pineal because it resembles a pine cone. It
is located beneath the posterior end of the corpus callosum in the brain. The com-
plete function of the pineal gland is not known, although it may have a function in
establishing sleep-wake cycles of daily biological rhythms. What is known is that
the pineal gland reaches its maximum size between the ages of 1 and 5 and usually
shrinks to one-fourth that size by the end of puberty. The hormone melatonin pro-
duced by the pineal gland is believed to suppress gonadotropin-releasing hormone
(GnRH) from the hypothalamus. You will learn more about this hormone in one of
the scenarios later in the chapter.

8.3 Anatomy of the Endocrine System 307

FIGURE 8.3 Endocrine
system glands. Hypothalamus

Pineal gland
Pituitary gland

Parathyroid gland Thyroid gland

(posterior side of
thyroid gland)

Adrenal gland

Pancreas

Ovary
(in female)

Testis
(in male)

Hypothalamus and Pituitary Gland You will study these two glands together
because their functions are closely linked. The pituitary gland has two parts—the anterior
pituitary and the posterior pituitary—that have very different jobs dependent on the
hypothalamus. The hypothalamus plays a major role as a gateway for the brain to
control the endocrine system.

TABLE 8.1 Glands, Hormones, Target Tissues, and Functions

Gland Hormone Target Tissue Function
Pineal Melatonin Brain Helps regulate daily biological rhythms;
Hypothalamus inhibits GnRH production
Hypothalamus GnRH (gonadotropin- Anterior pituitary Stimulates secretion of FSH and LH
releasing hormone)
CRH (corticotropin- Anterior pituitary Stimulates secretion of ACTH
releasing hormone)
TRH (thyrotropin- Anterior pituitary Stimulates secretion of TSH
releasing hormone)
GHRH (growth Anterior pituitary Stimulates secretion of GH
hormone–releasing
hormone)

308 CHAPTER 8 The Endocrine System

 TABLE 8.1 Glands, Hormones, Target Tissues, and Functions (continued)
Gland Hormone Target Tissue Function
Anterior TSH (thyroid-stimulating Thyroid Stimulates secretion of thyroid hormone and
pituitary hormone) growth of the thyroid
ACTH Adrenal cortex Stimulates secretion of glucocorticoids
(adrenocorticotropic and growth of the adrenal cortex
hormone)
FSH (follicle-stimulating 1. Ovaries 1. Stimulates secretion of estrogen
hormone)
2. Testes 2. Stimulates sperm production
LH (luteinizing 1. Ovaries 1. Stimulates ovulation
hormone)
2. Testes 2. Stimulates secretion of testosterone
GH (growth Liver, bone, cartilage, Stimulates widespread tissue growth
hormone) muscle, adipose tissue
Posterior ADH (antidiuretic Kidneys Increases water retention
pituitary hormone)

Oxytocin 1. Uterus 1. Stimulates uterine contractions

2. Lactating breasts 2. Stimulates release of milk
Thyroid T3 and T4 (thyroid Most tissues Elevates metabolic rate; increases heart and
hormone) respiration rates; stimulates appetite
Calcitonin Osteoblasts Stimulates bone deposition
Parathyroids PTH (parathyroid 1. Osteoclasts 1. Stimulates bone reabsorption to increase
hormone) blood calcium levels
2. Kidneys 2. Stimulates reabsorption of calcium by the
kidneys to maintain blood calcium levels
3. Small intestine 3. Stimulates calcium absorption
Pancreas Insulin Most tissues, liver Stimulates cells to take in glucose to lower
blood glucose levels; tells liver to store
glucose as glycogen
Glucagon Liver Stimulates glycogen conversion to glucose and
then its secretion to raise blood glucose levels
Adrenal Mineralocorticoids Kidneys Promote sodium (Na+) and water reabsorption;
cortex (aldosterone) promote potassium (K+) excretion; maintain
blood volume and pressure
Glucocorticoids Most tissues Stimulate the breakdown of protein and
(cortisol) fat to make glucose; suppress the immune
system; reduce inflammation
Androgens Most tissues Precursors to testosterone, responsible for
(dehydroepiandrosterone male secondary sex characteristics and for
[DHEA]) sex drive in both sexes

Adrenal Epinephrine Most tissues Raises metabolic rate; increases heart and
medulla respiration rates; increases blood glucose levels
(complements sympathetic nervous system)
Ovaries Estrogen Most tissues Stimulates female secondary sex characteristics;*
regulates menstrual cycle and pregnancy
Testes Testosterone Most tissues Stimulates male secondary sex characteristics,†
sex drive, and sperm production
Other Prostaglandins Many tissues Have a variety of functions, such as relaxing
tissues smooth muscle in respiratory airways and
blood vessels and causing contraction of
smooth muscle in the uterus

*Female secondary sex characteristics include breast development, axillary and pubic hair growth, menstruation, and fat deposition.
†Male secondary sex characteristics include muscle and skeletal development, deeper voice, aggression, and facial, axillary, and pubic hair growth.
 Spot Check Name and list the functions of all of the hormones that target the
kidneys.

The hypothalamus is connected to the pituitary gland’s two parts by a stalk called
the infundibulum, which serves as a passageway. Hormones produced by endocrine
cells in the hypothalamus enter the blood through the capillary beds in the hypothala-
mus. The blood and hormones are carried through the infundibulum in a portal vessel
(blood vessel directly connecting two capillary beds) to capillary beds in the anterior
pituitary. Hormones can then leave the bloodstream to bind to their receptors in the
anterior pituitary. This system of blood vessels allows for the direct distribution of
hormones through the blood from the hypothalamus to the anterior pituitary without
traveling to the rest of the body. Hormones from the hypothalamus directly affect the
release of hormones from the anterior pituitary. See Figure 8.4.

Hormones from Hypothalamus

GHRH TRH CRH GnRH

Growth Thyrotropin- Corticotropin- Gonadotropin-
Capillary hormone– releasing releasing releasing
releasing hormone hormone hormone
hormone

Hormones from Anterior Pituitary

GH TSH ACTH LH FSH

Capillary Growth Thyroid- Adrenocorticotropic Luteinizing Follicle-
hormone stimulating hormone hormone stimulating
hormone hormone

Bone Muscle Adipose Thyroid Adrenal Ovary Testis

tissue cortex

FIGURE 8.4 Hypothalamus–anterior pituitary target-tissue relationship. Hormones from the hypothalamus enter the
bloodstream and target the anterior pituitary, stimulating the release of hormones from the anterior pituitary into the bloodstream
to travel to their target tissues.

310 CHAPTER 8 The Endocrine System

 Spot Check What is common in the naming of hormones produced by the
hypothalamus that target the anterior pituitary?

The connection between the hypothalamus and the posterior pituitary is very dif-
ferent from that of the hypothalamus and the anterior pituitary. Groups of neuron cell
bodies (nuclei) in the hypothalamus produce antidiuretic hormone (ADH) and oxyto-
cin. These two hormones are delivered by axonal transport through the infundibulum
to the posterior pituitary, where they are stored. Nerve signals from the hypothalamus
travel through the infundibulum and trigger the release of ADH and oxytocin from the
posterior pituitary when they are needed. Although these two hormones are techni-
cally made in the hypothalamus, they are referred to as posterior pituitary hormones
because they are released from there. See Figure 8.5.

Thyroid Gland This gland, which resembles a bow tie, is anterior and lateral to the
trachea and just inferior to the larynx. T3 and T4 are two forms of the principal hor-
mone produced by the thyroid, which is called thyroid hormone. Their function is to
increase metabolism in most tissues. Calcitonin is also produced in the thyroid gland.
It functions to stimulate the deposition of calcium in the bone, making it more relevant
for children than adults.

Common Misconception
Calcitonin and T3 and T4 are hormones made by the thyroid gland, but only T3 and T4
are referred to as thyroid hormone.

Thyroid hormone is vital to metabolism regulation in the body. The production of

this hormone requires the mineral iodine. The natural nutritional sources of iodine are
ocean fish, shellfish, and seaweed. Because these foods are not common in everyone’s
diet on a regular basis, iodine is added to table salt, which is common in almost every-
one’s diet. Iodine is listed on the packaging as iodized salt. It is necessary to consume
an adequate amount of iodine to maintain homeostasis.

Parathyroid Glands There are usually four parathyroid glands in the body. They
are typically embedded in the posterior surface of the thyroid gland, with two on each
side of the trachea. They release parathyroid hormone (PTH), which stimulates both
the reabsorption of calcium from the bone and the absorption of calcium in the small
intestine and prevents the loss of calcium to urine in the kidney. See Figure 8.6.

Spot Check Is it likely that calcitonin and PTH would be at high levels in the
blood at the same time? Explain.

Pancreas The pancreas is part of the endocrine and digestive systems. This chap-
ter covers only its endocrine function. The pancreas is an elongated gland and has a
pebbly appearance. It is inferior and posterior to the stomach. Only about 2% of the
gland produces hormones for the endocrine system. The endocrine cells are grouped
to form 1 to 2 million pancreatic islets (islets of Langerhans). See Figure 8.7. The
two hormones produced by the islets—insulin and glucagon—are important in the
regulation of blood glucose levels. You will read about them in detail in one of the sce-
narios later in the chapter.

8.3 Anatomy of the Endocrine System 311

 FIGURE 8.5 Hypothalamus-pituitary relationship: (a) ___location
of the hypothalamus and pituitary gland; (b) the hypothalamus–
anterior pituitary relationship, in which releasing hormones from
the endocrine cells in the hypothalamus enter capillaries and
travel through the blood in a portal vessel to capillary beds in
the anterior pituitary; (c) ADH and oxytocin are produced by
neuron cell bodies in the hypothalamus, travel through axons,
and are released and stored in the posterior pituitary until they
are needed, at which time they are released from there into the
blood.

Hypothalamus
Infundibulum

Anterior lobe Midbrain

of pituitary
gland Posterior lobe
of pituitary
Sphenoidal gland
sinus
Sella turcica

Sphenoid bone
Pons
(a)

Hypothalamus

Hypothalamus
Endocrine cells Neuron cell
(secrete releasing bodies
hormones).

Capillary bed
Portal vessel
Endocrine Infundibulum Axons
cells
Oxytocin
Capillary bed
Antidiuretic
hormone

(b) (c) Capillary bed

Anterior pituitary Posterior pituitary

312 CHAPTER 8 The Endocrine System

 Larynx

Thyroid
gland

Parathyroid
glands

Trachea

FIGURE 8.6 Parathyroid

glands embedded on the
Posterior posterior surface of the thyroid
gland.

FIGURE 8.7 Pancreas.

The pancreatic ducts are
used for digestive secretions
Duct
only.
Digestive enzyme–
secreting cells
Hormone-secreting
islet cells
Pancreatic islet
(islet of Langerhans)
Capillary

Gallbladder Common
bile duct

Pancreatic Pancreas
duct

Small
intestine

8.3 Anatomy of the Endocrine System 313

FIGURE 8.8 Adrenal cortex Adrenal gland
and adrenal medulla. Kidney

Adrenal cortex

Adrenal
medulla

Adrenal Glands The adrenal glands appear to sit as a cap, superior and medial to
the kidneys. The two parts of the adrenal gland—the adrenal cortex and the adrenal
medulla—function to produce different hormones. See Figure 8.8.

Adrenal cortex The adrenal cortex is the outer layer of the adrenal gland. It produces
over 25 different hormones classified in three major categories: mineralocorticoids,
glucocorticoids, and androgens. Table 8.1 lists a major example for each class.

Adrenal medulla The adrenal medulla is the middle of the adrenal gland. It is often
stimulated by the sympathetic nervous system in situations of fear, pain, and stress.

Gonads The gonads (GO-nadz) are also endocrine glands. Gonads are the ovaries
in a female and the testes in a male, and they function in both the endocrine and repro-
ductive systems. You will examine their endocrine function in this chapter and again
with their reproductive function in the reproductive system chapters.

Ovaries The ovaries begin to produce their hormones at puberty and continue produc-
ing them until menopause. A major hormone produced in the ovaries is estrogen, which
is responsible for the development of secondary sex characteristics in the female.
(See Table 8.1.) You will learn about the cells of the ovaries and their production of
hormones in depth in the female reproductive system chapter.

Testes The testes produce the hormone testosterone in the fetus for the develop-
ment of male anatomy. Testosterone production is dormant from birth to puberty,
and then it begins again at puberty to promote the development of male second-
ary sex characteristics. (See Table 8.1.) Production of testosterone continues after
puberty throughout life but significantly decreases after midlife.

Spot Check Think back to the integumentary system and the skeletal system.
What effects does the increased production of testosterone and estrogen at puberty
have on sebaceous glands and osteoblasts?

Other Tissues So far, you have covered the major endocrine system glands, but
many other tissues in the body also produce hormones to communicate with other tis-
sues. For example, the heart produces atrial natriuretic hormone (ANH), a hormone
that targets the kidney to regulate urine production. The uterus makes prostaglandins,
hormones that cause the smooth muscle of the uterus to contract during childbirth.
Even endocrine cells of the stomach and small intestine make several hormones to

314 CHAPTER 8 The Endocrine System

regulate the production and secretion of digestive juices. You will continue to explore
the role of these and other hormones in many of the upcoming chapters.
In the next section, you will learn about the chemical composition of hormones
produced by endocrine glands.

Hormones

Learning Outcome
6. D
 escribe the chemical makeup of hormones, using estrogen, insulin, and epinephrine
as examples.

There are three general categories of hormones based on chemical structure: steroids,
amino acid derivatives, and proteins. The chemical composition is important because
it directly affects how the hormone relates to its receptor.

Steroids Steroid hormones are derived from a cholesterol molecule. You will read
more about cholesterol later in this chapter. Examples of steroid hormones include
estrogen, testosterone, progesterone, mineralocorticoids, and glucocorticoids. As lip-
ids, they can pass through cell membranes to reach receptors anywhere in the cell.

Clinical P int
The ability of steroid hormones to easily pass through cell membranes
allows for the clinical delivery of these hormones through the skin. A
birth control patch applied to the skin delivers doses of estrogen and
progesterone through the skin. Progesterone is covered in detail in
the female reproductive system chapter.

©Mike Watson Images/

Moodboard/Getty Images

Cholesterol often has a bad reputation as being harmful to the body. However, it
is needed to help maintain homeostasis by synthesizing steroid hormones and other
digestive salts that you will explore in the digestive system chapter. Cholesterol can be
acquired through the diet and can be produced by the liver. It is a steroid found in high
concentration in liver and egg yolks. It is also found in whole milk, butter, cheese, and
meats; but cholesterol is not found in plants.

Amino Acid Derivatives As the name implies, these hormones are derived from
amino acids. Thyroid hormone, epinephrine (ep-ih-NEF-rin), and melatonin are
examples of amino acid derivatives. This type of hormone may or may not be able
to cross cell membranes. For example, thyroid hormone can easily pass across a cell
membrane to reach a receptor inside the cell, while epinephrine cannot.

Proteins Protein hormones are made of chains of amino acids. Examples of protein
hormones include insulin, thyroid-stimulating hormone (TSH), follicle-stimulating
hormone (FSH), luteinizing hormone (LH), growth hormone (GH), parathyroid hor-
mone (PTH), antidiuretic hormone (ADH), adrenocorticotropic hormone (ACTH),
glucagon, calcitonin, oxytocin, and hormones from the hypothalamus. Proteins are too
large to pass through cell membranes.

Spot Check What is the chemical composition of the three classes of hormones
secreted by the adrenal cortex?

8.3 Anatomy of the Endocrine System 315

 Now that you have reviewed the chemical composition of hormones, you are ready
to learn about how it affects their relationship with receptors.

Clinical P int
As examples of amino acid and protein hormones, epi-
nephrine and insulin cannot pass through a cell mem-
brane. This means that they cannot be clinically delivered
through the skin. The digestive system further complicates
their clinical delivery. As you will discover in “Chapter 13,
The Digestive System,” proteins are partially digested in
the stomach and are not absorbed until later, in the small
intestine. Therefore, if taken orally, epinephrine and insulin
would be broken down before being absorbed into the
blood. Medical administration of epinephrine and insulin
FIGURE 8.9 A teen injecting must be by injection. See Figure 8.9.
insulin.
©Ian Hooton/SPL/Getty Images

Target Tissues

Learning Outcomes
7. Compare the ___location of receptors for protein hormones with that of receptors for
steroid hormones.
8. Differentiate autocrine, paracrine, endocrine, and pheromone chemical signals in
terms of the proximity of the target tissue.

There are many target tissues for the various hormones of the body. What makes a tis-
sue a target tissue is the presence of specific receptors for specific hormones based on
the hormone’s chemical makeup and shape.

Location of Hormone Receptors The two basic classes of receptors for hormones
are based on their ___location—either on the cell membrane or somewhere inside the cell.
Protein hormones must bind to receptors on the cell membrane because they cannot
enter the cell. They fit into the receptors on the basis of their specific shape—like a
key fits into a lock. The hormones may initiate a response directly on the membrane,
such as opening a channel; or they may initiate a response inside the cell, such as initi-
ating protein synthesis. If the response is to occur inside the cell, a second-messenger
system must be used. See Figure 8.10. In this system, the binding of a hormone in the
receptor on the cell membrane causes a chemical reaction inside the membrane. This
reaction creates a second messenger, which then carries the information to where it is
needed in the cell to initiate the function of the hormone. This is much like trying to
get an important message to a friend at a medical clinic. You can call the office and
have someone there relay the information you need to get to your friend.
Steroid hormones and thyroid hormone can directly cross the membrane and fit
into receptors inside the cell where the function will be carried out. This may be in the
cytoplasm or in the nucleus. See Figure 8.11. They do not need a second messenger.
This process is like calling your friend directly on his cell phone.

Location of the Target Tissue The ___location of the target tissue is also relevant to
the eventual delivery method of the hormone, as outlined in the list that follows. Hor-
mone function can be categorized by the ___location of the cells producing the hormone
relative to the ___location of their target tissues.

316 CHAPTER 8 The Endocrine System

 FIGURE 8.10 Location
Protein hormone 1 of receptors—protein
molecule hormones. A protein hormone
(1) fits into a receptor on the
cell membrane (2), causing a
Hormone-receptor 2 Adenylate
complex chemical reaction that forms
cyclase
a molecule called cAMP—a
Cell second messenger (3). The
Receptor molecule second messenger stimulates
membrane
changes inside the cell (4) as the
G protein function of the hormone. In this
ATP
case, molecule A changes to
3 B, which causes molecule C to
change to D (5).
cAMP

4 Cytoplasm
A
B
Cellular
changes

5
C
D

Nucleus

Steroid hormone FIGURE 8.11 Location

molecule of receptors—steroid
hormones. A steroid hormone
(1) passes through the cell
membrane and fits into a
1 receptor inside the nucleus
(2) to stimulate protein
synthesis (3 to 5).
Cell membrane

Newly forming
protein molecule

5 Ribosome
mRNA

Hormone-receptor
complex

4
Nucleus
Intracellular
receptor
molecule

mRNA

3
2 DNA

8.3 Anatomy of the Endocrine System 317

 • Autocrine refers to the secretion of a hormone by cells of the same tissue type that
the hormone targets. An example of this is the production of prostaglandins by
the smooth muscle of the uterus, which causes the smooth muscle of the uterus to
contract during birth.
• Paracrine refers to hormones that work on neighboring cells without having to go
through the blood to get to the target tissue. An example of this can be seen with
endocrine cells in the stomach, which cause neighboring cells to produce hydro-
chloric acid. You will read more about this in the digestive system chapter.
• Endocrine refers to hormones that travel through the blood to get to their target
tissue. The hormones discussed in this chapter are endocrine hormones.
• Pheromone refers to chemicals that cause a response outside the body, in another
individual. In developing fragrances, the perfume industry studies possible phero-
mones that may attract the opposite sex.
You have now covered the anatomy of the endocrine system—the glands, the type
of hormones they produce, and their target tissues with their receptors. It is time to
examine the physiology of the system.

Spot Check Explain the differences in autocrine hormone and pheromone in

terms of the secretion of the hormone and the ___location of the target tissue.

8.4 Physiology of the Endocrine System

The physiology of this system includes the regulation of hormone secretion and distri-
bution, the regulation of sensitivity of a target tissue to a hormone through the regula-
tion of its receptors, and the elimination of hormones.

Regulation of Hormone Secretion and Distribution

Learning Outcome
9. Explain the regulation of hormone secretion and its distribution.

Most hormones are not secreted at a constant rate. In order to maintain homeostasis,
they are secreted when there is a need; their secretion is usually regulated by negative
feedback mechanisms. The secretion of a hormone can be initiated in three ways:
• A neuron stimulating a gland. In the nervous system chapter, you studied how
neurons can synapse with a gland, a muscle, or the dendrite of another neuron.
An example of neural stimulation of a gland occurs when sympathetic neurons
stimulate the adrenal medulla to secrete epinephrine in times of pain, fear, and/or
stress.
• Another hormone stimulating a gland. An example of this can be seen when the
hormones released by the hypothalamus stimulate the secretion of hormones from
the anterior pituitary. For example, GnRH from the hypothalamus results in the
secretion of FSH and LH from the anterior pituitary.
• A substance other than a hormone stimulating a gland. An example of this
can be seen with the pancreas, which monitors blood glucose levels. Glucose is not
a hormone, but if glucose levels are high, the pancreas responds to that stimulation
by secreting insulin.
It will be helpful to look at an example of the secretion of a thyroid hormone and
the negative feedback mechanism that regulates it. If you go outside when it is very

318 CHAPTER 8 The Endocrine System

 FIGURE 8.12 Negative
feedback inhibition of the
hypothalamus and pituitary
gland by the thyroid
gland. Steps 1 to 4 are
1 stimulatory, while steps 5
and 6 are inhibitory.
6
TRH Negative feedback
inhibition

4
5
Target organs

TSH

Thyroid
hormone

Stimulatory effect Inhibitory effect

cool, but you are underdressed, the hypothalamus may try to speed up your metabo-
lism to generate more body heat. See Figure 8.12. This figure shows the following:
1. The hypothalamus releases thyrotropin-releasing hormone (TRH), which goes to
its target tissue, the anterior pituitary, and fits into receptors.
2. The anterior pituitary is then stimulated to release TSH, which goes to its target
tissue, the thyroid gland, and fits into receptors.
3. The thyroid is then stimulated to release thyroid hormone, which travels to several
target tissues.
4. Thyroid hormone travels to most cells, stimulating them to increase metabolism
(heat is given off as a by-product).
5. Thyroid hormone also travels to the anterior pituitary, where it inhibits the further
secretion of TSH.
6. Thyroid hormone also travels to the hypothalamus, where it inhibits the further
secretion of TRH.
This negative feedback mechanism is an example of homeostasis and is the thy-
roid’s method of saying to the anterior pituitary and hypothalamus that it has received
the message to secrete thyroid hormone and is following through on the message. It
keeps the secretion rate from going too high.

8.4 Physiology of the Endocrine System 319

 Spot Check Which of the three ways of stimulating a gland is used to stimulate
the anterior pituitary and thyroid glands?

The chemical composition affects how the

Protein Steroid
Capillary hormone hormone hormone is distributed in the blood. Thyroid
hormone, in the last example, can easily pass
Free hormones through cell membranes. However, if it were
allowed to do that, much of the thyroid hor-
Transport
mone would immediately go into the cells,
protein causing a huge spike in metabolism and then
a dramatic fall when the hormone was used
Receptor
Bound in plasma
up. The body has a way to time-release thy-
hormone membrane roid hormone and steroid hormones that can
easily pass through cell membranes. Transport
proteins, called plasma proteins, made by the
liver are used to bind to some of the hormone
Second- in the blood. The bond is a reversible one,
Blood Target cell messenger meaning that at any one time, some of the hor-
activation
mone will be free to enter the cell and some of
the hormone will be bound to plasma proteins,
Receptor in
nucleus
making it too large to enter the cell. As time
goes by, more of the hormone is freed from the
Tissue fluid
plasma proteins so that it can enter the cell. See
Figure 8.13. The process is similar to the way
a time-released cold medicine works: You may
take the medicine only once every 12 hours,
FIGURE 8.13 Transport and action of protein and steroid but its effect is released evenly throughout that
hormones.
time. Hormones that cannot cross a cell mem-
brane do not need to bind to plasma proteins.
Now that you have reviewed how hormone secretion and distribution are regu-
lated, you are ready to explore how a target tissue can regulate its sensitivity to a
hormone.

Receptor Regulation

Learning Outcome
10. Explain how the number of receptors can be changed.

Target tissues can regulate their sensitivity to a hormone by adjusting the number of
receptors for that hormone. Up-regulation is an increase in the number of receptors
for a given hormone. In this case, the cell has more receptors for the hormone to
bind, so it has become more sensitive to the hormone and the effects of the hormone
are increased. Down-regulation occurs when a cell decreases the number of recep-
tors for a hormone. Here, there are fewer opportunities to bind a hormone to a recep-
tor, so the cell is less sensitive to the hormone and the effects of the hormone are
reduced. See Figure 8.14. Down-regulation is often a response to chronically high
levels of a hormone. An example of this can be seen with adipocytes (fat cells) of
an obese individual. In this individual, chronically high carbohydrate consumption
results in chronically high glucose levels, and the pancreas responds with chroni-
cally high insulin levels. The adipocytes respond to the chronically high insulin lev-
els by down-regulating their receptors for insulin. This is similar to the response
of individuals in an arena who cover their ears to reduce their sensitivity to a loud
sound system.

320 CHAPTER 8 The Endocrine System

 Hormone Receptor FIGURE 8.14 Receptor
regulation: (a) up-regulation,
(b) down-regulation.

Response

Low receptor density Increased receptor density

Stronger responses
Weak responses Increased sensitivity

(a)

Response

High receptor density Reduced receptor density

Diminished responses
Strong response Reduced sensitivity

(b)

Hormone Elimination

Learning Outcome
11. Explain how hormones are eliminated from the body.

The effects of a hormone will continue until the hormone is eliminated from the sys-
tem. Therefore, the method of hormone elimination is important in regulating the dura-
tion of the hormone’s effects. Hormones may be eliminated from the body in four ways:
1. Excretion. The kidneys can remove a hormone from the blood and excrete it in
urine, or the liver can remove a hormone from the blood and excrete it in bile.
2. Metabolism. Enzymes in the blood, liver, kidneys, or other target tissues can break
down the hormone and excrete it or use it for cellular processes. For example, the break-
down of protein hormones results in amino acids that can be used for protein synthesis.
3. Active transport. A hormone such as epinephrine can be taken back up by a cell
through active transport so that it can be recycled and released at another time.
4. Conjugation. The liver can bind water-soluble molecules to a hormone so that it
will be excreted at a faster rate.

8.4 Physiology of the Endocrine System 321

 Half-life is the length of time it takes for one-half of a substance to be eliminated
from the circulatory system. Steroid hormones and thyroid hormone have their half-
lives extended by binding to plasma proteins. Their levels tend to be more constant.
Protein hormones and epinephrine have relatively short half-lives because they are
quickly degraded, recycled, or excreted.

Spot Check Why might it be an advantage to have a short half-life for

epinephrine?

Functions: Four Scenarios

Learning Outcome
12. E
 xplain the function of hormones by showing how they interact to maintain
homeostasis.

Four scenarios can help you understand the interaction of the glands and hormones
of this system: insulin and glucagon secretion, consequences of reduced melato-
nin production at puberty, adrenal cortex degeneration, and hormonal regulation of
childbirth. It is always helpful to create a chart of the relevant gland, hormone, target
tissue, and function when working with endocrine questions. Always remember that
if the function of a hormone involves another hormone, you must chart that hor-
mone too.

Insulin and Glucagon Secretion This scenario analyzes the role of insulin and
glucagon over a 12-hour period. Paul has a dinner at 6 p.m. He eats pasta and gar-
lic bread with chocolate cake for dessert, a meal rich in carbohydrates. His
digestive system will work to break down the carbohydrates into their
building blocks, monosaccharides (simple sugars), so that they can
be absorbed into the bloodstream. Soon after his meal, his blood
sugar level rises above homeostasis. Cells need glucose (blood
sugar), but too much sugar in the blood is harmful to the body.
Over time, it can lead to coronary artery disease, peripheral
nerve damage, and damage to small blood vessels in the kidney
and retina. So how does the body maintain normal, homeostatic
blood glucose levels?
Look at the chart for insulin and glucagon. See Table 8.2.
After the meal, Paul’s pancreas recognizes the increased
blood glucose levels, and it releases the hormone insulin, which
travels through the bloodstream to any cell that has an insulin
receptor. Once insulin fits into the receptor, that cell takes in glucose
from the blood, lowering blood glucose levels. Most cells have an insulin
©C Squared Studios/Getty Images receptor, including the liver. The liver will convert the glucose it takes in to

TABLE 8.2 Insulin and Glucagon

Gland Hormone Target Tissue Function
Pancreas Insulin Most tissues, liver Stimulates cells to take in glucose to lower blood
glucose levels; tells liver to store glucose as glycogen
Glucagon Liver Stimulates glycogen conversion to glucose and then its
secretion to raise blood glucose levels

322 CHAPTER 8 The Endocrine System

glycogen, a starch that is used as a storage molecule for glucose. Through the secretion
of insulin, the cells have taken in the glucose they need, and blood sugar levels are
brought back to homeostasis.
Paul does not snack before going to bed. By 6 a.m., it has been 12 hours since he
last ate. His cells have used the available glucose, but they still need more glucose to
carry out cellular respiration. Blood glucose levels have fallen below homeostasis. In
this case, Paul’s pancreas recognizes that blood glucose levels are below normal. His
pancreas responds by releasing glucagon. Glucagon travels everywhere through the
bloodstream, but it affects cells of the liver because they have receptors for glucagon.
Glucagon in the liver’s receptors causes the liver cells to convert stored glycogen
back to glucose for release back into the blood. Homeostatic blood glucose levels
are restored.

Spot Check Which of the three ways to stimulate a gland caused the release of
the hormones in this scenario?

Spot Check What type of feedback mechanism is involved in this case?

Spot Check Would the pancreas ever release large quantities of insulin and
glucagon at the same time? Explain.

Consequences of Reduced Melatonin Production at Puberty Natalie and

Nate (sister and brother) are about to enter puberty. Normally, the pineal gland’s
production of melatonin is reduced at puberty. This creates a chain of events that
involves many hormones. What are the consequences for Natalie of this decrease in
melatonin?
To answer this question, first look at the chart for melatonin. See Table 8.3. Keep
in mind that if the function of a hormone involves another hormone, you should con-
tinue charting.
Melatonin normally inhibits the production of GnRH by the hypothalamus. When
the melatonin is reduced, so is the inhibitory effect on the hypothalamus. The hypo-
thalamus is free to produce GnRH, which then goes to the anterior pituitary, telling it
to produce FSH and LH. FSH targets Natalie’s ovaries to stimulate the production of
estrogen, which will promote the development of secondary sex characteristics. LH
targets Natalie’s ovaries to stimulate ovulation.

TABLE 8.3 Effects of Melatonin

Gland Hormone Target Tissue Function
Pineal Melatonin Brain Helps regulate daily biological
Hypothalamus rhythms; inhibits GnRH production
Hypothalamus GnRH (gonadotropin-releasing Anterior pituitary Releases FSH and LH
hormone)
Anterior pituitary FSH (follicle-stimulating hormone) Ovaries Stimulates secretion of estrogen
LH (luteinizing hormone) Ovaries Stimulates ovulation
Ovaries Estrogen Most tissues Stimulates female secondary sex
characteristics; regulates menstrual
cycle and pregnancy

8.4 Physiology of the Endocrine System 323

 Spot Check What physical changes will we see in Natalie due to these hormone
interactions?

Spot Check How would the charting differ if it had been for Nate instead of
Natalie?

Spot Check What are the physical consequences of reduced melatonin

production at puberty for Nate?

Adrenal Cortex Degeneration This scenario looks at how the body deals with an
endocrine gland that is not functioning properly. David has just been diagnosed with
Addison’s disease. Addison’s disease is the result of adrenal cortex degeneration. His
adrenal cortex no longer functions to produce hormones. What are the consequences
of this disease for David?
To determine the answer to this question, begin by reviewing the chart for the
adrenal cortex. See Table 8.4. Note the three major classes of hormones produced by
the adrenal cortex.
Aldosterone is a major mineralocorticoid hormone that helps maintain
homeostasis by controlling fluid and electrolyte balance. It targets the kidney to
promote Na+ and water reabsorption and K+ excretion. The amount of water reab-
sorbed affects blood volume and therefore blood pressure. Without production of
aldosterone, David will have decreased ability to regulate blood pressure and blood
volume. He will also lose more Na+ in his urine and keep more K+ in his blood, dis-
rupting his electrolyte balance.
Another hormone important in maintaining homeostasis is cortisol. Cortisol is a
major glucocorticoid that is used to promote the breakdown of fat and protein to make
glucose, thus raising blood glucose levels. It also raises the amount of amino acids in
the blood. Cortisol is a major hormone for dealing with stress. It provides the means to
acquire the necessary glucose and amino acids in the blood to respond to stress. It also
suppresses the immune system and reduces inflammation. Without cortisol, David’s
ability to use fat and protein as fuel is reduced, as is his body’s ability to deal with
stress and inflammation.
Dehydroepiandrosterone (DHEA) is an androgen produced by the adrenal cortex.
It is a precursor to testosterone. The effects for David of decreased DHEA are minimal
because the adrenal cortex is not his main source of testosterone. The majority of his
testosterone comes from his testes.

TABLE 8.4 Hormones of the Adrenal Cortex

Gland Hormone Target Tissue Function
Adrenal cortex Mineralocorticoids Kidneys Promote sodium (Na+) and water reabsorption;
(aldosterone) promote potassium (K+) excretion; maintain blood
volume and pressure
Glucocorticoids Most tissues Stimulate the breakdown of protein and fat to make
(cortisol) glucose; suppress the immune system; reduce
inflammation
Androgens Most tissues Precursor to testosterone, responsible for male
(dehydroepiandrosterone secondary sex characteristics and for sex drive in
[DHEA]) both sexes

324 CHAPTER 8 The Endocrine System

 Clearly, the body has lost some of its ability to maintain homeostasis if the adrenal
cortex is not producing its hormones. That in itself is a move from homeostasis. How
does the body try to fix this? The hypothalamus will recognize the need for cortisol,
especially in times of stress. To see how it will respond, refer to Table 8.5.

TABLE 8.5 Hypothalamus Response to Decreased Cortisol

Gland Hormone Target Tissue Function
Hypothalamus CRH (corticotropin-releasing hormone) Anterior pituitary Releases ACTH
Anterior pituitary ACTH (adrenocorticotropic hormone) Adrenal cortex Stimulates secretion of
glucocorticoids and growth of
the adrenal cortex

The hypothalamus responds to the need for cortisol by producing corticotropin-

releasing hormone (CRH). The CRH goes to the anterior pituitary, telling it to pro-
duce ACTH. The ACTH travels to the adrenal cortex to stimulate its production of
glucocorticoids only—not mineralocorticoids or androgens. This negative feedback
response is intended to correct only the low cortisol levels and restore homeostasis.
If the adrenal cortex has degenerated, it will not be able to respond to the ACTH.
The hypothalamus will continue to see the need, so it will continue to produce more
CRH, which will cause the anterior pituitary to produce more ACTH. The high ACTH
levels in the blood, along with low cortisol levels, are one means of diagnosis for
Addison’s disease.

Spot Check What other levels in the blood might be examined to diagnose this
disease?

Spot Check Would Addison’s disease have a different effect on a female? Explain.

Hormonal Regulation of Childbirth This final scenario focuses on one of the hor-
mones involved in childbirth—oxytocin. See Table 8.6.
Dorothy is in her ninth month of pregnancy. In Figure 8.15, you can see that
Dorothy’s pregnancy is at full term. The fetal head is pushing on the neck of the uterus
(called the cervix), which causes the cervix to send nerve impulses to the brain. The
hypothalamus in the brain responds by stimulating the posterior pituitary to release
oxytocin. Oxytocin goes to its target tissue, the uterus, and causes it to contract.
The uterine contractions push on the fetus, causing more pressure on the cervix. The
whole cycle keeps repeating itself until the baby is born.

TABLE 8.6 Hormone Involved in Childbirth

Gland Hormone Target Tissue Function
Posterior pituitary Oxytocin Uterus Stimulates uterine contractions

8.4 Physiology of the Endocrine System 325

FIGURE 8.15 Oxytocin’s
effect on childbirth.

3
Hypothalamus stimulates
posterior pituitary to
2 secrete oxytocin.
Nerve impulses from
cervix transmitted to
brain.

4
Oxytocin stimulates
uterine contractions
that push fetus
toward cervix.

1
Head of fetus
pushes against
cervix.

Spot Check Which of the three ways to stimulate a gland was used to stimulate
the posterior pituitary in this scenario?

Spot Check What type of feedback mechanism was involved in this case?

8.5 Effects of Aging on the Endocrine System

Learning Outcome
13. Explain the effects of aging on the endocrine system.

In general, the levels of hormones decline with age. This can be seen most dramati-
cally with the hormones estrogen and testosterone. The production of both hormones
is dramatically reduced during midlife. Estrogen production by the ovaries ceases
with menopause. Testosterone production continues after midlife, but it gradually
declines and at age 80 is about 20% of what its peak was at age 20. Both estrogen
and testosterone serve as a lock on calcium in the bone. Therefore, the effects of
osteoporosis may be seen as the production of these hormones decreases with age.
Even if the levels of some other hormones remain high with age, the sensitivity
of their target tissues often decreases with down-regulation of receptors. This is often
seen in the development of diabetes mellitus in elderly people. We focus on that disor-
der in the next section.

326 CHAPTER 8 The Endocrine System

 Clinical P int
As women age, their ovaries stop releasing eggs and their menstrual periods eventu-
ally stop. This is called menopause, which you will read more about in “Chapter 16, The
Female Reproductive System.” To assess whether a woman is in menopause, blood
tests can be used to determine the level of FSH and estrogen. Women in menopause
will have increased levels of FSH and decreased levels of estrogen. During the onset of
menopause, periods may be irregular. Clinicians may also test thyroid hormone levels
to ensure that the irregular periods are caused by menopause and not caused by a
problem with the thyroid gland.

8.6 Diagnostic Tests for Endocrine System Disorders

Learning Outcome
14. D
 escribe common diagnostic tests used to diagnose endocrine system disorders.

Before you explore the disorders in this chapter, look at Table 8.7, which describes
common diagnostic tests and procedures for disorders of the endocrine system. Many
of these tests may be familiar as they have been mentioned in other chapters. How
they specifically work to help diagnose endocrine system disorders is explained in
the table.

TABLE 8.7 Common Diagnostic Tests for Endocrine System Disorders

Diagnostic Test or Screening Description
Blood test A procedure that involves obtaining a sample of blood and analyzing its contents.
Blood tests can reveal whether the appropriate amount of hormone is present.
Computed tomography (CT) An imaging technique used to visualize internal structures. The scan produces
images in “slices” of areas throughout the body. A CT scan can be used to determine
whether a tumor is present.
DEXA (dual-energy X-ray A test that uses low-dose radiation to measure bone density in the hip and vertebrae.
absorptiometry) scan DEXA scans can be used to determine changes in bone as bones age.
Magnetic resonance An imaging technique used to visualize internal structures. This test provides great
imaging (MRI) or nuclear contrast between various soft tissues in the body. MRI can be used to detect a tumor
magnetic resonance or changes in soft tissue.
imaging (NMRI)
Urinalysis A test that involves a physical, chemical, and microscopic examination of urine.
Results that do not fall within normal limits may indicate a condition or disease. A
urinalysis may reveal inappropriate levels of certain chemicals in the urine.
X-ray Electromagnetic radiation that sends photons through the body, allowing the
visualization of dense structures such as bone. X-rays can be used to determine
changes in bone growth.

Spot Check Which diagnostic tests listed in Table 8.7 can also be used to help
diagnose disorders in systems other than the endocrine system? Give examples of the
other uses.

8.6 Diagnostic Tests for Endocrine System Disorders 327

 8.7 Endocrine System Disorders
Learning Outcome
15. Describe endocrine system disorders and relate abnormal function to pathology.

By looking at the pathology of a disorder, you can often gain a better understanding
of the normal physiology of a system. You will begin this section by examining two
disorders termed diabetes: diabetes mellitus and diabetes insipidus.

Diabetes Mellitus
Diabetes mellitus is a problem with the use of insulin in blood glucose regulation.
Either insufficient insulin is produced, or the response to the insulin that is produced is
insufficient. There are two forms of this disease, distinguished by the cause.

Type 1 Diabetes Mellitus (Insulin Dependent) Type 1 diabetes mellitus is usu-

ally diagnosed before age 30. The exact cause of this disease is unknown, but many
think that it occurs because the body is challenged with a viral infection. The immune
system responds by making antibodies to fight the pathogen, but the antibodies also
attack the cells of the pancreatic islets that produce insulin. Once most of the islets
have been destroyed, the ability to regulate glucose levels in the blood is lost. Type 1
diabetics need to monitor their blood glucose levels closely and inject insulin to main-
tain homeostasis of blood glucose levels.

Type 2 Diabetes Mellitus Most diabetics have type 2 diabetes mellitus. This form
of the disease is characterized by the inability to respond to the insulin produced
by the pancreas. The number of receptors is insufficient to adequately respond to
the insulin produced in the regulation of blood glucose levels. In the beginning
of the disease, insulin levels may be high, but the cells have down-regulated their
receptors, so they are not responsive to the insulin produced. As a result, blood
glucose levels stay chronically high. The pancreas responds accordingly with more
and more insulin that has less and less of an effect. Eventually, the pancreas stops
responding to the high blood glucose levels, and insulin levels fall. If the disease
is diagnosed early in its progression, type 2 diabetics can be treated with med-
ications that increase cells’ sensitivity to insulin, dietary changes that moderate
blood glucose levels, and exercise, which encourages up-regulation of receptors. If
not treated early, however, the type 2 diabetic may have to be treated with insulin
as well.
Both types of this disease have similar symptoms. If cells cannot use the glucose
in the blood, they must turn to other sources of energy in the body, such as fat and
protein. Therefore, diabetes mellitus, left untreated, is a wasting disease character-
ized by visible weight loss and loss of muscle mass, even though the individual
may be eating a high-caloric diet. Normally, the kidney filters out the glucose in
the blood while removing wastes. It then reabsorbs all of the glucose so that none is
lost in urine. However, in either type of diabetes mellitus, there is too much glucose
in the blood. The kidney filters out the glucose but does not have time to completely
reabsorb all of it. As a result, some of the glucose is lost in urine (glucosuria).
Water follows the glucose, so urine output is increased (polyuria). The water for
the extra urine is taken from the blood, reducing blood volume. The hypothalamus
recognizes this and sends the signal for thirst, so the individual drinks to replace
the lost water (polydipsia, excessive thirst). The glucose lost in urine is unable
to enter the cells where it should be converted into ATP to be used for energy.
This causes a lack of energy and results in excessive hunger and increased appetite
(polyphagia).

328 CHAPTER 8 The Endocrine System

 Both types of diabetes mellitus have possible life-threatening complications.
Therefore, blood glucose levels need to be monitored closely. See Figure 8.16.
Hyperglycemia (too much sugar in the blood) has a devastating effect on the walls of
blood vessels. Even blindness and kidney failure can be the direct result of the dete-
rioration of vessels of the retina and kidney. Uncontrolled diabetes mellitus also leads
to other degenerative cardiovascular disease complications and neurological diseases.
Circulation to the tissues and nerves of the extremities may be compromised, leading
to neuropathy (diseases involving the nervous system) and tissue death.

Clinical P int
Prediabetes is a condition in which the blood glucose levels and results of the hemoglobin
A1c test, a measurement of the average glucose concentration in plasma over a 2- to
3-month period, are higher than normal but not high enough to be classified as diabetes
mellitus. The statistic of 79 million Americans over 20 years of age having prediabetes
gives insight on how many new cases of diabetes can potentially exist. The screening for
prediabetes is helpful in that it allows health care providers to work with patients on mea-
sures that might decrease their blood glucose and hemoglobin A1c levels and potentially
avoid the onset of the disease. Diabetes mellitus not only affects blood glucose levels but
can cause many other health complications, such as heart disease and stroke, hyperten-
sion, eye disorders, kidney disease, nervous system disorders, amputations, weakened
immune system, dental disease, and depression. Weight loss and increased physical
activity have been shown to prevent or delay the onset of type 2 diabetes mellitus.1

Spot Check Compare and contrast type 1 and type 2 diabetes mellitus in terms
of the cause, symptoms, and treatment of the disease.

Diabetes Insipidus
Diabetes insipidus is a totally different disease than diabetes mel-
litus. It has nothing to do with glucose, insulin, or the pancreas.
Diabetes insipidus is a problem with the posterior pituitary. In
this disease, the posterior pituitary does not release sufficient
ADH to cause water reabsorption in the kidneys. Therefore, too
much water goes out in urine (polyuria), and the water for the
extra urine is taken from the blood, reducing blood volume. The
hypothalamus recognizes this and sends the signal for thirst, so
the individual drinks to replace the lost water (polydipsia).
Even though diabetes mellitus and diabetes insipidus are
totally different diseases that have totally different causes, two
symptoms—polyuria and polydipsia—are common to both
disorders.

Growth Disorders
In addition to diabetes, other disorders of the endocrine system
include growth disorders. Growth disorders can be the result
of improper secretion of GH from the anterior pituitary. GH is
secreted during childhood to promote the growth of most tis-
sues. Levels of GH normally decrease in adulthood.
Growth disorders that result in a hypersecretion of GH are FIGURE 8.16 A glucometer measures the blood
usually caused by a pituitary tumor. Hypersecretion of GH will glucose level.
result in either gigantism or acromegaly. ©McGraw-Hill Education/Jill Braaten

8.7 Endocrine System Disorders 329

 Gigantism If hypersecretion of GH happens during childhood,
before the epiphyseal plates close, gigantism results. Individuals
with gigantism have accelerated bone growth, resulting in a larger
than usual stature due to excessive endochondral growth. They can
also suffer from swelling of soft tissues, peripheral nerve damage,
and delayed onset of puberty.

Acromegaly If there is normal secretion of GH in childhood but

hypersecretion of GH in adulthood, acromegaly results. In acro-
megaly, the epiphyseal plates have closed normally, preventing
any further elongation of long bones, but all of the bones become
more massive through excessive appositional bone growth (cov-
ered in the skeletal system chapter) in adulthood. This can be
especially seen in the bones of the face. See Figure 8.17. Adults
suffering from acromegaly may also have thickened skin, a deeper
voice, degenerative arthritis, peripheral nerve damage, headaches,
and organ enlargement. Hypersecretion of GH throughout life can
occur and would result in a giant with acromegaly.
Diagnosis of hypersecretion growth disorders involves blood
tests to measure hormone levels. In addition, CT, MRI, or X-rays
can be used to locate the presence of a pituitary tumor and deter-
mine any changes in tissues and bone that might indicate gigan-
tism or acromegaly.
FIGURE 8.17 Acromegaly.
©A. R. Coster/Hulton Archive/Getty Images
Pituitary Dwarfism If there is hyposecretion of GH during
childhood, pituitary dwarfism results. The individual is abnor-
mally short in stature. See Figure 8.18. Growth during childhood

FIGURE 8.18 Pituitary

dwarfism: person of normal
height (right) and person of short
stature resulting from pituitary
dwarfism (left).
©SPL/Science Source

330 CHAPTER 8 The Endocrine System

may be less than 2 inches per year, and puberty may be delayed or not come at all.
There is no main cause of hyposecretion of GH in children. A deficiency in GH secre-
tion can result from a congenital defect or from a brain injury, a tumor, or other health
conditions that occurred after the child was born. Diagnosis of hyposecretion growth
disorders involves blood tests to measure hormone levels. Repeat physical examina-
tions and growth charting will show whether growth has slowed down or whether it is
on track. MRI can be used to examine the pituitary gland. X-rays and DEXA scans can
be used to examine bone size and age.

Clinical P int
The treatment for growth disorders involves adjusting the hormone levels back to
normal. For individuals suffering from a hypersecretion of GH, adjustment of the GH
levels might result from removing the tumor that is responsible for the hypersecretion.
This may be done by surgery or radiation therapy. For individuals who suffer from
hyposecretion of GH, treatment involves GH injections to increase the levels of GH in
the body.

Goiters
Another endocrine system disorder involves the presence of goiters. A goiter is an
enlargement of the thyroid gland. Figure 8.19 shows an endemic goiter that resulted
from an iodine deficiency. As stated earlier, iodine is necessary in the diet for the
production of thyroid hormone. Normally, the anterior pituitary produces TSH to
stimulate the thyroid when metabolism is low. However, if iodine is not available in
the diet, hyposecretion of thyroid hormone results. This sets up a positive feedback
loop of continued stimulation of the thyroid gland by TSH from the anterior pituitary.
Even though the thyroid gland continues to enlarge with all the stimulation, func-
tional thyroid hormone is not produced. Other than the goiter, the effects of hypose-
cretion of thyroid hormone include weight gain, reduced appetite, constipation, dry
skin, and lethargy.
Hypersecretion of thyroid hormone can also result in an enlarged thyroid gland,
called a toxic goiter. The most common cause of this condition is Graves’ disease.
Graves’ disease is a type of hyperthyroidism caused by an autoimmune disorder. In
Graves’ disease, an antibody made by white blood cells
to fight a foreign invader mistakenly fits into TSH recep-
tors of the thyroid gland and acts like TSH. The anti-
body is made for life and has no regard for metabolism
levels, so the thyroid gland is constantly stimulated to
produce more and more thyroid hormone no matter what
the metabolism or anterior pituitary gland would indi-
cate. Other than the goiter, the effects of hypersecretion
of thyroid hormone can include weight loss, increased
appetite, bouts of diarrhea, soft skin, exophthalmos
(bulging eyes), and hyperactivity. Graves’ disease is
diagnosed by testing the blood for TSH levels, T4 levels,
TSH-receptor antibody levels, and radioactive iodine
uptake. Treatment can include iodine and other drugs
that inhibit the release of thyroid hormone or interrupt
thyroid hormone production. Surgery may also be used
to decrease the size of the goiter. It is important to note FIGURE 8.19 Endemic goiter resulting from an iodine
that radiation treatment or removal of part of the thyroid deficiency.
can cause hypothyroidism, which we discuss next. ©Biophoto Associates/Science Source

8.7 Endocrine System Disorders 331

 Hypothyroidism
Hypothyroidism is characterized by a hyposecretion of thyroid hormone. There are
two main causes of hypothyroidism, Hashimoto’s disease and hypothyroidism that
results from the treatment of hyperthyroidism:
• Hashimoto’s disease is an autoimmune disorder that results in the chronic inflam-
mation of the thyroid gland. The inflammation of the gland does not allow it to
function properly and results in hyposecretion of thyroid hormone.
• As mentioned previously, the treatment of hyperthyroidism can involve radiation
of the thyroid gland or surgical removal of part of the thyroid gland. Either of these
treatments can result in hyposecretion of thyroid hormone.
Symptoms of hypothyroidism include fatigue, weight gain, an enlarged thyroid
gland, intolerance of cold temperatures, joint and muscle pain, constipation, impaired
fertility, depression, and a slow heart rate. Hypothyroidism is more likely to affect
women between the ages of 40 and 60. Blood tests can be used to diagnose hypo-
thyroidism. These tests would detect TSH levels, T4 levels, and the presence of thy-
roid autoantibodies, which are antibodies formed against one’s own tissues. Physical
examination can be used to determine whether the thyroid is enlarged. Treatment of
hypothyroidism involves methods to reduce the size of the thyroid gland and the use of
synthetic thyroid hormone to increase thyroid hormone levels.

Spot Check Compare and contrast the causes of hypothyroidism and

hyperthyroidism.

Disease P int
Myxedema is a serious complication that occurs in people suffering from hypothy-
roidism. It usually occurs in the elderly population and can be triggered by infection,
trauma, surgery, certain medications, and other health
conditions such as hypoglycemia and stroke. Symptoms
of myxedema include an altered mental state, hypother-
mia, cardiovascular and gastrointestinal problems, and a
myxedematous face (characterized by puffiness, droop-
ing eyelids, swelling around the eyes, and hair loss).
Myxedema is diagnosed by testing the blood for thyroid
hormone levels and also testing electrolyte levels. It is
very important for people suffering from myxedema to
get treatment immediately as the condition can quickly
become lethal. Patients are usually placed in intensive
care and treated for shock, electrolyte imbalances, and
infection. They are monitored closely for heart attacks,
©Central Manchester University
and they receive synthetic thyroid hormone to increase Hospitals NHS Foundation Trust,
thyroid hormone levels. UK/Science Source

Earlier in the chapter you explored how Addison’s disease affected David. Addison’s
disease is caused by the hyposecretion of ACTH. In contrast, Cushing’s syndrome
involves the hypersecretion of ACTH, as you will learn next.

Cushing’s Syndrome
Cushing’s syndrome is a collection of disorders that results from the excess pro-
duction of ACTH from the pituitary gland. The hypersecretion of ACTH is usually
caused by a pituitary tumor. The excess ACTH causes high levels of cortisol in the

332 CHAPTER 8 The Endocrine System

 FIGURE 8.20 Cushing’s
syndrome.
(a) ©Mediscan/Alamy Stock Photo; (b)
©Biophoto Associates/Science Source

(a) (b)

blood. Individuals with Cushing’s syndrome have a variety of symptoms, such as a

moon face, obesity in the trunk of the body, collection of fat on the lower neck and
shoulders, muscle weakness, thin skin, compromised immunity, poor wound heal-
ing, hypertension, kidney stones, osteoporosis, glucose intolerance, and mental dis-
turbances. See Figure 8.20. Blood tests, urinalysis, and MRI can be used to diagnose
Cushing’s syndrome. Cushing’s syndrome is treated with drugs that block corticoste-
roid secretion or with surgery or radiation to remove tumors.
Table 8.8 summarizes all of the diseases and disorders described throughout the
chapter.

TABLE 8.8 Endocrine Diseases and Disorders

Disease/Disorder Description
Acromegaly Hypersecretion of GH from the anterior pituitary gland, which happens during adulthood,
resulting in bones becoming excessively massive.
Addison’s disease Degeneration of the adrenal cortex, which results in the inability to produce adequate amounts
of glucocorticoid hormones, mineralocorticoid hormones, and androgens.
Cushing’s A collection of health problems related to excess cortisol in the blood as a result of
syndrome hypersecretion of ACTH from the pituitary gland.
Diabetes insipidus A disorder in which the posterior pituitary does not release sufficient ADH to cause water
reabsorption in the kidney.
Diabetes mellitus A disorder that results from insufficient insulin produced by the pancreas or an insufficient
response to the insulin that is produced. There are two forms of this disease, based on the
cause: type 1 diabetes mellitus and type 2 diabetes mellitus.
Gigantism Hypersecretion of GH from the anterior pituitary gland, which happens during childhood,
before the epiphyseal plates close, resulting in excessive growth of bones.
Graves’ disease An autoimmune disorder characterized by hypersecretion of thyroid hormone from the thyroid gland.
Hashimoto’s An autoimmune disorder characterized by hyposecretion of thyroid hormone from the thyroid
disease gland.
Myxedema A complication of hypothyroidism, usually triggered by infection or trauma, that can result in
shock, coma, or death if not treated.
Pituitary dwarfism Hyposecretion of GH from the anterior pituitary gland, which happens during childhood,
resulting in unusually short stature.

Spot Check List and describe the diseases covered in this chapter that are
associated with hyposecretion of a particular hormone.

8.7 Endocrine System Disorders 333

Putting the Pieces Together

The Endocrine System

Integumentary system Lymphatic system
Provides the precursor molecule for Sends white blood cells to fight
calcitriol (vitamin D). pathogens in endocrine glands.

Reproductive hormones affect hair Glucocorticoids suppress the

growth for secondary sex immune system and reduce
characteristics. inflammation.

Skeletal system Respiratory system

Provides O2 for endocrine gland
Sella turcica protects the pituitary
tissue and removes CO2.
gland.

Hormones affect bone deposition Hormones such as epinephrine

and remodeling. increase airflow and respiratory
rate.

Muscular system
Digestive system
Skeletal muscles protect some
Provides nutrients for endocrine
glands, such as the adrenal glands.
system glands.

Hormones regulate blood

Hormones regulate gastric
calcium and glucose levels
secretions.
needed for muscle contractions.

Excretory/urinary system
Nervous system
Kidneys dispose of hormones that
Hypothalamus secretes releasing
are no longer needed.
hormones and sends nerve signals
to stimulate the pituitary gland.
Hormones regulate urine
Hormones regulate blood glucose production.
and electrolyte levels needed for
neuron function.
Reproductive system

Cardiovascular system Reproductive hormones have a

negative feedback effect on the
Blood transports hormones to hypothalamus.
their target tissues, provides
nutrients, and removes wastes. Hormones regulate sexual
development, sex drive, menstrua-
Hormones regulate blood volume tion, pregnancy, birth, and
and pressure. lactation.

FIGURE 8.21 Putting the Pieces Together—The Endocrine System: connections between the endocrine system
and the body’s other systems.

334 CHAPTER 8 The Endocrine System

Summary
8.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the endocrine system.

8.2 Overview
∙∙ The endocrine system and nervous system are used for communication to maintain homeostasis.
∙∙ Both of these systems use chemicals as messengers.
∙∙ Communication through the endocrine system is much slower to start, is less specific as to its target, and takes lon-
ger to end than communication by the nervous system.

8.3 Anatomy of the Endocrine System

∙∙ A
 gland may be a separate structure all on its own, or it may be groups of cells within an organ that function together
to produce hormones.
∙∙ A target tissue has receptors for a hormone based on shape.
Glands
∙∙ Pineal gland function is not completely known.
∙∙ The hypothalamus and pituitary gland are connected by the infundibulum and work closely with one another.
∙∙ The thyroid gland produces calcitonin and thyroid hormone, which requires iodine.
∙∙ The pancreas is part of the endocrine and digestive systems. It produces hormones to regulate blood glucose levels.
∙∙ The adrenal gland is divided into two parts: the adrenal cortex and adrenal medulla. Each part produces different
hormones.
∙∙ The gonads are ovaries and testes.
∙∙ Other tissues also make hormones.
Hormones
∙∙ T
 here are three categories of hormones based upon chemical composition: steroids, amino acid derivatives, and
proteins.
∙∙ The composition of a hormone affects how it relates to a receptor.
Target Tissues
∙∙ Receptors for hormones can be on the cell membrane or inside the cell.
∙∙ The ___location of the target tissue is relevant to the delivery method of a hormone.

8.4 Physiology of the Endocrine System

Regulation of Hormone Secretion and Distribution
∙∙ A gland may be stimulated to produce a hormone by a nerve, another hormone, or a substance other than a hormone.
∙∙ Thyroid hormone and steroid hormones bind to plasma proteins in the blood, so not all of the hormone enters the cell
at once.
∙∙ Protein hormones do not bind to plasma proteins because they cannot enter a cell.
Receptor Regulation
∙∙ U p-regulation is the increase in the number of receptors for a given hormone. It increases the cell’s sensitivity to a
hormone and therefore increases the effects of the hormone.
∙∙ Down-regulation is the decrease in the number of receptors for a given hormone. It decreases the cell’s sensitivity to
a hormone and therefore decreases the effects of the hormone.
Hormone Elimination
∙∙ Hormones can be eliminated from the system through excretion, metabolism, active transport, or conjugation.
∙∙ Half-life is the length of time it takes for one-half of a substance to be eliminated from the circulatory system.
Functions: Four Scenarios
∙∙ Hormones such as insulin and glucagon are used to maintain homeostasis.
∙∙ Hormones interact to bring about changes in the body.
∙∙ The endocrine system uses negative feedback mechanisms to achieve homeostasis.
∙∙ The endocrine system can use positive feedback mechanisms.

335
8.5 Effects of Aging on the Endocrine System
∙∙ In general, the levels of hormones decline with age.
∙∙ Even if the levels of some hormones remain high with age, the sensitivity of the target tissue often decreases with
down-regulation of receptors.

8.6 Diagnostic Tests for Endocrine System Disorders

∙∙ C
 ommon diagnostic tests for endocrine system disorders include blood tests, CT scan, DEXA scan, MRI, urinalysis,
and X-ray.

8.7 Endocrine System Disorders

∙∙ D iabetes mellitus is a problem with insulin in blood glucose regulation. It has two forms: type 1 and type 2. Symp-
toms for both types are excessive thirst, excessive urine production, and glucose in the urine. If uncontrolled, both
types may lead to life-threatening complications.
∙∙ Diabetes insipidus is a problem of insufficient ADH secretion from the posterior pituitary. The symptoms are exces-
sive thirst and excessive urine production.
∙∙ Growth disorders are a problem of GH secretion from the anterior pituitary. They include acromegaly, gigantism,
and pituitary dwarfism.
∙∙ Goiters can result from hyposecretion or hypersecretion of thyroid hormone.
∙∙ Hypothyroidism is characterized by a hyposecretion of thyroid hormone. The two main causes of hypothyroidism
are Hashimoto’s disease and hypothyroidism that results from the treatment of hyperthyroidism.
∙∙ Cushing’s syndrome is a collection of disorders that results from the excess production of ACTH from the pituitary
gland.

Key Words for Review

The following terms are defined in the glossary.

androgens half-life receptor

autocrine hormone second messenger
down-regulation mineralocorticoids secondary sex characteristics
endocrine pancreatic islets target tissue
gland paracrine thyroid hormone
glucocorticoids pheromone up-regulation
gonads plasma protein

336
 The

9 Cardiovascular
System—Blood
By this time in your life, you
have undoubtedly seen your own
blood. You may have seen it ooz-
ing from a cut on your finger,
being drawn from your arm into
a tube at the doctor’s office, or
forming a bruise under the skin
of your knee after a fall. The
sight of it may have fascinated
you, scared you, or even made you
feel faint. Regardless of how the
sight of blood makes you feel, you
certainly appreciate that blood is
vital to your health and
the way your cardio-
vascular system
functions. See
Figure 9.1.

Module 9: Cardiovascular System

337
 9.1 Word Roots and Combining Forms
Cardiovascular System
Major Organs and Structures:
heart, aorta, superior and inferior Learning Outcome
venae cavae 1. Use medical terminology related to the cardiovascular system.
Accessory Structures:
arteries, veins, capillaries
Functions:
agglutin/o: erythr/o: red leuk/o: white
transportation, protection by fighting clumping granul/o: phag/o: eat,
foreign invaders and clotting to
prevent its own loss, acid–base blast/o: primitive granules swallow
balance, fluid and electrolyte balance, cell hem/o: blood thromb/o: clot
and temperature regulation
coagul/o: clot hemat/o: blood
cyt/o: cell

9.2 Overview
The cardiovascular system has three components: the heart,
blood, and blood vessels. The heart serves as a pump to circu-
late blood through a closed circuit of blood vessels out to the
tissues of the body and back again to the heart. The heart and
blood vessels are covered in the next chapter.
This chapter focuses on the anatomy of blood and the
physiology of how blood works, which includes how blood is
produced, serves as a transportation system, fights foreign
invaders, and protects the body against its own loss. You will
FIGURE 9.1 The cardiovascular system. investigate how blood maintains the body’s homeostasis by
regulating the fluid and electrolyte balance and the acid–base
balance. You will also learn about blood typing, common
blood tests, and disorders of the blood. Your study begins with
the anatomy of blood.

9.3 Anatomy of Blood

Learning Outcome
2. Identify the components of blood.

As you may recall from “Chapter 2, Levels of Organization of the Human Body,”
blood is a connective tissue. As such, it is composed of different types of cells and cell
parts that exist in a fluid matrix known as plasma. The cells and cell parts are called
formed elements. An average adult has 4 to 6 liters of blood, which is approximately
8% of the body’s weight. A hematocrit blood test measures the ratio of the volume
of red blood cells to the total volume of blood. In this test, a tube of whole blood is
spun in a centrifuge and the formed elements separate from the plasma. As you can see
in Figure 9.2, three layers are formed. Although the formed elements are heavy and
settle to the bottom, they are not all the same. Red blood cells (RBCs)—45% of whole
blood—are the heaviest, so they settle at the very bottom of the tube. Above the red
blood cells is a thin, buff-colored layer of white blood cells (WBCs) and platelets—
less than 1% of whole blood. Above this layer is the clear, straw-colored plasma
(55% of whole blood). We discuss the components of blood in detail in the following
sections, beginning with plasma.

Spot Check Why is blood classified as a connective tissue?

338 CHAPTER 9 The Cardiovascular System—Blood

FIGURE 9.2 Composition of blood. Percentage by body weight
Patient having blood drawn: ©liquidlibrary/
PictureQuest/Getty Images

Blood is 8% of body
weight. Other tissues
and fluids are 92% of
body weight.

Percentage by volume
Plasma
(percentage by weight) Albumins
58%
Proteins 7%
Globulins
38%

Fibrinogen
4%
Plasma Water
Formed elements
55% 91%
White blood cells (number per cubic mm)
Neutrophils Ions
Platelets Buffy
40–70% 165–415 thousand coat < 1%
Nutrients
Lymphocytes White blood cells
20–50% 3.5–9.1 thousand Other solutes 2% Waste products
Formed
Monocytes Gases
elements
4–8%
45%
Regulatory
Eosinophils
substances
0–6%

Basophils Red blood cells

0–2% 4.0–5.6 million

Plasma

Learning Outcome
3. List the constituents of plasma and their functions.

As you can see in Figure 9.2, 91% of the total volume of plasma is water. The follow-
ing three types of dissolved proteins make up another 7% of plasma’s total volume:
• Albumins. Albumins are transport proteins dissolved in plasma. An example of an
albumin is the plasma protein that binds to thyroid hormone to extend its half-life
while traveling in the blood (covered in the endocrine system chapter).
• Globulins. The globulins are another class of plasma proteins. Examples of
globulins are the antibodies produced by white blood cells to fight foreign
pathogens. Antibodies are discussed later in this chapter and again in the lym-
phatic system chapter.
• Fibrinogen and clotting factors. Fibrinogen is a clotting protein dissolved in
plasma. Later in this chapter, we explain how fibrinogen comes out of solution

9.3 Anatomy of Blood 339

 to form a clot. Other chemicals, called clotting factors, are needed for the clot to
form. Serum is plasma with the fibrinogen and clotting factors removed. It is dis-
cussed later in this chapter in the section on blood typing.
The last 2% of plasma shown in Figure 9.2 is composed of many items already
mentioned in this text:
• Ions in solution are electrolytes. You studied several of them in previous chapters.
An example of an ion transported in plasma is Ca2+. Osteoblasts deposit excess
calcium ions from the blood into bone (the skeletal system chapter). Other ions in
plasma include Na+, K+, and Cl−.
• Nutrients are necessary chemicals for normal body function. Glucose is a good
example. If the blood glucose level falls below normal, the liver converts glycogen
to glucose and releases it to the blood (“Chapter 8, The Endocrine System”). Other
examples of nutrients are amino acids, fatty acids, and vitamins. These and other
nutrients are usually absorbed into the blood through the digestive system.
• Waste products are by-products of chemical reactions that occur in the cells.
They are secreted into the blood for removal. An example is bilirubin (bill-ee-RU-
bin), a waste produced from the breakdown of worn-out red blood cells. Bilirubin
is discussed later in the chapter. Other wastes—such as the nitrogenous wastes
removed from the blood by the kidneys—are covered in the excretory/urinary sys-
tem chapter.
• Gases, which enter or leave the body through the lungs, may be required by cells
for chemical reactions to occur. Gases may also be produced as a waste product of
cellular reactions. Examples of gases dissolved in plasma are oxygen and carbon
dioxide. However, most of the oxygen and carbon dioxide in the blood is carried
by red blood cells—not dissolved in plasma. How these gases are transported is
discussed in the respiratory system chapter.
• Regulatory substances are chemicals used for communication. Examples of reg-
ulatory substances dissolved in plasma are the endocrine hormones, covered in the
previous chapter.
Remember that the components of plasma are dissolved. Plasma is a solution
with proteins, ions, nutrients, waste products, gases, and regulatory substances as the
solutes and water as the solvent. The concentrations of these solutes are important for
homeostasis.

Spot Check Give an example of one regulatory substance that may be found in
plasma. Include where it is produced and its destination.

Now that you have covered the composition of plasma, you are ready to examine
the cells and cell parts—also known as formed elements—of whole blood.

Formed Elements

Learning Outcome
4. Identify the formed elements and list their functions.

Unlike the components of plasma, the formed elements of blood are not dissolved.
They include erythrocytes (eh-RITH-roh-sitz) (red blood cells), leukocytes (white
blood cells), and thrombocytes (platelets). Erythrocytes and leukocytes are cells, but
thrombocytes are cell fragments, not complete cells. You should be able to identify each
formed element and its function. Each is discussed here and summarized in Table 9.1.

340 CHAPTER 9 The Cardiovascular System—Blood

 TABLE 9.1 Formed Elements
Formed Element Description Function
Erythrocytes (RBCs) Red, biconcave disks with no nucleus; Mainly, transport oxygen and carbon
7.5 μm in diameter dioxide.

Erythrocytes

LM 1600x

Leukocytes (WBCs): Spherical cells that must be stained to Have various functions, depending
be seen on type. (See following entries.)
Neutrophil Faint granules; nucleus with multiple Phagocytizes microorganisms.
lobes connected by a filament; stains Numbers increase in bacterial
pink to purple; 10–12 μm in diameter infections.

LM 1600x

Basophil Prominent granules that stain blue- Releases histamine to promote

purple; lobed nucleus; 10–12 μm in inflammation and heparin to prevent
diameter unnecessary clot formation. Numbers
increase with allergies.

LM 1600x

Eosinophil Prominent granules that stain orange Attacks some worm parasites.
to bright red; lobed nucleus; 11–14 μm Numbers can increase with allergies.
in diameter

LM 1600x

Monocyte Large cell, two to three times the Leaves the blood to become
size of an RBC; nucleus that is round, a macrophage in the tissues.
kidney-shaped, or horseshoe-shaped; Phagocytizes bacteria, dead cells,
contains more cytoplasm than a and other debris.
lymphocyte; 12–20 μm in diameter

LM 1600x

continued

9.3 Anatomy of Blood 341

 TABLE 9.1 Formed Elements (continued)
Formed Element Description Function
Lymphocyte Round nucleus with little cytoplasm; Is important for the immune system.
6–14 μm in diameter Produces antibodies and other
chemicals to fight foreign pathogens
and is important for tumor control.

LM 1600x

Thrombocytes (platelets) Cell fragments surrounded by a Form platelet plugs and release
membrane; 2–4 μm in diameter clotting factors.

Platelets

LM 1600x

Note: μm = micrometer.
(all photos) ©McGraw-Hill Education/
Al Telser Erythrocytes These cells are commonly called red blood cells, a term that can be
used interchangeably with erythrocytes. Each erythrocyte is a biconcave disk, thick
around its rim and thin at its center. This shape gives the cell a greater surface area for
an exchange of gases in the lungs and at the tissues. Erythrocytes—the most plentiful
of the formed elements—function to transport oxygen and carbon dioxide. Note the
absence of a nucleus. In fact, there are very few organelles in the cytoplasm of a red
blood cell. Without mitochondria, erythrocytes cannot carry out aerobic respiration.
So red blood cells do not use the oxygen they transport.

Clinical P int
Without a nucleus, red blood cells do not contain any DNA. Yet you are probably aware
of blood DNA testing to establish paternity and forensic testing of blood DNA to deter-
mine who committed a crime. The DNA housed in the nuclei of white blood cells is what
is actually tested during blood DNA tests. It is amazing how few blood cells are truly
needed to supply sufficient DNA for these tests.

Spot Check What percentage of a single drop of blood is leukocytes?

Red blood cells spend their lives in blood vessels. They do not move out into the
tissues unless one of the vessels is broken. You will learn more about the life cycle of
a red blood cell later in the chapter.

Leukocytes These cells are commonly called white blood cells. Each of the five types
of leukocytes has a different appearance and function, but all have prominent nuclei
that must be stained to be seen. Three of the types—neutrophils (NEW-troh-fillz),

342 CHAPTER 9 The Cardiovascular System—Blood

basophils, and eosinophils (ee-oh-SIN-oh-fillz)—contain small granules that differ in
color when stained. These leukocytes are classified as granulocytes. Monocytes and
lymphocytes (LIM-foh-sitz) are agranulocytes because they do not contain visible
granules. The size and shape of the nucleus, the presence or absence of granules, and
the color they stain help distinguish one type of leukocyte from another.
Unlike erythrocytes, leukocytes can move out of blood vessels into the tissues. They
are often in circulation only as a means of getting to the tissues where they perform
their functions. These functions provide various defenses against foreign pathogens.
How leukocytes perform their functions is discussed in the lymphatic system chapter.

Neutrophils Neutrophils are the most common type of leukocyte. Neutrophils typically
make up 40% to 70% of all the white blood cells in circulation. Each neutrophil has a
lobed nucleus and faint granules in the cytoplasm that contain lysozymes used to destroy
bacteria. The number of neutrophils in circulation rises in response to bacterial infections.

Basophils Basophils are the least common type of leukocyte. Basophils average from
0% to less than 2% of all the white blood cells in circulation. The large, dark blue-purple
granules of a basophil are so prominent that it is difficult to see the S- or U-shaped nucleus.
The number of basophils in circulation tends to increase with allergies. A basophil’s
primary function is to release two chemicals—histamine and heparin—for defense:
1. Histamine released from basophils causes vessels to dilate (expand). This brings
more blood to an area and causes blood vessel walls to become more permeable.
The increased blood flow and permeability allow more leukocytes to move out of
the blood vessels into injured tissues more quickly.
2. Heparin released from basophils is an anticoagulant, which means it prevents
clotting. This chemical allows other leukocytes to move more freely.

Eosinophils Eosinophils make up 0% to 6% of the total circulating white blood

cells. Their granules stain orange to bright red, making them easy to distinguish from
other WBCs. Eosinophil numbers increase with parasitic infections and allergies.
The chemicals they secrete can be effective against large parasites such as hook-
worms and tapeworms.

Monocytes Monocytes make up 4% to 8% of the total circulating white blood cells.

Although monocytes and lymphocytes stain similarly, there are significant differences
between the two types. Monocytes are the largest of the WBCs, measuring two to three
times the size of a red blood cell. They have a large, round, kidney-shaped or horseshoe-
shaped nucleus surrounded by abundant cytoplasm. Monocytes migrate to tissues where
they become macrophages (MAK-roh-fayj-ez) and function to phagocytize (eat) dead
and dying tissue, microorganisms, and any other foreign matter or debris. The number
of monocytes in circulation increases with inflammation and viral infections.

Lymphocytes Lymphocyte cells are fairly common in circulating blood, making

up 20% to 50% of the total WBCs. Although lymphocytes and monocytes stain
similarly, lymphocytes are smaller and have less cytoplasm. Two of the subclasses
of lymphocytes are B cells and T cells. Although they look alike, they have different
immune system functions. B cells and T cells are discussed in detail in the lymphatic
system chapter.

Spot Check Why are the white blood cells shown in Table 9.1 not white?

Spot Check Which leukocyte(s) would you expect to increase in number if you
had hay fever?

9.3 Anatomy of Blood 343

 Thrombocytes These formed elements are commonly called platelets, a term that
may be used interchangeably with thrombocytes. Platelets are not actually cells but
cell fragments. Together, platelets and leukocytes make up approximately 1% of whole
blood, but platelets outnumber leukocytes. Platelets in the human body have many
important functions:
• Platelets secrete vasoconstrictors (chemicals that reduce the size of broken blood
vessels) to slow the flow of blood.
• Platelets secrete clotting factors to promote the formation of blood clots.
• Platelets form platelet plugs, which are discussed later in the chapter.
• Platelets secrete chemicals to attract neutrophils and monocytes to sites of
inflammation.
• Platelets destroy bacteria.
• Platelets secrete growth factors to stimulate mitosis to repair vessel walls.
You have covered the anatomy of blood by examining the composition of plasma
and studying each of the formed elements. Next, you will focus on the physiology of
blood, starting with how blood is produced.

9.4 Physiology of Blood

Hemopoiesis

Learning Outcome
5. C
 ompare the various forms of hemopoiesis in terms of ___location, starting cell, factors
influencing production, and final product.

Hemopoiesis (HE-moh-poy-EE-sis) is blood production. It is a continual process

designed to meet the demand of replacing circulating cells that have worn out or been
lost through bleeding. There are three types of hemopoiesis: thrombopoiesis, leuko-
poiesis, and erythropoiesis. In each form of production, note where the production
happens, what the beginning cell is, what causes the production to occur, and what the
final product is. See Table 9.2.

TABLE 9.2 Hemopoiesis

Type of Factor Causing What Produces
Hemopoiesis Where Starting Cell Production the Factor Final Product
Thrombopoiesis Red bone marrow Hemocytoblast Thrombopoietin Liver and kidneys Platelets
Leukopoiesis Red bone marrow Hemocytoblast Colony-stimulating Lymphocytes and White blood
factors macrophages cells
Erythropoiesis Red bone marrow Hemocytoblast Erythropoietin Kidneys Red blood cells

Figure 9.3 will be helpful while you are learning about each form of hemopoiesis.
The two most important rows in this figure are the top row (showing the starting cell)
and the bottom row (showing the final product).

344 CHAPTER 9 The Cardiovascular System—Blood

 Stem cell (hemocytoblast)

Megakaryoblast Monoblast Lymphoblast Myeloblast Proerythroblast

Progranulocyte Early
erythroblast

Megakaryocyte

Neutrophilic Eosinophilic Basophilic Intermediate

myelocyte myelocyte myelocyte erythroblast

Megakaryocyte breakup Late

erythroblast

Neutrophilic Eosinophilic Basophilic

band cell band cell band cell Reticulocyte

Platelets Monocyte
Neutrophil Eosinophil Basophil Red blood cell
Lymphocyte

Agranulocytes Granulocytes

White blood cells

FIGURE 9.3 Hemopoiesis.

9.4 Physiology of Blood 345

 Notice that the hemocytoblast (stem cell) is the starting cell for the production
of all the formed elements. This cell is said to be pluripotent, which means it can
become any one of seven different types of formed elements. Hemocytoblasts are
located in red bone marrow. They must be stimulated to grow and divide to become
one of the formed elements. It is important for you to know (in each form of hemo-
poiesis) what chemical (factor) causes the hemocytoblast to commit to production of
each formed element.
Myeloid hemopoiesis is the production of all the formed elements in the red
bone marrow. Only lymphocytes can also be produced in lymphoid tissues such as
the lymph nodes, thymus, and spleen. This additional production in sites outside
the red bone marrow is lymphoid hemopoiesis. It is covered in the lymphatic sys-
tem chapter.

Thrombopoiesis Thrombopoiesis is the production of platelets. It begins with

a hemocytoblast in the red bone marrow. When there is a need for more platelets,
the liver and kidneys produce a chemical called thrombopoietin. The target tissue
for thrombopoietin is the hemocytoblast. Thrombopoietin causes the hemocytoblast
to grow and divide to become a megakaryocyte (MEG-ah-KAIR-ee-oh-site). See
Figure 9.3. The megakaryocyte eventually breaks apart to become many platelets.
Although most of the platelets go into blood circulation immediately, 25% to 40% of
the newly formed platelets are stored in the spleen until they are needed.

Leukopoiesis Leukopoiesis is the production of leukocytes, which also begins

with a hemocytoblast in the red bone marrow. See Figure 9.3. Lymphocytes and
macrophages out in the tissues produce chemicals called colony-stimulating factors
(CSFs) when there is a challenge to the immune system. These factors also target
a hemocytoblast. There is a different CSF for each type of leukocyte production.
The production of each CSF is dependent on the immune system challenge. If it is
a bacterial infection, the CSF that stimulates neutrophil production is released. The
CSF travels to the red bone marrow to fit into a receptor on a hemocytoblast so that
the hemocytoblast grows and divides to produce neutrophils. Different CSFs would
be produced to promote the production of basophils or eosinophils in the case of
allergies. So each type of leukocyte can be produced in abundance, depending on
the need. An increase in any of their numbers can indicate the type of immune sys-
tem challenge.
Once produced, granulocytes and monocytes are stored in the red bone marrow
until they are needed. For example, neutrophils may be stored in the red bone marrow
until they are needed to fight an infection in an open wound. There are typically 10 to
20 times more granulocytes and monocytes in red bone marrow than in circulation.
Lymphocytes are made in red bone marrow but then migrate to tissues. T lymphocytes
migrate to the thymus, while B lymphocytes migrate to other lymphoid tissues such as
the lymph nodes and spleen. Lymphocytes are covered in more detail in the lymphatic
system chapter.
Circulating white blood cells do not stay in the blood long. They may be in circu-
lation only for a few hours before migrating to the tissues. Monocytes become mac-
rophages once they are in the tissues, and they may last a few years. Lymphocytes
migrate to the tissues but may continue to migrate back and forth between the tissues
and the blood. Lymphocytes typically last for weeks to decades.

Erythropoiesis Erythropoiesis is erythrocyte production. Erythropoiesis, too, begins

with a hemocytoblast in red bone marrow. The kidneys produce erythropoietin (EPO)
to stimulate red blood cell production when the oxygen blood level is low, a condi-
tion called hypoxemia. EPO travels from the kidneys through blood to the red bone
marrow in all cancellous bone. There, EPO fits into receptors on hemocytoblasts to
stimulate them to grow and divide to become red blood cells. Additional red blood

346 CHAPTER 9 The Cardiovascular System—Blood

cells increase the blood’s capacity to carry oxygen,
Hypoxemia
thereby increasing the oxygen level in the blood. This (inadequate O2 transport)
is a negative feedback response to a move away from
homeostasis. If blood oxygen levels are too low, more
Increased
red blood cells are produced to carry more oxygen to O2 transport
restore homeostasis. See Figure 9.4.
What causes hypoxemia? Certainly lung disorders Sensed by
kidneys
may cause low blood oxygen levels, but hypoxemia
can also occur without a disorder as the cause. Certain
environments and activities can promote hypoxemia,
including the following:
• High altitudes. The air is thinner at high altitudes
and contains less oxygen. Erythropoiesis is accel-
erated at high altitudes to provide more red blood Increased
cells to carry any available oxygen. RBC count

• Exercise. Starting an exercise program increases

the demand for oxygen in the tissues to perform
Secretion of
increased aerobic respiration. Erythropoiesis pro- erythropoietin
duction increases the number of red blood cells, so Accelerated
more oxygen can be carried to meet the demand. erythropoiesis

• Exposure to carbon monoxide (CO). Carbon

monoxide is a by-product of burning. Exposure to
carbon monoxide may happen through car exhaust,
improperly vented furnaces, and even cigarette
smoke. A smoker inhales carbon monoxide in every
puff of a cigarette. Hemoglobin carries carbon mon-
oxide more readily than it carries oxygen. Once the
hemoglobin picks up carbon monoxide, it does not Stimulation of
carry oxygen again under normal conditions. This red bone marrow
makes the hemoglobin nonfunctional for oxygen
transport. Erythropoiesis is accelerated to make up FIGURE 9.4 Negative feedback correction of hypoxemia.
for any nonfunctioning hemoglobin.

Clinical P int
Carbon monoxide (CO) poisoning is one of the most common fatal gas poisonings that
exists. Depending on its severity, carbon monoxide poisoning can cause headache,
nausea, weakness, loss of consciousness, and coma. Treatment includes removing the
patient from the source of carbon monoxide and giving him or her oxygen; in cases in
which the poisoning is severe, the use of a hyperbaric chamber may be considered.
When using items that are sources of carbon monoxide, great care should be taken
to make sure the area is well ventilated to avoid the buildup of carbon monoxide gas
in the environment. Additionally, the use of carbon monoxide detectors in the home is
another way to prevent carbon monoxide poisoning.

Common Misconception
Do not confuse carbon monoxide (CO) with carbon dioxide (CO2). Carbon dioxide is
produced by the body and is a gas normally found in the air we breathe.

9.4 Physiology of Blood 347

 • Blood loss. There are many reasons for blood loss. The loss may occur from dis-
ease, from an injury, or through donation to the local blood drive. The kidneys rec-
ognize the diminished blood oxygen level and secrete EPO to stimulate additional
erythropoiesis to make up for any loss.

Spot Check Professional basketball players train to be able to use aerobic

respiration continually during a game. How would the red blood count of a Miami Heat
player compare to that of a Denver Nuggets player? (Hint: Miami is at sea level; Denver
is the “mile-high city.”) Explain.

Spot Check How would the red blood count of a Miami Heat player likely
compare to that of a University of Miami anatomy and physiology professor? Explain.

Many changes to a hemocytoblast occur during the process of erythropoiesis. For

example, one large hemocytoblast becomes many smaller red blood cells. In the pro-
cess, hemoglobin is formed, the nucleus is lost, and the shape of the cell is changed to
a biconcave disk. Again, see Figure 9.3. All of this takes place in approximately 3 to
5 days in the red bone marrow once EPO has stimulated the hemocytoblast. Following,
you will learn more about the hemoglobin that must be produced.

Hemoglobin

Learning Outcome
6. Describe the structure and function of hemoglobin.

The cytoplasm of erythrocytes contains hemoglobin, a red, complex protein made

of four chains of amino acids called globins. See Figure 9.5. Each chain contains a
heme group with an iron ion at its center that can bind to one oxygen molecule, so
each hemoglobin molecule can carry four oxygen molecules. There are approximately
280 million hemoglobin molecules dissolved in the cytoplasm of each erythrocyte.
This makes the cytoplasm of a red blood cell a 33% solution of hemoglobin.
In addition to transporting oxygen from the lungs to the tissues, hemoglobin
transports hydrogen ions (H+) and carbon dioxide from the tissues to the lungs. Gas
transport is discussed more in the respiratory system chapter. Binding to H+ means

CH3 CH2CH2COOH
Globin (β1)
N
CH2=CH CH2CH2COOH
Globin (β1) N Fe N
CH3 CH3
N

CH2=CH CH3
Heme
Heme

Globin (β2) Globin (β2)

Hemoglobin

FIGURE 9.5 Hemoglobin molecule composed of four amino acid chains. Each chain has
a heme group with an iron ion at its center to carry oxygen.

348 CHAPTER 9 The Cardiovascular System—Blood

 Applied Genetics
Some people of African descent have a recessive gene in their DNA that codes for a
different form of hemoglobin. This alternative hemoglobin causes red blood cells to
change shape and sickle (form a crescent with points) in low blood oxygen situations.
See Figure 9.6. Having one copy of the gene results in a condition called sickle cell
trait, which typically has mild symptoms, if any. Having two copies of the gene results in
sickle cell disease, a much more serious condition that can cause death if not treated.
The sickled cells are sticky and can clump together, blocking blood flow to small vessels.
Although the consequences of the gene can be life-threatening, there is an advantage to
this form of hemoglobin for people living in areas plagued with malaria. The parasite that
causes malaria feeds on hemoglobin, but sickle cell hemoglobin is harmful to the para-
site. Thus, people with sickle cell hemoglobin are resistant to malaria.
©MOLEKUUL/SPL/age fotostock

that H+ will not be free in the blood to lower the blood’s pH. In order to
maintain homeostasis, hemoglobin acts as a buffer to resist a change in the
pH of blood.
Next, you will read about what is needed in a diet to form hemoglobin
and carry out erythropoiesis.

Nutritional Requirements for Erythropoiesis

Learning Outcome
7. Summarize the nutritional requirements of red blood cell production.

The key ingredient in hemoglobin is iron, because it carries the oxygen

needed for red blood cells to function. Some iron is normally lost each
day in urine and feces. The average loss is slightly higher for women
than men because of their additional blood loss with menstruation. Note
that not all iron from consumed food is absorbed. Acid in the stomach
converts only some of the iron consumed to a usable form that can be 7 μm
absorbed. In order to maintain homeostasis and carry out erythropoiesis,
FIGURE 9.6 Sickle cell disease. The
iron must be a part of a healthy diet. On average, the RDA for iron is crescent-shaped red blood cell has been
18 mg/day for a female, but a pregnant woman needs 27 mg/day to sup- deformed by sickle cell hemoglobin.
ply sufficient iron for erythropoiesis for herself and for the developing ©Meckes/Ottawa/Science Source
fetus. (See Appendix B.) Iron can be supplied in a diet through meat,
eggs, vegetables, and legumes.
Other nutrients necessary for erythropoiesis include the following:
• Folic acid and vitamin B12 for cell division. Folic acid is supplied in orange juice
and vegetables. Vitamin B12 is found in meat and dairy products.
• Copper and vitamin C for the enzymes necessary to form hemoglobin. Copper is
supplied in the diet through seafood, organ meats, and legumes. Vitamin C is found
in fruits and green vegetables.
You have reviewed the production of all the formed elements. Now it is time to
examine the life cycle of a red blood cell after it is produced from a hemocytoblast in
red bone marrow.

Spot Check Given what you have read about the role of iron, what happens
when iron levels are too low?

9.4 Physiology of Blood 349

 Life Cycle of a Red Blood Cell

Learning Outcome
8. Describe the life cycle of a red blood cell from its formation to removal.

The primary function of red blood cells is to transport oxygen and carbon dioxide
between the lungs and the tissues. To do this, red blood cells must be in constant
circulation, traveling under pressure through smaller and smaller blood vessels and
getting squeezed into single file in the capillaries. Because it is not an easy journey,
red blood cells survive only 110 to 120 days. After 110 to 120 days, the worn-
out red blood cells must be broken down. As these exhausted red blood cells are
destroyed, new red blood cells are produced to replace them. Erythropoiesis is an
impressive process. The body produces, on average, 2.5 million new red blood cells
every single second.

Spot Check Why can lymphocytes last for decades if erythrocytes last only
110 to 120 days?

The liver and spleen function to remove old, worn-out red blood cells. These
two organs break down the cells and process the hemoglobin. In both organs, hemo-
globin is broken down to heme and globin. Globins are the four chains of amino
acids. The chains are broken down to free amino acids, which are then recycled
to the red bone marrow. These are the exact amino acids that will be needed later
to form new hemoglobin during erythropoiesis. The heme is further broken down
to iron (recycled to the red bone marrow) and bilirubin (a waste that must be
removed from the body). The liver secretes bilirubin in bile, an important diges-
tive juice that is discussed in the digestive system chapter. The bilirubin is then
removed from the body with feces. The spleen secretes bilirubin into the blood
for the kidneys to remove and put in urine. As mentioned earlier in the chapter,
bilirubin is one of the wastes found in plasma. It is yellow in color, which accounts
for the straw color of plasma. The bilirubin that is put in urine by the kidneys gives
urine its yellow color. See Figure 9.7.
In the next section, you will see what happens if a blood vessel is broken.

FIGURE 9.7 The breakdown

Hemoglobin
of hemoglobin by the liver
and spleen.

Heme Globin

Bilirubin Iron Amino acids

Bile Blood Red bone marrow

Feces Urine

350 CHAPTER 9 The Cardiovascular System—Blood

 Clinical P int
If the liver is not functioning, the spleen alone must process all the hemoglobin from
worn-out red blood cells. That means all of the bilirubin will be secreted into the blood
instead of into bile. The added bilirubin in the
blood gives a yellow appearance to the skin and
eyes, a condition called jaundice. Jaundice is a
good indicator of liver malfunction.
Bacteria, normally found in the intestines,
change the color of bilirubin (secreted by the liver
in bile) to brown. This is why feces are brown no
matter what food was consumed. So light-clay-
colored stools are also an indicator of liver trouble. Source: CDC

Hemostasis

Learning Outcome
9. Describe the body’s mechanisms for controlling bleeding.

Hemostasis (he-moh-STAY-sis) means “the stopping of bleeding,” and it is more than

just blood clotting. Hemostasis is a three-step process: vascular spasm, platelet plug
formation, and blood clotting or coagulation (koh-ag-you-LAY-shun). Platelets are
important in all three steps of hemostasis. See Figure 9.8.

Vascular Spasm This is the immediate constriction of a broken vessel that reduces
blood flow. Vascular spasm can be started in several ways:
• Pain receptors in injured tissue can directly stimulate a vessel to constrict.
• Platelets in a broken vessel can release vasoconstrictors.
• Injury to the smooth muscle of a vessel wall can cause the vessel to constrict.
Vascular spasm lasts only a few minutes, but this allows time for the next two
hemostatic mechanisms to take effect.

Platelet Plug Formation Normally, platelets are prevented from sticking to vessel walls
because the walls are coated with a platelet repellent (like a nonstick, Teflon coating on a
frying pan) to ensure that blood flows through the vessels easily. However, if a vessel is

Vasoconstriction

Vessel Collagen
injury fibers
Endothelial cells Platelet plug Blood clot

(a) (b) (c)

FIGURE 9.8 Hemostasis: (a) vascular spasm, (b) platelet plug formation, (c) coagulation.

9.4 Physiology of Blood 351

 broken, collagen fibers of the vessel wall are exposed on the broken edges. Platelets stick
to the exposed collagen fibers, forming a platelet plug—another mechanism of hemostasis.
Note that a platelet plug is different from a blood clot. Once in the plug, platelets begin to
secrete factors that initiate the last mechanism of hemostasis—coagulation.

Blood Clotting (Coagulation) Blood clotting is the last mechanism of hemostasis to

occur, but it has the most lasting effects. The process of coagulation involves a series
of events that result in the dissolved protein fibrinogen coming out of solution to form
a solid fiber called fibrin. Fibrin then acts as a net to trap blood cells and platelets to
form a solid clot attached to the vessel walls. There are two different pathways to get
FIGURE 9.9 Pathways of the process started. See Figure 9.9.
coagulation.

Extrinsic Intrinsic
pathway pathway
Factor XII Platelets

Factor XI
Damaged Inactive
(active)
perivascular
tissues

Factor IX
Inactive
(active)

Factor III Factor VII Ca2+, PF3

Factor VIII
Inactive
(active)
Ca2+

Common
pathway

Factor X
Inactive
(active)

Factor III
Factor V
Ca2+
PF3

Prothrombin
activator
Factor V

Prothrombin
Thrombin Factor XIII
(factor II)
Ca2+

Fibrinogen Fibrin
Fibrin
(factor I) polymer

352 CHAPTER 9 The Cardiovascular System—Blood

Pathways of Blood Clotting

Learning Outcome
10. D
 escribe two pathways for blood clotting in terms
of what starts each, their relative speed, and the
clotting factors involved.

As shown in Figure 9.9, the two pathways at the top

of the figure merge to form a common pathway at the
bottom of the figure. As you study this figure, keep in
mind the following important details:
1. The extrinsic pathway, shown in the orange box,
is begun by damaged tissues.
2. The intrinsic pathway, shown in the yellow box,
is started by platelets.
3. Both the extrinsic and intrinsic pathways require FIGURE 9.10 Blood clot. Red blood cells and platelets are
the addition of calcium. caught up in a web of fibrin polymer strands forming a clot.
4. Both the extrinsic and intrinsic pathways require ©Science Photo Library/Getty Images
clotting factors, but it is a different set of factors
for each pathway.
5. There are fewer steps in the extrinsic pathway, so it is faster (15 seconds). The
intrinsic pathway involves more steps, so it is slower (3 to 6 minutes).
6. Both the extrinsic and intrinsic pathways lead to a common pathway, shown in purple.
7. Additional, different clotting factors are required in the common pathway.
8. All of the clotting factors are present in the blood at all times but in an inactive
form. Each step activates the next step, and this results in what is called a reaction
cascade, much like falling dominoes.
9. The end result is the formation of a fibrin polymer (solid fibrin strands). See
Figure 9.10.
It is important to have two pathways to accomplish the same end. For example,
as you can see in Figure 9.9, if you were missing factor VIII, you would not be able
to use the intrinsic pathway but could still form a clot using the extrinsic pathway
because it does not require factor VIII. However, if you were missing clotting factors
from both the intrinsic and extrinsic pathways, or from just the common pathway, you
would not be able to form a clot.
Most of the clotting factors are produced in the liver, which requires vitamin K for
their production. Half of the required vitamin K comes from bacteria in the intestines,
while the other half is supplied through diet. Vitamin K is found in liver, cabbage, spinach,
and vegetable oils. In order to maintain homeostasis, the adult RDA for vitamin K is
90 micrograms (µg) for adult females and 120 µg for adult males. (See Appendix B.)
Once a clot is formed, platelets shrink to draw the edges of the broken vessel
together. This is called clot retraction. It is similar to wound retraction, in which the
drying scab brings the edges of a wound closer together (discussed in the integumen-
tary system chapter). Platelets then secrete growth factors to encourage cells in the
vessel walls to undergo mitosis to repair the break.

Spot Check What are the similarities and differences between pathways
of coagulation in terms of initiation, clotting factors, need for calcium, and time?

Spot Check How are platelets involved in each of the three mechanisms
of hemostasis?

9.4 Physiology of Blood 353

 Elimination of Blood Clots

Learning Outcome
11. Describe what happens to blood clots when they are no longer needed.

A clot is vital if a vessel is broken, but once the vessel is healed, the clot is no longer
necessary. As soon as the vessel is repaired, another mini-reaction cascade of events
happens to change an inactive enzyme called plasminogen to plasmin. Plasmin dis-
solves the now unnecessary blood clot in a process called fibrinolysis.

Preventing Inappropriate Clotting

Learning Outcome
12. Explain what keeps blood from clotting in the absence of injury.

Inappropriate clotting—clotting that occurs when vessels are not broken—can have
disastrous consequences. Such clots may block vessels and disrupt the flow of blood to
the point of causing death. A stationary unwanted clot is called a thrombus. A mov-
ing unnecessary clot is called an embolus. There are several control mechanisms to
prevent inappropriate clotting:
• Platelet repulsion. This has already been mentioned. The lining of a vessel is very
smooth and coated with a platelet repellent to make sure platelets do not stick to
vessel walls.
• Dilution. Some small amounts of thrombin may always be in circulation, but the
circulation of the blood keeps the thrombin diluted and does not allow it to accu-
mulate enough in any one place to change fibrinogen to fibrin. See Figure 9.9.
• Anticoagulants. These chemicals interfere with the pathways of clotting. For
example, the liver produces antithrombin, which deactivates circulating throm-
bin; and basophils release heparin, which blocks prothrombin activator, a neces-
sary step in the reaction cascade. See Figure 9.9.
You have explored the three mechanisms of hemostasis and the way beneficial
clots are removed when they are no longer needed. You have also seen how inap-
propriate clots are prevented. But what if bleeding cannot be stopped? Then medical
intervention and possibly a transfusion may be necessary. In the next section, you will
learn about another important topic concerning blood—blood typing.

Blood Typing

Learning Outcomes
13. Explain what determines ABO and Rh blood types.
14. Explain how a blood type relates to transfusion compatibility.
15. Determine from a blood type the antigens and antibodies present and the transfusion
compatibility.
16. Predict the compatibility between mother and fetus given Rh blood types for both,
and describe the possible effects.

A blood type might be A+ or AB−. But what do the letters and positive or nega-
tive sign mean? The surface of blood cells may or may not have molecules called
antigens. These antigens have a unique shape, which marks cells as being self (part of
an individual, not foreign). The presence or absence of specific antigens on the cells

354 CHAPTER 9 The Cardiovascular System—Blood

is genetically determined. Remember that blood type is determined by the antigens on
the surface of the cells.
There are two basic groups of antigens: ABO and Rh. In the ABO group, there
are A antigens, B antigens, but no O antigens—O means no antigens of that group.
So if cells have just A antigens on their surface, the blood is type A. If cells have
just B antigens on their surface, the blood is type B. If cells have both A and B
antigens, the blood is type AB. If cells have neither A nor B antigens, the blood
is type O.
The Rh group contains several antigens named for the rhesus monkeys in which
they were first found. If an individual has any antigen from this group, the individual
is said to be Rh+ (positive). Most people are Rh+. If the Rh antigen is not present on
cells, the blood is Rh− (negative). Thus, if a blood type is AB−, it has A antigens, B
antigens, and no Rh antigens. If blood is type O+, it has no A or B antigens but does
have Rh antigens on the surface of its cells.
Antigens, however, are only part of the story. Antibodies are dissolved proteins
in plasma. Some of the globulins mentioned in the “Plasma” section at the beginning
of the chapter are antibodies. The role of an antibody is to seek out foreign antigens
and mark them for removal. Each antibody is specific to an antigen on the basis of its
shape. Anti-A antibodies react to A antigens; anti-B antibodies react to B antigens; and
anti-Rh antibodies react to Rh antigens. See Figure 9.11.
Dealing with ABO first, consider a young boy named Andre as an example. If
Andre is type B, he has B antigens on the surface of his cells and has anti-A antibodies
dissolved in his plasma. Anti-A antibodies travel through Andre’s blood seeking out
any A antigens that would be foreign to him. If the anti-A antibodies find any cells
with A antigens, they bind to the antigens and clump up several cells at a time. This

Red blood cells Plasma FIGURE 9.11 Antigens and

antibodies for each ABO
Type A blood type.
Red blood cells with type-A surface
antigens and plasma with anti-B
antibodies

Antigen A Anti-B antibody

Type B
Red blood cells with type-B surface
antigens and plasma with anti-A
antibodies

Antigen B Anti-A antibody

Type AB
Red blood cells with both type-A
Neither anti-A nor and type-B surface antigens and neither
anti-B antibodies anti-A nor anti-B plasma antibodies

Antigens A and B

Type O
Red blood cells with neither type-A
nor type-B surface antigens but both
anti-A and anti-B plasma antibodies

Antigens A and B Anti-A and anti-B

antibodies

9.4 Physiology of Blood 355

 Agglutinated red
Antigen A Red blood cell blood cells

Anti-B Anti-A
(a) antibody antibody (b) (c)

FIGURE 9.12 Agglutination. (a) Foreign type-A blood is introduced to Andre’s anti-A antibodies; (b) Andre’s anti-A antibodies
bind to A antigens on the foreign cells to agglutinate them for removal; (c) agglutinated blood.
(c) ©Chassenet/Science Source

clumping is called agglutination. See Figure 9.12. The agglutination of cells marks
them for removal by macrophages. So, if foreign cells with A antigens enter Andre’s
bloodstream, his anti-A antibodies see them as foreign and mark them for removal
through agglutination. Macrophages then come along and get rid of them. This is a
safety system to protect the body from foreign pathogens.
Type-A blood would never have anti-A antibodies because these antibodies would
agglutinate the blood’s cells and mark them for removal. Type-AB blood would never
have anti-A or anti-B antibodies because they would result in the destruction of blood
cells. Type-O blood would have both anti-A and anti-B antibodies because both A
and B antigens would be foreign. Appropriate ABO antibodies for each type are
believed to be acquired as a result of a childhood immune system response to bacteria
normally present in the intestines or other antigenic stimuli.

Spot Check What antigens and antibodies would be present in a person with
Type A type-A blood? Where would the antigens and antibodies be located?

Anti-Rh antibodies are a little different. An Rh− individual acquires the anti-Rh
Type B antibodies only if exposed to the Rh antigen. The immune system first recognizes
the antigen as foreign and then starts to produce anti-Rh antibodies to fight it. Once
started, anti-Rh antibody production will continue for life. This is very important for
Type AB pregnant women who are Rh−, as you will see shortly.

Type O Spot Check Would an Rh+ person produce anti-Rh antibodies?

FIGURE 9.13 ABO blood

typing. Each row shows the
Determining a Blood Type and Transfusion Compatibility Blood type can be
reaction of that type blood with determined by mixing a drop of blood with drops of different sera (plural of serum).
each of the sera. Agglutination As you may recall from the section on plasma earlier in the chapter, serum is plasma
appears as clumping of the with the clotting proteins removed. Antibodies are present in serum. Figure 9.13
cells. Type-A blood shows shows two bottles of serum: The blue bottle contains serum with anti-A antibodies,
agglutination when mixed with and the yellow bottle contains serum with anti-B antibodies. In the rows of test slides
anti-A serum. below the bottles, agglutination appears as clumping of the cells. The clumping can
©Jean-Claude Revy/ISM/Medical Images be seen with the naked eye—no microscope is needed. Notice there is no clumping for

356 CHAPTER 9 The Cardiovascular System—Blood

type-O blood mixed with either serum. This is because there are no A or B antigens on
the surface of the type-O cells for the antibodies in the sera to agglutinate.
Why is blood-typing information important? If bleeding cannot be stopped,
a transfusion may be necessary. The purpose of a transfusion of whole blood is
to get more red blood cells to the recipient’s bloodstream to carry more oxygen.
Remember: In a transfusion, the donor’s red blood cells must survive the recipi-
ent’s antibodies. A type-A+ recipient could not receive type-B+ blood because the
anti-B antibodies in the recipient’s blood would agglutinate the donated blood cells.
The clumped cells would block small vessels and cause a transfusion reaction
that could result in kidney failure and death. A type-AB person, with no anti-A or
anti-B antibodies, is considered to be a universal recipient. A type-O person, who
has neither A nor B antigens, is considered to be a universal donor. The anti-A and
anti-B antibodies present in type-O blood limit this type to being able to receive
blood only from type-O donors.

Spot Check To which blood types could a person with type B− donate blood?
From which blood types could a person with type B− receive blood?

Mother-Fetus Blood-Type Compatibility As mentioned before, anti-Rh anti-

bodies can have severe consequences for Rh-negative mothers. For example, if a
woman is Rh−, she does not have Rh antigens on her cells and she does not have
anti-Rh antibodies in her plasma unless she has been previously exposed to the
Rh antigen. Suppose she has not been exposed. If all of her children are also Rh−,
there will never be any incompatibility. But assume her first child is Rh+. While
she is carrying the fetus, her placenta acts as a barrier to the mixing of blood. The
fetal blood cells are kept from the mother’s circulation and all is well. At delivery,
the placenta tears away from the wall of the uterus so that it can be delivered after
the baby. Mixing of some of the fetal blood cells with the mother’s blood is likely
during the process. As a result, the mother has now been exposed to the Rh antigen
and begins to make anti-Rh antibodies. She will continue to produce the anti-Rh
antibodies for the rest of her life. Anti-Rh antibodies can cross the placenta to fetal
circulation in future pregnancies. If the next fetus is Rh−, there will be no prob-
lem because the fetus does not have any Rh antigens for the anti-Rh antibodies to
attack. However, if the next fetus is Rh+, the now present anti-Rh antibodies in
the mother’s blood will cross the placenta and attack all of the fetal blood cells.
The agglutinated cells are then cleared away. This condition—called hemolytic
disease of the newborn (HDN) or erythroblastosis fetalis—may result in anemia
(the condition of too few red blood cells) so severe as to cause the death of the
fetus. See Figure 9.14.

Clinical P int
An Rh− mother can be given anti-Rh antibodies by injection during her pregnancy
and immediately after delivery. The anti-Rh antibodies quickly target and bind to any
Rh antigen that may have entered her system from the fetus. If the Rh antigens are
removed before her immune system becomes aware, her production of anti-Rh anti-
bodies is prevented.
This is similar to a child cleaning up milk spilled on the carpet while his mother was
at work. If all evidence of the spill is removed before his mother returns, she may never
know the spill ever happened.

9.4 Physiology of Blood 357

 Maternal
circulation Maternal
circulation
Maternal
Rh-negative
red blood cell Maternal
Rh-negative
red blood cell
Fetal Rh-positive
red blood cell in the
maternal circulation
Anti-Rh
antibodies

Fetal
Rh-positive
red blood cell

First pregnancy Between pregnancies

(a) (b)

Maternal
circulation

Maternal anti-Rh
antibodies cross
the placenta

Agglutination of
fetal Rh-positive
red blood cells
leads to HDN

Second pregnancy
(c)

FIGURE 9.14 Hemolytic disease of the newborn. (a) First pregnancy: Fetal Rh+ red blood cells enter mother’s circulation
through a tear in the placenta, usually when the placenta is delivered. (b) Between pregnancies: Mother produces anti-Rh
antibodies. (c) Second pregnancy: Mother’s anti-Rh antibodies cross the placenta and agglutinate fetal Rh+ blood.

Spot Check Explain why hemolytic disease of the newborn will most likely not
affect the first Rh+ child of an Rh− mother.

Functions of Blood

Learning Outcome
17. Summarize the functions of blood by giving an example or explanation of each.

As you can see in Figure 9.15, Andre has severely scraped his knee. His wound is con-
tinuing to bleed through its dressing. In this section, you will explore what the blood in
his body is doing for Andre under normal circumstances and specifically with his injury.

358 CHAPTER 9 The Cardiovascular System—Blood

 The functions of blood include the following:
1. Transportation:
∙∙ Andre’s blood is transporting important nutrients
throughout his body while carrying away wastes and
debris from the wound.
∙∙ Andre’s blood is carrying oxygen to his tissues and
carbon dioxide away.
∙∙ Notice that Andre is wearing shorts. Andre’s blood is
transporting heat from his core to his skin, where it can
radiate off on a warm, sunny day, thereby regulating
his temperature.
∙∙ Andre’s blood is transporting hormones to regulate his
body and maintain homeostasis.
2. Protection:
∙∙ Andre’s white blood cells are fighting off any foreign
pathogens that may have entered his wound. Neutro-
phils are moving in large numbers to the site to fight
off any bacteria, and his macrophages are getting rid of
the damaged tissue and debris at the wound site.
∙∙ Andre’s blood is actively involved in hemostasis to pre-
vent its own loss. By the time the dressing was applied,
Andre had moved past vascular spasm and platelet
plug formation to coagulation. By the dressing, you
can see coagulation has not been completed yet.
3. Regulation:
FIGURE 9.15 Andre’s knee is bleeding.
∙∙ In order to maintain homeostasis, blood must be main- ©Bellurget Jean Louis/Jupiterimages/Getty Images
tained in a very narrow range of pH: 7.35 to 7.45. Free
hydrogen ions lower the blood pH. The hemoglobin in Andre’s blood binds to
hydrogen ions at the tissues, thereby acting as a buffer resisting a change in pH.
You will learn more about this in the respiratory system chapter.
∙∙ Another aspect of homeostasis is the maintenance of fluid balance in the tis-
sues. This is achieved by adjusting the volume of plasma. More water can be
taken into Andre’s blood from the tissues or can be given out from his blood to
the tissues, depending on need.
You have examined the anatomy and physiology of the blood. Next, you will learn
about the various common blood tests used in medicine to assess the blood.

9.5 Diagnostic Tests for Blood Disorders

Learning Outcome
18. Describe common diagnostic blood tests and explain what can be learned from them.

There are many tests that can be done to assess the health and composition of blood.
Table 9.3 shows some of the more common tests along with the normal values. Instru-
mentation and laboratory methods may vary from one laboratory to the next, so it is
always best to rely on the normal (reference) values from the laboratory performing
the test. Notice that there is a difference in values for men and women in the tests per-
taining to red blood cells. Men tend to have more red blood cells because testosterone
encourages erythropoiesis and because women have more fat deposition. There is an
inverse proportion between the amount of fat and erythropoiesis.

9.5 Diagnostic Tests for Blood Disorders 359

 TABLE 9.3 Blood Tests
Diagnostic Test Function and Normal Values
TESTS TO DETERMINE BLOOD COMPOSITION
Hematocrit This test measures the ratio of the volume
of red blood cells to the total volume
of blood. The volume of red blood cells
accounts for 38.8%–50.0% of the total
blood volume in males and 34.9%–44.5%
in females. See Figure 9.16.
Hemoglobin A hemoglobin measurement determines
the amount of hemoglobin in a given
amount of blood. The normal hemoglobin
measurement is 13.5–17.5 grams per
deciliter (g/dL) of blood for males and
©Corbis Images/Jupiterimages/ 12.0–15.5 g/dL of blood for females.
Getty Images
Red blood cell (RBC) count The normal number of red blood cells is
4.32–5.72 million cells/mcL of blood for
males and 3.90–5.03 million cells/mcL of
blood for females.
White blood cell (WBC) count The normal number of all the leukocytes is
3,500 to 10,500 cells/mcL of blood.
White blood cell (WBC) differential: A WBC differential gives the percentage of
each type of leukocyte in the total number
of leukocytes. Normal values follow:
Neutrophils Neutrophils: 40%–70%
Basophils Basophils: 0%–2%
Eosinophils Eosinophils: 0%–6%
Monocytes Monocytes: 4%–8%
Lymphocytes Lymphocytes: 20%–50%
Platelet count A normal platelet count is
150,000 to 450,00/mcL of blood.

OTHER DIAGNOSTIC TESTS FOR BLOOD DISORDERS

Blood clotting study: The PT test evaluates the ability of blood
to clot properly, and the PTT test evaluates
Prothrombin time (PT)
the function of clotting factors within the
Partial thromboplastin time (PTT) blood.
Bone marrow aspiration and biopsy This procedure involves collecting and
examining bone marrow for the presence
of abnormal cells.
Lumbar puncture This procedure involves collecting and
looking at cerebrospinal fluid (CSF)
surrounding the brain and spinal cord for
the presence of abnormal WBCs.

Source: Mayo Clinic Staff, Complete blood count (CBC), accessed: April 4, 2017. www.mayoclinic.org.

360 CHAPTER 9 The Cardiovascular System—Blood

 FIGURE 9.16 Hematocrit.
Hematocrit tube
100 Blood is drawn and then placed
in a centrifuge to separate the
90 formed elements from the rest
of the blood.

Hematocrit scale
80

Plasma
70

60

50
White blood cells
and platelets form
40 the buffy coat

30

20 Red blood cells

10

Male Female

Disease P int
Leukocytosis is a high white blood cell count. This is a normal response to a challenge
to the immune system. Here, more leukocytes are made to fight a particular pathogen.
Leukopenia (loo-koh-PEE-nee-ah), on the other hand, is a low white blood cell count.

Spot Check What should the total of all the values of a white blood cell
differential equal?

9.6 Blood Disorders

Learning Outcome
19. D
 escribe disorders of the cardiovascular system concerning blood and relate abnormal
function to pathology.

Each of the blood tests in Table 9.3 can be important in assessing an individual’s
health and helping determine a diagnosis. We now focus on some disorders involving
the blood.

Leukemia
Leukemia is a type of blood cancer. Like leukocytosis, leukemia also involves a
high white blood cell count, but the white blood cells in leukemia are immature

9.6 Blood Disorders 361

 and incapable of fighting off pathogens. The four major types of leukemia are
described here:
• Acute myeloid leukemia (AML) usually occurs in adult males. This cancer causes
abnormal granulocytes to quickly proliferate in the bone marrow. These abnor-
mal cells prevent healthy white blood cells from growing. Symptoms of AML are
abnormal bleeding and bruising, bone pain, fatigue, fever, skin rash, and weight
loss. AML is diagnosed by a physical exam, bone marrow aspiration and biopsy,
and blood tests such as a CBC and WBC. See Figure 9.17.
• Chronic myeloid leukemia (CML) occurs in middle-aged adults and in children.
CML causes the rapid growth of immature granulocytes in the bone marrow. CML
has three phases: chronic, accelerated, and blast crisis. The chronic phase usually
shows no symptoms; the accelerated phase is characterized by rapid cancerous
cell growth; and the blast crisis phase happens when CML goes untreated, caus-
ing individuals to suffer from bleeding and infection due to the failure of the bone
marrow. CML is diagnosed by blood tests, such as CBC, WBC, and platelet count,
and a bone marrow biopsy. See Figure 9.17.
• Acute lymphoblastic leukemia (ALL) usually occurs in children between the ages
of 3 and 7. It is the most common type of leukemia in children. ALL causes an
abnormal increase of lymphocytes. Symptoms include bone and joint pain, abnor-
mal bruising and bleeding, fatigue, fever, weight loss, petechiae (peh-TEE-kee-aye)
(small red or purple spots on the skin, caused by broken capillaries), swollen glands,
and night sweats. ALL is diagnosed using CBC, WBC, and platelet count blood
tests. Bone marrow aspiration, bone marrow biopsy, and lumbar puncture may also
be performed. See Figure 9.17.
• Chronic lymphoblastic leukemia (CLL) usually occurs in people over the age of
70. CLL affects the B lymphocytes, causing the cancerous cells to spread from
the bone marrow to the blood and potentially the lymph nodes, liver, and spleen.
Symptoms of CLL include abnormal bruising, excessive sweating, fatigue, fever,
reoccurring infections, weight loss, and enlarged lymph nodes, liver, and spleen.
CLL is diagnosed using CBC, white blood cell differential, and immunoglobulin
(antibody) testing. Bone marrow biopsy and a CT of the chest, abdomen, and pelvis
may also be performed. See Figure 9.17.
There are various treatments for leukemia based on the type, cause, and stage of
the disease. Treatments include bone marrow transplants, chemotherapy, radiation
therapy, and blood transfusions. Antibiotics are used to fight infections that result
from having leukemia.

Polycythemia
Polycythemia is a condition of too many cells in the blood. Since most of the formed
elements in blood are erythrocytes, polycythemia is often caused by overproduction of
red blood cells. There are two forms of this disorder.
• Primary polycythemia is cancer of the blood. Too many immature cells are produced
that do not function. Red blood cell counts can go as high as 11 million RBCs/mm3 in
polycythemia, and hematocrits may get as high as 80%.
• Secondary polycythemia is far more common than primary polycythemia.
With this form of the disorder, the RBC count typically ranges from 6 to
8 million RBCs/mm3 of blood. Secondary polycythemia can result from dehy-
dration, which lowers the ratio of plasma to formed elements, or accelerated
erythropoiesis due to hypoxemia caused by elevation, smoking, increased
oxygen demand due to exercise, pollution, or disease. An elevated hematocrit
means that there are more formed elements than normal for the amount of

362 CHAPTER 9 The Cardiovascular System—Blood

 (b)

(a) (c)

(d) (e)

FIGURE 9.17 Leukemia: (a) normal blood smear, (b) acute myeloid leukemia blood smear, (c) chronic myeloid leukemia blood
smear, (d) acute lymphoblastic leukemia blood smear, (e) chronic lymphoblastic leukemia blood smear.
(a) ©Jean-Claude Revy/ISM/Medical Images; (b, c, d, and e) ©Prof. Jean Bonhomme/ISM/Medical Images

plasma. This makes the blood thicker. It is harder for the heart to pump thicker
blood in the vessels, so this increases the heart’s workload and elevates blood
pressure.

Spot Check Explain the cardiovascular side effects of smoking.

9.6 Blood Disorders 363

 Anemia
Anemia is a disorder that results from insufficient red blood cells or hemoglobin
to carry enough oxygen to maintain homeostasis. There are three categories of
anemia:
• Inadequate erythropoiesis or hemoglobin production. This may be caused by
inadequate iron in the diet (iron deficiency anemia) or lack of intrinsic factor from
the stomach that allows vitamin B12 to be absorbed (pernicious anemia). Other
causes of this type of anemia include kidney failure, which results in reduced EPO
production, and red bone marrow destruction by some poisons, drugs, viruses, and
radiation (hypoplastic or aplastic anemia).
• Excessive bleeding (hemorrhagic anemia). This type of anemia may be caused
by trauma, failure to clot, or ulcers.
• Red blood cell destruction (hemolytic anemia). This type of anemia may
result from a drug reaction (penicillin allergy) or a blood incompatibility such as
hemolytic (HE-moh-LIT-ik) disease of the newborn. Other causes include inher-
ited factors (sickle cell disease, mentioned earlier, and thalassemia) and parasitic
infections (malaria).

Clotting Disorders
Hemophilia is a group of inherited disorders caused by the inability to make one or
more clotting factors. This prevents the reaction cascade necessary for clot formation.
Hemophilia is a sex-linked disorder resulting from a chromosomal abnormality that
occurs mostly in males. See Figure 9.18. The genetic abnormality causes a deficiency
in clotting factors VIII (hemophilia A) or IX (hemophilia B). People with this disorder
can have abnormal bleeding into tissues or joints. Hemophilia is diagnosed by a plate-
let count and clotting factor assays. Purified clotting factors from blood donations are
given to patients to treat this disease.

Common Misconception
Hemophilia has nothing to do with the number of platelets.

Applied Genetics
Human DNA consists of 23 pairs of chromosomes. Twenty-two pairs are called
autosomes. The sex chromosomes make up the last pair. They are designated as XX for
females and XY for males. The mother can contribute only one of her X chromosomes in
her egg. The father can contribute an X or a Y chromosome in his sperm. If the resulting
child is a girl, she will have inherited an X from her mother and an X from her father. If the
resulting child is a boy, he will have inherited an X chromosome from his mother and a
Y chromosome from his father. The genes for sex-linked disorders are located on the X
chromosome. They are passed from mother to son. See Figure 9.18.

Thrombocytopenia is a low platelet count (less than 100,000/mL of blood) that

may be caused by bone marrow destruction. One of the signs is excessive bruising
after minor trauma. Thrombocytopenia can have various causes that are categorized

364 CHAPTER 9 The Cardiovascular System—Blood

 Mother does not Father does not
have hemophilia have hemophilia

Possible children

Daughter without Daughter without Son without Son with

hemophilia hemophilia hemophilia hemophilia

Mother’s sex chromosomes: XX Dominant gene that does not code for hemophilia

Father’s sex chromosomes: XY Recessive gene that codes for hemophilia

FIGURE 9.18 Inheritance of a sex-linked disease: the sex chromosomes of the possible
children when the parents do not have hemophilia but the mother has one X chromosome
with the recessive gene for hemophilia.

in one of three ways: low production of platelets, increased destruction of plate-

lets in the bloodstream, or increased destruction of platelets in the liver or spleen.
Symptoms of thrombocytopenia include bruising, bleeding from the nose or in the
mouth, and petechiae. Thrombocytopenia can be diagnosed with a CBC, blood clot-
ting studies, and bone marrow aspiration and biopsy. Treatment depends on the
cause of the disease; there are times when a transfusion of platelets may be neces-
sary to control abnormal bleeding.
Disseminated intravascular coagulation (DIC) is the widespread coagulation
of blood in unbroken vessels caused by abnormally active blood clotting proteins.
This can occur during severe inflammation, cancer, or a systemic infection of the
blood called septicemia. It can also occur if blood flow slows significantly as in
a cardiac arrest. Circulating thrombin may then accumulate enough to form clots.
In the latter case, the clots may be more localized to an organ. Symptoms include
bleeding from multiple body sites, blood clots, bruising, and a decrease in blood
pressure. DIC is diagnosed using CBC, clotting tests, and platelet count blood
tests. Treatment is largely based on determining the cause of DIC and treating it.
Platelet transfusions can be used to increase blood count, and heparin can be used
to stop clotting.
Table 9.4 summarizes all of the blood diseases and disorders described throughout
the chapter.

9.6 Blood Disorders 365

 TABLE 9.4 Summary of Diseases and Disorders of the Blood
Type of Disease/Disorder Disease/Disorder Description
Leukemia Acute myeloid leukemia (AML) Usually occurs in adult males and causes abnormal
granulocytes to quickly proliferate in the bone marrow
Chronic myeloid leukemia (CML) Occurs in middle-aged adults and in children and
causes the rapid growth of immature granulocytes
in the bone marrow
Acute lymphoblastic leukemia Is the most common type of leukemia in children
(ALL) and causes an abnormal increase of lymphocytes
Chronic lymphoblastic leukemia Usually occurs in people over the age of 70 and
(CLL) causes cancerous B lymphocytes to spread from
the bone marrow to other parts of the body
Polycythemia Primary polycythemia Cancer of the blood that results in the production
of too many red blood cells
Secondary polycythemia Increased number of red blood cells due to
dehydration or hypoxemia
Clotting disorders Disseminated intravascular The widespread coagulation of blood in unbroken
coagulation vessels
Embolus A moving blood clot
Hemophilia An inherited disorder that results in a deficiency of
one or more clotting factors
Thrombocytopenia Low platelet count (less than 100,000/mL of blood)
Thrombus A stationary blood clot
Anemia Hemolytic anemia Red blood cell destruction resulting from inherited
factors such as sickle cell disease and thalassemia
Hemolytic disease of the Red blood cell destruction resulting from a blood
newborn incompatibility between mother and fetus
Hemorrhagic anemia Anemia resulting from excessive bleeding caused
by trauma, failure to clot, or ulcers
Hypoplastic or aplastic anemia Inadequate erythropoiesis or hemoglobin
production caused by kidney failure, resulting in
reduced EPO, and red bone marrow destruction by
some poisons, drugs, viruses, and radiation
Iron deficiency anemia Inadequate erythropoiesis or hemoglobin
production caused by inadequate iron in the diet
Pernicious anemia Inadequate erythropoiesis or hemoglobin production
caused by lack of intrinsic factor from the stomach,
which allows vitamin B12 to be absorbed
Other blood disorders Carbon monoxide poisoning Blood poisoning caused by inhalation exposure to
excessive levels of carbon monoxide gas
Leukocytosis High white blood cell count
Leukopenia Low white blood cell count
Sickle cell disease A genetic disorder that causes red blood cells to
become sickled in shape, resulting in those cells
clumping together and blocking blood flow

Spot Check Does leukocytosis always indicate a disorder or disease? Explain

your answer.

366 CHAPTER 9 The Cardiovascular System—Blood

Summary
9.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the cardiovascular system.

9.2 Overview
∙∙ The cardiovascular system is composed of the heart, blood vessels, and blood.

9.3 Anatomy of Blood

∙∙ Blood is a connective tissue of formed elements in a matrix of plasma.

Plasma
∙∙ Plasma is 91% water; 7% protein; and 2% ions, nutrients, waste products, gases, and regulatory substances.
∙∙ Plasma is a solution, and its concentration is important for homeostasis.

Formed Elements
∙∙ The formed elements of the blood are erythrocytes, leukocytes, and thrombocytes.
∙∙ Erythrocytes are biconcave disks with no nuclei. They contain hemoglobin that has iron to carry oxygen. In addition, red
blood cells carry carbon dioxide and hydrogen ions.
∙∙ There are five types of leukocytes that must be stained in order to be seen. Each type has its own function. These leuko-
cytes are neutrophils, basophils, eosinophils, monocytes, and lymphocytes.
∙∙ Thrombocytes, also called platelets, are fragments of cells that have many functions.

9.4 Physiology of Blood

Hemopoiesis
∙∙ Hemopoiesis is blood production. There are three forms: erythropoiesis, leukopoiesis, and thrombopoiesis.
∙∙ Thrombopoiesis starts from a hemocytoblast in the red bone marrow. The liver and kidneys start the process by producing
thrombopoietin when there is a need for more platelets.
∙∙ Leukopoiesis starts from a hemocytoblast in the red bone marrow. Lymphocytes and macrophages produce CSFs when
there is a challenge to the immune system. There is a different CSF for each type of leukocyte production.
∙∙ Erythropoiesis starts from a hemocytoblast in the red bone marrow. The kidneys start the process by releasing EPO in
situations of hypoxemia. Hypoxemia can result from disease, high elevation, increased exercise, blood loss, and carbon
monoxide.
∙∙ Iron, folic acid, vitamin B12, copper, and vitamin C are needed for erythropoiesis.

Hemoglobin
∙∙ The cytoplasm of erythrocytes contains hemoglobin, which is a red, complex protein made of four amino acid chains
called globins.
∙∙ Each globin chain contains a heme group with an iron at its center, which binds one oxygen molecule.
∙∙ The function of hemoglobin is to transport oxygen and act as a buffer to resist pH change in blood.

Nutritional Requirements for Erythropoiesis

∙∙ Iron is required for erythropoiesis; the RDA for iron is 18 mg/day for a female and 27 mg/day for a pregnant woman.
∙∙ Other nutrients required for erythropoiesis are folic acid, copper, and vitamin C.

Life Cycle of a Red Blood Cell

∙∙ Red blood cells are produced in the red bone marrow.
∙∙ Red blood cells carry oxygen and carbon dioxide through the bloodstream for 110 to 120 days before wearing out.
∙∙ The liver and spleen remove old, worn-out blood cells.
∙∙ Hemoglobin is broken down to heme and globin.
∙∙ Heme is further broken down to iron, which is recycled, and bilirubin, a waste product. The liver puts bilirubin in bile,
which eventually leaves the body in feces. The spleen secretes bilirubin into the blood, where it is removed by the kidneys
and excreted with urine.
∙∙ Globin is broken down by the liver and spleen to free amino acids, which are recycled.

367
Hemostasis
∙∙ Hemostasis is the stopping of bleeding.
∙∙ Hemostasis is a process with three stages—vascular spasm, platelet plug formation, and coagulation.
∙∙ Vascular spasm constricts the broken vessel to slow blood flow.
∙∙ Platelet plug formation occurs when platelets stick to exposed collagen fibers of broken vessel walls.
∙∙ Coagulation is the last stage to occur, but it is the most effective. It involves two pathways that result in a reaction cascade
of one clotting factor activating the next until a clot is formed.
∙∙ When blood clots are no longer needed, they are dissolved by a process called fibrinolysis.
∙∙ Inappropriate clotting is prevented by platelet repulsion, dilution of thrombin, and anticoagulants.

Pathways of Blood Clotting

∙∙ There are two pathways for blood clotting: extrinsic started by damaged tissues, and intrinsic started by platelets.
∙∙ Both pathways require calcium and clotting factors (a different set for each pathway).
∙∙ The extrinsic pathway is faster than the intrinsic pathway.
∙∙ Both pathways lead to a common pathway.

Elimination of Blood Clots

∙∙ A cascade of events changes an inactive enzyme called plasminogen to plasmin.
∙∙ Plasmin dissolves the unnecessary blood clot in a process called fibrinolysis.

Preventing Inappropriate Clotting

∙∙ A stationary unwanted clot is called a thrombus.
∙∙ A moving unnecessary clot is called an embolus.
∙∙ Mechanisms to control inappropriate clotting include platelet repulsion, dilution, and anticoagulants.

Blood Typing
∙∙ Blood typing is based on the presence of ABO and Rh antigens on the surface of cells.
∙∙ Antibodies are dissolved proteins in plasma that react to foreign antigens in a process called agglutination.
∙∙ Antibodies for the ABO group are acquired as a child.
∙∙ Antibodies for Rh antigens are acquired only through an exposure to the antigen.
Determining a blood type and transfusion compatibility:
∙∙ Blood types can be determined by mixing a drop of blood with sera containing known antibodies.
∙∙ In a transfusion, the donor’s cells must survive the recipient’s antibodies.
Mother-fetus blood-type compatibility:
∙∙ Rh− mothers need to be concerned about blood incompatibility with Rh+ babies.

Functions of Blood
∙∙ The functions of blood fall into three categories: transportation, protection, and regulation.
∙∙ Blood transports nutrients, waste products, gases, regulatory chemicals, and heat.
∙∙ Blood protects the body from its own loss through hemostasis. Leukocytes in the blood protect the body from foreign
pathogens.
∙∙ Blood regulates the fluid and electrolyte balance as well as the body’s acid–base balance.

9.5 Diagnostic Tests for Blood Disorders

∙∙ Common diagnostic tests for cardiovascular system disorders of the blood include hematocrit, hemoglobin, blood count,
WBC differential, blood clotting tests (PT and PTT), bone marrow aspiration, and lumbar puncture.

9.6 Blood Disorders

Leukemia
∙∙ Leukemia is a type of blood cancer characterized by an increase in immature white blood cells incapable of fighting off
pathogens.
∙∙ There are four major types of leukemia: acute and chronic myeloid leukemia, which both involve granulocytes; and acute
and chronic lymphoblastic leukemia, which both involve lymphocytes.

368
Polycythemia
∙∙ Polycythemia is too many red blood cells in the blood. Primary polycythemia is cancer of the blood. Secondary polcy-
themia is due to dehydration or hypoxemia.

Anemia
∙∙ Anemia is a type of disorder that provides insufficient red blood cells or hemoglobin to carry enough oxygen to
maintain homeostasis. There are three categories of anemia: inadequate erythropoiesis, hemorrhagic anemia, and
hemolytic anemia.

Clotting Disorders
∙∙ Clotting disorders include hemophilia, thrombocytopenia, and disseminated intravascular coagulation.

Key Words for Review

The following terms are defined in the glossary.

agglutination formed elements leukocyte

clotting factor granulocyte lymphoid
coagulation hematocrit myeloid
erythrocyte hemocytoblast pluripotent
erythropoietin hemoglobin serum
fibrin hemopoiesis thrombocyte
fibrinogen hemostasis

369
 The Cardiovascular

10 System—Heart
and Vessels
You often encounter mechanical
fluid pumps in everyday life.
For example, your car has an oil
pump, a fuel pump, and a water
pump to circulate their respective
fluids through the appropriate
hoses. Your body has a similar
pump—the heart—that circulates
blood through your body’s vessels
to carry out the functions of the
circulatory system. See Figure 10.1.
Unlike the mechanical pumps that
run only when occasionally needed,
the heart pumps constantly and is
far more durable and long-lasting.
Your heart began beating around
day 22 while you were in your
mother’s womb, and it will likely
continue to beat and pump blood
every minute of every day until the
day you die. How efficiently your
heart works may determine the
quality and the length of your life.
©Mark Andersen/Getty Images

Module 9: Cardiovascular System

370
10.1 Word Roots and Combining Forms
Cardiovascular System
Major Organs and Structures:
Learning Outcome heart, aorta, superior and inferior
venae cavae
1. Use medical terminology related to the cardiovascular system.
Accessory Structures:
arteries, veins, capillaries
arter/o, arteri/o: coron/o: heart vas/o: vessel Functions:
artery pericardi/o: vascul/o: vessel transportation, protection by fighting
foreign invaders and clotting to
ather/o: fatty pericardium ven/o: vein prevent its own loss, acid–base
substance rhythm/o: rhythm
balance, fluid and electrolyte balance,
ven/i: vein temperature regulation
atri/o: atrium sphygm/o: pulse ventricul/o:
brady/: slow steth/o: chest ventricle
cardi/o: heart tachy: rapid

10.2 Overview
In the preceding chapter, you explored part of the cardiovascular
system—the blood. In this chapter, you will study this system
further to include the heart and vessels, which work together
to distribute blood to the body. You will see the anatomy of
the heart and revisit cardiac muscle tissue, which enables the
heart to function a lifetime without fatigue. You will explore
the physiology of the heart in terms of its blood flow, electri-
cal conduction system, cycle of contraction and relaxation, and
regulation. You will then move on to the vessels, covering first
their anatomy and then the physiology of how the heart and FIGURE 10.1 The cardiovascular system.
vessels function together to maintain blood pressure and flow.
Your study begins with heart anatomy.

10.3 Heart Anatomy

Learning Outcome
2. Identify the chambers, valves, and features of the heart.

The heart is a hollow organ about the size of an adult fist and weighs approximately
300 grams (g), or 10 ounces (oz). See Figure 10.2. It has a broad, superior base
attached to the great vessels and a pointed apex (end) immediately superior to the dia-
phragm. The heart is located between the chest’s pleural cavities in the mediastinum,
deep to the sternum. Normally tilted, approximately two-thirds of the heart rests left of
the midsagittal plane. Depending on body size and type, the heart may be positioned
more upright (tall bodies) or more tilted (barrel-chested bodies).

Spot Check Which is more inferior, the base of the heart or the apex
of the heart?

Pericardium
The pericardial sac that you see in Figure 10.2 is part of the pericardium—a serous
membrane. As you may recall from “Chapter 1, The Basics,” the pericardium is a
fluid-filled, double-walled membrane. The pericardial sac (parietal pericardium)
anchors the heart to the great vessels (aorta and venae cavae), the posterior wall of
the thorax, the sternum, and the diaphragm. It has a tough outer fibrous layer that
does not allow for expansion. It also has a thin serous lining of epithelial tissue.

10.3 Heart Anatomy 371

 Third rib
Base of
heart
Heart

Apex of
heart
Sternum

Diaphragm

(a)

Pericardial sac Aorta

Right
lung
Left lung
Pulmonary
Superior trunk
Pleural vena
membranes cava Parietal pericardium
(cut edge):
Fibrous
Diaphragm layer
(b) Epithelial
Epicardium layer
(visceral
pericardium)

Heart (covered
by the epicardium)

Pericardial cavity Parietal

pericardium

(c)

FIGURE 10.2 The position of the heart in the thorax: (a) relationship of the heart to the sternum and ribs, (b) relationship
of the heart to the pleural cavities of the lungs and the diaphragm, (c) frontal view with the lungs retracted and the pericardial
sac cut.

The epicardium (visceral pericardium) is a more delicate layer composed of simple

squamous epithelial tissue over loose areolar connective tissue. It is in direct contact
with the surface of the heart. Normally, the two layers of the pericardium are close
together with pericardial fluid between the layers to reduce the friction caused by the
heart’s pumping action. However, disease or inflammation may cause the amount of
pericardial fluid to increase, restricting room for the heart to expand. Figure 10.3
shows the pericardium in relation to the heart wall.

372 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 FIGURE 10.3 The pericardium
and the heart wall.

Pericardial
cavity

Parietal pericardium
(cut edge):
Epithelial layer

Fibrous
layer

Endocardium

Coronary
Myocardium blood vessels

Epicardium
(visceral pericardium)

Disease P int
Cardiac tamponade (tam-po-NAID) is the buildup of excessive fluid within the
pericardium. Disease or inflammation can cause this fluid buildup, resulting in more
pericardial fluid produced. An injury, causing internal bleeding into the pericardial
space, can also result in cardiac tamponade. Because the pericardial sac does not
allow for expansion, the excess serous fluid or blood compresses the heart and may
lead to heart failure.

Heart Wall
In addition to showing the pericardium, Figure 10.3 shows the three layers of the
heart wall—the epicardium, the myocardium, and the endocardium. These layers are
described in the following list:
• The epicardium is the most superficial layer, composed of simple squamous epithelial
tissue over loose areolar connective tissue.
• The myocardium is composed of cardiac muscle tissue and a fibrous skeleton of
collagen and elastic fibers. The cardiac muscle of the myocardium does the heart’s
work by contracting to pump blood out of the heart and then relaxing so that the
heart can refill. The muscle is arranged in a spiral pattern, which creates a twisting

10.3 Heart Anatomy 373

FIGURE 10.4 Spiral
arrangement of cardiac muscle
in the heart: (a) anterior view;
(b) view from the apex of the
heart, showing the spiral pattern.
(a, b) Photo and illustration by Roy
Schneider, University of Toledo. Heart
model courtesy of Dr. Carlos Baptista.

(a)

(b)

or wringing motion when the heart contracts. See Figure 10.4. The collagen fibers
in the myocardium are nonconductive, so they act as insulators for cells carrying
electrical signals within the heart wall. These fibers also give structural support to
the heart around the valves and the vessel openings. The elastic fibers in this layer
enable the heart to return to shape after contractions.
• The endocardium lines the four chambers of the heart. Like the epicardium, it is
also composed of simple squamous epithelial tissue over loose areolar connective
tissue. Extensions of the epicardium cover the surface of the heart’s valves and
continue on as the lining of vessels.

Disease P int
Inflammation of the heart’s various layers can result in a serious medical condition.
Pericarditis, or inflammation of the pericardium, can be associated with other medical
conditions such as autoimmune disorders, cancers, HIV, hypothyroidism, and kidney
failure. It can also result from a heart attack, surgery, or an injury to the thoracic
cavity. If the inflammation of the pericardium is not treated, it can cause arrhythmias
or cardiac tamponade or it can restrict the heart’s movement, which may lead to
heart failure. Myocarditis, or inflammation of the myocardium, is usually caused by
a viral, bacterial, or fungal infection that makes its way to the heart’s myocardium.
If left untreated, myocarditis can result in heart failure, cardiomyopathy (disease of
the heart muscle), or pericarditis. Endocarditis is inflammation of the inside lining
of the heart. The inflammation associated with endocarditis affects the tissue lining
the heart chambers and covering the valves. Endocarditis is commonly caused by a
bacterial infection. The bacteria can stick to the heart’s endocardium and eventually
grow into a vegetation (mass of bacterial growth) in the heart chamber or on the valve.
The vegetation will interfere with the valve’s function, allowing blood to regurgitate

374 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 (leak) into the heart chamber. Untreated endocarditis can lead to congestive heart
failure, arrhythmias, or the formation of emboli from pieces of vegetation that might
have broken off and are traveling in the blood vessels.

Chambers and Valves

The human heart is divided into four chambers, which can be seen externally in
Figure 10.5. The two superior chambers—the right and left atria (A-tree-uh)—
receive blood for the heart, while the two inferior chambers—the right and left
ventricles—pump blood out of the heart. Figure 10.5 also shows the atria’s small,
hollow, earlike flaps called auricles (AW-ri-kulz), which slightly increase the atria’s
volume. Sulci are depressions on the surface of the heart and mark the division of
the chambers externally. The coronary sulcus marks the separation of the atria from
the ventricles. The anterior interventricular sulcus and posterior interventricular
sulcus mark the separation of the right and left ventricles.

Superior
vena cava
Superior
vena cava Right
Aorta pulmonary
Left artery
Right Pulmonary pulmonary
auricle trunk artery Right
pulmonary
Left auricle veins
Coronary
sulcus
Left atrium
Anterior Left
interventricular pulmonary
Right sulcus veins Right
ventricle atrium

Inferior
Inferior vena cava
vena cava Left ventricle

Apex of the heart

(a) (b)

Left ventricle

Interventricular
sulcus

Right ventricle
(c)

FIGURE 10.5 Surface anatomy of the heart: (a) anterior view , (b) posterior view , (c) anterior view of a cadaver heart.
(c) ©McGraw-Hill Education/Christine Eckel

10.3 Heart Anatomy 375

 If you were to look at the internal workings of the heart in Figure 10.6, you would
see a complete wall called the interatrial septum, which separates the two atria from
each other. The wall is complete because a hole has closed that existed in the fetal heart
(this will be covered soon with blood flow through the heart). The closure of the hole
is called the fossa ovalis. Another wall, the interventricular septum, separates the two
ventricles. These two myocardial walls effectively divide the heart into right and left
sides. Each side of the heart serves as a separate pump for blood. The right side of the
heart pumps blood to the lungs (short distance), while the left side of the heart pumps
blood to the rest of the body (long distance). Because the left side’s workload is greater
than the right side’s, the left ventricle has a thicker myocardium. Always look at the outer
walls of the ventricles on a dissected heart or illustration to determine right from left. See
Figure 10.6 for anterior and posterior views of the internal anatomy of the heart.

Spot Check How can you determine the right ventricle from the left ventricle?

You can also see the presence of valves in Figure 10.6. The atria are separated
from the ventricles by the atrioventricular (AV) valves—the tricuspid valve lies
between the right atrium and the right ventricle, and the bicuspid (mitral) valve (MY-
tral) lies between the left atrium and the left ventricle. Notice that there are tendinous
cords attaching the cusps of the AV valves to mounds of papillary muscle in the ven-
tricles. These cords resemble parachute cords anchoring the valve (parachute) to the
muscle. You will learn how these structures work together to direct blood flow when
the cardiac cycle is discussed later in the chapter.
Semilunar valves—the pulmonary valve and the aortic valve—are located between
each ventricle and the vessel that carries the pumped blood away from the heart. The pul-
monary valve (not shown in Figure 10.6) lies between the right ventricle and the pulmonary
trunk. The aortic valve lies between the left ventricle and the aorta. See Figure 10.6. The
purpose of all the heart’s valves is to ensure the flow of blood in one direction by prevent-
ing backflow. You will learn more about how valves work later in the chapter.

Disease P int
Rheumatic heart disease is an inflammatory condition of the heart associated with
rheumatic fever, which causes inflammation in various body systems. Rheumatic fever
is caused by a group A streptococcal bacterial infection, usually in cases of untreated
inflammation of the pharynx—pharyngitis (referred to as streptococcal pharyngitis or
strep throat). Rheumatic fever can affect the joints, skin, central nervous system, and heart.
In the heart, rheumatic fever can cause carditis (inflammation of the heart), which affects
all of the heart layers including the valves. Damage caused by this disease can be long-
lasting and affect an individual years later, resulting in chronic rheumatic heart disease.
In this case, the heart’s valves have undergone stenosis (a narrowing or constricting of
the valves) from the presence of the group A streptococcal infection. Arrhythmias and
ventricular dysfunction can also result from chronic rheumatic heart disease. Depending
on how severe the heart damage is, heart failure may also occur. Rheumatic fever is
diagnosed by physical examination and by testing for group A streptococcal infection.
Electrocardiograms (explained later in the chapter) are done to assess the damage to
the heart. Treatment for recurring carditis associated with rheumatic fever may include
nonsteroidal anti-inflammatory drugs or corticosteroids to treat the inflammation.

So far, you have become familiar with the anatomy of the heart. Now it is time
to revisit cardiac muscle tissue to expand on what you learned about histology in
“Chapter 2, Levels of Organization of the Human Body.”

376 CHAPTER 10 The Cardiovascular System—Heart and Vessels

Superior vena cava

Aorta

Aortic valve Pulmonary trunk

Interatrial septum

Left atrium
Fossa ovalis
Mitral
Right atrium (bicuspid)
valve

Left ventricle
Tricuspid valve
Papillary muscle

Tendinous cords
Interventricular septum
Right ventricle
Endocardium
Myocardium
Inferior vena cava

Epicardium

(a)

Right atrium

Aorta Aorta
Left atrium
Left atrium
Left auricle
Right AV
valve Right ventricle
Left AV
valve Left AV
valve
Papillary
muscle
Left ventricle

Tendinous
cords

Left Right Left

Apex
Apex
(b) Anterior portion Posterior portion

FIGURE 10.6 Internal anatomy of the heart: (a) anterior view, (b) dissection of a cadaver heart.
(b) ©Christine Eckel

10.3 Heart Anatomy 377

 Cardiac Muscle Tissue

Learning Outcomes
3. Relate the structure of cardiac muscle to its function.
4. Explain why the heart does not fatigue.

As you recall from Chapter 2 and can see in Figure 10.7, cardiac muscle is stri-
ated (striped) and branching and has one nucleus per cell. The specialized junctions
between cells—intercalated disks (in-TER-kah-lay-ted)—enable the fast transmis-
sion of electrical impulses from one cell to another. With this feature, contractions of
both atria are stimulated simultaneously, so they contract together as one. The same
holds true for the ventricles.
Unlike skeletal muscle cells that can perform tetany if nerve impulses are frequent
enough, all cardiac muscle cells have an absolute refractory period (recall a muscle
twitch, discussed in the muscular system chapter). The absolute refractory period pre-
vents the cardiac muscle from going into tetany and gives the heart chambers a chance
to fill between contractions.
By staying aerobic, cardiac muscle cells avoid fatigue, oxygen debt, and the
buildup of lactic acid. Cardiac muscle cells also have the following special adaptations
that enable them to use aerobic respiration almost exclusively:
• Cardiac muscle cells have many very large mitochondria to perform aerobic
respiration.
• Cardiac muscle cells are rich in myoglobin (protein for storing oxygen).
• Cardiac muscle cells are rich in glycogen (a starch that can be converted to glucose
to be used as fuel).
• Cardiac muscle cells can use a variety of fuels as energy sources (glucose, fatty
acids, amino acids, and ketones).
Some cardiac muscle cells are further adapted to generate and carry electrical
impulses. You will learn more about them during the discussion of the heart’s electrical
conduction system.

Spot Check How does myoglobin help prevent the heart from fatiguing?

Cardiac muscle

Nucleus (central)

Cardiac
muscle cell

Intercalated disks
(special junctions
between cells)

Striations
LM 800x

FIGURE 10.7 Cardiac muscle tissue.

©Ed Reschke

378 CHAPTER 10 The Cardiovascular System—Heart and Vessels

10.4 Heart Physiology
The function of the heart is to pump blood to meet the needs of the body. It is a sophis-
ticated pump that can be regulated to meet the level of need, whether it is to pump
faster or slower. Now that you are familiar with the heart’s anatomy, you are ready to
explore how the heart works, starting with blood flow through the heart.

Blood Flow through the Heart

Learning Outcome
5. Trace blood flow through the heart.

Common Misconception
All blood is red. In Figure 10.8, the colors orange and violet are used to signify
the level of oxygen in the blood. Other illustrations or models you may have seen
use red and blue. Thus, many people believe oxygen-rich blood is red and oxygen-
poor blood is blue. This common misconception is very strong and is unfortunately
reinforced by the models, charts, and book illustrations used in education. Some
students will insist that oxygen-poor blood in their veins is blue and will try to prove
it by pointing to the vessels on the anterior surface of their wrists. However, these
vessels are deep to the collagen in the skin, and collagen makes the
vessels appear blue. When asked if they have ever had blood drawn
and, if so, what the color was, these same students will answer,
“Yes, but as soon as the blood hit the air it was exposed to
oxygen and then turned red.” The reason blood enters a
tube when drawn from a vein in the doctor’s office or lab is
because there is a vacuum in the tube. No oxygen or air is
present. All blood is red.

©liquidlibrary/PictureQuest/Getty Images

Look at Figure 10.8 closely, and read the following description of its steps. It shows
the pathway of blood through the heart. You may find it helpful to review this figure
several times before moving on.
1. Blood enters the right atrium of the heart from the superior and inferior venae
cavae.
2. Blood passes through the tricuspid valve to the right ventricle.
3. Blood is forced through the pulmonary valve to the pulmonary trunk.
4. Blood travels through the pulmonary trunk to the pulmonary arteries.
5. Blood travels to the lungs, where CO2 is unloaded and O2 is loaded.
6. Blood returns to the heart from the lungs through the four pulmonary veins to
enter the left atrium.
7. Blood passes through the bicuspid (mitral) valve to the left ventricle.
8. Blood is forced through the aortic valve to the aorta.
9. Blood travels from the aorta to the rest of the body.
10. Blood returns to the heart through the superior and inferior venae cavae.

10.4 Heart Physiology 379

 9
9 9
10

Aorta 9 Left pulmonary

artery

5
5
Pulmonary trunk
Superior 8
4
vena cava
Left pulmonary
veins
Right 6
pulmonary 6
veins

7 Left atrium
1

Right
atrium Left AV
3
(bicuspid) valve
Right AV
(tricuspid)
Aortic valve
valve 8
2

Left ventricle
Right
ventricle

Inferior
10
vena cava

FIGURE 10.8 The pathway of blood flow through the heart. Steps 4 to 6 illustrate the circulation of blood through the lungs.
Steps 8 to 10 illustrate the circulation of blood through the body. Violet arrows indicate oxygen-poor blood, while orange arrows
indicate oxygen-rich blood.

As you can see in Figure 10.8, the right side of the heart pumps blood to the lungs
and back (pulmonary circuit). At the lungs, CO2 is unloaded from the blood and O2
is loaded into the blood. Once the blood is returned from the lungs, the left side of the
heart pumps blood out to all parts of the body to be returned once again to the right
side of the heart (systemic circuit). At the tissues of the body, O2 is unloaded and CO2
is loaded. See Figure 10.9.

Spot Check Where will blood be immediately after passing through the
tricuspid valve?

Spot Check Through what valve will blood pass next after the left ventricle?

Now that we have discussed the flow of blood through the heart, note that while a
fetus is developing inside of its mother, the flow of blood through the fetal heart is dif-
ferent than previously described. In a fetal heart, an opening called the foramen ovale

380 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 CO2 O2

Pulmonary circuit

O2-poor, O2-rich,
CO2-rich CO2-poor
blood blood

Systemic circuit

CO2 O2

FIGURE 10.9 General diagram of the pulmonary and systemic circuits.

10.4 Heart Physiology 381

 Ductus
arteriosus

Foramen
ovale
Placenta

Ductus
venosus

FIGURE 10.10 Fetal heart anatomy and circulation. The foramen ovale allows blood to
bypass the right ventricle and lungs, and the ductus arteriosus allows blood to enter the
aorta from the pulmonary artery.

is located in the interatrial septum. This opening allows blood in fetal circulation to
bypass the right ventricle and the lungs. There is also a blood vessel called the ductus
arteriosus that connects the aorta and the pulmonary artery. A fetus does not need
to send blood to its own lungs because it receives oxygenated blood from its mother.
Once the baby is born, the foramen ovale closes and becomes the fossa ovalis. The
ductus arteriosus also closes, completely separating the blood within the aorta and the
pulmonary artery. See Figure 10.10.
You have now seen the direction of flow as blood moves through the heart, but
how is blood pumped? To understand this, you must first understand how the cardiac
muscle of the heart is stimulated to contract.

Cardiac Conduction System

Learning Outcome
6. Describe the heart’s electrical conduction system.

As you may recall from the muscular system chapter, cardiac muscle is autorhythmic,
meaning it does not need to be stimulated by the brain to contract. Modified cardiac
muscle cells initiate and carry the electrical impulses as part of a conduction system
that stimulates heart contractions. The nervous system may further modify the amount
and frequency of the contractions (as you will see later in the chapter), but nerve
impulses are not needed to initiate a heart contraction.
Follow along with Figure 10.11 to understand the pathway of signals in the heart’s
conduction system.
1. A heartbeat (heart contraction) is started by the sinoatrial (SA) node, a patch
of specialized cardiac muscle cells located in the wall of the right atrium near the
opening for the superior vena cava. The SA node is the heart’s pacemaker.

382 CHAPTER 10 The Cardiovascular System—Heart and Vessels

Interatrial
septum SA node

SA node

AV node
Left atrium
AV node
AV bundle AV bundle
(Bundle of His)
Left bundle
Right bundle branch
branch Bundle branches

Purkinje fibers

Purkinje fibers

Interventricular
(a) septum (b)

FIGURE 10.11 The cardiac conduction system.

2. From the SA node, modified cardiac muscle cells carry electrical impulses across
the myocardium of both atria, causing them to depolarize and contract together as
one (shown by black arrows).
3. While step 2 is happening, other modified cardiac muscle cells carry electrical
impulses from the SA node to the atrioventricular (AV) node, located on the
right atrium’s interatrial septum. It is from this node that the ventricles will be
stimulated to contract.
4. The atrioventricular (AV) bundle (bundle of His) divides into branches that con-
tinue to carry the electrical impulses from the AV node down the interventricular
septum toward the heart’s apex. Collagen fibers of the heart’s fibrous skeleton
insulate the specialized cardiac muscle cells, so the electrical impulses go only to
their proper destination.
5. Purkinje fibers (per-KIN-jee) fan out from the ends of the AV bundle to the walls
of the ventricles, stimulating the cardiac muscle cells of the ventricular myocardium
to depolarize and contract.

Spot Check List in order the parts of the electrical conduction system used to
stimulate ventricular contractions.

Now that you have studied the blood flow through the heart and the conduction
system that stimulates the heart to contract, you are ready to put these two concepts
together to begin to understand a cardiac cycle.

Cardiac Cycle

Learning Outcome
7. Describe the events that produce the heart’s cycle of contraction and relaxation.

10.4 Heart Physiology 383

 A cardiac cycle is one complete contraction and relaxation of the heart. This cycle
may be repeated 70 to 80 times every minute. Before you examine the events of a car-
diac cycle, you need to become familiar with the terms systole and diastole. Systole
(SIS-toe-lee) is contraction, and diastole (die-AS-toe-lee) is relaxation. These terms
can be used for individual chambers, but if no chamber is specified, they usually refer
to the action of the ventricles.
You also need to understand the concepts of volume, pressure, and flow. Think
of a heart chamber as a syringe. See Figure 10.12a. As you pull back on the plunger
of a syringe, the volume inside the syringe increases and the pressure decreases. The
air pressure outside the syringe is greater than the air pressure inside the syringe, so
air rushes into the syringe until the pressures are equal. Now see Figure 10.12b. As
you push the plunger into the syringe, the volume inside the syringe decreases and the
pressure increases. The air pressure inside the syringe is greater than the air pressure
outside the syringe, so air rushes out of the syringe until the pressures are equal. Keep
this analogy in mind as you go through the phases of the cardiac cycle.

Phases of the Cardiac Cycle Note that the right and left atria go through systole
and diastole together at the same time and that the right and left ventricles also work
together with each other. Similarly, the AV valves function together, as do the semilu-
nar valves. The four phases of a cardiac cycle happen in the following order:
1. Atrial systole. After the SA node fires, the atria depolarize and contract together,
creating decreased volume and higher pressure in the atria than in the ventricles.
The increased pressure pushes blood through the AV valves (tricuspid and bicus-
pid) into the ventricles. It is important to note that the pressure of the blood due to
the atria’s contracting is what forces the AV valves to open.
2. Atrial diastole. The atria then repolarize and relax. The elastic fibers in the walls
of the atria return the atria to shape, increasing the volume and decreasing the pres-
sure in the atria. The blood pressure in the superior and inferior venae cavae (on
the right side of the heart) and the pulmonary veins (on the left side of the heart)

1 1
Volume increases. Volume decreases.
P2
P2 3
2 2
Pressure decreases. 3 Pressure increases.

3 3
Air flows in. Air flows out.
2
2 1
1

P1
P
nt

nt
die

die

1
1
<P
1
>P
gra

gra
2
P
2
re
P

re
su

ssu
s
Pre

Pre

(a) (b)

FIGURE 10.12 Concepts of volume, pressure, and flow. (a) As the volume increases, the pressure decreases within the
syringe, so air rushes in to equalize the pressure inside and outside the syringe. (b) As the volume decreases, the pressure
increases within the syringe, so air rushes out to equalize the pressure inside and outside the syringe.

384 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 is then greater than the pressure inside the atria, so blood rushes in from these
vessels to fill the right and left atria.
3. Ventricular systole. Once the conduction system has carried the electrical
impulses from the AV node to the Purkinje fibers, the ventricles depolarize and
contract together. Papillary muscles also contract, pulling on the tendinous cords
(chordae tendineae) to ensure that the AV valves stay closed and do not swing
open toward the atria. This prevents the backflow of blood to the atria—as you
can see in Figure 10.13a. Contraction of the ventricles decreases the volume and
increases the pressure inside the ventricles. As a result, blood is pushed through
the pulmonary and aortic valves into the pulmonary trunk and aorta, respectively.

Pulmonary FIGURE 10.13 The action of

veins heart valves on the left side
of the heart. (a) Ventricular
Aorta systole: The bicuspid valve is
closed because the papillary
Left atrium
muscle contracts to keep the
Aortic cusps of the valve from opening
semilunar Bicuspid valve
valve (open) (closed) toward the atria, and blood
flowing toward the left atrium
causes the cusps of the valve
Chordae to overlap. The aortic semilunar
tendineae
(tension high)
valve is open because the
cusps of the valve are pushed
open by the blood flowing
Papillary muscle toward the aorta. (b) Ventricular
(contracted) diastole: The bicuspid valve is
opened by the blood flowing
Cardiac muscle into the left ventricle. The
(contracted) semilunar valve is closed
because the cusps of the valve
Left ventricle overlap as they are pushed by
(contracted) the blood in the aorta toward
the dilated left ventricle. Similar
(a) action is taking place on the
right side of the heart at the
Pulmonary same time.
veins

Aorta
Left atrium
Aortic
semilunar
valve (closed) Bicuspid
valve (open)

Chordae
tendineae
(tension low)

Papillary muscle
(relaxed)

Cardiac muscle
(relaxed)

Left ventricle
(dilated)
(b)

10.4 Heart Physiology 385

 4. Ventricular diastole. The ventricles then repolarize and relax. The elastic fibers
in the ventricle walls return the ventricles to shape, increasing the volume and
decreasing the pressure in the ventricles. The pressure inside the now full atria
is greater than that inside the relaxed ventricles, so blood moves through the AV
valves from the atria to the ventricles. (Note: The atria are not contracting in this
phase. Blood is passively moving from the atria to the ventricles due to a differ-
ence in pressure.) The pressure is also greater in the pulmonary trunk and aorta
than inside the ventricles, but blood is caught in the cup-shaped semilunar pul-
monary and aortic valves as it tries to return from these vessels to the ventricles.
Once filled with blood, these valves are tightly closed to prevent backflow to the
ventricles from the pulmonary trunk and aorta. See Figure 10.13b. Blood travel-
ing passively from the atria to the ventricles in this phase reduces the pressure in
the atria, so blood also moves passively from the venae cavae and pulmonary veins
to the atria. All four chambers fill with blood during ventricular diastole.
The heart rests after the four phases have been completed to ensure enough time
for all of the chambers to fill. The contraction of the atria in the next cycle pushes
more blood into the already full ventricles, which expands the ventricular walls, mak-
ing the ventricles more likely to contract.
Heart Sounds during the Cardiac Cycle You may have had an opportunity to lis-
ten to a heart through a stethoscope (instrument for hearing heart sounds). The sounds
you hear—lubb-dupp, lubb-dupp, lubb-dupp—are caused not by the valves themselves
but by the turbulence of the blood when the valves close. The lubb corresponds to the
turbulence on the AV valves, and the dupp corresponds to the turbulence created when
the pulmonary and aortic valves close. The pause between heart sounds corresponds to
the rest between heartbeats.

Spot Check What chambers are filling during ventricular diastole before
atrial systole?

Cardiac Rhythm How often cardiac cycles occur is determined by the pacemaker—
the SA node. A normal pace (sinus rhythm) is usually 70 to 80 beats per minute,
although common rates may be in the range of 60 to 100 beats per minute. The SA
node would set a faster pace, but the pace is normally kept in check by the autonomic
nervous system through the vagus nerve. This is called vagal tone.
An ectopic focus occurs when any part of the conduction system other than the SA
node is setting the pace. Any cardiac muscle cell is capable of becoming a pacemaker.
A nodal rhythm occurs if the AV node is the ectopic focus. Hypoxemia, caffeine,
nicotine, electrolyte imbalance, and some drugs may cause an ectopic focus.
An arrhythmia (a-RITH-mee-ah) is an abnormal heart rhythm. One cause for an
arrhythmia is heart block, in which one part of the heart’s conduction system fails to
send its signals. If the ventricles do not receive the signals from the SA node via the
AV node and AV bundle, they will beat at their own pace of 20 to 40 beats per minute.
Their contractions, however slow, will not be coordinated with the contractions of the
atria, and the efficiency of the heart will be compromised.

Disease P int
Atrial fibrillation is the most common type of arrhythmia. In this case, the “faulty”
electrical signals cause the atria to beat very rapidly in an irregular pattern. An
irregular, fast atrial contraction results in pooling of the blood in the atria and an
uncoordinated heartbeat. When the contractions of the atria and ventricles are not in
sync, blood is not efficiently pumped out of the ventricles or to the rest of the body.
Atrial fibrillation can result in stroke or heart failure if not monitored and treated.

386 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 Clinical P int
A defibrillator is a device used to deliver an electric shock to the
heart when the heart has an arrhythmia. The electric shock inter-
rupts the abnormal rhythm of the heart, allowing the normal heart
rhythm to resume.

Electrocardiogram
©Exactostock/SuperStock

Learning Outcome
8. Interpret a normal EKG, explaining what is happening electrically in the heart.

An electrocardiogram (ECG or EKG) is a means of looking at cardiac rhythms. It

is a graph showing the electrical activity in the heart, not the amount of contraction
of the cardiac muscle. Figure 10.14 shows a normal ECG. The five waves on an ECG
per cardiac cycle represent only three electrical events, outlined in the following list:
• The P wave shows the depolarization of the atria.
• The Q, R, and S waves together represent the ventricles depolarizing.
• The T wave represents the ventricles repolarizing.
You may ask, Where does a normal ECG show the atria repolarizing? It does not
show that event because repolarization of the atria occurs at the same time that the
ventricles are depolarizing (a much larger event).
Figure 10.15 shows the relationship of an ECG and the contraction of the
myocardium.

FIGURE 10.14 A normal

0.8 second electrocardiogram.

R R

+1
Millivolts

P wave T wave

0
Q
S

–1

Atria Ventricles Atria Ventricles

contract contract contract contract

10.4 Heart Physiology 387

 Millivolts

Millivolts
Milliseconds Milliseconds
(a) (b)

R
Millivolts

Millivolts
QRS complex
P

Q
S

Milliseconds Milliseconds
(c) (d)
Millivolts

Millivolts

Milliseconds Milliseconds
(e) (f)
Millivolts

Milliseconds
(g)

FIGURE 10.15 The relationship of an ECG and contraction of the myocardium. The purple areas in each drawing (a–g)
indicate where tissues are depolarizing, and the green areas indicate where tissues are repolarizing. The graphs next to each
drawing show the corresponding portion of the ECG pattern.

Spot Check What is happening in the atria and ventricles in the interval
between the T wave and the next P wave?

The sole purpose of all the physiology you have covered so far in this chapter is to
efficiently pump blood out of the heart. But questions remain: How much blood? Does
the amount ever change, and if so, how does it change? We now answer these ques-
tions focusing first on the amount of blood pumped by the heart.

388 CHAPTER 10 The Cardiovascular System—Heart and Vessels

Cardiac Output

Learning Outcomes
9. Calculate cardiac output given heart rate and stroke volume.
10. Explain the factors that govern cardiac output.

Cardiac output is the amount of blood ejected by each ventricle of the heart each
minute. This output is highly adjustable to meet the needs and activity level of the
body. Cardiac output (CO) is calculated by multiplying the heart rate (HR: beats
per minute) by the stroke volume (SV: the amount of blood ejected from each
ventricle per beat). So CO = HR × SV. If the heart rate is 75 beats/min and the
stroke volume is 70 mL/beat, then the cardiac output equals 5,250 mL/min. As you
may recall, the volume of blood in the body is typically 4 to 6 liters. At this heart
rate and stroke volume, all of the blood in the body is pumped through the heart
in 1 minute.

Spot Check What is the cardiac output if the heart rate is 100 beats/min and the
stroke volume is 80 mL/beat?

Exercise can greatly increase cardiac output. The difference between the cardiac
output of a heart at rest and the maximum cardiac output the heart can achieve is the
cardiac reserve. Aerobic exercise and training can increase the cardiac reserve and
make the heart work more efficiently. You will explore the impact of exercise on the
heart later in the chapter.
Next, you will learn more about cardiac output by studying heart rate and stroke
volume.

Heart Rate This measurement is made by feeling a pulse in an artery. Each heart-
beat creates a surge in pressure that can be felt in the arteries carrying blood away from
the heart. Commonly, the radial artery is felt on the anterior surface of the wrist, but
arteries in the neck and legs can also be used. See Figure 10.16.
As you will learn later in the chapter (under “Heart Regulation”), heart rate varies
on a minute-by-minute basis. However, at rest, the normal heart rate for adult males is
64 to 72 beats/min and for adult females is 72 to 80 beats/min. The human heart may at
times beat too fast or too slow. Tachycardia and bradycardia are two of the conditions
in which this may be the case.

Disease P int
Tachycardia (tak-ih-KAR-dee-ah) is a persistent resting adult heart rate greater than
100 beats/min. Stress, anxiety, drugs, heart disease, and fever can all cause tachy-
cardia. On the opposite end of the spectrum is bradycardia, which is a persistent
resting adult heart rate that is less than 60 beats/min. Causes for this condition can
be sleep, endurance training for athletes, and hypothermia.

Stroke Volume This volume also plays a key role in determining cardiac output.
Stroke volume is the amount of blood ejected by each ventricle with each heartbeat,
but it is not the amount of blood each ventricle can hold. Ventricles cannot completely

10.4 Heart Physiology 389

 empty themselves with each contraction. There are three
factors that affect stroke volume:
Superficial
temporal a. • Preload is the amount of tension in the myocardium of
Facial a. the ventricular walls. If the walls have been stretched by
Common
carotid a. the amount of blood entering, the ventricles will con-
tract more forcibly. This follows the Frank-Starling
law of the heart, which basically states that the heart
must pump out the amount of blood it receives. If more
blood comes in, more blood must go out.
• Contractility refers to the responsiveness of the car-
Brachial a. diac muscle to contract. You may recall that stretching
smooth muscle makes it more likely to contract, but this
Femoral a. works differently. In this case, calcium makes cardiac
Radial a.
muscle more excitable, resulting in greater contractility.
• Afterload concerns the pressure in the pulmonary
trunk and aorta during diastole. As you may remem-
ber from the cardiac-cycle discussion, the ventricles
return to shape after systole. Blood pressure is then
higher in the arteries than in the ventricles, so blood
Popliteal a. tries to flow back to the ventricles. The cuplike valves
in the pulmonary trunk and aorta catch the blood, and
this closes the valves. The increased pressure of the
blood in these vessels is afterload. This pressure on
the valves must first be overcome before the ventri-
cles can eject additional blood. This is like someone
Posterior going through a swinging door and then standing on
tibial a. Dorsal the other side. You must apply enough pressure on the
pedal a.
door to move the door and the person ahead of you
before you can go through the door yourself.
FIGURE 10.16 Arterial
pressure points.
Heart Regulation

Learning Outcome
11. S
 ummarize nervous and chemical factors that alter heart rate, stroke volume, and
cardiac output.

Adjusting either the heart rate or the stroke volume can change the cardiac output. Any-
thing that changes the heart rate is called a chronotropic factor. Positive factors increase
the heart rate, while negative factors decrease the rate. Consider the following examples.

Chronotropic Factors of the Autonomic Nervous System As mentioned before,

the nervous system does not initiate heart contractions, but it can modify their fre-
quency. Two centers located in the medulla oblongata are the cardiac accelerator
center and the cardiac inhibitory center:
• The cardiac accelerator center uses sympathetic neurons to stimulate the SA and
AV nodes to speed up the heart rate.
• The cardiac inhibitory center uses parasympathetic neurons of the vagus nerve to
keep the SA node at 70 to 80 beats/min (vagal tone). If the vagus nerve is severed,
the SA node will typically set the pace at 100 beats/min.
The three types of sensors that feed information to the centers in the medulla oblon-
gata are the proprioceptors, baroreceptors, and chemoreceptors. They are explained in
the following list:

390 CHAPTER 10 The Cardiovascular System—Heart and Vessels

• Proprioceptors (pro-PREE-oh-sep-torz). As you will remember from the nervous
system chapters, these nerve endings are located in the body’s muscles, joints, and
tendons. The information they send alerts the centers to any change in the body’s
activity level.
• Baroreceptors. These sensors are located in the aorta and carotid arteries. See
Figure 10.17. They maintain homeostasis by alerting the centers to any changes in
blood pressure. If blood pressure falls, the cardiac accelerator center stimulates the
SA and AV nodes to increase the heart rate in an effort to restore blood pressure to
homeostasis.
• Chemoreceptors. These sensors monitor pH, carbon dioxide, and oxygen in the
blood. They are located at the aortic arch, on carotid arteries, and in the medulla

Chemoreceptors External carotid

artery

External carotid
artery Baroreceptors

Right common
carotid artery

Left common
Right subclavian carotid artery
artery
Left subclavian
artery

Aortic arch Chemoreceptors

Baroreceptors

FIGURE 10.17 Baroreceptors and chemoreceptors in arteries superior to the heart.

10.4 Heart Physiology 391

 oblongata. See Figure 10.17. Although these sensors do have an effect on heart
rate, they are much more important for setting the respiratory rate. You will learn
more about how they work in the respiratory system chapter.

Chronotropic Effects of Chemicals As you may suspect, epinephrine from the adre-
nal medulla has a positive chronotropic effect on heart rate, as it complements the sympa-
thetic nervous system. Other positive chronotropic chemicals are caffeine, norepi­nephrine,
nicotine, and thyroid hormone. Potassium ions have a negative chronotropic effect
because they interfere with repolarization of the myocardium. Increased potassium can
slow the heart. Potassium ions are used as part of a lethal injection to stop a heart.

Spot Check What would be the effect on heart rate of a breakfast of two cups
of coffee and a cigarette? Explain.

You will be exploring more about heart physiology once you have studied blood
vessel anatomy. Then you will be able to begin to understand how the heart and vessels
work together to maintain blood pressure and flow.

10.5 Vessel Anatomy

Learning Outcomes
12. Locate and identify the major arteries and veins of the body.
13. Compare the anatomy of the three types of blood vessels.

The three types of blood vessels in the body differ by ___location and direction of flow, as
explained in the following list:
• Arteries carry blood away from the heart to capillaries.
• Capillaries allow for the exchange of materials between the blood and tissues.
• Veins deliver blood from the capillaries back to the heart.
See Figures 10.18 and 10.19 for the major arteries and veins in the body.
Along with direction of blood flow and ___location, the histology of the walls of arter-
ies, veins, and capillaries also differs. See Figure 10.20 for a comparison of the walls
of arteries and veins.
Notice, in the figure, that arteries and veins have three basic layers to their walls,
called tunics. These different tunic layers are explained in the following list:
• Tunica externa is the outermost layer of the vessel wall. It is composed of loose
connective tissue, which serves to anchor the vessel to surrounding tissue and
provide passage for nerves and small vessels supplying blood to the external
wall. Internal walls are fed by diffusion.
• Tunica media is the middle layer of the vessel wall. It is the thickest layer, com-
posed mostly of smooth muscle. This tunic is more muscular in arteries than in
veins of comparable size. There may be elastic fibers in this layer, depending on
the vessel. You will cover this shortly.
• Tunica interna is the lining of the vessel wall. It is composed of endothelium
(simple squamous epithelial tissue and fibrous tissue). It is vital that this layer is
very smooth and secretes a chemical to repel platelets so that blood can easily flow
through the vessel.
Arteries and veins have subtypes based on size. Following, you will explore exam-
ples of each type of vessel and the subtypes in the order of blood flow.

392 CHAPTER 10 The Cardiovascular System—Heart and Vessels

Superficial temporal a.

External carotid a.
Vertebral a.
Internal carotid a.

Common carotid a. Subclavian a.

Brachiocephalic a.
Aorta
Axillary a.
Coronary a.
Intercostal a.

Brachial a.

Renal a.
Superior
Radial a. mesenteric a.

Common iliac a.
Inferior
mesenteric a.
External iliac a.

Internal iliac a. Gonadal a.

Ulnar a.

Deep femoral a.

Femoral a.

Popliteal a.

Anterior tibial a.

Posterior
tibial a.
Fibular a.

FIGURE 10.18 The major systemic arteries. Many vessels are shown on only one side for clarity but occur on both sides
(a. = artery).

10.5 Vessel Anatomy 393

Superficial
temporal v.
External jugular v.

Internal jugular v.
Subclavian v.
Right brachiocephalic v.

Axillary v. Superior vena

cava

Brachial vv. Hepatic v.

Median cubital v.
Inferior vena
Renal v. cava

Ulnar vv.
Radial vv.
Gonadal v.
Common iliac v.

External iliac v.

Internal iliac v.

Femoral v.

Great saphenous v.

Popliteal v.

Posterior tibial vv.

Anterior tibial vv.

FIGURE 10.19 The major systemic veins. Many vessels are shown on only one side for clarity but occur on both sides
(v. = vein, vv. = veins).

394 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 Artery Vein

Lumen

Valve

Endothelium
of tunica interna
Connective tissue
(elastic and collagenous
fibers)

Tunica media

Tunica externa

(a) (b)

Endothelium
of tunica
interna
Lumen
Middle layer
(tunica
media)

Outer layer
(tunica
externa)

(c)

FIGURE 10.20 The structural differences of arteries and veins: (a) artery, (b) vein,
(c) micrograph showing cross sections of a small artery (arteriole) at the bottom and a
small vein (venule) at the top.
(c) ©McGraw-Hill Education/Al Telser

Arteries
Conducting Arteries These are the largest of the arteries. Examples of conducting
arteries include the pulmonary arteries, the aorta, and the common carotid arteries.
They carry blood away from the heart. Because of their proximity to the heart, they
need to withstand the high pressure generated by ventricular systole. For this reason,
they have the most muscle and elastic fibers in their walls so that they can expand with
each heartbeat and then return to shape.

10.5 Vessel Anatomy 395

 Distributing Arteries These arteries are medium-size. They distribute blood from
the conducting arteries to organs. Examples include the hepatic artery, which carries
blood to the liver, and the renal arteries, which carry blood to the kidneys. They have
some elastic fibers in their walls to hold their shape, but they do not need to expand as
much as conducting arteries with every heartbeat.

Resistance Arteries These are the smallest of the arteries. Examples are the small
arterioles that deliver blood to the capillaries. Arterioles have little, if any, elastic fibers.
Each arteriole can feed a bed of approximately 100 capillaries. Precapillary sphincters
(circular muscles) in the arterioles open or close to regulate blood flow to the capillaries.
See Figure 10.21.

Arteriole forming an
arteriovenous shunt

Arteriole Precapillary
sphincter

Smooth Arteriole
muscle cell
Capillaries
Precapillary Venule
sphincter
Artery Vein

Capillary

Blood flow Blood flow

(a) (b)

Endothelial cell

Tissue fluid

Slit

Tissue fluid

Capillary

(c)

FIGURE 10.21 Blood flow to a capillary bed. (a) Arterioles have circular, smooth muscle cells that act as precapillary sphincters
to control blood flow to capillaries. (b) Some arterioles connect directly to small veins (venules), forming an arteriovenous shunt
(explained later in the chapter). (c) Capillary walls are a single endothelial cell thick, allowing for the exchange of materials between
blood and tissue fluid.

396 CHAPTER 10 The Cardiovascular System—Heart and Vessels

Capillaries
Microscopic capillaries are the smallest of all the vessels. Their one wall is composed
of endothelium—only one cell thick with its basement membrane (this is similar
to epithelial tissue, discussed in “Chapter 2, Levels of Organization of the Human
Body”). See Figure 10.21c. This thin-walled anatomy is necessary so that fluids and
other materials can be exchanged between the tissues and the capillary blood. For
example, oxygen is loaded to the red blood cells in the capillaries in the lungs, while
carbon dioxide is being unloaded from the capillary blood to the lungs so that it can be
exhaled. Blood cells move through the capillaries in single file to ensure the maximum
transfer of materials.
The body has approximately a billion capillaries arranged in capillary beds, yet
not every cell is bordered by a capillary. How materials are transferred between the
capillary blood and these cells is explained in the lymphatic system chapter. From the
capillaries, blood moves to the smallest of the veins—the venules.

Veins
The volume of the vessels continually decreases as blood moves from larger to
smaller arteries to the capillaries. The opposite is true as blood continues on its
path to the heart through the veins. Small veins called venules lead to medium and
then large veins before returning blood to the heart. As the diameter of the veins
increases, so does their volume. The total volume of all the veins is greater than
that of the arteries. If you remember the discussion earlier about the concepts of
volume and pressure, you will understand that the increased volume means blood
pressure is less in veins than it is in arteries. The decreased pressure means the
walls of the veins do not need to be as thick and sturdy as those of the arteries.
Arterial walls will hold an artery open even if empty. The thinner walls of veins
collapse when a vein is empty.

Venules These are the smallest of the veins, and they receive blood from the
capillaries. Unlike the case with larger veins, there is no smooth muscle in the tunica
media of venules.

Medium Veins Unlike venules, medium veins do have smooth muscle in the tunica
media of their walls. Examples of medium veins are the radial and ulnar veins in the
forearms. Many of these veins, especially in the limbs, have valves formed by folds of
the tunica interna. See Figure 10.20b. The valves help direct the flow of blood to the
heart by preventing backflow. You will see how this works later in the chapter, in the
section “Venous Return.”

Large Veins These veins have some smooth muscle in all three tunics. Exam-
ples of large veins are the venae cavae, pulmonary veins, internal jugular vein, and
renal veins.

Spot Check Explain how the histology of arteries, veins, and capillaries,
respectively, allows for these structures to transport blood away from the heart, transport
blood to the heart, and facilitate gas exchange.

10.6 Vessel Physiology

Blood vessels serve as the pipelines in the heart’s distribution system for blood. The
anatomy of the various routes directly affects the system physiology. Following, we
discuss the possible routes, starting with coronary circulation.

10.6 Vessel Physiology 397

 Circulatory Routes

Learning Outcome
14. Describe coronary and systemic circulatory routes.

Coronary Route The heart makes up only 0.5% of the body’s weight, yet receives
5% of the circulating blood. This rich blood supply is another reason the heart can stay
aerobic. The heart’s myocardium is not fed by the blood passing through the chambers. It
has its own circulation route composed of coronary arteries and veins. See Figure 10.22.
If you take a close look at Figure 10.23, you will see two openings within the
aortic valve. The pressure of blood filling the cusps of the valve as it tries to return to
the heart during ventricular diastole forces oxygen-rich blood into the right and left
coronary arteries. These two arteries then branch to form the coronary arteries that
lead to capillary beds in the heart’s tissues. See Figure 10.22c.
Twenty percent of the blood from the capillaries is directly returned to the right
atrium of the heart from small veins. The rest of the blood in coronary circulation is
FIGURE 10.22 Coronary
circulation: (a) anterior view,
(b) posterior view, (c) polymer
cast of coronary arteries.
(c) ©Martin Dohrn/Royal College of
Surgeons/Science Source

Right coronary
artery Left coronary
artery

Anterior cardiac Great cardiac

vein vein

Small cardiac Anterior

vein interventricular
artery (left anterior
Right ventricle descending artery)

Left ventricle

(a)

Cardiac vein

Circumflex
Left atrium
artery

Middle cardiac Right atrium

vein
Coronary sinus
Left marginal
vein Posterior
interventricular
artery
Left ventricle
Right ventricle

(b) (c)

398 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 FIGURE 10.23 Superior
view of the aortic valve with a
section of the aorta removed.

Aorta

Part of aorta
removed

Aortic valve
cusps

Opening of
right coronary
artery

Right coronary Opening of

artery left coronary
artery

collected by the great cardiac vein and the middle cardiac vein and then emptied into
the coronary sinus before entering the right atrium. See Figure 10.22.

Spot Check What is the term for the pressure of blood filling the cusps of the
valve as it is trying to return to the heart during ventricular diastole?

Systemic Routes These routes carry blood from the heart to tissues in the body
(other than the heart) and back again. The simplest route goes like this:
Heart → arteries → capillaries → veins → heart
Notice that capillaries are mentioned only once in this route. Consider the follow-
ing example of this circulatory route.
Blood leaves the heart’s right ventricle to travel through the pulmonary trunk to
pulmonary arteries, to arterioles, to capillaries covering air sacs (alveoli) in the lungs.
Oxygen is loaded to the blood within the capillaries, and carbon dioxide is unloaded.
From these capillaries, blood travels through venules to pulmonary veins to the left
atrium of the heart. See Figure 10.24.

Common Misconception
The red and blue colors for the vessels in Figure 10.24 indicate the amount of oxygen
in the blood. Red is oxygen-rich, while blue is oxygen-poor. Some students make the
mistake of thinking arteries are always shown in red and veins are always shown in blue.
Here is the prime example of the error of that misconception: The pulmonary arteries are
shown in blue because they are carrying oxygen-poor blood away from the heart to the
lungs. Pulmonary veins are shown in red because they are returning oxygen-rich blood
to the heart. It is better to know arteries and veins by direction of flow than by color in an
illustration. Arteries carry blood away from the heart, and veins carry blood to the heart.

10.6 Vessel Physiology 399

 Right
pulmonary
artery Left
Superior Aorta pulmonary
vena cava artery

Pulmonary
capillaries
Pulmonary
capillaries

LA
RA
Right
pulmonary Left
veins pulmonary
veins
Pulmonary
trunk LV

Right lung RV Left lung

Inferior vena cava

FIGURE 10.24 Pulmonary circulation (pulmonary circuit). The microscopic capillaries and the microscopic air sacs in the lungs
are greatly enlarged for clarity.

Alternative Routes There are two types of alternative systemic routes in the body:
portal routes and anastomoses.

Portal routes A portal route contains two capillary beds before blood is returned to
the heart. In this type of circulation, blood travels in the following route:
Heart → arteries → capillaries → intervening vessels → capillaries → veins → heart
Because there are two capillary beds, this type of route allows materials to be
exchanged twice between the blood and tissues before returning to the heart. Examples
of portal routes can be found between the hypothalamus and pituitary gland (covered
in the endocrine system chapter), in the kidney (covered in the excretory/urinary sys-
tem chapter), and between the intestines and the liver.
To better understand portal routes, take a close look at the example of the hepatic
portal route between the intestines and the liver. See Figure 10.25. In this route,
blood travels from the heart to arteries to capillary beds in the small intestine and
other digestive organs. Here, digested nutrients are absorbed into the blood through
capillaries. Blood then travels through small veins leading to the hepatic portal vein
(intervening vessels) to capillary beds in the liver, where the nutrients are processed.
Blood then exits the liver via the hepatic vein on its way back to the heart. Again,
blood travels through two capillary beds in this route before returning to the heart.
Understanding this route will be important when you study the digestive system.

Anastomoses Anastomoses (ah-NAS-tah-MO-seez), which are the second type of

alternative routes, involve vessels merging together. The three types of anastomoses
are explained in the following list:

400 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 Head and upper-
limb capillaries

Lungs
Deoxygenated blood

Oxygenated blood

Superior
vena cava

Aorta

Hepatic artery

Inferior
vena cava

Splenic artery

Hepatic vein Hepatic

Liver portal vein
capillaries Mesenteric artery
Small intestine (to intestine)
capillaries

Renal efferent Renal afferent

arterioles arterioles

Common Trunk capillaries

iliac vein Common
iliac artery

Lower-limb capillaries

FIGURE 10.25 Hepatic portal route: a diagram of circulatory system routes. Note that blood travels from the mesenteric
artery to capillaries in the small intestine, where nutrients are absorbed, and on to the hepatic portal vein that delivers blood to a
second bed of capillaries in the liver, where the absorbed materials are processed.

1. Arteriovenous anastomoses. This type of route is often called a shunt. It merges

an artery with a vein, skipping a capillary bed. You may ask why this would ever
be done. After all, the point of circulation is to deliver materials to the tissues and
take other wastes away, and that happens in the capillaries. This type of route is
used in the fingers, palms, toes, and ears in conditions of extreme cold. The capil-
lary beds are then temporarily bypassed so that heat is not lost. This is a protective
mechanism. See Figure 10.21b.
2. Arterial anastomoses. This type of circulatory route merges two arteries to pro-
vide collateral routes to the same area. These routes can be found in the heart, to

10.6 Vessel Physiology 401

 make sure all parts of the heart are adequately fed, and at joints, where movement
may block one of the routes.
3. Venous anastomoses. This type of route is the most common of the anastomoses.
It merges veins to drain an organ.

Venous Return

Learning Outcome
15. Explain how blood in veins is returned to the heart.

You now understand that the pressure created by ventricular systole propels blood
through the arteries and capillaries, but what causes the blood to move through the
veins on its way back to the heart?
Five mechanisms aid in venous return:
• Pressure gradient. Even though there is less pressure in the veins than in the
arteries, the pressure in veins due to the action of the heart does propel blood
toward the heart.
• Gravity. Blood moves through veins above the heart due to gravity, and it flows
downhill.
• Thoracic pump. The chest expands every time a breath is inhaled. This increases
the volume and decreases the pressure within the chest. As air rushes in to equalize
the pressure, blood in the veins of the abdominal cavity is sucked into the inferior
vena cava of the thoracic cavity by the same principle.
• Cardiac suction. You were introduced to this mechanism during the cardiac-cycle
discussion. Atria return to shape during atrial diastole. This creates less pressure in
the atria than in the superior and inferior venae cavae and the pulmonary veins, so
blood is sucked into the atria from the veins.
• Skeletal muscle pump. This mechanism is especially effective in the limbs. Skel-
etal muscle action massages blood through the veins, while the valves in the veins
prevent backflow. See Figure 10.26.
As you are aware, ventricular contractions force blood out of the heart under pres-
sure. That same pressure causes blood to continue on its journey through the arteries,
capillaries, and veins (to a lesser extent) as blood is returned to the heart. We focus
next on the dynamics of blood pressure, resistance, and flow.

Blood Pressure, Resistance, and Flow

Learning Outcomes
16. Explain the relationship between blood pressure, resistance, and flow.
17. Describe how blood pressure is expressed and how mean arterial pressure and pulse
pressure are calculated.

Blood flow is the amount of blood flowing to an area in a given amount of time, and it
is usually expressed in milliliters per minute (mL/min). Blood pressure is the force of
the blood against the vessel walls, and it is dependent on three things: cardiac output,
blood volume, and resistance. You can use a garden hose as an analogy for the vessel.
As you read the following list, think of the pressure and flow of water as it moves
through a hose:
• Cardiac output is a factor because it takes into account the force of ventricular
contractions. (How strong is the pump for the hose?)

402 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 To heart FIGURE 10.26 The skeletal
muscle pump. Skeletal muscle
action massages blood through
the veins in the direction of the
heart.

To heart

Relaxed skeletal
muscle

Vein
Valve open

Contracted
skeletal muscle

Vein

Valve closed

• Blood volume makes a difference because more blood exerts a greater force on the
vessel walls. (How far is the hose’s water faucet turned on?)
• Resistance makes a difference in these three ways:
1. Blood viscosity (thickness). The amount of albumins and red blood cells
determines the thickness of blood. Thicker blood offers more resistance to flow
and requires more pressure to get it to move. (What if the hose contained honey
instead of water?)
2. Vessel length. The greater the vessel length, the more friction occurs between
the blood and the vessel walls. Friction slows the blood. (What would be the
force of the same amount of water coming out of a 100-foot hose versus a
10-foot hose?) Vessel length becomes a factor in people who are obese. More
pressure is needed to propel blood through their longer system of vessels to
feed their increased tissue mass.
3. Vessel radius. Vessel radius becomes a factor because the smaller the radius, the
more blood comes in contact with the walls of the vessel. (What happens to the
amount of flow if the hose diameter is reduced?) As you will see shortly, vessel
radius (through vasoconstriction and vasodilation) can be controlled in several
different ways to regulate blood pressure.

Spot Check Would blood flow be faster in the aorta or in the femoral artery?
Explain in terms of resistance.

Blood pressure is usually measured in the brachial artery by using a sphygmoma-

nometer (SFIG-moh-mah-NOM-ih-ter) that has a pressure cuff and a device to inflate
the cuff. The original instruments (sphygmomanometers) measured blood pressure as
the amount of pressure necessary to lift a column of mercury a certain distance, so the
units for blood pressure are millimeters of mercury (mmHg). Newer sphygmomanom-
eters typically use a dial to indicate pressure using the same units. Two pressures are

10.6 Vessel Physiology 403

 recorded and expressed as systolic pressure/diastolic pressure. For example, a normal
blood pressure for a 20- to 30-year-old is 120/72 mmHg. The systolic pressure created
in the brachial artery during ventricular systole is 120 mmHg. The diastolic pressure
created in the brachial artery during ventricular diastole is 72 mmHg.
Pulse pressure indicates the surge of pressure that small arteries must withstand
with each ventricular contraction. It is determined by this equation: Pulse pressure =
systolic pressure − diastolic pressure. The pulse pressure for our 20- to 30-year-old is
120 − 72 = 48 mmHg. As stroke volume increases, pulse pressure also increases.

Disease P int
Hypotension is chronic low pressure below 90/60 mmHg. It can be caused by
dehydration, blood loss, or anemia. Prehypertension is diagnosed when the
resting systolic pressure is 120 to 139 mmHg and/or diastolic pressure is 80 to
89 mmHg. Hypertension results when resting pressures are greater than 140/
90 mmHg. Usually, there are no symptoms associated with hypertension unless the
blood pressure is dangerously high. Because symptoms are absent, the disease
can cause organ damage such as heart or kidney disease before individuals even
know they have it. Hypertension is treated
with medications that lower blood pressure
and with lifestyle modifications. Physicians
may suggest that patients alter their diet to
limit salt intake, lose weight, reduce stress,
stop smoking, and exercise. It is important
to control hypertension because if left
untreated, it can lead to kidney disease,
heart attack, stroke, poor vision, and poor
blood supply to extremities. Hypertension
can also weaken small arteries and can
cause aneurysms, which are weaknesses in
arterial vessel walls that can balloon out and
©Don Farrall/Getty Images
even rupture.

Mean arterial pressure (MAP) is the average pressure arteries must be able to with-
stand. It is determined by the following equation: MAP = diastolic pressure + ⅓ pulse
pressure. But if this is an average, why isn’t the equation simply systolic pressure +
diastolic pressure divided by 2? This would be the case if the amount of time of
ventricular systole in the cardiac cycle was the same as the amount of time of ventricu-
lar diastole, but the cardiac cycle includes a rest between heartbeats. So there is more
time in a relaxed state than in a contracted state. Blood pressure is further altered by
arteries expanding and then recoiling, so pressure does not reach a peak and then drop
to zero. The MAP for the 20- to 30-year-old in our example is 72 + ⅓(48) = 88 mmHg.

Spot Check What are the pulse pressure and mean arterial pressure for a
25-year-old individual whose blood pressure is 150/96 mmHg?

Regulation of Blood Pressure and Flow

Learning Outcome
18. Explain how blood pressure and flow are regulated.

404 CHAPTER 10 The Cardiovascular System—Heart and Vessels

Blood pressure and flow can be regulated locally (by the tissues), hormonally (by the
endocrine system), or neurally (by the nervous system). How each of these works is
discussed here.

Local Control Tissues can autoregulate their own blood supply in four different ways:
1. Opening of precapillary sphincters. If there is inadequate blood flow, wastes such
as carbon dioxide, lactic acid, and hydrogen ions build up in the tissues. The presence
of wastes stimulates vasodilation and the opening of precapillary sphincters, creat-
ing more blood flow. Increased blood flow to the capillaries brings more oxygen to
the tissues (to remove the lactic acid) and removes the wastes. The waste removal
ends the vasodilation and closes the precapillary sphincters. Think about this: There
are about a billion capillaries in the human body arranged in beds. Sphincters con-
trol the blood flow to these capillary beds, and three-fourths of the capillary beds are
empty at any given time because the sphincters are closed to them. You do not have
enough blood to fill all of the capillaries, nor do you have a heart strong enough to
pump all the blood that would be necessary to fill all of the capillaries at any one
time. This is a lot like a sprinkler system. Imagine a house on a lake. A lake pump is
used to water the yard. All of the grass needs to be watered, but Nadine, the owner,
does not have a lake pump big enough to run the 70 sprinklers necessary to water all
of the grass at one time, so her sprinklers are arranged in zones. At 5 a.m., zone 1
turns on its seven sprinklers, and zone 1 grass is watered for 30 minutes. When that
is finished, the lake pump sends water to the seven sprinklers covering zone 2’s
grass, and so on. By 10 a.m., all of the grass has been watered one zone at a time.
All the grass is satisfied, and Nadine did not have to buy a bigger pump. The body’s
system is even better! Nadine’s grass gets watered on a schedule whether it needs
it or not. Grass in shady areas is probably overwatered, and grass in sunny areas
is underwatered. Local control related to the body’s capillaries, however, is based
solely on need. When waste builds up in an area, precapillary sphincters open and
blood flow increases to take the waste away—immediately—when it is needed, not
on some arbitrary schedule. When the wastes are gone, the precapillary sphincters
close, so blood is diverted to other areas where it is needed. All the tissues are fed
and wastes are taken away efficiently without any more strain on the pump (heart)
than is absolutely necessary.
2. Inflammation. In response to an injury or the presence of a pathogen, damaged
tissues or basophils release vasodilators in the local area to stimulate inflamma-
tion. This inflammatory response dilates vessels and makes them more permeable,
thereby increasing blood flow to the area. The increased blood flow delivers more
white blood cells to the area to fight pathogens, which accounts for the redness,
heat, and swelling associated with inflammation.
3. Reactive hyperemia. If circulation to an area is cut off for a time and then
restored, vessels overdilate, flushing an area with blood. An example of this can
be seen when you cross your legs at the knee. When you remove the top knee, you
may notice a red area on the knee where the leg rested. Here is another example: If
you are out in the cold so long that vessels have constricted in the skin to save heat
for the core (the skin appears white) and then you come inside where it is warm,
the vessels in the skin overdilate and the skin appears red.
4. Angiogenesis. Persistent buildup of metabolic waste causes new vessel growth
(angiogenesis) to increase the blood supply to the area. Heart patients, depend-
ing on their condition, may be encouraged to exercise. The buildup of wastes in
cardiac muscle tissue promotes the growth of new vessels to provide collateral
(additional) circulation in the heart. Fast-growing cancer tumors can also stimulate
angiogenesis to feed a tumor and remove its wastes. This is an important area of
cancer research. If angiogenesis can be prevented in this case, the tumor can be
starved and the tumor’s growth may be slowed.

10.6 Vessel Physiology 405

 Hormonal Control The endocrine system can also be used to maintain homeostasis
by regulating blood pressure and flow by the use of the following four hormones:
• ADH (also called vasopressin). As you may recall from the endocrine system
chapter, ADH targets the kidney to cause water retention. By preventing water loss
in urine, blood volume and therefore pressure are maintained.
• Aldosterone. This mineralocorticoid (studied in the endocrine system chapter)
targets the kidney to cause sodium to be retained in the blood. Water follows the
sodium, so again, by preventing water loss in urine, blood volume and pressure are
maintained.
• Angiotensin II. Angiotensin II is a vasoconstrictor produced by the liver when
blood pressure falls below homeostasis. Widespread vasoconstriction increases
blood pressure.

Clinical P int
An enzyme, ACE, is needed to produce angiotensin II. People who have high blood
pressure may be prescribed ACE inhibitors to lower their blood pressure.

• Epinephrine. Epinephrine complements the sympathetic nervous system by caus-

ing vasoconstriction, which limits blood flow to most vessels except those vessels
going to cardiac and skeletal muscle.

Neural Control The brain also regulates blood pressure and flow. The vasomotor
center in the medulla oblongata uses sympathetic fibers to constrict most vessels
except those going to cardiac and skeletal muscles. This center and the cardiac centers
of the medulla oblongata are influenced by three reflexes—the baroreflex, chemore-
flex, and medullary ischemic reflex—which are explained in the following list:
• Baroreflex. Baroreceptors in the aortic arch and carotid arteries (covered earlier
in the chapter) constantly send signals. If the pressure is too high, messages from
these receptors cause the medulla oblongata’s cardiac inhibitory center to increase
vagal stimulation of the heart, thereby decreasing the heart rate and blood pressure.
• Chemoreflex. Chemoreceptors monitor oxygen, carbon dioxide, and pH. If oxy-
gen levels fall, carbon dioxide levels rise, and pH falls, the vasomotor center will
initiate widespread vessel constriction. This increases blood pressure, increasing
blood flow to the lungs for more gas exchange. Oxygen levels then rise, carbon
dioxide levels fall, and pH also rises.
• Medullary ischemic reflex. If blood flow to the brain decreases, the cardiac
accelerator center and the vasomotor center send sympathetic signals to increase
heart rate and increase vasoconstriction. This increases pressure and blood flow to
the brain. The medullary ischemic reflex is effective for even simple actions, like
standing suddenly after being in a supine position, such as lying on your back. In
this case, change of position reduces blood flow to the brain temporarily.
You have covered a great deal of anatomy and physiology in this system. Now you can
FIGURE 10.27 Nick and Kate put it all together by revisiting Nick and Kate (from the integumentary system chapter)
on a morning run. on their morning run to see the effect of exercise on their cardiac output (Figure 10.27).
©Image Source/Corbis/Getty Images

Spot Check How might damage to the medulla oblongata affect how the
vasomotor and cardiac centers control blood pressure and flow?

406 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 Disease P int
Shock is a serious, life-threatening condition characterized by the body’s organ
systems not getting enough blood flow to sustain normal function. The different
categories of shock, based on their causes, follow:
●● Cardiogenic shock happens when the heart cannot pump enough blood to meet
the body’s needs. This can be caused by a variety of factors such as damage of
the heart muscle from a heart attack, extreme arrhythmias, dysfunctional valves,
or a rupture in the heart’s ventricular septum.
●● Hypovolemic shock occurs when the body undergoes severe fluid and
blood loss, which results in not having enough blood to pump to meet the
body’s needs. Often, hypovolemic shock can be caused by internal bleeding
or bleeding from cuts or injuries. It can also be caused by fluid loss through
extreme perspiration, diarrhea, burns, and vomiting.
●● Septic shock can be caused by any microorganism that causes an infection.
Usually, people who suffer from septic shock either are very young or elderly
or have a compromised immune system. In either case, the person does not
have the ability to fight the infection, so it takes over and eventually enters the
bloodstream. The infection causes very low blood pressure, which can lead to
organ dysfunction and shock.
●● Neurogenic shock is a condition of the nervous system in which stimulus to
the sympathetic nervous system is lost, resulting in the inability to keep the
appropriate amount of muscle tone in the tunica media of the blood vessels. This
results in the pooling of blood, as opposed to the adequate pumping of blood to
the body’s systems.

In any category of shock, the low blood pressure interferes with normal blood
circulation, preventing organs from getting enough blood to function properly. Symptoms
of shock include cyanosis, chest pain, confusion, dizziness, rapid and weak pulse, shallow
breathing, and, in some cases, loss of consciousness. Shock is an emergency situation
that requires immediate attention. Emergency medical assistance should be obtained
and first-aid procedures for treatment of shock should be performed until help arrives.

Effects of Exercise on Cardiac Output

Learning Outcome
19. Explain the effect of exercise on cardiac output.

Nick and Kate begin their morning run with a resting heart rate and resting cardiac out-
put. Once the run has started, proprioceptors in their joints, muscles, and tendons alert
the cardiac accelerator center in the medulla oblongata of the increased activity level.
The center sends messages along sympathetic neurons to increase their heart rates.
Meanwhile, Nick’s and Kate’s muscles are doing increased aerobic respiration,
which causes more metabolic wastes to build up in the tissues. Locally, vasodilation
and the opening of precapillary sphincters in the muscles increase blood flow, so more
of the accumulating wastes are carried away in the blood. This stimulates a chemore-
flex to increase blood flow to the lungs. If Nick and Kate make a habit of regular exer-
cise, the chronic buildup of wastes stimulates angiogenesis to improve the collateral
circulation in their coronary arteries.
As Nick and Kate continue to run, their muscles are massaging their veins, which
increases the venous return to the heart. This added preload results in a greater stroke
volume because the heart must pump out what it receives. So Nick’s and Kate’s heart

10.6 Vessel Physiology 407

 rates and stroke volumes have increased during the run, and these increases, together,
greatly increase their cardiac output. Their cardiac reserve may easily be four to five
times larger than their resting cardiac output.

10.7 Effects of Aging on the Cardiovascular System

Learning Outcome
20. Summarize the effects of aging on the cardiovascular system.

You have seen how the cardiovascular system works in the previous scenario, but Nick
and Kate are relatively young adults. What would be the effects of aging on their car-
diovascular systems?
If their cardiovascular systems maintain homeostasis within a normal blood pressure
range, there may be little to no effect of aging on their hearts. If either Nick or Kate is hyper-
tensive, however, there may be dramatic changes. These changes include the following:
• Vascular resistance increases with age in individuals with hypertension. This
increases afterload, which then requires higher diastolic and mean arterial pressure
to move the same amount of blood through the system.
• Decreased resting stroke volume decreases cardiac output, which means the heart
becomes less efficient.
• The vessels thicken and become less elastic. This makes the vasculature more sus-
ceptible to developing atherosclerosis (discussed in the final section of this chapter).
The effects of lifestyle can also make a difference in how this system ages. Here
are some of the effects:
• Physical conditioning can improve aerobic capacity in elderly individuals by
increasing their cardiac output and ability to use oxygen effectively. It is possible
for well-conditioned older people to exceed the aerobic capacity of people who are
much younger and not as well conditioned.
• Physical conditioning slows or reduces the vascular stiffening that may occur
with aging.
• Exercise over a lifetime can significantly increase the collateral circulation in the
heart. This provides multiple avenues for blood to feed areas of myocardium that
may have otherwise died if a coronary artery becomes blocked.
• A diet low in sodium helps keep blood pressure under control.
• Nonsmokers avoid the associated polycythemia that develops in smokers, whose
blood cells carry carbon monoxide instead of oxygen. Not smoking helps keep the
blood from becoming too thick and adding to the workload of the heart.

Spot Check What can you do now to ensure a more efficient cardiovascular
system in old age? Explain in terms of physiology.

10.8 Diagnostic Tests for Heart and Vessel Disorders

Learning Outcome
21. Describe common diagnostic tests used to diagnose heart and vessel disorders.

Before you explore the disorders in this chapter, look at Table 10.1, which describes
common diagnostic tests and procedures for disorders of the heart and vessels.
Although you have already covered electrocardiography in detail, there are other
diagnostic tools to consider when studying cardiovascular system disorders.

408 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 TABLE 10.1 Diagnostic Tests Used for Heart and Vessel Disorders
TESTS USED TO ASSESS THE PHYSIOLOGY OF THE HEART AND VISUALIZE ITS ANATOMY
Echocardiography A test that uses sound waves to create a
picture of the heart.
Electrocardiography A test that records the heart’s electrical
(ECG or EKG) activity and shows certain problems, such as
abnormal heartbeats or damage to the heart.
Heart CT scan Computed tomography of the heart.
Nuclear heart scan A procedure that uses a radioactive dye to
view the heart.
TESTS USED TO ASSESS CARDIAC FUNCTION DURING ACTIVITY
Holter monitor A machine worn by the patient that
Electrodes attached to
continuously monitors the heart’s rhythms
chest under clothing during everyday activities.

Electrocardiogram strip

Recording
device

Stress test A test that monitors the heart’s electrical

activity, blood pressure, and heart rate while
the patient is exercising.

©Charles Thatcher/Getty Images

TESTS USED TO VISUALIZE CORONARY VESSELS, ARTERIES, AND VEINS

Cardiac A procedure in which contrast dye is injected
catheterization through a catheter into the heart. The
movement of the dye through the valves,
heart chambers, and coronary arteries is
monitored by X-ray.
CT angiography A noninvasive way to perform coronary
angiography using computed tomography.
Ultrasound An imaging technique, using sound waves,
to visualize internal structures.
Venography A test used to view vessels in the body.
Contrast dye is injected into the vein. The
movement of the dye through the vein is
monitored by X-ray.

10.8 Diagnostic Tests for Heart and Vessel Disorders 409

 Spot Check Compare and contrast a stress test and the Holter monitor.

10.9 Disorders of the Heart and Vessels

Learning Outcome
22. Describe heart and vessel disorders and relate abnormal function to pathology.

You have already read about a few different heart and vessel disorders throughout the
chapter. Now it is time to expand your knowledge about pathological conditions that
affect the cardiovascular system. First you will explore disorders of the heart valves.

Valve Disorders
Within the chapter, you have examined the importance of the heart valves in making
sure that blood flows in one direction and that mixing of deoxygenated and oxygenated
blood does not occur. You have also read about how rheumatic fever can cause chronic
rheumatic heart disease resulting in valve stenosis. Two additional valve disorders—
murmurs and prolapse—affect the function of the valve.

Murmur A murmur is an abnormal heart sound. It may be a functional murmur

(not a problem) or a pathological murmur (possible leaky valve). The murmur often
makes a ssh sound. If the heart sound is lubbssh dupp, lubbssh dupp, the AV valves
may be suspected of leaking because the abnormal sound is occurring with the first
sound in the cardiac cycle.

Prolapsed Valve A prolapsed valve is characterized by a valve leaflet that “billows”

or bends in a way that prevents it from closing properly. This can be caused by degenera-
tion of the valve or the chordae tendineae. While mitral valve prolapse is the most com-
mon type of prolapse, this condition can affect any
valve found within the heart. Inability of the valve
to close can cause regurgitation (backflow) of blood
in the heart, as shown in Figure 10.28. If the regur-
gitation is severe enough, ventricular enlargement,
arrhythmias, endocarditis, or stroke may occur. A
prolapsed valve is diagnosed using echocardiog-
raphy. Treatment usually involves monitoring the
disorder. Some individuals may be medicated to treat
Normal closure the arrhythmias, and others may eventually need the
faulty valve replaced.
Next, you will learn about disorders involving
the cardiac vessels.

Vessel Disorders
As you have already read, the vessels are responsi-
ble for transporting blood all over the body. Various
disorders can affect the ability of vessels to trans-
Prolapse closure
port blood. We discuss a few of them here.
FIGURE 10.28 Mitral valve
prolapse. Inability of the valve Atherosclerosis Atherosclerosis results in the buildup of fatty deposits within
to close causes regurgitation arterial walls, which causes the walls to roughen and project to the lumen (open
(backflow) of blood to the left space) within the vessel. Atherosclerosis often begins as a result of hypertension
atrium. or viral infection that weakens the arterial wall. Monocytes stick to the tunica

410 CHAPTER 10 The Cardiovascular System—Heart and Vessels

interna at the weakened area and then proceed to the tunica media, where they
become macrophages. As macrophages, they consume fats and cholesterol from the
blood and develop a foamy appearance. The buildup of the fatty deposits (plaque)
thickens the arterial wall and makes the lining of the artery rough. This obstructs
blood flow and provides a surface to which platelets stick. Platelets complicate the
condition by secreting growth factors to stimulate mitosis in the vessel walls, fur-
ther reducing the size of the lumen. The narrowed, rough interior of the artery is a
prime ___location for developing blood clots to form. If the atheroma (fatty deposit)
becomes calcified, the condition is called arteriosclerosis. See Figure 10.29.
When atherosclerosis or arteriosclerosis obstructs the coronary arteries that supply
blood to the heart, coronary artery disease, or CAD, results. If not treated, CAD
can go on to cause further damage to the heart by potentially causing myocardial
infarction, which you will read about in the next section. A variety of tests are used
to diagnose CAD, such as coronary angiography, echocardiography, electrocardi-
ography, stress test, and nuclear stress test. See Table 10.1. Treatment for CAD may
include medications that lower blood pressure. Surgery may also be required to
restore blood flow to the heart. Physicians may also suggest lifestyle changes that
include eating a heart-healthy diet low in sodium, not smoking, reducing stress, and
limiting alcohol intake.

FIGURE 10.29
Atherosclerosis: (a) a healthy
artery, (b) an artery with
atherosclerosis, showing
plaque buildup and reduced
lumen.
(a, b) ©Ed Reschke

(a) Lumen Artery wall

Complicated plaque

(b) Lumen Artery

wall

10.9 Disorders of the Heart and Vessels 411

 Clinical P int
Blocked coronary arteries can be treated through angioplasty or coronary bypass
surgery. Angioplasty involves threading a balloon-tipped catheter through a vessel in
the leg to the blocked coronary artery. The balloon is inflated within the blockage to
open the vessel lumen. A stent may be used as part of the balloon system to hold the
vessel open after the catheter is withdrawn.
Coronary bypass surgery involves harvesting a vessel and inserting its ends before
and after the obstruction to effectively bypass the blockage. Several vessels can be
used, like the great saphenous vein of the leg or a collateral branch of a mammary
artery. But, as you will remember, the anatomy of the walls of arteries differs from that
of veins in regard to how much pressure the vessels can withstand.

Collapsed Dilated
balloon catheter balloon catheter Stent
and stent and stent deployed

Plaque

Thrombophlebitis Thrombophlebitis (THROM-boh-fleh-BY-tis) is inflammation

of a vein, caused by thrombosis (formation of a blood clot in a blood vessel). There
are many causes of thrombosis, including surgery, immobility, and pathological condi-
tions that cause the blood to clot abnormally. The two types of thrombophlebitis are
• deep venous thrombosis, which affects deep veins; and
• superficial thrombophlebitis, which affects veins close to the skin’s surface.
Symptoms of thrombophlebitis include inflammation of the body part with the
affected vein, pain, redness, and tenderness over the inflamed vein. See Figure 10.30.
Thrombophlebitis is diagnosed using tests that allow physicians to visualize the
vein, such as ultrasound and venography. Although superficial thrombophlebitis
does not usually cause any major health issue, deep venous thrombosis can result
in chronic pain and swelling and pulmonary embolism (a blood clot that has trav-
eled to the lungs). Treatment involves controlling the pain with analgesics, treating
any infection that might be present, controlling the inflammation with nonsteroidal
anti-inflammatory drugs, using anticoagulants to thin the blood, and administering
thrombolytic drugs designed to dissolve the blood clot. If severe, the vein can be
surgically removed.

Varicose Veins Varicose veins are veins in which the valves that prevent the back-
flow of blood are not working properly. The dysfunctional valves allow the blood to pool,

412 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 FIGURE 10.30
Thrombophlebitis: (a) normal
blood flow compared to
thrombus within vein,
(b) inflammation caused by
deep venous thrombosis.
Blood
flow (b) ©Dr. P. Marazzi/Science Source

Blood
clot

Valve

(a) (b)

causing the vein to enlarge. See Figure 10.31. Varicose veins are usually secondary
to some other condition, such as thrombophlebitis or pregnancy, and are commonly
found in the legs. While visibly unattractive, most varicose veins do not cause signifi-
cant health problems. If the varicose veins cause pain, treatment can include raising
the legs while sitting or sleeping, avoiding standing for long periods, and wearing
support hose. As with thrombophlebitis, if the varicose veins are severe, they can be
surgically removed.
Now it is time to move on to disorders that affect the myocardium.

FIGURE 10.31 Varicose

Varicose
veins: (a) normal vein compared
veins to a varicose vein, (b) varicose
veins in the legs.
(b) ©DIGIcal/E+/Getty Images

Blood
flow

Open
Closed
valve
valve

Normal vein Varicose vein

(a) (b)

10.9 Disorders of the Heart and Vessels 413

 Myocardial Disorders
Up to this point, we have discussed cardiac disorders that affect specific parts of the
heart (like the valves) or a part of the cardiovascular system (like the vessels). In this
section, we explain disorders that affect the muscular layer of the heart.

Myocardial Infarction As mentioned earlier, atherosclerosis may cause CAD, which

results in blocked blood flow in a coronary artery. This lack of blood flow—ischemia
(is-KEE-mee-ah)—can lead to a myocardial infarction (MI)—the death of myocar-
dial tissue fed by the affected artery—commonly called a heart attack. Symptoms can
vary for men and women, but most people experience the following:
• A crushing pain in the chest that may radiate to the neck and jaw and down the
left arm
• Shortness of breath or difficult breathing
• Sweating
• Nausea
• A feeling of impending doom
In addition to the symptoms mentioned here, women may experience light-
headedness, sleep disturbances, indigestion, anxiety, and unusual fatigue lasting for
several days.

Angina Pectoris Angina pectoris is a heaviness or pain in the chest caused by a

temporary or reversible myocardial ischemia. The hypoxemia from the reduced blood
flow causes the heart to use anaerobic respiration to produce the energy it needs. The
buildup of lactic acid produces the associated pain.

Congestive Heart Failure Congestive heart failure occurs if one of the ventricles
is not working as efficiently as the other. As you can see in Figure 10.32a, if the right
ventricle’s output exceeds the left ventricular output, more blood is going to the lungs
than can return to the left side of the heart. Blood pressure then builds in the lungs,
forcing more fluid out into the pulmonary tissue (pulmonary edema), which interferes
with gas exchange in the lungs. If the left ventricle’s output exceeds the output of the
right ventricle, the pressure builds out in the systemic circuit and systemic edema
results. This can be seen as swelling of the hands, fingers, and feet but also leads to
enlargement of the liver and kidney damage. See Figure 10.32b.
To complete your study of heart and vessel disorders, you will now focus on heart
defects that are present at birth.

Spot Check Discuss how stroke volume, including preload, contractility, and
afterload, may be affected in a patient with heart failure.

Congenital Heart Defects

As you read in Chapter 1, congenital defects are those present at birth. The heart is an
organ that has a unique physiology during gestation, which changes once the baby is
born. Earlier in this chapter, you read about the anatomy and physiology of the fetal
heart and the transition of the fetal heart to that of a newborn. There are times when
that transition is not complete, resulting in congenital heart defects such as patent
ductus arteriosus (PDA). As you have already read, once the baby is born, the duc-
tus arteriosus should close, resulting in a completely separate aorta and pulmonary
artery. When the ductus arteriosus does not close after birth, a patent ductus arteriosus

414 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 FIGURE 10.32 Congestive
heart failure. The relative
amount of blood ejected from
each side of the heart is shown
1 with blue arrows. (a) Left-sided
heart failure leads to pulmonary
1 edema. (b) Right-sided heart
More blood is ejected failure leads to systemic
from the right ventricle edema.
than the left ventricle.

2
Blood pressure builds 3
in capillaries within the
lungs.

3
High blood pressure
in the lungs forces
fluid out into
pulmonary tissues.

(a)

1
More blood is ejected
from the left ventricle
than the right ventricle.

2
Blood pressure builds
in capillaries out in
body tissues.

1
2

3
High blood pressure
in systemic capillaries
forces fluid out into
systemic tissues.
3
(b)

results. See Figure 10.33. Because the aorta remains open to the pulmonary artery,
deoxygenated blood and oxygenated blood mix. This can cause the heart to become
overworked and increase the pressure in the arteries in the lungs. The most common
symptom of a PDA is a heart murmur. Babies can also experience difficulty breathing

10.9 Disorders of the Heart and Vessels 415

FIGURE 10.33 Three
congenital heart defects: an
atrial septal defect, a patent
ductus arteriosus, and a Patent ductus
ventricular septal defect. arteriosus
Aorta

Pulmonary artery

Left ventricle
Atrial septal
defect

Right atrium
Ventricular
septal defect

Right ventricle

and feeding and poor growth. PDAs can be treated with medication or surgical proce-
dures to close the ductus arteriosus.
Other common congenital heart defects are covered here:
• Atrial septal defect (ASD) is a hole in the septum that separates the right and left
atria. See Figure 10.33. This allows oxygenated blood from the left atrium to mix
with deoxygenated blood from the right atrium.
• Ventricular septal defect (VSD) is a hole in the septum that separates the right
and left ventricles. See Figure 10.33. The oxygenated blood in the left ventricle
that should normally flow to the aorta and the rest of the body mixes with the
deoxygenated blood in the right ventricle.
• Valve defects include stenosis (narrowing of the valves), atresia (a valve that
lacks a hole for blood to travel through), and regurgitation (a valve does not close
tightly enough and allows blood to flow back through). Any valve defect will alter
the flow of blood through the heart.
• Tetralogy of Fallot (teh-TRAL-oh-jee of fah-LOW) is a combination of four
heart defects: pulmonary valve stenosis, VSD, overriding aorta, and right
ventricular hypertrophy. See Figure 10.34. Valve stenosis and VSD were cov-
ered in the previous two list items. An overriding aorta is a defect involving
the position of the aorta. In this case, the aorta is positioned between the right
and left ventricles, allowing the deoxygenated blood from the right ventricle to
flow to the aorta instead of the pulmonary artery. Right ventricular hypertrophy
is the enlargement of the ventricle, which results from the ventricle working
harder than normal.
Table 10.2 summarizes all of the diseases and disorders described throughout the
chapter.

416 CHAPTER 10 The Cardiovascular System—Heart and Vessels

 Displacement of
aorta over ventricular
septal defect

Ventricular septal
defect—opening
Narrowing of the between the left and
pulmonary valve right ventricles

Thickening of wall
of right ventricle

FIGURE 10.34 Tetralogy of Fallot: four abnormalities that result in insufficiently oxygenated
blood pumped to the body.

Spot Check Describe the relationship between atherosclerosis, CAD,

myocardial infarction, and angina pectoris.

TABLE 10.2 Summary of Diseases and Disorders of the Cardiovascular System

Type of Disease/Disorder Disease/Disorder Description
Valve disorders Murmur An abnormal heart sound.
Prolapse A valve in which the leaflet “billows” or bends in a way that
prevents it from closing properly.
Stenosis A narrowing of the valve, causing incomplete closure.
Heart rate and rhythm Arrhythmia An abnormal heart rhythm.
disorders
Atrial fibrillation A condition in which faulty electrical signals cause the atria
to beat very rapidly and in an irregular pattern.
Bradycardia A persistent resting adult heart rate that is less than
60 beats/min.
Tachycardia A persistent resting adult heart rate that is greater than
100 beats/min.
Blood pressure disorders Hypertension The condition that results when resting pressures are greater
than 140/90 mmHg.
Hypotension Chronic low pressure, below 90/60 mmHg.

(continued)

10.9 Disorders of the Heart and Vessels 417

 TABLE 10.2Summary of Diseases and Disorders of the Cardiovascular System
(continued)
Type of Disease/Disorder Disease/Disorder Description
Prehypertension The condition diagnosed when the resting systolic pressure is
120 to 139 mmHg and/or diastolic pressure is 80 to 89 mmHg.
Shock A life-threatening condition characterized by the body’s organ
systems, especially the brain, not getting enough blood flow
to sustain normal function. There are different categories of
shock: cardiogenic shock, hypovolemic shock, septic shock,
and neurogenic shock.
Cardiac vessel disorders Aneurysm A weakness in arterial vessel walls that can balloon out and
possibly rupture.
Arteriosclerosis Calcification of the atheroma, or fatty deposit, within the blood
vessel.
Atherosclerosis A condition that results in the buildup of fatty deposits within
arterial walls, which causes the walls to roughen and project to
the lumen (open space) within the vessel.
Coronary artery Obstruction of the coronary arteries that supply blood to the
disease (CAD) heart, usually caused by arteriosclerosis or atherosclerosis.
Thrombophlebitis Inflammation of a vein, caused by thrombosis.
Varicose veins Veins in which dysfunctional valves cause the backflow and
pooling of blood, resulting in enlarged veins.
Myocardial disorders Angina pectoris A heaviness or pain in the chest caused by a temporary or
reversible myocardial ischemia.
Congestive heart A condition in which one of the ventricles is not working as
failure efficiently as the other.
Myocardial The death of myocardial tissue due to ischemia.
infarction (MI)
Inflammatory cardiac Endocarditis Inflammation of the endocardium.
disorders
Myocarditis Inflammation of the myocardium.
Pericarditis Inflammation of the pericardium.
Congenital heart defects Atrial septal defect A hole in the septum that separates the right and left atria.
(ASD)
Congenital valve Valve defects including stenosis, or narrow valves; atresia,
disorders in which a valve lacks a hole for blood to travel through; and
regurgitation, in which the valve does not close tightly enough
and allows blood to flow back through the valve.
Patent ductus The failure of the ductus arteriosus to close after birth.
arteriosus (PDA)
Tetralogy of Fallot A combination of four congenital heart defects: pulmonary
valve stenosis, VSD, overriding aorta, and right ventricular
hypertrophy.
Ventricular septal A hole in the septum that separates the right and left ventricles.
defect (VSD)
Other cardiovascular Cardiac tamponade A buildup of excessive fluid within the pericardium.
disorders
Rheumatic heart Heart disease caused by rheumatic fever, which results in
disease carditis and valve stenosis.

418 CHAPTER 10 The Cardiovascular System—Heart and Vessels

Putting the Pieces Together

The Cardiovascular System

Integumentary system Lymphatic system
Helps radiate heat of the blood for Sends white blood cells to fight
temperature regulation. pathogens in the cardiovascular
system.
Delivers fluids for sweat
production; provides nutrients and Provides fluid for lymph.
removes wastes.

Respiratory system
Skeletal system
Provides O2 for cardiovascular
Red bone marrow produces blood tissues and removes CO2;
cells and platelets. regulates blood pH.

Provides nutrients and removes Blood transports O2 and CO2.

wastes.

Digestive system
Muscular system
Provides nutrients to cardiovascular
Skeletal muscle pump moves blood
tissues and to the red bone marrow
through veins so that it can return to
for hemopoiesis.
the heart.

Blood transports absorbed

Provides nutrients and removes
nutrients.
wastes.

Nervous system Excretory/urinary system

Kidneys dispose of wastes in the
Innervates smooth muscle of blood
blood and regulate blood volume,
vessels for vasoconstriction and
composition, pressure, and pH.
vasodilation to regulate blood
pressure and flow; medulla
Blood pressure provides the force
oblongata regulates heart rate.
for filtration in the kidney.

Provides nutrients and removes

wastes.
Reproductive system
Testosterone promotes
Endocrine system erythropoiesis.
Hormones regulate blood
volume and pressure. Blood transports reproductive
hormones; vasodilation enables
Blood transports hormones to erection.
their target tissues; provides
nutrients and removes wastes.

FIGURE 10.35 Putting the Pieces Together—The Cardiovascular System: connections between the cardiovascular system
and the body’s other systems.

10.9 Disorders of the Heart and Vessels 419

Summary
10.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the cardiovascular system.

10.2 Overview
∙∙ The heart serves as a pump to circulate blood through a system of vessels.

10.3 Heart Anatomy

∙∙ The heart is located in the mediastinum and is tilted, with two-thirds resting left of the midsagittal plane.
∙∙ The heart is the size of an adult fist and weighs approximately 300 g, or 10 oz.

Pericardium
∙∙ The heart is surrounded by the pericardium.

Heart Wall
∙∙ The heart is composed of three walls: the epicardium, the myocardium, and the endocardium.

Chambers and Valves

∙∙ The heart has four chambers: two atria, which receive blood; and two ventricles, which pump blood out of the heart.
∙∙ There are two AV valves located between the atria and the ventricles, and there are two semilunar valves between the
ventricles and the arteries taking blood away from the heart.

Cardiac Muscle Tissue

∙∙ Cardiac muscle is striated, is branching, has one nucleus per cell, and has intercalated disks.
∙∙ Cardiac muscle tissue is specially adapted to stay aerobic.

10.4 Heart Physiology

Blood Flow through the Heart
∙∙ Blood flows from the venae cavae to the right atrium, through the tricuspid valve to the right ventricle, through the
pulmonary valve to the pulmonary trunk, to pulmonary arteries, and to the lungs. Blood then returns from the lungs
through the pulmonary veins, to the left atrium through the bicuspid valve, to the left ventricle through the aortic valve,
to the rest of the body.

Cardiac Conduction System

∙∙ Cardiac muscle is autorhythmic.
∙∙ Electrical impulses start at the SA node and proceed to the right atria and to the AV node, which then send the signals to
the AV bundle and bundle branches to the Purkinje fibers.

Cardiac Cycle
∙∙ A cardiac cycle is one complete contraction and relaxation of the heart.
∙∙ Systole is contraction, and diastole is relaxation.
∙∙ The cardiac cycle includes atrial systole, atrial diastole, ventricular systole, ventricular diastole, and a rest.
∙∙ The SA node normally sets the cardiac rhythm.

Electrocardiogram
∙∙ An electrocardiogram shows the electrical activity of the heart during a cardiac cycle.
∙∙ It includes P, Q, R, S, and T waves.

Cardiac Output
∙∙ Cardiac output is the amount of blood ejected by each ventricle of the heart each minute.
∙∙ Cardiac output is dependent on heart rate and stroke volume.
∙∙ CO = HR × SV.
∙∙ Stroke volume is dependent on preload, contractility, and afterload.

420
Heart Regulation
∙∙ The heart can be regulated by the autonomic nervous system through the cardiac accelerator and inhibitory centers in the
medulla oblongata, which get information from proprioceptors, baroreceptors, and chemoreceptors.
∙∙ The heart can be regulated by chemicals.

10.5 Vessel Anatomy

Arteries
∙∙ The three types of blood vessels are arteries, capillaries, and veins.
∙∙ Arteries and veins have three layers (tunics) to their walls, while capillary walls have only one layer.
∙∙ Arteries carry blood away from the heart.

Capillaries
∙∙ Capillaries are the site of exchange of materials between the blood and tissues.

Veins
∙∙ Veins return blood back to the heart.

10.6 Vessel Physiology

Circulatory Routes
∙∙ The coronary route supplies blood to the heart.
∙∙ The typical systemic route includes one capillary bed.
∙∙ Alternative routes vary in the number of capillary beds or involve the merging of vessels.

Venous Return
∙∙ Blood is returned to the heart through veins by five mechanisms: a pressure gradient, gravity, the thoracic pump, cardiac
suction, and the skeletal muscle pump.

Blood Pressure, Resistance, and Flow

∙∙ Blood flow is the amount of blood flowing to an area in a given amount of time.
∙∙ Blood pressure is the force of blood against the vessel walls.
∙∙ Blood pressure is dependent on cardiac output, blood volume, and resistance.
∙∙ Blood pressure is measured as systolic pressure/diastolic pressure.
∙∙ Pulse pressure = systolic pressure – diastolic pressure.
∙∙ MAP = diastolic pressure + 1/3 pulse pressure.

Regulation of Blood Pressure and Flow

∙∙ Blood pressure and flow can be regulated locally, hormonally, and neurally.

Effects of Exercise on Cardiac Output

∙∙ Exercise increases cardiac output by raising the heart rate and the stroke volume.

10.7 Effects of Aging on the Cardiovascular System

∙∙ If blood pressure remains normal throughout life, age-related changes to the cardiovascular system may be minimal.
∙∙ If an individual is hypertensive, age-related changes may include an increase in vascular resistance, decreased stroke
volume, and thicker, less elastic vessels that are prone to atherosclerosis.
∙∙ Lifestyle choices like exercising, dieting, and not smoking can make a difference.

10.8 Diagnostic Tests for Heart and Vessel Disorders

∙∙ Common diagnostic tests for cardiovascular system disorders include echocardiography, electrocardiography, heart CT
scan, nuclear heart scan, Holter monitor, stress test, cardiac catheterization, CT angiography, ultrasound, and venography.

10.9 Disorders of the Heart and Vessels

Valve Disorders
∙∙ A murmur is an abnormal heart sound.
∙∙ A prolapsed valve is a valve in which the leaflet “billows” or bends in a way that prevents it from closing properly.

421
Vessel Disorders
∙∙ Atherosclerosis is a condition that results in the buildup of fatty deposits within arterial walls.
∙∙ Thrombophlebitis is inflammation of a vein, caused by thrombosis.
∙∙ Varicose veins are veins in which dysfunctional valves cause the backflow and pooling of blood.

Myocardial Disorders
∙∙ Myocardial infarction is the death of myocardial tissue due to ischemia.
∙∙ Angina pectoris is a heaviness or pain in the chest caused by a temporary or reversible myocardial ischemia.
∙∙ Congestive heart failure is a condition in which one of the ventricles is not working as efficiently as the other.

Congenital Heart Defects

∙∙ Atrial septal defect is a hole in the septum that separates the right and left atria.
∙∙ Ventricular septal defect is a hole in the septum that separates the right and left ventricles.
∙∙ Congenital valve defects include stenosis, atresia, and regurgitation.
∙∙ Tetralogy of Fallot is a combination of four congenital heart defects: pulmonary valve stenosis, VSD, overriding aorta,
and right ventricular hypertrophy.

Key Words for Review

The following terms are defined in the glossary.

afterload cardiac output preload

anastomoses chronotropic factor pulse pressure
angiogenesis diastole stroke volume
arrhythmia intercalated disks systole
atherosclerosis ischemia tunics
baroreceptors mean arterial pressure (MAP) venous return
cardiac cycle portal route

422
 11 The Lymphatic
System
Deborah is in her 60s, so she has had
plenty of experience with vaccinations.
As an infant, she had polio before the
polio vaccine became available. When
she was 5, she received a smallpox vac-
cination, which left a scar on her arm that
remains to this day. She also had chicken
pox as a child and, as a result, developed
some immunity to the virus. However,
Deborah is still susceptible to developing
shingles later in her life from the same
virus that caused her chicken pox. It is
now recommended that people over 60
years old receive a shingles vaccination
to help prevent the disease. Deborah’s
grandchildren receive multiple vaccina-
tions, even one for chicken pox.
All the vaccinations you have received
up to this point in your life have activated
cells of your lymphatic system to better
prepare you to defend yourself against
specific pathogens. Along with providing
immunity, your lymphatic system does
much more. See Figure 11.1.
©Terry Vine/Blend Images/Getty Images

Module 10: Lymphatic System

423
 11.1 Word Roots and Combining Forms

Learning Outcome
1. Use medical terminology related to the lymphatic system.

immun/o: protection lymphaden/o: lymph node thym/o: thymus gland

lymph/o: lymph splen/o: spleen

Lymphatic System
11.2 Overview
Major Organs and Structures: The human body contains two systems of circulating fluids—the
thymus gland, spleen, tonsils cardiovascular system and the lymphatic system. In the cardio-
Accessory Structures: vascular system chapters, you studied the circulation of blood.
thoracic duct, right lymphatic duct,
lymph nodes, lymph vessels, In this chapter, you will explore the lymphatic system, which
MALT, Peyer’s patches involves the circulation of lymph, a fluid derived from blood.
Functions: Your exploration of the lymphatic system will begin by
fluid balance, immunity, lipid
absorption, defense against examining the anatomy—the lymph, vessels, and lymphoid
disease tissues—of lymph circulation. You will learn about the body’s
three lines of defense against pathogens and see how specific
immunity differs from nonspecific defenses. Then, as you did
in all of the system chapters, you will explore the effects of
aging and disorders of the system. Your first topic is the fluid
of the system—lymph.

11.3 Anatomy of the Lymphatic System

Lymph and Lymph Vessels

Learning Outcomes
2. Explain the origin and composition of lymph.
3. Describe lymph vessels.
4. Explain the route of lymph from the blood and back again.

FIGURE 11.1 The lymphatic Lymph is a fluid derived from plasma, but it has fewer dissolved proteins. This fluid
system.
from plasma leaves the capillaries to become interstitial fluid (extracellular fluid
out in the tissues), which washes over the tissues delivering nutrients to the cells and
washing away wastes, cellular debris, viruses, bacteria, and loose (possibly cancerous)
cells. Lymph reaches cells that are not immediately adjacent to blood capillaries, so it
helps these cells meet their nutrient and waste-removal needs.
Unlike the circulation of blood through a closed system of blood vessels, this fluid
leaves the system of blood vessels through the capillaries due to blood pressure and
must then return to the cardiovascular system through a network of open lymph cap-
illaries and vessels that drain the tissues of what is now called lymph. As you can
see in Figure 11.2, gaps between the endothelial cells of the lymph capillaries allow
lymph, bacteria, and even loose cells to enter the vessel. Valves inside the lymph ves-
sels (shown in Figure 11.3) direct the flow of lymph to larger and larger lymph vessels.
These vessels eventually drain into one of two collecting ducts—the thoracic duct and
the right lymphatic duct.
The thoracic and right lymphatic ducts deliver lymph to the subclavian veins,
where it rejoins the circulating blood. As you can see in Figure 11.4, the right lym-
phatic duct drains lymph from the right side of the head, the right arm, and the right
side of the thorax to the right subclavian vein. The thoracic duct delivers lymph from
the rest of the body to the left subclavian vein.

424 CHAPTER 11 The Lymphatic System

 FIGURE 11.2 Lymphatic
capillaries: (a) interspersed with
a blood capillary bed, (b) lymph
entering a lymph capillary.

Venule

Lymphatic
capillary Lymphatic
vessel
Tissue cells

Capillary bed

Arteriole
Lymph

(a)
Opening

Interstitial
fluid

Endothelium
of lymphatic
capillary

Valve

(b)

Lymph

Valve closed
(backflow of lymph
is prevented)

(a)

Fluid entering
lymphatic capillary

Direction of Valves open

FIGURE 11.3 Valves lymph flow in (lymph flows
in lymphatic vessels: capillary forward)
(a) micrograph, (b) diagram
showing one-way direction
of flow.
(a) ©McGraw-Hill Education/Dennis (b)
Strete

11.3 Anatomy of the Lymphatic System 425

Right internal jugular vein
Left internal jugular vein

Right lymphatic duct

Thoracic duct

Left subclavian vein

Right subclavian vein

Superior vena cava Thoracic lymph nodes

Thoracic duct

Diaphragm

(a)

Drained by Drained by
right lymphatic thoracic duct
duct

(b)

FIGURE 11.4 Lymph drainage to the subclavian veins: (a) in the thoracic region, (b) of the whole body.

426 CHAPTER 11 The Lymphatic System

 The pressure from the buildup of interstitial fluid in the tissues causes this fluid to
enter lymph capillaries as lymph. Once lymph is in the capillaries, the skeletal muscle
pump moves lymph through the lymph vessels to the collecting ducts and back into
blood circulation at the subclavian veins. This is the same skeletal muscle pump that is
partially responsible for venous return in the cardiovascular system.
In summary, the cardiovascular and lymphatic systems are interconnected by this
shared fluid—called plasma while in blood, interstitial fluid when it leaves the capil-
laries with fewer proteins to go to the tissues, and lymph when it is drained into lymph
capillaries. It must be returned to the bloodstream to make up for the lost volume at the
blood capillaries. See Figure 11.5.

Spot Check Where specifically will lymph in the tissues of the left leg reenter
the bloodstream?

Spot Check Which collecting duct delivers the lymph from the left leg to that
___location?

Open lymphatic
capillaries

Lymph flow
Pulmonary
capillary
network
Lymph
nodes

Lymphatic
vessels

Blood flow
Subclavian
veins

Lymph flow Systemic

capillary
network

Open lymphatic
capillaries

FIGURE 11.5 Fluid exchange between the cardiovascular and lymphatic systems.
Arrows within the blood vessels show the path of blood. Arrows outside the blood vessels
show the path of lymph leaving the blood capillaries and rejoining the circulatory system at
the subclavian veins.

11.3 Anatomy of the Lymphatic System 427

 Disease P int
The lymphatic drainage process is an important part of a healthy,
functioning lymphatic system. However, certain conditions may
block drainage. For example, elephantiasis is a tropical disease
caused by a roundworm that blocks lymphatic drainage. The
roundworm gets into the system through a mosquito bite and
infects a lymph node (to be discussed shortly), which blocks the
flow of lymph, causing edema in the area before the blockage.
Typical areas include the legs, arms, breasts, or scrotum.

©R. Umesh Chandran, TDR, WHO/Science Source

You now understand how a common fluid links the cardiovascular and lymphatic
systems and you are aware of the blood vessels they share for this fluid’s delivery to
the tissues. Next, you will examine the lymphatic system’s cells.

Cells of the Lymphatic System

Learning Outcome
5. Describe cells of the lymphatic system and list their functions.

The primary cells of this system are leukocytes—particularly, lymphocytes. As you

may recall from the cardiovascular system chapter on blood, all of the formed elements
are produced in the red bone marrow. The cells of this system fall into the following
five categories:
• Natural killer cells (NK cells). These large lymphocytes are important in nonspecific
defense, which is covered in detail later in this chapter. NK cells destroy bacteria, fight
against transplanted tissues, attack cells infected by viruses, and destroy cancer cells.
• T lymphocytes (T cells). These lymphocytes migrate from the red bone marrow
to the thymus gland, where they mature. Several classes of T cells, based on their
function, include the following:
1. Thelper cells are important for nonspecific defense and specific immunity by rec-
ognizing foreign pathogens and activating the cells to fight them.
2. Tcytotoxic cells directly kill cells infected by viruses and cancer cells in specific
immunity.
3. Tmemory cells are also used in specific immunity. They remember pathogens that have
been introduced to the body so that repeat exposure can be fought more swiftly.
4. Tregulatory cells suppress an immune response by inhibiting multiplication and
chemical secretions from other T cells. Tregulatory cells are important in limiting
and preventing autoimmune responses.
• B lymphocytes (B cells). These lymphocytes migrate from the red bone marrow to
lymphoid tissues, such as lymph nodes, tonsils, and the spleen (covered in the next
section). B cells also function as antigen-presenting cells (APCs) by constantly
sampling material from their environment, processing it, and then displaying it for
other cells to see. You will learn how this works when you review the physiology
of this system. There are two basic types of B cells:
1. Bplasma cells are important in specific immunity because they produce antibodies,
which are dissolved proteins in plasma that seek out specific foreign antigens for
their destruction.

428 CHAPTER 11 The Lymphatic System

 2. Bmemory cells, like Tmemory cells, remember pathogens that have been introduced
to the body so that repeat exposure can be fought more swiftly. You will learn
more about this when we discuss humoral immunity later in this chapter.
• Macrophages. These cells are not lymphocytes. They are monocytes that were
produced in the red bone marrow and have migrated to the tissues to become mac-
rophages. Their purpose, in the nonspecific defense of the body, is to phagocytize
bacteria, debris, and dead neutrophils. Like B cells, macrophages are APCs.
• Dendritic cells. These are immune system cells of the epidermis that stand guard
to alert the body of pathogens entering through the skin. They also function as
APCs. You were introduced to these cells in the integumentary system chapter.
Lymphoid tissues were mentioned as the ___location for several of the preceding cells.
These tissues and organs are discussed in the next section.

Spot Check What important functions of the immune system might be affected
by a disease that decreases a person’s number of viable T cells?

Lymphoid Tissues and Organs

Learning Outcome
6. Identify lymphoid tissues and organs and explain their functions.

Lymphoid tissues and organs may be as small as a scattering of lymphocytes in

mucous membranes or may be full-size organs, such as the spleen. Many of the tissues
are shown in Figure 11.6.

Spot Check Red bone marrow is shown in Figure 11.6. Why is red bone marrow
relevant to this system?

Mucosa-Associated Lymphatic Tissue Mucosa-associated lymphatic tissue

(MALT) is a scattering of lymphocytes located throughout the mucous membranes
lining tracts to the outside environment, such as the tracts for the digestive, respiratory,
urinary, and reproductive systems. The purpose of MALT is to stand guard against and
fight any pathogens trying to enter the body.

Peyer’s Patches These patches of lymphatic tissue are located at the distal end of
the small intestine, just before the opening to the large intestine. Peyer’s patches are
an example of more densely packed pockets of lymphocytes called nodules. These
particular nodules fight any bacteria moving into the small intestine from the colon,
where they naturally reside.

Lymph Nodes These lymphatic structures act as filters along lymph vessels.
Lymph nodes remove anything that may be potentially harmful in lymph, much like a
water-purification filter may remove impurities in the drinking water arriving at your
kitchen faucet. Each lymph node has many nodules packed with lymphocytes and
macrophages. As you can see in Figure 11.7, several lymph vessels direct lymph flow
into the lymph node. There, fibers trap debris, cells, and bacteria picked up by the
lymph in the tissues. Macrophages phagocytize the debris, while lymphocytes mount
an attack on the pathogens. If an infection is present, germinal centers (sites for clon-
ing lymphocytes) in the lymph nodes produce more B lymphocytes. Meanwhile, the
lymph circulates through the lymph node on its way to larger lymph vessels.
Lymph nodes are located in specific areas, as outlined in the following list, to filter
lymph as it is drained from different regions. See Figure 11.6.
• Cervical lymph nodes are located in groups in the neck. They filter lymph from the
head and neck.

11.3 Anatomy of the Lymphatic System 429

FIGURE 11.6 Lymphoid
tissues and organs.

Palatine tonsil

Cervical lymph nodes

Left subclavian
vein
Right lymphatic duct

Axillary lymph
Thymus
node

Thoracic duct
Spleen

Abdominal,
intestinal,
and mesenteric
lymph nodes

Red bone marrow Inguinal lymph

nodes

Popliteal lymph nodes

Lymphatic vessels

430 CHAPTER 11 The Lymphatic System

Afferent
lymphatic Efferent
vessel lymphatic
vessel

Lymph
flow
Lymph Nodule
flow

Germinal
center Germinal Capsule
(B cells) center

(a) (b)

Lymphatic
vessels

FIGURE 11.7 Lymph

node: (a) lymph node
showing direction of lymph Lymph node
flow, (b) micrograph of a
lymph node, (c) dissection Blood vessels
of lymph node and lymph
vessels. Muscle
(b) ©McGraw-Hill Education/Al
Telser; (c) ©Dr. Kent M. Van De
Graaff (c)

• Axillary lymph nodes are located in the axillary region and the lateral margin of
the breast. They filter lymph from the breasts and arms.
• Thoracic lymph nodes are located in the mediastinum surrounding the trachea and
bronchi. They filter lymph from organs in the thoracic cavity.
• Abdominal lymph nodes are located in the posterior wall of the abdominopelvic
cavity. They filter lymph from the urinary and reproductive systems.
• Pelvic lymph nodes are deep in the pelvic region and surround the iliac arteries and
veins. They also filter lymph from the urinary and reproductive systems.

11.3 Anatomy of the Lymphatic System 431

FIGURE 11.8 Inguinal lymph
nodes of a cadaver.
©McGraw-Hill Education/Rebecca
Gray
Internal
abdominal
oblique
muscle

Femoral
nerve

Superficial
inguinal
lymph nodes

Femoral
Femoral artery vein

Great saphenous
vein Deep
femoral
Sartorius muscle artery

• Intestinal and mesenteric lymph nodes are located in the mesenteries and surround the
mesenteric arteries and veins. They filter lymph from the digestive organs. Lymph from
the digestive system appears milky because it carries the products of lipid digestion.
• Popliteal lymph nodes are located in the popliteal region (behind the knee). They
filter lymph from the leg.
• Inguinal lymph nodes are superficial in the groin. They filter lymph from the lower
limbs. See Figure 11.8.
When a pathogen is under attack by the lymph node’s lymphocytes, the lymph node
may become swollen and painful to the touch. This condition is called lymphadenitis
(lim-FAD-eh-neye-tis). Understanding lymph drainage is helpful in locating the primary
site of the cause of the attack.

Clinical P int
For example, look at Figure 11.9, which shows the lymph drainage for the right breast.
Swollen, painful lymph nodes in the right axillary region may indicate the presence of
cancer cells that have metastasized from the right breast and have been trapped in
the right axillary lymph nodes. Likewise, if breast cancer in the right breast has been
found through other means (self-exam, mammography, or needle biopsy), a biopsy of
the right axillary lymph nodes may give a good indication of whether the tumor has
metastasized. If it has, the lymph should have carried any loose, metastatic cancer cells
to the right axillary lymph nodes.

Spot Check Which lymph nodes may be tender to the touch if Megan has a
strep throat infection?

432 CHAPTER 11 The Lymphatic System

Tonsils Like lymph nodes, tonsils are lymphoid tissue Right internal jugular vein
with high concentrations of lymphocytes. As you can Right lymphatic duct
see in Figure 11.10, three types of tonsils—one pharyn-
geal, two palatine, and numerous lingual tonsils—ring the Right
subclavian
pharynx (throat) to guard against pathogens entering vein
the body through the nose or mouth. Each tonsil has pits
(crypts) to give the lymph nodules (small, localized col-
lections of lymphoid tissue) more exposure to whatever may
be passing by. The locations of the tonsils are as follows:
• The pharyngeal tonsil (adenoids) is located on the Axillary
lymph nodes
roof of the nasopharynx (section of throat at the back
of the nasal cavity).
Lymphatics
• The palatine tonsils, located laterally in the orophar- of breast
ynx (section of the throat at the back of the mouth)
are commonly recognized as the tonsils. These tonsils
often swell and become inflamed during a throat infec-
tion and can be seen by looking in the mouth.
• The lingual tonsils have many nodules filled with lym-
FIGURE 11.9 Lymph drainage of the right breast.
phocytes at the root of the tongue.

Pharyngeal tonsil

Soft palate

Palatine tonsil

Lingual tonsil

(a)

Tonsillar crypts

Lymphatic
nodules

Pharyngeal
epithelium
(b)

FIGURE 11.10 Tonsils: (a) ___location of tonsils, (b) histology of a pharyngeal tonsil showing crypts.
(b) ©Biophoto Associates/Science Source

11.3 Anatomy of the Lymphatic System 433

 Thymus Gland Another
important lymphoid tissue
is the thymus gland, which
is located in the superior Thymus in fetus
mediastinum between the
sternum and the aortic
arch. It is well developed
at birth and continues to
develop during childhood,
but it starts to shrink
around the age of 14. See (a)
Figure 11.11 for a relative
size comparison between
a fetal thymus and that of
an adult.
T cells migrate from
Thymus in
the red bone marrow to adult
the thymus gland, where
they mature. In the matu-
ration process, the thymus
introduces self-antigens to
the developing T cells.
If the T cell reacts to the
self-antigen, the T cell is
destroyed. Only those T
cells that do not react to
self-antigens are stimu-
lated to further develop by
chemicals secreted by the
thymus. These T cells are (b)
an important part of the
immune system because FIGURE 11.11 Thymus gland: (a) of a fetus, (b) of an
they react only to foreign adult.
(not self-) antigens.

Spleen You have already studied the spleen in relation to its role in the life cycle of
a red blood cell and as a reservoir for blood, but it also has functions in the lymphatic
system. The spleen is located in the upper left quadrant (ULQ), posterior and lateral
to the stomach. See Figure 11.12. Tissues in the spleen consist of two types—red
pulp and white pulp. Red pulp serves as a reservoir for RBCs and destroys old, worn-
out red blood cells. White pulp is a reservoir for lymphocytes and macrophages, and
it functions similarly to lymph nodes as a site of battle between lymphatic cells and
pathogens. The spleen also maintains homeostasis by regulating blood volume by
transferring excess fluid in the blood to the lymphatic system as lymph.

Clinical P int
Trauma to the spleen can be dangerous because it is such a highly vascular organ. In
cases of trauma, surgical removal of the spleen is often easier than trying to deal with
a repair and possible fatal hemorrhaging. It is possible to live a normal life without a
spleen. Without a spleen, there is no reservoir for blood. However, the other functions
of the spleen can be accomplished by the liver (breakdown of erythrocytes) and other
lymphoid tissues (storage of lymphocytes and site to fight pathogens).

434 CHAPTER 11 The Lymphatic System

 Diaphragm

Spleen

Splenic artery

Splenic vein

Pancreas

Kidney

Inferior vena
cava

Aorta

(a)

Spleen
Capsule

Splenic
artery
White
Splenic pulp
vein

Hilum

Red
pulp

(b) (c)

FIGURE 11.12 The spleen: (a) spleen in a cadaver with the stomach removed, (b) medial surface of the spleen, (c) white and
red pulp.
(a) ©McGraw-Hill Education/Dennis Strete; (c) ©McGraw-Hill Education/Al Telser

11.4 Physiology of the Lymphatic System

You are already familiar with the circulation of lymph. It is forced out of capillaries
due to blood pressure and washes over tissues to deliver nutrients and remove wastes.
The pressure of the lymph in the tissues forces lymph back into lymph capillaries so
that the lymph vessels can return it to the bloodstream at the subclavian veins. But how
does this system fight pathogens? To understand the answer to this question, you need
to study the physiology of defense.

Three Lines of Defense

Learning Outcome
7. Summarize three lines of defense against pathogens.

11.4 Physiology of the Lymphatic System 435

 The three basic lines of defense against pathogens are the following:
1. External barriers
2. Inflammation, antimicrobial proteins, fever, and other active attacks
3. Specific immunity

Nonspecific Resistance versus Specific Immunity

Learning Outcome
8. Contrast nonspecific resistance and specific immunity.

The first two lines of defense are considered to be nonspecific resistance, while the
third is specific immunity. The lines of defense are not mutually exclusive, as more
than one line of defense is likely to be at work at the same time to eliminate the same
pathogen. What is the difference between nonspecific resistance and specific immunity?
• Nonspecific defenses are widespread, meaning they work to fight many pathogens
without prior exposure. These defenses work to fend off any pathogen in the same
way every time the pathogen comes along in the body.
• Specific immunity is just that—specific. It requires a prior exposure to a pathogen
so that the system can recognize the pathogen, react to the pathogen to fight it off,
and then remember the specific pathogen so that it can be fought off faster and
stronger if it ever occurs in the body again.
Now that you are familiar with the differences of the two types of defenses, you are
ready to explore the three lines of defense, starting with the two lines of nonspecific
defenses.

Nonspecific Defenses

Learning Outcome
9. Describe the body’s nonspecific defenses.

The two lines of nonspecific defense are

1. external barriers; and
2. inflammation, antimicrobial proteins, fever, and other active attacks.
Most of these have been mentioned in chapters you have already covered, but it
will be helpful to refresh your memory in regard to how they relate to this system.

External Barriers This first line of defense protects body tissues from pathogens in
the outside environment.

Skin Skin acts as an external barrier to pathogens for several reasons:

• Keratin is a tough protein that bacteria cannot easily break through.
• Skin is dry, with few nutrients for bacteria and other pathogens.
• The skin has an acid mantle, which makes it inhospitable for bacteria and other
pathogens.

Mucous membranes Mucous membranes (lining all the tracts through the body for
the respiratory, digestive, urinary, and reproductive systems) also serve as an external
barrier for the following reasons:

436 CHAPTER 11 The Lymphatic System

• Mucus traps microbes.
• Mucus, tears, and saliva contain lyso- Splinter
zymes to destroy pathogens.
• Deep to the mucous membranes is Bacteria Epithelium
loose areolar connective tissue with
fibers to hamper the progress of
pathogens.
We turn now to the body’s second line
of nonspecific defense.

Inflammation, Antimicrobial Proteins,

Fever, and Other Active Attacks Like 5
From damaged
external barriers, each of these nonspe- tissue
Phagocytosis
cific defenses works against a variety of 1
pathogens in the same way regardless of Inflammatory
chemicals 4
the number of exposures to the patho-
Chemotaxis
gen. You will investigate each of them
individually.
2
3
Inflammation The functions of inflam- Margination
Diapedesis
mation are threefold. See if you can pic-
ture how the steps in the inflammatory
process meet the following functions of
inflammation:
• To limit the spread of pathogens
• To remove debris and damaged tissue
Neutrophils Increased Dilated blood
• To initiate tissue repair permeability vessel

As you will recall from “Chapter 1,

FIGURE 11.13 The inflammatory response, illustrating margination,
The Basics,” the signs of inflammation diapedesis, chemotaxis, and phagocytosis.
are redness, heat, pain, and swelling.
(Follow along with Figure 11.13 as you
read more about inflammation.) The steps in the inflammatory process are as follows
(in order of occurrence):
1. Chemicals (vasodilators) are released by damaged tissues and basophils. The
chemicals diffuse across the surrounding tissues and affect any blood vessels in
the area. The dilation of these vessels causes increased blood flow to the area and
increased vessel permeability. The increased blood flow accounts for the signs of
redness and heat (blood from the core transports heat), while the increased perme-
ability accounts for the swelling and pain (more fluid to tissues causes the swell-
ing, which puts pressure on nerve endings, causing the pain). The heat increases
the local metabolic rate to increase cell division and healing. The increased blood
flow dilutes possible toxins produced by pathogens, provides cells with more oxy-
gen and nutrients, and removes more wastes. The increased permeability facilitates
the movement of leukocytes to the tissues.
2. WBCs stick to the walls of the dilated vessels in the inflamed area (margination).
See Figure 11.13. Neutrophils will be the first on the scene.
3. WBCs crawl through the vessel walls (diapedesis).
4. WBCs move to where the concentration of chemicals from damaged tissues is the
greatest (chemotaxis). Since the chemicals move by diffusion, the greatest con-
centration will be at the source of the damage.

11.4 Physiology of the Lymphatic System 437

 5. WBCs phagocytize foreign material, debris, and pathogens along the way (phago-
cytosis). The accumulation of WBCs, debris, bacteria, and interstitial fluid is
called pus.

Spot Check How does inflammation help with tissue repair?

Spot Check How does inflammation help remove debris and damaged tissue?

Spot Check How does inflammation limit the spread of pathogens?

Inflammation works this way for all sorts of pathogens to limit their spread, to
remove debris and damaged tissue, and to initiate tissue repair. If another splinter (like
the one in Figure 11.13) damages tissue a week from Tuesday, the response will be the
same because this is a nonspecific line of defense.

Antimicrobial proteins There are two types of antimicrobial proteins that provide
the body with nonspecific resistance to pathogens. These antimicrobial proteins—
interferons and the 20 inactive proteins that make up the complement system—are
explained as follows:
• Interferons are chemicals released by virally infected cells. They do not help the
cell that produced them. Instead, interferons encourage surrounding healthy cells
to make antiviral proteins so that the virus will not invade them. Interferons also
activate macrophages and NK cells to fight cancer cells.
• The complement system includes 20 inactive proteins (always present in the
blood) that may be activated by the presence of a pathogen. Once activated, the
proteins initiate one of several different pathways to ensure pathogen destruc-
tion through increased inflammation, breaking apart of the pathogen (cytolysis),
or coating a pathogenic cell to make it easier for a macrophage to phagocytize it
(opsonization).

Fever Most people view a fever as a bad thing, but it is another method of non-
specific defense. A fever is initiated by the production of chemicals (pyrogens) from
activated macrophages. These pyrogens travel to the hypothalamus, which then raises
the set point for body temperature. The body responds by shivering to produce more
heat, while the blood vessels in the skin constrict to preserve the heat being gener-
ated. Once the new set point is reached (a stage called stadium), the liver and spleen
hoard zinc and iron, which are necessary for bacteria growth. This gives time for other
defenses to work to defeat the pathogen and increase cellular metabolism needed to
heal damaged tissue. Once the pathogen is defeated, the hypothalamus resets the tem-
perature to normal and the brain may initiate sweating to cool the body to homeostasis
(defervescence). See the graph of body temperature in Figure 11.14.

Other active attacks This line of defense refers to the functions of leukocytes other
than lymphocytes. You have already studied them in the cardiovascular system chapter
on blood. As a means of nonspecific resistance, these cells make their attacks with the
same speed and strength each time any pathogen enters the body. Here is how each of
these cell types works:
• Neutrophils fight bacteria.
• Basophils release histamine to promote inflammation.
• Eosinophils attack worm parasites.
• Monocytes become macrophages to phagocytize bacteria.

438 CHAPTER 11 The Lymphatic System

 Shivering

Temperature (degrees Celsius)

39 2 3

A B C
Normal body 1. Onset of fever 3. Infection ends
temperature 2. Stadium 4. Defervescence

38

37 1 4

Time (hours)
Sweating
Body temperature
Temperature set by
the hypothalamus

FIGURE 11.14 Graph of a fever. Normal body temperature approximates the temperature set by the hypothalamus.
(1) The onset of a fever begins when the hypothalamus raises the set point. (2) The body temperature then approximates
the new set point; this is called stadium. (3) Once the infection ends, the hypothalamus resets the body temperature to
normal. (4) The body temperature decreases in a process called defervescence.

Specific Immunity

Learning Outcome
10. Explain the role of an APC in specific immunity.

As mentioned earlier, specific immunity differs from nonspecific resistance because it

requires a prior exposure to a pathogen in order to work. During the first exposure, the
immune system recognizes the specific pathogen as being foreign, reacts to it, and then
remembers it. The process starts with an antigen-presenting cell. How does an APC work?
Figure 11.15 shows an APC in the process of presenting an antigen. In this case,
the APC is a macrophage, but the process is the same for B cells and other APCs.
Imagine that the APC is in an axillary lymph node. Its job is to sample antigens in the
surrounding environment by phagocytosis (1). It may sample a foreign antigen or a
self-antigen. Next, a lysosome fuses with the vesicle carrying the phagocytized anti-
gen (2). The antigens and the enzymes of the lysosome mix (3). The antigen is broken
down to fragments, or degraded (4). Most of the antigen residue is expelled from the
cell by exocytosis (5). Some of the antigen fragments (epitopes) are displayed on an
MHC protein on the surface of the APC (6).
An MHC protein is like a billboard posting what the APC has sampled. MHC stands
for major histocompatibility complex. Other cells in the body have MHC proteins too.
Unlike APC cells that sample their surrounding environment and post what they find,
these other body cells present what is inside themselves on their MHC protein. In that
case, the MHC protein is posting, “This is me.” Therefore, an MHC protein displays what
is self and what is foreign. Specific immunity hinges on being able to tell the difference.
If the MHC protein displays self-antigens, nothing happens. However, if the epitope in
the MHC is foreign, a specific immune response is initiated. In the next section, we
explain how that is accomplished in humoral immunity, one form of specific immunity.

11.4 Physiology of the Lymphatic System 439

 1
Phagocytosis of
antigen Antigen Vesicle Lysosome

2
Lysosome fuses with
the vesicle containing
the antigen

3
Enzymes from the Epitope
lysosome and the
antigen mix
1 MHC
6 protein
4 2
Enzymes break down
the antigen
3
4
5
Antigen residue is
exocytosed 5

6
Antigen fragment
(epitope) is displayed
on an MHC protein

FIGURE 11.15 Antigen-presenting cell in the process of antigen presentation.

Spot Check Explain the relationship between an APC and MHC proteins and
the role they play in specific immunity.

Humoral (Antibody-Mediated) Immunity

Learning Outcome
11. Explain the process of humoral immunity.

This form of specific immunity involves B cells making antibodies to attack a foreign
antigen. It begins when a B cell (APC) in lymphoid tissue displays an epitope from its
environment on an MHC protein. A Thelper cell passing by either does nothing because the
epitope is self or reacts to it by binding to the B cell because it recognizes the epitope as
foreign. (Remember: All T cells that react to self are destroyed in the thymus.) The Thelper
cell then communicates to the B cell by releasing a chemical (interleukin-2) that tells the
B cell that the epitope is foreign and that the B cell should clone itself. The steps up to
this point have been the recognize stage of specific immunity. See Figure 11.16.
Under the direction of the Thelper cell, the B cell (still in the lymphoid tissue) begins
to clone itself in the germinal centers in the lymphatic nodules. This clone develops
(differentiates) into two types of B cells—plasma B cells that start to produce specific
antibodies (to attack the specific antigen that was displayed previously) and memory
B cells (that do nothing now). The antibodies produced by the plasma B cells leave
the lymphoid tissue with the lymph and enter the blood at the subclavian veins. From
there, they travel throughout the body seeking out the specific antigen from the spe-
cific pathogen wherever it may be. The antibodies may cover up the binding sites of
the foreign invader (rendering the invader harmless), activate the complement system,

440 CHAPTER 11 The Lymphatic System

 1 FIGURE 11.16 Humoral
1 immunity: (1) antigen
Antigen presentation
Helper T cell presentation and Thelper cell
B cell displays foreign B cell
epitope on MHC protein. Epitope recognition, (2) cloning and
Thelper cell recognizes differentiation, (3) antibody
MHC protein
the epitope as foreign,
binds to B cell, and Interleukin-2 production for the attack.
secretes interleukin-2.

2
Cloning
Interleukin-2 stimulates
B cell to clone itself. 2
Differentiation
Cloned B cells differentiate
to become plasma B cells
and memory B cells.

3 Plasma cells
Attack 3 Memory B cell
Plasma B cells release
antibodies specific to
the antigen for attack.

Antibodies

or agglutinate the antigen so that macrophages can phagocytize it. Note that the B cell
does not need to be present at the attack site because antibodies, which act as guided
missiles, are sent from bunkers in the lymphoid tissues where the B cells reside. This
paragraph describes the react stage of humoral immunity. Again, see Figure 11.16.

Spot Check What method of attack do antibodies to blood-typing antigens

(A, B, Rh) use? (Hint: See the cardiovascular system chapter on blood.)

It takes 3 to 6 days for humoral immu-

Primary response Secondary response
nity to accomplish antibody production in
the first exposure to the pathogen. It will
take another 10 days before the amount
Amount of antibody in serum

of antibody production reaches its peak.

Once the pathogen is defeated, the amount
of antibody in the system decreases, but it
never totally drops to zero. If the pathogen
enters the body again, Bmemory cells will
recognize it immediately. The Bmemory cells
will then increase antibody production to
reach a peak in approximately 2 to 5 days,
instead of 13 to 16. See Figure 11.17.
In this way, the pathogen will likely be
defeated before any signs of its presence
are even noticed. With a repeated expo-
0 5 10 15 20 25 0 5 10 15 20 25
sure like this, antibody production will
Days from first exposure Days from reexposure
stay high because the immune system has to antigen to same antigen
learned that this pathogen reoccurs. Spe-
cific immunity does not prevent a pathogen FIGURE 11.17 Graph of primary and secondary response in humoral immunity.

11.4 Physiology of the Lymphatic System 441

 from entering the body. Instead, it fights it so much faster and stronger with repeated
exposure that the pathogen is defeated before it can make you sick. This paragraph
describes the remember stage of specific immunity.

Cellular (Cell-Mediated) Immunity

Learning Outcome
12. Explain the process of cellular immunity.

This is another form of specific immunity, and, as such, it works on the principles of rec-
ognize, react, and remember. However, cellular immunity is a little more complicated.
Like humoral immunity, cellular immunity starts with an antigen-presenting cell, or
any other cell presenting something on an MHC molecule. The epitope can be an anti-
gen the cell sampled from its external environment (such as an APC) or a fragment of
something in the cytoplasm of the cell itself (such as other body cells). The epitope may
even be a part of an unusual (foreign) protein formed inside a cancer cell. In this form of
immunity, a Thelper or Tcytotoxic cell reacts by binding to the APC because it recognizes the
epitope as being foreign. It verifies that the epitope is foreign by binding to a costimula-
tion protein on the APC, if there is one. Then either T cell releases interleukin-1 to cause
the T cell to clone itself to become many Tcytotoxic cells (TC), Thelper cells (TH), and Tmemory
cells (TM) that all recognize this antigen as foreign (recognize stage). See Figure 11.18.
An activated Tcytotoxic cell then travels throughout the body seeking cells with this
specific foreign antigen. If it finds the foreign antigen, it docks to the cell and delivers
a lethal hit to the cell. Unlike the antibodies released from B cells safe and secure in
lymphoid tissue, Tcytotoxic cells mount a direct cell-to-cell attack. The Thelper cells of the
clone secrete interleukins to attract neutrophils and NK cells to the area, attract and
activate macrophages to clean up any debris, and further activate more Tcytotoxic and
B cells. Of the T cells, only Tcytotoxic cells directly attack a pathogen or cancer cell
(react stage) in this form of specific immunity. See Figure 11.19.
Cellular immunity is effective against virally infected cells. Viruses are basically
pieces of nucleic acids surrounded by a protein coat. They penetrate a cell of choice
(specific to each virus) and insert their viral (foreign) nucleic acid into the DNA of
the cell. The cell then drops its normal function to become a viral factory, producing
more and more virus until the cell bursts with all of the virus it has produced. The free
virus (enclosed in its protein coat) then seeks out other cells to invade. Tcytotoxic cells
destroy the self cell that has been turned into a viral factory.
Tmemory cells stand by until the pathogen reoccurs in the body. If it does reoccur,
these cells mount a cellular immunity response that is faster and stronger than the ini-
tial response (remember stage).

Clinical P int
In some instances, organ transplantation is a viable treatment option for thousands of
patients with dysfunctional organs damaged by disease or trauma. Organ transplanta-
tion in the United States exceeded 30,000 for the first time annually in 2015.1 But trans-
planted organs are considered foreign tissue, so the body’s immune system naturally
attacks this foreign tissue. Important breakthroughs in tissue typing and the develop-
ment of immunosuppressant (anti-rejection) drugs allow for more organ transplants
and increased survival rates. For example, the first human heart transplant occurred in
1967 but the patient survived just 18 days.2 In 2016, 88% of patients were expected to
survive the first year after surgery and the 5-year survival rate expectation was 75%.3
Advancements in scientific research and the improved development of these drugs
over time have made successful organ transplantation possible.

442 CHAPTER 11 The Lymphatic System

 Costimulation FIGURE 11.18 Cellular
protein immunity: (1) antigen
1 1 Antigen recognition, (2)
Antigen recognition
costimulation to verify
MHC protein the epitope is foreign, (3)
cloning and differentiation,
TC or TH
2 (4) lethal hit or interleukin
Costimulation secretion to initiate other
APC outcomes.
3
2
Cloning and
differentiation
TC or TH
Interleukin-1
4
Lethal hit or
interleukin secretion
3 TC TH TM
for other outcomes
or
TC TH TM
TH TM
TC

Activated T cells Memory T cells

TC TH
4

MHC protein
MHC
protein

Pathogenic APC
cell
Destruction of Activate Thelper
pathogenic cell cells and B cells
Attract neutrophils and
NK cells
Activate macrophages

Spot Check How do the locations of the lymphocytes involved in humoral and
cellular immunity differ during the attack on the pathogen?

Forms of Acquired Immunity

Learning Outcome
13. Compare the different forms of acquired immunity.

Another way of looking at specific immunity is to consider how it is acquired. The four
terms that become relevant in this discussion of acquired immunity are explained in
the following list:
• Passive is used to indicate that the immunity was acquired through someone or
something else (an animal like a horse or a pig).
• Active is used to indicate that the body actively created its own immunity.

11.4 Physiology of the Lymphatic System 443

FIGURE 11.19 Tcytotoxic cell
attacking a cancer cell.
(a) Tcytotoxic cell docks to a
cancer cell. (b) Tcytotoxic cell
delivers a lethal hit to the T cell
cancer cell.
(a, b) ©Dr. Andrejs Liepins/Science T cell
Source

Cancer cell
Dying cancer cell

(a) 10 μm (b)

• Natural is used to indicate that the immunity was accomplished through naturally
occurring means.
• Artificial is used to indicate that the immunity was not acquired through naturally
occurring means.
These terms are used to classify the four types of acquired immunity:
• Natural active immunity is what has been described in the previous explana-
tions of humoral and cellular immunity. A pathogen invades the body through
everyday activities; the body responds by recognizing the specific pathogen as
foreign and reacting to it by producing antibodies or activating Tcytotoxic cells to
destroy the pathogen. The body then remembers the specific pathogen so that it
can fight the pathogen faster and stronger if it reappears. An example of this is
catching a cold from someone in your class. Your body recognizes the cold virus
as foreign, activates Tcytotoxic cells to destroy your virally infected cells, and then
remembers that specific cold virus so you do not get that cold again. The fact
that you may get a cold every year does not mean your immune system is faulty.
It just means that there are many different cold viruses. Specific immunity is
specific to each cold virus.
• Natural passive immunity means that the body has acquired specific immunity
through natural means from someone else. Some antibodies can pass from mother
to child through breast milk. The child has specific immunity to some pathogens
because the child has acquired its mother’s antibodies. This is one of many reasons
some mothers choose to nurse their infants.
• Artificial active immunity occurs when the body acquires a pathogen in an artificial
way and then develops its own humoral or cellular immunity. Examples of this are
the smallpox, polio, and chicken pox vaccinations mentioned at the beginning of this
chapter. Deborah was vaccinated on her arm with weakened antigens from the small-
pox virus. So she did not come in contact with the antigens through normal, everyday
activities—a health care worker scratched the skin of Deborah’s arm with a substance
prepared in a laboratory that was designed to expose Deborah to a harmless smallpox
virus antigen without causing her to get smallpox. Deborah’s body recognized the
antigen as foreign, reacted to it by making antibodies, and now remembers that anti-
gen, so it will attack it faster and stronger if it should ever enter Deborah’s body again.

444 CHAPTER 11 The Lymphatic System

• Artificial passive immunity is acquired when an individual receives an injection
of serum containing antibodies from another person or an animal such as a horse
or pig. Antibodies can also be synthetically made or produced by bacteria. The
effect is temporary because the body has not actively developed the mechanism to
replace the injected antibodies that will eventually be used up. This type of immu-
nity is used for the emergency treatment of tetanus, rabies, and snakebites.

Spot Check Which of the four types of acquired immunity listed in the
preceding paragraphs is provided by an injection of Rhogam for Rh− mothers?

Clinical P int
Vaccines are preparations of pathogenic particles that have been killed or weakened
so that they do not cause disease. These harmless particles provide cells of the lym-
phatic system a first exposure to a specific, potentially lethal pathogen. As a result of
the clinical administration of a vaccine, APCs present epitopes of the killed or weak-
ened pathogen and Thelper cells respond by starting the recognize, react, and remem-
ber steps of humoral and cellular immunity to that particular pathogen. In this way, the
body develops specific immunity to mount a faster and stronger attack on a live, stron-
ger version of the pathogen in future exposures.

You have now become familiar with the three lines of defense in the body. Note
that T cells are important in more than one line of defense. We summarize their role in
the following section.

Importance of Thelper Cells in Nonspecific

Resistance and Specific Immunity

Learning Outcome
14. Explain the importance of Thelper cells to specific and nonspecific defense.

As you can see in Figure 11.20, Thelper cells provide a vital role in nonspecific
defense and specific immunity. Thelper cells activate macrophages for nonspecific
defenses such as inflammation and fever. Thelper cells are also important for both
forms of specific immunity. In humoral immunity, these cells first recognize what
is foreign and then release interleukin-2 to have B cells react by cloning themselves
and producing antibodies. In cellular immunity, Thelper cells recognize what is for-
eign and release interleukin-1 to get Tcytotoxic cells to clone themselves and attack.
Keep in mind the importance of these cells when you read about disorders and HIV
later in the chapter.
You can now combine all of this information concerning anatomy and physiol-
ogy to clearly understand the functions of this system.

Spot Check Describe the role of Thelper cells in both nonspecific and
specific immunity.

11.4 Physiology of the Lymphatic System 445

FIGURE 11.20 Importance
of Thelper cells. Macrophage,
B cell, or other
antigen-presenting
cell

Thelper cell

Macrophage-
Interleukin-2 Interleukin-1
activating factor

Macrophage activity
Clonal selection Clonal selection
Leukocyte chemotaxis
of B cells of cytotoxic T cells
Inflammation

Nonspecific defense Humoral immunity Cellular immunity

Functions of the Lymphatic System

Learning Outcome
15. Explain the functions of the lymphatic system.

Remember Andre from the cardiovascular system chapter on blood? See Figure 11.21.
In the following list, we explain the different functions of Andre’s lymphatic system as
a general example of how a healthy lymphatic system works.
• Fluid balance. Every minute of every day, Andre loses fluid (lymph) from his car-
diovascular system. In order to maintain homeostasis, the interstitial fluid washes
over his tissues, delivering nutrients and removing wastes. It is collected by open-
ended lymph vessels, which return it back to his bloodstream at his subclavian
veins as lymph.
• Lipid absorption. The lymph drained from Andre’s digestive system organs car-
ries the products of lipid digestion from the glass of milk he had for breakfast this
morning. You will learn more about this in the digestive system chapter.
• Defense against disease. Although the skin as an external barrier has been bro-
ken with the scrape on his knee, Andre’s other nonspecific defenses are at work to
FIGURE 11.21 Andre is
bleeding through the bandage
destroy any pathogens that may have entered the damaged tissue. Dendritic cells
on his knee. in the skin are serving as APCs to present foreign antigens to Thelper cells so that
©Bellurget Jean Louis/Jupiterimages/ macrophages can be activated. These Thelper cells may also activate the comple-
Getty Images ment system. The inflammatory process has started, too, and will bring neutrophils

446 CHAPTER 11 The Lymphatic System

 to the area. The neutrophils will crawl out of the dilated blood vessels and move to
the damaged tissue, consuming bacteria along the way.
• Immunity. Andre is still very young. His thymus gland is still growing and
maturing the T cells that detect foreign antigens and destroying those that react
to his own cells. His T cells will be vital for his lymphatic system to accomplish
the third line of defense, whether it be humoral or cellular immunity. Andre’s
immune system is capable of making at least 10 billion different antibodies,
each specific to a particular pathogen. Hopefully, Andre will never be exposed
to that many different pathogens, but his capacity for developing specific immu-
nity is there as he needs it.
What will happen to this system when Andre becomes an old man? We focus next
on the effects of aging on the lymphatic system.

11.5 Effects of Aging on the Lymphatic System

Learning Outcome
16. Summarize the effects of aging on the lymphatic system.

Andre’s ability to move fluid between his cardiovascular system and the lymphatic
system does not decrease with age. Lymph will continue to leave his blood vessels to
nourish cells far from his blood capillaries and remove their wastes. Lymph will also
continue to carry the products of lipid digestion in his old age.
The number of B cells in Andre’s lymphoid tissues will remain relatively stable.
What will be affected is his number of new T cells because his thymus will have
shrunk and much of the tissue will have been replaced with connective tissue. His
T cells in other lymphoid tissues will still be able to clone themselves, but not as many
will be made with each clone. The decrease in Thelper cells could mean that his recogni-
tion of pathogens will be slower. This slowdown may be a reason that cancer is more
prevalent in elderly people.
Vaccinations might not offer as much protection as they did when Andre was
younger. A good example of this is Deborah, who had chicken pox as a child and
developed natural active immunity to the virus. The virus remained latent in her
nerves while her immune system kept it from becoming active. But as Deborah ages,
her immune system slows down, and the same virus may reemerge to cause painful
lesions called shingles.
The age-related changes to the immune system may have a positive effect if the
elderly individual has allergies because this hyperimmune response may be slowed as
well. Allergies and other lymphatic system disorders are discussed in the final section
of this chapter.

11.6 Diagnostic Tests for Lymphatic System

Disorders
Learning Outcome
17. Describe common diagnostic tests used for lymphatic system disorders.

Like the tables for other systems, Table 11.1 presents common diagnostic tests used for
lymphatic system disorders. A lot of the tests may be familiar to you as they have been
mentioned in previous chapters, but their specific relation to the lymphatic system is
explained in Table 11.1.

11.6 Diagnostic Tests for Lymphatic System Disorders 447

 TABLE 11.1 Diagnostic Tests for Lymphatic System Disorders
Diagnostic Test Function and Normal Values

Bone marrow A procedure used to collect and examine bone marrow for the presence of
aspiration and biopsy abnormal cells.
Computed tomography (CT) An imaging technique used to visualize internal structures. The scan produces
images in “slices” of areas throughout the body. In regard to lymphatic system
disorders, CT can be used to determine changes in lymphatic organs.
Lumbar puncture A procedure used to collect and look at cerebrospinal fluid (CSF) surrounding the
brain and spinal cord for the presence of abnormal WBCs.
Lymph node biopsy A procedure used to collect and examine part of a lymph node for the presence of
abnormal cells.
Magnetic resonance imaging An imaging technique used to visualize internal structures. This test provides great
(MRI) or nuclear magnetic contrast between various soft tissues in the body. In regard to disorders of the
resonance imaging (NMRI) lymphatic system, MRI can be used to detect changes in lymphatic organs.
White blood cell (WBC) A blood test that determines the number of leukocytes. The normal number of all
count the leukocytes is 3,540–9,060/mm3 of blood.
White blood cell (WBC) A blood test that gives the percentage of each type of leukocyte in the total number
differential: of leukocytes. Normal values:
Neutrophils Neutrophils: 40%–70%
Basophils Basophils: 0%–2%

Eosinophils Eosinophils: 0%–6%

Lymphocytes Lymphocytes: 20%–50%

Monocytes: 4%–8%
Monocytes
X-ray Electromagnetic radiation that sends photons through the body, allowing the
visualization of dense structures. In regard to lymphatic system disorders, X-rays
can be used to view the spleen for diagnosis of splenomegaly.

Spot Check How can imaging tests such as X-rays, MRIs, and CT scans be used
to help diagnose lymphatic system disorders?

11.7 Lymphatic System Disorders

Learning Outcome
18. Describe lymphatic system disorders and relate abnormal function to pathology.

Lymphoma
Lymphoma is a type of cancer that affects white blood cells and can develop in the
organs of the lymphatic system.
There are two types of lymphoma: Hodgkin lymphoma and non-Hodgkin lym-
phoma. Both types of lymphoma are characterized by abnormal B-cell or T-cell lym-
phocytes. Hodgkin lymphoma is characterized by the presence of abnormal B cells
called Reed-Sternberg cells. These cells are large, multinucleated macrophages that
do not function as normal lymphocytes. They also proliferate and grow into tumors.
Similar to Hodgkin lymphoma, non-Hodgkin lymphoma is characterized by abnor-
mal B cells and T cells; however, these abnormal cells are not considered to be the
Reed-Sternberg cells distinctive of Hodgkin lymphoma.
Hodgkin lymphoma is less common than non-Hodgkin lymphoma. The symp-
toms of both Hodgkin and non-Hodgkin lymphomas are similar. Individuals may

448 CHAPTER 11 The Lymphatic System

suffer from lymph node swelling, fever, weight loss, fatigue, and night sweats.
Diagnosis is accomplished by physical examination, blood tests to determine the
presence of abnormal WBCs or the presence of Reed-Sternberg cells (in the case
of Hodgkin lymphoma), and bone marrow and lymph node biopsies. Treatment
options for these cancers are also similar and include chemotherapy, radiation,
medications, and bone marrow transplants.

Multiple Myeloma
Multiple myeloma is cancer of the plasma cells in the bone marrow. See Figure 11.22.
As you may recall, B cells differentiate into two types of cells, memory cells and
plasma cells. Plasma cells are responsible for secreting antibodies to fight infections.
In multiple myeloma, plasma cell growth is accelerated and eventually forms tumors
in bone tissue. Symptoms include abnormal bleeding and infection resulting from ane-
mia, fatigue, fever, and bone fractures. Multiple myeloma is diagnosed using a variety
of blood tests, including CBC, bone X-rays, bone density testing, and bone marrow
biopsy. Treatment involves a combination of therapies such as chemotherapy, radiation,
bone marrow transplant, and medications used to reduce pain and prevent fractures.

Splenomegaly
Splenomegaly is an enlargement of the spleen that can be caused by any number of
pathological conditions, including anemia, cancers, and certain infections. Symptoms
include tenderness or pain in the upper left abdomen or back, hiccups, and the inability
to eat a large meal. Doctors can diagnose splenomegaly by physical examination, X-ray,
CT scan, or MRI. The danger of an enlarged spleen is its effect on circulating blood cells.
The enlarged spleen will trap blood cells, therefore reducing the number of circulating
blood cells in the body. Trapped red blood cells are eventually destroyed in the spleen
along with abnormal red blood cells. The excess cells can clog the organ, preventing it
from functioning properly. Treatment of splenomegaly involves treating the cause of the
condition. A splenectomy (surgical removal of the spleen) may also be performed.

Allergies
As you discovered in the “Chapter 1, The Basics,” allergies are hypersensitivities
to a foreign antigen (allergen). The process in an allergy is the same as an immune
response—the immune system recognizes the foreign antigen, reacts to it, and then
remembers it so that it can mount a faster and stronger attack if it should ever occur
in the body again. The difference between an allergic reaction and a normal immune
response is that the allergic response produces undesirable side effects such as
increased inflammation. The effect may even be lethal.
Asthma is an example of an immediate hypersensitivity in which the allergen is
inhaled. The allergen triggers the release of histamines in the bronchioles of the lungs,
and this causes the bronchioles to constrict, making breathing difficult. You will learn
more about asthma in the next chapter.

FIGURE 11.22 Multiple

myeloma in plasma cells from a
bone marrow aspiration.
©Prof. Jean Bonhomme/ISM/Medical
Images

11.7 Lymphatic System Disorders 449

 Disease P int
Anaphylaxis (AN-ah-fih-LAK-sis) is an example
of an immediate allergic reaction that can be life-
threatening. An immune response to penicillin
or bee stings is the most common cause. In
anaphylaxis, systemic vasodilation (systemwide
dilation of blood vessels) within a few minutes
of exposure to the allergen can cause a drop in
blood pressure and even cardiac failure.

©Marco Uliana/Shutterstock

Other allergies, called delayed hypersensitivities, may take hours or even days to
develop side effects. Examples of these allergies include contact hypersensitivities to
poison ivy, poison oak, soaps, or cosmetics. The allergen in this type of allergy comes in
contact with epithelial cells (skin, mucous membranes). Next, T cells initiate inflamma-
tion, which causes excessive itching. Scratching the affected area further damages tissue.
Allergies are hypersensitivities to foreign antigens, but some disorders of the lym-
phatic system do not involve foreign antigens at all. These disorders are autoimmune
disorders, in which the body’s immune system attacks the body’s own tissues.

Autoimmune Disorders
Rheumatoid arthritis, Graves’ disease, and myasthenia gravis are examples of some of
the autoimmune disorders you have already studied in previous chapters. Why does the
immune system attack its own tissues? One explanation is molecular mimicry (in which
one molecule is so similar in structure to another molecule that it is mistaken for the other
molecule). To understand this, picture an action movie with a highly paid star. The movie
studio protects its investment in the star by replacing the star with a stunt double during
dangerous action scenes. Since the stunt double’s appearance is so similar to the star, the
viewer never notices the difference. The same mistaken identity happens in molecular
mimicry. An APC presents an epitope for a newly acquired foreign pathogen on its MHC
protein. This epitope is unique but is very similar in shape to a self-antigen in the body. A
Thelper cell recognizes the epitope as foreign and continues the process for humoral immu-
nity, cellular immunity, or both forms of specific immunity. After the pathogen is defeated,
the immune system continues to act against the self-antigen that is so similar. Here, the
immune system is mistaking self-tissue as foreign tissue. The immune system is designed
to fight the pathogen for life, which makes this mistake a lifelong problem that is very dif-
ficult to treat. Immunosuppressant drugs may help manage the progression of the disease.
You have seen how the immune system can overreact in the case of allergies and
mistakenly react in autoimmune disorders. The immune system can also fail to react
whatsoever in immunodeficiency disorders, which you will explore next.

Clinical P int
A treatment option for rheumatoid arthritis and other autoimmune system disorders
is a class of drugs called biologic disease-modifying antirheumatic drugs (biologic
DMARDs). These drugs are genetically engineered to mimic the immune system pro-
teins we naturally produce. With rheumatoid arthritis, the immune system is attacking
the joints causing damage and inflammation. Biologic DMARDs function by altering the
specific signals used by the immune system to cause the inflammation associated with
rheumatoid arthritis. This alteration in the immune system results in a decrease in joint
inflammation and a decrease in the progression of rheumatoid arthritis.

450 CHAPTER 11 The Lymphatic System

Immunodeficiency Disorders
As you recall from “Chapter 1, The Basics,” immunodeficiency disorders are disorders
that affect a part of the immune system, resulting in the inability of the immune system
to adequately defend the body from pathogens. This usually involves lymphocytes not
working properly or an inadequate production of antibodies. Immunodeficiency disor-
ders can fit into two categories based on what caused the immunodeficiency:
• Congenital immunodeficiency disorders are those present at birth. These disor-
ders are usually inherited and are very rare.
• Acquired immunodeficiency disorders are those that develop from a disease or
disorder acquired during one’s lifetime. Use of certain prescribed drugs can also
cause an individual to develop an acquired immunodeficiency.
An example of an acquired immunodeficiency disorder is AIDS. AIDS is an acro-
nym for acquired immune deficiency syndrome. Acquired means that it is not inher-
ited. Immune deficiency means that the immune system fails to provide protection
against pathogens. Syndrome refers to the collection of symptoms and signs of disease.
Acquired immune deficiency syndrome is the final stage of an HIV (human immuno-
deficiency virus) infection.
How does this virus render the immune system deficient? The answer lies in the
cells HIV invades—Thelper cells. By invading these T cells and turning them into viral
factories, HIV prevents the processes of specific immunity and nonspecific resistance
from even starting (explained earlier in the chapter, in the section on the importance of
Thelper cells). As soon as an infected T cell has produced its fill of new HIV particles,
it bursts and is destroyed. With the loss of Thelper cells, the immune system loses its
ability to recognize what is foreign. See Figure 11.23.
An HIV test is used to determine whether a person is infected with the virus. The
test detects the presence of HIV antibodies, but confirming an actual HIV infection
is complicated by HIV’s invasion of Thelper cells. Antibodies should normally peak in
13 to 16 days, but in the case of HIV infections, antibodies may take 2 to 8 weeks to
reach detectable levels. In some rare cases it may take 6 months before there are suf-
ficient antibodies to produce an HIV-positive result.
A T-cell count is a good indicator of an HIV infection’s progression. Note that a
normal T-cell count is 600 to 1,200 cells/mm3. AIDS is indicated if the T-cell count is

Envelope:
Glycoprotein

Phospholipid

Matrix Dying
T cell
Capsid

Emerging
Reverse viruses
transcriptase

RNA

(a) (b) 1 μm

FIGURE 11.23 Infected T cell: (a) HIV virus, (b) dying T cell with emerging HIV.
(b) ©NIBSC/SPL/Science Source

11.7 Lymphatic System Disorders 451

 less than 200 cells/mm3. Without enough Thelper cells to rec-
ognize a foreign pathogen, the body loses its ability to fight
opportunistic infections (infections normally fought off by
healthy immune systems).
One common opportunistic infection is Kaposi sarcoma—
a cancer of the epithelial cells lining blood vessels that
is characterized by bruiselike lesions on the skin. See
Figure 11.24. Other opportunistic infections include patho-
gens such as Pneumocystis (a group of respiratory fungi),
herpes simplex virus, tuberculosis bacteria, and cytomegalo-
virus. Death from infection is inevitable once AIDS has been
diagnosed. However, it may take a few months to several
years from the time of an AIDS diagnosis.
Currently, there is no cure for AIDS. However, many
FIGURE 11.24 Kaposi sarcoma. people have been able to live decades with an HIV infection
Source: National Cancer Institute (NCI) before it develops into AIDS because of the availability of
effective combinations of drugs introduced in the 1990s.
Table 11.2 summarizes all of the diseases and disorders described throughout
the chapter.

TABLE 11.2Summary of Diseases and Disorders

of the Lymphatic System
Disease/Disorder Description
Allergies Hypersensitivities to a foreign antigen.
Autoimmune disorders Disorders that result from the immune system
attacking self-antigens.
Elephantiasis A tropical disease caused by a roundworm that
blocks lymphatic drainage.
Immunodeficiency Disorders that affect a part of the immune system,
disorders resulting in the inability of the immune system
to adequately defend the body from pathogens.
Congenital immunodeficiency disorders are those
present at birth. Acquired immunodeficiency
disorders are those that develop from a disease or
disorder acquired during one’s lifetime.
Lymphoma A type of cancer that affects white blood cells
and can develop in the organs of the lymphatic
system. There are two types of lymphoma: Hodgkin
lymphoma and non-Hodgkin lymphoma.
Multiple myeloma Cancer of the plasma cells in the bone marrow.
Splenomegaly An enlargement of the spleen that can be caused
by any number of pathological conditions, including
anemia, cancers, and certain infections.

Spot Check Explain the difference in the following types of lymphatic system
disorders: hypersensitivities, autoimmune disorders, and immunodeficiency disorders.

452 CHAPTER 11 The Lymphatic System

Putting the Pieces Together

The Lymphatic System

Integumentary system Cardiovascular system
Has dendritic cells to guard against Provides fluid for lymph.
pathogens; protects against fluid
loss. Sends white blood cells to fight
pathogens in the cardiovascular
Sends white blood cells to fight system.
pathogens in the integumentary
system.
Respiratory system

Skeletal system Provides O2 for lymphatic tissues

and removes CO2; thoracic pump
Red bone marrow produces white helps return lymph to the
blood cells. cardiovascular system.

Sends white blood cells to fight Sends white blood cells to fight
pathogens in the skeletal system. pathogens in the respiratory
system.

Muscular system Digestive system

Moves lymph through lymph vessels Provides nutrients to lymphatic

so it can be returned to the tissues.
cardiovascular system.
Transports products of lipid
Sends white blood cells to fight digestion; sends white blood cells
pathogens in the muscular to fight pathogens in the digestive
system. system.

Excretory/urinary system
Nervous system
Kidneys maintain fluid and
Microglia serve as immune system electrolyte balance.
cells to fight pathogens in the CNS.
Sends white blood cells to fight
pathogens in the excretory/urinary
Endocrine system system.

Glucocorticoids suppress the Reproductive system

immune system and reduce
inflammation. Sustentacular cells form a
blood-testis barrier to isolate
Sends white blood cells to fight developing sperm from the
pathogens in endocrine system immune system.
glands.
Sends white blood cells to fight
pathogens in the reproductive
system.

FIGURE 11.25 Putting the Pieces Together—The Lymphatic System: connections between the lymphatic system and the
body’s other systems.

11.7 Lymphatic System Disorders 453

Summary
11.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the lymphatic system.

11.2 Overview
∙∙ The lymphatic system involves the circulation of lymph, a fluid derived from blood.

11.3 Anatomy of the Lymphatic System

Lymph and Lymph Vessels
∙∙ Lymph is derived from plasma but has fewer dissolved proteins.
∙∙ Lymph washes over tissues to deliver nutrients and remove wastes, cell debris, bacteria, viruses, and loose (possible
cancerous) cells.
∙∙ Lymph leaves blood vessels due to blood pressure.
∙∙ Lymph is returned to the bloodstream by open-ended lymph vessels through the skeletal muscle action.
∙∙ Lymphatic collecting ducts return lymph to the bloodstream at the subclavian veins.

Cells of the Lymphatic System

∙∙ NK cells are lymphocytes that destroy bacteria, fight against transplanted tissues, attack virally infected cells, and destroy
cancer cells.
∙∙ T cells are lymphocytes that are important in nonspecific defense and specific immunity.
∙∙ There are four types of T cells: Thelper cells, Tcytotoxic cells, Tmemory cells, and Tregulatory cells.
∙∙ B cells are lymphocytes that serve as APCs and are important in humoral immunity because they produce antibodies.
∙∙ Macrophages are monocytes that have migrated to the tissues, where they phagocytize bacteria, debris, and dead
neutrophils.
∙∙ Dendritic cells are located in the epidermis and serve as APCs.

Lymphoid Tissues and Organs

∙∙ MALT is a scattering of lymphocytes in mucous membranes lining tracks to the outside environment.
∙∙ Peyer’s patches are nodules of lymphocytes at the distal end of the small intestine.
∙∙ Lymph nodes filter lymph from different regions of the body on its way back to the bloodstream.
∙∙ Tonsils ring the pharynx to guard against pathogens entering the body through the nose or mouth.
∙∙ The thymus gland matures T cells that recognize foreign antigens and destroys T cells that react to self-antigens.
∙∙ The spleen has red pulp to store red blood cells and white pulp to store lymphocytes and macrophages.
∙∙ The spleen is a battle site for lymphocytes to attack pathogens. It regulates the amount of fluid in the blood by transferring
excess fluid to the lymphatic system as lymph.

11.4 Physiology of the Lymphatic System

Three Lines of Defense
∙∙ The three lines of defense against pathogens are (1) external barriers; (2) inflammation, antimicrobial proteins, fever, and
other active attacks; and (3) specific immunity.
∙∙ The first two lines are nonspecific defenses, while the third is specific immunity.

Nonspecific Resistance versus Specific Immunity

∙∙ Nonspecific defenses are widespread and function the same way every time.
∙∙ Specific immunity requires a prior exposure to a pathogen so that it can recognize, react, and remember the
pathogen.
∙∙ Specific immunity reacts faster and stronger to repeated exposures to a pathogen.

Nonspecific Defenses
∙∙ External barriers include the skin and mucous membranes.
∙∙ Inflammation functions to limit the spread of pathogens, to remove debris and damaged tissue, and to initiate tissue
repair.

454
∙∙ Inflammation involves the release of vasodilators from damaged tissue and basophils and the margination, diapedesis,
and chemotaxis of leukocytes that phagocytize pathogens along the way.
∙∙ Antimicrobial proteins include interferon, produced by virally infected cells so that other healthy cells will make
antiviral proteins, and the complement system of 20 inactive proteins that, when activated, can destroy pathogens in
several ways.
∙∙ Fever is a defense initiated by pyrogens from macrophages that cause the hypothalamus to reset the body’s
temperature.
∙∙ Other attacks from leukocytes complete the list of nonspecific defenses.

Specific Immunity
∙∙ APCs present epitopes of what they have sampled from their external environment on MHC proteins.
∙∙ Other cells present internal self-antigens on MHC proteins.

Humoral (Antibody-Mediated) Immunity

∙∙ Humoral immunity involves B cells producing antibodies.

Cellular (Cell-Mediated) Immunity

∙∙ Cellular immunity involves Tcytotoxic cells directly killing cells with foreign antigens.
∙∙ Both types of specific immunity require Thelper cells to recognize what is foreign.

Forms of Acquired Immunity

∙∙ Immunity can be acquired naturally or artificially through passive or active processes.

Importance of Thelper Cells in Nonspecific Resistance and Specific Immunity

∙∙ Thelper cells activate macrophages for nonspecific defense such as inflammation and fever.
∙∙ Thelper cells recognize what is foreign and release interleukin-2 to activate B cells in humoral immunity.
∙∙ Thelper cells recognize what is foreign and release interleukin-1 to activate Tcytotoxic cells in cellular immunity.

Functions of the Lymphatic System

∙∙ The lymphatic system helps maintain the fluid balance in the blood.
∙∙ The lymphatic system distributes lymph to wash over tissues (as interstitial fluid) to deliver nutrients and remove
wastes.
∙∙ The lymphatic system carries absorbed products of lipid digestion.
∙∙ The lymphatic system provides nonspecific defenses.
∙∙ The lymphatic system provides specific immunity against specific pathogens.

11.5 Effects of Aging on the Lymphatic System

∙∙ The ability to move fluid between the cardiovascular and lymphatic systems does not decrease with age.
∙∙ The number of B cells in the lymphoid tissues will remain relatively stable.
∙∙ The thymus gland shrinks with age.
∙∙ The number of new T cells decreases with age.
∙∙ The immune response may slow with age.

11.6 Diagnostic Tests for Lymphatic System Disorders

∙∙ Common diagnostic tests for lymphatic system disorders include bone marrow aspiration, CT scan, lumbar puncture,
lymph node biopsy, MRI, WBC count, WBC differential, and X-ray.

11.7 Lymphatic System Disorders

∙∙ Lymphoma is a type of cancer that affects white blood cells and can develop in the organs of the lymphatic system.
∙∙ Multiple myeloma is cancer of the plasma cells in the bone marrow.
∙∙ Splenomegaly is an enlargement of the spleen.
∙∙ Allergies are hypersensitivities to a foreign antigen.
∙∙ Autoimmune disorders result from the immune system attacking self-antigens.
∙∙ Immunodeficiency disorders result in the inability of the immune system to adequately defend the body from
pathogens.

455
Key Words for Review
The following terms are defined in the glossary.

acquired immune deficiency diapedesis major histocompatibility complex

syndrome (AIDS) epitope (MHC)
acquired immunity humoral immunity margination
anaphylaxis interferons molecular mimicry
antigen-presenting cell interleukins nonspecific resistance
cellular immunity interstitial fluid pyrogen
chemotaxis lymph specific immunity
complement system lymphadenitis

456
 12 The Respiratory
System
Everyone is anxiously waiting to hear that
first breath as a baby is born. The parents
may breathe a sigh of relief when they
hear her first cry. It is the result of their
baby’s first intake of air from outside her
body, but it certainly will not be her last.
Her body will continue the process
of breathing until death—
24 hours a day, 365 days
a year, for possibly
75 years or more.
Rarely will she give
her breathing con-
scious thought,
yet day after day
her respiratory
anatomy will continue
to perform the functions of the
system. See Figure 12.1.
©Stephen Marks/Stone/Getty Images

Module 11: Respiratory System

457
 12.1 Word Roots and Combining Forms

Learning Outcome
1. Use medical terminology related to the respiratory system.

alveol/o: alveolus, air sac lob/o: lobe rhin/o: nose

bronch/o: bronchial tube nas/o: nose sinus/o: sinus
bronchi/o: bronchus pharyng/o: pharynx spir/o: breathing
bronchiol/o: bronchiole phren/o: diaphragm thorac/o: chest
capn/o: carbon dioxide pneum/o: air trache/o: trachea
cyan/o: blue pneumon/o: air
laryng/o: larynx pulmon/o: lung

Respiratory System 12.2 Overview

Major Organs and Structures: The word respiration has several usages. In “Chapter 2, Levels
nose, pharynx, larynx, trachea,
bronchi, lungs
of Organization of the Human Body,” you studied cellular res-
Accessory Structures:
piration as a cellular process performed by mitochondria to
diaphragm, sinuses, nasal cavity release energy from the bonds in a glucose molecule. In the
Functions muscular system chapter, you studied aerobic and anaerobic
gas exchange, acid–base balance,
speech, sense of smell, creation
respiration as variations of cellular respiration. In this chap-
of pressure gradients necessary ter, you will study respiration first as breathing (ventilation),
to circulate blood and lymph
which is the movement of air into (inspiration) and out of the
lungs (expiration). Then you will explore respiration as the
exchange of gases in two areas—between the air in the lungs
and the blood in capillaries and between the blood in the capil-
laries and the tissues out in the body. Once you understand how the exchange of gases
takes place, you will be prepared to investigate how gases are transported in the blood.
As with all of the other human body systems you have covered so far, it is impor-
tant to understand the anatomy of the system before tackling the physiology. So you
will begin by studying the anatomy of this system.

12.3 Anatomy of the Respiratory System

Learning Outcome
2. T
 race the flow of air from the nose to the pulmonary alveoli and relate the function of
each part of the respiratory tract to its gross and microscopic anatomy.

FIGURE 12.1 The respiratory As you can see in Figure 12.2, the entire respiratory system’s anatomy is housed in
system. the head, neck, and thorax. In general, the anatomy in the head and neck is the upper
respiratory tract, while the anatomy from the trachea through the lungs is the lower
respiratory tract.
You have already studied some of this anatomy, such as the pleurae (serous mem-
brane), in “Chapter 1, The Basics.” To refresh your memory, a serous membrane is a
double-walled, fluid-filled membrane. In the case of the pleurae, the visceral pleura is
in contact with the lung’s surface, while the parietal pleura is not. The parietal pleura
lines the thoracic cavity and covers the diaphragm’s superior surface. Fluid exists
between the visceral and parietal pleurae. This anatomy will be important when you
study the mechanics of breathing, later in the chapter.
Before you get started on the rest of the anatomy, consider the way air enters and
moves through the body. Take a deep breath now with your mouth closed, and trace the
air in that breath as it travels on its route (follow along with Figure 12.2). The air enters

458 CHAPTER 12 The Respiratory System

Frontal sinus Sphenoid
sinus

Nasal cavity
Soft palate

Hard palate Pharynx

Epiglottis
Nostril

Esophagus
Oral cavity

Trachea
Larynx
Visceral
pleural
membrane
Bronchus
Pleural fluid
(located
between
membranes)
Bronchial tree
Parietal
pleural
Right lung membrane

Left lung

Diaphragm

FIGURE 12.2 The respiratory system anatomy.

the nasal cavity through the nose. From there it goes to the pharynx (FAIR-inks), to
the larynx (LAIR-inks), to the trachea (TRAY-kee-ah), to the bronchi (BRONG-kye)
(where it enters the lungs), to the bronchial tree, and finally to the tiny air sacs called
alveoli (al-VEE-oh-lye) (not shown in the figure). At the alveoli, the second part of
respiration—the exchange of gases—takes place.

Disease P int
Pleurisy is characterized by inflammation of the pleurae. This condition has a variety
of causes, including respiratory infections such as tuberculosis or pneumonia, cancer,
trauma or injury to the chest, inflammatory conditions such as lupus or rheumatoid
arthritis, pulmonary embolus, or conditions related to asbestos exposure. Pleurisy
causes pain in the chest, especially when taking a deep breath or coughing. The pain
is caused by the friction of the two inflamed membranes rubbing against each other.
Breathing can become difficult, and this could lead to additional symptoms such as
cyanosis, tachypnea, and shortness of breath. To diagnose pleurisy, physicians listen
to breath sounds and may order a series of tests including a blood test, CT scan,
chest X-ray, and ultrasound.

12.3 Anatomy of the Respiratory System 459

 Now you are ready to zoom in on all of the respira-
tory system’s specific anatomy (that we have just men-
tioned) in the order that the air traveled through it in your
Nasal deep breath. You will need to become familiar with the
bone gross and microscopic anatomy along the way because
this is important in understanding precisely how the
Minor
Lateral
alar
anatomy functions.
cartilage
cartilages
Nose
Septal Air enters the nasal cavity through the nose’s two nares
nasal Dense (NAH-reez) (nostrils). The nasal bones superiorly and
cartilage connective the plates of hyaline cartilage at the end of the nose are
tissue
responsible for the nose’s shape. You can feel where the
Major
alar nasal bone ends and cartilage begins at the bridge of the
cartilage nose. See Figure 12.3.

Nasal Cavity
As you can see in Figure 12.4c, a septum divides the
FIGURE 12.3 The nose. nasal cavity into right and left sides. The ethmoid
©Jose Luis Pelaez Inc/Blend bone (superiorly), the vomer (inferiorly), and a septal cartilage anteriorly form the
Images LLC septum. The anterior part of the nasal cavity (the vestibule) is lined by stratified
squamous epithelial tissue with stiff guard hairs to block debris from entering the
respiratory tract.
The nasal cavity widens posterior to the vestibule to make room for three bony,
lateral ridges called the nasal conchae (KON-kee). See Figure 12.4b. The ethmoid
bone forms the superior and middle nasal conchae, while the inferior nasal concha is
a separate bone. This portion of the nasal cavity is lined by mucous membranes that
trap debris and warm and moisturize the incoming air. The nasal conchae provide extra
surface area for the mucous membranes to function. The mucous membranes are com-
posed of ciliated pseudostratified columnar epithelial tissue. The cilia move mucus and
any trapped debris posteriorly so that it can be swallowed. Olfactory neurons located in
the roof of the posterior nasal cavity detect odors and provide the sense of smell.

FIGURE 12.4 The anatomy

of the upper respiratory tract:
Frontal sinus
(a) sagittal view of cadaver,
Cribriform plate
(b) sagittal section showing
internal anatomy (nasal septum Nasal conchae:
has been removed), (c) nasal Superior
septum and regions of the Middle
pharynx. Sphenoidal sinus
(a) ©McGraw-Hill Education/Rebecca Inferior
Gray
Hard palate
Nasopharynx

Tongue
Uvula

Larynx:
Oropharynx
Epiglottis

Laryngopharynx

Trachea
Esophagus

(a)

Superior
460 CHAPTER
Frontal sinus 12 The Respiratory System Nasal
Middle conchae
Inferior
(a)

Superior
FIGURE 12.4 The anatomy
Frontal sinus Nasal of the upper respiratory
Middle conchae tract (continued).
Inferior

Vestibule Sphenoidal sinus

Nostril Pharyngeal tonsil

Hard palate Opening of

auditory tube
Uvula
Palatine tonsil
Tongue
Lingual tonsil

Epiglottis

Hyoid bone

Larynx

Trachea

Esophagus

(b)

Nasal septum:
Ethmoid bone

Vomer

Septal
cartilage

Pharynx:
Nasopharynx

Oropharynx

Laryngopharynx

(c)

12.3 Anatomy of the Respiratory System 461

 Study Hint
Take a look up your own nose by using a flashlight and a mirror. You can see the hairs
in the vestibule and notice that the posterior nasal cavity appears very red and moist.
These are the moist, mucous membranes, and their rich blood supply
moisturizes and warms the air. You should also see
that there is limited space for air to pass because of
the protruding nasal conchae. This causes more air
to come in contact with the mucous membranes, so
they are better able to function.
©Richard Hutchings

Spot Check Why do you think the vestibule is stratified epithelial tissue instead
of mucous membranes?

Sinuses You studied the sinuses of the frontal, ethmoid, sphenoid, and maxilla
bones in the skeletal system chapter. The frontal and sphenoidal sinuses are shown in
Figure 12.4. These cavities within the bones are also lined with respiratory epithelial
tissue to warm and moisturize the air. The mucus produced in the sinuses is drained to
the nasal cavity through small openings.

Disease P int
Inflammation of the epithelium in the sinuses (sinusitis) causes
increased mucus production, and the accompanying swell-
ing may block its drainage to the nasal cavity. The pres-
sure within the sinuses created by the buildup of
mucus causes a sinus headache. Decongestants
(vasoconstrictors) help reduce the swelling,
thereby improving mucus drainage, which
reduces the increased pressure.
©Ingram Publishing

At this point in your deep breath, the inspired air leaving the nasal cavity has been
partially warmed and moistened, and some of its debris has been trapped. The struc-
ture the air encounters next—the pharynx—is explained now.

Pharynx
The pharynx, commonly called the throat, is divided into three regions based on
___location and anatomy—the nasopharynx, the oropharynx, and the laryngopharynx
(lah-RING-oh-FAIR-inks). You will explore these in the paragraphs that follow.
Nasopharynx As you can see in Figure 12.4c, the nasopharynx is located posterior
to the nasal cavity and the soft palate. This passageway is also lined by ciliated pseu-
dostratified columnar epithelial tissue whose cilia move mucus and trapped debris to
the next region of the pharynx so that it can be swallowed. The pharyngeal tonsils
and the opening to the auditory tube (eustachian tube) are located in this region.

Oropharynx This region of the pharynx (shown in Figure 12.4c) is inferior to the
nasopharynx. The oropharynx is common to the respiratory and digestive systems as a
passageway for air, food, and drink. For the oropharynx to withstand the possible abra-
sions caused by the passage of solid food, it must be lined with a more durable tissue—
stratified squamous epithelial tissue. In addition, the palatine tonsils are located in this
region to deal with any incoming pathogens.

462 CHAPTER 12 The Respiratory System

Laryngopharynx This region of the pharynx extends from the level of the epiglot-
tis to the beginning of the esophagus. Like the oropharynx, the laryngopharynx is
lined by stratified squamous epithelial tissue to handle the passage of air, food, and
drink. See Figure 12.4c. Solids and liquids continue on from the laryngopharynx to
the esophagus, but inspired air moves through an opening (glottis) to the larynx, the
next structure in the respiratory pathway.

Epiglottis Epiglottis

Hyoid Hyoid
bone bone

Laryngeal Fat
prominence
Corniculate
Thyroid cartilage Thyroid
cartilage cartilage

Arytenoid
Cricoid
cartilage
cartilage Vestibular
fold (false
Cricoid vocal cord)
Tracheal
cartilage
Trachea cartilage

Membranous Vocal fold

part of trachea (true vocal
cord)
(a) (b) (c)

FIGURE 12.5 The larynx: (a) anterior view, (b) sagittal section, (c) posterior view.

Larynx
The larynx is a cartilage box (voice box) of nine separate cartilages, eight of which
are composed of hyaline cartilage connective tissue. The epiglottis (the ninth cartilage
of the larynx) is composed of elastic cartilage connective tissue. As you can see in
Figure 12.4b, the epiglottis stands almost
vertically over the glottis. Its function is
to fold over the glottis during swallowing Vestibular
to prevent solids and liquids from enter- fold
ing the larynx. You will learn more about
how this works in the digestive system Vocal cord
chapter. The epiglottis remains in its ver- Glottis
tical position at all other times to ensure
the easy passage of air from the laryngo- Corniculate
cartilage
pharynx through the glottis to the larynx. (a) (b)
Figure 12.5 gives you a closer look at
the larynx. Here you can see the laryn- Thyroid cartilage
geal prominence (“Adam’s apple”) of Epiglottis
the thyroid cartilage. It enlarges to be Cricoid cartilage
more visible in men than women due to Vestibular
Vocal cord
the presence of testosterone. You can also fold
Glottis
see (in this figure) the two arytenoid Arytenoid
Inner lining
cartilages (ah-RIT-en-oyd) and the two cartilage
of trachea
corniculate cartilages (kor-NIK-you- Corniculate
(c) cartilage (d)
late) that operate the vocal cords.
FIGURE 12.6 Action of laryngeal muscles on the vocal cords: (a) adduction
Vocal Cords The walls of the larynx showing just the cartilages and the vocal cords, (b) adduction as seen with all
are muscular to operate the vocal cords tissues present, (c) abduction showing just the cartilages and the vocal cords,
shown in Figures 12.5b, 12.6, and 12.7. (d) abduction as seen with all tissues present.

12.3 Anatomy of the Respiratory System 463

 There are two sets of folds in the inner wall of the larynx—the
Anterior vestibular folds and the vocal cords. The vestibular folds have no
function in speech. They are important in closing the larynx during
Epiglottis swallowing.
Glottis
Figure 12.6 shows how the vocal cords are abducted (spread apart)
and adducted (brought closer together) by muscles pulling on the ary-
Vestibular fold
tenoid and corniculate cartilages. The opening formed by abducting
Vocal cord the vocal cords is the glottis. Air passing through adducted vocal cords
causes them to vibrate to make sounds of varying pitch depending on
Trachea
the tautness of the cords. So speech is a very active process, which
Corniculate
involves muscles pulling on cartilages of the larynx to operate the
cartilage vocal cords. The larynx at the vocal cords is lined with stratified squa-
mous epithelial tissue to withstand the vibrations.

Posterior
Trachea
From the larynx, inspired air travels to the trachea, a rigid tube with
FIGURE 12.7 Endoscopic view of the vocal 18 to 20 C-shaped cartilages composed of hyaline cartilage con-
cords as seen with a laryngoscope. nective tissue. See Figure 12.8. These cartilages hold the trachea
©CNRI/SPL/Getty Images open for the easy flow of air. The C-shaped cartilages are open

Larynx

C-shaped
cartilage
Trachea

Bronchi and
bronchial
tree

(a)
Anterior

Mucus C-shaped
Ciliated
hyaline
epithelial cell
Mucociliary cartilage
escalator
Goblet Ciliated
epithelial epithelium
Particles of
debris cell
Mucous
Cartilage gland

Lumen of
Mucous
trachea
gland
Connective
Chondrocytes tissue

Smooth
muscle

Posterior
(b) (c)

FIGURE 12.8 The trachea and bronchi: (a) anterior view, (b) longitudinal view of the trachea showing cilia moving mucus and
debris , (c) transverse section of the trachea showing C-shaped cartilage.

464 CHAPTER 12 The Respiratory System

 FIGURE 12.9 Lining of
trachea: epithelial tissue of the
trachea, showing ciliated cells
and goblet cells.
©NIBSC/SPL/Getty Images

Goblet cell

Cilia

4 μm

posteriorly with smooth muscle bridging the gap. This feature allows the esophagus
(directly posterior to the trachea) room to expand into the tracheal space when swal-
lowed food passes on its way to the stomach. If the cartilages were circular instead
of C-shaped, a swallowed piece of meat could get hung up on each cartilage as it
passed down the esophagus.
Like the nasal cavity and the nasopharynx, the trachea is lined with ciliated
pseudostratified columnar epithelial tissue with goblet cells that secrete mucus. See
Figures 12.8 and 12.9. The air you breathe is full of particles, such as dust, pollen,
and smoke particles. You may have seen the dust in the air as the sun shines through
a window. Even during sleep, the cilia of the trachea move mucus and any trapped
debris up (like an escalator) toward the pharynx to be swallowed. See Figure 12.8b.
This prevents the accumulation of debris in the lungs.

Disease P int
The smoke inhaled with each drag on a cigarette contains
a lot of particles, but the respiratory anatomy is designed
to prevent this debris from accumulating in the lungs.
However, the increased amount of debris may, over
time, cause the lining of a habitual smoker’s trachea to
go through metaplasia, changing from ciliated epithelial
tissue to a more durable, nonciliated tissue. Without
the ciliated escalator, the respiratory system resorts to
coughing up the debris. As a result, the long-term smoker
develops the smoker’s hack each morning to move the
debris inspired each night.
©PictureNet/Getty Images

12.3 Anatomy of the Respiratory System 465

 Spot Check Compare the direction the cilia move debris in the nasopharynx to
the direction they move debris in the trachea. How do they differ?

Spot Check A patient on a ventilator has a tube inserted into the trachea through
a procedure called a tracheostomy. What should be done to the air delivered through a
ventilator considering the respiratory anatomy leading to the trachea has been bypassed?

The trachea splits to become the right and left main bronchi, each of which enters
its respective lung. You will explore the lungs and bronchial tree together, looking first
at their gross anatomy, as shown in Figure 12.10.

Lungs and the Bronchial Tree

As you can see in Figure 12.10b, the right and left main bronchi each enters its
respective lung at an area on the medial surface of the lung called the hilum. This
is the same ___location used by pulmonary arteries and veins to enter and leave the
lung. The left bronchus (BRONG-kuss) is slightly more horizontal than the right
bronchus due to the ___location of the heart. The main bronchi and all of their further
branches make up the bronchial tree. See Figure 12.10c.
Upon entering the lung, each main bronchus branches to become the lobar bronchi,
each going to a separate lobe of the lung. The left lung has fewer lobes (two) than the
right, again because of the position of the heart. The right lung has three lobes, and
therefore three lobar bronchi.
FIGURE 12.10 Gross anatomy
Apex of lung Larynx
of the lungs and bronchial
tree: (a) anterior view;
(b) medial views of the right Right superior
(upper) lobe Trachea
and left lungs; (c) bronchogram
(radiograph of the bronchial
tree), anterior view. Right main
bronchus Left superior
©Walter Reiter/Medical Images
(upper) lobe
Superior lobar
bronchus

Small bronchus
of bronchial tree Cardiac
impression
Terminal
bronchiole

Right inferior
(lower) lobe
Left inferior
(lower) lobe
Right middle lobe
(a)

Apex
Superior lobe

Pulmonary arteries
Hilum Hilum
Main bronchi
Middle Pulmonary veins Cardiac
lobe impression
Inferior lobe

Diaphragmatic
surface
(b) Right lung Left lung

466 CHAPTER 12 The Respiratory System

 FIGURE 12.10 Gross anatomy
of the lungs and bronchial tree
(continued ).

Trachea

Main bronchi

Lobar bronchi

Small bronchi of
the bronchial tree

(c)

Common Misconception
The lungs fill with air, but they are not hollow like a balloon. A cross section of a lung
appears solid—more like Styrofoam composed of tiny beads. Each of the tiny beads is
a tiny, hollow air sac that can fill with inspired air. See Figure 12.11.

Anterior

Breast
Pericardial
cavity Sternum

Ribs
Heart

Left lung

Right lung
Visceral
pleura
Aorta
Pleural
cavity Vertebra

Spinal cord
Parietal
pleura

Posterior

FIGURE 12.11 Cross section of a cadaver through the thoracic cavity.

©McGraw-Hill Education/Rebecca Gray

12.3 Anatomy of the Respiratory System 467

 Lobar bronchi further divide to smaller and smaller bronchi that branch to form
the bronchial tree. See Figure 12.10c. All of the bronchi are supported by cartilage
plates, which hold them open for the easy passage of air. The smallest bronchi further
branch to form bronchioles. These small tubes do not have cartilage in their walls.
Instead, their walls have smooth muscle that allows them to dilate or constrict to
adjust airflow. You will learn more about this later in the chapter. Each bronchiole
supplies air to a lobule (subsection of a lobe) of the lung composed of tiny air sacs
called alveoli. See Figure 12.12a.

Blood flow
Pulmonary Blood flow
venule Pulmonary Bronchioles Pulmonary
arteriole vein
Pulmonary
artery

Blood flow Smooth

muscle
Capillary network on
surface of alveolus

Alveolar
sac

Alveoli
(a)
Respiratory
Great alveolar membrane:
Macrophage cell Alveolar
fluid (with
Air space surfactant)
Alveolus
within
alveolus Single
squamous
Nucleus of cell alveolar
simple wall
Diffusion
squamous of O2
alveolar cell Single cell
capillary
Fluid with wall
Diffusion
surfactant of CO2

Pulmonary
capillary Red blood
endothelium cell
(wall) Capillary

(b) (c)

FIGURE 12.12 Bronchiole, alveoli, and the respiratory membrane: (a) clusters of alveoli at the end of a bronchiole and the
network of capillaries covering them, (b) cells of the alveoli, (c) respiratory membrane.

Spot Check Penny is an inquisitive 18-month-old girl who likes to see what fits
into what. One morning, she put a small, metal washer that she found on the floor into her
nose just as her mother entered the room. Her mother gasped when she saw what Penny
had done. This scared Penny, so she gasped, too, and the metal washer was gone. She
had inhaled it. What route do you think the metal washer will take (trace the pathway)?

Spot Check In which lung will the doctor at the clinic find the metal washer?
Explain.

468 CHAPTER 12 The Respiratory System

Alveoli

Learning Outcomes
3. Explain the role of surfactant.
4. Describe the respiratory membrane.

The alveoli are clustered like grapes at the end of the bronchiole. As you can see in
Figure 12.12, a network of capillaries covers the alveoli. This is vital for gas exchange,
as you will read shortly. Figure 12.13 shows the histology of the alveoli with respect to
the bronchioles and blood supply to the capillaries. There are approximately 150 million
alveoli in each human lung. Each alveolus is a tiny air sac with two types of cells in its
walls—simple squamous cells and great alveolar cells. Most of the alveolar wall is com-
posed of one layer of thin squamous cells that allow for rapid gas exchange across their
surface. The great alveolar cells (shown in Figure 12.12b) are important because they
secrete a fluid called surfactant. Next, you will find out why this fluid is so important.

FIGURE 12.13 Histology of

Alveoli the lung: micrograph of alveoli,
a bronchiole, and a branch of a
pulmonary artery.
©Ed Reschke/Photolibrary/Getty
Images

Alveolar duct

Bronchiole:
Epithelium
Smooth muscle

Branch of
pulmonary artery

1 mm

Spot Check Why must the vessel represented in this figure be an artery and not
a capillary, and why must the tube be a bronchiole and not a bronchus of the bronchial
tree? (Hint: Look at the histology.)

Surfactant To understand the importance of surfactant, you must first understand a

property of water: high surface tension. This basically means that water will always try to
have the smallest surface area to volume ratio possible. In other words, water forms beads
or drops because a sphere has a smaller surface area to volume ratio than a flat sheet. This
is why water forms beads or drops on smooth surfaces like glassware in your dishwasher.
Surfactant reduces the surface tension of water much like the rinse agent you may
add to your dishwasher to avoid water spots. The rinse agent reduces the surface tension

12.3 Anatomy of the Respiratory System 469

 of water (sheeting action), so water sheets off your glassware instead of forming beads
that leave water spots as the glasses dry. Surfactant also causes water to form a thin
sheet instead of a bead. Why is this important? By the time air has entered the alveoli,
it has been thoroughly moisturized by all the mucous membranes it has passed along
the respiratory route. If a bead of water were to form inside the tiny alveoli, the plump
bead might touch the wall on the opposite side of the air sac and cause the thin, delicate
walls of the alveoli to stick together, and this would cause the alveoli to collapse. A thin
sheet of water in the alveoli (instead of a plump bead) reduces the chance of the alveoli
walls collapsing on each other. Collapsed alveoli do not easily fill with air.

Disease P int
A fetal respiratory system does not mature until late
in pregnancy. The alveoli in infants born before the
lungs are mature often collapse because of the lack of
sufficient surfactant. This condition, called respiratory
distress syndrome (hyaline membrane disease), is a
common cause of neonatal death. Oxygen under positive
pressure can be administered along with surfactant to
keep the lungs (alveoli) inflated between breaths.
©Brand X Pictures/PunchStock

Respiratory Membrane So far, you have seen in Figure 12.12a and b the rela-
tionship of the alveoli to the bronchioles and the cells that make up the alveoli. In
Figure 12.12c, you can see the structure formed by the capillary network adjacent to
the alveoli—the respiratory membrane. This is a very important structure because it is
the ___location of gas exchange in the lung. Take a closer look at this figure. The respira-
tory membrane is composed of the thin layer of water with surfactant in the alveoli, the
single squamous cell alveolar wall, and the single cell capillary wall. If all of the respira-
tory membrane in one lung were laid out in a single layer, it would cover approximately
70 square meters (m2), equivalent to the floor of a room 25 feet by 30 feet.
You have now covered all of the anatomy that the air of your deep breath encountered
along its way to the respiratory membrane. It is time to explore the way this respiratory
anatomy functions, starting with how you took the deep breath in the first place.

12.4 Physiology of the Respiratory System

Mechanics of Taking a Breath

Learning Outcome
5. Explain the mechanics of breathing in terms of anatomy and pressure gradients.

Air moves (but is not pushed) along the respiratory passageways on its way to the lungs
because of pressure differences within the chest. This is much like the syringe example
you became familiar with while studying blood flow through the heart (see Figure 10.12
in “Chapter 10, The Cardiovascular System—Heart and Vessels”). The syringe example
explained the relationship between volume, pressure, and flow. If the volume of space in
the syringe is increased, the pressure inside the syringe is decreased, so air flows into the
syringe to equalize the pressures inside and outside the syringe. Likewise, if the volume
of space in the syringe is decreased, the pressure inside the syringe is increased, so air
flows out of the syringe to equalize the pressures. As a result, pushing or pulling on the
plunger changes the volume of the syringe.
How does the body change the volume of the chest? See Figure 12.14. Concentrate
on the major muscles for breathing in this figure. As you can see in Figure 12.14a and b,

470 CHAPTER 12 The Respiratory System

during inspiration the external intercostal, pectoralis minor, and sternocleidomastoid
muscles contract to expand the rib cage, and the diaphragm contracts to flatten its dome
shape. The combined effect of these contractions is an increase in the size (volume) of the
chest cavity. All that needs to be done for normal expiration is to have the same muscles
relax. Then the rib cage returns to its normal position and the diaphragm becomes dome-
shaped again due to the recoil of abdominal organs. See Figure 12.14c. The volume of
the chest is decreased, and air flows from the body. Expiration during normal breathing
is a passive process (no energy required) involving the relaxation of muscles. But you
can also see in Figure 12.14d that forced expiration involves the contraction of muscles
too. The internal intercostals and abdominal wall muscles do contract in forced expira-
tion; however, these muscles are not used for expiration during normal breathing. Forced
expiration is intentionally forcing air out of the lungs, which happens when blowing out a
candle or inflating a balloon. In this case, energy for muscle contraction is required.
So far in this explanation of the mechanics of breathing, you have seen how the muscles
of the chest can increase the volume of the chest, but what about the volume of each lung?
How is the volume of the lungs increased? This involves the pleural membranes and the
pleural fluid. The parietal pleura is attached to the thoracic wall and diaphragm, while the
visceral pleura is attached to the lung. The pleural fluid between the parietal and visceral
pleurae cause the two pleurae to stick together and move as one. As the respiratory mus-
cles expand the thoracic wall and flatten the diaphragm, the parietal pleura moves with the
wall and diaphragm. As the parietal pleura moves with the thoracic wall and diaphragm,
the visceral pleura and the lung move with it—expanding the lung along with the tho-
racic cavity. As the lung expands, the pressure within the lung (intrapulmonary pressure)
decreases, so air moves in until the pressure inside the lung is equal to the pressure outside
the body. The intrapulmonary and atmospheric pressures are then equal. When inspira-
tion ends, the thoracic wall returns to its original position and its volume is diminished.

Sternocleidomastoid
elevates sternum

Sternum
moves
up and out Pectoralis minor
elevates ribs
External
intercostal
muscles pull
ribs up and out

Diaphragm
contracts
Diaphragm
contracts more

(a) (b)

FIGURE 12.14 Respiratory muscles: (a) external intercostal muscles and diaphragm at the beginning of inspiration; (b) additional
muscle action to continue inspiration; (c) recoil of abdominal organs, causing diaphragm to dome when it relaxes; (d) muscle actions
during forced expiration.

12.4 Physiology of the Respiratory System 471

(a) (b)
FIGURE 12.14 Respiratory muscles (continued).

Posterior internal
intercostal muscles
pull ribs down and
inward
Diaphragm

Diaphragm
Abdominal organs
recoil and press Abdominal organs
diaphragm upward force diaphragm
higher

Abdominal wall
muscles contract
and compress
abdominal organs

(c) (d)

Disease P int
A pneumothorax (collapsed lung) occurs if air is introduced in the pleural cavity
between the pleural membranes. Just as fluid holds the parietal and visceral pleurae
together, air between the pleurae allows them to separate. Normally, there is tension
on the lung, keeping it partially inflated at all times. However, in a pneumothorax, the
pleurae separate, so the lung may recoil and separate from the thoracic wall. The air
in a pneumothorax may be introduced by a penetrating trauma like a knife wound
or broken rib, medical procedures such as inserting a needle to withdraw pleural
fluid, or even a disease like emphysema (covered later in this chapter). Diagnosis of a
pneumothorax involves listening to breath sounds to determine if they are absent or
decreased, doing a chest X-ray, and testing arterial blood gases to determine if there
is an adequate ratio of O2 and CO2 in the blood. In mild cases, the pneumothorax
may correct itself without medical intervention. In more severe cases, a chest tube
may need to be introduced into the pleural space to remove the air to inflate the
lung, and surgery may be required to repair the opening into the pleural space. In
a hemothorax, blood is introduced into the pleural cavity. This can be caused by
blood clotting defects, thoracic surgery, severe respiratory infections, or lung cancer.
If the hemothorax is not treated, it can lead to a pneumothorax, among other severe
complications. Diagnosis of a hemothorax includes listening to breath sounds to
determine if they are absent or decreased, doing a chest X-ray and a CT scan of
the lungs, and analyzing pleural fluid to determine the presence of blood. Treatment
involves controlling the cause of the bleeding and inserting a chest tube to remove
the blood from the pleural cavity. In severe cases, surgery may be necessary.

472 CHAPTER 12 The Respiratory System

The pressure is now greater in the lung than outside the body, so air flows from the body
until the intrapulmonary and atmospheric pressures are again equal. Figure 12.15 shows
the muscle action and the pressure changes during inspiration and expiration.

No airflow

Atmospheric pressure
Pleural cavity

Intrapulmonary pressure
Diaphragm

1
At rest

Rib

Rib Rib

Rib
Sternum Sternum Sternum Sternum
Ribs elevated, thoracic Sternum swings up, Ribs depressed, thoracic Sternum swings down,
cavity expands laterally thoracic cavity expands cavity narrows thoracic cavity contracts
anteriorly posteriorly

2 3
Inspiration Expiration

Airflow
Airflow

Diaphragm flattens Diaphragm rises

FIGURE 12.15 A respiratory cycle of inspiration, expiration, and rest. (1) At rest, atmospheric and intrapulmonary pressures are
equal, and there is no airflow. (2) In inspiration, the thoracic cavity expands laterally, vertically, and anteriorly; intrapulmonary pressure
falls below atmospheric pressure; and air flows into the lungs . (3) In expiration, the thoracic cavity contracts in all three directions,
intrapulmonary pressure rises above atmospheric pressure, and air flows out of the lungs . There is a rest between breaths.

12.4 Physiology of the Respiratory System 473

 Measurements of Pulmonary Function

Learning Outcome
6. Define the measurements of pulmonary function.

How well the respiratory system functions to move air into and out of the lungs can be
measured in pulmonary function (spirometry) tests. A spirometer is a device used to
measure the volume of air moved. Figure 12.16 shows a photo of Gabe, who is breath-
ing into the spirometer to determine his various lung volumes and lung capacities
(capacities are determined by adding two volumes). Table 12.1 defines the various
values, and Figure 12.17 shows a graph of Gabe’s values.

FIGURE 12.16
Spirometry. A spirometer is
used to measure lung volumes
and capacities.
©Edwige/BSIP/Medical Images

Exercise may temporarily increase the tidal volume for an individual, but this
does not mean that all of the other values will increase. The maximum amount
of air the respiratory system can move (vital capacity) does not change on a tem-
porary (minute-by-minute) basis. So if there is an increase in tidal volume dur-
ing a workout, there must be a decrease in the inspiratory and expiratory reserve
volumes.
Lung volumes and capacities vary from one individual to another due to gender,
size, age, and physical condition. In general, a woman’s vital capacity is less than a
man’s; a tall, thin person has a greater vital capacity than someone short and obese;
and a trained athlete has a greater vital capacity than someone who has a sedentary
lifestyle.
Compliance is another measurement of pulmonary function. It measures how well
the lung can expand and return to shape (elasticity). It is harder to expand the lungs
and the thorax if there is decreased compliance. This may be due to the buildup of scar
tissue in the lung (pulmonary fibrosis), collapse of the alveoli (respiratory distress syn-
drome), skeletal disorders (scoliosis or kyphosis), or chronic obstructive pulmonary
disorders (COPDs) such as asthma, chronic bronchitis, emphysema, and lung
cancer (discussed later in the chapter).

474 CHAPTER 12 The Respiratory System

 TABLE 12.1 Lung Volumes and Capacities
Volume or Capacity Definition Typical Value
Tidal volume (TV) The tidal volume is the amount of air moved in a normal 500 mL
breath (inspired or expired) at rest.
Inspiratory reserve volume (IRV) The inspiratory reserve volume is the amount of air that 3,000 mL
can be forcefully inspired beyond the amount inspired in
a normal breath at rest.
Expiratory reserve volume (ERV) The expiratory reserve volume is the amount of air that 1,100 mL
can be forcefully expired beyond the amount expired in a
normal breath at rest.
Residual volume (RV) The residual volume is the amount of air in the lungs that 1,200 mL
cannot be moved.
Functional residual capacity (FRC) The functional residual capacity is the amount of air 2,300 mL
remaining in the lungs after the expiration of a normal
breath at rest. FRC = ERV + RV
Inspiratory capacity (IC) The inspiratory capacity is the maximum amount of air 3,500 mL
that can be inspired after the expiration of a normal
breath at rest. IC = TV + IRV
Vital capacity (VC) Vital capacity is the maximum amount of air that can be 4,600 mL
moved. VC = IC + FRC
Total lung capacity (TLC) The total lung capacity is the maximum amount of air the 5,800 mL
lung can hold. TLC = VC + RV

6,000 6,000
Maximum TLC
inspiration

5,000 5,000

4,000 4,000
Volume (mL)

Volume (mL)

3,000 3,000

IRV

TV IC
2,000 2,000

Maximum
RV
1,000 expiration 1,000
ERV VC

0 0
Time
(a) (b)

FIGURE 12.17 Graphs of pulmonary volumes and capacities: (a) graph showing normal breaths and maximum inspiration
and expiration, (b) graph representing the volumes (shown in blue) and capacities (shown in green) represented in graph (a)
(TV = tidal volume, IRV = inspiratory reserve volume, ERV = expiratory reserve volume, RV = residual volume, IC = inspiratory
capacity, VC = vital capacity, TLC = total lung capacity).

12.4 Physiology of the Respiratory System 475

 At this point, you have become familiar with the anatomy of the respiratory system
and how it works to deliver air into and out of the lungs. You can now begin to explore
the second part of respiration—the exchange of gases—by looking at the gases present
in the air you breathe.

Composition of Air

Learning Outcome
7. Define partial pressure and explain its relationship to a gas mixture such as air.

Gases diffuse across membranes from high concentration to low concentration until
the concentrations are equal. So it is important to be able to talk about quantities of
gases. The air you breathe is a mixture of gases—78.6% nitrogen, 20.9% oxygen, 0.04%
carbon dioxide, and variable amounts of water vapor depending on humidity levels.
Gases fill whatever space is available to them and can be compressed, so volume is not
a good measure of the amount of a gas. For example, an open scuba tank (of a given
volume) will fill with air, but more air can be pumped under pressure into the same
tank before it is sealed (compressed air). Therefore, the amount of a gas is expressed
not as volume but in terms of the pressure a gas exerts. In the case of a mixture of
gases, like air, the amount of each gas is expressed as a partial pressure—the amount
of pressure an individual gas contributes to the total pressure of the mixture. So, if the
total pressure of the air (atmospheric pressure) is 760 mmHg, then the partial pressure
of nitrogen (PN2) is 78.6% of 760, or 597 mmHg; the partial pressure of oxygen (PO2)
is 20.9% of 760, or 159 mmHg; the partial pressure of carbon dioxide (PCO2) is 0.04%
of 760, or 0.3 mmHg; and the remainder, 3.7 mmHg, is the partial pressure of water
vapor. All of the partial pressures of the gases added together equal the total pressure
of the air (760 mmHg).
You will need to understand partial pressures as a measurement of the amount of a
gas when you study gas exchange in the lung and out at the tissues in the next section
of this chapter.

Spot Check The atmospheric pressure in Miami on Wednesday was

760 mmHg. However, the atmospheric pressure in Denver on the same day was
640 mmHg. What was the partial pressure of CO2 in Denver that day? What was the
partial pressure of O2?

Gas Exchange

Learning Outcome
8. E
 xplain gas exchange in terms of the partial pressures of gases at the capillaries and
the alveoli and at the capillaries and the tissues.

Before studying gas exchange, it will be helpful for you to keep these two facts in mind:
(1) Carbon dioxide is a waste product produced in the tissues through cellular respira-
tion, and (2) blood travels to the lungs to be oxygenated. With that stated, we begin
by explaining gas exchange at the respiratory membrane between an alveo-
lus and a capillary in the lung. In this discussion, we use general symbols—greater
than (>), less than (<), and equal (=)—instead of worrying about specific values for
the moment. Follow along with the numbered steps in Figure 12.18 as you read this
section on gas exchange.

476 CHAPTER 12 The Respiratory System

 Common Misconception
Oxygen and carbon dioxide diffuse across a membrane because of a difference in concen-
tration (concentration gradient) of the same gas. You must compare apples to apples and
oranges to oranges, never apples to oranges. In other words, always compare the PO on
2
one side of the respiratory membrane to the PO on the other side of the membrane, and
2
then compare the PCO on one side of the respiratory membrane to the PCO on the other
2 2
side of the membrane. Never compare the PCO to the PO . Oxygen diffuses only if there is a
2 2
concentration gradient for oxygen across the respiratory membrane. Carbon dioxide diffuses
only if there is a concentration gradient for carbon dioxide across the respiratory membrane.

Alveolus in lung

4 O2 1
In the lung, In the lung,
PCO2 alveolus < PCO2 capillary; PO2 alveolus > PO2 capillary;
therefore, CO2 diffuses therefore, O2 diffuses
into the alveolus until into the capillary until
PCO2 alveolus = PCO2 capillary. Capillary in lung PO2 alveolus = PO2 capillary.
CO2

Capillary at tissues O2

3 2
At the tissues, At the tissues,
PCO2 tissues > PCO2 capillary; PO2 capillary > PO2 tissues;
therefore, CO2 diffuses CO2 therefore O2 diffuses into
into the capillary until the tissues until
PCO2 tissues = PCO2 capillary. PO2 capillary = PO2 tissues.

Tissues of the body

Indicates direction of diffusion

FIGURE 12.18 Gas exchange between capillaries and alveoli in the lung and between capillaries and tissues in the body.

12.4 Physiology of the Respiratory System 477

 1. Blood coming from the right side of the heart to the lung is low in oxygen. In com-
parison, the air inspired to the alveolus in the lung is high in oxygen. PO2 alveolus >
PO2 capillary, so oxygen diffuses across the respiratory membrane into the blood of
the capillary until the partial pressures on both sides of the respiratory membrane
are equal: PO2 alveolus = PO2 capillary. Will there still be some oxygen left in the alveolus
after the gas exchange has taken place? Yes, because not all of it diffused into the
blood; only the amount of oxygen necessary to make the partial pressures equal
on both sides diffused. Some oxygen will be expired from the alveolus.
2. The oxygen-rich blood travels from the lung to the left side of the heart before trav-
eling to the capillaries at the tissues of the body. Here the tissues have been using
oxygen to perform cellular respiration: C6H12O6 + 6O2 → 6CO2 + 6H2O. As a
result, the tissues are relatively low in oxygen compared to the high amount in the
blood in the capillary: PO2 capillary > PO2 tissues. So oxygen diffuses into the tissues until
the partial pressure of oxygen in the blood equals the partial pressure of oxygen in
the tissues: PO2 capillary = PO2 tissues.
3. Meanwhile, mitochondria in the cells of the tissues have been producing carbon
dioxide as a waste product of cellular respiration. As a result, the concentration
of carbon dioxide is much higher in the tissues than in the blood of the capillary:
PCO2 tissues > PCO2 capillary. So carbon dioxide diffuses into the blood of the capillary
until the concentrations are equal: PCO2 tissues = PCO2 capillary.
4. The blood leaving the capillaries at the tissues of the body travels to the right side of
the heart before returning to the lungs. It has lost some of its oxygen and has gained
carbon dioxide through diffusion at the tissues of the body. So it makes sense to
have started this explanation of gas exchange by saying the blood coming to the
lungs was oxygen-poor. It makes just as much sense to say the partial pressure of
carbon dioxide is greater in the blood of the capillary at the alveolus than in the
air of the alveolus because there is so little carbon dioxide in inspired air (0.04%):
PCO2 capillary > PCO2 alveolus. So carbon dioxide diffuses across the respiratory membrane
to the alveolus until the partial pressure of carbon dioxide in the capillary equals
the partial pressure of carbon dioxide in the alveolus. PCO2 capillary = PCO2 alveolus.

Comparison of Inspired and Expired Air

Learning Outcome
9. Compare the composition of inspired and expired air.

Given what you have read about the composition of air and gas exchange, you should
be able to compare the composition of inspired and expired air. For this comparison,
you will examine gas exchange using specific values. See Figure 12.19. As you can
see in this figure, inspired air has more oxygen than expired air, and inspired air has
less carbon dioxide than expired air.

Factors That Influence Gas Exchange

Learning Outcome
10. Explain the factors that influence the efficiency of alveolar gas exchange.

Several factors influence the effectiveness of alveolar gas exchange. They are explained
in the following list:
• Concentration of the gases. The concentration of the gases matters because the
greater the concentration gradient, the more diffusion takes place. For example,
gas exchange of oxygen will increase if a patient is administered oxygen instead

478 CHAPTER 12 The Respiratory System

 FIGURE 12.19 Changes in PO2
Inspired air Expired air and PCO2 along the respiratory
PO2 = 160 PO2 = 120 route. Values are expressed in
PCO2 = 0.3 PCO2 = 27 mmHg. (a) Oxygen diffuses into
the arterial ends of pulmonary
capillaries, and CO2 diffuses
into the alveoli because of
Alveolus differences in partial pressures.
(b) As a result of diffusion (at the
PO2 = 104 PCO2 = 40 PO2 = 104 PCO2 = 40 venous ends of the pulmonary
capillaries), the concentrations
(a) (b) of O2 are equal on both sides
of the respiratory membrane, as
PO2 = 40 PCO2 = 45 PO2 = 104 PCO2 = 40 are the concentrations of CO2
on both sides of the respiratory
Pulmonary capillary
membrane. (c) The partial
pressure of O2 is reduced in
the pulmonary veins due to the
(c) mixing of blood drained from
Blood in the bronchi and bronchial tree.
PO2 = 95 pulmonary veins (d) Oxygen diffuses out of the
PCO2 = 40 arterial end of capillaries to the
tissues, and CO2 diffuses out
of the tissues to the capillaries
due to the differences in partial
pressures. (e) As a result of
Right Left diffusion (at the venous ends
of tissue capillaries), the
concentrations of O2 are equal
in the capillaries and the tissues,
Heart
as are the concentrations of
CO2 in the capillaries and the
tissues.

Tissue capillary

PO2 = 40 PCO2 = 45 PO2 = 95 PCO2 = 40

(e) Interstitial (d)

fluid
PO2 = 40 PCO2 = 45 PO2 = 40 PCO2 = 45

PO2 = 20 PCO2 = 46

Tissue cells

12.4 Physiology of the Respiratory System 479

 Fluid and blood Alveolar walls
cells in alveoli thickened by edema

(a) (b) (c)

FIGURE 12.20 Influences on gas exchange: (a) normal alveoli, (b) alveoli of pneumonia patient, (c) alveoli of emphysema patient.

of breathing room air. In contrast, gas exchange of oxygen will be less at higher
altitudes because the air is thinner and does not contain as much oxygen.
• Membrane area. Membrane area matters because the greater the area of
the respiratory membrane, the greater the opportunity for gas exchange. For
example, Figure 12.20 shows alveolar tissue for a healthy individual, a pneu-
monia patient, and a person with emphysema. You will notice the lack of respi-
ratory membrane for the emphysema patient. This is because emphysema breaks
down the alveolar walls. The reduced membrane area means less gas will be
exchanged.
• Membrane thickness. The thickness of the respiratory membrane matters because
the thicker the membrane, the harder it is for gases to diffuse across it. Look again
at Figure 12.20. Pneumonia may cause excess fluid in the alveoli and swelling of
the alveolar walls, which make gas exchange much more difficult.
• Solubility of the gas. Gases must be able to dissolve in water if they are to diffuse
across a membrane into the blood. For example, nitrogen is 78.6% of the air you
breathe, but it does not diffuse across the respiratory membrane because it is not
soluble at normal atmospheric pressure. Oxygen and carbon dioxide are soluble at
normal atmospheric pressure.

Spot Check Grace administered CPR to a nonbreathing accident victim without

a pulse. She did chest compressions to help circulate the victim’s blood. She also inspired
air and then blew expired air into the victim. Why does Grace’s expired air help the patient
in terms of gas exchange? Explain in terms of the partial pressures involved.

Clinical P int
Scuba divers breathe air from their tanks. It is not pure oxygen; it is air that has
been compressed so that the tank can hold more. If divers go to significant depths,
nitrogen becomes soluble because of the increased pressure—every 10 meters of
water is equal to another full atmosphere of pressure. Although nitrogen can then
diffuse across the respiratory membrane, this is all right because nitrogen does

480 CHAPTER 12 The Respiratory System

 not react with anything in the blood. It becomes very relevant, however, during the
ascent from the dive. If the diver comes up too quickly, nitrogen comes out of solu-
tion as a gas wherever it is in the body. This is similar to club soda being uncapped
and poured. See Figure 12.21. Removing the
cap relieves the pressure within the can or
bottle. The carbon dioxide in the club soda
quickly comes out of solution as bubbles with
the reduced pressure. The nitrogen bubbles
can cause severe damage to the diver’s
nerves and other tissues. Divers must ascend
very slowly to allow nitrogen to slowly come
out of solution, diffuse across the respiratory
membrane in the alveoli, and be exhaled.
Decompression sickness, or the bends, is
the disorder that results if a diver ascends
from depths too quickly. The treatment is
to put the diver immediately in a hyperbaric
(increased-pressure) chamber and put the
body under sufficient pressure to have the
nitrogen dissolve again and then to slowly FIGURE 12.21 Glass of club
decrease the pressure so that the nitrogen soda.
can be exhaled. ©robert-sijan/iStock/Getty Images

• Ventilation-perfusion coupling. This basically means that the airflow to the lung
must match the blood flow to the lung. Ideally, the maximum amount of air should
go to where there is the maximum amount of blood in the lung. This is accom-
plished through local control in two ways:
1. Lung perfusion (blood flow to alveoli). As blood flows toward alveolar
capillaries, it is directed to lobules in the lung where the partial pressure of
oxygen is high. How? Alveolar capillaries constrict where the partial pres-
sure of oxygen is low, so blood is diverted to where the partial pressure of
oxygen is high.
2. Alveolar ventilation (airflow to alveoli). Smooth muscles in the walls of
bronchioles are sensitive to the partial pressure of carbon dioxide. If the
partial pressure of carbon dioxide increases, the bronchioles dilate. If the
partial pressure of carbon dioxide decreases, the bronchioles constrict. Air-
flow is therefore directed to lobules where partial pressure of carbon dioxide
is high.
Ventilation-perfusion coupling is very important because it allows the respiratory sys-
tem to compensate for damaged lung tissue. If an area of the lung is damaged, less air
and less blood are directed to that area. See Figure 12.22.

Spot Check The atmospheric pressure is 760 mmHg in New York City and
630 mmHg in Breckenridge, Colorado. In which city should more gas exchange take
place? Explain.

12.4 Physiology of the Respiratory System 481

 Decreased PO2 in alveoli Increased PO2 in blood
causes consriction of vessels causes dilation
pulmonary vessels. of pulmonary vessels.

Blood flow to alveoli Blood flow to alveoli

is decreased. is increased.

If airflow decreases Blood flow matches airflow. If airflow increases

(a)

If blood flow decreases If blood flow increases

Decreased PCO2 in alveoli causes Airflow matches blood flow. Increased PCO2 in alveoli causes
constriction of bronchioles. dialation of bronchioles.

Airflow to alveoli Airflow to alveoli

is decreased. is increased.
(b)

FIGURE 12.22 Ventilation-perfusion coupling: (a) perfusion adjusted to changes in

ventilation, (b) ventilation adjusted to changes in perfusion.

Gas Transport

Learning Outcome
11. Describe the mechanisms for transporting O2 and CO2 in the blood.

You have now studied how carbon dioxide and oxygen are exchanged across mem-
branes into and out of the blood, but how are these gases carried in the blood from one
place to another? To understand gas transport, first look at Figures 12.23 (systemic
gas exchange and transport) and 12.24 (alveolar gas exchange and transport). Notice
the red and blue arrows in these figures. The blue arrows represent CO2, while the red
arrows represent O2. The thickness of the arrows represents the relative amounts of
the gases being exchanged. Although there are three blue arrows and two red arrows
in each figure, concentrate on the largest blue arrow (representing 70% of the CO2)
and the largest red arrow (representing 98.5% of the O2). These two arrows explain the
majority of gas transport in the blood happening at the body’s tissues (Figure 12.23)
and at the alveoli (Figure 12.24).

Systemic Gas Exchange and Transport You should already be aware that the tis-
sues of the body produce CO2 as a waste product of cellular respiration and that, because
the PCO2 tissues > PO2 capillary, CO2 diffuses from the tissues into the capillaries. Now you
need to understand that the diffused carbon dioxide mixes with water in the blood to form
carbonic acid (H2CO3). Carbonic acid, because it is in water, separates into its two ions:
a bicarbonate ion (HCO3−) and a hydrogen ion (H+)—remember from “Chapter 2,

482 CHAPTER 12 The Respiratory System

 Carbaminohemglobin Hb + CO2 CO2 (23%)

Carbamino compounds Plasma protein + CO2

Dissolved CO2 gas (in plasma) CO2 (7%)

H+ + HCO3– H2CO3 H2O + CO2 CO2 (70%)

H+ + HbO2 HHb + O2 O2 (98.5%)

Dissolved O2 gas (in plasma) O2 (1.5%)

Capillary Tissue

FIGURE 12.23 Systemic gas exchange and transport. The blue arrows represent CO2
transport , while the red arrows represent O2 transport . The thickness of
the arrows represents the relative amounts of the gases being transported. Compound
formulas are included in the figure for Hb (hemoglobin), HbO2 (oxyhemoglobin), and HHb
(deoxyhemoglobin).

Levels of Organization of the Human Body,” that water allows for ions in solution.
This reaction is shown in Figure 12.23 where the largest blue arrow enters the blood:
CO2 + H2O → HCO3− + H+
Free hydrogen ions in the blood would lower the pH of the blood, but notice in
Figure 12.23 that the free hydrogen ion (H+) reacts with oxyhemoglobin (HbO2) to
become deoxyhemoglobin (HHb) and oxygen (O2):
H+ + HbO2 → HHb + O2
Hemoglobin releases oxygen in the presence of a hydrogen ion and then binds to it
(H+). By binding to the free hydrogen ions, hemoglobin helps maintain homeostasis
by acting like a buffer, resisting a change of pH in the blood. PO2 capillary > PO2 tissues so
oxygen diffuses to the tissues until PO2 tisues = PO2 capillary.

12.4 Physiology of the Respiratory System 483

 Respiratory membrane

Carbaminohemglobin Hb + CO2

Carbamino compounds Plasma protein + CO2 CO2 (23%)

Dissolved CO2 gas (in plasma) CO2 (7%)

H+ + HCO3– H2CO3 H2O + CO2 CO2 (70%)

H+ + HbO2 HHb + O2 O2 (98.5%)

Dissolved O2 gas (in plasma) O2 (1.5%)

Capillary Air in alveoli

FIGURE 12.24 Alveolar gas exchange and transport. The blue arrows represent
CO2 transport , while the red arrows represent O2 transport. The thickness of
the arrows represents the relative amounts of the gases being transported. Compound
formulas are included in the figure for Hb (hemoglobin), HbO2 (oxyhemoglobin), and HHb
(deoxyhemoglobin).

The blood containing deoxyhemoglobin and bicarbonate ions continues to the right
side of the heart and on to the alveoli of the lung. You will now learn what happens in
alveolar gas exchange and transport, as shown in Figure 12.24.

Alveolar Gas Exchange and Transport Again, you should focus on the largest red
and blue arrows representing oxygen and carbon dioxide in Figure 12.24. In the alveo-
lus, the PO2 alveolus > PO2 capillary so oxygen diffuses into the capillaries. When it does, deoxy-
hemoglobin reacts with oxygen to release hydrogen ions and form oxyhemoglobin:
HHb + O2 → HbO2 + H+
The now free hydrogen ions (H+) in the capillary at the alveolus bind to the bicar-
bonate ions (HCO3−) to form carbonic acid (H2CO3) in the blood. This results in

484 CHAPTER 12 The Respiratory System

carbon dioxide and water. Notice that this is the reverse of the reaction happening for
carbon dioxide at the tissues. PCO2 capillary > PCO2 alveolus so carbon dioxide diffuses across
the respiratory membrane to the alveolus until PCO2 capillary = PCO2 alveolus.
H+ + HCO3− → H2CO3 → CO2 + H2O
Basically, most of the oxygen is transported in the blood by hemoglobin as oxyhemo-
globin, and most of the carbon dioxide is transported in the blood as bicarbonate ions.
Hemoglobin functions to carry oxygen from the lungs to the tissues and hydrogen ions
from the tissues to the lungs.

Clinical P int
You have already read about hemoglobin carrying carbon monoxide (CO) in
the cardiovascular system chapter on blood. Hemoglobin binds to carbon monoxide
210 times more tightly than to oxygen, and it does not carry oxygen as long as it is bound
to carbon monoxide. CO is produced during combustion, so it can be emitted from
improperly vented furnaces, cars (exhaust), and
even cigarettes as they are smoked. Typically,
less than 1.5% of hemoglobin is bound to car-
bon monoxide in nonsmokers, while 10% of a
heavy smoker’s hemoglobin may be bound to
carbon monoxide. Mechanics need to ventilate
their garages while they work because even
just a 0.1% concentration of CO in the air can
bind to 50% of the worker’s hemoglobin, and a
0.2% atmospheric concentration can be lethal. ©Hisham F. Ibrahim/Getty Images

Regulation of Respiration

Learning Outcome
12. Explain how respiration is regulated to homeostatically control blood gases and pH.

Now that you have become familiar with how oxygen and carbon dioxide are trans-
ported in the blood, you are ready to examine how the respiratory system is regulated
to homeostatically control blood gases and pH.
The main control centers for respiration are located in the medulla oblongata. See
Figure 12.25. From there, messages to stimulate inspiration travel through inspiratory (I)
neurons that go to the spinal cord and then out to the diaphragm and intercostal muscles
(by way of the phrenic and intercostal nerves). Expiratory (E) neurons in the medulla
oblongata send signals only for forced expiration.
As you have previously learned, increasing the frequency of nerve impulses causes
longer muscle contractions and, therefore, deeper inspirations. If the length of time
(duration) is increased for each stimulus, the inspiration is prolonged and the breathing
is slower. When nerve impulses from the inspiratory neurons end, muscles relax and
expiration takes place.
Information concerning the need for regulation comes to the respiratory centers in the
medulla oblongata from several sources. These sources are explained in the following list:
• Stretch receptors located in the walls of bronchi and bronchioles of the lung send
signals to the medulla oblongata as to the degree of the chest’s expansion. When
maximum expansion has been reached, the medulla oblongata stops sending inspi-
ratory messages. This prevents overinflation of the lungs, and it is most important
in infants. This action is called the Hering-Breuer reflex.

12.4 Physiology of the Respiratory System 485

 Pons
• Proprioceptors in the muscles and joints send signals
to respiratory centers during exercise so that venti-
Pontine respiratory lation is increased. The respiratory centers in the
group medulla oblongata can increase the depth and rate of
respiration.

• The pontine respiratory group in the pons receives

input from the hypothalamus, limbic system, and
Medullary cerebral cortex. It then sends signals to the medulla
respiratory
center
oblongata to adjust the transitions from inspiration
to expiration. In that way, the breaths become shorter
Medulla oblongata and shallower or longer and deeper. This center helps
adjust respirations to special circumstances, such as
Medial view sleep, exercise, or emotional responses like crying.
of brainstem
• The cerebral cortex can exert voluntary control over
Spinal cord the respiratory system, but this is limited control. For
example, a stubborn child may threaten to hold his
breath to get his way. However, if he is allowed to do
so, he will eventually pass out and will start breath-
Phrenic Intercostal ing again.
nerve nerves
• Peripheral chemoreceptors in the aortic arch and
Internal intercostal
carotid arteries (discussed in the cardiovascular sys-
muscles (involved tem chapter on the heart and vessels) and central
in forced expiration) chemoreceptors in the medulla oblongata send
information to the respiratory centers in the medulla
oblongata concerning pH, CO2, and O2. The periph-
eral chemoreceptors (shown in Figure 12.26) moni-
External intercostal tor the blood, while the central chemoreceptors
muscles (involved monitor the cerebrospinal fluid (CSF). Why monitor
in inspiration)
both fluids? Both fluids must be monitored in order
to maintain homeostasis. Hydrogen ions in the blood
cannot pass the blood-brain barrier, but carbon diox-
ide does cross the barrier. When it does, it reacts with
Diaphragm the water in the CSF to form H+, just as it does at the
(involved in tissues when mixing with the water in the blood. An
inspiration)
increased concentration of hydrogen ions in either
fluid means reduced pH. The most important driver
of respiration is pH, the next is CO2, and the driver of
Anterior
minor importance is O2. Respiration is adjusted by the
medulla oblongata to maintain pH in the homeostasis
FIGURE 12.25 Control centers range for blood of 7.35 to 7.45. Acidosis occurs if the pH of the blood is less than
for respiration. 7.35. The medulla oblongata then stimulates hyperventilation (increased respira-
tory rate) to blow off CO2 through expiration to raise the pH. Alkalosis results if
the pH of the blood is greater than 7.45. The medulla oblongata then stimulates
hypoventilation (decreased respiratory rate) to keep CO2 in the blood to lower the
pH. Hypercapnia, increased carbon dioxide in the blood, causes the pH to fall in
both fluids. Oxygen is of minor importance as a driver of respiration because the
blood’s hemoglobin is usually 97% saturated with oxygen during normal breath-
ing. Oxygen drives respiration only during extreme conditions, such as mountain
climbing at high altitudes, and when it does, this is called hypoxic drive.

You have now explored all of the respiratory anatomy and the physiology of this
system. It is time to put that information together to see how the functions of this
system are carried out for Carol, who is on a break from her job in the business office
at the hospital. See Figure 12.27.

486 CHAPTER 12 The Respiratory System

 FIGURE 12.26 Peripheral
Chemoreceptors External carotid chemoreceptors of
artery
respiration. These
chemoreceptors monitor blood
External carotid gases (CO2 and O2) and blood
artery pH. They send signals to the
respiratory centers in the
medulla oblongata along the
Right common vagus and glossopharyngeal
carotid artery nerves.

Left common
Right subclavian carotid artery
artery
Left subclavian
artery

Aortic arch Chemoreceptors

Functions of the Respiratory System

Learning Outcome
13. Explain the functions of the respiratory system.

Carol appears to be a relatively young, healthy woman who is a smoker. Although her
respiratory system functions normally at present, her lifestyle choice to continue to
smoke may have harmful, long-term effects on her respiratory system. In the following
list, we explain the effects on each of the functions of this system:
• Gas exchange. Carol’s respiratory system functions to exchange carbon dioxide
and oxygen across the respiratory membranes of her lungs and out to the tissues of
her body. However, each time she inspires through a lit cigarette, she also exchanges
carbon monoxide across her respiratory membrane, which then binds to the hemo-
globin in her blood. Hemoglobin bound to CO no longer functions to carry oxygen,
so her levels of O2 in the blood will fall (hypoxia). Her kidneys notice the decreased
O2 levels and secrete erythropoietin (EPO, discussed in the cardiovascular system
chapter on blood) to stimulate erythropoiesis to increase the RBC count and the
available hemoglobin to carry O2.

12.4 Physiology of the Respiratory System 487

 • Acid–base balance. Carol’s respiratory system regulates her acid–base balance by
increasing respirations whenever the pH of her blood begins to fall below homeostasis.
Hyperventilation gets rid of more CO2, so the pH of the blood increases. If Carol’s blood
pH rises above homeostasis, her respiratory rate will slow (hypoventilation), so any
CO2 in her system remains in the blood longer, thus lowering her pH to normal levels.
• Speech. The muscles of Carol’s larynx contract to move the arytenoid and cornic-
ulate cartilages that operate her vocal cords and cause them to vibrate to produce
sound. Even the sinuses connected to her nasal cavity will aid in her speech by
giving resonance to her voice. However, her smoking tends to irritate and dry the
lining of her larynx. This may lead to laryngitis and a scratchy voice.
• Sense of smell. Olfactory neurons in the epithelium of the roof of Carol’s nasal
cavity detect odors for her sense of smell (covered in detail in the chapter on the
senses). Carol’s smoking may cause these receptors to become less sensitive, limit-
ing her ability to sense odors and appreciate flavors.
• Creation of pressure gradients necessary to circulate blood and lymph. The
FIGURE 12.27 Carol smoking muscles used during respiration increase the volume of the thoracic cavity, caus-
a cigarette. ing the pressure inside the cavity to fall. As you have learned in this chapter, this
©ZenShui/Frederic Cirou/Getty Images pressure decrease will cause air to flow into Carol’s lungs. However, you have
also studied this mechanism in the circulatory and lymphatic systems as the tho-
racic pump. This pressure decrease in the thorax also helps Carol’s blood return
(through the inferior vena cava) to her heart and helps her lymph return (through
the thoracic duct) to her left subclavian vein. The thoracic pump created by this
system will be less effective if Carol’s blood becomes thicker due to smoking-
related polycythemia (discussed in the chapter on blood).
Carol’s respiratory system is functioning now, but what can she expect to be the
effects of growing older even if she decides to stop smoking?

Spot Check Other than smoking, what other environmental and lifestyle choices
would have an adverse effect on the respiratory system? Explain.

12.5 Effects of Aging on the Respiratory System

Learning Outcome
14. Summarize the effects of aging on the respiratory system.

Aging has many effects on the respiratory system, which basically lead to a decline in
maximum function. These effects are as follows:
• With age, more mucus accumulates in the respiratory tract because the ciliated
escalator becomes less efficient. The inability to efficiently clear debris leaves
older people open to more respiratory infections. So vaccines to prevent infections,
such as flu and pneumonia, are highly recommended for elderly individuals.
• Thoracic wall compliance decreases due to the diminished ability to expand the chest
that comes with age. This can be due to weakened respiratory muscles, stiffening
of the cartilages in the rib cage, decreased height of the vertebrae from age-related
osteoporosis, and kyphosis. The net effect of the reduced compliance is reduced
vital capacity because the ability to fill the lungs (inspiratory reserve volume) and
the ability to empty the lungs (expiratory reserve volume) are both decreased.
• Some of the alveolar walls may break down, and this reduces the area of the respi-
ratory membrane. The remaining membrane thickens with age, reducing alveolar
gas exchange. Tidal volume gradually increases with age to compensate for the
reduced area and thickening of the respiratory membrane.

488 CHAPTER 12 The Respiratory System

• Obstructive sleep apnea (breathing repeatedly stops and starts during sleep) may
develop in elderly people as the pharyngeal muscles intermittently relax and block
the airway during sleep. This form of apnea may or may not be accompanied by
snoring, and it is more prevalent in people who are overweight.

Spot Check How might obstructive sleep apnea alter blood pH and O2 and
CO2 levels?

The effects of aging may not be readily apparent in a healthy individual, but they
may diminish even the healthy individual’s ability to perform vigorous exercise. After
exploring the relevent diagnostic tests, you will complete your study of this system by
examining what can go wrong—respiratory disorders.

12.6 Diagnostic Tests for Respiratory System Disorders

Learning Outcome
15. Describe common diagnostic tests used for respiratory system disorders.

Table 12.2 presents common diagnostic tests used for respiratory system disorders. A
lot of the tests may be familiar to you as they have been mentioned in previous chapters,
but their specific relation to the respiratory system is explained.

TABLE 12.2 Diagnostic Tests for Respiratory System Disorders

Diagnostic Test or Screening Description
Arterial blood gas A test of the arterial blood that determines the level of O2 and CO2 in the blood.
Biopsy A procedure in which tissue is collected and examined for the presence of abnormal cells.
Chest X-ray The use of electromagnetic radiation that sends photons through the body to create a
visual image of dense structures such as the lungs.
Complete blood count (CBC) A series of blood tests including hematocrit, hemoglobin, red blood cell count, white
blood cell differential, white blood cell count, and platelet count.
Computed tomography (CT) An imaging technique used to visualize internal structures. The scan produces images
in “slices” of areas throughout the body. In regard to disorders of the respiratory
system, CT can be used to determine changes in the organs of the respiratory system
located in the head, neck, and chest.
Cultures and sputum A procedure that involves collecting a culture or sputum from a patient and
analysis performing various tests to identify the microorganism causing an infection.
Mantoux test for TB A test that determines whether a person has developed an immune response to the
bacterium that causes tuberculosis.
Monospot test A test used to determine the presence of antibodies to infectious mononucleosis.
Oxygen saturation test A test that measures the amount of oxygen being carried by red blood cells.
Peak flow meter A test that measures the rate at which a person can exhale air.
Pulmonary angiogram An X-ray of the blood vessels in the lungs.
Pulse oximetry The use of infrared light to determine the amount of oxygenated hemoglobin in the blood.
Rapid influenza test A test used to determine the presence of influenza antigens.
Rapid strep test A test used to determine whether strep bacteria are present in the patient’s throat.
Spirometry A test that measures the respiratory system functions of moving air into the lungs and
moving air out of the lungs.
Thoracentesis A procedure in which fluid is removed from the chest through a needle or tube.
Ultrasound An imaging technique in which sound waves create visual images of internal structures.

12.6 Diagnostic Tests for Respiratory System Disorders 489

 Spot Check Consider all of the diagnostic tests listed in Table 12.2. Which tests
can be used to diagnose a respiratory infection?

12.7 Respiratory System Disorders

Learning Outcome
16. Describe respiratory system disorders and relate abnormal function to pathology.

The respiratory disorders discussed in this section fall into three categories: infections,
chronic obstructive pulmonary diseases (COPDs), and lung cancer.

Respiratory Infections
Cold The most common respiratory infection is the common cold, which is com-
monly caused by a rhinovirus. Its symptoms include congestion, sneezing, and increased
mucus production. This infection can easily spread to the sinuses, throat, and middle
ear. Typically, a cold runs its course in about a week.

Applied Genetics
Cystic fibrosis is the most common fatal genetic disease in the United States. As you
read in “Chapter 2, Levels of Organization of the Human Body,” cystic fibrosis is caused
by a single gene in the human DNA that codes for a faulty chloride channel on cell mem-
branes. People with a faulty cystic fibrosis transmembrane regulator (CFTR) gene pro-
duce a sticky mucus that cannot be easily moved by the respiratory epithelium’s ciliated
escalator. As a result, the sticky mucus accumulates in the lungs and airways, and this
then leads to infection. Gene therapy for cystic fibrosis began in 1990 when scientists
were successful in introducing correct copies of the gene to cells in laboratory cultures.
In 1993, common rhinoviruses were tried as a delivery mechanism (vector) to deliver
the correct gene. These viruses were tried as vectors because rhinoviruses specifically
invade respiratory cells and deliver a piece of nucleic acid to the invaded cell. If the rhi-
novirus could be modified to carry and insert the correct copy of the CFTR gene, it would
deliver it to the appropriate type of cell in a cystic fibrosis patient. Since then, other vec-
tors have been tried in an effort to find the most efficient way of introducing the correct
gene to the affected cells. Life span of the respiratory cells also needs to be considered
to determine the correct vector and treatment schedule. The research into gene therapy
for this disease continues.1
©MOLEKUUL/SPL/age fotostock

Influenza Flu is a respiratory—not digestive—illness caused by a virus. In addition

to its cold symptoms, flu is characterized by fever, chills, and muscle aches. Flu can be
diagnosed by physical examination. A rapid flu test can also be performed to test for the
presence of influenza viral antigens. The mortality rate for influenza is approximately
1%, with most of the deaths occurring in very young children and elderly people.
Influenza viruses mutate and change often, so vaccines are created each year to protect
against the expected viral flu strains for that year.

Pharyngitis This condition is commonly known as a sore throat. Pharyngitis is caused

by inflammation of the pharynx, which usually results from respiratory infections such
as the cold or flu. Other symptoms associated with pharyngitis are fever, headache,

490 CHAPTER 12 The Respiratory System

rash, swollen lymph nodes in the neck, and muscle aches. Physical examination of the
throat and laboratory tests such as a rapid test or throat culture may be done to deter-
mine which type of organism (bacterium or virus) is responsible for the infection.

Disease P int
Strep throat (a) is a common bacterial infection
that causes pharyngitis. Group A streptococcus
comprises the bacteria responsible for this
infection. Symptoms of strep throat can include
fever, sore throat, malaise, painful swallowing,
headache, rash, and loss of appetite. Health
care providers can perform a rapid strep test
or a throat culture to determine whether the (a)
©Biophoto Associates/Science Source
group A streptococcus bacteria are present.
If the test shows the presence of group A
streptococcus bacteria, then antibiotics can be
prescribed for treatment.
Mononucleosis (mono) (b) is a viral infection
that causes pharyngitis. It is known as the kissing
disease because it is often transmitted through
saliva and close contact with an infected person.
Symptoms of mono include fatigue, fever, a sore
(b)
throat that gets progressively worse, swollen ©Dr. P. Marazzi/Science Source
tonsils that become covered with white or yellow
patches, loss of appetite, muscle aches, rash, swollen lymph nodes, and a swollen
spleen. Similar to the test for strep throat, a monospot test is a rapid test that can be
performed to determine whether a patient is positive for mononucleosis. Because mono
is caused by a virus, antibiotics will not treat the disease; therefore, treatment is usually
geared toward relieving the symptoms.

Laryngitis This condition is characterized by the inflammation of the larynx accom-

panied by the loss of the voice (hoarseness). Usually, a respiratory viral infection such
as a cold or flu causes laryngitis. Other causes include pneumonia, croup, bronchitis,
gastroesophageal reflux (which is covered in the digestive system chapter), allergies, or
exposure to irritants and chemicals. Because viral infections commonly cause laryngitis,
antibiotics may not be helpful in treating this condition. Resting the voice and using
certain medications can help with the discomfort associated with laryngitis.

Croup Croup is characterized by a loud, seal-like, barking cough and difficulty

breathing. It is common in infants and children and is usually caused by a viral or bacte-
rial respiratory infection that results in inflammation of the larynx. In severe cases, the
airway can become so inflamed that it swells shut, cutting off the air supply and possibly
resulting in death if not treated. Croup is diagnosed by listening to the characteristic
cough associated with the disease. Physicians will also listen to breath sounds to deter-
mine whether they are decreased or accompanied by wheezing or whether expiration
and inspiration are prolonged. Visual examination of the chest during respiration may
also indicate difficulty breathing. Treatment depends on the cause of the disease, but
medications are used to manage the symptoms and inflammation associated with croup.

Tuberculosis This infection is caused by the Mycobacterium tuberculosis bacterium

that enters the lungs by way of air, blood, or lymph. The lungs react to the infection

12.7 Respiratory System Disorders 491

 by walling off bacterial lesions with scar tissue that diminishes lung compliance.
See Figure 12.28. Health care workers are tested for exposure to the bacteria with
a Mantoux test.

Pertussis This highly contagious bacterial infection causes the paralysis of cilia
in the respiratory epithelium. The accumulation of mucus and debris results in a
whooping cough, which gives this disorder its common name. Pertussis can be diag-
nosed by the symptoms present (the whooping cough), a CBC (which would show
elevated lymphocytes), and sputum cultures (which would determine the presence
of the bacterium that causes pertussis). Pertussis vaccine is one part of the DPT shot
routinely given in the United States to children. (D stands for diphtheria, P stands
for pertussis, and T stands for tetanus).

FIGURE 12.28 Lung X-ray Acute Bronchitis Sometimes, inflammation of the bronchial tubes follows a respira-
showing tuberculosis. tory infection, such as the ones already discussed. This is known as acute bronchitis.
©stockdevil/iStock/Getty Images The bacterium or virus responsible for the respiratory infection may travel to the bronchi
and the lungs, causing a productive cough (cough with mucus), wheezing, shortness of
breath, and pain in the chest. Other symptoms can include fatigue and fever. To deter-
mine whether a patient has acute bronchitis, a health care provider listens to the lungs
and may perform the following diagnostic tests: chest X-ray, pulse oximetry, and/or
examination of sputum samples for evidence of bacteria. Treatment for chronic bronchi-
tis is based on the cause of the disease. Antibiotics may be given if the cause is a bacte-
rial infection. Other treatments may be geared toward relieving the symptoms associated
with acute bronchitis.

Pneumonia This infection can be caused by bacteria, a virus, a fungus, or even a

protozoan. Symptoms include fever, difficulty breathing, and chest pain. In this type
of infection, fluid accumulates in the alveoli (pulmonary edema), and inflammation
causes the respiratory membrane to thicken, thereby reducing gas exchange. Diagnosis
of pneumonia occurs through a variety of tests such as arterial blood gas, CT scan,
CBC, and sputum cultures.

Chronic Obstructive Pulmonary Disorders

Chronic obstructive pulmonary disorders (COPDs) cause
the long-term decrease in ventilation of the lungs. Many
COPDs are the result of cigarette smoking.

Chronic Bronchitis You have previously covered acute

bronchitis and its relation to respiratory infections. Chronic
bronchitis often results from long-term irritation of the epi-
thelium of the bronchial tree. With the subsequent inflam-
mation, cilia are lost and mucus is overproduced. Without
the cilia escalator, mucus and debris accumulate, leading to
further chronic inflammation and infections. The long-term
effect is a decrease in the diameter of the bronchioles, which
reduces ventilation of the alveoli. Chronic bronchitis often
leads to emphysema.

Emphysema In this disorder, constant inflammation from

irritants narrows bronchioles, reducing the airflow to the
lungs. The respiratory system tries to clear built-up mucus
FIGURE 12.29 Ruptured alveoli from a lung of a patient and debris—often from chronic bronchitis—by coughing.
with emphysema. The coughing causes increased pressure in the alveoli that
©Dr. Tony Brain/Science Source results in rupturing of the alveolar walls. See Figure 12.29.

492 CHAPTER 12 The Respiratory System

This loss of respiratory membrane reduces gas exchange and reduces the recoil of
the lung (compliance). Symptoms of emphysema include shortness of breath and an
enlargement of the thoracic cavity (barrel chest).

Asthma This disorder involves increased constriction of the lower respiratory tract due
to a variety of stimuli. The symptoms include wheezing, coughing, and shortness of breath.
Although no definitive cause has been found, asthma and allergies often go together.
Whatever the cause, asthma is characterized by chronic airway inflammation, airway
obstruction, and airway hyperreactivity in which the smooth muscle overreacts to a stim-
ulus by constricting the bronchioles. Treatment involves avoiding the stimulus—if it can
be determined—and drug therapy.

Respiratory Distress Syndrome

Respiratory distress syndrome is a condition of the lungs that results in a lack of
oxygen in the blood. Acute respiratory distress syndrome (ARDS) typically occurs
in patients who are already experiencing chronic illness or have had major trauma.
Infection or an injury causes inflammation of the lung tissue, which results in col-
lapsed alveoli and excess fluid accumulation in the alveoli. This in turn affects gas
exchange in the following ways:
• By interfering with membrane area (Collapsed alveoli reduce the amount of mem-
brane area available for gas exchange.)
• By interfering with membrane thickness (Inflammation of lung tissue increases
respiratory membrane thickness, which makes it harder for gas to diffuse across
the respiratory membrane.)
• By interfering with ventilation-perfusion coupling (Damaged parts of the lung
receive less air and less blood flow.)
Common infections that can lead to ARDS are sepsis (presence of bacteria in
the bloodstream) and pneumonia. Symptoms of ARDS include difficulty breathing,
tachypnea, and the feeling of not getting enough air. Patients may also experience
confusion and low blood pressure, which is related to organs not getting enough
oxygen due to the low amounts of oxygen in the bloodstream. Diagnosis of ARDS
involves an arterial blood gas test to check the oxygen levels in the blood. Chest
X-rays are done to determine whether there is excess fluid in the lungs. Additional
tests, such as CBC, blood cultures, and sputum cultures, are performed in an effort
to find the source of possible infection. ARDS is treated by administering oxygen
therapy to increase the levels of oxygen in the blood. Intravenous fluids may also be
given to improve circulation and provide nutrients. Medications may be prescribed
to treat an infection.

Cancers of the Respiratory System

Two types of respiratory system cancers are laryngeal cancer and lung cancer.

Laryngeal Cancer Laryngeal cancer (cancer of the larynx) is commonly asso-

ciated with the use of tobacco products or excessive alcohol consumption. See
Figure 12.30. The cancer starts in the larynx and can metastasize to other areas of the
head and neck. Symptoms of laryngeal cancer include a hoarse voice, a lump in the
neck, and difficulty swallowing or breathing. Laryngeal cancer is diagnosed by biopsy
to determine whether cancerous cells are present. If cancer is present, the physician
may also perform CT scans and chest X-rays to determine whether the cancer has
spread to other areas. Treatment of laryngeal cancer involves removal of the cancerous
tumor by surgery, radiation, or chemotherapy. Depending on the extent of the tumor,

12.7 Respiratory System Disorders 493

(a) (b)

FIGURE 12.30 Laryngeal cancer: (a) normal larynx compared to a cancerous larynx (b) cancerous larynx.
(b) ©Biophoto Associates/Science Source

a laryngectomy (removal of the larynx and vocal cords) may be performed. It is likely
that treatment for laryngeal cancer will affect a person’s ability to speak and swallow,
and rehabilitation may be necessary.

Lung Cancer There are three different types of lung cancers:

• Squamous cell carcinoma originates in the bronchial epithelium. In this form of
lung cancer, the ciliated epithelium undergoes metaplasia first, changing to stratified
epithelial tissue. Cancerous cells further divide, invading tissues of the bronchial
walls and forming tumors that can block airways.
• Adenocarcinoma originates in the mucous glands of the bronchial tree in the
lung. Like squamous cell carcinoma, it also invades other tissues of the bronchial
tree and lung.
• Oat cell carcinoma is the least common form of lung cancer, but it is the most
deadly because it easily metastasizes to other tissues. It usually begins in a main
bronchus and then invades the mediastinum and travels to other organs.
The symptoms of lung cancer include chest pain, blood in the sputum, cough,
weight loss, and difficulty breathing. Lung cancer is diagnosed by a variety of tests
including biopsy, CT, MRI, chest X-ray, thoracentesis, sputum test, bone scan, and
CBC. As with laryngeal cancer, treatment of lung cancer involves removing the
cancerous cells and preventing the growth of new cancerous cells. Surgery may be
performed to remove part of the lung (lobectomy) or the entire lung (pneumonectomy).
FIGURE 12.31 Lung cancer. Radiation therapy and chemotherapy may also be used to kill cancerous cells. See
©Science Source Figure 12.31.

494 CHAPTER 12 The Respiratory System

 Table 12.3 summarizes all of the diseases and disorders described throughout the
chapter.

TABLE 12.3 Summary of Diseases and Disorders

of the Respiratory System
Type of Disease/ Disease/
Disorder Disorder Description

Infections Acute Inflammation of the bronchial tubes

bronchitis following a respiratory infection.
Cold The most common respiratory infection,
which is caused by a rhinovirus.
Croup A viral or bacterial respiratory infection
that results in inflammation of the larynx;
characterized by a loud, seal-like, barking
cough and difficulty breathing.
Flu A respiratory infection caused by an
influenza virus.
Laryngitis Inflammation of the larynx accompanied by
loss of the voice or hoarseness of the voice.
Mononucleosis A viral infection that causes pharyngitis.
Pertussis A bacterial respiratory infection that
causes the paralysis of cilia in the
respiratory epithelium. The resulting
accumulation of mucus and debris
causes a distinctive whooping cough.
Pharyngitis Inflammation of the pharynx, which
usually results from respiratory infections
such as a cold or flu.
Pneumonia An infection resulting in pulmonary
edema and inflammation, which causes
the respiratory membrane to thicken,
thereby reducing gas exchange.
Strep throat A common bacterial infection caused by
group A streptococcus.
Tuberculosis A respiratory infection caused by the
Mycobacterium tuberculosis bacterium.
Chronic obstructive Asthma Increased constriction of the lower
pulmonary respiratory tract due to a variety of
disorders (COPDs) stimuli.
Chronic Long-term irritation of the bronchial tree’s
bronchitis epithelium, resulting in inflammation, loss
of cilia, and overproduction of mucus.
Emphysema Loss of respiratory membrane caused
by chronic coughing, which results in
increased pressure in the alveoli that
leads to rupturing of the alveolar walls.
Respiratory Acute Respiratory distress in patients who are
distress respiratory already experiencing illness or have had
distress major trauma.
syndrome
(ARDS)

12.7 Respiratory System Disorders 495

 TABLE 12.3Summary of Diseases and Disorders of the
Respiratory System (continued)
Type of Disease/ Disease/
Disorder Disorder Description
Hyaline Respiratory distress in premature infants
membrane due to the collapse of alveoli from the
disease lack of surfactant.
Cancers Laryngeal Cancer of the larynx, which is
cancer commonly associated with the use of
tobacco products or excessive alcohol
consumption.
Lung cancer Cancer of the lungs. There are three
types: squamous cell carcinoma,
adenocarcinoma, and oat cell carcinoma.
Other respiratory Acidosis Condition in which the pH of the blood is
disorders less than 7.35.
Alkalosis Condition in which the pH of the blood is
greater than 7.45.
Cystic fibrosis A genetic disease that causes the
production of a sticky mucus that cannot
be easily moved by the respiratory
epithelium’s ciliated escalator. The mucus
accumulation in the lungs and airways
leads to infection.
Hemothorax Blood in the pleural cavity.
Hypercapnia Increased carbon dioxide in the blood.
Pleurisy Condition characterized by inflammation
of the pleurae.
Pneumothorax A collapsed lung, which occurs if air is
introduced in the pleural cavity between
the pleural membranes.
Sinusitis Inflammation of the epithelium in the
sinuses, which results in increased mucus
production.

Spot Check What is the difference between acute respiratory distress

syndrome and hyaline membrane disease?

496 CHAPTER 12 The Respiratory System

Putting the Pieces Together

The Respiratory System

Integumentary system Cardiovascular system
Has guard hairs in the nose to trap Blood transports O2 and CO2.
debris.
Allows for the exchange of O2 and
Allows for the exchange of O2 and CO2.
CO2 in system tissues.

Lymphatic system
Skeletal system
Sends white blood cells to fight
Ribs protect lungs, bone gives pathogens in the respiratory
structure to the nasal passages to system.
warm and moisturize inspired air, and
sinuses give resonance to the voice. Allows for the exchange of O2 and
CO2 in system tissues; thoracic
Allows for the exchange of O2 pump helps return lymph to the
and CO2 in system tissues. cardiovascular system.

Muscular system Digestive system

Skeletal muscles are responsible for Provides nutrients for respiratory
inspiration and forced expiration. system tissues.

Allows for the exchange of O2

Allows for the exchange of O2
and CO2 in system tissues.
and CO2 in system tissues.

Nervous system
Excretory/urinary system
Medulla oblongata regulates the
respiratory rate. Kidneys secrete EPO when the
blood oxygen level is low.
Allows for the exchange of O2 and
CO2 in system tissues. Allows for the exchange of O2 and
CO2 in system tissues.

Endocrine system
Reproductive system
Hormones such as epinephrine
increase airflow and respiratory Allows for the exchange of O2
rate. and CO2 in a fetus.

Allows for the exchange of O2 and Allows for the exchange of O2

CO2 in system tissues. and CO2 in system tissues.

FIGURE 12.32 Putting the Pieces Together—The Respiratory System: connections between the respiratory system
and the body’s other systems.

12.7 Respiratory System Disorders 497

Summary
12.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the respiratory
system.

12.2 Overview
∙∙ Cellular respiration is performed by mitochondria in cells to process energy.
∙∙ Respiration as a system refers to the movement of gases into and out of the lungs and the exchange of gases between the
alveoli and capillaries in the lung and capillaries and tissues in the body.

12.3 Anatomy of the Respiratory System

∙∙ The air in an inspiration enters the nasal cavity through the nose and continues on to the nasopharynx, oropharynx, and
laryngopharynx. It then travels through the glottis to the larynx, to the trachea, to the main bronchi, to the bronchial tree,
and finally to the alveoli.

Nose
∙∙ The nasal bones and nasal cartilages shape the nose.

Nasal Cavity
∙∙ The mucous membranes of the nasal cavity warm and moisturize the air and remove debris.
∙∙ Nasal conchae provide extra surface area.

Pharynx
∙∙ The pharynx is composed of the nasopharynx, oropharynx, and laryngopharynx.
∙∙ The epithelial tissue varies in each part of the pharynx based on the materials that travel through each area.

Larynx
∙∙ The larynx is a cartilaginous box that contains the vocal cords.
∙∙ Muscles in the larynx move cartilages that allow the vocal cords to vibrate to produce sound.

Trachea
∙∙ The trachea has 18 to 20 C-shaped cartilages that hold it open for the easy passage of air.
∙∙ The trachea splits to form the main bronchi.

Lungs and the Bronchial Tree

∙∙ Each main bronchus enters a lung and then further divides to form the bronchial tree.
∙∙ Bronchioles have smooth muscle in their walls and lead to small air sacs in the lung called alveoli.

Alveoli
∙∙ Alveoli have walls of simple squamous cells and great alveolar cells that produce surfactant.
∙∙ Surfactant reduces the surface tension of water so that alveoli do not collapse.
∙∙ The respiratory membrane is composed of the thin layer of water with surfactant in the alveoli, the single squamous cell
alveolar wall, and the single cell capillary wall.

12.4 Physiology of the Respiratory System

Mechanics of Taking a Breath
∙∙ Inspiration results from intercostal muscles and the diaphragm’s contracting to increase the volume of the thoracic cavity,
thereby decreasing its pressure.
∙∙ Air flows due to pressure gradients.
∙∙ Pleural membranes cause the lung to expand with the thoracic cavity.
∙∙ Normal expiration is caused by the relaxation of the intercostal muscles and diaphragm.
∙∙ Forced expiration is caused by muscle contraction.

498
Measurements of Pulmonary Function
∙∙ A spirometer can be used to measure lung volumes and capacities.
∙∙ Compliance measures how well the lung can expand and return to shape.

Composition of Air
∙∙ Air is a mixture of gases including nitrogen, oxygen, carbon dioxide, and water vapor.
∙∙ Partial pressure is the amount of pressure an individual gas contributes to the total pressure of the mixture.

Gas Exchange
∙∙ Gas exchange happens between the alveoli and the capillaries in the lung and between the capillaries and the tissues of
the body.
∙∙ Gases diffuse across membranes because of a concentration gradient until the concentrations on both sides of the mem-
brane are equal.

Comparison of Inspired and Expired Air

∙∙ Inspired air has more oxygen and less carbon dioxide than expired air.

Factors That Influence Gas Exchange

∙∙ Gas exchange is influenced by concentration of the gases, membrane area, membrane thickness, solubility of the gas, and
ventilation-perfusion coupling.

Gas Transport
∙∙ Most of the oxygen is transported in the blood by hemoglobin as oxyhemoglobin, and most of the carbon dioxide is trans-
ported in the blood as bicarbonate ions.
∙∙ Hemoglobin functions to carry oxygen from the lungs to the tissues and to carry hydrogen ions from the tissues to the
lungs.

Regulation of Respiration
∙∙ Respiration is controlled by respiratory centers in the medulla oblongata.
∙∙ The medulla oblongata receives information concerning the need to control respiration from stretch receptors, the pons,
the cerebral cortex, and chemoreceptors.
∙∙ The drivers of respiration are pH, CO2, and O2 (in that order).

Functions of the Respiratory System

∙∙ The functions of the respiratory system include gas exchange, acid–base balance, speech, sense of smell, and creation of
pressure gradients necessary to circulate blood and lymph.

12.5 Effects of Aging on the Respiratory System

∙∙ The ciliated escalator becomes less efficient, so more mucus and debris accumulate in the respiratory tract, and this can
lead to infection.
∙∙ Thoracic wall compliance decreases, causing reduced vital capacity.
∙∙ Some alveolar walls break down with age and thicken, thereby reducing gas exchange.
∙∙ Obstructive sleep apnea may occur if the pharyngeal muscles block the airway.

12.6 Diagnostic Tests for Respiratory System Disorders

∙∙ Common diagnostic tests for respiratory system disorders include: arterial blood gas, biopsy, chest X-ray, CBC, CT,
culture and sputum analysis, Mantoux test, monospot test, oxygen saturation test, peak flow meter, pulmonary angio-
gram, pulse oximetry, rapid influenza test, spirometery, thoracentesis, and ultrasound.

12.7 Respiratory System Disorders

∙∙ A cold is the most common respiratory infection, which is caused by a rhinovirus.
∙∙ Influenza (flu) is a respiratory illness caused by a virus.
∙∙ Pharyngitis is inflammation of the pharynx.
∙∙ Laryngitis is inflammation of the larynx accompanied by the loss of the voice.
∙∙ Croup is a viral or bacterial respiratory infection characterized by a seal-like cough and breathing difficulty.

499
∙∙ Tuberculosis is a respiratory infection caused by the Mycobacterium tuberculosis bacterium.
∙∙ Pertussis is a bacterial infection that causes the paralysis of cilia in the respiratory epithelium.
∙∙ Acute bronchitis is inflammation of the bronchial tubes following a respiratory infection.
∙∙ Pneumonia is an infection resulting in pulmonary edema and inflammation.
∙∙ Chronic obstructive pulmonary disorders (COPDs) include chronic bronchitis, emphysema, and asthma.
∙∙ Respiratory distress syndrome is a condition of the lungs that results in a lack of oxygen in the blood.
∙∙ Cancers of the respiratory system include laryngeal cancer and lung cancer.

Key Words for Review

The following terms are defined in the glossary.

alveoli gas exchange respiratory membrane

bronchial tree gas transport spirometry
chronic obstructive pulmonary inspiration surfactant
disorders (COPDs) inspiratory reserve volume (IRV) tidal volume (TV)
compliance partial pressure ventilation
expiration pharynx ventilation-perfusion coupling
functional residual capacity (FRC) pneumothorax vital capacity (VC)

500
 13 The Digestive
System
Hungry? Perhaps you would
like a cheeseburger? Your
burger could be made of beef,
turkey, soy, or even tofu. All of
these burger choices are good
sources of protein. The bun is
made of carbohydrates, and the
cheese is composed of lipids
(fat). So, a cheeseburger is a
perfect food to use in study-
ing how the digestive system
works to digest proteins, carbo-
hydrates, and lipids. Although
the digestion of a cheeseburger
starts with the first bite, this
is only the beginning of the
functions of this system. See
Figure 13.1.
©Westend61/Getty Images

Module 12: Digestive System

501
 Oral
cavity
0.5 meter (from tongue Digestive System
Tongue Major Organs and Structures:
to duodenum)
esophagus, stomach, small
Esophagus intestine, large intestine
Accessory Structures:
liver, pancreas, gallbladder,
Stomach cecum, teeth, salivary glands
Functions:
ingestion, digestion, absorption,
Gallbladder defecation
Duodenum
Pancreas

1.0 m

Jejunum
(2.2–2.4 m)
5.5–6.0 meters
(small intestine)

FIGURE 13.1 The digestive system .

Ileum 13.1 Word Roots and Combining Forms

(3.3–3.6 m)

Learning Outcome
1. Use medical terminology related to the digestive system.

chol/e: gall, bile emet/o: vomit gloss/o: tongue

col/o: colon enter/o: intestine hepat/o: liver
Appendix cyst/o: bladder, esophag/o: peps/o: digestion
Cecum sac esophagus rect/o: rectum
duoden/o: gastr/o: stomach sigmoid/o: sigmoid
duodenum gingiv/o: gums colon
Large
intestine
(large intestine)

13.2 Overview
1.5 meters

Learning Outcome
2. Differentiate between mechanical digestion and chemical digestion.

The anatomy of the digestive system is like a complicated tube—

one end of the tube is the mouth and the other end is the anus. This
tube—called the alimentary canal or gastrointestinal (GI) tract—
Anus
may be as long as 8 meters. See Figure 13.2. It twists and turns,
FIGURE 13.2 The alimentary canal starting at the enlarges and narrows as it uses muscle contractions to push its con-
oral cavity and ending at the anus. The relative tents toward its end. You insert food in the mouth but see a very
length of each section is shown. different product emerge at the anus. In this chapter, you will be

502 CHAPTER 13 The Digestive System

exploring the anatomy of the digestive system and what happens to food (a cheese-
burger) along its journey through each section of the alimentary canal. You will also
look at the way digestion is regulated, the effects of aging on the system, and digestive
system disorders.
The cheeseburger’s journey begins in the mouth and continues to the pharynx,
esophagus, stomach, small intestine, large intestine, and anus, where the journey ends.
All along the pathway, mucous membranes and mucosa-associated lymphatic tissue
(MALT) line the alimentary canal to fight any foreign invaders—such as bacteria—
that may enter with the food (discussed in the lymphatic system chapter). Along with
studying the structures of the alimentary canal, you will need to study the accessory
structures in each section of the tract. These accessory structures—including the
teeth, tongue, salivary glands, liver, gallbladder, bile ducts, and pancreas (shown in
Figure 13.3)—are necessary for the system to carry out its functions.
Before you get started, it is important to understand the two types of digestion—
mechanical and chemical. Mechanical digestion is the breakdown of large pieces of
complex molecules to smaller pieces of complex molecules. On the other hand, chemical

FIGURE 13.3 The digestive

Oral cavity system, including accessory
structures.

Teeth

Tongue
Parotid
(salivary) gland
Sublingual
(salivary) gland

Pharynx
Submandibular
(salivary) gland

Liver
Esophagus
Bile duct

Gallbladder
Stomach

Transverse
colon
Ascending
Pancreas colon
Descending
Large
Small intestine colon
intestine
Cecum
Sigmoid
colon
Rectum
Anus

13.2 Overview 503

 digestion is the breakdown of complex molecules to their building blocks so that they
can be absorbed. As a result of chemical digestion, proteins are broken down to their
amino acids, carbohydrates to their monosaccharides, and lipids to their fatty acids and
glycerol. Mechanical digestion must happen first for chemical digestion to take place.

Spot Check What would be the end result of mechanical digestion of a complex
carbohydrate compared to the end result of chemical digestion of a complex carbohydrate?

Next, you will learn about the structures of the mouth and how they help mechani-
cally and chemically digest a cheeseburger.

13.3 Anatomy and Physiology of the Digestive System

Anatomy in the Mouth

Learning Outcome
3. Describe the digestive anatomy of the oral cavity.

Oral Cavity The mouth can also be called the oral cavity. The roof of the oral cav-
ity consists of the hard palate, formed by the maxilla and palatine bones, and the soft
palate, composed of soft tissue. As you can see in Figure 13.4, the soft palate ends
with the uvula, a posterior projection that
Lip directs materials downward to the pharynx
so that they do not travel to the nose. The
sidewalls of the oral cavity are the cheeks,
and the floor of the cavity is where the
tongue is attached. The oral cavity is lined
Hard palate by stratified squamous epithelial tissue,
which is a very durable epithelial tissue
that can withstand the abrasions of manip-
Soft palate
ulating solid food in the mouth.
Uvula

Palatine Teeth A baby is not born with teeth

tonsils but will develop two sets of teeth over its
lifetime—a deciduous (primary) set and
Tongue
a permanent (secondary) set. See Fig-
ure 13.5. The baby’s first set of teeth—the
Lingual frenulum
Salivary duct deciduous teeth—begin to erupt, or grow
orifices: in, at approximately 6 months and will be
Sublingual
complete by the age of 2 years. This pri-
Submandibular
mary set consists of 10 teeth in each jaw.
Later, as the permanent teeth erupt, they
Lip push out the deciduous teeth. See Fig-
ure 13.6. This secondary set begins to erupt
at 6 years of age and will not be fully com-
plete, with 16 teeth in each jaw, until the
individual reaches 17 to 25 years of age.

FIGURE 13.4 The oral cavity.

Spot Check How many teeth do you have in your mouth? If you do not have
32 teeth, which teeth are missing?

Figure 13.7 shows that a tooth is held in its bony socket (alveolus) in the jaw by
periodontal ligaments. The tissue surrounding a tooth is the gingiva (JIN-jih-vah),

504 CHAPTER 13 The Digestive System

Names of Names of
deciduous teeth: permanent teeth:
Central incisor Central incisor
(erupts at 6–8 months; (erupts at 6–9 years)
lost at 5–7 years)
Lateral incisor
(erupts at 7–9 years)
Lateral incisor
(erupts at 8–11 months; Canine
lost at 6–8 years) (erupts at 9–12 years)

First premolar
(erupts at 10–12 years)
Canine
(erupts at 16–20 months;
Second premolar Maxillary
lost at 8–11 years)
(erupts at 10–12 years) teeth
Maxillary
teeth
First molar
First molar (erupts at 6–7 years)
(erupts at 10–16 months;
lost at 9–11 years)
Second molar
(erupts at 11–13 years)

Second molar Third molar

(erupts at 20–24 months; (wisdom tooth,
lost at 9–11 years) erupts at 17–25 years)

(a) (b)

FIGURE 13.5 Teeth of the upper jaw: (a) deciduous teeth, (b) permanent teeth.

Enamel
Crown

Gingiva

Dentin

Pulp cavity
with nerves
and vessels

Root canal
Root
*

* Periodontal
ligaments
* *
FIGURE 13.6 Cadaver skull of a child, showing
permanent teeth and deciduous teeth. Permanent Artery, nerve,
Apical vein
teeth are shown with an asterisk and are waiting
foramen
to erupt.
©McGraw-Hill Education/Rebecca Gray FIGURE 13.7 Anatomy of a tooth.

13.3 Anatomy and Physiology of the Digestive System 505

 commonly called the gum. The portion of the tooth emerging from the gingiva is
called the crown. The crown is covered by a very hard, smooth, white layer called
enamel. The enamel’s function is to protect the underlying layer, the dentin. The
root of the tooth, below the gum line, is not covered by enamel. Deep to the dentin is
a pulp cavity that contains the blood vessels and nerve for the tooth.

Tongue The tongue is composed of skeletal muscle tissue anchored to the floor of
the oral cavity by a medial fold called the lingual frenulum (shown in Figures 13.4
and 13.8). On the tongue’s superior surface, stratified squamous epithelial tissue cov-
ers the lingual papillae, which house the taste buds. As you will recall from the ner-
vous system chapter on senses, taste buds contain nerve endings that sense sweet, sour,
salt, bitter, and umami. The purpose of the tongue is to manipulate what is ingested
(eaten) and to provide the sense of taste.

Salivary Glands The salivary glands, which produce about 1.0 to 1.5 liters (L) of
saliva a day, consist of the parotid glands (anterior to the ears), the submandibular
glands (inferior to the angle of the mandible on each side), and the sublingual glands
(below the tongue). See Figures 13.3 and 13.8. Each gland produces saliva that travels
to the oral cavity through ducts. The saliva, which is mostly water, also contains the
enzymes amylase and lingual lipase, along with mucus, lysozymes, and antibodies.
Saliva secretion is initiated by taste receptors that send signals by way of the facial and
glossopharyngeal nerves to centers in the medulla oblongata and pons. These control
centers also receive other stimuli so that odors, sight, or even the thought of food may
stimulate saliva secretion.

Disease P int
A tooth’s enamel wears down and thins with age. A dental caries, commonly called
a cavity, is an erosion through the enamel into the dentin. If the erosion continues
to the pulp cavity, bacteria may gain access and travel beyond the tooth’s root. This
infection is called an abscess.
Caries The mouth is full of bacteria. Every time you
eat, bits of food are wedged between the teeth and
between each tooth and the gingiva. Bacteria feed
on this buffet left out for them, digest the food, and
then excrete their acidic waste in the same ___location.
Enamel This waste erodes the enamel to form a caries and
irritates the gingiva, causing it to become inflamed
and infected (gingivitis). As gingivitis progresses, the
Dentin gingiva pulls away from the tooth and recedes. This
allows more food to become wedged between the
Pulp cavity tooth and the gingiva and more unprotected dentin
with nerves to be exposed. The daily bacteria buildup that forms
and vessels
on the tooth is plaque. Plaque can be flossed and
brushed away, but if it is allowed to remain, it hardens
to form tartar, which must be removed by a dental
professional.
If gingivitis goes untreated, the inflammation and
infection can spread to the ligaments and bone that hold
the teeth in place (periodontitis). This causes the teeth
to become loose and eventually fall out. Periodontitis is
the most common cause of tooth loss in adults.

506 CHAPTER 13 The Digestive System

 Parotid duct

Buccinator
muscle
Lining of
cheek
Tongue

Lingual frenulum
Parotid
Ducts of the gland
sublingual gland

Masseter
Sublingual muscle
gland

Submandibular
Mandible gland

Submandibular
duct

FIGURE 13.8 Salivary glands.

Physiology of Digestion in the Mouth

Learning Outcome
4. Explain the physiology of mechanical and chemical digestion in the mouth.

Think again of the example of the cheeseburger. You bite into it with your teeth. The
process of chewing, called mastication, uses the masseter and temporalis muscles to
move the jaw in a crushing motion, while the tongue, orbicularis oris, and buccinator
muscles work to keep the food between the teeth. This begins mechanical digestion—
breaking the bite of cheeseburger into smaller pieces.
Saliva from the salivary glands mixes with the bite of cheeseburger in the mouth.
The saliva’s pH is 6.8 to 7.0. At this pH, amylase partially breaks down the carbo-
hydrates from the bun. This is the beginning of chemical digestion. Lingual lipase
does nothing at this pH, but it is activated later by the lower pH of the stomach.
Amylase, however, will no longer function at the lower pH in the stomach. Thus,
it is important to masticate the bite of cheeseburger thoroughly because doing so
allows for mechanical digestion and also gives amylase sufficient time to partially
break down the carbohydrates in chemical digestion before the food is swallowed.
The mucus in the saliva moistens the bite of food (now called a bolus), making it
easier to swallow.
The lysozymes and antibodies in the saliva are not used for digestion. They destroy
and inhibit the growth of bacteria that may have entered with the bite. Digestion is
finished in the mouth when the tongue pushes the bolus to the pharynx.

Spot Check Saliva is secreted when you are chewing gum. How might chewing
sugarless gum prevent the formation of dental caries?

13.3 Anatomy and Physiology of the Digestive System 507

 Anatomy from the Mouth to the Stomach

Learning Outcome
5. Describe the digestive anatomy from the mouth to the stomach.

Pharynx The parts of the pharynx were covered in the respiratory system chapter,
but it will be helpful to review them here. The nasopharynx leads from the nasal cav-
ity to the oropharynx. The oropharynx is a funnel leading from the oral cavity to the
laryngopharynx. This funnel is lined by stratified squamous epithelial tissue and has
smooth muscle in its walls. The laryngopharynx leads to the trachea and the esopha-
gus. The respiratory and digestive pathways intersect in the pharynx.
Epiglottis The epiglottis is made of elastic cartilage connective tissue. It is one of the
cartilages of the larynx. It stands guard over the glottis, which is the opening of the larynx.
Esophagus The esophagus is a straight, muscular tube that extends from the laryngo-
pharynx, travels through the mediastinum, penetrates the diaphragm, and connects to the
stomach. It is lined by stratified squamous epithelial tissue. Deep to the epithelial lining is a
submucosa of connective tissue containing esophageal glands that secrete protective mucus
for the esophagus. The upper one-third of the esophagus has skeletal muscle in its walls,
while the middle one-third has a mixture of skeletal and smooth muscle and the lower
one-third has just smooth muscle in the walls of the esophagus. See Figure 13.9. Unlike
the trachea that is held open by C-shaped cartilages, the esophagus is normally collapsed.

Spot Check Trace the bite of cheeseburger from the oral cavity to the stomach.
What is the swallowed bite called?

FIGURE 13.9 The walls of

the esophagus inferior to the
diaphragm.
Diaphragm

Serous
membrane

Lumen

Mucosa:
Stratified squamous
epithelium
Submucosa:
Esophageal gland
Blood
Muscular layer
vessels

508 CHAPTER 13 The Digestive System

Physiology of Digestion from the Mouth to the Stomach

Learning Outcome
6. Explain how materials move from the mouth to the stomach.

Once the bolus has been sufficiently masticated in the mouth, it is time to swallow. Swal-
lowing, called deglutition (dee-glue-TISH-un), is a very complex process controlled by
the medulla oblongata. It requires four cranial nerves (V, VII, IX, and XII) to stimulate
the muscle contractions necessary to move the bolus from the pharynx to the esophagus.
Follow along in Figure 13.10 to see the steps of the process. Swallowing begins with the
tongue pushing the bolus back to the pharynx (1). The larynx pushes up, causing the epi-
glottis to close over the glottis (2). This ensures that the bolus moves into the esophagus
and not into the larynx as the pharyngeal muscles push the bolus down (3). Once in the
esophagus, the muscular walls move the bolus along its length in wavelike contractions

Hard
palate Pharyngeal
constrictor
muscles:
Soft palate
Bolus Superior

Middle Bolus
Tongue

Epiglottis
Epiglottis Inferior Hyoid bone

Larynx Inferior
Trachea pharyngeal
constrictor
Esophagus
muscles

1 2
Tongue pushes the bolus to the back of Larynx pushes up and the epiglottis closes over
the pharynx. the glottis.

Soft
palate

Superior
pharyngeal
constrictor
muscles Esophagus

Peristaltic wave
Bolus
Bolus

Esophagus Stomach

3 4
The bolus moves to the esophagus. Esophageal muscles move the bolus toward the stomach
through peristaltic contractions.

FIGURE 13.10 Swallowing: the four steps of deglutition.

13.3 Anatomy and Physiology of the Digestive System 509

 called peristalsis (per-ih-STAL-sis) (4). Gravity aids in the movement toward the stom-
ach if the individual is in an upright position, but being upright is not necessary. The
bolus can still move to the stomach even if the individual is upside down.

Anatomy of the Stomach

Learning Outcome
7. Describe the digestive anatomy of the stomach.

The stomach is a J-shaped organ found in the upper left quadrant of the abdomen,
immediately inferior to the diaphragm. It is a muscular sac capable of holding 1.0 to
1.5 L after a meal, but it can stretch to hold up to 4 L when extremely full. Follow
along with Figure 13.11 as the anatomy of the stomach is described.

Esophagus Fundus

Body

Longitudinal muscle layer

Cardiac
sphincter Circular muscle layer Muscular
Pyloric
wall
sphincter Oblique muscle layer
Less re
er curvatu Submucosa
Pyloric orifice
Mucosa
Pyloric canal
e

Pyloric region
ur
at

rv
cu
Duodenum a ter
Gre
Gastric rugae
(a)

Esophagus Fundus

Lesser Cardiac sphincter

curvature

Duodenum Cardiac region

Pyloric
orifice Body

Pyloric Rugae
sphincter

Pyloric Greater curvature

region

(b)

FIGURE 13.11 Anatomy of the stomach: (a) gross anatomy, (b) internal surface of a cadaver’s stomach, (c) radiograph of a
stomach.
Fundus
(b) ©McGraw-Hill Education/Rebecca Gray

Gastric rugae
510
Pyloric sphincter CHAPTER 13 The Digestive System

Body
Duodenum
region

(b)

Fundus

Gastric rugae
Pyloric sphincter

Body
Duodenum

Pyloric region

FIGURE 13.11 Anatomy of

the stomach (continued).
(c) (c) ©Dr. Kent M. Van De Graaff

The cardiac sphincter (lower esophageal sphincter) controls the opening to the
stomach from the esophagus. This circular muscle’s purpose is to allow food to enter the
stomach and make sure it does not return to the esophagus. The stomach can be described
in terms of the following areas: the lesser curvature on the inside of the J; the greater
curvature on the outer side of the J; the fundus, superior to the cardiac sphincter; the
body, making up the majority of the stomach; and the pyloric region leading to the
smooth muscle pyloric sphincter, which regulates the passage of materials to the duo-
denum. There are three layers of smooth muscle in the walls of the stomach: outer lon-
gitudinal muscles, middle circular muscles, and inner oblique muscles. Having muscles
oriented in different directions allows for maximum churning of the stomach’s contents.

Disease P int
It is crucial that the cardiac sphincter closes tightly
after the bolus has entered the stomach, as the
mucosa lining the esophagus provides insufficient
protection from the gastric juices produced in the
stomach. Irritation, creating a burning sensation,
results if gastric juices leak back to the esophagus.
This is commonly called heartburn because of the
close proximity of the end of the esophagus to the
heart. Chronic leakage of gastric juices back to
the esophagus is called gastroesophageal reflux
disease (GERD).
©Brand X Pictures/Punchstock

Longitudinal wrinkles called gastric rugae (ROO-guy) can be seen inside the
stomach when the stomach is empty. See Figure 13.11. These wrinkles become less
apparent as the stomach stretches. They also allow for more surface area to accommo-
date microscopic depressions in the lining, called gastric pits, that extend to form gas-
tric glands. Five different types of cells line the gastric pits and gastric glands. These
cells are shown in Figure 13.12, and their functions are described in the following list.
The cells and their products are summarized in Table 13.1.
• Mucous cells secrete a highly alkaline mucus to protect the stomach walls from
the hostile environment caused by the acid and digestive enzymes produced in the
stomach.

13.3 Anatomy and Physiology of the Digestive System 511

FIGURE 13.12 Gastric pits and
gastric glands. Regenerative
cells are not shown.

Gastric pits

Mucous
cells Mucosa

Gastric Parietal Submucosa

gland cells

Muscle
Endocrine layers
cells
Serous
membrane
Chief cells

• Endocrine cells secrete many hormones, but we will focus on the hormone gas-
trin. Its function is explained in Table 13.1.
• Parietal cells produce and secrete hydrochloric acid and intrinsic factor. Their
functions are explained in Table 13.1.
• Chief cells secrete pepsinogen and gastric lipase. Again, their functions are
explained in Table 13.1.
• Regenerative cells are stem cells that divide and differentiate to replace any of
the other cells of the gastric pits and gastric glands. Regenerative cells are very
necessary because the cells lining the stomach are short-lived, lasting only 3 to 6
days due to the stomach’s harsh, acidic environment. The gastric pits’ cells must be
continually replaced.
The stomach has several mechanisms it uses to protect itself from the harsh envi-
ronment created by the cells of the gastric pits and gastric glands. These mechanisms
include the following:
1. The lining has the highly alkaline mucous coat that resists the hydrochloric acid
and digestive enzymes.
2. There is epithelial cell replacement of the lining by the regenerative cells.
3. There are tight junctions between epithelial cells, so acid and enzymes cannot get
to the submucosa and smooth muscle walls made of mostly protein.

512 CHAPTER 13 The Digestive System

 Gastric Juices: Chemicals Produced in the Gastric Pits
TABLE 13.1
and Gastric Glands of the Stomach
Chemical Produced By Function

Gastrin Endocrine cells Tells chief and parietal cells to produce their products

Hydrochloric Parietal cells • Converts pepsinogen to pepsin, which partially breaks down proteins
acid through chemical digestion
• Activates lingual lipase, which, along with gastric lipase, partially breaks
down lipids through chemical digestion
• Converts iron in the diet to a usable form that can be absorbed
• Destroys some bacteria

Intrinsic factor Parietal cells Allows vitamin B12 to be absorbed

Pepsinogen Chief cells Changes to pepsin to partially break down proteins

Gastric lipase Chief cells Partially breaks down lipids

Mucus Mucous cells Protects the stomach walls

Physiology of Digestion in the Stomach

Learning Outcomes
8. Explain the physiology of mechanical and chemical digestion in the stomach.
9. Explain the feedback mechanism of how food moves from the stomach to the small intestine.

In this section, you will continue to trace the cheeseburger on its journey through the
digestive system. During swallowing, the medulla oblongata sends signals to the stom-
ach telling it to relax. As the bolus is moved down the esophagus by peristalsis to the
stomach, the stomach’s cardiac sphincter opens to allow the bolus to enter. This relax-
ation of the stomach and the opening of the cardiac sphincter allow the stomach to fill.
As the stomach fills, the three layers of smooth muscle in the stomach’s walls stretch,
causing the muscular walls to contract. These contractions result in peristaltic waves
in the direction of the pyloric canal. The pyloric sphincter remains closed, however,
making sure the contents stay in the stomach.
As the bolus enters the stomach, the endocrine cells of the gastric pits produce
the hormone gastrin. Gastrin targets chief cells and parietal cells, telling the chief
cells to produce pepsinogen and gastric lipase and telling the parietal cells to produce
hydrochloric acid and intrinsic factor. The hydrochloric acid (HCl) produced by the
parietal cells has a pH of 0.8. It converts pepsinogen (produced by the chief cells) to
pepsin, which partially breaks down proteins (the burger) in the bolus. This is the start
of the chemical digestion of proteins in the bolus. The hydrochloric acid also activates
lingual lipase from the saliva that mixed with the bolus in the mouth. The activated
lingual lipase works together with the gastric lipase produced by the chief cells to
partially break down the lipids in the bolus (the cheese). This is the start of chemi-
cal digestion of the lipids in the bolus. The intrinsic factor produced by parietal cells
allows vitamin B12 to be absorbed later in the small intestine.

Spot Check Consider the composition of muscle tissue. What would happen
to the walls of the stomach if the stomach did not have the protective mechanisms
mentioned earlier?

The churning of the stomach continues mechanical digestion by mixing all the
gastric juices with the bolus. This liquefies the contents of the stomach, now called

13.3 Anatomy and Physiology of the Digestive System 513

 chyme (KYME). At this point, the carbohydrates have been partially digested in the
mouth by amylase, the lipids have been partially digested in the stomach by lingual
lipase and gastric lipase, and the proteins have been partially digested in the stom-
ach by pepsin. As the mixing continues, the pH of the chyme falls due to hydrochlo-
ric acid’s low pH. As the pH of the stomach’s contents approaches 2, the endocrine
cells of the gastric pits are prevented from producing any more gastrin. With less and
less gastrin, the chief and parietal cells are also prevented from producing their prod-
ucts. This is a good example of maintaining homeostasis using a negative feedback
mechanism. This low pH also causes the pyloric sphincter to begin to open, allowing
approximately 3 milliliters (mL) of chyme to leave the stomach at a time. Digestion in
the stomach is complete when the chyme exits the pyloric sphincter.
Chyme travels within the first part of the small intestine—the duodenum (du-oh-
DEE-num). However, accessory structures play a large role in the digestion occur-
ring in the duodenum. Therefore, we focus next on the anatomy of these accessory
structures—the liver, the gallbladder, the pancreas, and the relevant ducts connecting
these structures to the duodenum.

Anatomy of Digestive Accessory Structures

Learning Outcome
10. D
 escribe the anatomy of the digestive accessory organs connected to the duodenum
by ducts.

Liver The liver is a large, reddish-brown organ immediately inferior to the dia-
phragm on the right side of the abdominal cavity. See Figure 13.13. It has four lobes:
the right and left lobes, separated by the falciform ligament; the quadrate lobe,
next to the gallbladder; and the caudate lobe, which is the most posterior lobe. The
falciform ligament is a sheet of mesentery that suspends the liver from the diaphragm
and anterior abdominal wall. The round ligament is a remnant, or leftover piece, of
the umbilical vein, which had delivered blood from the mother’s placenta to the liver
in the fetus. The liver is a highly vascular organ that is arranged in hepatic lobules.
As you can see in Figure 13.14, each hepatic lobule has a central vein as a hub
and sheets of liver cells (hepatocytes) radiating out like spokes on a wheel. The liver
receives oxygenated blood from the hepatic artery and nutrient-rich blood from the

Inferior
vena cava
Falciform
ligament
Sternum

5th rib

Liver
Right
lobe
Left lobe

Round
ligament
Gallbladder
(a) (b)

FIGURE 13.13 Gross anatomy of the liver: (a) ___location, (b) anterior view, (c) inferior view.
Gallbladder Quadrate lobe

Right
514 CHAPTER 13 The Digestive
lobe System Falciform
ligament

Left lobe
 (b)

Gallbladder Quadrate lobe FIGURE 13.13 Gross anatomy

of the liver (continued).
Right
Falciform
lobe
ligament

Left lobe

Cystic duct

Hepatic duct

Hepatic artery

Hepatic portal
vein

Common
bile duct

Inferior vena Caudate

cava lobe
(c)

hepatic portal vein. The hepatic vein drains blood from the liver. The digestive func-
tion of the hepatocytes is to produce bile. Bile is a yellow-green fluid containing bile
acids, synthesized from cholesterol (a steroid), and lecithin (a phospholipid). Both
of these components function to aid in the digestion of lipids by emulsifying lipid

FIGURE 13.14 Hepatic

lobule.

To hepatic vein and

inferior vena cava

Hepatic
lobule

Central
vein

Hepatic
duct
Hepatic
ductules Hepatic
portal vein

Hepatic
Hepatocyte artery

From aorta
To common bile duct From capillary
beds in small
intestine

13.3 Anatomy and Physiology of the Digestive System 515

 droplets. Emulsification involves breaking the lipids into smaller droplets, a process
much like the way detergents emulsify grease when you wash your dishes. Enzymes
can then complete chemical digestion of lipids more efficiently. The other contents of
bile are waste products that include bilirubin (from the breakdown of hemoglobin),
cholesterol, neutral fats, bile pigments, and minerals. Bile travels within the liver from
the hepatocytes, to hepatic ductules, to the right and left hepatic ducts, and to the com-
mon hepatic duct, which exits the liver and leads to the common bile duct. The liver
produces approximately 500 to 1,000 mL of bile per day, which is equivalent to one-
quarter to one-half of a large 2 L bottle of soda. See Figures 13.14 and 13.15.

Right hepatic duct

Left hepatic duct

Common hepatic duct

Cystic duct

Pyloric sphincter

Accessory
pancreatic duct

Body of pancreas

Pancreatic duct

Gallbladder Tail of
pancreas
Common
bile duct

Duodenum

Hepatopancreatic
sphincter

Head of pancreas

Pancreatic
Bile duct duct

Duodenal lumen

FIGURE 13.15 Gross anatomy

of the gallbladder, pancreas, Opening to Hepatopancreatic
and bile ducts. duodenum sphincter

516 CHAPTER 13 The Digestive System

Common Bile Duct The common bile duct is a tube running from the common
hepatic duct to the duodenum. The cystic duct also feeds into the common bile duct.
The hepatopancreatic sphincter at the opening to the duodenum regulates the pas-
sage of materials from the common bile duct and pancreatic duct into the duodenum.
See Figure 13.15 to understand the ___location of these ducts with respect to the liver,
gallbladder, pancreas, and duodenum.

Gallbladder As you can see in Figure 13.15, the gallbladder is a pear-shaped sac
on the inferior side of the liver. It stores and concentrates the bile produced by the
liver. As the liver continually produces bile, it fills the common bile duct. Between
meals, any overflow of bile in the common bile duct accumulates in the gallbladder
through the cystic duct because the hepatopancreatic sphincter remains closed. The
gallbladder then concentrates the bile by absorbing some of the water and electrolytes.
When needed for digestion, the smooth muscle in the walls of the gallbladder con-
tracts, squeezing the bile through the cystic duct to the common bile duct through the
relaxed hepatopancreatic sphincter to the duodenum.

Disease P int
If the gallbladder concentrates the bile too much, the cholesterol in bile may precipitate
(settle out as a solid), forming gallstones (cholelithiasis). When the gallbladder is
directed to release its bile, the stones may block the cystic duct, causing pain and
inflammation (cholecystitis). Surgery—a cholecystectomy—may be necessary to
remove the gallbladder and the gallstones within.

©McGraw-Hill
Education/Ken
Cavanagh

(b) Abdominal X-ray (frontal view) showing

(a) Gallstones gallstones in the gallbladder
©Dorling Kindersley/Getty Images ©BSIP/Science Source

Pancreas The ribbonlike pancreas has a pebbly appearance (again, see Fig-
ure 13.15), and it is retroperitoneal, meaning it is posterior to the parietal perito-
neum. The pancreas functions as two glands: (1) as an endocrine gland, because it
produces the hormones insulin and glucagon secreted into the blood, and (2) as an
exocrine gland, because it produces the bicarbonate ions and enzymes for protein,
lipid, and carbohydrate digestion that are secreted into the pancreatic duct. The

13.3 Anatomy and Physiology of the Digestive System 517

 bicarbonate ions work to neutralize the low pH of the chyme entering the duode-
num from the stomach. The pancreatic duct runs the length of the pancreas and
joins with the common bile duct as it opens to the duodenum.
Keep in mind that these organs—the liver, gallbladder, and pancreas—are not part
of the cheeseburger’s path. These organs secrete digestive chemicals that are delivered
to the small intestine through ducts. Their digestive juices go to the duodenum; the
cheeseburger does not go through these ducts to these accessory organs. See Table 13.2.

TABLE 13.2 Digestive Juices from the Liver, Gallbladder, and Pancreas
Accessory
Structure Chemical Secreted Route Taken to the Duodenum Function
Liver Bile Hepatic ductules to the hepatic ducts Emulsifies lipids
and then to the common bile duct;
possibly overflows through the cystic
duct into the gallbladder between meals

Gallbladder Bile Cystic duct to the common bile duct Emulsifies lipids

Pancreas Bicarbonate ions Pancreatic duct to the duodenum Neutralizes the acids of chyme
Enzymes for Pancreatic duct to the duodenum Chemically digests carbohydrates
carbohydrates
Enzymes for proteins Pancreatic duct to the duodenum Chemically digests proteins
Enzymes for lipids Pancreatic duct to the duodenum Chemically digests lipids

Now that you are familiar with the accessory organs, their secretions, and the ducts
associated with the digestive system, you are ready to learn about the small intestine.

Spot Check What fluid(s) flow(s) through the cystic duct? What fluid(s) flow(s)
through the common bile duct? What fluid(s) flow(s) through the pancreatic duct?

Anatomy of the Small Intestine

Learning Outcome
11. Describe the digestive anatomy of the small intestine.

The small intestine is composed of the duodenum, the jejunum (je-JEW-num), and
the ileum. See Figure 13.16. Digestion is completed in the duodenum, and absorp-
tion takes place throughout the small intestine, as you will read shortly. Although it
may look as though the small intestine is very unorganized, the mesentery membranes
neatly arrange the blood vessels and nerves traveling to and from each section of the
small intestine. See Figure 13.16.
The duodenum—the first section of the small intestine—is the next leg of the
cheeseburger’s journey.

Duodenum The duodenum is the first 25 cm (10 inches) of the small intestine; it
is located immediately after the stomach’s pyloric sphincter. See Figures 13.15 and
13.16. As with the entire small intestinal tract, there is smooth muscle in the duode-
nal walls, and the duodenal lining has circular folds with many tiny projections called
villi. See Figure 13.17. The villi are covered with simple columnar epithelial cells and
mucus-producing goblet cells. The simple columnar epithelial cells have a brush border
of microvilli to give these cells extra surface area for absorbing nutrients. Inside the villi

518 CHAPTER 13 The Digestive System

 Stomach

Circular
Duodenum folds

Ascending Jejunum
colon

Ileocecal
junction

Cecum

Appendix

Mesentery
Ileum

FIGURE 13.16 Gross anatomy of the small intestine showing the circular folds of the lining.

Brush border of microvilli

of epithelial cells

Simple columnar
epithelium

Lacteal

Goblet cells
Villus

Blood capillary
network

Arteriole
Venule
Lymph vessel

(a) (b)

FIGURE 13.17 Intestinal villi: (a) micrograph—each villus in the image is about 1 mm high; (b) structure of a villus, showing
simple columnar epithelial cells with a brush border of microvilli, goblet cells, capillaries, and a lacteal.
(a) ©Meckes/Ottawa/Science Source

13.3 Anatomy and Physiology of the Digestive System 519

 are capillaries and small lymphatic vessels called lacteals (LAK-tee-alz). Absorption
of nutrients takes place through the villi, either into the capillaries or into the lacteals.
The lining of the duodenum also contains endocrine cells. These cells make two
hormones—secretin and cholecystokinin (KOH-leh-sis-toe-KIE-nin)—that target the
gallbladder and pancreas, telling them to release bicarbonate ions, digestive enzymes,
and bile to be delivered to the duodenum.
The duodenum, like the jejunum and ileum, has tight junctions between cells of the
epithelial lining to protect itself from the acidic chyme. Only small amounts of chyme
should enter the duodenum at any one time. This helps keep the mucous lining from
becoming overwhelmed, and it gives the duodenum time to neutralize the chyme.

Spot Check How much chyme is allowed to enter the duodenum at one time?

Jejunum The jejunum—the second part of the small intestine (see Figure 13.16)—
has a very rich blood supply that gives it a pink appearance. The jejunum measures
approximately 2.2 to 2.4 m in length and its villi are slightly smaller than those in the
duodenum. Circular folds in the lining allow extra surface area for absorption. Most of
the absorption of nutrients takes place in the jejunum.

Ileum The ileum is the last part of the small intestine, measuring 3.3 to 3.6 m in
length. Its walls are less muscular and thinner than the jejunum’s. The ileum’s lin-
ing is characterized by nodules of lymphocytes called Peyer’s patches. These nodules
increase in size as they approach the large intestine, and they function to destroy any
bacteria or other pathogens entering the small intestine from the large intestine. The
ileocecal valve (ILL-ee-oh-SEE-cal) is a sphincter muscle at the juncture of the ileum
and the large intestine; it regulates the passage of materials from the ileum to the large
intestine. See Figures 13.16 and 13.19.

Physiology of Digestion in the Small Intestine

Learning Outcome
12. E
 xplain the physiology of chemical digestion in the duodenum, including the hormones
and digestive secretions involved.

When the acidic chyme enters the duodenum, the endocrine cells of the duodenum
begin to secrete their hormones—secretin and cholecystokinin. One minor role of these
two hormones is to target the stomach’s parietal and chief cells, telling them to stop
producing hydrochloric acid and pepsinogen. If chyme is now entering the duodenum,
there is no further need for digestion in the stomach. This is a second negative feedback
mechanism to stop digestion in the stomach and maintain homeostasis. It comple-
ments the negative feedback mechanism of low pH in the stomach, mentioned earlier.
Another role of these two hormones is to target the pancreas, telling it to release
enzymes to complete carbohydrate, lipid, and protein digestion. These digestive
enzymes travel through the pancreatic duct to the common bile duct and through the
hepatopancreatic sphincter. Then they move into the duodenum to complete lipid, car-
bohydrate, and protein digestion. You will now investigate how that works.
The low pH of the chyme entering the duodenum stimulates the duodenal endocrine
cells to secrete secretin. This hormone mainly targets the pancreas, telling the pan-
creas to release bicarbonate ions to neutralize the acidic chyme. This bicarbonate solu-
tion from the pancreas carries pancreatic enzymes for lipid, protein, and carbohydrate
digestion from the pancreas, through the pancreatic duct, to the common bile duct, and
to the duodenum. The bicarbonate ions combine with the hydrogen ions of the hydro-
chloric acid to form carbon dioxide and water. The carbon dioxide is absorbed into the

520 CHAPTER 13 The Digestive System

blood and carried to the lungs, where it is eventually expelled. All of these steps are
necessary to help protect the duodenum from the low pH and maintain homeostasis.
When partially digested lipids enter the duodenum, the duodenum’s endocrine cells
release cholecystokinin, which travels through the blood to its main target tissues—the
gallbladder and the hepatopancreatic sphincter. Cholecystokinin tells the gallbladder
to squeeze (contract) and release its bile through the cystic duct to the common bile
duct. Cholecystokinin also tells the hepatopancreatic sphincter to relax so that the bile
in the common bile duct can enter the duodenum.

Spot Check How does cholecystokinin help the bicarbonate ions and enzymes
from the pancreas reach the duodenum?

Bile helps complete lipid digestion by emulsifying (breaking up) the lipids to tiny
droplets so that the lipases (enzymes) from the pancreas can break the lipids down to
their building blocks—fatty acids and glycerol. Bile also helps activate some of the
other digestive enzymes from the pancreas.
The pancreatic enzymes complete protein digestion by breaking the protein mol-
ecules down to their building blocks, amino acids, while carbohydrate-digesting
enzymes from the pancreas break down the chyme’s carbohydrates to their building
blocks, monosaccharides (simple sugars).
In the small intestine, the mechanical and chemical digestion of the cheeseburger
introduced in the beginning of the chapter is complete. The fats in the cheese are bro-
ken down to fatty acids and glycerol. The proteins of the burger are broken down to
amino acids. And the carbohydrates of the bun are broken down to monosaccharides.
The nutrients, waste products from the bile, and the indigestible materials continue on
to the jejunum and ileum, where nutrient absorption occurs through the villi.
The chyme moves through the sections of the small intestine via two types of con-
tractions. See Figure 13.18. Segmentation is a stationary constriction of the smooth
muscle in ringlike patterns. This type of contraction further churns the chyme, mix-
ing in the bile and digestive enzymes to finish chemical digestion. It also allows for
maximum contact between chyme and the villi, facilitating maximum absorption of
nutrients. Once the chyme has churned and mixed with the bile and digestive enzymes,
it continues to move through the jejunum and ileum through peristalsis (wavelike con-
tractions, mentioned earlier, during swallowing).

(a) (b)

FIGURE 13.18 Segmentation and peristalsis of the small intestine: (a) segmentation, (b) peristalsis.

13.3 Anatomy and Physiology of the Digestive System 521

 Absorption of Nutrients in the Small Intestine

Learning Outcome
13. Explain how nutrients are absorbed in the small intestine.

Monosaccharides and amino acids are absorbed into capillaries through the epithelium
of the villi by facilitated diffusion. Fatty acids and glycerol are absorbed across the
epithelial membranes of the villi by diffusion. They are then coated with proteins and
exocytosed to the lacteals, the small lymph vessels located in the villi. They will con-
tinue to travel through lymph vessels to the thoracic duct to the left subclavian vein,
where they will enter the bloodstream.
The ileum reabsorbs 80% of the bile acids in the chyme, while the other 20% will
leave the body during defecation. This is the body’s way of removing cholesterol. The
liver will make new bile acids from cholesterol to replace the lost 20% of bile acids.
What was not absorbed moves through the ileocecal sphincter into the large intestine.

Anatomy of the Large Intestine

Learning Outcome
14. Describe the anatomy of the large intestine.

The large intestine (colon) is made up of six regions: the cecum, the ascending colon,
the transverse colon, the descending colon, the sigmoid colon, and the rectum. See
Figure 13.19. Altogether, these regions measure about 1.5 m in length and 6.5 cm in
diameter. Although the large intestine is shorter than the small intestine, it is termed
large because its diameter is greater.

Cecum The cecum is a blind pouch (does not lead anywhere) inferior to the juncture
of the ileocecal valve in the lower right quadrant of the abdomen. The appendix is a
dead-end tube extending approximately 7 cm from the inferior portion of the cecum. It
contains many lymphocytes.

Disease P int
Inflammation of the appendix—appendicitis—can be extremely serious because the
appendix can rupture and spill its contents into the abdominopelvic cavity. These contents
are filled with bacteria, which may infect the entire abdominopelvic cavity if released.

Ascending Colon The ascending colon begins at the ileocecal valve and passes up
the right side of the abdominal cavity toward the right lobe of the liver. As it approaches
the liver, it forms a right-angle bend called the right colic (hepatic) flexure.

Transverse Colon The transverse colon is a continuation of the large intestine that
extends from the right colic flexure across the abdomen to the area of the spleen.
There, the colon forms another right angle called the left colic (splenic) flexure.

Descending Colon The descending colon is a continuation of the large intestine

that extends from the left colic flexure down the left side of the abdominal cavity.

Sigmoid Colon The sigmoid colon is a continuation of the large intestine that forms an
S shape in the pelvic cavity. It connects to the last part of the large intestine, the rectum.

Rectum The rectum is approximately 15 cm long, and it ends with the anal canal.
See Figure 13.19b. The anus contains two sphincter muscles: the smooth muscle

522 CHAPTER 13 The Digestive System

 Taenia coli Transverse
colon

Right colic (hepatic) Left colic (splenic)

flexure flexure

Mesenteric
arteries

Serous
Ascending layer
colon
Muscular
layer
Mucous
membrane

Ileum Descending
colon
Ileocecal
sphincter

Orifice of
appendix
Haustra
Cecum

Appendix Sigmoid
colon

Rectum

(a) Anal canal

Rectum

Anal canal

Internal anal
External anal sphincter
sphincter

(b) Anus

FIGURE 13.19 The large intestine: (a) gross anatomy, (b) the anal canal.

13.3 Anatomy and Physiology of the Digestive System 523

 internal anal sphincter, controlled by the autonomic nervous system, and the skeletal
muscle external anal sphincter, controlled by the somatic nervous system.
All of the large intestine’s regions contain smooth muscle in the walls, but the
ascending, transverse, descending, and sigmoid colons also contain longitudinal bands
of smooth muscle called taenia coli. The taenia coli cause the large intestine’s walls
to bulge, forming pouches called haustra (HAW-stra). See Figure 13.19. Unlike the
small intestine, the large intestine does not contain villi. Instead, it is lined by simple
columnar epithelial tissue, except for the lower part of the anal canal, which is strati-
fied squamous epithelial tissue. This tissue needs to be stratified to withstand the abra-
sion of materials leaving the body.

Spot Check A major function of the small intestine is to absorb nutrients. Given
what you have just read about the anatomy of the large intestine, do you think the large
intestine will have a similar function? Explain.

Physiology of Digestion in the Large Intestine

Learning Outcome
15. E
 xplain the physiology of the large intestine in terms of absorption, preparation of
feces, and defecation.

Chyme (minus the absorbed nutrients) enters the large intestine in a very liquid state.
The large intestine functions to absorb water, and this compacts its contents into feces.
This process can take 12 to 24 hours. During that time, the large intestine also absorbs
some electrolytes (especially sodium and chloride ions) and vitamin K produced by bac-
teria living in the large intestine. The large intestine then stores fecal matter until it is
removed (defecation).
The absorption of water in the large intestine is important to maintain
homeostasis. Even after the water is absorbed and the feces have been compacted,
feces are still typically composed of 75% water and 25% solid matter. The solid
matter consists of bacteria that normally live in the colon, indigestible carbohy-
drates (dietary fiber), lipids, and a mixture of sloughed-off epithelial cells, diges-
tive juices, mucus, and a small amount of protein. The lipids and proteins are not
from the cheeseburger. They are from broken-down epithelial cells and bacteria,
which normally live in the colon and have died. Indigestible carbohydrates from the
cheeseburger feed the bacteria that reside in the large intestine. In return, the bac-
teria produce some B vitamins and vitamin K, a necessary vitamin for the produc-
tion of clotting factors. Although these bacteria provide a very beneficial service,
they also produce a gas called flatus, which is not so desirable, as it can cause a
bloated feeling and an unpleasant odor. The amount of flatus produced depends on
the amount of bacteria present in the colon and the type of food ingested. The large
intestine normally contains 7 to 10 L of gas. A typical human expels approximately
500 mL of flatus per day.
How do materials move through the large intestine? Upon entering the large intes-
tine, materials pass up the ascending colon by peristalsis to the transverse colon,
where the materials stop. Distension (expansion) of the stomach and duodenum causes
a mass movement, which moves the feces from the transverse colon to the descending
colon, to the sigmoid colon, and on to the rectum. Distension of the walls of the rec-
tum triggers the defecation reflex. This reflex drives the feces downward and relaxes
the internal anal sphincter. Even though this is an involuntary reflex, defecation occurs
only if the external anal sphincter is voluntarily relaxed. See Figure 13.20 for the def-
ecation reflex’s reflex arc.

524 CHAPTER 13 The Digestive System

 Impulses from
cerebral cortex

Spinal cord
(integration Sensory
center) neurons

Motor
neurons

Stretch
receptors

Voluntary
motor Sigmoid
fibers colon

Stretch
receptors

Rectum

Internal anal
sphincter
Anal canal

External anal
sphincter

FIGURE 13.20 As you will recall from Chapter 6, a reflex arc contains five parts:
a receptor, an afferent neuron, an integration center, an efferent neuron, and an effector. In
the defecation reflex, (1) stretch receptors in the rectal wall (2) send messages via afferent
sensory neurons (3) to the spinal cord (integration center). The spinal cord (4) sends motor
messages via efferent motor neurons (5) to the rectal wall, causing it to contract (effector),
and to the internal anal sphincter, causing it to relax (effector). The cerebrum determines
whether the external sphincter will relax so that defecation can occur (this step is not part of
the reflex).

Disease P int
If the large intestine absorbs too much water, the feces will become harder to move,
leading to constipation. Increased fluid intake, increased dietary fiber, and exercise
can help move feces along. The increased pressure to push with constipation can
cause hemorrhoids, which are bulging anal veins. They may be internal to the rectum
or external to the anus.
On the other hand, if the large intestine absorbs too little water, diarrhea may
occur. A runny stool can result from irritation of the intestine caused by bacteria. In the
case of diarrhea, the ileum’s contents pass through the colon too quickly for adequate
water absorption and compaction of feces to take place.

13.3 Anatomy and Physiology of the Digestive System 525

 Types of Absorbed Nutrients

Learning Outcome
16. Summarize the types of nutrients absorbed by the digestive system from the diet.

Until now, you have concentrated on the digestion and absorption of the major nutri-
ents of a cheesesburger: proteins, carbohydrates, and lipids. To maintain homeostasis,
the digestive system must absorb these nutrients from the diet.
• The proteins in the burger were chemically digested to amino acids and were
absorbed into the blood of capillaries in the small intestine.
• The carbohydrates in the bun were chemically digested to monosaccharides and
were also absorbed into the blood of capillaries in the small intestine.
• The lipids of the cheese were chemically digested to fatty acids and glycerol and
were absorbed into the lacteals in the small intestinal villi.
 ther nutrients, like vitamins and minerals, are also absorbed by the digestive
O
system.
• Vitamins can be categorized as fat soluble or water soluble. Fat-soluble vitamins
(A, D, E, and K) are absorbed along with the products of lipid digestion, so they
must be ingested with fats to be absorbed. On the other hand, water-soluble vita-
mins (the B complex and C) are absorbed by simple diffusion. Vitamin B12 is an
exception. It must first bind to intrinsic factor in the stomach and then be endocy-
tosed by cells of the ileum for absorption. A list of vitamins and their RDAs can be
found in Appendix B.
• Minerals are electrolytes that are absorbed along the length of the small intes-
tine, and some, like sodium and chloride, can also be absorbed in the large intes-
tine. Sodium is absorbed with sugars and amino acids. Chloride ions are mostly
absorbed by active transport in the ileum. Potassium is absorbed by simple dif-
fusion once water has been absorbed. Most minerals are absorbed at a constant
rate. The kidneys excrete whatever excess may have been absorbed. Calcium and
iron are an exception, as the body absorbs them to meet its level of need. You
may recall from the skeletal system chapter that the hormone PTH regulates the
absorption of calcium in the small intestine. A list of minerals and their RDAs can
be found in Appendix B.

Spot Check What would be the effects of a fat-free diet on the liver and on the
absorption of nutrients?

Circulation of Absorbed Nutrients

Learning Outcome
17. Trace the circulation of the nutrients once they have been absorbed.

All blood from the capillaries in the stomach and intestines is circulated directly to the
hepatic portal system so that it can be processed in the liver. See Figure 13.21. The
hepatic portal vein drains the nutrient-rich blood from the capillaries in the villi and
carries it to the capillary beds in the liver. There, the liver removes excess glucose,
amino acids, iron, vitamins, and other nutrients for storage. It also recycles the 80% of
bile acids reabsorbed from the ileum to form bile for lipid digestion in the future. The
fatty acids and glycerol absorbed into lacteals in the villi will join the bloodstream at
the subclavian veins and eventually reach the liver through the hepatic artery.

526 CHAPTER 13 The Digestive System

 Inferior vena cava
FIGURE 13.21 Veins of the
hepatic portal system. Veins
Hepatic veins
drain nutrient-rich blood from
capillary beds in the digestive
Liver Stomach organs and deliver it to capillary
Gastric veins
beds in the liver through the
Gallbladder hepatic portal vein. Once
processed, the blood leaves the
Spleen liver through the hepatic vein on
its way to the inferior vena cava
Hepatic and then the heart.
portal vein
Tail of pancreas
Duodenum

Head of pancreas

Superior Inferior
mesenteric vein mesenteric vein

Descending colon
Ascending colon

Small intestine

Appendix

Parts of the stomach, pancreas, duodenum,

and transverse colon have been removed.

Control of Digestion

Learning Outcome
18. Explain the control of digestion.

Control of digestion is through the autonomic nervous system. Parasympathetic fibers

of the vagus nerve stimulate digestion, while sympathetic neurons from the celiac gan-
glion suppress digestion in part by diverting blood to skeletal muscles and the heart.

Functions of the Digestive System

Learning Outcome
19. Summarize the functions of the digestive system.

Now that you have completed the anatomy and physiology involved in the digestive
system, it is time to summarize the functions of this system while Lisa enjoys the
cheeseburger her mother has prepared. See Figure 13.22. These functions include:
• Ingestion. This function involves the intake of food into the mouth. By her smile,
you can see that Lisa has seen an orthodontist to straighten her teeth. Healthy teeth
and a properly aligned bite will help Lisa begin the next function of this system.

13.3 Anatomy and Physiology of the Digestive System 527

 • Digestion. Lisa begins mechanical digestion of her cheeseburger as
soon as she starts to chew. Mechanical digestion breaks down large
pieces of complex molecules to smaller pieces of complex molecules.
This type of digestion continues in the stomach. Chemical digestion
breaks complex molecules into their building blocks. It, too, begins in
the mouth, where carbohydrates are partially broken down, and it con-
tinues in the stomach, where proteins and lipids are partially broken
down. Chemical digestion is completed in the small intestine, where
the carbohydrates are completely broken down to monosaccharides,
the lipids are completely broken down to fatty acids and glycerol,
and the proteins are completely broken down to amino acids.
• Absorption. The products of digestion are absorbed through the villi
in the small intestine. Monosaccharides and amino acids are absorbed
through facilitated diffusion into the villi’s epithelial cells and then
into capillaries to travel to the liver through the hepatic portal vein.
FIGURE 13.22 Lisa. Using simple diffusion, the epithelial cells of the villi absorb fatty
©KidStock acids and glycerol. They are then coated with protein and endocytosed
to lacteals in the villi to travel with lymph to subclavian veins.
• Defecation. The stretching of Lisa’s stomach and duodenum during the consump-
tion of this meal will initiate a mass movement in her colon. When the previously
undigested materials and bacteria stretch the walls of Lisa’s rectum, a defecation
reflex will result, but it will be Lisa’s decision as to when to defecate. It is impor-
tant to understand that most of the feces removed from the body are not meta-
bolic wastes, produced by chemical processes in cells. They are simply what was
inserted in the mouth and never absorbed by the body’s cells.
Lisa is a healthy teenager whose digestive system is serving her well. However,
what can she expect to happen as she ages?

Spot Check The treatment for colon cancer may involve an ileostomy, which
creates an opening in the abdominal wall so that the contents of the ileum may be
discharged directly from the body, bypassing the colon. What would the discharge look
like? How does this surgery affect the functions of this system?

13.4 Effects of Aging on the Digestive System

Learning Outcome
20. Summarize the effects of aging on the digestive system.

The effects of aging on the digestive system can be seen in many of the structures
along the alimentary canal, starting with the mouth.
• The effects of aging can be seen in the mouth. The enamel on the teeth thins and
the gingiva recedes, allowing for increased tooth decay and loosening of the teeth.
This interferes with proper mastication. Proper dental hygiene can minimize these
effects. The receptors in the taste buds and nose become less sensitive, leading to a
decreased appetite. This may compromise the nutritional status. Although the person
may be eating less because of a diminished appetite, there may be weight gain due to
a slower metabolism.
• The lining of the stomach begins to atrophy with age. This can result in less intrin-
sic factor produced. With less intrinsic factor, less vitamin B12 is absorbed from
the diet, possibly leading to pernicious anemia.

528 CHAPTER 13 The Digestive System

• The liver may metabolize drugs differently as it ages. Geriatric patients may need
to have dosages adjusted for drugs they had been taking long-term.
• Movement through the large intestine slows with age. The longer materials stay in
the large intestine, the more water is absorbed. This can lead to constipation.

13.5 Diagnostic Tests for Digestive System Disorders

Learning Outcome
21. Describe common diagnostic tests used for digestive system disorders.

Like the tables for other systems, Table 13.3 presents common diagnostic tests used
for digestive system disorders. A lot of the tests may be familiar to you, as they have
been mentioned in previous chapters, but their specific relation to the digestive system
is explained in the table.

Clinical P int
With age, the cumulative effects of ingested carcinogens on the walls of the large intes-
tine may lead to polyps, which are precancerous growths. A colonoscopy is recom-
mended to check for polyps on a routine basis for individuals with a family history of
colon cancer. The incidence of colon cancer increases with age.

TABLE 13.3 Common Diagnostic Tests for Digestive System Disorders

Diagnostic Test or Screening Description
Barium swallow/upper GI An X-ray test used to examine the upper digestive tract, which includes the
series esophagus, stomach, and small intestine.
Colonoscopy A procedure in which a lighted colonoscope is used to visualize the colon.
Computed tomography (CT) An imaging technique used to visualize internal structures. The scan produces images
in “slices” of areas throughout the body. In regard to digestive system disorders, CT
can be used to determine changes in digestive organs that might indicate disease.
Fecal occult blood test A noninvasive procedure that detects the presence of blood in stool.
Hepatic screening A collection of several tests used to determine whether the liver is functioning
properly. The test measures several different enzymes produced by the liver.
Laparoscopy A procedure in which a lighted laparoscope is used to visualize, collect biopsies from,
or perform surgical procedures in the abdomen or pelvic region.
Magnetic resonance An imaging technique used to visualize internal structures. This test provides great
imaging (MRI) contrast between various soft tissues in the body. In regard to digestive system disorders,
MRI can be used to detect changes in digestive organs that might indicate disease.
Proctoscopy A procedure in which a lighted endoscope is used to visualize the rectum.
Sigmoidoscopy A procedure in which a lighted sigmoidoscope is used to visualize the lower colon
and rectum.
Stool culture A procedure that involves collecting a stool sample and performing various tests to
detect the presence of disease-causing pathogens.
Ultrasound An imaging technique in which sound waves are used to visualize internal structures.
In the digestive system, ultrasound may be used to visualize digestive organs for any
abnormalities.

13.5 Diagnostic Tests for Digestive System Disorders 529

 13.6 Digestive System Disorders

Learning Outcome
22. Describe digestive system disorders and relate abnormal function to pathology.

You have already become familiar, through the course of

this chapter, with many digestive disorders: dental car-
ies, abscesses, gingivitis, periodontitis, gastroesophageal
reflux disease, gallstones, constipation, diarrhea, hemor-
rhoids, polyps, and colon cancer. Now you will complete
your study of digestive disorders by exploring additional
disorders that affect the digestive system.

Leukoplakia
Leukoplakia are white patches that occur on the surface
of the tongue, inside the mouth, or on the inside surfaces
of the cheek. See Figure 13.23. The white patches are
caused by constant irritation, usually from contact with
FIGURE 13.23 Leukoplakia. rough surfaces like dentures, tobacco products, or teeth
©Dr. Nigel Stollery/Medical Images with rough surfaces. Hairy leukoplakia is a disorder
commonly seen in people with HIV or with compromised
immune systems. It is caused by the Epstein-Barr virus
and is characterized by fuzzy, white patches on the tongue.

Gastroenteritis
Gastroenteritis is inflammation of the gastrointestinal tract
caused by a bacterial, viral, or parasitic infection. Gastro-
enteritis can cause diarrhea, stomach cramping, vomiting,
fever, weight loss, excessive sweating, and dehydration. A
health care provider may perform an examination of the
abdomen and rectum along with a stool culture to diagnose
the cause of gastroenteritis. Although the body will usually
fight off the infection, care must be taken to replace the
fluids and electrolytes lost from the vomiting and diarrhea.

Diverticular Disease
It is common for people to develop small pouches
(diverticula) in the lining of the large intestine as they age.
See Figure 13.24. The diverticula tend to bulge outward
through weak portions in the wall of the large intestine. A
person with multiple diverticula has a condition known as
diverticulosis. Diverticulosis is common in people over
the age of 60. Although this condition usually does not
FIGURE 13.24 Diverticula in the large intestine. cause symptoms of pain or discomfort, in some people it
©David M. Martin, M.D./Science Source
may cause bloating and constipation.
Diverticulitis is inflammation of the diverticulum. Individuals suffering from
diverticulitis have abdominal pain and tenderness. The pain can be mild to severe and
can be accompanied by nausea, vomiting, fever, or diarrhea. In severe cases, diverticu-
litis can cause bleeding, infection, small tears (perforations), or blockages in the colon.
Only some people with diverticulosis get diverticulitis, in which case a person is said
to have diverticular disease. See Figure 13.25.
Diverticular disease is diagnosed through colonoscopy to detect the presence
of diverticula. Ultrasound and CT scans can reveal diverticulitis in specific locations

530 CHAPTER 13 The Digestive System

within the colon. Diverticular disease is treated by
maintaining the appropriate amount of fiber in the diet.
Antibiotics and pain medications may also be used to
help with any infection or discomfort associated with
the condition.

Abdominal Hernias
Abdominal hernias are protrusions of the contents in
the abdomen through a weak portion in the abdomi-
nal wall. The different types of abdominal hernias—
inguinal, umbilical, and incisional hernias—are
described here:
• Inguinal hernias are protrusions into the groin.
These hernias are more common in males due to
weakness remaining in the abdominal wall follow- FIGURE 13.25 Diverticular disease.
©CNRI/Science Source
ing the descent of the testes through the inguinal
canal into the scrotum (covered in the male repro-
ductive system chapter).
• Umbilical hernias are protrusions through the umbilicus. These hernias occur due
to weakness in the abdominal wall where the umbilical cord was once attached.
• Incisional hernias are protrusions through an incision from past abdominal surgery.
Although most hernias do not cause pain or discomfort, a bulge may be visible,
resulting from the protrusion of the abdominal contents through the abdominal wall.
Some hernias may resolve without treatment, and for those that do not resolve on their
own, surgery is an option.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a condition characterized by abdominal pain and
discomfort, a change in the frequency of bowel movements, and a change in the con-
sistency of stool. Patients may experience cramping, diarrhea, and constipation. The
cause of IBS is unknown. IBS is diagnosed by physical exam, stool cultures, sigmoid-
oscopy, colonoscopy, and blood tests. Treatment depends on the symptoms experi-
enced by the patient.

Crohn’s Disease
Crohn’s disease is a type of autoimmune inflammatory bowel disease that causes chronic
inflammation along the gastrointestinal tract. While any part of the gastrointestinal tract
may be affected, usually the inflammation associated with Crohn’s affects the intestines.
Symptoms of Crohn’s disease include abdominal cramping, fever, fatigue, diarrhea, and
weight loss. Physical exam, barium enema, colonoscopy, CT scan, endoscopy, MRI, sig-
moidoscopy, upper GI series, blood tests, and stool culture can all be used when diagnos-
ing this disorder. Treatment can involve dietary changes, medications, and surgery.

Peptic Ulcers
Peptic ulcers are erosions of the digestive tract lining due to an imbalance of gastric
juices (hydrochloric acid and pepsin) and the protection provided by the mucosa. Once
through the mucosa, the gastric juices may continue to erode the protein-rich muscular
walls. Peptic ulcers are named for where they occur, such as esophageal ulcers, gastric
ulcers, or duodenal ulcers. See Figure 13.26.
• Esophageal ulcers may happen in the lower esophagus if there is reflux of gastric
juices through the cardiac sphincter.

13.6 Digestive System Disorders 531

 (a) (b)

FIGURE 13.26 Peptic ulcers: (a) peptic ulcers, (b) stomach that has been opened and laid flat to show several ulcers.
(b) ©Dr. Jill Urban, Dallas County Medical Examiner’s Office, Dallas, TX

• Gastric ulcers of the stomach are often the result of a bacterium, Helicobacter
pylori (H. pylori). Continued use of nonsteroidal anti-inflammatory drugs
(NSAIDs), such as aspirin, may also cause these ulcers.
• Duodenal ulcers—the most common—result when the acidic chyme entering the
duodenum through the pyloric sphincter is not sufficiently neutralized.
Contrary to popular belief, stress does not cause ulcers. Chronic stress may, how-
ever, increase the chances of an ulcer forming and can slow its healing. During chronic
stress, the sympathetic nervous system reduces the production of mucus in the diges-
tive tract, lowering the protection from the gastric juices.

Intussusception
Intussusception occurs when a portion of the intestines folds back into itself, similar
to a telescope, resulting in obstruction of the intestines and possible ischemia. See
Figure 13.27. This condition usually occurs in children, in the area where the small
and large intestines meet. Ultrasound is used to diagnose intussusception, and if con-
firmed, an air enema (introduction of air into the larger intestine) may be performed
to reduce or “uncoil” the affected area. If the reduction using the air enema does not
work, surgery is required.

Cirrhosis
Cirrhosis is a condition of the liver characterized by the formation of scar tissue. The
scar tissue will eventually block blood flow to parts of the liver and interfere with the
liver’s ability to function properly. The two main causes of cirrhosis are excessive
alcohol consumption and chronic hepatitis infection. Although symptoms in the early
stages are uncommon, as the disease progresses, one might experience weakness,
weight loss, fatigue, nausea, fluid accumulation in the abdomen, and itching. Physi-
cians may use physical exams, blood tests for liver function, CT, MRI, and ultrasound
to diagnose cirrhosis. Treatment for cirrhosis is geared toward treating the complica-
tions of impaired liver function and treating the causes of the disease. While the liver
has the ability to regenerate new cells to replace damaged ones, a liver with advanced
cirrhosis no longer has this capability. For this reason, a liver transplant may also be
necessary.

532 CHAPTER 13 The Digestive System

 Colon Colon

Blood Blood
supply to supply Constricted
to
intestine intestine
blood supply

Colon Colon

Small Small
intestine intestine

Small Colon Small Colon

intestine intestine Intussuscepted Intussuscepted
section of section of
small intestine small intestine

(a) (a)

(b) (b)

FIGURE 13.27 Intussusception: (a) normal small intestine compared to an intussuscepted section of the small intestine with
constricted blood supply, (b) section of an intussuscepted section of the small intestine during surgical repair.
(b) ©Ryan G. Gates, DVM, Cuyahoga Falls Veterinary Clinic, fallsvetclinic.com

Hepatitis
Hepatitis is inflammation of the liver, usually caused by a viral infection. It is a seri-
ous condition that can lead to cirrhosis, liver cancer, and liver failure. The five
types of hepatitis, distinguished by the viruses that cause it, and their modes of trans-
mission are described in the following list:
• The hepatitis A virus causes acute liver disease that can last for a few months. It is
transmitted by ingestion of fecal matter, direct contact with an infected person, or
ingestion of contaminated food products.

13.6 Digestive System Disorders 533

 • The hepatitis B virus causes liver disease that ranges in severity. Hepatitis B infec-
tions can be acute or chronic. This disease is transmitted by contact with infected
blood or other body fluids, by sexual contact with an infected person, from mother
to newborn, or by shared contaminated needles during drug use.
• The hepatitis C virus can lead to an acute condition but more likely causes a
chronic infection that can eventually cause cirrhosis or liver cancer. Hepatitis C
usually spreads through contact with infected blood by sharing contaminated nee-
dles during drug use.
• The hepatitis D virus causes a very serious liver disease, which is uncommon in
the United States. The hepatitis D virus must have the hepatitis B virus present
in order to spread throughout the body, causing damage to the liver. This virus
spreads in the same way as hepatitis B.
• The hepatitis E virus, which causes an acute liver infection, is also uncommon in
the United States but is common in other countries around the world. It is trans-
mitted by ingestion of fecal matter. Outbreaks of hepatitis E are usually associated
with contaminated water supplies.
Other medical conditions such as excessive alcohol and drug use, and cer-
tain medications, can also cause hepatitis. The symptoms of hepatitis include an
enlarged liver, fluid in the abdomen, and jaundice. Hepatitis can be diagnosed by
ultrasound, liver function tests, liver biopsy, and blood tests for the presence of the
virus.

Clinical P int
Because health care providers are often exposed to blood and other body fluids from
patients who may be infected with hepatitis, it is recommended that they receive the
hepatitis B vaccination to reduce the risk of contracting the disease. The vaccine is also
available and recommended for children and adults who may be at risk for contracting
hepatitis B.

Vomiting
Vomiting can result from irritation anywhere along the digestive tract. It is controlled
by an emetic center in the medulla oblongata. It begins with a deep breath. The hyoid
bone and larynx are elevated, closing off the glottis, while the soft palate is elevated,
closing off the nasopharynx. The diaphragm and abdominal muscles forcefully con-
tract, putting pressure on the stomach and its contents. The cardiac sphincter opens
and the contents of the stomach are forcefully expelled.

Food Poisoning
It is important to understand the cause of a food poisoning. Is it caused by bacteria?
Or the toxins the bacteria produce? Heat from cooking may destroy the bacteria but
not the toxins they produce. The various types of bacteria and/or their toxins, which
can cause food poisoning, are explained in the following list:
• Staphylococcal food poisoning is usually contracted from a food handler.
Bacteria contaminating the food make toxins, which cause nausea, diarrhea, and
vomiting. The symptoms occur 1 to 6 hours after eating the contaminated food.
• Salmonellosis is caused by the bacteria in contaminated food (meat, poultry,
milk). These bacteria are destroyed by heat. The symptoms of nausea, diarrhea,
and vomiting can occur up to 36 hours after eating.

534 CHAPTER 13 The Digestive System

• Botulism is caused by toxins made by a common
bacterium found in the soil. This toxin is a power-
ful neurotoxin that prevents muscle contractions.
You may eat a raw green bean directly from the
garden and ingest the bacteria. This is not harmful.
However, if the green beans are improperly canned
and not all of the bacteria are destroyed in the pro-
cess, the toxins they produce may be fatal.

Parasites
A parasite is an organism that lives on or in another
organism (the host) and obtains its nourishment there.
Parasites may or may not be harmful to the host. With
digestive parasites, it is important to understand what
they eat. For example, do they eat what is passing by,
or do they eat you? The following list contains specific
information about the types of parasites that might be FIGURE 13.28 Adult tapeworm.
found in the digestive system. Source: CDC

• Pinworms. These small, white worms commonly live in the digestive tract of
humans and feed on the partially digested food going by. They crawl out the
anus to lay their eggs, which causes an itching sensation. Contaminated fingers
then spread the eggs to surfaces on which they are able to survive. Here is an
example of how this worm may be spread: Jimmy is a kindergarten student who
has pinworms. As he is coloring, he begins to squirm in his chair because of
the itching caused by the worms. It becomes more and more uncomfortable,
prompting Jimmy to ask his teacher to be excused to go to the restroom. There,
he solves his problem by scratching his itch directly. Having been well trained
by his parents, Jimmy washes his hands when he is done. But Jimmy is only 5
years old. Not all of his fingers necessarily get wet if he is in a hurry, as he is
in this case. So Jimmy returns to color the sky blue in his drawing. Sally, who
is worm-free, asks to borrow Jimmy’s blue crayon. Having learned to share,
Jimmy gives her the now pinworm-egg-contaminated crayon. Sally puts the
end of the crayon in her mouth as she contemplates what she wants to
color blue. Sally has now ingested the pinworms. The ingested eggs will
hatch in her intestine. These worms are easily spread to other individuals
within families and schools.
• Tapeworms. The larvae of these worms—from undercooked beef, pork, or
fish—infect the digestive tract. They attach to the intestinal wall by suck-
ers and feed off the partially digested materials passing by. Tapeworms
are segmented worms, and their segments may break off and appear in the
feces. Tapeworms may live in the digestive tract for years, and can grow up
to 6 meters in length. See Figure 13.28.
• Roundworms. The ingested eggs of this parasite hatch into larvae in the
upper intestine, enter the bloodstream, and travel to the lungs. Here, they
cause respiratory symptoms. When coughed to the pharynx, the larvae are
then swallowed, returning the worms to the intestine. The adult worms may
stay in the intestine, or they may migrate, cutting through intestinal walls.
See Figure 13.29.
• Giardia. These protozoans are prevalent in streams, lakes, and rivers,
especially where beavers are present. This infection results from ingest- FIGURE 13.29 Roundworms. A CDC
ing untreated, contaminated water. The symptoms of nausea, abdominal technician holds a mass of roundworms
cramps, and weight loss may last for weeks. passed by a child.
Source: James Gathany/CDC

13.6 Digestive System Disorders 535

 Malabsorption
Malabsorption is the inability to absorb the appropriate nutrients needed by the body.
This inability results from problems with digestion of food, absorption of nutrients
from food, or transport of nutrients from food to the bloodstream. Symptoms include
diarrhea, weight loss (despite the amount of food consumed), and anemia. Malabsorp-
tion can be diagnosed on the basis of physical exams, blood tests, stool culture, endos-
copy, and contrast imaging tests.
Table 13.4 summarizes all of the diseases and disorders described through-
out the chapter.

TABLE 13.4 Summary of Diseases and Disorders of the Digestive System

Type of Disease/
Disorder Disease/Disorder Description
Oral cavity Dental caries Erosion through the enamel into the dentin of the tooth.
disorders (cavities)

Gingivitis Inflammation of the gingiva.

Hairy leukoplakia Fuzzy, white patches on the tongue caused by the Epstein-Barr virus;
common in HIV-positive or immunocompromised patients.

Leukoplakia White patches that occur on the surface of the tongue, inside the mouth,
or on the inside surfaces of the cheek.

Periodontitis Inflammation and infection of the ligaments and bone that hold the teeth in
place.

Accessory Cholecystitis Inflammation of the gallbladder.

organ disorders

Cirrhosis A condition of the liver characterized by the formation of scar tissue.

Gallstones A condition in which cholesterol in bile precipitates the forming of

(cholelithiasis) gallstones in the gallbladder.

Hepatitis Inflammation of the liver, usually caused by a viral infection. There are five
types of the hepatitis virus: A, B, C, D, and E.

Gastrointestinal Appendicitis Inflammation of the appendix.

tract disorders

Colon cancer Cancer of the large intestine.

Constipation The result of too much water being reabsorbed from feces, making the
feces hard to move.

Crohn’s disease An autoimmune inflammatory bowel disease that causes chronic

inflammation along the gastrointestinal tract.

Diarrhea The result of not enough water being reabsorbed from feces, resulting in
runny stool.

Diverticular The presence of diverticula in the large intestine (diverticulosis), which

disease become inflamed (diverticulitis).

Gastroenteritis Inflammation of the gastrointestinal tract, caused by a bacterial, viral, or

parasitic infection.

536 CHAPTER 13 The Digestive System

 Summary of Diseases and Disorders of the Digestive System
TABLE 13.4
(continued)
Type of Disease/
Disorder Disease/Disorder Description
Gastroesophageal Chronic leakage of gastric juices back to the esophagus.
reflux disease
(GERD)

Hemorrhoids A condition in which the increased pressure to push with constipation

causes anal veins to bulge.

Intussusception A condition that occurs when a portion of the intestines folds back into
itself, similar to a telescope, resulting in obstruction of the intestines and
possible ischemia.

Irritable bowel A condition characterized by abdominal pain, discomfort, changes in the

syndrome (IBS) frequency of bowel movements, and changes in the consistency of stool.

Peptic ulcer Erosion of the digestive tract lining due to an imbalance of gastric juices
(hydrochloric acid and pepsin) and the protection provided by the
mucosa.

Polyps Precancerous growths in the large intestine.

Other digestive Abdominal Protrusions of the abdomen’s contents through a weak portion in the
disorders hernias abdominal wall. Inguinal hernias are protrusions into the groin, umbilical
hernias are protrusions through the umbilicus, and incisional hernias are
protrusions through an incision from past abdominal surgery.

Food poisoning Gastrointestinal illness caused by various types of bacteria and/or their
toxins.

Malabsorption The inability to absorb the appropriate nutrients needed by the body due
to problems with digestion of food, absorption of nutrients from food, or
transport of nutrients from food to the bloodstream.

Parasites Organisms that live on or in another organism and obtain their

nourishment there. Some intestinal parasites are pinworms, tapeworms,
roundworms, and giardia.

Vomiting The expulsion of the stomach’s contents.

13.6 Digestive System Disorders 537

Putting the Pieces Together

The Digestive System

Integumentary system Cardiovascular system
Vitamin D production in the skin Blood transports absorbed
enables calcium absorption in the nutrients.
small intestine.
Provides nutrients for tissues of the
Provides nutrients for tissues of cardiovascular system.
the integumentary system.
Lymphatic system
Skeletal system Transports products of lipid
Provides protection for some digestion; sends white blood cells
digestive organs. to fight pathogens in the digestive
system.

Provides nutrients for tissues of

Provides nutrients for tissues of
the skeletal system.
the lymphatic system.

Muscular system
Respiratory system
Skeletal muscles are used for
Allows for the exchange of O2
chewing and swallowing; muscles
and CO2 in system tissues.
provide protection for some
digestive organs.
Provides nutrients for tissues of
Provides nutrients for tissues of the respiratory system.
the muscular system.

Excretory/urinary system
Nervous system
Liver processes absorbed
Parasympathetic division innervates nutrients.
digestive organs.
Provides nutrients for tissues of
Provides nutrients for tissues of the the excretory/urinary system.
nervous system.

Reproductive system
Endocrine system
Decreased digestive motility
Hormones regulate gastric during the first trimester may
secretions. cause morning sickness.

Provides nutrients for tissues of Provides nutrients for tissues of

the endocrine system. the reproductive system.

FIGURE 13.30 Putting the Pieces Together—The Digestive System: connections between the digestive system and the
body’s other systems.

538 CHAPTER 13 The Digestive System

Summary
13.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the digestive system.

13.2 Overview
∙∙ S tructures of the digestive system form the alimentary canal.
∙∙ Mechanical digestion is the breakdown of large pieces of complex molecules to smaller pieces of complex molecules.
∙∙ Chemical digestion is the breakdown of complex molecules to their building blocks so that they can be absorbed.

13.3 Anatomy and Physiology of the Digestive System

Anatomy in the Mouth
∙∙ D eciduous teeth are replaced by permanent teeth.
∙∙ The purpose of the tongue is to manipulate what is ingested and to provide the sense of taste.
∙∙ The parotid glands, the submandibular glands, and the sublingual glands produce saliva.

Physiology of Digestion in the Mouth

∙∙  echanical and chemical digestion takes place in the mouth.
M
∙∙ The masseter and temporalis muscles move the jaw for mastication.
∙∙ Amylase in saliva partially digests carbohydrates.
∙∙ Mucus mixes with the food to make it easier to swallow.
∙∙ The bite of food is called a bolus before it is swallowed.

Anatomy from the Mouth to the Stomach

∙∙ T he pharynx is composed of the nasopharynx, the oropharynx, and the laryngopharynx.
∙∙ The esophagus is a tube that goes through the diaphragm to connect with the stomach.

Physiology of Digestion from the Mouth to the Stomach

∙∙ D eglutition (swallowing) involves four cranial nerves.
∙∙ The epiglottis closes off the glottis so that the bolus moves to the esophagus.
∙∙ Peristalsis moves the bolus through the esophagus.

Anatomy of the Stomach

∙∙ T he stomach has three layers of smooth muscle in its walls, each oriented in a different direction.
∙∙ The lining of the stomach has rugae for more surface area to accommodate gastric pits that lead to gastric glands.
∙∙ Gastric pits and gastric glands are composed of five types of cells: mucus-producing cells, chief cells, parietal cells,
endocrine cells, and regenerative cells.
∙∙ Parietal cells produce hydrochloric acid and intrinsic factor.
∙∙ Chief cells produce pepsinogen and gastric lipase.
∙∙ Endocrine cells produce gastrin.

Physiology of Digestion in the Stomach

∙∙  uring swallowing, the medulla oblongata sends signals to the stomach, telling it to relax.
D
∙∙ The cardiac sphincter opens to allow the bolus to enter.
∙∙ Stretching of the stomach walls starts peristaltic contractions.
∙∙ The pyloric sphincter remains closed until the pH of the stomach contents reaches 2.
∙∙ Hydrochloric acid changes pepsinogen to pepsin so that proteins are partially digested.
∙∙ Hydrochloric acid activates lingual lipase, which partially digests lipids along with gastric lipase.
∙∙ Intrinsic factor binds to vitamin B12 so that it can be absorbed later.
∙∙ Once gastric secretions are mixed with the bolus, it is called chyme.

Anatomy of Digestive Accessory Structures

∙∙ T he liver’s four lobes are arranged in hepatic lobules.
∙∙ Hepatocytes produce bile that contains bile acids and lecithin, both of which aid in the chemical digestion by
emulsifying lipids.

539
∙∙  ile is released into hepatic ductules leading to the hepatic duct.
B
∙∙ The common bile duct is a tube common to the hepatic duct, the cystic duct, and the pancreatic duct.
∙∙ The hepatopancreatic sphincter controls the opening of the common bile duct to the duodenum.
∙∙ The gallbladder collects the overflow of bile from the common bile duct and concentrates it.
∙∙ The pancreas secretes bicarbonate ions and enzymes for carbohydrate, lipid, and protein digestion.

Anatomy of the Small Intestine

∙∙  he small intestine is composed of the duodenum, the jejunum, and the ileum.
T
∙∙ All parts of the small intestine have smooth muscle in their walls and are lined by villi.
∙∙ Endocrine cells of the duodenum secrete secretin and cholecystokinin.
∙∙ The ileocecal valve controls the movement of materials from the small intestine to the colon.

Physiology of Digestion in the Small Intestine

∙∙  ecretin is released from endocrine cells of the duodenum in response to the acidic chyme.
S
∙∙ Secretin causes the pancreas to release bicarbonate ions to neutralize the chyme in the duodenum.
∙∙ Cholecystokinin is secreted by endocrine cells in the duodenum in response to the presence of lipids.
∙∙ Cholecystokinin targets the gallbladder (causing it to release bile) and the hepatopancreatic duct (causing it to relax).
∙∙ The release of bicarbonate ions from the pancreas carries the digestive enzymes through the pancreatic duct to the
duodenum, where all further chemical digestion is completed.
∙∙ Segmentation ensures that all the contents of the small intestine come in contact with villi for absorption.
∙∙ Peristalsis further moves the contents through the jejunum and ileum to the ileocecal valve.

Absorption of Nutrients in the Small Intestine

∙∙ M onosaccharides and amino acids are absorbed through the epithelium of the villi into capillaries by facilitated
diffusion.
∙∙ Fatty acids and glycerol are absorbed across the epithelial membranes of the villi by diffusion, coated with proteins,
and exocytosed to lacteals.

Anatomy of the Large Intestine

∙∙ T he colon is composed of the cecum, the ascending colon, the transverse colon, the descending colon, the sigmoid
colon, and the rectum.
∙∙ The anus contains two sphincter muscles: the smooth muscle internal anal sphincter, controlled by the autonomic
nervous system, and the skeletal muscle external anal sphincter, controlled by the somatic nervous system.

Physiology of Digestion in the Large Intestine

∙∙ T he large intestine absorbs water, compacts materials to form feces, and then stores the feces until they are removed
through defecation.
∙∙ Bacteria living in the large intestine produce vitamin K and flatus.
∙∙ Stretching of the stomach and duodenum causes a mass movement of fecal material from the transverse colon to the
rectum.
∙∙ Stretch receptors in the rectal walls initiate the defecation reflex.
∙∙ Defecation happens voluntarily when the external anal sphincter is relaxed.

Types of Absorbed Nutrients

∙∙ Proteins, carbohydrates, lipids, vitamins, and minerals are absorbed in the small intestine.

Circulation of Absorbed Nutrients

∙∙ T he hepatic portal vein drains nutrient-rich blood from the capillaries in the villi and carries it to the capillary beds
in the liver.
∙∙ The fatty acids and glycerol absorbed into lacteals in the villi join the bloodstream at the subclavian veins and even-
tually reach the liver through the hepatic artery.

Control of Digestion
∙∙ T he autonomic nervous system controls digestion.
∙∙ Parasympathetic fibers of the vagus nerve stimulate digestion.
∙∙ Sympathetic neurons from the celiac ganglion suppress digestion in part by diverting blood to skeletal muscles and
the heart.

540
Functions of the Digestive System
∙∙ The functions of the digestive system include ingestion, digestion, absorption, and defecation.

13.4 Effects of Aging on the Digestive System

∙∙  ooth enamel thins, and the gingiva recede.
T
∙∙ The lining of the stomach atrophies.
∙∙ The liver may metabolize drugs differently.
∙∙ Movement of material through the large intestine slows with age.

13.5 Diagnostic Tests for Digestive System Disorders

∙∙ C
 ommon diagnostic tests for digestive system disorders include barium swallow, colonoscopy, CT, fecal occult
blood test, hepatic screening, laparoscopy, MRI, proctoscopy, sigmoidoscopy, stool culture, and ultrasound.

13.6 Digestive System Disorders

∙∙  eukoplakia are white patches that occur inside the mouth.
L
∙∙ Gastroenteritis is inflammation of the gastrointestinal tract.
∙∙ Diverticular disease is the presence of inflamed diverticula in the large intestine.
∙∙ Abdominal hernias are protrusions of the abdomen’s contents through the abdominal wall.
∙∙ Irritable bowel syndrome is a condition of abdominal pain, discomfort, and changes in the frequency and consis-
tency of bowel movements.
∙∙ Crohn’s disease is an autoimmune inflammatory bowel disease.
∙∙ A peptic ulcer is erosion of the digestive tract lining.
∙∙ Intussusception is a condition that occurs when a portion of the intestines folds back into itself.
∙∙ Cirrhosis is a condition of the liver characterized by the formation of scar tissue.
∙∙ Hepatitis is inflammation of the liver caused by a virus.
∙∙ Vomiting is the expulsion of the stomach’s contents.
∙∙ Food poisoning is a gastrointestinal illness caused by various types of bacteria and/or their toxins.
∙∙ Parasites are organisms that live on or in another organism and obtain their nourishment there.
∙∙ Malabsorption is the inability to absorb the appropriate nutrients.

Key Words for Review

The following terms are defined in the glossary.

alimentary canal deglutition mass movement

bolus diarrhea mastication
caries emulsify mechanical digestion
chemical digestion feces parasite
chyme flatus peristalsis
constipation ingestion segmentation
defecation lacteals

541
 14 The Excretory/
Urinary System
As you well know, no matter how
much you reduce, reuse, and recycle,
you still generate waste in your home.
You also know that you must have
a system for removing this waste on
a regular basis if your household is
going to function properly. While the
waste hauler in your area removes the
waste you place in trash bags, your
septic system or city sewer system
handles the waste you flush down
the drain. Your body handles waste
in a similar fashion. For example, the
liver and spleen recycle the iron and
amino acids when they break down
a worn-out red blood cell’s hemo-
globin, but the bilirubin produced in
the process is a metabolic waste that
must be completely removed from
the body. Bilirubin is carried away in
feces during defecation and is flushed
out of the body with urine. The
excretory system’s job is to remove
bilirubin and the rest of the body’s
metabolic wastes. See Figure 14.1.
©didi/Getty Images

Module 13: Urinary System

542
14.1 Word Roots and Combining Forms

Learning Outcome
1. Use medical terminology related to the excretory/urinary system.

azot/o: nitrogen nephr/o: kidney ur/o: urinary tract, urine

cyst/o: urinary bladder pyel/o: renal pelvis ureter/o: ureter
glomerul/o: glomerulus ren/o: kidney urethr/o: urethra

14.2 Overview Excretory/ Urinary System

Major Organs and Structures:
kidneys, ureters, urinary bladder,
urethra
Learning Outcome Accessory Structures:
2. Define excretion and identify the organs that excrete waste. lungs, skin, liver
Functions:
removal of metabolic wastes, fluid
The excretory system removes the body’s metabolic wastes through and electrolyte balance, acid–base
a process called excretion. Excretion of wastes is different from def- balance, blood pressure regulation
ecation, which you studied in the digestive system chapter. Although
you may think of defecation as removing waste, the feces removed
from the body through defecation are mostly undigested materials
and bacteria that were not previously present in your body’s cells.
An exception to this is bilirubin, the waste produced from the break-
down of hemoglobin in the liver and spleen. Metabolic wastes are
wastes produced by the cells—bilirubin is a good example.
Several organs of your body—the skin, lungs, liver, and
kidneys—excrete metabolic wastes. See Figure 14.2. These
organs and the excretions they are responsible for carrying out
are explained in the following list:
• The skin removes some salts, lactic acid, and urea with sweat.
• The lungs remove carbon dioxide with every humidified,
expired breath.
• The liver removes bilirubin by putting it in bile.
• The kidneys remove nitrogenous wastes (wastes containing
nitrogen), excess minerals, bilirubin, and excess hydrogen FIGURE 14.1 The excretory/urinary system.
ions by producing urine.

(a) (b) (c) (d)

FIGURE 14.2 Organs of the excretory system: (a) skin, (b) lungs, (c) liver, (d) kidney.

14.2 Overview 543

 As you can tell from the preceding list, water is often used to eliminate metabolic
wastes. Sweat, humidified air, bile, and urine all contain water. Water conservation
and its use in excretion are addressed later in the chapter.

Sources of Nitrogenous Wastes

Learning Outcome
3. List the body’s major nitrogenous wastes and their sources.

Kidneys are the primary organs of this system. The excretory system
H O
is sometimes referred to as the urinary system when the focus is on
N C only the kidneys and their urine production. The nitrogenous wastes
H H H 2N NH2 removed by the kidneys can be lethal to the body if they are allowed
Ammonia Urea to accumulate in the blood in excessive amounts. These wastes are
described in the following list, and their chemical structures are
O NH shown in Figure 14.3.

C
H
N C • Ammonia is produced from the breakdown of amino acids. It is
HN C HN N CH3 extremely toxic, but it is quickly converted by the liver to urea, a
C O
C C C CH2 less toxic waste.
N N
O
H H O • Urea is the most common nitrogenous waste produced in the
Uric acid Creatinine body, accounting for 50% of that waste. It is ultimately formed
from the breakdown of proteins.
FIGURE 14.3 Nitrogenous wastes. Notice that
nitrogen is part of the chemical structure for each • Uric acid is formed from the breakdown of nucleic acids.
waste. • Creatinine is formed from the breakdown of creatine phosphate,
a stable energy storage molecule (discussed in the muscular sys-
tem chapter, under “Muscle Metabolism”).

Overview of Kidney Function

Learning Outcome
4. List the functions of the kidneys in addition to urine production.

You have read about the kidneys in earlier chapters because they function in mul-
tiple systems. You may recall that the kidneys are important in the body’s homeo-
stasis of calcium through their role in vitamin D synthesis (the integumentary and
skeletal system chapters). They are also important to the cardiovascular system
in several ways. For example, the kidneys produce erythropoietin to stimulate red
blood cell production when blood oxygen levels are low (the cardiovascular system
chapter on blood). The kidneys also help regulate blood volume, blood pressure,
and the blood’s concentration of solutes by adjusting the amount of water they use
to produce urine (the cardiovascular system chapter on heart and vessels, and later
in this chapter).
Throughout the rest of this chapter, you will explore the following anatomy and
physiology of kidneys and the urinary system:
• The kidneys’ excretion of wastes in urine
• The kidneys’ role in the regulation of blood volume and pressure by the formation
of urine
• The delivery of urine from the body
• The way urine production is controlled

544 CHAPTER 14 The Excretory/Urinary System

 In addition to studying the anatomy and physiology of this system, you will also learn
about how aging affects the excretory system and what can go wrong when the anatomy
and physiology do not work. You will begin by exploring the anatomy of the kidney.

14.3 Anatomy of the Kidney

Learning Outcome
5. Describe the external and internal anatomy of the kidneys.

The kidneys are dark red, bean-shaped organs about the size of a tightly clenched
fist. Like the pancreas, the kidneys are retroperitoneal (posterior to the parietal perito-
neum). See Figure 14.4. The kidneys extend from T11 to L3 (vertebrae) on each side
of the vertebral column and are somewhat protected superiorly by the ribs. The right

Posterior

Kidney

Adipose tissue

Parietal
peritoneum Spleen

Aorta
Inferior vena cava Small intestine
Large intestine
Pancreas
Stomach
Liver

(a)

Adrenal gland Liver

12th rib

Kidney
Parietal peritoneum

Renal fascia Renal capsule

Hip bone (cut) Large intestine

(b)

FIGURE 14.4 Retroperitoneal position of the kidney: (a) transverse section through the torso at the level of the kidney,
(b) sagittal cut through the torso at the right kidney.

14.3 Anatomy of the Kidney 545

 kidney is slightly lower than the left due to the position of the liver. As Figure 14.4
shows, a fibrous renal capsule, surrounded by adipose tissue (perirenal fat capsule),
also protects the kidney. This fatty pad absorbs the mechanical shock to the kidney that
may occur with a fall. Renal fascia (a connective tissue covering) anchors the kidney
to the posterior muscle wall of the body’s abdomen.

Spot Check Once the abdominal organs have been pushed aside, what
specific membrane must be pierced to access the kidney?

Figure 14.5 shows the kidney’s external and internal anatomy. In the figure, you
can see a notch on the medial surface of the kidneys. This notch in a kidney is called

Renal artery
Adrenal gland
Major calyx

Renal Renal pelvis

capsule

Renal medulla

Renal vein
Renal pyramid

Hilum Adipose tissue in

renal sinus

Ureter Renal cortex

(a) Minor calyx

Fibrous capsule Renal cortex

Renal medulla

Renal sinus

Adipose tissue in renal sinus

Minor calyx Renal pelvis

Major calyx

Renal pyramid
Renal blood vessels

(b) Ureter

FIGURE 14.5 Gross anatomy of the kidney: (a) major anatomical features of the kidneys, (b) coronal section of a cadaver kidney.
(b) ©McGraw-Hill Education/Rebecca Gray

546 CHAPTER 14 The Excretory/Urinary System

the renal hilum. As with the hilum in the lung, all structures entering or leaving the
kidney do so at the hilum. In this figure, you can see that the renal artery enters the
kidney, while the renal vein and the renal pelvis (leading to the ureter) exit the kid-
ney. If you were to grab hold and remove the renal pelvis, renal artery, and renal vein
from the kidney, you would be left with the space they occupied. This space is the
renal sinus. Adipose tissue fills whatever space is available in the renal sinus.
Look at Figure 14.5 (a and b) closely as you explore the internal anatomy of a
kidney. Each kidney has three layers: the thin, outer fibrous renal capsule; a layer deep
to the capsule called the renal cortex; and the inner renal medulla. In the diagram,
the renal medulla appears to be composed of triangles called pyramids. The renal
pyramids are actually three-dimensional cones, each leading to a funnel-like structure
called a minor calyx (KAY-licks). Two or more minor calyces (KAY-lih-seez) may
merge to form a major calyx, which empties into the renal pelvis. The calyces look
and act like funnels that collect urine and deliver it to the renal pelvis. You should also
note the many blood vessels that are present in this frontal section of the kidney. The
kidney has and needs a very rich blood supply to function properly.
All of the structures you have read about so far in this chapter can be seen with
a naked eye. However, the functional unit of the kidney—a nephron (NEF-ron)—is
microscopic. We explain the anatomy of a nephron next.

Anatomy of a Nephron

Learning Outcome
6. Describe the anatomy of a nephron.

Each kidney contains over 1 million nephrons. These structures produce urine. The
anatomy of a nephron appears fairly complicated when seen in total. However, Fig-
ure 14.6, which shows the ___location of a nephron’s anatomy in a kidney, simplifies its
arrangement so that you can understand its components. There are two principal parts
to a nephron—the renal corpuscle and the renal tubule.

Renal Corpuscle The renal corpuscle is like an elaborate filter in a cup. It is com-
posed of a glomerulus (glo-MER-you-lus) and a glomerular capsule (Bowman’s
capsule). See Figure 14.6c. An afferent arteriole delivers blood to a capillary bed
called the glomerulus (the filter) inside the glomerular capsule (the walls of the cup).
Cells of the capsule extend over each of the capillaries in the glomerulus, forming a
filtration membrane. Whatever is filtered out of the blood through this membrane is
caught in the glomerular capsule space and delivered to the next part of the nephron—
the renal tubule. Meanwhile, the blood in the glomerular capillaries continues on its
journey out of the renal corpuscle through the efferent arteriole.

Study Hint
You have seen the words afferent and efferent before, when they were used in describ-
ing the direction of nerve impulses. The direction is important in the nervous system
and here again in the excretory system. Just remember E stands for exit. Efferent nerve
impulses exit the CNS, and efferent arterioles exit the glomerulus.

Renal Tubule A tubule is simply a hollow tube. The renal tubule can be divided
into three sections on the basis of anatomy and ___location—the proximal convoluted
tubule (PCT), the nephron loop (loop of Henle), and the distal convoluted tubule
(DCT). The walls of the tubule are simple epithelia that allow for the exchange of
materials. What flows through the tubules eventually becomes urine. Figure 14.6b
shows a nephron’s renal tubule stretched out so that you can easily see each of the

14.3 Anatomy of the Kidney 547

 Glomerulus
Proximal
convoluted Glomerular
Nephrons Renal tubule capsule
cortex Parietal
Visceral layer of layer of
Collecting glomerular capsule
duct glomerular
forming a filtration capsule
membrane

Renal Capsular
medulla space

Afferent
arteriole
(c)
Minor calyx
Efferent
Distal convoluted arteriole
tubule (DCT)

Afferent arteriole

Collecting Renal corpuscle:

duct (CD) Glomerular capsule
Glomerulus
Nephron Efferent arteriole
loop Proximal
convoluted
tubule (PCT)

Renal
tubule

(a)

Flow of blood Flow of tubular fluid

Calyx
(b)

FIGURE 14.6 Microscopic anatomy of a nephron: (a) ___location of a nephron in a kidney, (b) anatomy of a nephron stretched out
so that the parts can be more easily seen, (c) the renal corpuscle.

sections and the direction of flow for the components of urine. The proximal convo-
luted tubule is directly connected to the glomerular capsule. It twists and turns (con-
volutes) before descending to form the nephron loop in the renal pyramid. The renal
tubule then ascends out of the renal pyramid to form the distal convoluted tubule in the
renal cortex. Several distal convoluted tubules connect to a shared collecting duct that
empties at the very end of the renal pyramid into a minor calyx. When you examine the
nephron in Figure 14.6a, you can see that the renal corpuscle, the proximal convoluted
tubule, and the distal convoluted tubule are located in the renal cortex, while the neph-
ron loop and the collecting duct are located in the renal pyramid of the renal medulla.

Study Hint
The word proximal refers to the position of the tubule relative to the glomerular cap-
sule. The proximal convoluted tubule is directly attached to the glomerular capsule.
Although part of the distal convoluted tubule rests right next to the glomerular capsule
(as you will see shortly), it is termed distal because it is not directly attached to the
glomerular capsule. In fact, it is the third section of tubule away (distant) from the glo-
merular capsule.

548 CHAPTER 14 The Excretory/Urinary System

 Glomerular Afferent
capsule arteriole
Juxtaglomerular
Glomerulus apparatus

Distal
convoluted
tubule

Glomerulus
Efferent
arteriole

Afferent arteriole

Proximal
convoluted
tubule

Nephron loop Juxtaglomerular

cells Juxtaglomerular
Macula densa apparatus
Distal convoluted
tubule
Glomerular capsule
(a)

Efferent arteriole
(b)

FIGURE 14.7 Nephron: (a) as it occurs in a kidney, (b) juxtaglomerular apparatus.

Unlike Figure 14.6, which shows a nephron stretched out, Figure 14.7 shows a
nephron as it occurs in the kidney. You can see in this close-up of the renal corpuscle
that the distal convoluted tubule is very close to the afferent and efferent arterioles as
they enter and leave the glomerular capsule. Here, the epithelial cells of the distal con-
voluted tubule are very close together, forming a structure called the macula densa.
You can also see specialized smooth muscle cells—juxtaglomerular cells (JUX-ta-
glo-MER-you-lar)—surrounding the afferent arteriole. Together, the juxtaglomerular
cells and the macula densa make up a structure called the juxtaglomerular appara-
tus. This structure is discussed later in the chapter in regard to the control of urine
production, but now it is time to get back to the structures involved in producing urine.

Spot Check List the parts of a nephron in order.

Flow of Urine Components through a Nephron

Learning Outcome
7. Trace the components of urine through a nephron.

The glomerular capsule catches whatever is removed from the blood in the glomeru-
lus. This material collected by the glomerular capsule is called filtrate. Later in the
chapter, you will explore how filtrate is refined along the way to become the urine that
eventually leaves the body. For now, it is important for you to understand the direction

14.3 Anatomy of the Kidney 549

 of flow through the nephron. This flow is clearly shown in Figure 14.6b. Materials
flow in this direction:
Glomerular capsule → PCT → nephron loop → DCT → collecting duct → minor calyx
It is time to look at a nephron with the blood flow surrounding it. Figure 14.8 shows
a nephron with two networks of capillaries. This complete figure appears complicated
because it does not have the nephron and its tubules stretched out, but much of what it
depicts is the same as the explanation you have just read. For example, notice that the
renal corpuscle and the convoluted tubules are in the renal cortex, while the nephron
loop and collecting duct extend down into the renal medulla. This figure also shows
the afferent arteriole leading to the glomerulus and the efferent arteriole exiting out of
the glomerular capsule. What is new in this figure is that the efferent arteriole leads to
a complex capillary bed surrounding the renal tubule—the peritubular capillaries.
The two capillary beds—the glomerulus and the peritubular capillaries—form a
portal route so that materials can be exchanged twice between the nephron and the
blood in the capillaries before the blood exits the kidney. In the next section, you will
trace the blood flow associated with a nephron.

Blood Flow to a Nephron

Learning Outcome
8. Trace the flow of blood through a nephron.

Follow along with Figure 14.8 as you read this section. Blood enters the kidney
through the renal artery. It travels through smaller and smaller arteries leading to the

FIGURE 14.8 The renal Glomerular

capsule
nephron and the associated
blood vessels.
Proximal
convoluted
Afferent tubule
arteriole
Renal Distal
cortex convoluted Glomerulus
tubule
Efferent
arteriole
From renal
artery

To renal
vein
Peritubular
Venules capillaries

Renal
medulla
Descending
limb
Nephron
Ascending loop
limb
Collecting
duct

550 CHAPTER 14 The Excretory/Urinary System

afferent arteriole, which feeds the glomerulus. From the glomerulus, blood flows out
the efferent arteriole to the peritubular capillaries, which then feed into venules, to
larger and larger veins, and, finally, to the renal vein that exits the kidney.
Through a series of processes, materials are exchanged between capillaries and
nephrons in both directions. Now that you have studied the nephron’s anatomy
and its associated blood vessels, you are ready to explore the processes of urine
formation.

Spot Check Where does blood go after leaving the efferent arteriole?

14.4 Physiology of Urine Production

Learning Outcome
9. D
 escribe filtration, reabsorption, and secretion in the kidneys with regard to the
products moving in each process, the direction of movement, and the method of
movement.

Urine production involves three processes: filtration, reabsorption, and secretion. For
each process, it is important to note what materials are moving and the direction of the
movement. Are the materials moving from the capillaries to the tubules or from the
tubules to the capillaries? You will start with the first process—filtration.

Filtration
Filtration occurs between the glomerulus and the glomerular capsule of the renal cor-
puscle. The thin capillary walls of the glomerulus and the cells that cover them act
as a filter that allows materials to cross, depending on size—small molecules may
pass through, while larger molecules cannot. You may recall from “Chapter 2, Levels
of Organization of the Human Body,” that filtration is a passive process (does not
require energy). An example of filtration in your home is your coffee maker: Gravity
forces water and the essence of coffee through the filter because they are small, while
coffee grounds remain behind because they are big.
However, gravity does not drive filtration in the kidney. Instead, high pressure
(blood pressure) forces materials out of the glomerular capillaries to the space
inside the glomerular capsule. Adjusting the diameter of the afferent and efferent
arterioles regulates this high pressure and ultimately the glomerular filtration
rate (GFR). If the diameter of the afferent arteriole is greater than that of
the efferent arteriole, more blood can enter than can leave the glomerulus. This
causes high pressure in the glomerulus, forcing materials out of the glomerular
capillaries. The higher the pressure, the greater the glomerular filtration rate and
the greater the amount of materials filtered. You will learn more about how this is
regulated later. The direction of movement in filtration is from the capillaries to
the tubules. The materials moved are water, some nitrogenous wastes, amino acids,
glucose, and mineral salts, such as sodium and calcium. These materials comprise
the beginnings of urine. Blood cells and proteins do not filter out because they
are too big.
If you look at the list of filtered materials closely, you may wonder why these mate-
rials are filtered out of the blood. After all, amino acids and glucose are the products
of digestion, and they are needed by the cells to build proteins and carry out cellular
respiration. The point of filtration is that it is simply based on size. Filtration does fil-
ter out some small nitrogenous wastes, but at the same time it also filters out materials
that the body should keep in the blood. So a second process—reabsorption—is needed
to recapture the materials that should stay in the blood.

14.4 Physiology of Urine Production 551

 Reabsorption
Reabsorption begins between the proximal convoluted tubule and the peritubular cap-
illaries and continues along the renal tubule. In this process, 100% of the glucose,
100% of the amino acids, and variable amounts of the mineral salts that were filtered
out of the blood are actively transported (requiring energy) from the tubules to the
capillaries. In addition, 99% of the water that was filtered into the glomerular capsule
is reabsorbed by osmosis into the bloodstream.

Disease P int
Blood glucose levels are higher than normal in uncontrolled diabetes mellitus. Therefore,
more glucose is filtered out of the blood in the glomerulus. However, reabsorption is
time-limited: It can occur only while the filtrate is flowing through the renal tubule.
If there is more glucose in the filtrate than can be reabsorbed in that amount of
time, not all of the glucose will be reabsorbed. So some of the excess
glucose will be found in the urine excreted from the body.
Although this does bring down the abnormally high blood
glucose levels, the levels will rise again with the next meal. This
is not a homeostasis mechanism; it is a sign that the body is not
using glucose properly.
©Stockbyte/Getty Images

Spot Check Could reabsorption happen in the renal corpuscle before filtration?
Explain.

At this point in urine production (after reabsorption), the tubules contain some
nitrogenous wastes, some mineral salts, and 1% of the water that was filtered. The rest
of the filtrate has been returned to the blood. The third process of urine production—
secretion—completes the process of removing wastes from the blood.

Secretion
In secretion, the nephron removes the rest of the wastes that remain in the blood.
In this process, materials move from the peritubular capillaries to the tubules. These
materials include the rest of the nitrogenous wastes (those that could not be filtered
because of their size), excess hydrogen ions, excess potassium, and the by-products of
drug metabolism.
Removing excess hydrogen ions is crucial if the blood’s pH is to remain in the
homeostatic range of 7.35 to 7.45. Acidosis results if the blood’s pH falls below this
range, and alkalosis results if blood pH rises above this range. Both conditions are
potentially lethal. Acidosis may first be seen as disorientation that may lead to coma.
Alkalosis may start with hyperexcitability of the PNS along with spontaneous stimula-
tion of muscle contractions and continue to spasms, convulsions, and possible death.
What causes these acid–base imbalances, and how are they fixed?
The two forms of acidosis based on cause are described in the following list:
• Respiratory acidosis happens if the respiratory system cannot eliminate sufficient
CO2. For example, a patient with emphysema may not have sufficient ventilation
of the alveoli in his lungs due to the breakdown of his alveolar walls. So his respi-
ratory system cannot eliminate enough CO2 to keep up with the CO2 produced
from cellular respiration in his tissues and homeostasis cannot be maintained.

552 CHAPTER 14 The Excretory/Urinary System

 FIGURE 14.9 Homeostasis of
Respiratory system:
blood pH.
Hypoventilate to keep CO2
©Don Farrall/Getty Images

Blood pH Blood pH returns

rises to normal

Blood pH Blood pH returns

falls to normal

Normal blood pH 7.35–7.45

Respiratory system:
Hyperventilate to get rid of CO2

Urinary system: Increase

secretion of H+

• Metabolic acidosis happens if there is decreased kidney elimination of hydro-

gen ions or increased production of acidic substances through metabolism. For
example, anaerobic respiration results in lactic acid buildup in the muscles,
which makes its way into the bloodstream. Metabolic acidosis can also occur in
diabetics who have poor control of their blood sugars. You have already learned
that diabetes mellitus is a wasting disease in which the body may need to break
down fats and proteins for energy because it cannot use the sugar in the blood.
This type of metabolism produces acidic ketones, and their presence in the blood
lowers the pH.
Whatever the cause, whenever the body goes into acidosis, both the respiratory and
the excretory systems will try to fix the imbalance. The respiratory system increases
the respiratory rate (hyperventilation), and the excretory system increases secretion
of the excess hydrogen ions to bring the pH of the blood back to homeostasis. See
Figure 14.9.
Just as there are two forms of acidosis, there are also two forms of alkalosis based
on cause:
• Respiratory alkalosis occurs during hyperventilation. In this case, too much CO2
is being blown off and homeostasis cannot be maintained.
• Metabolic alkalosis is relatively rare, but it can occur if there is prolonged vomit-
ing, which results in the repeated loss of stomach acids.
Whatever the cause, whenever the body goes into alkalosis, the respiratory system
will try to fix it by reducing the respiratory rate. This keeps more CO2 in the blood.
The kidneys can raise the pH of the blood by secreting excess H+ during secretion,
but they cannot add more H+ to the blood to lower the pH. The kidneys can manage
only whatever amount of H+ is in the blood in the first place. They cannot add to it.
See Figure 14.9.

14.4 Physiology of Urine Production 553

 Clinical P int
Many drugs are also cleared from the blood by secretion in the
kidneys. Drug dosages are often determined to keep up
with this clearance in the kidneys. ©Jeffrey Coolidge/Getty Images

Figure 14.10 summarizes the urine production processes. Through these three
processes—filtration, reabsorption, and secretion—urine production has cleared
wastes, excess hydrogen ions, and excess potassium from the blood and can now be
considered complete. Yet further reabsorption of water may take place in the distal
convoluted tubule and the collecting duct for water conservation. We explain this fur-
ther next.

Urine Production in the Kidney

Renal arteries

Afferent arteriole

Glomerulus Efferent arteriole

Water
Nitrogenous waste
Renal Amino acids
corpuscle Glucose 1
Mineral salts Filtration

Glomerular
capsule
Nephron 2
Reabsorption
Proximal
convoluted tubule
100% glucose, 100%
amino acids, 99% water,
Renal Peritubular
and some mineral salts
tubule capillaries
Nephron loop

3
Distal Secretion
convoluted tubule
The rest of nitrogenous
waste, excess hydrogen
Renal venules
ions, excess potassium
ions

Collecting duct
Renal veins

FIGURE 14.10 The processes of urine production: (1) filtration, (2) reabsorption,
(3) secretion. This figure also shows the pathway for the components of urine (yellow), as
well as blood flow associated with a nephron (red). Bold blue arrows show the direction
materials are moving during each process.

554 CHAPTER 14 The Excretory/Urinary System

14.5 Water Conservation
Water conservation by the kidney is truly remarkable. Approximately 1.5 L of urine is
excreted per day. This is the same amount as three-fourths of a 2 L bottle of your favorite
soda. Think about this: This amount represents only 1% of the water filtered out of the blood
at the glomeruli because the rest was reabsorbed. If there were no reabsorption, 150 L of
urine (75 2 L bottles) would be produced per day, assuming you would have the time to take
in that much water. Just where is the water in the body, and where does it come from?

Water in the Body

Learning Outcome
10. Describe the fluid compartments of the body and how water moves between them.

Your body is approximately 50% to 75% water. Men tend to have slightly more water
than women because women deposit more fat, which does not contain much water.
Body water is located in two major fluid compartments—intracellular and extracel-
lular. Sixty-five percent of body water is in the cytoplasm of your cells (intracellu-
lar). The other 35% of water is outside your cells (extracellular), as tissue fluid, blood
plasma, lymph, CSF, synovial fluid, fluids of the eye (humors), bile, and serous fluid.
Water moves between the two fluid compartments by osmosis, traveling easily
across membranes to equalize the concentration of solutes on both sides and maintain
homeostasis. Osmosis occurs very quickly to minimize the formation of concentration
gradients of solutes in order to maintain homeostasis. Most of the solutes in the fluids
are electrolytes, such as sodium in the extracellular fluids and potassium in the intra-
cellular fluids. Fluid and electrolyte balance are therefore tied together. Figure 14.11
shows the movement of water between the major fluid compartments.
In Figure 14.11 you can see that water enters the body through the fluids you drink.
This is the major source of water for the body, but not the only one. You may remem-
ber that water is also formed in the cells through cellular respiration (C6H12O6 +
6O2 → 6CO2 + 6H2O + energy). This additional source is considered to be metabolic
water because it is derived from a chemical process that occurs in the cells.
As you can see in Figure 14.12, the body’s daily intake and output of water should
be equal to maintain homeostasis. Although most of the water you take in is from
drinks, food and metabolic water do make significant contributions to water balance.
At the same time, urine output is the major way the body rids itself of water, while
sweat, water evaporated from the skin, expired air, and feces also make significant

Intracellular fluid

Digestive tract

Bloodstream Interstitial fluid Lymph Bloodstream

FIGURE 14.11 The movement of water between major fluid compartments.

14.5 Water Conservation 555

FIGURE 14.12 Daily water
Intake Output
intake and output. 2,500 mL /day 2,500 mL /day

Metabolic water Feces

200 mL 200 mL

Expired air
300 mL

Food
700 mL
Evaporation
through skin
400 mL

Sweat 100 mL

Drink Urine
1,600 mL 1,500 m
mLL

contributions to the amount of water leaving the body. Since urine output is so vital
to maintaining fluid and electrolyte balance in the body, we focus next on how urine
production and its volume are regulated.

14.6 Regulation of Urine Volume and Concentration

Learning Outcome
11. Explain how urine volume and concentration are regulated.

You can significantly adjust the intake of water and electrolytes by what you con-
sume. However, the kidney’s urine production is the only way to significantly adjust
the amount of water and electrolytes in the blood through what leaves the body. The
kidney cannot increase the amount of water or electrolytes in the blood, but it can pre-
vent their loss by adjusting the amount of water and electrolytes that may exit during
urine production. The principal electrolyte in this process is sodium. Where sodium
goes, water usually follows. The volume of urine is determined by the amount of water

556 CHAPTER 14 The Excretory/Urinary System

in it, while the concentration of urine is determined by the relative amount of solutes it
contains. Sodium is a very important solute in the regulation of urine volume. Another
important electrolyte in urine production is potassium. As you will see in the explana-
tions that follow, potassium usually moves in the opposite direction of sodium.
Consider the two statements that follow, which you may intuitively agree make
sense. They sum up the kidneys’ role in the homeostasis of fluids and electrolytes in the
body. Once you grasp the goal, you can proceed to investigate how the goal is reached.
• If the blood’s concentration of solutes is higher than normal, the kidneys will put
out small volumes of concentrated (many solutes) urine. In this way, the kidneys
conserve water in the blood and eliminate excess solutes from the blood.
• If the blood’s concentration of solutes is lower than normal, the kidneys will put
out large volumes of dilute (few solutes) urine. In this case, water is removed from
the blood, and the solutes in the blood are conserved.
You may want to keep coming back to these statements as you read about the
hormonal, autonomic, and diuretic mechanisms that control urine production.

Hormonal Mechanisms of Control

There are three main hormones—antidiuretic hormone (ADH), aldosterone, and
atrial natriuretic hormone (ANH)—that regulate urine production in the kidneys.
Both ADH and aldosterone result in less urine produced, but they do so in very dif-
ferent ways. On the other hand, ANH increases urine production. How each of these
hormones work is explained here.

Antidiuretic Hormone As you may recall from the endocrine system chapter, antidi-
uretic hormone (ADH) is produced by the hypothalamus, but it is stored and then released
from the posterior pituitary when commanded by the hypothalamus. The hypothalamus
monitors blood sodium concentration and blood pressure. If blood sodium concentration
increases or blood pressure falls, the hypothalamus sends nerve signals to the posterior
pituitary telling it to release ADH. ADH targets distal convoluted tubules and collecting
ducts in the nephron. The effect of ADH on these structures is that it makes them more
permeable, so more water is reabsorbed. This decreases water loss to urine and there-
fore helps maintain blood volume, blood pressure, and homeostasis. It is important to
note that ADH has an effect on only water reabsorption, not sodium reabsorption. Under
the influence of ADH, the kidneys conserve water, but not sodium. Sodium is allowed
to exit with urine, reducing the sodium concentration in the blood. See Figure 14.13.

Aldosterone You studied this hormone in the endocrine system chapter. As you
may recall, aldosterone is a mineralocorticoid produced in the adrenal cortex that tar-
gets the kidneys. It maintains homeostasis by regulating the amount of active transport
in the nephron. If aldosterone levels are up, more sodium ions are actively transported
from the tubule to the peritubular capillaries and more potassium ions are secreted.
Water follows the sodium by osmosis, so more water moves to the peritubular capil-
laries too. The result of aldosterone secretion is reduced urine output, with both water
and sodium conserved in the blood, and increased potassium in urine.
In the case of ADH, the hypothalamus monitors the blood and sends the signal
for ADH release. How does the adrenal cortex know when to secrete aldosterone?
The juxtaglomerular apparatus, mentioned earlier (Figure 14.7), regulates aldosterone
secretion. The juxtaglomerular apparatus monitors blood traveling through the affer-
ent arteriole. It also secretes renin (REE-nin) under any of the conditions listed here
and shown in Figure 14.14.
• Blood pressure falls (hypotension).
• The level of sodium in the blood is too low (hyponatremia).
• The level of potassium in the blood is too high (hyperkalemia).

14.6 Regulation of Urine Volume and Concentration 557

FIGURE 14.13 Action of If blood pressure falls or Na+ increases in the blood:
antidiuretic hormone. The
pathway shown in red
represents the negative Hypothalamus
feedback mechanism to restore
homeostasis. Na+ level decreases
in the blood

Thirst Stimulates posterior

pituitary to release ADH

Negative
feedback

Stimulates the distal

convoluted tubule and collecting
ducts to reabsorb more water

Reduces urine Helps maintain blood volume and blood

volume pressure by decreasing water loss to urine;
sodium is allowed to exit with urine

Renin is a chemical that helps maintain homeostasis by converting angiotensino-

gen, a protein from the liver, to angiotensin I. An enzyme called angiotensin-converting
enzyme (ACE), produced in the lungs and kidneys, then converts angiotensin I to
angiotensin II. Angiotensin II targets the adrenal cortex, telling it to secrete aldoste-
rone. Aldosterone’s effect on urine production prevents a further drop in blood pres-
sure from the loss of water to urine, maintains the level of sodium in the blood, and
lowers the level of potassium in the blood. See Figure 14.15.

Spot Check Jake is a roofer who is applying asphalt to a roof in Miami in

August. His strenuous work in the hot environment results in profuse sweating,
producing 3 L of sweat over 2 hours. His sweat is less concentrated than his
extracellular fluid. What effect will this have on his urine volume and concentration?
Explain the mechanisms involved.

Clinical P int
Patients with high blood pressure (hypertension) may be prescribed ACE inhibitors.
This medication interferes with the enzyme that converts angiotensin I to angiotensin II.
Aldosterone is produced in the adrenal cortex only when angiotensin II fits into recep-
tors. So ACE inhibitors inhibit aldosterone secretion. Without aldosterone, urine output
is increased and blood volume (and therefore blood pressure) is reduced.

558 CHAPTER 14 The Excretory/Urinary System

 If blood pressure falls, blood Na+ level falls, or K+ level rises: FIGURE 14.14 Action of
aldosterone. The pathway
Reduces blood shown in red represents the
K+ level negative feedback mechanism
to restore homeostasis.
Adrenal cortex is stimulated
to secrete aldosterone

Stimulates renal Negative

tubules feedback

Increase Na+ Increase K+

reabsorption secretion

Less Na+ and More K+ in

water in urine urine

Maintains blood volume and

sodium concentration

Stimulation of the adrenal cortex to secrete aldosterone FIGURE 14.15

The renin-angiotensin-
aldosterone connection.
Liver releases angiotensingen
to the bloodstream.
Kidney secretes
renin.

Renin changes
angiotensinogen to
angiotensin I.
Kidneys and lungs
secrete angiotensin
converting enzyme
(ACE).

Angiotensin I is
changed to angiotensin II.

Adrenal cortex
releases aldosterone.

14.6 Regulation of Urine Volume and Concentration 559

 Spot Check Cameron is in a car accident and has internal bleeding. As a result,
his blood pressure suddenly falls. What has to happen for the kidneys to reabsorb more
sodium, and therefore more water, in an attempt to maintain blood pressure?

Atrial Natriuretic Hormone This is the third hormone that helps maintain
homeostasis by regulating urine production. Unlike the first two hormones—ADH
and aldosterone—this hormone is likely to be new to you. Cells in the right atrium of
the heart produce atrial natriuretic hormone (ANH) when the blood pressure in the
right atrium is too high. ANH results in increased urine production in four ways. They
are explained in the following list and shown in Figure 14.16.
• ANH dilates the afferent arterioles while constricting the efferent arterioles in the
kidney. This causes increased pressure in the glomeruli, so the glomerular filtra-
tion rate is increased. More water, glucose, amino acids, and mineral salts move
across the filtration membrane into the glomerular capsule.
• ANH inhibits the production of renin by the juxtaglomerular apparatus. Inhibiting
renin means that angiotensin I, angiotensin II, and aldosterone will not be pro-
duced. This inhibits water and sodium reabsorption.
• ANH inhibits the secretion of ADH from the posterior pituitary. This also limits
water conservation.
• ANH inhibits sodium reabsorption in the nephron directly. Since water follows
sodium, if less sodium is reabsorbed, it follows that less water is reabsorbed.
Now that you have become familiar with the three hormonal mechanisms that con-
trol urine production, you are ready to investigate the autonomic nervous system’s
control of urine production.

Nervous System Mechanisms of Control

The sympathetic nervous system exerts its control of urine production during heavy
exercise or acute conditions like a traumatic drop in blood pressure that may occur with
FIGURE 14.16 Action of If there is increased blood pressure to the right atrium:
atrial natriuretic hormone. The
pathways shown in red Blood Na+ level is
decreased.
represent negative feedback
Cells of the right atrium
mechanisms to restore release ANH
Blood volume and
homeostasis. blood pressure
are reduced.

Negative
feedback

Stimulates the kidney to increase

filtration and decrease water and
Na+ reabsorption

Increase in urine output

560 CHAPTER 14 The Excretory/Urinary System

sudden blood loss. In these cases, sympathetic neurons cause constriction in the kidney’s
afferent arterioles. Because this reduces the amount of blood entering the glomeruli, the
glomerular filtration rate is also decreased. In order to maintain homeostasis, blood is
diverted from the kidney and sent to the brain, heart, and skeletal muscles instead.

Diuretics

Learning Outcome
12. Explain how diuretics, such as medications, caffeine, and alcohol, affect urine production.

In addition to hormonal and nervous mechanisms of control, diuretics, such as alcohol,

caffeine, and diuretic drugs, can also affect urine production. A diuretic is anything
that increases urine volume. The following list contains more specific information
about the various types of diuretics and their impact on the body:
• Alcohol inhibits the secretion of ADH. If large quantities of alcohol are consumed,
this effect may be so great that the large quantity of dilute urine that is excreted
may actually exceed the amount of fluids consumed. This can lead to dehydration
and excessive thirst.
• Caffeine increases the blood flow to the kidney, and this increases the glomerular
filtration rate. It also decreases the amount of sodium reabsorbed, so the net effect
is large volumes of urine containing sodium.
• Diuretic drugs are often prescribed for hypertensive patients to reduce their blood
pressure. Many of these drugs work by inhibiting the active transport of sodium.
These drugs result in large volumes of urine containing sodium. Although reduc-
ing blood volume through increased urine production does decrease blood pres-
sure, care must be given in administering these medications so that the body’s
electrolytes remain balanced and homeostasis is maintained.
You have studied the anatomy of the kidney, the processes of urine production, and the
mechanisms that control urine production. Next, you will learn what happens to urine once
it is produced. You will begin by exploring the anatomy involved with urine excretion.

Spot Check In what ways could the glomerular filtration rate be increased?

14.7 Anatomy of Ureters, Urinary Bladder, and Male

and Female Urethras

Learning Outcome
13. Describe the anatomy of the ureters, urinary bladder, and male and female urethras.

Figure 14.17 shows the structures of the urinary system. In it, you can see the kid-
neys, the ureters, the urinary bladder, and the urethra. You have already covered the
anatomy of the kidney, but it will be helpful to review the calyces and renal pelvis that
lead to the ureters. See Figure 14.18.

Ureters
The minor and major calyces of the kidney deliver urine to the renal pelvis. The ure-
ters are an extension of the renal pelvis. Like the kidneys, these muscular tubes are
also retroperitoneal. The ureters carry urine from the renal pelvis to the urinary blad-
der. Each ureter travels posterior to the urinary bladder and enters the bladder at its
base. A small flap at the ureter’s opening to the bladder prevents backflow of urine to
the ureter when the urinary bladder contracts.

14.7 Anatomy of Ureters, Urinary Bladder, and Male and Female Urethras 561
 Kidney

Renal Renal
vein artery

Ureters

Urinary
bladder
(a) Urethra (b)

FIGURE 14.17 The urinary system: (a) anterior view, (b) view of a cadaver showing the kidneys, ureters, and
urinary bladder (the parietal peritoneum has been removed).
(b) ©McGraw-Hill Education/Christine Eckel

Urinary Bladder
Figure 14.19 shows the urinary bladder in a female and in a
male. Although there are obvious differences in the urethras,
the anatomy of the urinary bladder is the same for both
sexes. The urinary bladder is covered by the parietal perito-
neum superiorly, and it sits posterior to the pubic symphysis.
The urinary bladder functions to store urine until its release.
So the bladder’s anatomy has the ability to stretch. The
Major calyx
mucosa lining the bladder is transitional epithelial tissue,
and the lining has many folds (rugae) that are less conspicu-
Minor calyx ous when the bladder is stretched. Urine fills the bladder
from the bottom. As a result, the urinary bladder stretches
and expands upward as it fills. The rugae flatten, and the
transitional epithelium gets thinner. The maximum amount
Renal pelvis
the bladder can hold is 700 to 800 mL. A feeling of fullness
is typically felt at 500 mL. Three openings at the base of
the bladder—two ureters and a urethral opening—define a
triangular area called the trigone (TRY-gon). This area is
often the site of infection in the urinary bladder. Three layers
of smooth muscle make up the detrusor muscle (de-TRUE-
sor) of the bladder’s walls. This muscle is very important in
the physiology of passing urine. At the base of the bladder,
Ureter
the detrusor muscle thickens to form the internal urethral
sphincter. This muscle compresses the tube leading from
FIGURE 14.18 The calyces and renal pelvis. the bladder (the urethra), so urine remains in the bladder.
You will read about passing urine as soon as you have fin-
ished studying the anatomy leading out of the body.

Common Misconception
Figure 14.19 may lead to a misconception: Although it appears in this figure that the
ureters enter the urinary bladder at the top, they actually travel behind the bladder and
enter at the bladder’s base. The openings where they enter the bladder are labeled
ureteral openings in this figure.

562 CHAPTER 14 The Excretory/Urinary System

Urethra
The urethra is a tube that deliv- Ureter
ers urine from the urinary blad-
der to the outside. It begins at Detrusor muscle
the internal urinary sphincter at
the urinary bladder’s base. The Urinary bladder
urethra passes through the pel-
Rugae
vic floor, where it is encircled
by a skeletal muscle called the
external urethral sphincter. Trigone
Since it is skeletal muscle, the
external urinary sphincter is
under voluntary control. The Internal urethral
Ureteral openings
biggest difference in male and sphincter
female urinary anatomy is the
Urethra External urethral
length of the urethra. A female sphincter
urethra is approximately 3 to
Pelvic floor
4 cm and opens to the out­ External urethral
side (external urethral orifice) orifice
be­tween the clitoris and the
vaginal opening. In compari-
son, the male urethra is approxi-
(a)
mately 11 to 18 cm long and can
be divided into three distinct
areas: The prostatic urethra
is surrounded by the prostate;
the membranous urethra pen- Ureter
etrates the pelvic floor; and,
finally, the longest section, the Ureteral
penile urethra, passes through Rugae
openings
the length of the penis to the
Urinary
external urethral orifice. Male bladder
reproductive structures, such
as the prostate gland and bul- Detrusor
bourethral glands, also secrete Trigone muscle
fluids into the male urethra.
Internal urethral
These structures are discussed Prostatic sphincter
in the male reproductive system urethra
Prostate
chapter. gland
Now that you have become
familiar with the anatomy that Membranous External urethral
urethra sphincter
delivers urine to the outside of
the body, it is time to look at how
the passing of urine—micturition
(mik-choo-RISH-un)—is initiated.
Penile
urethra
Penis

External
urethral orifice

(b)

FIGURE 14.19 The urinary bladder and urethra: (a) female, (b) male.

14.7 Anatomy of Ureters, Urinary Bladder, and Male and Female Urethras 563
 14.8 Physiology of the Passing of Urine

Learning Outcome
14. D
 escribe the micturition reflex and explain how the nervous system and urinary
sphincters control the voiding of urine.

The production of urine happens 24/7. In contrast, micturition is the passing or void-
ing of urine. A micturition reflex controls the voiding of urine in infants, but once toi-
let training has been accomplished, impulses from higher centers in the brain can, and
likely will, influence the reflex. Follow along with the steps shown in Figure 14.20 as
this reflex is explained.
1. The reflex arc for micturition begins with stretch receptors in the urinary bladder’s
walls (afferent neurons).
FIGURE 14.20 Neural Cerebrum
control of micturition. Steps 1
to 3 involve a reflex, and steps 4
to 6 involve higher brain
control.

Pons

Descending 4
pathways Ascending
pathways

Sacral region 2
of spinal cord

Somatic Parasympathetic Pelvic

motor nerves nerves
nerves
Ureter
3 Urinary 1
bladder

External
urethral
sphincter

564 CHAPTER 14 The Excretory/Urinary System

2. As the bladder fills, these receptors send signals to the sacral region of the spinal
cord (integration center).
3. Parasympathetic neurons go from the spinal cord to the detrusor muscle (effector),
causing it to contract, and to the internal urethral sphincter (effector), causing it to
relax. Urine is then voided.
Toilet training affects the outcome of the reflex. Continue to follow along with
Figure 14.20 to see the additional steps for micturition to occur.
4. At the same time as step 3, the afferent signals are also sent to the pons and
ultimately to the cerebrum.
5. If it is timely to pass urine, the pons sends a signal to the sacral region of the spinal cord.
6. Motor neurons send signals to the external urethral sphincter, causing it to relax
so that urine can be passed. However, if it is not timely to pass urine, the pons will
respond to the afferent signals from the stretch receptors by sending inhibitory
signals to the external urethral sphincter. These signals will prevent the external
sphincter from relaxing in order to retain urine in the bladder.
You have now covered the organs of the excretory system, the anatomy of the uri-
nary system, the processes and control of urine production, and the way urine is passed
from the body. You are ready to review how all of this relates to the functions of the
excretory system.

14.9 Functions of the Excretory System

Learning Outcome
15. Summarize the functions of the excretory system.

As you can see in Figure 14.21, Nikki and Chris are healthy kids out for a movie. They
had enough money for the theater tickets and popcorn but not enough to purchase any
beverages. Consider the functions of the excretory system—listed here—as they
relate to Chris while he watches his movie.
• Removal of metabolic wastes. All the while that Chris is watching the movie,
his skin removes small amounts of urea with sweat, his lungs remove CO2 from
his blood, his liver removes bilirubin from the breakdown of his hemoglobin and
puts it in bile, his spleen puts bilirubin in plasma for the kidneys to remove, and his
kidneys remove nitrogenous wastes.
• Maintenance of the body’s fluid and electrolyte balance. Chris is eating salty
popcorn while he is watching the movie, but he is not drinking fluids. The net
result is increased sodium in his blood. His kidneys will conserve water to main-
tain blood volume while allowing the excess sodium to exit with urine. His net
urine output will be a small volume of concentrated urine.
• Maintenance of the body’s acid–base balance. Chris’s kidneys secrete any
excess H+ in the blood, and his lungs remove CO2 from the blood with every breath
to maintain blood pH at homeostatic levels. His respiratory rate will fluctuate with
his blood pH, increasing if his blood pH falls and decreasing if his pH rises.
• Regulation of blood pressure. All the salty popcorn is likely to increase Chris’s
thirst. His hypothalamus monitors the sodium level of his blood. Because it is
high from all the salty popcorn and lack of additional fluids, his hypothalamus
increases his thirst. Once the movie is over and Chris begins to drink fluids again,
his blood volume will rise. If the increased fluid intake increases his blood volume FIGURE 14.21 Nikki and Chris
and therefore his blood pressure too much, his kidneys will produce an increased at the theater.
volume of urine to reduce his blood volume and reduce his blood pressure. ©Stockbyte/Getty Images

14.9 Functions of the Excretory System 565

 Spot Check What hormone is likely to be released to regulate urine production
while Chris is eating all the salty popcorn but not drinking fluids? Explain.

Spot Check What hormone is likely to be released to regulate urine production

if Chris drinks large amounts of fluids after the movie? Explain.

Now that you have reviewed the functions of the excretory system, you can explore
the effects of aging on the system.

14.10 Effects of Aging on the Excretory System

Learning Outcome
16. Summarize the effects of aging on the excretory system.

Aging of the excretory system primarily affects the urinary system. Some of the effects
involve the kidneys’ production of urine, but the voiding of urine can be affected as
well. The effects on urine production are as follows:
• Typically, the size of the kidneys and the number of functioning nephrons decrease
by one-third by the age of 80. This is partly due to the narrowing and hardening of
the arteries supplying the kidneys and glomeruli.
• With the reduced number of functioning nephrons, the glomerular filtration rate
decreases along with the reserve capacity. Even so, the waste removal by the kid-
neys is normally sufficient in the elderly. However, other diseases may put pressure
on the urinary system and cause it to fail more quickly in elderly individuals.
• Drugs are cleared less efficiently with age, so drugs remain in circulation longer.
Drug dosages may need to be adjusted in elderly people to compensate for the
poor clearance.
• Responsiveness to ADH also decreases in older persons, making water balance
a problem. The sense of thirst may also be diminished, which means they may
become dehydrated.
The effects of aging on the passing or voiding of urine affect both men and women:
• By the time they are 50 years old, 50% of men experience benign prostatic
hyperplasia (BPH). This will increase to 80% of men over 80.1 In this condition,
the prostate enlarges toward its center, compressing the urethra. This makes emp-
tying the bladder more difficult.
• Elderly women are prone to incontinence (urine leakage), especially if vaginal
childbirths have weakened the pelvic floor muscles and external urethral sphincter.
Now you are aware of what may occur naturally with aging. However, disorders of
the excretory system may or may not have anything to do with aging, as you will learn
in the final section of this chapter.

14.11 Diagnostic Tests for Excretory System Disorders

Learning Outcome
17. Describe common diagnostic tests used for excretory system disorders.

Like the tables for other systems, Table 14.1 presents common diagnostic tests used
for excretory system disorders. A lot of the tests may be familiar to you as they have

566 CHAPTER 14 The Excretory/Urinary System

been mentioned in previous chapters, but their specific relation to the excretory system
is explained in the table.

TABLE 14.1 Common Diagnostic Tests for Excretory System Disorders

Diagnostic Test
or Screening Description
Biopsy A procedure in which tissue is collected and examined for the presence of abnormal cells.
Blood test A procedure that involves obtaining a sample of blood and analyzing its contents. In regard to
excretory disorders, blood tests can reveal the blood’s composition, which may indicate
a problem with kidney function.
Computed An imaging technique used to visualize internal structures. The scan produces images in “slices”
tomography (CT) of areas throughout the body. In regard to excretory system disorders, CT can be used to
determine changes in the organs located in the lower abdomen and pelvic regions.
Cystoscopy A procedure in which a lighted cystoscope is used to visualize the urinary bladder, lower urinary
tract, and prostate.
Intravenous An X-ray of the kidneys and the urinary tract that involves using contrast dye injected
pyelography intravenously.
Ultrasound An imaging technique in which sound waves create visual images of internal structures. In the
excretory system, ultrasound may be used to examine the urinary tract.
Urinalysis A test that involves a physical, chemical, and microscopic examination of urine. Results that do
not fall within normal limits may indicate a condition or disease.

Spot Check Explain what an intravenous pyelogram is and how it is used

to specifically diagnose disorders of the excretory system.

14.12 Disorders of the Excretory System

Learning Outcome
18. Describe excretory system disorders and relate abnormal function to pathology.

Urinary Tract Infections

Urinary tract infections (UTIs) are infections that affect any structure—including
the urethra, urinary bladder, ureters, and kidneys—along the urinary tract. You will
explore a few of these infections in the following paragraphs.
Urethritis is an infection of the urethra, which can be caused by bacteria, viruses,
or fungi. Usually, the bacteria that cause this infection reside in or around the anus
and make their way to the urethra, where infection can result. Urethritis is more
common in women because the opening of the urethra is closer to the anus than it is
in men. Other organisms, like those that cause sexually transmitted infections, can
also cause urethritis in both men and women. Symptoms of urethritis include painful
and frequent urination. A discharge may also be present if the cause of the infec-
tion is a sexually transmitted organism. If urethritis is not treated, the infection can
travel up to other parts of the excretory system and continue to cause infections such
as cystitis.
Cystitis is an inflammation of the urinary bladder, usually caused by a bacterial
infection. It is far more common in women than men because the pathway for the

14.12 Disorders of the Excretory System 567

 bacteria to the urinary bladder (the urethra) is far shorter in women. The symptoms
include the frequent passing of small amounts of urine accompanied by a burning sen-
sation. The prevalence of cystitis is increased when women become sexually active
because of the introduction of more bacteria to the genital area. The infection can travel
up the ureters to the renal pelvis (pyelitis) and even on to the renal cortex (pyelone-
phritis). In general, cystitis, pyelitis, and pyelonephritis are classified as urinary tract
infections and are treated with antibiotics.

Hydronephrosis
Hydronephrosis is the buildup of urine in the kidney. This results when the flow of
urine from the kidney is blocked due to factors such as kidney stones, blood clots,
tumors, or birth defects that cause a narrowing of the ureter. This backup of urine
causes the kidney to swell, and the increased pressure inside the kidney causes damage.
See Figure 14.22. Diagnostic tests used to diagnose this condition are CT, intravenous
pyelography, ultrasound, blood tests, and urine tests. If diagnosed early, hydronephro-
sis is treatable with no resulting kidney damage. Treatment involves removing the
obstruction to restore the normal flow of urine from the kidney.

Polycystic Kidney Disease

Polycystic kidney disease (PKD) is an inherited disorder that causes multiple cysts to
form on the kidneys. See Figure 14.23. The cysts interrupt the normal function of the

FIGURE 14.22
Hydronephrosis.
©Martin Rotker/Medical Images

568 CHAPTER 14 The Excretory/Urinary System

FIGURE 14.23 Polycystic kidney. FIGURE 14.24 Kidney stones.
©Arthur Glauberman/Science Source ©Hank Morgan/Science Source

kidney, causing high blood pressure and kidney infections. PKD can be diagnosed using
CT, MRI, intravenous pyelography, and blood tests.

Applied Genetics
PKD is an inherited kidney disease passed down to family members as an autosomal
dominant trait; this means that if one parent carries the gene for PKD, the offspring have
a 50% chance of developing the disease. Genetic testing can be done to determine
whether a person has the PKD gene and is at risk for developing the disease.
©MOLEKUUL/SPL/age fotostock

Kidney Stones
Calcium or uric acid can precipitate out of urine and form solid stones in the
renal pelvis, as shown in Figure 14.24. Small stones often pass without notice,
but larger stones can block the renal pelvis or ureters. The blocked flow of urine
increases the pressure within the kidney and can result in damage to nephrons.
The kidneys continue to produce urine whether the flow is blocked or not. This
increases pressure on the stone. The continued pressure on the sharp-edged stone
may cause it to move toward the bladder and may cause intense pain as it passes
along the ureter. Possible treatments include medication to dissolve the stone, a
procedure using sound waves to break up the stone (lithotripsy), and surgery to
remove the stone.

Glomerulonephritis
From the name glomerulonephritis, you know that this disorder is an inflam-
mation of the filtration membrane in the glomerulus of the nephron. There are
two forms of this disorder—acute and chronic. Acute glomerulonephritis usu-
ally occurs 1 to 3 weeks after a severe bacterial infection in the body. Antibodies
are produced to fight the infection, and in doing so, they attach to antigens. The
antibody-antigen complexes batter the walls of the glomeruli in the kidneys due
to the increased pressure. As a result of the irritation, the filtration membrane in
the renal corpuscle becomes inflamed and more permeable, allowing plasma pro-
teins and leukocytes in the filtrate. Water follows the plasma proteins, resulting in

14.12 Disorders of the Excretory System 569

 higher-than-normal volumes of urine containing protein and blood cells. Acute glo-
merulonephritis is usually time-limited. Once the antibody-antigen complexes are
cleared from the blood by macrophages, the inflammation is resolved. On the other
hand, chronic glomerulonephritis is just that—chronic. In this form of glomerulo-
nephritis, the constant irritation to the filtration membrane causes it to thicken and
be replaced by connective tissue. This may decrease the amount of filtration to the
point of renal failure.

Renal Failure
You really need only part of one kidney to carry out the necessary functions for a
normal life. Yet the body has two kidneys, and this provides tremendous reserve
capacity. As you have already read, the effects of aging take a toll on kidney func-
tion. The ability to clear nitrogenous waste from the blood can be measured by
assessing the blood urea nitrogen (BUN). This blood test expresses the amount of
one of the nitrogenous wastes—urea—in the blood. Slightly higher levels indicate
renal insufficiency (azotemia). Seriously elevated levels indicate uremia, charac-
terized by the vomiting, diarrhea, and arrhythmias associated with increased nitrog-
enous waste in the blood. Complete kidney failure usually results in convulsions,
coma, and death within a few days. Treatment for kidney failure is kidney transplan-
tation or dialysis, in which a machine filters the excess fluid, salt, and nitrogenous
wastes in the blood.

Spot Check Dialysis is usually performed at a dialysis center three times a week
for 3 to 5 hours at a time. Why might it be more difficult to manage blood pressure for a
patient on dialysis?

Cancers of the Excretory System

Various cancers can affect the excretory system. Here, you will explore two of them—
kidney cancer and bladder cancer.

Kidney Cancer The most common type of kidney cancer is renal cell carcinoma.
The malignant tumors involved in renal cell carcinoma are adenocarcinomas (tumors
that originate in glandular epithelial tissue). Renal cell carcinoma usually affects peo-
ple between the ages of 50 and 70 years, occurring more often in men than in women.
Other risk factors for renal cell carcinoma include smoking, obesity, use of certain
drugs, exposure to certain chemicals, and a history of polycystic kidney disease.
Renal cell carcinoma can go undetected for some time because symptoms often do not
appear until the cancer has progressed, making it harder to treat. Symptoms include
blood in the urine (hematuria), pain between the lower back and the upper abdomen
(flank), fever, and the presence of a mass. Renal cell carcinoma is usually diagnosed
by CT scan or MRI, and its treatment depends on the stage of the cancer. Surgery to
remove the kidney (nephrectomy) may be performed.

Bladder Cancer Bladder cancer is usually caused by transitional cell carcinoma.

Risk factors for bladder cancer include smoking and exposure to certain drugs and
chemicals. Symptoms include hematuria, anemia, dysuria, and possible pelvic pain.
Diagnosis of bladder cancer involves the viewing of the urinary bladder using an endo-
scope (cystoscopy) and biopsy to determine the presence of cancerous cells. For can-
cers that are noninvasive, removal of the cancerous tissue followed by chemotherapy
may be the preferred treatment method. In more severe cases, a cystectomy (removal
of the urinary bladder) may be necessary.

570 CHAPTER 14 The Excretory/Urinary System

 Table 14.2 summarizes all of the diseases and disorders described throughout the
chapter.

TABLE 14.2 Summary of Diseases and Disorders of the Excretory System

Type of Disease/
Disorder Disease/Disorder Description
Urinary tract infections Cystitis Inflammation of the urinary bladder, usually caused by a
(UTIs) bacterial infection.
Pyelitis Infection of the renal pelvis.
Pyelonephritis Infection of the renal cortex.
Urethritis An infection of the urethra caused by bacteria, viruses, or
fungi.
Kidney disorders Glomerulonephritis An inflammation of the filtration membrane in the glomerulus of
the nephron. The condition can be acute or chronic.
Hydronephrosis A buildup of urine in the kidney, which results from an
obstructed flow of urine from the kidney.
Kidney stones Solid stones in the renal pelvis formed by calcium or uric acid
that has precipitated out of urine.
Polycystic kidney An inherited disorder that causes multiple cysts to form on the
disease (PKD) kidneys, interrupting normal function.
Renal failure Failure of the kidneys to clear nitrogenous wastes from the
blood.
Cancers Bladder cancer Cancerous tumor of the bladder usually caused by transitional
cell carcinoma.
Kidney cancer Cancerous tumor of the kidney. The most common type
of kidney cancer is renal cell carcinoma, characterized by
malignant tumors that originate in glandular epithelial tissue of
the kidney.
Other excretory disorders Benign prostatic Enlargement of the prostate gland.
hyperplasia (BPH)
Incontinence Urine leakage.

14.12 Disorders of the Excretory System 571

Putting the Pieces Together

The Excretory/Urinary System

Integumentary system Cardiovascular system
Removes some nitrogenous waste Blood pressure provides the
in sweat. force for filtration in the kidney.

Disposes of wastes and maintains Kidneys dispose of wastes in blood

fluid and electrolyte balance. and regulate blood volume,
composition, pressure, and pH.

Skeletal system
Lymphatic system
Ribs protect the kidneys.
Sends white blood cells to fight
pathogens in the excretory/urinary
Kidneys activate vitamin D for system.
calcium absorption, dispose of
wastes, and maintain fluid and Kidneys maintain fluid and
electrolyte balance. electrolyte balance.

Muscular system Respiratory system

Skeletal muscles control the passing Allows for the exchange of O2
of urine. and CO2 in system tissues.

Kidneys dispose of wastes and

Kidneys secrete EPO when the
maintain the electrolyte balance
blood oxygen level is low.
needed by muscles.

Nervous system Digestive system

Micturition reflex and higher brain Provides nutrients for tissues of
centers regulate urine elimination. the excretory/urinary system.

Liver processes absorbed

Kidneys dispose of wastes and nutrients.
maintain the electrolyte balance
needed by neurons.
Reproductive system
Endocrine system Sexual response in male and
female blocks the passing of
Hormones regulate urine
urine.
production.
Removes metabolic wastes
Kidneys dispose of hormones that produced by the fetus; semen is
are no longer needed. ejaculated through the urethra.

FIGURE 14.25 Putting the Pieces Together—The Excretory/Urinary System: connections between the excretory/urinary
system and the body’s other systems.

572 CHAPTER 14 The Excretory/Urinary System

Summary
14.1 Word Roots and Combining Forms
∙∙ S
 ee the heading at the beginning of the chapter to learn the medical terminology that relates to the excretory/urinary
system.

14.2 Overview
∙∙ E xcretion is the removal of metabolic wastes from the body.
∙∙ The skin, lungs, liver, and kidneys remove metabolic wastes.

Sources of Nitrogenous Wastes

∙∙ Nitrogenous wastes include ammonia, urea, uric acid, and creatinine.

Overview of Kidney Function

∙∙ Kidneys function in the integumentary, skeletal, cardiovascular, and excretory systems.

14.3 Anatomy of the Kidney

∙∙  he kidneys are retroperitoneal.
T
∙∙ Each kidney has three layers: the renal capsule, the renal cortex, and the renal medulla.
∙∙ Pyramids are located in the renal medulla.
∙∙ Calyces collect urine from the pyramids and deliver it to the renal pelvis.
∙∙ The renal sinus is the space occupied by the renal artery, renal vein, and renal pelvis.

Anatomy of a Nephron
∙∙  nephron has two basic parts: the renal corpuscle and the renal tubule.
A
∙∙ The renal corpuscle is composed of the glomerulus and the glomerular capsule.
∙∙ The renal tubule is composed of the proximal convoluted tubule, the nephron loop, and the distal convoluted tubule.
∙∙ The renal corpuscle and convoluted tubules are located in the renal cortex.
∙∙ The nephron loop and collecting duct are located in the pyramid.
∙∙ The juxtaglomerular apparatus is located between the afferent arteriole, efferent arteriole, and distal convoluted
tubule.

Flow of Urine Components through a Nephron

∙∙ T
 he components of urine flow from the glomerular capsule, to the proximal convoluted tubule, to the nephron loop,
to the distal convoluted tubule, to the collecting duct, and to a minor calyx.

Blood Flow to a Nephron

∙∙ B
 lood flows from the renal artery, to smaller arteries, to the afferent arteriole, to the glomerulus, to the efferent
arteriole, to the peritubular capillaries, to venules, to larger veins, and to the renal vein.

14.4 Physiology of Urine Production

∙∙ Urine production involves three processes: filtration, reabsorption, and secretion.

Filtration
∙∙ F iltration happens in the renal corpuscle.
∙∙ Materials move from the glomerulus to the glomerular capsule by filtration.
∙∙ The materials moved are water, glucose, amino acids, some nitrogenous wastes, and mineral salts.

Reabsorption
∙∙ R eabsorption happens along the renal tubule.
∙∙ Materials move from the tubules to the peritubular capillaries.
∙∙ The materials moved are 100% of the glucose, 100% of the amino acids, variable amounts of mineral salts, and
water.

573
Secretion
∙∙  ecretion happens along the renal tubule.
S
∙∙ Materials move from the peritubular capillaries to the tubules.
∙∙ Materials moved include nitrogenous wastes, excess hydrogen ions, excess potassium ions, and some drugs.
∙∙ The secretion of hydrogen ions helps to maintain the blood’s acid–base balance.

14.5 Water Conservation

Water in the Body
∙∙  he human body is 50% to 75% water, which is held in two fluid compartments.
T
∙∙ Of the body’s water, 65% is intracellular, while the other 35% is extracellular.
∙∙ Water moves easily between compartments by osmosis to minimize concentration gradients.
∙∙ Daily water intake should equal daily water output.

14.6 Regulation of Urine Volume and Concentration

∙∙ Urine volume and concentration are regulated through hormones, the nervous system, and diuretics.

Hormonal Mechanisms of Control

∙∙ The hormones that control urine production are ADH, aldosterone, and ANH.

Nervous System Mechanisms of Control

∙∙ The sympathetic nervous system reduces urine production.

Diuretics
∙∙ Diuretics increase urine production.

14.7 Anatomy of Ureters, Urinary Bladder, and Male and Female

Urethras
Ureters
∙∙ T he ureters are retroperitoneal.
∙∙ The ureters deliver urine from the renal pelvis to the urinary bladder.
∙∙ The ureters go posterior to the bladder and enter the bladder at its base.

Urinary Bladder
∙∙ T he urinary bladder is a storage sac with smooth muscle in its walls.
∙∙ The trigone is a triangular area of the bladder floor and is defined by the openings to the ureters and the urethra.
∙∙ At the base of the urinary bladder, the detrusor muscle thickens to form the internal urinary sphincter.

Urethra
∙∙ T he urethra delivers urine from the urinary bladder to the outside.
∙∙ The urethra of a male is longer than that of a female.
∙∙ The urethra is surrounded by the external urinary sphincter (made of skeletal muscle) as it passes through the pelvic
floor.
∙∙ The male urethra can be divided into three sections: the prostatic urethra, the membranous urethra, and the penile
urethra.

14.8 Physiology of the Passing of Urine

∙∙ T he passing of urine is called micturition.
∙∙ The micturition reflex controls the passing of urine in infants, but higher brain centers influence the reflex after
toilet training.

14.9 Functions of the Excretory System

∙∙ T
 he functions of the excretory system are removal of metabolic wastes, maintenance of the body’s fluid and electro-
lyte balance, maintenance of the body’s acid–base balance, and regulation of blood pressure.

574
14.10 Effects of Aging on the Excretory System
∙∙  he size of the kidneys and the number of nephrons decrease.
T
∙∙ The glomerular filtration rate and reserve capacity decrease.
∙∙ Drugs are cleared less efficiently.
∙∙ Responsiveness to ADH is decreased.
∙∙ Eighty percent of elderly men experience benign prostatic hyperplasia, which makes micturition difficult.
∙∙ Elderly women often experience incontinence due to weakened pelvic floor muscles.

14.11 Diagnostic Tests for Excretory System Disorders

∙∙ C
 ommon diagnostic tests for excretory system disorders include biopsy, blood tests, CT, cystoscopy, intravenous
pyelography, ultrasound, and urinalysis.

14.12 Disorders of the Excretory System

∙∙  rinary tract infections can affect any structure along the urinary tract.
U
∙∙ Hydronephrosis is a buildup of urine in the kidney.
∙∙ Polycystic kidney disease is an inherited disorder that causes multiple cysts to form on the kidneys.
∙∙ Kidney stones in the renal pelvis are formed by calcium or uric acid that has precipitated out of urine.
∙∙ Glomerulonephritis is inflammation of the filtration membrane in the glomerulus.
∙∙ Renal failure usually begins as azotemia and is characterized by nitrogen wastes in the blood.
∙∙ Two types of cancer that affect the excretory system are kidney cancer and bladder cancer.

Key Words for Review

The following terms are defined in the glossary.

cystitis hyponatremia nitrogenous wastes

dialysis metabolic acidosis renal corpuscle
diuretic metabolic alkalosis renal tubule
excretion metabolic waste respiratory acidosis
fluid compartments metabolic water respiratory alkalosis
glomerulonephritis micturition secretion
hyperkalemia nephron

575
 The Male

15 Reproductive
System
Reproduction is necessary for
a species to survive. Each new
generation replaces the genera-
tion that is dying, and so human
beings continue to populate the
earth. However, it is not necessary
for each individual to reproduce to
stay alive. You can live a normal,
healthy life without ever having a
child. Yet, even if you choose not
to reproduce, your reproductive
system goes a long way in defining
who you are, whether you are male
or female. See Figure 15.1.
©Image Source/Getty Images

Module 14: Reproductive System

576
15.1 Word Roots and Combining Forms
Male Reproductive System
Major Organs and Structures:
Learning Outcome testes
Accessory Structures:
1. Use medical terminology related to the male reproductive system. scrotum, spermatic ducts
(epididymis, ductus deferens),
accessory glands (seminal
andr/o: male orchid/o: testis, sperm/o: sperm vesicles, prostate gland,
crypt/o: hidden testicle spermat/o: sperm bulbourethral glands), penis
Functions:
epididym/o: pen/o: penis test/o: testis, production and delivery of sperm,
epididymis prostat/o: testicle secretion of sex hormones

orch/o: testis, testicle prostate vas/o: duct, vas

orchi/o: testis, testicle semin/i: semen deferens

15.2 Overview

Learning Outcome
2. Explain what is needed for male anatomy to develop.

Before you explore the specifics of the male reproductive system,

you must first understand what is necessary for an individual to
develop as a male. All humans start from a zygote (fertilized egg). A
sperm from the father penetrates an egg from the mother to combine
the genetics of both. See Figure 15.2. The 23rd pair of chromosomes
(sex chromosomes—X, Y) determines the gender of the offspring. FIGURE 15.1 Male reproductive system.
All eggs carry an X chromosome. If the sperm carries a Y chromo-
some, the zygote will be male (XY). If the sperm carries an X chromosome, the resulting
zygote will be female (XX). So the father’s sperm determines the offspring’s gender.
However, sex determination is more complicated than just acquiring the Y chro-
mosome. The Y chromosome contains a gene called the sex-determining region of
the Y (SRY). This gene codes for the production of a protein that reacts with other
genes so that androgen receptors are produced in the developing fetus. As you may
recall from the endocrine system chapter, androgens are male hormones—testosterone
is a prime example. By 8 to 9 weeks in the fetus, the developing gonads start produc-
ing testosterone if the Y chromosome is present. Testosterone fitting into the androgen
receptors causes the reproductive anatomy to develop as male. Without testosterone
and the androgen receptors, the fetal reproductive anatomy would develop as female
under the influence of the abundant estrogen in the mother’s circulation.

Applied Genetics
Androgen-insensitivity syndrome is a genetic disorder in which the external reproduc-
tive anatomy of these individuals is clearly female, but menstruation at puberty does not
occur. These individuals are genetically male (XY). On further examination, internal testes
are found in the abdomen, and there are no ovaries, uterus, or vagina. This syndrome
is the result of the lack of androgen receptors in the developing fetus. Even though the
testes produce testosterone, there are no receptors for it to have an effect.
©MOLEKUUL/SPL/age fotostock

In this chapter, you will learn about how the male reproductive anatomy develops,
how this anatomy functions, and how it is controlled. You will also investigate the
effects of aging on this system, as well as male reproductive disorders. Your study
begins with the primary reproductive organs in the male—the testes.

15.2 Overview 577

FIGURE 15.2 Chromosomal
sex determination.

X
Sperm
X XX - female

Egg

Y
X XY - male

15.3 Male Reproductive Anatomy

Learning Outcome
3. Describe the anatomy of the testes.

The reproductive system is composed of primary organs that produce gametes (sex
cells, like sperm and eggs) and secondary organs and structures that are necessary for
reproduction to occur. In the male, the primary sex organs are the testes.

Testes
The testes (testicles) belong to the endocrine and male reproductive systems because
they produce the hormone testosterone and they produce sperm. In an adult, each testis
(singular of testes) is a slightly flattened, oval structure measuring approximately 4 cm
long, 3 cm deep (anterior to posterior), and 2.5 cm wide.
Figure 15.3 shows the development of the testes from 3 months in a fetus to a 1-month-
old infant. Notice the testes originate retroperitoneal in the abdominal cavity. Each testis
is attached to the fetal scrotal swelling by a short cord called the gubernaculum (GOO-
ber-NACK-you-lum). As the fetus grows, all the body structures enlarge except the guber-
naculum, which remains firmly attached to the developing scrotum. As you can see in this
figure, the net effect of the gubernaculum’s stable size is that it pulls the testes down from
the abdominal cavity into the developing scrotum, so that by 1 month the infant’s testes
have fully descended to the scrotum outside the abdominal cavity. The testes descend
through an opening in the abdominal wall called the inguinal canal.

Common Misconception
Although Figure 15.3 is meant to show the change in position of the testes over time in
a developing fetus, it does not show the change in size of the structures over time. The
body size of a 1-month-old infant is much larger than a fetus at 3 months. The only struc-
ture in these images that stays the same size over this time period is the gubernaculum.
The gubernaculum appears to have shrunk only because all of the other structures
relative to it have grown.

578 CHAPTER 15 The Male Reproductive System

Abdominal Peritoneum
wall

Testis

Lower
abdominal
cavity Testis
Gubernaculum
Inguinal canal
Developing Pubic
penis symphysis Gubernaculum

(a) (b)

Testis
Scrotum
Gubernaculum
(c)

FIGURE 15.3 Descent of the testes: (a) 3-month fetus, (b) 6-month fetus, (c) 1-month-old infant.

Why do testes descend? For the testes to produce viable sperm—those that can
survive outside the testes—the temperature of each testis must be approximately 2°C
cooler than the core body temperature (35°C versus 37°C). It would be too warm in
the abdominal cavity for viable sperm production if the testes did not descend to the
scrotum. How this temperature difference is maintained is discussed later in the chapter.

Disease P int
Approximately 3% of male infants are born with
undescended testes, a condition called cryptorchidism.
For the majority of infants with this condition, the testes
descend sometime during the first year. However, if
the testes do not descend within the infant’s first year
of life, the condition may be corrected by testosterone
injections or surgery to guide the testes through the
inguinal canal. If not corrected, cryptorchidism can lead
to sterility and increase the risk for testicular cancer. ©Medicimage/Medical Images

Spot Check Why would cryptorchidism result in sterility?

Each testis has an outer fibrous capsule called the tunica albuginea (TYU-nih-kah
AL-byu-JIN-ee-ah). See Figure 15.4. Inside this capsule, the testis is divided into
250 to 300 wedge-shaped lobules. Each lobule contains one to four seminiferous
tubules (sem-ih-NIF-er-us). These tubules lead to a network of ducts called the

15.3 Male Reproductive Anatomy 579

 Spermatic cord

Ductus
deferens
Ductus
deferens Spermatic
Efferent cord
ductule
Head of
epididymis Epididymis

Rete
testis Blood
vessels
and a
Testis, nerve
covered
Testis, by tunica
covered albuginea
by tunica
albuginea

Lobule
Tail of
epididymis
Scrotum
Interstitial
(folded down)
cells
Seminiferous
tubules
2 cm
(a) (b)

FIGURE 15.4 The testes and associated structures: (a) cadaver testis with the scrotum pulled away and the ductus deferens
separated from the spermatic cord; (b) the anatomy of the testis, epididymis, and spermatic cord.
(a) ©McGraw-Hill Education/Dennis Strete

rete testis (REE-tee), located posteriorly in the testes, still within the fibrous capsule.
Sperm are produced in the seminiferous tubules. You will read more about sperm pro-
duction later in the chapter. Interstitial cells (cells of Leydig) lie between seminiferous
tubules in the lobules. These are endocrine cells that produce testosterone.

Spot Check What is likely the least number of seminiferous tubules per testis?
What is likely the greatest number of seminiferous tubules per testis?

Now that you have become familiar with the anatomy of the testes, you can explore
the anatomy of the secondary reproductive organs and structures, starting with where
the testes are housed—the scrotum.

Secondary Sex Organs and Structures

Learning Outcome
4. Describe the male secondary sex organs and structures and their respective functions.

The secondary reproductive organs and structures in the male are the scrotum, sper-
matic cord, spermatic ducts, accessory glands, and penis. These structures allow
reproduction to occur.

Scrotum The scrotum is a pendulous (hanging from the torso) sac that houses the
testes. Along with the penis, the scrotum makes up the external genitalia of the male. Both
structures occupy a diamond-shaped space called the perineum (PER-ih-NEE-um).
Figure 15.5 places the perineum between the pubic bone (anteriorly), the ischial
tuberosities (laterally), and the coccyx (posteriorly).

580 CHAPTER 15 The Male Reproductive System

 The walls of the scrotum con-
sist of skin, smooth muscle, and Location of
pubic symphysis
connective tissue. The smooth
muscle wall is the dartos muscle
(see Figure 15.6), which reacts
to temperature changes by con- Scrotum
tracting and relaxing. It contracts Perineal raphe
when it is cold, thereby reduc-
ing the space in the scrotum and
drawing the testes together. This Location of
ischial tuberosity
helps keep the testes warm. The
contraction of the dartos muscle
also reduces the surface area of Anus
the scrotum to reduce heat loss.
However, if it is warm, the dartos
Location of
muscle relaxes, maximizing the coccyx
space for the testes to help keep
them cool. FIGURE 15.5 The male
A medial wall divides the scrotum into two compartments—one for each testis. The perineum.
left testis is usually suspended lower than the right in the scrotal sac, so the testes are
not compressed against each other between the thighs. The medial septum also pro-
tects each testis from possible infection in the other compartment. An apparent seam—
perineal raphe (RAY-fee)—externally marks the ___location of the medial septum on the
scrotum. See Figure 15.5.

FIGURE 15.6 The scrotum

and spermatic cord.

Spermatic cord:

Fascia of
Inguinal
spermatic cord
canal
Cremaster
muscle

Ductus
Spermatic deferens
cord
Pampiniform
plexus

Testicular
artery

Epididymis

Testis
Median septum
of scrotum
Dartos
muscle
Cremaster
muscle
Scrotal skin

15.3 Male Reproductive Anatomy 581

 Spermatic Cord Figure 15.6 displays the spermatic cord. This structure is a com-
posite of several structures, as the cutaway for the left testis demonstrates. The right
spermatic cord (in Figure 15.6) shows the cremaster muscle as the outer layer of the
spermatic cord completely covering the testis. This muscle is derived from the internal
abdominal oblique muscle. Like the dartos muscle, the cremaster plays an important
role in temperature regulation for the testes. When cold, the cremaster muscle con-
tracts, drawing the testis closer to the body for warmth. When warm, the cremaster
muscle relaxes, so the testis hangs farther away from the body to keep cool.
The cremaster muscle has been cut away on the right in Figure 15.6 so that you can
view the other structures of the spermatic cord. You can see the ductus (vas) deferens,
a red testicular artery, and a blue network of veins called the pampiniform plexus.
All of these structures and the cremaster muscle make up the spermatic cord. The
ductus deferens is a tube that carries sperm. It is subsequently discussed as one of the
spermatic ducts. Here, we focus on the blood supply to and from the testes.

Clinical P int
Often, childless couples seek medical help if they are having trouble conceiving.
The doctor may first ask what type of underwear the man wears. Briefs and tight
jeans hold the testes closer to the body than boxer shorts and loose-fitting pants. The
closer the testes are to the body,
the warmer they will be. This slight
temperature difference may be the
cause of the problem.
©khvost/iStock/Getty Images

Pelvic cavity The testicular artery (which originates from the

abdominal aorta) is a very slender artery that has low
blood pressure. In fact, the pressure in the testicular artery
37°C is so low that it does not produce a pulse. As a result,
the testicular artery provides a poor oxygen supply to the
Pampiniform testes. Sperm develop large mitochondria to compensate
Testicular
artery plexus for the diminished oxygen; this adaptation allows them to
make use of any available oxygen. Although the pressure
Blood flow Blood flow of the blood delivered to the testes through the testicular
artery is low, the blood is still warm because it comes
from the body’s core. This warm blood would warm the
testes if not for the pampiniform plexus, which works as
Heat transfer we explain next.
You should be aware that blood cools once it has
reached the testes and is away from the body’s core. So the
Arterial blood cools Venous blood carries blood returning from the testes is cooler than the blood
as it descends away heat as it ascends arriving. The pampiniform plexus is not a single vein.
It is a network of small veins surrounding the testicular
artery. It acts much like the radiator in your car, in that it
35°C surrounds the warm artery with cooler veins to cool the
Testis Warmest Coolest arterial blood even more before it arrives at the testes.
blood blood Figure 15.7 shows just one vein of the pampiniform
plexus network next to the testicular artery so that you
FIGURE 15.7 The transfer of heat from the testicular artery can see the transfer of heat.
to the pampiniform plexus. Warm blood flowing through the
testicular artery is cooled by the blood in the pampiniform
plexus network of veins (shown here as a single vein for Spot Check What structures have an effect on
simplicity). The net effect is a lowering of the temperature of the temperature of the testes?
blood arriving at the testes by approximately 2°C.

582 CHAPTER 15 The Male Reproductive System

Spermatic Ducts We continue our discussion of secondary reproductive organs and
structures by examining the ducts that carry sperm. They are shown in Figure 15.8
and described in the following list:
• Efferent ductules. As you read earlier, sperm are produced in the seminiferous
tubules and move to the rete testis inside each testis. From the testes, sperm travel
through efferent ductules to the epididymis. These tiny ducts have ciliated cells to
move sperm along.
• Epididymis. The epididymis (EP-ih-DID-ih-miss) is a single-coiled duct (about
6 m, or 18 ft. long) that forms a ridge adhering to the posterior side of each
testis. Sperm mature and are stored here. However, sperm are immature when
they first arrive at the head of the epididymis from the efferent ductules. It takes
approximately 20 days for sperm to travel from the head to the tail. All along
the way, the epididymis reabsorbs excess water secreted by the testes. Once the
sperm reach the tail of the epididymis, they are stored. There, sperm remain
viable for 40 to 60 days. If not ejaculated, sperm disintegrate and the epididymis
reabsorbs them.

Clinical P int
Just as women are encouraged to perform monthly breast self-exams, men are encour-
aged to self-examine their testes. The best place to perform this exam is in the shower
with a soapy hand to palpate the testes, feeling for lumps. The epididymis can normally
be felt as a ridge along the posterior of each testis. It should not be confused with
something abnormal.

• Ductus deferens. At the tail of the epididymis, the sperm duct makes a 180-degree
turn to become the ductus (vas) deferens. This muscular duct travels up the spermatic
cord, through the inguinal canal into the abdominal cavity, and goes posterior to the
urinary bladder. There, it widens to form an ampulla before it merges with a duct
from the seminal vesicle to form the ejaculatory duct. This pathway is shown in
Figure 15.8a and b.
• Ejaculatory duct. The ejaculatory duct carries sperm from the ductus deferens,
and fluid from the seminal vesicle, through part of the prostate gland (PROS-tate)
to where it opens to the prostatic urethra. Again, see Figure 15.8.

Accessory Glands The male has five accessory glands—two seminal vesicles, one
prostate gland, and two bulbourethral (Cowper’s) glands. These glands function
together to produce semen, a fluid ejaculated during orgasm. Semen is 10% sperm;
the remainder is the different fluids produced by these three glands. These accessory
glands are shown in Figure 15.8 and described in the following list:
• Seminal vesicles. The seminal vesicles are approximately the size of a little finger.
Each of these two glands is associated with a ductus deferens posterior to the uri-
nary bladder. They secrete a thick, yellowish fluid that makes up 60% of semen. It
contains sugar and other carbohydrates to nourish sperm and a protein that will help
semen adhere to the vaginal walls, where it is deposited during intercourse.
• Prostate gland. As you may recall from the excretory/urinary system chapter, the
prostate gland surrounds the urethra inferior to the urinary bladder. It produces a
thin, whitish fluid that makes up 30% of semen. The prostatic fluid is alkaline to
help protect sperm from the acidity of the vagina, where the semen is deposited
during intercourse.

15.3 Male Reproductive Anatomy 583

Rectum
Urinary bladder

Seminal vesicle
Pubic bone

Ampulla of Ductus
ductus deferens (vas) deferens

Ejaculatory duct Root of penis

Urethra
Prostate gland

Corpus cavernosum
Bulbourethral
gland Corpus spongiosum

Penis
Epididymis
Glans penis
Testis
Prepuce
Scrotum

(a)

Ureter

Urinary bladder
Ampulla of
ductus deferens

Seminal vesicle

Prostate gland Ejaculatory duct

Prostatic urethra Bulbourethral

gland

Bulb of
Ductus (vas) penis
deferens Root of
penis Crus of
penis
Head of epididymis

Epididymis
Efferent ductule

Testis
Rete testis

Tail of Penis
epididymis Shaft Trabecular muscle

Urethra
Glans
(b)

FIGURE 15.8 The male reproductive system: (a) sagittal view, (b) posterior view.

584 CHAPTER 15 The Male Reproductive System

• Bulbourethral glands. The bulbourethral glands are named for their position
near the bulb of the penis and the urethra. See Figure 15.8b. They produce trace
amounts of a fluid that lubricates the end of the penis to make intercourse easier
and neutralizes the pH of the male urethra, which usually carries acidic urine.

Spot Check What is the composition of semen? Be specific.

Penis The last secondary reproductive structure you need to understand is the penis.
The reproductive function of the penis is to become erect to facilitate the deposition
of sperm in the vagina during intercourse. It is the anatomy of the penis that makes
this function possible. The anatomy of the penis is shown from different views in
Figures 15.8 and 15.9. You will find it helpful to compare the views in both figures.
As you can see in Figure 15.8a, half of the penis—the root—is internal, so it
is not seen externally. The other half, which is visible externally, is composed of
the shaft and glans. The shaft and glans of a nonerect penis are approximately 8 to
10 cm (3 to 4 in.) long and
3 cm in diameter, whereas
the dimensions of an erect
penis range from 13 to 18 cm
(5 to 7 in.) in length and 4 cm Veins
in diameter.
The glans is the ex­pand­ed Nerve
distal tip of the penis. The Arteries
external urethral orifice (open­ Corpora
ing) is located here. The glans cavernosa
is highly sensitive because of Connective tissue
its many nerve endings for (fascia) Urethra
sexual stimulation. The skin Corpus
covering the shaft of the Subcutaneous spongiosum
tissue
penis is loose to allow for Skin
the enlargement of the penis Prepuce
during erection. This skin External urethral orifice Glans penis
extends to form the prepuce
(foreskin), which covers the (a) (b)

skin of the glans. The prepuce FIGURE 15.9 Anatomy of the penis: (a) superficial dissection, lateral view; (b) cross section
is often surgically removed of the shaft.
(circumcision) from new-
borns. The skin of the glans and the facing skin of the prepuce have sebaceous glands
that produce a waxy substance called smegma.
The penis is composed of three columns of erectile tissue. All of these columns have
spaces within the tissue that fill with blood to expand the penis and cause it to become
erect during sexual arousal. Two of the columns—corpora cavernosa (singular: corpus
cavernosum)—have large spaces, while the third column—corpus spongiosum—has
smaller spaces. Partitions between the spaces are composed of smooth muscle called
trabecular muscle. As you can see in Figure 15.8a, the penile urethra is located
in the corpus spongiosum, and the glans is composed only of corpus spongiosum.
The internal end of the corpus spongiosum is called the bulb. The bulbospongiosus
muscle, composed of skeletal muscle tissue, surrounds the bulb. The internal ends of
the corpora cavernosa form a Y, and each arm of the Y shape is called a crus (plural:
crura). The crura anchor the penis internally to the pubic arch. The muscles discussed
here are new to you, but you will understand their function when you read about the
male sexual response, later in the chapter.
You have now become familiar with the reproductive anatomy of the male body.
Next, you will continue your study of anatomy by examining the male gamete—a sperm.

15.3 Male Reproductive Anatomy 585

 Anatomy of a Sperm

Learning Outcome
5. Describe the anatomy of a sperm.

As shown in Figure 15.10, a spermatozoon is a single cell with two principal parts—a
head and a tail. The head is basically the nucleus, containing 23 chromosomes and an
acrosome cap. The acrosome is a lysosome that contains enzymes that are eventually used
to penetrate an egg. The tail contains a central flagellum used to propel the sperm on its
journey. The section of the tail connected to the head (midpiece) is wider than the rest of
the tail. This is because of the large mitochondria surrounding the flagellum. These mito-
chondria make use of any available oxygen to perform cellular respiration, which supplies
ATP to energize the tail. As you may notice in this figure, there is an absence of cytoplasm
and other organelles. Spermatozoa are developed to be as efficient as possible. Their
function is simply to deliver their genetic material to fertilize an egg. Next, you will inves-
tigate the physiology of this system in the male that ultimately produces these gametes.

Spot Check Given the function of a sperm, explain the need for each part of
its anatomy.

FIGURE 15.10 Mature

spermatozoon: (a) head and
part of tail, (b) anatomy of a Acrosome
sperm cell. Head
(a) ©BSIP SA/Alamy Stock Photo
Nucleus

Midpiece (with
Mitochondrion mitochondria)

Flagellum

Tail

2 μm

(a) (b)

15.4 Physiology of the Male Reproductive System

Learning Outcome
6. Explain the hormonal control of puberty and the resulting changes in the male.

The physiology of the male reproductive system is governed by genetics and the endo-
crine system. You have already read how the SRY gene results in the formation of andro-
gen receptors in the fetus. The developing gonads in the fetus produce large amounts of

586 CHAPTER 15 The Male Reproductive System

testosterone to fit into these receptors so that the male anatomy continues to develop.
Testosterone production ceases a few months after birth and remains dormant until
puberty. Puberty is the first few years of adolescence; it begins with the production of
FSH and LH at approximately age 10 to 12 in boys. It ends with the first ejaculation of
viable sperm at around age 13.

Hormonal Control at Puberty

As you may remember from the endocrine system chapter, the hypothalamus secretes
GnRH at puberty, which targets the anterior pituitary. The anterior pituitary responds
by producing FSH and LH. FSH targets the testes to stimulate sperm production. It
does this by stimulating sustentacular (Sertoli) cells in the seminiferous tubules to
produce a protein called androgen-binding protein (ABP). This protein allows testos-
terone to accumulate in the tubules to initiate sperm production. Without this protein,
testosterone has little effect in the testes.
LH targets the interstitial cells between seminiferous tubules in the testes, telling
them to produce testosterone. The testosterone initiates sperm production in the semi-
niferous tubules and travels throughout the body targeting many tissues to produce the
male secondary sex characteristics.

Male Secondary Sex Characteristics These characteristics were originally dis-

cussed in the endocrine system chapter, but it will be helpful to review them. The male
secondary sex characteristics include the following:
• Skeletal and muscle development
• Changes in the larynx that cause a deeper voice
• Development of axillary and pubic hair with activation of associated apocrine glands
• Development of facial hair and possible thickening of hair on the torso and limbs
• Development of the libido (sex drive)

Spot Check What are the specific target cells for FSH and LH?

It is time to explore how sperm production is accomplished, beginning at puberty.

Sperm Production

Learning Outcome
7. Explain the stages of meiosis and contrast meiosis to mitosis.

Sperm production starts at puberty to produce cells with only 23 chromosomes. Until now,
you have been aware that mitosis is the type of cell division that produces all of the body’s
cells except gametes. The body’s cells have 46 chromosomes (23 pairs). The type of cell
division that produces cells with half the normal number of chromosomes is called meiosis.

Mitosis versus Meiosis As you may recall from “Chapter 2, Levels of Organiza-
tion of the Human Body,” mitosis is a one-division process, in which a parent cell of
46 chromosomes replicates and divides to produce two daughter cells. Each daughter
cell has a set of 46 chromosomes that is identical to the set of the other daughter cell
and to that of the parent cell, which no longer exists after the division takes place.
Meiosis works very differently.
As you can see in Figure 15.11, meiosis involves two divisions. Meiosis I (first
division) is shown on the left in this figure. Instead of showing all 46 chromosomes (an
amount called diploid, 2n), this figure shows just two pairs of chromosomes so that you
can more easily see what is happening. Notice that between mid-to-late prophase and

15.4 Physiology of the Male Reproductive System 587

 First Meiotic Division (Meiosis I) Second Meiotic Division (Meiosis II)
(continued from the bottom of previous column)
Early prophase I
Prophase II
Chromosomes
Nucleus

Chromatids

Middle prophase I

Pair of chromosomes

Metaphase I

Metaphase II

Equatorial
plane

Anaphase I

Anaphase II

Telophase I

Telophase II

Prophase II (top of next column)

FIGURE 15.11 Meiosis. For simplicity, this diagram shows the stages of meiosis for just two of the 23 pairs of chromosomes.
Notice that crossing-over and independent assortment in the two divisions of meiosis result in four gametes that are not
identical, but each gamete has half the chromosomes as the starting cell.

588 CHAPTER 15 The Male Reproductive System

metaphase, the chromosomes no longer look exactly like the original chromosomes.
The chromatids have broken and exchanged parts. This is called crossing-over. This
event does not happen in mitosis. The chromosomes also align randomly before this
first division occurs. In other words, not all of the maternal chromosomes are on one
side and all of the paternal chromosomes are on the other before division occurs.
This random arrangement causes an assortment of chromosomes in the resulting two
daughter cells. This independent assortment and crossing-over creates new combi-
nations of DNA that will provide genetic variety in the eventual sperm.
Meiosis II (second division) is shown on the right in Figure 15.11. In this divi-
sion, note the result. Four cells are produced through meiosis II, each having half
the number of chromosomes (this amount is called haploid, n) as the original parent
cell (23 instead of 23 pairs). You should also note that the chromosomes in the four
resulting cells are not identical to each other due to the independent assortment and
crossing-over during meiosis I.
In summary, meiosis is a two-division process that starts with a parent cell of 46
chromosomes (23 pairs). It results in four daughter cells, each having 23 chromo-
somes. The set of chromosomes in each daughter cell is different from the sets in the
other daughter cells due to independent assortment and crossing-over.
Now that you have seen how meiosis can produce cells with 23 chromosomes,
you are ready to examine sperm production specifically. It involves two processes—
spermatogenesis and spermiogenesis.

Spermatogenesis and Spermiogenesis

Learning Outcome
8. E
 xplain the processes of sperm production and differentiate between spermatogenesis
and spermiogenesis.

Spermatogenesis The first process in sperm production is spermatogenesis. Its

purpose is to produce four cells (each with 23 chromosomes) from a specialized stem
cell (germ cell) with 46 chromosomes. Germ cells are stem cells designed to form
gametes. In the male, these germ cells are called spermatogonia. These cells are
formed in the male fetus, but they remain dormant until testosterone levels rise at
puberty, when sperm production begins. Spermatogenesis is explained in the follow-
ing steps and shown in Figure 15.12.
1. A spermatogonium near the basement membrane of the seminiferous tubule first
divides by mitosis. This produces two identical spermatogonia. One spermatogo-
nium (type A) remains near the basement membrane to serve as a spermatogonium
later. This provides a continual, lifetime supply of germ cells. The other spermato-
gonium (type B) migrates slightly away from the wall toward the lumen (hollow
center) of the seminiferous tubule. It will continue on in the production process.
2. Spermatogonium B enlarges to become a primary spermatocyte. Note that at this
stage this cell still has 46 chromosomes (2n). Sustentacular cells in the seminifer-
ous tubule form a blood-testis barrier (BTB) to isolate these spermatocytes from
the immune system. The sustentacular cells form tight junctions with each other to
isolate the primary spermatocytes on the lumen side of the BTB. This is like shut-
ting a tight door behind them. A blood supply is still available to the sustentacular
cells but is not available to the spermatocytes. The sustentacular cells will need
to care for the spermatocytes from now on by providing the developing cells with
nutrients and removing their wastes. Meiosis (through independent assortment and
crossing-over) produces cells with a different genetic makeup from that of body
cells. These cells would be seen as foreign by the body’s immune system, but the
BTB prevents the immune system from destroying these cells.

15.4 Physiology of the Male Reproductive System 589

 Seminiferous FIGURE 15.12 Sperm
tubule production. (a) Steps 1 through
Basement
membrane
4 show spermatogenesis.
Spermiogenesis follows
spermatogenesis, causing
spermatids to develop into
1
Spermatogonium sperm cells. (b) Sustentacular
(germ cell) 46 cells involved in sperm
production.
Type A

46 Mitotic division
Type B
46 Sustentacular cells Spermatogonium
Daughter cell (germ cell)
Blood-testis
barrier
2

Primary Sustentacular
spermatocyte 46 cell
3 Blood-testis
First meiotic barrier
division

Secondary
spermatocyte 23 23
Tight
junction
Second meiotic between
division sustentacular
4 Sustentacular
cells
23 cell nucleus
Spermatid 23 23 23
Secondary
spermatocyte

23 23 23 23

Spermiogenesis Spermatid

Spermatid
becoming a
sperm cell
23
23 23 23
Lumen of
seminiferous
tubule Sperm cell

Sperm
cells

(a) (b)

3. Once protected by the BTB, the primary spermatocyte goes through meiosis I. This
produces two equal-size, genetically unique secondary spermatocytes, each having
23 chromosomes (n). The sustentacular cells, which have a blood supply, are respon-
sible for continuing to care for these secondary spermatocytes behind the BTB.
4. Each secondary spermatocyte undergoes meiosis II, which produces in total four
spermatids from the one original spermatogonium type B. Notice in Figure 15.12
that spermatids look nothing like sperm. They have cytoplasm and no tail. These
spermatids are ready to go through the next process—spermiogenesis.

590 CHAPTER 15 The Male Reproductive System

 FIGURE 15.13
Spermiogenesis.
Flagellum
Nucleus

Mitochondria

Golgi apparatus

Excess
cytoplasm

Excess cytoplasm
and most organelles lost

Tail

Mitochondria
Midpiece
Centriole

Head

Acrosome

Spot Check How do the chromosomes compare among the four spermatids?

Spermiogenesis Spermiogenesis, the second process in sperm production, trans-

forms spermatids to functional sperm. Spermiogenesis is shown in Figure 15.12 and in
more detail in Figure 15.13. During this process, each spermatid forms a tail and sheds
its cytoplasm to become a sperm having the anatomy you studied earlier. Even though
a sperm is fully formed at the end of this process, it will not be able to propel itself until
it has matured in the epididymis. Once spermiogenesis is finished, sustentacular cells
flush sperm out of the seminiferous tubules to move them on their way. It takes, on
average, 74 days to go from one type-B spermatogonium to four viable, mature sperm.
A young man in his prime produces about 400 million sperm per day. Figure 15.14
shows the histology of a testis so that you can see the result of sperm production.

Spot Check What happens to the sustentacular fluid used to flush sperm out of
the seminiferous tubules?

Sperm production, and the male reproductive system as a whole, is under hor-
monal control by the hypothalamus, pituitary, and testes. In the next section, you will
learn how hormones maintain homeostasis for this system.

15.4 Physiology of the Male Reproductive System 591

 Blood vessel
Interstitial
cells
Seminiferous
Blood vessel tubule

Germ cells Spermatids

Sustentacular
cell nuclei
Sustentacular Tubule lumen
cell
Germ cells
Connective
Tails of tissue wall
spermatozoa of tubule

Interstitial cells

(a) (b) 50 μm

FIGURE 15.14 Histology of a testis: (a) scanning electron micrograph of a seminiferous tubule with spermatozoa in the lumen,
(b) light micrograph of a seminiferous tubule without spermatozoa at the time. Source for part (a): Copyright by R.G. Kessel and
R.H. Kardon, Tissues and Organs: A Text-Atlas of Scanning Electron Microscopy, 1979, W.H. Freeman. All rights reserved.
(a) ©Susumu Nishinaga/Science Source (b) ©Ed Reschke

Spot Check Physical trauma to the testes can result in sterility because of the
immune system’s action. Explain how this might happen.

Hormonal Control in the Adult Male

Learning Outcome
9. Explain the hormonal control of the adult male reproductive system.

You are already familiar with the green arrows in Figure 15.15 because they show the
same interactions that begin at puberty (discussed earlier). However, this diagram also
shows the negative feedback mechanisms involved with these hormones. For example,
testosterone stimulates spermatogenesis in the testes if there is androgen-binding pro-
tein, and it stimulates libido and secondary sex characteristics in many other body
tissues. But testosterone also has a negative feedback effect on the hypothalamus,
inhibiting any further production of GnRH, and on the anterior pituitary, reducing its
sensitivity to GnRH. Inhibiting GnRH production means that FSH and LH production
is also inhibited. This negative feedback loop prevents the overproduction of testoster-
one and maintains homeostasis. As a result, testosterone levels are maintained within
homeostatic levels.
Figure 15.15 also includes a hormone called inhibin, which is produced by susten-
tacular cells in the seminiferous tubules. Like nurses who care for patients on a ward,
sustentacular cells care for developing sperm in the tubules. Sustentacular cells produce
ABP when they receive FSH and can handle more sperm production (patients), but
they produce inhibin when their ward is full and they cannot handle any more. This is
like sending a message to the hospital administration to stop sending any more patients.
Inhibin targets the anterior pituitary to inhibit FSH production. As you may recall, FSH
stimulates sustentacular cells to produce ABP, and both FSH and ABP are needed in
the seminiferous tubules for testosterone to have an effect on sperm production. Without
FSH and ABP, sperm production is put on hold. Inhibin has no effect on LH production
from the anterior pituitary. It affects only the pituitary’s production of FSH.

592 CHAPTER 15 The Male Reproductive System

 1
FIGURE 15.15 Hormonal
The hypothalamus releases control of the male reproductive
GnRH to stimulate the anterior GnRH system.
pituitary to release LH and FSH.
Hypothalamus

2
LH targets intersitial cells of the
testes to stimulate testosterone
production.
Anterior
3 pituitary
5
FSH targets sustentacular cells of 1
the seminiferous tubules to
increase spermatogenesis and LH, FSH
inhibin production.
Inhibin
LH FSH
4 6
2 3
Testosterone stimulates
spermatogenesis, development
of sex organs, and secondary sex Interstitial Sustentacular
characteristics. cells of (Sertoli) cells
testis of seminiferous
tubules
5
Testosterone has a negative Testosterone
feedback effect on the
hypothalamus and anterior 4
pituitary to reduce LH and FSH
production.
Development of
sex organs and Spermatogenesis
6 secondary sex
Inhibin has a negative feedback characteristics
effect on the anterior pituitary’s
production of FSH.

Inhibitory Stimulatory

Clinical P int
Anabolic steroids are drugs like testosterone or drugs that act like testosterone.
They are often prescribed by doctors to treat conditions such as delayed puberty or
cryptorchidism. As you have already learned about testosterone, anabolic steroids
make muscles bigger and bones stronger. Some adults and teens take illegal (not
medically prescribed) anabolic steroids to lower body fat and increase muscle size
and strength. The dose of illegal steroids is often 10 to 100 times higher than what
would normally be prescribed, and more than one steroid may be taken in combina-
tion (called stacking).

Spot Check What effect does inhibin have on testosterone production?

Spot Check Given what you know of the effects of testosterone, predict
the effects of illegal anabolic steroid use on (a) body tissues in general, (b) the
hypothalamus, (c) the anterior pituitary, (d) levels of FSH and LH, (e) the testes, and
(f) sperm production.

15.4 Physiology of the Male Reproductive System 593

 Pathway for Sperm

Learning Outcome
10. Trace the path a sperm takes from its formation to its ejaculation.

You have become familiar with the male anatomy, sperm anatomy, sperm production,
and the hormonal control of the male reproductive system. But how do sperm get to
where they need to go in order to fertilize an egg? First, review the pathway they must
travel to leave the male body:
Sperm travel from the seminiferous tubules → to the rete testes → to the efferent
ductules → to the epididymis → to the ductus deferens → to the ejaculatory
ducts → to the urethra → to outside the body.
Now that you have reviewed the pathway, you are ready to study how sperm move
from the epididymis to outside the body during the male sexual response.

Clinical P int
A surgical procedure called a vasectomy can be done to make
the male sterile as a form of birth control. In a vasectomy, a
section of each ductus deferens in the scrotum is excised
(removed). The cut ends are then ligated (tied) or cauterized
(sealed) to ensure complete blockage. This procedure does
not affect sperm or semen production. Rather, it simply pre-
vents sperm from traveling past the excision. As a precaution,
the patient’s semen should be tested for sperm after the proce-
dure to make sure the vasectomy was successful.

Sexual Response in the Male

Learning Outcome
11. Describe the stages of the male sexual response.

The male sexual response has four stages—arousal, emission, ejaculation, and
resolution. Two of these stages—emission and ejaculation—make up orgasm
in the male. These stages are described in the following list and summarized in
Figure 15.16.
• Arousal. The most obvious sign of this phase is an erection of the penis. This
can be the result of an autonomic reflex from stimulation of the penis, or it can
be initiated by sight, sound, smell, or even thought. Neural signals cause the
arteries in the penis to dilate, so the penile erectile tissues engorge with blood.
This compresses the veins carrying blood away from the penis. The net effect
of more blood coming into the penis than leaving is that the penis becomes
enlarged, rigid, and erect. This erection makes penetration of a woman’s vagina
possible. The bulbourethral glands also secrete their lubricating fluid during
this stage.
• Emission. During emission, sperm are moved by peristaltic contractions through
the ductus deferens to its ampulla. Contractions here move sperm through the ejac-
ulatory duct to the urethra. In addition, the prostate and seminal vesicles add their
secretions to semen during this stage.

594 CHAPTER 15 The Male Reproductive System

 Arousal

Arteries in the penis dilate,

erectile tissues become
engorged, the penis
becomes erect, and
bulbourethral glands
secrete lubricating fluid.

Resolution

Arteries to the penis

constrict, and muscles in Emission
the erectile tissues force
excess blood from the Peristaltic contractions move
penis through the veins. sperm through the ductus
The penis becomes deferens to the ampulla, the
flaccid again. ampulla contracts, and
sperm are moved through
the ejaculatory duct to the
urethra. Prostate and
seminal vesicles secrete
their fluids.

Ejaculation

The internal urinary sphincter

closes, the prostate and
seminal vesicles secrete
additional fluid, and the Semen in urethra
bulbocavernosus muscle
contracts to force semen out
the urethra.

FIGURE 15.16 The male sexual response.

• Ejaculation. This stage is characterized by a pronounced, temporary increase in

heart rate and blood pressure. During this stage, the internal urethral sphincter
closes, so sperm and urine never mix. The presence of semen in the urethra initi-
ates a reflex, which causes additional secretion of fluids from the seminal vesicles
and prostate, as well as contractions of the bulbocavernosus muscle at the root of
the penis. The additional fluid and the muscle contractions force semen from the
urethra. A typical ejaculation has a volume greater than 2.5 mL with more than
20 million sperm/mL, of which 60% are normal-shaped and motile.1 The release
of tension and accompanying intense, pleasurable sensation for the male during
ejaculation make up the male orgasm. Although it is not typical, it is possible to
have orgasm without ejaculation.

Disease P int
Infertility in the male—the inability to fertilize an egg—is considered to be a sperm
count less than 20 million sperm/mL with a larger-than-normal percentage of misshapen
or immobile sperm.

15.4 Physiology of the Male Reproductive System 595

 • Resolution. This stage immediately follows ejaculation. Sympathetic neurons con-
strict the arteries bringing blood to the penis, while trabecular muscles in the erec-
tile tissues contract to force excess blood from the penis through the veins. The net
result of resolution is that the penis decreases in size and becomes flaccid again. A
refractory period of 10 minutes to a few hours follows resolution, during which
time the male is unable to have another erection.

Spot Check What might stimulate an erection?

Spot Check What physically happens to cause a penis to become erect?

You have explored the changes in this system over a life span—from a fetus, to an
adolescent going through puberty, to an adult. You will now investigate the effects of
aging on this system as the male approaches old age.

15.5 Effects of Aging on the Male Reproductive

System

Learning Outcome
12. Explain the effects of aging on the male reproductive system.

Testosterone production peaks at age 20 and declines from there, so that at age 80, a
male may make only 20% of his peak production of testosterone. The decreased level
of testosterone does not mean sperm production ceases. Although it is not common to
do so, men in their 70s and 80s have fathered children.
The negative feedback mechanism of high testosterone is also lost by the greatly
diminished testosterone levels. So GnRH is not inhibited, and FSH and LH levels
increase, rising to significantly higher levels after age 50. The increased levels of these
two hormones result in the male climacteric or andropause. This event is sometimes
referred to as the “male menopause,” but this term is inaccurate. Menopause means
the cessation of the menses (menstrual periods in women), an event that does not
occur in the male. Most men have few symptoms during andropause, but some may
experience hot flashes and mood swings.
Another effect of aging on the male is erectile dysfunction (ED or impotence).
An occasional inability to achieve an erection is not considered erectile dysfunction.
However, ED is the frequent (more than half the time) inability to achieve an erec-
tion sufficient to penetrate a vagina. ED occurs in about 20% of men in their 60s and
increases to 50% of men in their 80s. In a normal erection, a nerve stimulus results
in the release of a chemical that causes the smooth muscle in the arteries deliver-
ing blood to the penis to relax. So the arteries dilate, and the erectile tissues become
engorged. The arteries remain dilated until an enzyme degrades the chemical. Drugs,
such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), treat erectile
dysfunction by inhibiting the enzyme that degrades the chemical so that the arteries
remain dilated longer.
Aging in the male also affects the prostate gland. The size of the prostate remains
relatively stable in an adult until about age 45. Then it slowly enlarges. Eighty percent
of men have benign prostatic hyperplasia (BPH) by the age of 80. As the name
suggests, this is a noncancerous, nonmetastatic enlargement, which grows toward the
middle of the prostate. This enlargement compresses the urethra, making micturi-
tion and emptying the bladder more difficult. A man with this condition has frequent
micturition because the bladder is not fully emptied and has difficulty maintaining a
steady stream of urine.

596 CHAPTER 15 The Male Reproductive System

15.6 Diagnostic Tests for Male Reproductive
System Disorders

Learning Outcome
13. Describe common diagnostic tests used for male reproductive system disorders.

Like the tables for other systems, Table 15.1 presents common diagnostic tests used
for male reproductive system disorders. Some of the tests may be familiar to you, as
they have been mentioned in previous chapters, but their specific relation to the male
reproductive system is explained.

Common Diagnostic Tests for Male Reproductive

TABLE 15.1
System Disorders
Diagnostic Test or Screening Description
Digital rectal exam (DRE) A procedure in which the doctor inserts fingers into the rectum to detect any
abnormalities, such as an enlarged prostate.
Laboratory tests/microscopic Procedures that involve collecting urine or specimen samples from the urinary tract
examination of samples to determine the presence of viruses or bacteria that may cause infection.
Prostate-specific antigen A test that measures the presence of prostate-specific antigens in the blood.
(PSA) test Increased levels may indicate prostate cancer.
Transrectal ultrasound and A procedure in which ultrasound technology is used to assess the prostate for
biopsy of the prostate evidence of cancer. If a mass is detected, a sample is collected and examined by a
laboratory for the presence of cancerous cells.
Ultrasound An imaging technique in which sound waves create visual images of internal
structures. In the male reproductive system, ultrasound may be used to determine
the cause of a hydrocele, examine a mass in the testis, and diagnose epididymitis
and cryptorchidism.

15.7 Male Reproductive System Disorders

Learning Outcome
14. D
 escribe male reproductive system disorders and relate abnormal function to
pathology.

During the course of this chapter, you have become familiar with some male repro-
ductive disorders, including androgen-insensitivity syndrome, cryptorchidism, erectile
dysfunction, and benign prostatic hyperplasia. You will now explore a few more.

Prostate Cancer
Other than skin cancer, prostate cancer is the most common cancer in men over 50. In
this condition, the prostatic enlargement occurs to the outside, so there is little effect
on the urethra. The lack of the typical symptoms seen with BPH may allow the cancer
to proceed undetected. A digital rectal exam (DRE) can be performed from the rec-
tum by palpating the prostate to check its size. See Figure 15.17. This cancer can also
be detected by a blood test measuring prostate-specific antigen (PSA) levels. This
antigen is produced in greater amounts when prostate cancer is present. Eighty per-
cent of individuals survive prostate cancer if it is detected and treated early.

15.7 Male Reproductive System Disorders 597

 FIGURE 15.17 Digital rectal exam for examination of the prostate.

Testicular Cancer
Testicular cancer is most common in white males between the ages of 15 and 34. Rou-
tine testicular self-exams are recommended for early detection. This form of cancer is
highly curable if treated early. See Figure 15.18.

(a) (b)

FIGURE 15.18 Testicular cancer: (a) normal testicle, (b) cancerous testicle.
(a) ©VideoSurgery/Science Source (b) ©Boilershot Photo/Science Source

598 CHAPTER 15 The Male Reproductive System

Hypospadias
Hypospadias (high-poh-SPAY-dee-as) is a congenital defect
(present at birth) in which the urethra opens on the ventral
side or base of the penis instead of on the tip of the glans.
It can usually be surgically corrected during an infant’s
first year.

Hydrocele
A hydrocele is a condition in which fluid has accumulated
and caused swelling in the scrotum. See Figure 15.19. This
condition can affect newborns, as fluid may leak into the
scrotum as the testicles descend from the abdomen into
the scrotum. Hydroceles can also affect adult men, usually
resulting from a disorder of the testes such as epididymitis FIGURE 15.19 Hydrocele.
©Biophoto Associates/Science Source
(covered in the next paragraph) or testicular cancer. Hydro-
celes in men may also accompany inguinal hernias (covered
in the digestive system chapter). Hydroceles typically do not cause additional symp-
toms other than swelling. Physicians may perform an ultrasound on the testicles to
determine whether the cause is an infection or a tumor. Most hydroceles are left to
resolve (self-correct) on their own.

Epididymitis
Epididymitis is inflammation of the epididymis, usually caused by a bacterial infec-
tion. The bacterial infection can be caused by a number of factors, such as surgery,
bladder catheterization, or infections that are present in other parts of the urinary tract
that spread to the epididymis. Symptoms include swelling, pain, tenderness, fever, and
fluid around the testes (hydrocele). Physical exam, ultrasound, and urinalysis are used
to diagnose this condition. Treatment involves antibiotics for the bacterial infection
and immobilization of the scrotum to reduce pain from repetitive movements.

Phimosis
Phimosis (fi-MOH-sis) is a condition of the penis characterized by tight foreskin
that cannot be pulled back over the glans penis. See Figure 15.20. This condition
usually happens in newborns and young boys and can resolve on its own. Because
the tight foreskin can interfere with normal function of the penis, such as urination
and sexual activity, unresolved phimosis must be treated. Treatment can include the
topical application of a corticosteroid cream that stretches
the foreskin so that it may be retracted over the glans penis.
Circumcision can also be performed to correct phimosis.

Sexually Transmitted Diseases

Sexually transmitted diseases (STDs), also known as sexu-
ally transmitted infections (STIs), are infections that are
passed through sexual contact. The most common STDs
are herpes, HIV, human papillomavirus (HPV), gonorrhea,
chlamydia, and syphilis.
A few viral infections that are transmitted sexually are
herpes, HIV, and HPV. These should all be familiar, as you
have covered them in previous chapters. As you might recall
from the integumentary system chapter, the herpes simplex
virus causes sores on the skin, mucous membranes, and geni-
tals. The herpes simplex virus can be passed through sexual FIGURE 15.20 Phimosis.
contact with an infected person or direct contact with a sore. ©Dr. P. Marazzi/Science Source

15.7 Male Reproductive System Disorders 599

 You also read about warts in the integumentary system chapter and should recall
that warts are caused by HPV. These warts may appear on the skin, but they can also
affect the genitals. Like the herpes virus, HPV can be spread through sexual contact
with an infected person. You will revisit HPV in the next chapter to discuss its impact
on the female reproductive system.

Clinical P int
Both the Centers for Disease Control and Prevention and the American Academy of
Pediatrics recommend that boys be routinely vaccinated against HPV. Boys can begin
receiving the vaccination as early as 9 years old. The vaccine can help protect boys
against genital warts; may reduce the risk of cancers of the head, neck, and anus; and
will reduce the spread of HPV to young girls, thus ultimately reducing the risk of cervical
cancer in women.2

In the lymphatic system chapter, you explored HIV and its resulting syndrome,
AIDS. HIV can be passed through contact with the body fluids (blood, semen, or vagi-
nal secretions) of an infected person. Currently, there is no cure for either of these viral
infections, and treatment is aimed at relieving the symptoms of the disease.
Sexually transmitted infections can also be caused by bacteria. Examples are gon-
orrhea, chlamydia, and syphilis:
• Gonorrhea is an STD caused by the bacterium Neisseria gonorrhoeae. Gonorrhea
can spread to the genitals, mouth, or anus. The infection causes burning during
urination and a white to yellow or green discharge from the penis. If not treated,
gonorrhea can cause epididymitis. Gonorrhea is diagnosed by testing a urine sam-
ple or swabbing the urethra for the presence of the bacteria. Antibiotics are used
to treat the infection. Some strains of drug-resistant gonorrhea are becoming more
prevalent, making the disease harder to treat.
• Chlamydia is another bacterial infection that is spread through sexual contact. The
bacterium responsible for the infection is Chlamydia trachomatis. The symptoms
of chlamydia are similar to those listed for gonorrhea: burning during urination
and penile discharge. Chlamydia can spread to the epididymis, causing additional
pain and inflammation. Chlamydia is diagnosed by urinalysis or culture of a speci-
men collected from the penis. If Chlamydia trachomatis is found, the disease can
be treated with antibiotics.
• Syphilis is an STD caused by the bacterium Treponema pallidum. Syphilis
causes sores on the genitals, anus, rectum, or mouth. The disease is spread
through direct contact with a syphilis sore. See Figure 15.21. There are three
stages of this disease: the primary stage (the appearance of sores), the second-
ary stage (development of a rash on various parts of the body), and the latent
stage (primary and secondary symptoms disappear, and the disease lies dormant
for years, after which the infection damages internal organs). Syphilis is diag-
nosed by a specimen sample from the sore viewed under a microscope or by
a blood test to determine the presence of the bacterium Treponema pallidum.
Syphilis is easy to treat using antibiotics; but, if untreated, damage to organs
can eventually cause death.

Spot Check What can a male do to protect himself from the effects of
FIGURE 15.21 Syphilis. reproductive disorders? Be specific.
Source: M. Rein, VD/CDC

600 CHAPTER 15 The Male Reproductive System

 Table 15.2 summarizes all of the diseases and disorders described throughout the
chapter.

TABLE 15.2 Summary of Diseases and Disorders of the Male

Reproductive System
Type of Disease/ Disease/
Disorder Disorder Description

Structural Cryptorchidism A condition of undescended testes that occurs in male infants.

abnormalities
Hypospadias A congenital defect in which the urethra opens on the ventral side or base of
the penis instead of on the tip of the glans.
Phimosis A condition of the penis characterized by tight foreskin that cannot be pulled
back over the glans penis.
Cancers Prostate cancer Cancer of the prostate gland.
Testicular Cancer in one or both testicles.
cancer
Sexually Chlamydia An STD caused by the Chlamydia trachomatis bacterium.
transmitted
diseases (STDs)
Gonorrhea An STD caused by the Neisseria gonorrhoeae bacterium.
Herpes A viral infection that causes sores on the genitals, anus, or mouth.
HIV The virus that causes AIDS.
HPV A viral infection resulting in the growth of warts on the genitals. The infection
is caused by the human papillomavirus.
Syphilis An STD caused by the Treponema pallidum bacterium.
Other Epididymitis Inflammation of the epididymis, usually caused by a bacterial infection.
reproductive
disorders
Hydrocele A condition in which fluid has accumulated and caused swelling in the scrotum.
Infertility The inability to fertilize an egg.

15.7 Male Reproductive System Disorders 601

Putting the Pieces Together

The Reproductive Systems

Integumentary system Cardiovascular system
Apocrine glands secrete Blood transports reproductive
pheromones to attract the hormones; vasodilation
opposite sex; mammary glands enables erection.
secrete milk to nourish an infant.
Testosterone promotes
Reproductive hormones erythropoiesis.
promote sebum production.

Lymphatic system
Skeletal system
Sends white blood cells to
Bones of the pelvis protect fight pathogens in the
some reproductive organs. reproductive system.

Reproductive hormones
Sustentacular cells form a
promote endochondral bone
blood-testis barrier to isolate
growth and serve as a lock
developing sperm from the
on calcium in the bone.
immune system.

Muscular system
Respiratory system
Muscle contractions are involved
in ejaculation and childbirth. Allows for the exchange of O2
and CO2 in system tissues.
Reproductive hormones
promote muscle growth and Allows for the exchange of
development. O2 and CO2 in a fetus.

Nervous system Digestive system

Nerve impulses innervate Provides nutrients for tissues
muscles involved in erection, of the reproductive system.
ejaculation, and childbirth.
Decreased digestive motility
Reproductive hormones during the first trimester may
affect the production of cause morning sickness.
hypothalamus releasing
hormones.
Excretory/urinary
system
Endocrine system
Removes metabolic wastes
Hormones regulate sexual
produced by the fetus; semen
development, sex drive,
is ejaculated through the
menstruation, pregnancy, birth,
urethra.
and lactation.
Sexual response in male and
Reproductive hormones
female blocks the passing of
have a negative feedback
urine.
effect on the hypothalamus.

FIGURE 15.22 Putting the Pieces Together—The Reproductive Systems: connections between the male and female
reproductive systems and the body’s other systems.

602 CHAPTER 15 The Male Reproductive System

Summary
15.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the male reproductive
system.

15.2 Overview
∙∙ All humans start from a zygote.
∙∙ Gender is determined by sperm from the father.
∙∙ The SRY gene on the Y chromosome codes for a protein so that androgen receptors are produced in a male fetus.
∙∙ Testosterone and androgen receptors are needed in the fetus for male anatomy to develop.

15.3 Male Reproductive Anatomy

Testes
∙∙ Testes belong to the endocrine and reproductive systems because they produce testosterone and sperm.
∙∙ Testes descend from the abdomen to the scrotum because of the gubernaculum.
∙∙ For the testes to produce viable sperm, the temperature of each testis must be approximately 2°C cooler than the core
body temperature.
∙∙ Each testis is divided into lobules.
∙∙ Sperm are produced in the seminiferous tubules.
∙∙ Interstitial cells, located between seminiferous tubules, produce testosterone.

Secondary Sex Organs and Structures

∙∙ The testes are housed in the scrotum.
∙∙ The spermatic cord suspends each testis and is composed of the cremaster muscle, the ductus deferens, the testicular
artery, and the pampiniform plexus.
∙∙ The pampiniform plexus is a network of veins surrounding the testicular artery.
∙∙ The temperature of the testes is maintained by the dartos muscle, the cremaster muscles, and the pampiniform plexus.
∙∙ The spermatic ducts are the efferent ductules, the ductus deferens, and the ejaculatory ducts.
∙∙ The five accessory glands in the male are two seminal vesicles, one prostate gland, and two bulbourethral glands.
∙∙ The accessory glands produce the fluids in semen.
∙∙ The penis has an internal root and an external shaft and glans.
∙∙ The penis is composed of three columns of erectile tissue.

Anatomy of a Sperm
∙∙ A spermatozoon is a single cell with two principal parts—a head and a tail.
∙∙ The head contains 23 chromosomes and an enzyme-filled acrosome used to penetrate an egg.
∙∙ The tail contains a midpiece with large mitochondria to produce the energy to move the tail’s flagellum.

15.4 Physiology of the Male Reproductive System

∙∙ Testosterone production ceases a few months after birth and does not resume until puberty.
∙∙ Puberty begins with the production of FSH and LH, and it ends with the first ejaculation of viable sperm.

Hormonal Control at Puberty

∙∙ FSH stimulates sustentacular cells to produce ABP.
∙∙ ABP and testosterone are needed for testosterone to have an effect on sperm production.
∙∙ LH stimulates interstitial cells to produce testosterone.

Sperm Production
∙∙ Mitosis is a one-division process that forms all body cells.
∙∙ Meiosis is a two-division process that forms gametes.
∙∙ Crossing-over and independent assortment in meiosis create new combinations of DNA that provide genetic variety
in sperm.
∙∙ Sperm production involves two processes—spermatogenesis and spermiogenesis.

603
Spermatogenesis and Spermiogenesis
∙∙ Spermatogenesis involves meiosis to form four spermatids from one spermatogonium.
∙∙ Spermiogenesis is the development of four sperm from four spermatids.

Hormonal Control in the Adult Male

∙∙ Testosterone has a positive effect on many tissues, but it also has a negative feedback effect on the hypothalamus and the
anterior pituitary.
∙∙ Sustentacular cells produce the hormone inhibin, when they are busy with sperm production, so that FSH from the
anterior pituitary is inhibited.
Pathway for Sperm
∙∙ Sperm travel from the seminiferous tubules to the rete testes, to the efferent ductules, to the epididymis, to the ductus
deferens, to the ejaculatory ducts, to the prostatic urethra, to the penile urethra, and then to outside the body.
Sexual Response in the Male
∙∙ The four stages of the male sexual response during intercourse are arousal, emission, ejaculation, and resolution.
∙∙ Arousal results in an erection.
∙∙ During emission, sperm move to the urethra and accessory glands secrete fluids for semen.
∙∙ During ejaculation, sperm are forcefully expelled from the urethra.
∙∙ During resolution, excess blood is forced from the penis, thus causing it to become flaccid.

15.5 Effects of Aging on the Male Reproductive System

∙∙ Testosterone production peaks at age 20 and declines from there, so at age 80 a male may make only 20% of his peak
production of testosterone.
∙∙ Sperm production continues into old age.
∙∙ Increased FSH and LH levels rise significantly after age 50, producing andropause.
∙∙ Erectile dysfunction occurs in about 20% of men in their 60s and increases to 50% of men in their 80s.
∙∙ Eighty percent of men have benign prostatic hyperplasia by the age of 80.

15.6 Diagnostic Tests for Male Reproductive System Disorders

∙∙ Common diagnostic tests for male reproductive system disorders include digital rectal exam, laboratory tests, prostate-
specific antigen test, transrectal ultrasound and biopsy of the prostate, and ultrasound.

15.7 Male Reproductive System Disorders

∙∙ Prostate cancer is cancer of the prostate gland.
∙∙ Testicular cancer is cancer in one or both testicles.
∙∙ Hypospadias is a congenital defect in which the urethra opens on the ventral side or base of the penis.
∙∙ Hydrocele is a condition in which fluid has accumulated and caused swelling in the scrotum.
∙∙ Epididymitis is inflammation of the epididymis.
∙∙ Phimosis is a condition of the penis characterized by tight foreskin that cannot be pulled back over the glans penis.
∙∙ Sexually transmitted diseases are infections that are passed through sexual contact.

Key Words for Review

The following terms are defined in the glossary.

blood-testis barrier (BTB) gamete semen

climacteric infertility smegma
crossing-over meiosis spermatic cord
cryptorchidism pampiniform plexus spermatogenesis
ejaculation puberty spermiogenesis
emission resolution zygote
erection secondary sex characteristics

604
 The Female

16 Reproductive
System
Men and women are similar, but they
are also very different when it comes to
their reproductive systems. For example,
a man’s reproductive system only has
to produce and deliver male gametes
(sperm) to contribute to reproduction.
On the other hand, a woman’s reproduc-
tive system must supply a gamete (an
egg), receive the male gametes, provide a
place for the developing fetus to mature,
facilitate the birthing process, and then
nourish the infant. See Figure 16.1. The
man’s reproductive system will produce
hormones and gametes every day from
puberty into old age, while the woman’s
will not. Her reproductive system works
in monthly cycles, while his does not.
However, with all their differences,
women are like men in that they do not
need to reproduce to survive. And even if
they both choose not to reproduce, their
reproductive systems define the second-
ary sex characteristics that contribute
greatly to who they are.
©Mango Productions/Corbis/Getty Images

Module 14: Reproductive System

605
 16.1 Word Roots and Combining Forms
Female Reproductive System
Major Organs and Structures:
ovaries Learning Outcome
Accessory Structures:
uterus, uterine tubes, vagina,
1. Use medical terminology related to the female reproductive system.
vulva, breasts
Functions: amni/o: amnion mamm/o: breast ov/o: egg
production of an egg, housing of
the fetus, birth, lactation, secretion cervic/o: cervix, mast/o: breast ovari/o: ovary
of sex hormones neck men/o: menses, ovul/o: egg
chorion/o: chorion menstruation salping/o: uterine
episi/o: vulva metr/o: uterus tube
gynec/o: female metri/o: uterus uter/o: uterus
hyster/o: uterus o/o: egg vagin/o: vagina
lact/o: milk oophor/o: ovary vulv/o: vulva

16.2 Overview

Learning Outcome
2. Explain what is needed for female anatomy to develop.

Before you start exploring the female reproductive system, you should understand
what is necessary for an individual to develop female anatomy. As you may recall
from the male reproductive system chapter, a female zygote has XX as the sex chromo-
FIGURE 16.1 The female somes (23rd pair) instead of XY as in the male. Without the SRY gene on the Y chromo-
reproductive system. some, and therefore the lack of androgen receptors and testosterone, a zygote develops
female reproductive anatomy. In this chapter, you will study the female anatomy and how
it functions. As with the previous chapter concerning the male, you will explore the hor-
monal changes at puberty and the hormonal effects of the adult female reproductive sys-
tem. You will also examine the way gametes develop, the effects of aging on the female
reproductive system, and reproductive disorders. However, this chapter does not end
there. You will continue your study of this system to include pregnancy and its effects
on a woman’s body should she choose to reproduce. Your study begins with the female
reproductive anatomy.

16.3 Female Reproductive Anatomy

Female gametes (ova, eggs) are produced and developed in the primary sex organ of
the female reproductive system—the ovaries.

Ovaries

Learning Outcome
3. Describe the anatomy of the ovary and its functions.

Ovaries are small, oval organs suspended in the pelvic cavity by ligaments. Each ovary
measures 3 cm long, 1.5 cm wide, and 1 cm thick. Like the testes, the ovaries are
enclosed in a capsule called the tunica albuginea. Inside the capsule, each ovary has
two basic layers: an outer cortex containing bubblelike follicles that enclose gametes
and an inner medulla that contains the ovary’s arteries and veins. Follicles secrete
hormones each month and go through stages of development along with the ova. In
Figure 16.2, you can see many of their development stages. These stages are explained
more fully later in the chapter, when you will revisit this figure.

606 CHAPTER 16 The Female Reproductive System

 FIGURE 16.2 The anatomy
Ovarian of an ovary showing follicles at
ligament different stages of development
over time.
Cortex

Medulla

Blood
vessels

Suspensory
ligament

Follicles

Tunica
albuginea

Spot Check Like the testes, the ovaries belong to the endocrine and
reproductive systems. Why do ovaries belong to both systems?

Figure 16.3 shows the internal female reproductive anatomy. Here you can see
the ovaries and their position relative to the uterus. A broad band of connective
tissue (broad ligament) is an extension of the peritoneum. It holds the ovaries and

Suspensory ligament
Uterine tube
with ovarian blood
Ovary vessels and nerves

Ovarian
Ampulla ligament

Fundus of
Isthmus uterus

Infundibulum

Round
Fimbriae ligament

Secondary
oocyte Endometrium
Body
of uterus
Myometrium
Broad
Perimetrium ligament

Cervical canal Uterine

blood vessels
Cervix

Cervical orifice FIGURE 16.3 The internal female reproductive

anatomy: (a) posterior view of the reproductive
Vagina tract, (b) anterior view of the reproductive tract
(a) of a cadaver.

Suspensory
ligament
16.3 Female Reproductive Anatomy 607

Uterine tube
 Cervical orifice

Vagina
FIGURE
(a) 16.3 The internal female reproductive anatomy (continued).
(b) ©McGraw-Hill Education/Rebecca Gray

Suspensory
ligament

Uterine tube
Uterus:
Fundus
Ovary

Ovarian ligament
Body

Round ligament
Cervix

Vagina

(b)

uterine tubes in their relative position to the uterus. The suspensory ligament attaches
the lateral edge of the ovary to the posterior wall of the pelvic cavity and encloses
the ovarian artery and vein, while the ovarian ligament attaches the medial edge
of the ovary to the uterus.

Secondary Female Reproductive Organs and Structures

Learning Outcome
4. D
 escribe the female secondary reproductive organs and structures and their
respective functions.

Like the ovaries, much of the secondary female reproductive anatomy—the uterus,
uterine tubes, and vagina—is internal. The external secondary structures include the
vulva, which is composed of the reproductive structures located in the perineum, and
the breasts. Below, we focus on the internal secondary reproductive structures first.

Uterus The uterus is held in place by the broad and round ligaments and is usually
tipped over the urinary bladder. The uterus is a pear-shaped, hollow organ with a thick
wall composed of three layers. These layers are shown in Figure 16.3 and described
in the following list:
• Perimetrium. This is the outermost layer of the uterine wall, and it may also be
called the visceral peritoneum.
• Myometrium. This is the thickest layer of the uterine wall. It is composed of
smooth muscle that contracts to expel uterine contents, whether the contents be the
lining that is shed each month or a fetus during birth.

608 CHAPTER 16 The Female Reproductive System

Uterine tube Fimbriae

Ovary

Uterus
Cervix
Urinary bladder

Peritoneum

Pubic symphysis Rectum

Mons pubis

Urethra Vagina

Clitoris

Anus
Labium minora

Labium majora
Vaginal
rugae
Vaginal orifice

FIGURE 16.4 The female reproductive system (midsagittal view).

• Endometrium. This layer is the lining of the uterus. It has two sublayers: the
stratum functionalis and the stratum basalis. The stratum functionalis is the
superficial two-thirds of the lining that is typically shed each month. The stratum
basalis is the deep one-third of the lining. Its purpose is to generate new stratum
functionalis each month. You will learn more about how these layers change later
in the chapter.
Three areas describe the uterus: The broad superior curve is the fundus; the wide
midportion is the body; and the narrow, inferior portion is the cervix (neck). As you
can see in Figure 16.3, the uterine tubes open to the uterus between the fundus and
the body, and the cervix opens to the vagina. Mucous glands in the lining of the cervix
produce a thick mucus to block bacteria from entering the uterus from the vagina. The
uterus measures 4 cm wide at the fundus, 7 cm from the cervix to the fundus, and
2.5 cm thick. This organ has a tremendous capacity to expand with a pregnancy, as
you will learn later in the chapter. See Figure 16.4.

Uterine Tubes Each uterine tube can also be called a fallopian tube or oviduct.
This tube is open-ended and measures approximately 10 cm from the ovary to the
uterus. Figure 16.3 shows that the uterine tube’s flared end (infundibulum) near
the ovary has fingerlike projections called fimbriae (FIM-bree-eye). Notice that
fimbriae are not attached to an ovary, nor do they cover it. Instead, the fimbriae
sway to coax an egg released from the ovary into the uterine tube. If that happens,
ciliated cells lining the uterine tube move the egg along the wide part of the tube
(ampulla) to the narrow part of the tube (isthmus) before delivering the egg to the
uterus. See Figure 16.5.

16.3 Female Reproductive Anatomy 609

 Vagina The last structure of the female internal reproductive
anatomy is the vagina. It is an 8- to 10-cm canal that has three
functions:
1. The vagina allows for the flow of the menses (shedding of the
uterine lining) during a monthly cycle called menstruation.
Through most of the month, the cervix produces a thick mucus
to prevent any microorganisms from entering the uterus from the
vagina. However, during menstruation, the uterine lining is shed
from the uterus by smooth muscle contractions of the myometrium
through the cervical canal, to the vagina, and out of the body.
2. The vagina is a receptacle for semen. Figures 16.3 and 16.4
show ridges in the vaginal walls called vaginal rugae. The
purpose of these ridges is to provide increased surface area for
extension and stretch.
3. The vagina serves as the birth canal. The vagina is highly exten-
sible (easily stretched) to be able to accommodate the birth
of a baby.
The mucous membranes lining the vagina extend and fold
inward to form a membrane over the external vaginal opening. This
somewhat fragile membrane, called the hymen, usually has some
4 μm holes in it by puberty to allow for discharge of the menses, but it
FIGURE 16.5 Ciliated epithelial lining of the may not be totally ruptured until intercourse. The status of a hymen
uterine tube. is not an indication of virginity as it can also be easily ruptured by
©SPL/Science Source strenuous exercise or tampon use.
As you may recall from “Chapter 2, Levels of Organization of the Human Body,” the
vaginal lining in a young girl is composed of simple cuboidal epithelial tissue. However,
at puberty, estrogen causes the lining of the vagina to undergo metaplasia. This process
changes the lining to a much more durable tissue called stratified squamous epithelial
tissue, which better accommodates sexual intercourse. This epithelial tissue also serves
another purpose. The epithelial cells are rich in glycogen, which bacteria (naturally occur-
ring in the vagina) process to produce lactic acid. This acid lowers the pH of the vagina. A
low pH is important to discourage the growth of, or even kill, harmful microorganisms. It
is possible for microorganisms to travel from the vagina, through the cervix, up the uterus,
and out the open ends of the uterine tubes to the pelvic cavity. So the low pH due to bene-
ficial bacteria in the vagina helps prevent harmful bacteria from infecting the pelvic cavity.

Spot Check What else prevents harmful bacteria in the vagina from infecting
the pelvic cavity?

The external vaginal opening is located between the urethral orifice and the anus
in the female perineum. Figure 16.6 shows the perineum and the external genitalia,
collectively called the vulva.

Vulva The vulva is a collection of reproductive structures in the female perineum.

These structures are shown in Figures 16.4 and 16.6 and explained in the following list:
• Mons pubis. This is a mound of adipose tissue, covered with pubic hair, and is
superficial to the pubic symphysis.
• Labia. The labia are folds of skin and adipose tissue that frame the vestibule,
which is an area that contains the urethral and vaginal openings. The labia majora
(lateral folds) are thicker and have hair, while the labia minora (medial folds) are
thinner and are hairless. The prepuce is a fold formed where the labia minora meet
anteriorly. It forms a hood over the clitoris.

610 CHAPTER 16 The Female Reproductive System

 Mons pubis
Prepuce

Clitoris
Labia majora (glans)

Urethral
Labia minora opening
Vaginal
Vestibule opening
Hymen

Anus

(a)

Pubic
Pubic symphysis bone
Glans
Clitoris
Crus Urethral
Vestibular glands orifice

Vestibular
bulb

Vaginal
orifice

Anus

(b)

FIGURE 16.6 The female perineum: (a) superficial anatomy, (b) deep anatomy.

• Clitoris. This structure is similar to the male penis in that it is composed of two
columns of erectile tissue (corpus cavernosa) and includes a glans that has many
nerve endings for sexual stimulation. See Figure 16.4. Unlike the anatomy of the
penis, most of the erectile tissue of the clitoris is internal, with only the glans
exposed externally. The clitoris does not enclose the urethra as does the penis, and
so it does not have any urinary function.
• Vestibular bulbs. The vaginal opening is bracketed on each side by vestibular
bulbs of erectile tissue deep to the labia majora. These bulbs become engorged with
blood during excitement, so they tighten around the penis. This further increases
the sexual stimulation of the penis.
• Vestibular glands. Several vestibular glands surround the vaginal opening. They
secrete a lubricating fluid during excitement to make sexual intercourse easier. The
fluid is released into the lower part of the vagina and the vestibule. These glands
are similar to the bulbourethral glands in the male.

16.3 Female Reproductive Anatomy 611

 Fascia Secretory
cells
Adipose tissue
Myoepithelial
Suspensory ligaments cells
Rib
Lobe

Lobules
(c)
Pectoralis
major m.

Areola Nipple

Nipple
Areolar glands

Lactiferous sinus
Lactiferous ducts
Lobe Lactiferous Lactiferous
duct sinus
(a) (b)

FIGURE 16.7 The female breast: (a) anterior view of a lactating breast; (b) sagittal section of a breast; (c) enlargement of part
of a lobe, showing myoepithelial cells important for the release of breast milk.
(c) ©Don W. Fawcett/Science Source

Breasts The function of a mammary gland housed in a breast is to produce milk to

nourish an infant. There is no correlation between breast size and the amount of milk
that can be produced (Figure 16.7). You will learn how milk is produced later in the
chapter, when you explore lactation (milk production) after pregnancy.
Each breast is superficial to a pectoralis major muscle and is composed mostly of
adipose tissue and collagen. See Figure 16.7c. Suspensory ligaments support the
shape of the breast and attach the breast to the fascia of the pectoralis major muscle
deep to it. Bras can give added support to these ligaments.
Externally, each breast contains a nipple surrounded by a darker area called the
areola. See Figure 16.7a. This area has many nerve endings sensitive to cold and
touch and responsive to sexual arousal. Smooth muscle deep to the areola is respon-
sible for erecting the nipple. As you can see in this figure, there are small bumps in
the areola. These bumps are areolar glands that secrete a substance to prevent chafing
and cracking of the nipple during nursing.
Although a mammary gland is present in young girls and enlarges during
puberty, the mammary gland of each breast does not fully develop until the first
pregnancy. You will examine the hormonal controls for the mammary glands’
development later in the chapter. For now, you will continue to concentrate on the
breast anatomy.
Each mammary gland is divided into 15 to 20 lobes that are further divided into
lobules in a lactating breast (one producing milk). See Figure 16.7 (a, b, and c). Milk
is produced by secretory cells in the lobules, released through the action of myoepi-
thelial cells, and drained by lactiferous ducts that widen to form lactiferous sinuses
before reaching the nipple. As you may recall from the integumentary system chapter,
mammary glands are modified sweat glands.
You have now covered all of the female reproductive anatomy. Next, you will inves-
tigate the reproductive physiology, starting with what happens to a young woman at
puberty.

612 CHAPTER 16 The Female Reproductive System

 Spot Check Explain ways in which the female reproductive anatomy is designed
to accommodate the male reproductive anatomy and bring a male to orgasm during
intercourse.

16.4 Physiology of the Female Reproductive

System
As with the male, the physiology of the female reproductive system is governed by
genetics and the endocrine system. You have already read about the genetics, in which
a female zygote has XX as the sex chromosomes. As in a male, a female’s hypothala-
mus and the anterior pituitary of her endocrine system produce the hormones—GnRH,
FSH, and LH—to begin puberty.

Hormonal Control at Puberty

Learning Outcome
5. Explain the hormonal control of puberty and the resulting changes in the female.

Puberty begins between the ages of 8 and 10 for most girls. At that time, the hypo-
thalamus releases GnRH, which triggers the anterior pituitary to release FSH
and LH. FSH targets follicles in the ovary, telling them to produce estrogen. Like
testosterone, estrogen is a steroid hormone based on a chemically modified choles-
terol molecule. There are several forms of estrogen: estradiol, estriol, and estrone.
Together, these forms of estrogen target most tissues to produce the female secondary
sex characteristics.

Female Secondary Sex Characteristics It will be helpful to review (from the

endocrine system chapter) these sex characteristics, which begin to develop at
puberty:
• Breast development. This is usually the first sign that puberty has started. The
breasts enlarge, and lobules and ducts form, beginning at puberty. As stated earlier,
the breasts do not fully develop until the first pregnancy.
• Development of axillary (armpit) and pubic hair. The ovaries produce small
amounts of androgens, which are responsible for this sex characteristic and the
libido (sex drive) in women. As you may recall from the endocrine system chapter,
androgens are also produced in a woman’s adrenal cortex.
• Widening of the pelvis. As you learned in the skeletal system chapter, the female
pelvis has a rounded pelvic brim and a large pelvic opening to accommodate the
birth of a baby.
• Fat deposition. Estrogen causes a girl’s body to deposit more adipose tissue. This
deposition typically takes place in the breasts, hips, mons pubis, and buttocks. In an
adult, a woman’s body fat needs to be at a minimum of 22% to sustain a pregnancy.
• Menstruation. This is the monthly shedding of the uterine lining. It takes longer
for this sex characteristic to develop because menstruation cannot begin unless the
girl’s body fat reaches 17%. Menstruation typically starts about age 12. Ovulation
(the release of an egg from an ovary) is the result of the hormone LH but does not
usually occur during the first year of menstrual cycles. You will learn more about
the menstrual cycle shortly.

16.4 Physiology of the Female Reproductive System 613

 Disease P int
Some women experience painful periods (dysmenorrhea) or the absence of a
menstrual period (amenorrhea). Dysmenorrhea may result from a number of problems
such as endometriosis, fibroids, or pelvic infections (explained later in the chapter
under “Disorders of the Female Reproductive System”). In some women, the cause
is unknown. Physicians may diagnose dysmenorrhea using physical examination and
other tools such as laparoscopy, ultrasound, and MRI, which will indicate if there are
any conditions of the reproductive organs that may be causing the pain. A number of
factors that affect the complex hormonal balance that controls the female reproductive
system can cause amenorrhea, including genetic disorders, endocrine disorders,
autoimmune disorders, infections, tumors, and certain drugs. Physical examinations
along with blood tests for appropriate hormone levels are used to determine the
cause of this condition.

Spot Check Female athletes who excessively train and rid their diet of fat often
stop menstruating. What might be the reason for this?

Unlike a male, who begins to produce gametes at puberty and continues to produce
them every day for the rest of his life, a female produces all of her eggs by the time she
is born. At puberty, she merely continues to further develop the eggs that are already
present. Next, you will explore how this happens.

Oogenesis

Learning Outcome
6. Explain oogenesis in relation to meiosis.

Egg production is called oogenesis (oh-oh-JEN-eh-sis). Like spermatogenesis in the

male, oogenesis forms gametes (ova, eggs) that have a haploid number of chromo-
somes (23, n). Unlike spermatogenesis, which produces four viable spermatids from
each spermatogonia, oogenesis produces only one viable ovum from each oogonium
(oh-oh-GO-nee-um) (germ cell). Each ovum is developed along with the follicle that
surrounds it. A follicle is a group of surrounding cells responsible for caring for the
oocyte—an immature female reproductive cell—by providing nutrients and removing
wastes and also responsible for producing hormones. Like sustentacular cells in the
male, the follicle also isolates and protects the egg from the mother’s immune system.
This protection is necessary because the egg goes through independent assortment and
crossing-over during meiosis in oogenesis. This results in genetic variation that would
be seen as foreign to the mother’s immune system. Figure 16.8 shows the steps of this
development for both the ovum and the follicle. Follow along with this figure as the
process is explained in the following paragraphs.
Oogonia undergo mitosis in the ovaries before birth until they number 6 million to
7 million. Shortly before birth, oogonia begin to go through meiosis I to become pri-
mary oocytes. Not all of the oogonia and primary oocytes survive. In fact, many degen-
erate by a process called atresia (a-TREE-zee-ah), so only approximately 2 million
primary oocytes are present at birth. All of the surviving oogonia have become primary
oocytes by the time an infant is 6 months old. Unlike the male, whose germ cells (type-A
spermatogonia) continue through life, no oogonia remain after the female infant is
6 months old. The primary oocytes remain dormant in mid-meiosis I until adolescence.
Notice in Figure 16.8 that primary oocytes are diploid (46 chromosomes, 2n).

614 CHAPTER 16 The Female Reproductive System

 Development of Egg (Oogenesis) Development of Follicle (Folliculogenesis)

Before birth Before birth

Primordial follicle
Oocyte
2n Multiplication Oocyte
Mitosis Follicle
of oogonia
cells

Primary follicle
Primary
follicle

Adolescence to
2n Primary menopause
oocyte Fluid-filled
vesicles

Secondary
follicle

Adolescence to Primary
menopause oocyte
Meiosis I
Mature follicle

Secondary
n
oocyte

n
First polar
body (dies)

Secondary
oocyte
Ovulation
(oocyte
released)
Secondary oocyte
n
(ovulated)

If not fertilized If fertilized

Corpus luteum
n
n n
Corpus luteum
forms
Dies Meiosis II
n
Second polar
body (dies)

Corpus luteum

Zygote 2n
Corpus
albicans

Embryo
(a) (b)

FIGURE 16.8 Oogenesis and folliculogenesis: (a) the production of primary oocytes before birth (shown with a purple
background) and their development each month from adolescence to menopause (shown with a green background), (b) the
development of follicles before birth (shown with purple background) and each month from adolescence to menopause.

16.4 Physiology of the Female Reproductive System 615

 Further atresia reduces the number of primary oocytes to approximately 400,000
by puberty. At adolescence, FSH stimulates some primary oocytes each month to
finish meiosis I. In this division, each primary oocyte produces two daughter cells—
a secondary oocyte and a first polar body. Notice in Figure 16.8 that the daughter
cells are not of equal size. All of the cytoplasm and organelles go to the secondary
oocyte. The first polar body simply has 23 chromosomes. Because it lacks cytoplasm
and organelles, the first polar body is likely to die before going through meiosis II.
This unequal division is very important because the secondary oocyte must provide all
the cytoplasm and organelles necessary for a fertilized egg to survive. If fertilization
occurs, the sperm will contribute only 23 chromosomes. It was stripped of its cyto-
plasm and organelles during spermiogenesis.
The secondary oocyte continues meiosis to mid-meiosis II with a second polar
body still enclosed. The secondary oocyte is ovulated (released from the ovary) in this
state. If, and only if, a sperm fertilizes the egg, meiosis II is completed and the second
polar body is expelled. If fertilization does not occur, the secondary oocyte with its
second polar body inside is expelled from the uterus with the menses.

Clinical P int
If an egg is surrounded by sperm in a lab (in vitro fertilization),
fertilization is recognized to have taken place by the
expulsion of the second polar body.

Figures 16.8b and 16.9 show the changes

in the follicle (folliculogenesis) during oogen-
esis. A primordial follicle is a simple layer of cells surrounding the primary oocyte.
If the follicle receives FSH, it begins to grow and starts secreting hormones. You
will explore which hormones shortly. Notice that as the follicle develops, fluid is
produced in which the secondary oocyte floats. Although FSH stimulates several
follicles and their oocytes to develop each month, most will undergo atresia during
the month so that, typically, only one or two follicles mature. A mature (Graafian)
follicle eventually ruptures to release the egg and its fluid during ovulation. After
ovulation the follicle changes to a yellow color. At this stage it is called a corpus
luteum (yellow body). If the egg is fertilized, the corpus luteum will remain in this
stage and continue to secrete hormones to support the pregnancy for 90 days. If
the egg is not fertilized, the corpus luteum shrinks, turns white, and stops secret-
ing hormones within 2 weeks. It is then called a corpus albicans (white body,
Figure 16.9).

Spot Check What are the functions of a follicle during oogenesis?

Spot Check Why would a woman’s age affect the condition of her eggs more
than a man’s age would affect the condition of his sperm?

By revisiting the ovary, you can see these changes in the follicles. In Figure 16.9,
each of the follicle stages has been labeled. Notice that the follicles are located in the
ovary’s cortex, where they undergo their changes.
You have become familiar with oogenesis and the role of follicles. You have also
read about the female reproductive system’s cyclic nature. Now it is time to explore
the hormones that target the follicles and the hormones that are made by the follicles
to produce this system of cycles.

616 CHAPTER 16 The Female Reproductive System

 Ovulated oocyte Corpus luteum Corpus albicans FIGURE 16.9 Developing
follicles within the ovary.

Ovarian Suspensory
ligament ligament

Blood
vessels
Oocyte

Primary
oocyte

Mature Primordial
follicle follicles
with
primordial
oocytes

Secondary Primary
follicle follicles

Common Misconception
Figure 16.9 may lead to a misconception. It is meant to show the changes to one follicle
over a monthly cycle, and it does a good job of showing the progression of all the
stages you have just explored. However, you should understand that the follicle does
not move within the ovary. There is no conveyor belt delivering the mature follicle
to a specific spot for ovulation, as this diagram may suggest. A follicle goes through
all the changes shown in one spot. The first primordial follicle shown on the right in
this figure will go through all of its stages, and the ovum will be ovulated from that
beginning position near the suspensory ligament. The first primordial follicle shown
on the left in this figure will have its ovum ovulated at its beginning position near the
ovarian ligament.

Hormonal Control in the Adult Female

Learning Outcome
7. E
 xplain the hormonal control of the adult female reproductive system and its effect on
follicles in the ovary and the uterine lining.

The female reproductive cycle has two parts: the ovarian cycle, which affects the
follicles and oocytes in the ovary, and the menstrual cycle, which affects the endo-
metrial lining of the uterus. The two cycles are in harmony in the sense that they
happen together. Figure 16.10 separates the two cycles, but you should be aware that
the events in the ovarian cycle affect events in the menstrual cycle. This figure charts
a 28-day cycle. Although this is the typical length for a reproductive cycle, it is not
uncommon for a cycle to last anywhere from 20 to 45 days.

16.4 Physiology of the Female Reproductive System 617

 Anterior pituitary secretion
LH

FSH
Developing follicles Corpus luteum
Corpus
Tertiary Ovulation albicans
Ovarian events

Secondary

Primary

Involution
New primordial
follicles

Days 1 3 5 7 9 11 13 15 17 19 21 23 25 27 1

(a) Follicular phase Luteal phase

Ovarian hormone

Progesterone
secretion

Estradiol
Thickness of endometrium

Menstrual fluid

Days 1 3 5 7 9 11 13 15 17 19 21 23 25 27 1

(b) Menstrual phase Proliferative phase Secretory phase Premenstrual

phase

FIGURE 16.10 Female reproductive cycle: (a) ovarian cycle, (b) menstrual cycle. The hormones in the ovarian cycle are to
scale, but the hormones in the menstrual cycle are not. The peak for progesterone production is 17 times greater than the peak
for estrogen.

Figure 16.10 shows what happens beginning on day 1. Follow along with the figure
as you read the explanation:
• On day 1, the uterine lining (stratum functionalis) begins to shed. This is the first
day of the woman’s period. The menstrual flow will typically continue for 4 to
5 days. This is called the menstrual phase (days 1 to 5) in the menstrual cycle.
• Also on day 1, the anterior pituitary secretes FSH, which targets the primordial follicle
in the ovary. This causes the primordial follicle to develop and to secrete estrogen. As
the follicle develops, more and more estrogen is produced. Estrogen levels reach a peak
just before day 14. This is called the follicular phase (days 1 to 14) in the ovarian cycle.

618 CHAPTER 16 The Female Reproductive System

• The increasing amounts of estrogen secreted by the follicle target the anterior pitu-
itary to inhibit FSH production, so FSH levels go down (day 5). A follicle is already
developing, so no further stimulation by FSH is needed. This is a negative feedback
mechanism that helps maintain homeostasis. Estrogen does not inhibit the ante-
rior pituitary’s production of LH, so LH levels continue to rise. A peak of estrogen
causes LH levels to reach a peak at day 14. FSH levels also rise slightly at this time.
• The estrogen secreted by the follicle also targets the uterine lining, causing it to
thicken. This is the proliferative phase (days 5 to 14) of the menstrual cycle.

Common Misconception
The length of a woman’s reproductive cycle up to the events on day 14 is highly
variable. It can be days or even weeks longer than 14 days. Nutri-
tion, activity levels, stress, illness, and many other variables can
cause the length of this portion of the reproductive cycle
to be variable. This makes it difficult for a woman to pre-
dict when she will ovulate. In a typical cycle, ovulation
occurs on day 14. However, once ovulation happens, the
remaining length of the cycle does not usually vary from
another 14 days. ©Tom Grill/Getty Images

Figure 16.10 also shows what happens during

the rest of a woman’s reproductive cycle, begin-
Cumulus
ning with day 14. Again, follow along with the oophorus
figure while reading the explanation:
• The peak of estrogen combined with a peak of
Oocyte

LH causes the mature follicle to rupture and Stigma

release its egg (ovulation) on day 14. The egg,
the cells immediately surrounding it (cumulus
oophorus), and the follicular fluid are released Ovary
from the ovary. See Figure 16.11. Currents cre-
ated by the movement of the fimbriae of the
uterine tubes draw the egg toward the tube’s
infundibulum. If the egg reaches the tube, it
sticks to it and ciliated cells in the lining of the 0.1 mm
uterine tube start the egg on its 3-day journey
to the uterus. If the egg does not reach the tube, FIGURE 16.11 Ovulation in a human (endoscopic view). The stigma
is a bump on the ovary that oozes follicular fluid prior to the rupture of
it is eventually reabsorbed somewhere in the
the follicle. Ovulation takes 2 to 3 minutes.
pelvic cavity. The egg must be fertilized in the ©Petit Format/Science Source
uterine tube within 24 hours of ovulation if it is
to remain viable.
• Another effect of these ovulation-initiating hormones is the thinning of the mucus
created by the cervix. This effect lasts only a short time so that sperm have easier
access to the uterus.
• The ruptured follicle remains in the ovary, but it changes to become a corpus luteum.
The corpus luteum releases two hormones: estrogen and progesterone (another
steroid hormone). This is the luteal phase in the ovarian cycle. Together these
hormones inhibit FSH and LH production in the anterior pituitary. Again, this is a
negative feedback mechanism that helps maintain homeostasis. If an egg has just
been released for a pregnancy to occur, no new eggs need to be developed at this time.

16.4 Physiology of the Female Reproductive System 619

 • High levels of estrogen and progesterone cause the uterine lining to continue to thicken
and its endometrial glands to secrete glycogen, a nutritional source for a fertilized egg.
This secretory phase of the menstrual cycle is preparation for a possible pregnancy.
If a sperm fertilizes the egg in the uterine tube, the corpus luteum continues to
produce high levels of estrogen and progesterone for 90 days. This hormone production
regulates the pregnancy and maintains the rich lining of the uterus until the placenta
(an organ developed in the uterus to support a pregnancy) is developed to produce
pregnancy hormones. You will study the placenta later when you read about pregnancy.
If a sperm does not fertilize the egg in the uterine tube, the corpus luteum will go
through involution (shrinkage). This happens typically on day 22. So you can continue
your investigation beginning with that day:
• Although the involution of the corpus luteum begins on day 22, the estrogen and pro-
gesterone output from the corpus luteum are not really affected until the shrinkage
is complete on day 26. Then, the levels of these two hormones fall drastically. The
corpus luteum has now become a corpus albicans that no longer secretes hormones.
• The drop in estrogen and progesterone on day 26 signals the anterior pituitary that
fertilization has not occurred. This signal triggers the production of FSH in the
anterior pituitary. It is time to get a new primordial follicle started for the next
reproductive cycle.
• The drop in estrogen and progesterone on day 26 also affects the uterine lining. It
causes arterioles in the stratum functionalis to spasm, and this disrupts the blood
supply and causes menstrual cramps. The disruption to the blood flow causes the
stratum functionalis to die and begin to break down. See Figure 16.12. This is the
premenstrual phase of the menstrual cycle. The dead tissue mixes with clotted
blood and other fluids to be discharged on day 1 of the next cycle.
Thus, whether this cycle ends and a new cycle begins depends upon whether an
egg is fertilized or not. If the egg is fertilized, the corpus luteum continues and a new
reproductive cycle will not begin again until after the pregnancy ends. However, if
the egg is not fertilized, the corpus luteum shrinks to become a corpus albicans and a
new cycle begins in a few days. The corpus luteum is in the ovary. If an egg is to be
fertilized, that will happen in a uterine tube. Here is the huge question: How does the
corpus luteum know what happened to the egg?

Uterus

Artery
and vein Stratum Stratum
functionalis functionalis

Endometrial Artery
gland and vein

Stratum Stratum
basalis basalis

(a) Myometrium (b) (c)

FIGURE 16.12 Changes in the endometrium throughout the menstrual cycle: (a) proliferative phase, (b) secretory phase,
(c) menstrual phase.

620 CHAPTER 16 The Female Reproductive System

 The answer is this: The developing fertilized egg secretes another hormone—
human chorionic gonadotropin (hCG). The hCG targets the corpus luteum so that
it continues to produce estrogen and progesterone to support a pregnancy for 90 days,
at which time the placenta takes over hormone production. You will learn more about
this soon, when the chapter addresses pregnancy.

Spot Check Megan began to ovulate when she was 13. She chose not to have
children and so never had a pregnancy. She stopped menstruating when she was 53.
How many eggs is she likely to have ovulated in her lifetime? How does this number
compare to the number of eggs she had at puberty and the number left at menopause?

Clinical P int
Some hCG is cleared from the system daily by the kidneys, so it can be found
in urine. Early home pregnancy tests work by detecting this pregnancy
hormone in urine. These tests can be effective as soon as 8 to
9 days after fertilization (day 22 to day 24 of the reproductive
cycle). This time frame is before the woman’s next
cycle would have predictably begun.

©Photodisc Collection/Getty Images

Spot Check If an early pregnancy test can detect a pregnancy within 8 or

9 days, why does this correlate to day 22 (and after) in the reproductive cycle?

Now that you have become familiar with the hormones regulating a woman’s
reproductive cycle, you can move on to investigate her sexual response.

The Female Sexual Response

Learning Outcome
8. Describe the stages of the female sexual response.

The female sexual response goes through four stages—arousal, plateau, orgasm, and
resolution. These stages are shown in Figure 16.13 and explained in the following
list. As with the male, a woman’s sexual response may be initiated by thought, touch,
sound, or smell. The neurological control and vascular events of her sexual response
are similar to those of the male. Here are some of the features of each stage:
• Arousal. During this stage, the innermost part of the vagina dilates and the vaginal
lining secretes a fluid that, along with the fluids from the vestibular glands, lubri-
cates the vestibule and vagina to make intercourse easier. The nipples of the breasts
become erect and are more sensitive to sexual stimulation, which increases arousal.
• Plateau. During this stage, the uterus assumes a more upright position instead of
being tipped over the urinary bladder. The lower one-third of the vagina constricts
around the penis due to the engorgement of the vestibular bulbs. This constric-
tion, along with the vaginal rugae, stimulates the penis. The erectile tissue of the
clitoris also becomes engorged with blood. Pelvic thrusting during intercourse
pulls the prepuce (formed by the labia minora) back and forth over the clitoris,
further stimulating it.

16.4 Physiology of the Female Reproductive System 621

 Unstimulated

The uterus is
tipped over the
urinary bladder,
and the vagina
is relatively
narrow.
Uterus
Urinary bladder
Labia minora

Resolution
The reproductive anatomy
returns to a prearousal state.

Arousal

The innermost part

of the vagina
dilates, the vaginal
Orgasm lining and
vestibular glands
The vagina secrete lubricating
contracts fluids, and the
rhythmically, and nipples of the
the uterus breasts become
dips down into erect.
the possible pool
of semen.

Plateau
The uterus assumes an upright position, the vestibular
bulbs become engorged to constrict the vagina around
the penis, and the clitoris becomes engorged.

FIGURE 16.13 The female sexual response. The female reproductive anatomy is shown in an unstimulated state and through
the phases of arousal, plateau, orgasm, and resolution.

• Orgasm. The vagina rhythmically contracts during this stage. The uterus under-
goes peristaltic contractions that may cause the cervix to dip down into the possible
pool of semen. This facilitates the journey for sperm. The woman experiences an
intense sensation spreading from the clitoris to the pelvis, which may be accom-
panied by pelvic throbbing and a feeling of warmth. Her heart rate and respiratory
rate increase.
• Resolution. During this stage, her reproductive anatomy returns to a prearousal
state—the vagina relaxes, the clitoris and vestibular bulbs are drained of excess
blood, the uterus once again tips over the urinary bladder, and the nipples are no
longer erect. Unlike a male, a female does not usually have a refractory period—
she can be immediately capable of another sexual response.
Although the sexual response stages do not change as a woman gets older, aging
does affect her reproductive anatomy. You will explore the effects of aging next.

622 CHAPTER 16 The Female Reproductive System

16.5 Effects of Aging on the Female
Reproductive System

Learning Outcome
9. Explain the effects of aging on the female reproductive system.

Like the male, a female goes through a climacteric in midlife (typically in her 50s).
This stage of her life is often labeled menopause, but that is only one event of a
broader condition (as you will see shortly). Her climacteric begins due to a decreased
number of follicles (1,000 or less) and their decreased sensitivity to FSH and LH.
Because of this insensitivity, the remaining follicles in her ovaries release less and
less estrogen and progesterone until eventually the secretion of these hormones from
the ovaries ceases altogether. Her anterior pituitary initially responds to the lack of
estrogen and progesterone by secreting more FSH and LH in a negative feedback
effort to keep the system going. The higher levels of FSH and LH are a means of
determining that the climacteric has begun.

Spot Check Why has the number of follicles decreased?

The diminished levels of estrogen and progesterone have significant effects on a

woman’s anatomy:
• Her ovaries stop releasing eggs, and her menstrual periods eventually stop (menopause).
At this point, few if any follicles with oocytes remain. Her periods may become more
irregular before they stop altogether. Menopause is determined to have occurred
when there has been a lack of menses for a year.
• Hot flashes (intense feelings of warmth accompanied by sweating) are common as
blood vessels constrict and then dilate due to the changing hormone levels. They
cease once menopause is complete and the hormones have stabilized.
• The tissues of the vagina, labia minora, clitoris, uterus, uterine tubes, and breast
atrophy. The thinning of the vagina and decreased secretions from it may cause
dryness and make intercourse uncomfortable. If that is the case, the use of lubri-
cants can facilitate more pleasurable intercourse. However, the effects of aging do
not have to have an effect on a woman’s enjoyment of a sexual relationship.
• Vaginal yeast infections become more common.
• Bone mass declines. As you may recall from the skeletal system chapter, estrogen
acts as a lock on calcium in the bone. The risk for osteoporosis increases during
and after the climacteric.
• Muscle and connective tissue decrease. This leads to sagging of the breasts and
diminished support for the urinary bladder, uterus, vagina, and rectum. As a result,
these organs can drop out of position (prolapse). This can lead to loss of control of
micturition (incontinence) or difficult bowel movements. This effect of aging may
be increased if the woman has had children with vaginal deliveries.
• The skin becomes thinner. This is due to decreased fat in the hypodermis.
• Cholesterol levels rise, increasing the risk for cardiovascular disease.

Spot Check Vaginal yeast infections often occur due to a lack of beneficial
bacteria in the vagina. How does aging affect the presence of these bacteria?

16.5 Effects of Aging on the Female Reproductive System 623

 The effects of these changes can be treated with hormone replacement therapy
(HRT). However, estrogen replacement has been associated with increased risks of
breast cancer, stroke, and heart disease. A woman and her doctor should weigh the
possible risks versus the benefits in each individual situation.
A woman’s adrenal glands continue to produce androgens, such as testosterone,
throughout and after her climacteric. These hormones are responsible for maintain-
ing her sex drive and slowing her loss of bone and muscle mass. Without high levels
of estrogen and progesterone to counteract the masculinizing effects of androgens, a
woman’s skin may coarsen and some facial hair may develop.
You have read about some of the signs and symptoms associated with the aging of
the female reproductive system. It is time to explore some of the disorders associated
with this system.

16.6 Diagnostic Tests for Female

Reproductive System Disorders

Learning Outcome
10. Describe common diagnostic tests for female reproductive system disorders.

Like the tables for other systems, Table 16.1 presents common diagnostic tests used
for female reproductive system disorders. Some of the tests may be familiar to you, as
they have been mentioned in previous chapters, but their specific relation to the female
reproductive system is explained.

Common Diagnostic Tests for Female Reproductive System

TABLE 16.1
Disorders
Diagnostic Test
or Screening Description
Biopsy A procedure in which tissue is collected and examined for the presence of abnormal cells.
Blood test A procedure that involves obtaining a sample of blood and analyzing its contents. In
regard to female reproductive system disorders, blood tests can reveal hormone levels,
pregnancy, and the presence of infection.
Colposcopy A procedure in which a lighted colposcope is used to visualize the vagina and cervix.
Hysteroscopy A procedure in which a lighted hysteroscope is used to visualize the uterus.
Laboratory tests/ Procedures that involve collecting urine or specimen samples from the female
microscopic examination reproductive tract to determine the presence of viruses or bacteria that may cause
of samples infection.
Laparoscopy A procedure in which a lighted laparoscope is used to visualize, collect biopsies from, or
perform surgical procedures in the abdomen or pelvic region.
Mammogram An X-ray of the breast that is used in screening for breast cancer or breast disease.
Pap smear A part of the gynecologic exam that helps detect abnormal cells in the lining of the cervix.
Pregnancy test A test that detects human chorionic gonadotropin (hCG) hormone in pregnant women.
Ultrasound An imaging technique in which sound waves create visual images of internal structures.
In the female reproductive system, ultrasound may be used to determine whether a
woman is pregnant or detect any structural abnormalities of the reproductive organs
and the developing fetus.

624 CHAPTER 16 The Female Reproductive System

16.7 Disorders of the Female Reproductive System

Learning Outcome
11. Describe female reproductive disorders and relate abnormal function to pathology.

Breast Cancer
Breast cancer is the abnormal growth of breast tissue, usually occurring in the lactifer-
ous ducts and lobules of the breast. Other than skin cancer, breast cancer is the most
common form of cancer in women. Some of the risk factors are the following:
• Breast cancer risk increases with age. Most women are over 60 years old when
they are first diagnosed.
• Family history plays a role. You are more likely to develop breast cancer if a family
member has been diagnosed with it.
• Personal history also plays a part. Breast cancer often reoccurs in the other breast.
• Genetic mutations can increase the risk of breast cancer. They are described in the
“Applied Genetics” box later in this section.
• Reproductive history and menstrual history also matter. Breast cancer is more
common in women who have not had children, who started menstruating before
the age of 12, or who have experienced menopause after the age of 55.
• Lifestyle choices can increase the risk of breast cancer. Obesity, lack of physical
activity, and increased alcohol consumption increase the risk of breast cancer.
Detection of breast cancer usually begins with a monthly self-exam and mammography
(taking an X-ray of a breast). See Figure 16.14. Because breast cancer often metastasizes,

FIGURE 16.14 Breast

cancer detection and
treatment: (a) mammography;
(b) mammogram, with a
tumor indicated by the
arrow; (c) patient after a
mastectomy; (d) same
patient after reconstructive
surgery.
(a) ©Jeff Kaufman/Getty Images;
(b) ©UHB Trust/Getty Images;
(c, d) ©Biophoto Associates/
Science Source

(a) (b)

(c) (d)

16.7 Disorders of the Female Reproductive System 625

 lymph nodes may be biopsied once the cancer has been detected. Treatment of breast
cancer may include chemotherapy, surgery (lumpectomy to remove a tumor, or mastec-
tomy to remove the breast and possibly underlying tissue), radiation, immunotherapy,
and hormone therapy.

Clinical P int
Mammography and breast self-exams are important tools in breast cancer detection.
The American Cancer Society recommends that women should have annual mammo-
grams starting at age 45 until age 54. Women 55 and older should continue to have
mammograms every 1 to 2 years as long as they are in good health.

Ovarian Cancer
Ovarian cancer is cancer of the ovaries. This form of cancer can be difficult to
diagnose due to the lack of symptoms some women experience. An enlarged ovary
in a postmenopausal woman may be a sign of ovarian cancer. If ovarian cancer is
suspected, physicians can perform an ultrasound, CT, MRI, and laparoscopy to
confirm the diagnosis. Blood tests may also be done to look for specific cancer
markers. Treatment depends on the severity of the cancer and can involve surgery,
chemotherapy, and radiation.

Applied Genetics
Women with mutations in their BRCA1 or BRCA2 gene have a substantially greater risk of
developing breast and ovarian cancer. It is possible to genetically test for these changes.
Once the presence of the mutations in either the BRCA1 or BRCA2 gene has been deter-
mined, some women choose to have double mastectomies and oophorectomies (surgical
removal of the ovaries) before any cancer has been detected. The National Cancer Insti-
tute reports that this prophylactic removal of the breasts and ovaries is an effective way to
reduce the risk of breast and ovarian cancer.1
©MOLEKUUL/SPL/age fotostock

Cervical Cancer
Cervical cancer—a slow-growing cancer that has few symptoms—is often caused
by human papillomavirus (HPV) infection. Cervical cancer is typically detected by
swabbing the cervix (Pap smear) and examining the collected cells for abnormal
growth. See Figure 16.15. Treatment options include the removal of the uterus
(hysterectomy).

Fibroids
A fibroid is a noncancerous growth. The tumor is usually composed of muscle
and fibrous tissue. Fibroids are extremely common and can be found either in the
uterus, in the endometrium, or on the outside of the uterus. A pelvic exam, ultra-
sound, hysteroscopy, MRI, and biopsy are all diagnostic tests that can be used to
determine whether a fibroid is present. If a fibroid is not causing any problems, it is
usually left untreated. However, if the fibroid is causing pain or bleeding, growing
very large, or interfering with fertility, various treatments can be used to remove it.
See Figure 16.16.

626 CHAPTER 16 The Female Reproductive System

 FIGURE 16.15 Pap smear.
(a) A tool called a speculum is
inserted in the vagina and then
opened to widen the vaginal
walls so the cervix can be seen.
(b) Cells are collected from the
cervix to be evaluated in a lab.

(a) (b)

FIGURE 16.16 Removal of

uterine fibroid.
©CNRI/Science Source

Endometriosis
Endometriosis is the growth of endometrium in places other
than the uterus. See Figure 16.17. The most likely locations are
the uterine tubes or the lining of the pelvic cavity. Because hor-
mones travel throughout the entire system, the endometrium
responds to hormones no matter where it is located. Thus,
as the endometrium thickens in the uterus in response to the
estrogen and progesterone produced in the ovarian cycle, the
misplaced endometrium also thickens and becomes rich in the
uterine tubes with this condition. Just as the stratum functiona-
lis sheds each month in the uterus, so does the stratum func-
tionalis lining the pelvic cavity in endometriosis. However, in
endometriosis, there is nowhere for the shed endometrium to
go in the pelvic cavity. Consequently, it irritates pelvic struc-
tures until it is eventually reabsorbed. This happens with each
sexual cycle, and it may cause painful periods (dysmenorrhea).
Endometriosis often blocks the uterine tubes, causing infertility FIGURE 16.17 Endometriosis in the abdominal cavity.
because the sperm cannot reach the egg. ©Dr. Najeeb Layyous/Science Source

16.7 Disorders of the Female Reproductive System 627

 Spot Check What would happen to the signs and symptoms of endometriosis
after menopause? Explain.

Sexually Transmitted Diseases

In “Chapter 15, The Male Reproductive System,” you learned how the following
common sexually transmitted diseases/infections (STDs/STIs) affect men: herpes, HIV,
human papillomavirus (HPV), gonorrhea, chlamydia, and syphilis. You already know
the description of the diseases, what causes them, and how they are transmitted. Now
you will learn how these same diseases affect women.
Because of the differences in the male and female reproductive tract, women may
experience symptoms differently than men do. For instance, in women the symptoms
of gonorrhea and chlamydia may be mild or absent. Women may not experience the
burning or discharge that might alert them to the presence of an infection, or they may
mistake the infection for something else. For this reason, women may not get the infec-
tion treated in the early stages, and it may spread to other parts of their reproductive
tracts. Untreated STDs in women can cause pelvic inflammatory disease (PID). PID
is an infection of the reproductive tract, including the uterus and uterine tubes, that
can cause damage to the reproductive tract, resulting in infertility, ectopic pregnancies,
abscess formation, and chronic pain in the lower abdomen.
All of the common STDs mentioned may also be passed from mother to baby
during a vaginal delivery. This occurs if the baby passes through the birth canal and
comes in contact with any genital sores, vaginal fluids, or infected blood it encounters.
If a woman has been diagnosed with an STD, the physician will take great care to
monitor and treat her condition throughout the pregnancy. If, at the time of delivery, it
appears unsafe for the fetus to pass through the birth canal due to the infections pres-
ent, the physician might opt to do a cesarean section to reduce the risk of transmitting
the disease to the baby during delivery.

16.8 Pregnancy

Learning Outcome
12. List the four requirements of pregnancy.

Just by looking at Joan and Rick in Figure 16.18, you can

see that their reproductive systems are functioning to pro-
duce their secondary sex characteristics. You can easily
determine from these obvious signs who is male and who
is female. By their response to the early pregnancy test
results that Joan is holding in her hand, you can assume
that they have also produced gametes, another function
of the reproductive system for both sexes. In the rest of
this chapter, you will explore the additional functions
Joan’s reproductive system performs to house a develop-
ing fetus, facilitate the birth, and provide nourishment for
the infant.
To begin your study of pregnancy, consider the four
basic requirements for a pregnancy to happen:
1. There must be a sperm and an egg.
2. The sperm must meet the egg.

FIGURE 16.18 Joan and Rick view an early pregnancy test. 3. The sperm must fertilize the egg.
©Digital Vision/Getty Images 4. The fertilized egg must implant in the uterus.

628 CHAPTER 16 The Female Reproductive System

 As you may already know, the mother and father need not be present for the first
three requirements. Eggs and sperm can be collected from the parents and fertilized in
a lab. But there is no substitute for a uterus to house the developing fetus.
You are already familiar with sperm and egg production. So you can continue your
investigation of pregnancy with the second requirement—how the sperm meets the
egg under typical conditions.

Clinical P int
A variety of contraceptive and family planning methods can be used by women
and men to prevent one or more of the requirements for a pregnancy from happen-
ing. These various methods have variable rates of success. Contraceptive methods
can include hormonal methods, barrier methods, intrauterine devices, sterilization,
behavioral methods, emergency contraception, and dual protection methods. Note
that protecting yourself from pregnancy does not automatically mean that you are
protected from sexually transmitted diseases or infections.

Pathway for Sperm to Meet an Egg

Learning Outcome
13. Trace the pathway for a sperm to fertilize an egg.

Joan’s egg must be fertilized within 24 hours of ovulation if it is going to survive, but
it will have traveled only to the ampulla of her uterine tube in this amount of time. This
means Rick’s sperm must travel the distance to the ampulla to fertilize the egg. Only
one of the millions of sperm deposited in the vagina will be allowed to fertilize the egg.
What happens to the rest? Some are likely to be deformed, having two heads or faulty
tails. Some will die from the acids of Joan’s vagina. Still others will leak out of the
vagina and not travel to the uterus at all. Not all of the surviving sperm will accomplish
the journey from the vagina along the mucous threads in the cervical canal to the uterus.
Some sperm will be destroyed in the uterus by leukocytes before they reach the open-
ings to the uterine tubes. Half the sperm reaching this point will travel into the wrong
tube. However, those sperm that do go the distance can survive in the female reproduc-
tive tract for up to 6 days after ejaculation.
The complete journey for a mature sperm follows:
Epididymis → ductus deferens → ejaculatory duct → urethra → vagina → uterus
(cervix, body) → uterine tube (isthmus, ampulla).

Fertilization to Implantation

Learning Outcome
14. Describe the events necessary for fertilization and implantation.

Although sperm can make the journey to the egg within 5 to 10 minutes of ejacula-
tion in the vagina, a sperm cannot fertilize an egg for about 10 hours. During that
time, Rick’s sperm must first go through a process called capacitation. The sperm’s
cell membrane is reinforced with cholesterol. This helps protect Rick’s spermatic
ducts from a premature release of the digesting enzymes in the acrosome cap. During
capacitation, the acids of the vagina and other fluids of Joan’s reproductive tract break
down the cholesterol and stimulate the sperm to swim faster, so that after 10 hours, the
sperm are able to release the enzymes of the acrosome cap to penetrate an egg.

16.8 Pregnancy 629

 Spot Check At what point in a sperm’s journey does capacitation begin?

Figure 16.19 shows the process of fertilization. Although only one sperm will be
allowed to fertilize the egg, hundreds of sperm may be needed to break through the
cells surrounding the egg (granulosa cells). Follow along with the figure as you read
the steps:
1. The capacitated sperm release their acrosomal enzymes to penetrate through the
cells surrounding the egg.

Sperm

Granulosa cell
Egg

Capacitated sperm

Egg membrane

1
A capacitated sperm releases 2
acrosomal enzymes to
penentrate through cells Fusion of egg and
surrounding the egg. sperm plasma
membranes

2 Sperm nucleus 3
A sperm fuses with the egg’s fertilizing egg
plasma membrane.
Granules

3 Fertilization membrane
Granules form a fertilization
membrane as soon as a
sperm enters the egg.

FIGURE 16.19 The process of fertilization. (a) Hundreds of sperm approach an egg. (b) In step 1, sperm release acrosomal
enzymes to break through surrounding granulosa cells. (c) In step 2, a single sperm fuses with the plasma membrane of the egg
and its nucleus enters the egg to fertilize it (the merging of genetic material of the sperm and egg is not shown). As soon as this
one sperm’s nucleus enters the egg, step 3, granules inside the egg form a fertilization membrane that prevents any other sperm
from entering.

630 CHAPTER 16 The Female Reproductive System

2. A sperm fuses with the egg’s plasma membrane.
3. The sperm nucleus enters the egg, and the egg immediately prevents any fur-
ther sperm from gaining access by forming a fertilization membrane that sperm
cannot penetrate. Granules inside the egg form this membrane. The fertilization
membrane is important to establish the correct number of chromosomes in the
fertilized egg (just 46).
4. The nuclei of the sperm and egg rupture within the fertilized egg, and the chromo-
somes mix to form a single nucleus. The cell is now called a zygote.
The zygote undergoes mitotic division (cleavage) as the ciliated cells of the uter-
ine tube lining move it along toward the uterus. Figure 16.20 shows the stages of the
divisions. As you can see in this figure, 6 to 7 days after fertilization, a blastocyst
implants in the uterine lining. At this point, all four of the pregnancy requirements
have been met.
The developing fertilized egg will be called a blastocyst from implantation to
week 3, an embryo from weeks 3 to 9, and a fetus from week 9 until birth. Gestation
(the time from fertilization to birth) is 266 days, or 280 days from the start of Joan’s
last menstrual period.
You have already become aware of some of the hormones that will control a
pregnancy. For example, you have read that a corpus luteum produces hormones
for 90 days if an egg is fertilized. You now continue your exploration of the female
reproductive system by looking at the many hormones involved in a pregnancy.

Spot Check Sperm can survive in the female reproductive system for 6 days,
but they need to have 10 hours after ejaculation to undergo capacitation. Ovulation
typically occurs on day 14 of a woman’s menstrual cycle. An ovulated egg can survive
only up to 24 hours if it is not fertilized. Given this information, on what days of a
woman’s reproductive cycle could sexual intercourse result in pregnancy? Explain.

Sperm nucleus FIGURE 16.20 Migration from

fertilization to implantation:
Egg nucleus the stages of development
from fertilization of a secondary
oocyte to implantation of a
blastocyst.

Day 0 Zygote First cleavage Day 1 Day 2 Day 3 Day 4

division 2-cell stage 4-cell stage

Fertilization
occurs about
12–24 hours
after ovulation
Day 6–7
Blastocyst
Ovary implantation

Uterus Endometrium
Ovulation

16.8 Pregnancy 631

 Hormonal Control of Pregnancy

Learning Outcome
15. Explain the hormonal control of pregnancy.

In addition to hormones secreted by the zygote and corpus luteum, hormones are
secreted by the placenta and its associated membranes during pregnancy. The placenta
starts to develop soon after the blastocyst implants, and its development will be com-
plete by 90 days. The placenta functions to secrete hormones to regulate Joan’s preg-
nancy, her mammary development, and fetal development. As you may recall from
the cardiovascular system chapter on blood, the placenta also serves as a barrier to the
mixing of blood between the mother and the fetus while nutrients are being delivered
to the fetus from her blood and wastes are being taken away.
Each of the hormones that regulate a pregnancy is explained in the following list:
• Human chorionic gonadotropin from the developing blastocyst causes the corpus
luteum to continue to secrete estrogen and progesterone.
• Joan’s estrogen levels from the corpus luteum and later the placenta rise to 30 times
normal during a pregnancy. Over the length of the pregnancy, this hormone causes
Joan’s breasts to double in size, encourages her external genitalia and uterus to
grow, causes her uterus to be more irritable (prone to contract), and causes her
pubic symphysis to become more elastic.
• Progesterone is produced first by the corpus luteum and then by the placenta. Along
with estrogen, this hormone suppresses FSH and LH secretion so that no additional
eggs are developed during the pregnancy. Progesterone suppresses uterine contrac-
tions, promotes a rich lining of the uterus for the developing blastocyst and embryo
to feed upon, and promotes the development of mammary glands and ducts.
• The placenta produces human chorionic somatomammotropin (HCS), which
regulates Joan’s carbohydrate and protein metabolism so that glucose and amino
acids are available in the blood for the developing fetus. However, this is not a self-
sacrificing gesture. Although HCS also reduces Joan’s sensitivity to insulin so that
more glucose stays in her bloodstream for the fetus, it also increases Joan’s ability
to use fatty acids as a fuel substitute for glucose.

Disease P int
The insulin insensitivity effect produced by HCS may be responsible for gestational
diabetes. This form of diabetes mellitus affects less than 10% of women during their
pregnancy. Symptoms include increased urine output, excessive thirst, and hypergly-
cemia. These symptoms and the condition itself usually end with the birth of the baby
and the immediate delivery of the placenta. However, the likelihood of developing
type 2 diabetes mellitus within 15 years is significantly increased.

• Joan’s thyroid hormone levels rise. This hormone increases the metabolism for
both Joan and the fetus.
• Joan secretes more parathyroid hormone as her fetus takes more and more calcium
from her blood. PTH increases osteoclast activity to keep Joan’s calcium levels at
homeostasis.
• Joan’s adrenocorticotropic hormone levels rise so that more glucocorticoids are
produced by her adrenal glands. This results in protein breakdown to produce more
glucose for the fetus.

632 CHAPTER 16 The Female Reproductive System

• Joan’s aldosterone levels increase for fluid retention to increase her blood volume
and maintain homeostasis.
So what are all the effects of these hormones on Joan’s body? In the next section,
you will explore how her body adjusts to a pregnancy.

A Woman’s Adjustment to Pregnancy

Learning Outcome
16. Explain the adjustments a woman’s body makes to accommodate a pregnancy.

Pregnancy puts a strain on many of Joan’s body systems. Some of the effects are due
to hormones, and other effects are simply due to the growth of the fetus putting pres-
sure on Joan’s anatomy. These effects are described in the following list and shown in
Figure 16.21.
• There is decreased motility (movement) in the digestive system, especially in the
first trimester. This may cause nausea (morning sickness) for Joan.
• Pressure builds on Joan’s stomach from the growing fetus. This causes pressure on
the cardiac sphincter of the stomach, which may then leak. The reflux of stomach
acid to the esophagus causes heartburn for the mother.

FIGURE 16.21 A full-term

fetus in the uterus.

Breast

Liver
Stomach

Ascending
colon

Umbilical
cord
Uterus
Descending
colon

Ovary Ilium

Urinary
bladder

Pubic
symphysis

16.8 Pregnancy 633

 • Joan’s cardiac output increases 30% due to her increased blood volume. She
has more blood volume because the fetus uses oxygen from her blood too. This
decreases Joan’s blood oxygen levels, so her kidneys respond by secreting EPO to
boost her red blood cell production.
• Pressure from the weight of the uterus may cause hemorrhoids or varicose veins.
• Joan’s kidneys produce more urine because her blood volume is increased, and
they are filtering more waste—waste from the mother and the fetus.
• Although more urine is produced, the growth of her uterus limits the amount of
urine Joan’s urinary bladder can hold. This causes more frequent micturition,
which often interrupts Joan’s sleep as the pregnancy progresses.
• Joan’s respiratory ventilation increases 50%. This is because the high level of proges-
terone makes Joan more sensitive to carbon dioxide. To move the additional air, her
body must breathe either faster or deeper. Joan’s respiratory rate increases because the
depth of her breaths cannot increase due to the pressure on her diaphragm from the
growing fetus.
• The integumentary system is affected in several ways: Stretch marks may appear
on Joan’s rapidly expanding abdomen and breasts, her linea alba may darken and
be referred to as the linea nigra, and melanocytes may increase melanin produc-
tion, producing a mask of pregnancy that is visible on her face.
• Increased thyroid secretion raises Joan’s basal metabolic rate by 15%. She may feel
overheated and have an increased appetite.

Nutritional Requirements for a Pregnancy

Learning Outcome
17. Explain the nutritional requirements for a healthy pregnancy.

Although Joan’s appetite is increased and she may think she is eating for two, she really
needs only an additional 300 calories per day to support a pregnancy. It is important
not to gain too much weight during a pregnancy. Normal weight gain over the course
of a pregnancy is 24 pounds.
A balanced diet is essential. The Mayo Clinic recommends a balanced diet during
pregnancy with special emphasis on four nutrients: folic acid, calcium, protein, and
iron.2 These nutrients and their recommended daily allowances are explained in the
following list:
• Folic acid is important to prevent birth defects, especially those concerning
neural development. The Mayo Clinic recommends 800 μg per day during preg-
nancy. Sources of folic acid include leafy green vegetables, citrus fruits, cereals,
and beans.
• Calcium is necessary for bone development in the fetus and bone maintenance
in the mother. The Mayo Clinic recommends 1,000 mg per day during preg-
nancy. Pregnant teens require 1,300 mg per day. Dairy products are a good
source of calcium.
• Protein is very important for fetal growth, especially during the second and third
trimesters. The Mayo Clinic recommends 71 g per day during pregnancy. Good
sources of protein include lean meat, poultry, fish, eggs, dried beans, peanut butter,
and dairy products.

634 CHAPTER 16 The Female Reproductive System

• Iron is important for increased hemoglobin production to maintain the increased
blood volume. The Mayo Clinic recommends 27 mg per day during pregnancy.
Sources of iron include lean red meat, poultry, fish, nuts, and dried fruit.
Prenatal care is important for the health of both the mother and the developing
fetus. A doctor may prescribe prenatal vitamins and nutritional supplements to com-
plement Joan’s diet. Proper nutrition is needed to sustain a pregnancy to full term. You
will investigate next the events that will naturally end the pregnancy at full term and
bring about the birth of Joan’s baby.

Spot Check What would be a good menu for a day while pregnant? Explain.

Initiating the Birth Process

Learning Outcome
18. Explain what initiates the birth process.

The developing fetus plays a role in the timing of parturition (PAR-chur-ISH-un), the
process of birth. The steps that initiate the birth process are explained in the following
list. Follow along with Figure 16.22 as you read this list:
1. The hypothalamus in the fetus releases corticotropin-releasing hormone (CRH)
due to stress (confines of a small space relative to the growing fetus). CRH targets
the fetal anterior pituitary to release ACTH.
2. ACTH, in turn, targets the fetal adrenal glands so that glucocorticoids are
released. This is similar to what happens to an adult’s body under stress (the
endocrine system chapter).
3. The fetal glucocorticoids travel to the placenta.
4. The fetal glucocorticoids cause the placenta to adjust the level of its hormones.
Progesterone production levels off at around 6 months, while estrogen levels keep
increasing. As stated earlier, estrogen makes the uterus more irritable (likely to
contract), while progesterone suppresses contractions. So estrogen begins to have
an increased effect, encouraging uterine contractions as the pregnancy reaches full
term. The placenta and the membranes associated with it also produce prostaglan-
dins that make the myometrium more likely to contract.
5. Smooth muscle of Joan’s myometrium stretches more and more as the pregnancy
progresses. As you may recall from the muscular system chapter, smooth muscle
is more likely to contract if stretched. So this makes Joan’s uterus more likely
to contract. In fact, weak Braxton Hicks contractions (false labor) are com-
mon during pregnancy. Stretch receptors in the myometrium signal the mother’s
hypothalamus.
6. Joan’s hypothalamus signals her posterior pituitary to secrete oxytocin. This hor-
mone promotes labor (uterine contractions to bring about birth) in two ways: Oxy-
tocin directly stimulates the myometrium to contract, and it stimulates the placenta
to produce more prostaglandins.
7. Uterine contractions cause the head of the fetus to press harder on the cervix.
This causes more signals to be sent to Joan’s hypothalamus, so more oxytocin
is released. The fetal head pushing on the cervix also stimulates Joan’s cervix
to release prostaglandins. As you might guess, this becomes a positive feedback
mechanism that will not end until the fetus is expelled from the uterus.

16.8 Pregnancy 635

1
Stress causes the fetal
hypothalamus to release CRH Mother’s
targeting the fetal anterior hypothalamus
pituitary (red arrow). 5
Mother's
posterior
pituitary
2
The fetal anterior pituitary
releases ACTH targeting
the fetal adrenal cortex 2
(green arrow). Glucocorticoids Progesterone

4
3
The fetal adrenal cortex 3
Estrogen and 6
releases adrenal prostaglandins
glucocorticoids targeting the Oxytocin
placenta (blue arrow). Placenta
ACTH

4
The placenta levels off 1
production of progesterone
(yellow arrow) and increases CRH 7
production of estrogen and
prostaglandins (orange arrow). Uterine smooth
muscle contractions
Stress

5 FIGURE 16.22 Initiating the birth process. The action of the various hormones are
Stretching the uterine represented by colored arrows.
muscles sends nerve signals
to the mother’s hypothalamus
(black arrow).
The Birth Process
6
The stimulated mother’s
hypothalamus sends signals
Learning Outcome
to the mother’s posterior 19. Describe the birth process.
pituitary to release oxytocin.
Now that you are familiar with what starts the birth process, you are ready to explore
7
the three stages of parturition. These stages are shown in Figures 16.23 and 16.24.
Oxytocin (brown arrow) and
estrogen with prostaglandins Stage 1 This stage begins with regular uterine contractions. During this stage, the
(orange arrow) cause more
uterine contractions resulting cervical canal widens (dilation) and the cervix thins (effacement). Stage 1 ends
in a positive feedback when the cervical canal reaches 10 cm (the diameter of a fetal head). The amniotic
mechanism. sac, in which the fetus floats, often ruptures during this stage. This event is called
the breaking of the waters.

Stage 2 During this stage, the baby is expelled. The crowning of the baby’s
head is usually seen first because a fetus most often assumes a head-down position
in the seventh month. At this point, the doctor may make an incision (episiotomy)
in Joan’s perineum to widen the vaginal opening. The episiotomy is angled away
from her anus to prevent the perineum tearing into her anus as the baby is born.
The head is the most difficult part to expel. Once it is delivered, the rest of the
body is expelled more easily.

Stage 3 The placenta detaches from Joan’s uterus and is expelled during this stage.
Further contractions of the uterus ensure that all of the placenta and its associated
membranes (together, at this time, called afterbirth) are expelled. These contractions
also help close blood vessels that had led to the placenta. About 350 mL of blood is
normally lost when the placenta detaches.

636 CHAPTER 16 The Female Reproductive System

 Placenta Amniotic sac
Pubic symphysis

Umbilical cord

Urethra

Vagina

Cervix

Rectum
Ruptured
amniotic
sac
(a) (b)
Placenta Placenta
Uterus

Umbilical
cord

(c) (d)

FIGURE 16.23 The birth process: (a) early stage 1, (b) late stage 1, (c) stage 2, (d) stage 3.

(a) (b) (c)

FIGURE 16.24 Childbirth: (a) crowning, (b) expulsion, (c) delivery of the placenta.
(a, b) ©Petit Format/Science Source; (c) ©Jason Edwards/Getty Images

Lactation

Learning Outcome
20. Explain the process of lactation.

Once the placenta is delivered, the major source of pregnancy hormones is gone.
Estrogen and progesterone levels drop drastically. All through the pregnancy, these
two hormones together caused breast development but also suppressed the effects of

16.8 Pregnancy 637

 prolactin released from the anterior pituitary. Prolactin is a hormone that stimulates
milk production (lactation) in the mammary glands. The increased prolactin at birth
(without suppression by estrogen and progesterone) causes milk production within a
few days.
Late in the pregnancy, Joan’s mammary glands produce colostrum, a thin,
watery fluid containing protein, lactose (milk sugar), and many of her antibodies
but one-third less fat than breast milk. This is all right for the first 1 to 3 days after
birth because the newborn has plenty of fat. By day 3, prolactin causes the mother’s
milk to come in.
Suckling on Joan’s breast causes the milk ejection reflex. The sensory endings
in her nipple send signals to her hypothalamus for oxytocin release. Oxytocin causes
myoepithelial cells (see Figure 16.7c) in her mammary lobules to contract to release
milk to the lactiferous ducts in the breast. This causes the milk to travel to the nipple
for the baby. The reflex is repeated every time the infant nurses.
Prolactin levels also surge each time the infant nurses. See Figure 16.25. This
ensures that there will be ample milk production to meet the needs of the infant. On
average, 1.5 L of milk is produced each day. If Joan chooses not to nurse or stops nurs-
ing, the surges of prolactin cease and her milk production ends.
There are many reasons why a mother may choose to nurse a newborn. Some of
them are listed here:
• Breast milk provides good nutrition.
• Breast milk contains many of the mother’s antibodies to provide passive natural
immunity to the baby.
• Breast milk has a laxative effect.
• Breast milk helps colonize helpful bacteria in the infant’s intestines.
You have covered the physiology of a healthy pregnancy for Joan and Rick. To
finish the content of this chapter, you will investigate some of the things that could go
wrong in a pregnancy.

FIGURE 16.25 Prolactin

secretion in a nursing mother. Protactin surges
©Jose Luis Pelaez Inc/Blend Images LLC

Feedings

Pregnancy Lactation

638 CHAPTER 16 The Female Reproductive System

Disorders of Pregnancy

Learning Outcome
21. Describe disorders of pregnancy and relate abnormal function to pathology.

Spontaneous Abortion (Miscarriage) Fifty percent of all zygotes are lost before
delivery. Most of these will be lost because they never implanted. If that is the case,
the woman may never know that her egg had been fertilized.
Of the zygotes that do implant, 10% to 15% will end in a spontaneous abortion.3
The reasons for this include fetal abnormalities, improper implantation, or premature
detachment of the placenta (placental abruption).

Common Misconception
It is important to differentiate the term spontaneous abortion from abortion. An abor-
tion is an intentional medical procedure to prematurely end a pregnancy so that the
fetus will not survive. On the other hand, a spontaneous abortion is a natural, prema-
ture ending to a pregnancy. It can also be called a miscarriage.

Ectopic Pregnancy An ectopic pregnancy occurs when the fertilized egg implants
anywhere other than the uterus. The most likely ___location is in a uterine tube. These
pregnancies are doomed from the start. A uterine tube cannot support a pregnancy,
and the developing embryo cannot be relocated. The growing embryo will eventually
cause the uterine tube to rupture, causing a potentially life-threatening situation for the
mother. See Figure 16.26.

(b)

FIGURE 16.26 Ectopic pregnancy: (a) ectopic pregnancy within the uterine tube,
(b) ruptured uterine tube with implanted embryo.
(a) (b) ©Yoav Levy/Medical Images

16.8 Pregnancy 639

 Spot Check A uterine tube is usually removed in an ectopic pregnancy. Does
this affect the woman’s fertility?

Preeclampsia Preeclampsia is pregnancy-induced hyper-

tension accompanied by protein in the urine that usually
occurs after 20 weeks in the pregnancy. The mother’s blood
pressure and weight are closely monitored throughout a
pregnancy to detect this disorder. The hypertension may
be slight (140/90 mmHg or higher). A sudden weight gain
(more than 2 pounds in a week) late in pregnancy may indi-
cate edema associated with the hypertension. Although the
cause of this condition is not clear, the cure is known—the
birth of the baby. Preeclampsia can lead to serious, poten-
tially fatal consequences for the mother and the baby.

Fetus Placental Abruption Placental abruption (abruption

placentae) is a condition in which the placenta becomes pre-
maturely detached from the uterine wall. This is a serious
Placenta condition that can potentially cause bleeding, lack of oxygen
to the developing fetus, shock, and death for the mother.
Cervix

FIGURE 16.27 Placenta previa. Placenta Previa Placenta previa is a condition in which
©Zephyr/Science Source the placenta is positioned over the cervix, blocking the open-
ing to the uterus. See Figure 16.27. In many cases, placenta previa resolves on its
own, but if it does not, the placenta can detach when labor begins. This premature
detachment will deprive the fetus of oxygen during delivery and could result in brain
damage. In cases in which placenta previa has not resolved, physicians deliver the
baby by cesarean section to avoid the premature detaching of the placenta during a
vaginal delivery.
Table 16.2 summarizes all of the diseases and disorders described throughout the
chapter.

TABLE 16.2 Summary of Diseases and Disorders of the Female Reproductive

System
Type of Disease/Disorder Disease/Disorder Description
Cancers Breast cancer Abnormal growth of breast tissue, usually occurring in the
lactiferous ducts and lobules of the breast.
Cervical cancer Cancer of the cervix.
Ovarian cancer Cancer of the ovaries.
Sexually transmitted Chlamydia A bacterial infection caused by Chlamydia trachomatis.
diseases (STDs)
Gonorrhea A bacterial infection caused by Neisseria gonorrhoeae.
Herpes A viral infection that causes sores on the genitals, anus, or mouth.
HPV A viral infection resulting in the growth of warts on the genitals.
The infection is caused by the human papillomavirus.
Syphilis A bacterial infection caused by Treponema pallidum.

640 CHAPTER 16 The Female Reproductive System

 Summary of Diseases and Disorders of the Female
TABLE 16.2
Reproductive System (continued)
Type of Disease/Disorder Disease/Disorder Description
Pregnancy disorders Ectopic pregnancy The type of pregnancy that occurs when the fertilized egg implants
anywhere other than the uterus.
Gestational diabetes A form of diabetes mellitus that affects women during their pregnancy.
Placenta previa A condition in which the placenta is positioned over the cervix,
blocking the opening to the uterus.
Preeclampsia Pregnancy-induced hypertension accompanied by protein in the
urine that usually occurs after 20 weeks in the pregnancy.
Spontaneous The loss of a zygote before delivery, either before or after
abortion implantation. Reasons include fetal abnormalities, improper
(miscarriage) implantation, or placental abruption.
Other reproductive Endometriosis The growth of endometrium in places other than the uterus.
disorders
Fibroids Noncancerous tumors found either in the uterus, in the
endometrium, or on the outside of the uterus.

16.8 Pregnancy 641

Putting the Pieces Together

The Reproductive Systems

Integumentary system Cardiovascular system
Apocrine glands secrete Blood transports reproductive
pheromones to attract the hormones; vasodilation
opposite sex; mammary glands enables erection.
secrete milk to nourish an infant.
Testosterone promotes
Reproductive hormones erythropoiesis.
promote sebum production.

Lymphatic system
Skeletal system
Sends white blood cells to
Bones of the pelvis protect fight pathogens in the
some reproductive organs. reproductive system.

Reproductive hormones
Sustentacular cells form a
promote endochondral bone
blood-testis barrier to isolate
growth and serve as a lock
developing sperm from the
on calcium in the bone.
immune system.

Muscular system
Respiratory system
Muscle contractions are involved
in ejaculation and childbirth. Allows for the exchange of O2
and CO2 in system tissues.
Reproductive hormones
promote muscle growth and Allows for the exchange of
development. O2 and CO2 in a fetus.

Nervous system Digestive system

Nerve impulses innervate Provides nutrients for tissues
muscles involved in erection, of the reproductive system.
ejaculation, and childbirth.
Decreased digestive motility
Reproductive hormones during the first trimester may
affect the production of cause morning sickness.
hypothalamus releasing
hormones.
Excretory/urinary
system
Endocrine system
Removes metabolic wastes
Hormones regulate sexual
produced by the fetus; semen
development, sex drive,
is ejaculated through the
menstruation, pregnancy, birth,
urethra.
and lactation.
Sexual response in male and
Reproductive hormones
female blocks the passing of
have a negative feedback
urine.
effect on the hypothalamus.

FIGURE 16.28 Putting the Pieces Together—The Reproductive Systems: connections between the female and male
reproductive systems and the body’s other systems.

642 CHAPTER 16 The Female Reproductive System

Summary
16.1 Word Roots and Combining Forms
∙∙ See the heading at the beginning of the chapter to learn the medical terminology that relates to the female reproductive
system.

16.2 Overview
∙∙ A female zygote has XX as the sex chromosomes.

16.3 Female Reproductive Anatomy

∙∙ Ovaries produce ova and are therefore the primary sex organs of the female reproductive system.

Ovaries
∙∙ An ovary has two layers: a cortex containing follicles and a medulla containing blood vessels.
∙∙ Ligaments suspend the ovaries in the pelvic cavity and anchor them to the uterus.

Secondary Female Reproductive Organs and Structures

∙∙ The ovaries, uterus, and vagina are internal.
∙∙ The vulva and breasts are external.
∙∙ The uterus has three layers: the perimetrium, the myometrium, and the endometrium.
∙∙ The uterine tubes transport eggs to the uterus.
∙∙ The vagina allows for the flow of the menses, is a receptacle for sperm, and serves as the birth canal.
∙∙ The vulva includes the following: the mons pubis, labia, clitoris, vestibular bulbs, and vestibular glands.
∙∙ The breasts contain mammary glands that do not fully develop until the first pregnancy.

16.4 Physiology of the Female Reproductive System

Hormonal Control at Puberty
∙∙ Puberty begins when the GnRH from the hypothalamus stimulates the anterior pituitary to secrete FSH and LH.
∙∙ FSH stimulates follicles in the ovaries to produce estrogen.
∙∙ Estrogen is responsible for the development of female sex characteristics.

Oogenesis
∙∙ One haploid gamete is formed from each oogonium.
∙∙ A follicle is responsible for caring for an oocyte and producing hormones.
∙∙ All oocytes have been produced from oogonia by birth.
∙∙ Many oogonia and oocytes are lost by atresia.
∙∙ Oogenesis is halted mid-meiosis I until puberty.
∙∙ Secondary oocytes are formed each month.
∙∙ Meiosis II is not completed unless an egg is fertilized.
∙∙ Follicles develop along with an oocyte.
∙∙ Some primordial follicles develop each month after puberty.
∙∙ Mature follicles rupture to release an egg during ovulation.
∙∙ After ovulation, the follicle becomes a corpus luteum, which secretes hormones.
∙∙ If the egg does not become fertilized, the corpus luteum becomes a corpus albicans.

Hormonal Control in the Adult Female

∙∙ A reproductive cycle is composed of two parts: an ovarian cycle and a menstrual cycle.
∙∙ A reproductive cycle is typically 28 days and begins on the first day of a woman’s period.
∙∙ The ovarian cycle has a follicular phase and a luteal phase.
∙∙ The menstrual cycle has the following phases: menstrual, proliferative, secretory, and premenstrual.
∙∙ Ovulation typically occurs on day 14.

The Female Sexual Response

∙∙ The female sexual response includes four stages: arousal, plateau, orgasm, and resolution.
∙∙ Unlike the male, a woman does not usually have a refractory period in her sexual response.

643
16.5 Effects of Aging on the Female Reproductive System
∙∙ A woman’s body goes through a climacteric in midlife due to the decreased production of estrogen and progesterone.
∙∙ Menstruation ceases during menopause.
∙∙ Hot flashes are common.
∙∙ The tissues of the vagina, labia minora, clitoris, uterus, uterine tubes, and breast atrophy.
∙∙ Bone mass declines.
∙∙ Skin becomes thinner.
∙∙ Cholesterol levels rise.

16.6 Diagnostic Tests for Female Reproductive System Disorders

∙∙ Common diagnostic tests for female reproductive system disorders include biopsy, blood tests, colposcopy, hysteroscopy,
laboratory tests, laparoscopy, mammogram, Pap smear, pregnancy test, and ultrasound.

16.7 Disorders of the Female Reproductive System

∙∙ Breast cancer is the abnormal growth of breast tissue, usually occurring in the lactiferous ducts and lobules of the breast.
∙∙ Ovarian cancer is cancer of the ovaries.
∙∙ Cervical cancer is cancer of the cervix often caused by human papillomavirus (HPV) infection.
∙∙ A fibroid is a noncancerous growth.
∙∙ Endometriosis is the growth of endometrium in places other than the uterus.
∙∙ Sexually transmitted diseases and infections affect women differently than men because of the differences in their
reproductive anatomy.

16.8 Pregnancy
∙∙ The four requirements of a pregnancy are that there must be a sperm and an egg, the sperm must meet the egg, the sperm
must fertilize the egg, and the fertilized egg must implant.

Pathway for Sperm to Meet an Egg

∙∙ An egg must be fertilized within 24 hours of ovulation if it is to survive.
∙∙ The complete journey for a mature sperm follows:
Epididymis → ductus deferens → ejaculatory duct → urethra →
vagina → uterus (cervix, body) → uterine tube (isthmus, ampulla).

Fertilization to Implantation
∙∙ Sperm must go through capacitation to fertilize an egg.
∙∙ Many sperm may be needed to break through the cells surrounding the egg.
∙∙ Only one sperm will be allowed to penetrate the egg—the rest will be rejected.
∙∙ The nuclei of the sperm and egg rupture, the chromosomes mix, and a new nucleus forms.
∙∙ The zygote undergoes mitotic divisions on its way to the uterus.
∙∙ The blastocyst implants in the lining of the uterus 6 days after fertilization.

Hormonal Control of Pregnancy

∙∙ Hormones are made by the fertilized egg, the corpus luteum, and the placenta, along with other endocrine glands during
a pregnancy.
∙∙ The hormones that control a pregnancy include HCG, estrogen, progesterone, HCS, thyroid hormone, PTH, ACTH,
glucocorticoids, and aldosterone.

A Woman’s Adjustment to Pregnancy

∙∙ Many of the body systems are affected by the pregnancy hormones and the growing fetus’s pressure on the female
anatomy.

Nutritional Requirements for a Pregnancy

∙∙ Only an additional 300 calories are required to sustain a pregnancy.
∙∙ A balanced diet rich in folic acid, calcium, protein, and iron is essential for a pregnancy.

644
Initiating the Birth Process
∙∙ The fetus has a role in the timing of parturition.
∙∙ The hormones involved in initiating parturition lead to a positive feedback mechanism that ends with the birth of the baby.

The Birth Process

∙∙ There are three stages to the birth process: dilation of the cervix, expulsion of the baby, and delivery of the afterbirth.

Lactation
∙∙ Throughout the pregnancy, estrogen and progesterone suppress the effects of prolactin.
∙∙ Once the placenta is delivered and the source of estrogen and progesterone is gone, prolactin stimulates milk production.
∙∙ Colostrum production precedes milk production in the first few days after birth.
∙∙ Suckling on the breast causes oxytocin release and the milk-ejection reflex.
∙∙ Prolactin levels surge with each feeding to ensure ample milk production to meet the baby’s needs.
∙∙ The many reasons for nursing include the following: breast milk provides good nutrition; the antibodies present in breast
milk provide the baby some immunity; the milk has a laxative effect on the baby; and breast milk helps colonize helpful
bacteria in the baby’s intestines.

Disorders of Pregnancy
∙∙ Of the zygotes that do implant, 15% are miscarried.
∙∙ An ectopic pregnancy occurs if the fertilized egg implants anywhere other than in the uterus.
∙∙ Preeclampsia is pregnancy-induced hypertension accompanied by protein in the urine.
∙∙ Placental abruption is a condition in which the placenta becomes prematurely detached from the uterine wall.
∙∙ Placenta previa is a condition in which the placenta is positioned over the cervix.

Key Words for Review

The following terms are defined in the glossary.

afterbirth folliculogenesis milk-ejection reflex

atresia gestation oogenesis
capacitation labor ovarian cycle
colostrum lactation ovulation
crowning mammography parturition
effacement menopause prolapse
episiotomy menstrual cycle

645
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 A

Appendix
The Metric System

18

7
The metric system is commonly used in science and medicine. This appendix will help
you with conversions between the metric and U.S. systems.

17
Length

16
TABLE A.1 Units of Length

6
15
Metric Unit Metric Equivalent Conversion to U.S. System

14
Kilometer (km) 1,000 m 0.62 mile; 1.6 km/mile
Meter (m) 100 cm; 1,000 mm 39.4 inches; 1.1 yards

13
Centimeter (cm) 1/100 m; 0.01 m; 10 mm 0.39 inch; 2.5 cm/inch

5
Millimeter (mm) 1/1,000 m; 0.001 m 0.039 inch

12
Micrometer (μm) 1/1,000 mm; 0.001 mm

11
Examples of metric lengths:

4
Measure the length and the width of your thumb in inches and centimeters, using the

10
ruler provided on this page. Also measure the maximum distance you can spread your
thumb and index finger apart. Knowing these metric measurements will give you a

9
reference when you read about metric lengths in the text.

8
Weight

3
TABLE A.2 Units of Weight 7
Metric Unit Metric Equivalent Conversion to U.S. System
6

Kilogram (kg) 1,000 g 2.2 pounds (lb)

Gram (g) 1,000 mg 0.035 ounce (oz); 28.5 g/oz
2
5

Milligram (mg) 1/1,000 g; 0.001 g

Microgram (μg) 1/1,000 mg; 0.001 mg
4

Examples of metric weights:

3

U.S. penny: 2.50 g

U.S. nickel: 5.00 g
2

5-pound bag of sugar: 2.268 kg

1
0 cm

0 in

FIGURE A.1
Ruler inch and metric.

A-1
 Volume

TABLE A.3 Units of Volume

Metric Unit Metric Equivalent Conversion to U.S. System
Liter (L) 1,000 mL 1.06 quarts; 0.264 gallon
Deciliter (dL) 1/10 L; 0.1 L
Milliliter (mL) 1/1,000 L; 0.001 L 0.034 ounce (oz); 29.4 mL/oz
Microliter (μL) 1/1,000 mL; 0.001 mL

Examples of metric volumes:

Large bottle of soda: 2L
12 oz can of soda: 355 mL

A-2 APPENDIX A
 B

Appendix
Nutrition Table
The following table shows the nutritional goals for age-gender groups
based on dietary intakes and dietary guidelines recommendations.

Daily Nutritional Goals for Age-Sex Groups Based on Dietary

TABLE B.1
Reference Intakes and Dietary Guidelines Recommendations
Source Child Female Male Female Male Female Male Female Male Female Male Female Male
of Goala 1–3 4–8 4–8 9–13 9–13 14–18 14–18 19–30 19–30 31–50 31–50 51+ 51+

2,200, 2,400,
Calorie Level(s) 1,400, 2,800, 2,600,
Assessed 1,000 1,200 1,600 1,600 1,800 1,800 3,200 2,000 3,000 1,800 2,200 1,600 2,000
Macronutrients

Protein, g RDA 13 19 19 34 34 46 52 46 56 46 56 46 56
Protein, % kcal AMDR 5–20 10–30 10–30 10–30 10–30 10–30 10–30 10–35 10–35 10–35 10–35 10–35 10–35

Carbohydrate, g RDA 130 130 130 130 130 130 130 130 130 130 130 130 130

Carbohydrate, % kcal AMDR 45–65 45–65 45–65 45–65 45–65 45–65 45–65 45–65 45–65 45–65 45–65 45–65 45–65
Dietary fiber, g 14 g/1,000 14 16.8 19.6 22.4 25.2 25.2 30.8 28 33.6 25.2 30.8 22.4 28
kcal
Added sugars, % kcal DGA < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10%
Total fat, % kcal AMDR 30–40 25–35 25–35 25–35 25–35 25–35 25–35 20–35 20–35 20–35 20–35 20–35 20–35
Saturated fat, % kcal DGA < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10% < 10%
Linoleic acid, g AI 7 10 10 10 12 11 16 12 17 12 17 11 14
Linolenic acid, g AI 0.7 0.9 0.9 1 1.2 1.1 1.6 1.1 1.6 1.1 1.6 1.1 1.6
Minerals
Calcium, mg RDA 700 1,000 1,000 1,300 1,300 1,300 1,300 1,000 1,000 1,000 1,000 1,200 1,000b
Iron, mg RDA 7 10 10 8 8 15 11 18 8 18 8 8 8
Magnesium, mg RDA 80 130 130 240 240 360 410 310 400 320 420 320 420
Phosphorus, mg RDA 460 500 500 1,250 1,250 1,250 1,250 700 700 700 700 700 700
Potassium, mg AI 3,000 3,800 3,800 4,500 4,500 4,700 4,700 4,700 4,700 4,700 4,700 4,700 4,700
Sodium, mg UL 1,500 1,900 1,900 2,200 2,200 2,300 2,300 2,300 2,300 2,300 2,300 2,300 2,300
Zinc, mg RDA 3 5 5 8 8 9 11 8 11 8 11 8 11
Copper, mcg RDA 340 440 440 700 700 890 890 900 900 900 900 900 900

Manganese, mg AI 1.2 1.5 1.5 1.6 1.9 1.6 2.2 1.8 2.3 1.8 2.3 1.8 2.3
Selenium, mcg RDA 20 30 30 40 40 55 55 55 55 55 55 55 55

A-3
 TABLE B.1 Daily Nutritional Goals for Age-Sex Groups Based on Dietary
Reference Intakes and Dietary Guidelines Recommendations (continued)
Source Child Female Male Female Male Female Male Female Male Female Male Female Male
of Goala 1–3 4–8 4–8 9–13 9–13 14–18 14–18 19–30 19–30 31–50 31–50 51+ 51+

2,200, 2,400,
Calorie Level(s) 1,400, 2,800, 2,600,
Assessed 1,000 1,200 1,600 1,600 1,800 1,800 3,200 2,000 3,000 1,800 2,200 1,600 2,000
Vitamins
Vitamin A, mg RAE RDA 300 400 400 600 600 700 900 700 900 700 900 700 900
Vitamin E, mg AT RDA 6 7 7 11 11 15 15 15 15 15 15 15 15
c
Vitamin D, IU RDA 600 600 600 600 600 600 600 600 600 600 600 600 600c
Vitamin C, mg RDA 15 25 25 45 45 65 75 75 90 75 90 75 90
Thiamin, mg RDA 0.5 0.6 0.6 0.9 0.9 1 1.2 1.1 1.2 1.1 1.2 1.1 1.2
Riboflavin, mg RDA 0.5 0.6 0.6 0.9 0.9 1 1.3 1.1 1.3 1.1 1.3 1.1 1.3

Niacin, mg RDA 6 8 8 12 12 14 16 14 16 14 16 14 16

Vitamin B6, mg RDA 0.5 0.6 0.6 1 1 1.2 1.3 1.3 1.3 1.3 1.3 1.5 1.7
Vitamin B12, mcg RDA 0.9 1.2 1.2 1.8 1.8 2.4 2.4 2.4 2.4 2.4 2.4 2.4 2.4

Choline, mg AI 200 250 250 375 375 400 550 425 550 425 550 425 550

Vitamin K, mcg AI 30 55 55 60 60 75 75 90 120 90 120 90 120

Folate, mcg DFE RDA 150 200 200 300 300 400 400 400 400 400 400 400 400

a
RDA = Recommended Dietary Allowance, AI = Adequate Intake, UL = Tolerable Upper Intake Level, AMDR = Acceptable Macronutrient Distribution Range,
DGA = 2015–2020 Dietary Guidelines recommended limit; 14 g fiber per 1,000 kcal = basis for AI for fiber.
b
Calcium RDA for males ages 71+ years is 1,200 mg.
c
Vitamin D RDA for males and females ages 71+ years is 800 IU.
Sources: U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015, December). 2015–2020 Dietary Guidelines for Americans
(8th ed.). Available at http://health.gov/dietaryguidelines/2015/guidelines/.

A-4 APPENDIX B
 C

Appendix
Spot Check
Answers
Chapter 1: The Basics bone); muscle tissue (examples should be one of the following:
skeletal, cardiac, and smooth); nervous tissue (examples should
1 Answers may vary. Your nose is on the anterior surface of your be one of the following: neurons and neuroglia).
head, superior to your mouth and medial and inferior to your eyes.
11 Integumentary system, skeletal system, muscular system, nervous
2 The liver is in the right upper quadrant. The liver is in the right system, endocrine system, cardiovascular system, lymphatic
hypochondriac and epigastric regions. system, respiratory system, digestive system, excretory/urinary
3 The cavities in the axial region are the dorsal cavity, the thoracic system, male reproductive system, female reproductive system.
cavity, and the abdominopelvic cavity. These three cavities
can be further divided; the dorsal cavity includes the cranial
and vertebral cavities, the thoracic cavity includes the pleural Chapter 3: The Integumentary System
cavities and the pericardial cavity, and the abdominopelvic cavity 1 The forearm has thin skin; therefore, its epidermis does not
includes the abdominal cavity and the pelvic cavity. have a stratum lucidum. The lips have thick skin; therefore, their
4 The parietal peritoneum is attached to the inferior surface of epidermis does have a stratum lucidum.
the diaphragm. The parietal pleural membranes and the parietal 2 A cut would need to extend into the dermis to bleed.
pericardium are attached to the superior surface of the diaphragm.
3 The eyelashes would be extremely long. Growing ½ inch per
5 Negative feedback. month for 3 years could cause eyelashes to be 18 inches in length!
6 Answers will vary based on the student’s age, gender, lifestyle 4 The increasing fibers hamper the movement of bacteria.
choices, environment, and heredity.
5 There would be no keratinocytes to generate new waterproof
7 Vertigo is a symptom; it cannot be quantified or measured. epidermal cells and no melanocytes to provide melanin for
8 Inflammation is a normal immune response of the body to protection from UV light.
pathogens that enter the body through injury and disease. 6 Hailey has a first-degree burn over approximately 4.5% of her body.
9 Palliative treatment. 7 Discussion question; answers may vary.
10 Flu and AIDS are two examples: answers may vary. 8 Wood’s light and skin biopsy.
9 Cellulitis and impetigo are bacterial skin infections. Warts and
Chapter 2: Levels of Organization of the Human Body herpes are viral infections. Tinea infections are fungal infections.
Scabies is a parasitic infection.
1 Protons: 19; electrons: 19; neutrons: 20.
2 Both liquids are bases. They both release OH−. Liquid Y is
stronger. Liquid Y releases 1,000 times more ions than liquid X. Chapter 4: The Skeletal System
3 Carbohydrate—the ratio of C:H:O is 1:2:1. 1 Any three of the following: parietal, frontal, occipital, temporal,
4 Removing heat slows down the chemical reactions of bacteria. sternum, ribs.
5 A cell in a testicle that produces testosterone would need large 2 Any two of the following: facial bones, ethmoid bone, sphenoid
amounts of smooth ER and Golgi complexes. bone, vertebrae, sacrum, coccyx.
6 The water in the beaker is a hypotonic solution compared to 3 Ilium, ischium, pubis.
the egg white. The weight of the egg would increase as water is 4 Sacroiliac joint.
transported across the membrane through osmosis to the inside
5 The matrix of compact bone is arranged in osteons, whereas the
of the egg.
matrix of cancellous bone is arranged in trabeculae. The matrix
7 ATP. of all three types of cartilage is the same—proteoglycans and
8 Codon: CGG; anticodon: GCC. water with fibers.
9 The DNA of a brain cell is identical to the DNA of a bone cell. 6 The matrix of bone is hard and does not allow for diffusion, so
There is only half of the amount of DNA in a sperm cell as there bone cells require a blood supply to supply nutrients and remove
is in a brain cell. wastes. Cartilage matrix does allow for diffusion to supply nutrients
10 Epithelial tissues (examples should be one of the following: simple and remove wastes, so no direct blood supply is necessary.
squamous, simple cuboidal, stratified squamous, simple columnar, 7 Yes. The shaft (diaphysis) of the humerus is compact bone
pseudostratified ciliated columnar, and transitional); connective arranged in osteons. The central canal of each osteon contains
tissues (examples should be one of the following: loose/areolar, blood vessels and a nerve. If the diaphysis is broken, the blood
dense regular, dense irregular, adipose, blood, cartilage, and vessels of each osteon would also be broken.

A-5
 8 Class: fibrous joint; type: syndesmosis. 9 In the sympathetic division, the preganglionic neuron is short
9 Endochondral ossification. and the postganglionic neuron is long. In the parasympathetic
division, the preganglionic neuron is long and the postganglionic
10 Calcium will be taken from the bone to bring blood calcium levels
neuron is short.
back to normal.
10 The local potential was at threshold when reaching the trigger
11 Discussion question; answers may vary. They should include
zone, resulting in an action potential for you, but it must
exercise to put stress on the bones and a diet rich in calcium and
have been subthreshold for the friend, so no action potential
vitamin D to ensure appositional bone growth.
resulted.
12 Complete, open, oblique fracture of the humerus.
11 The optic nerve.
13 X-ray.
12 Answers may vary but should include repetition of input over
14 Kyphosis. time to give the dendrites a chance to grow and make new
15 Osteosarcomas. connections for long-term memory.
16 Discussion question; answers may vary. 13 Wernicke’s area is for incoming language, of which there is none
in this example.
Chapter 5: The Muscular System 14 This helps maintain resting membrane potential.

1 Answers will vary. 15 A nerve conduction study uses electrodes to stimulate the nerve
while reading the conduction of the impulse as it reaches its end
2 Left. point.
3 Synergists for hip flexion: pectineus, iliacus, psoas major, 16 Discussion question; answers may vary.
iliopsoas, sartorius, tensor fasciae latae and rectus femoris.
Antagonists to hip flexors: biceps femoris and gluteus maximus.
Chapter 7: The Nervous System—Senses
4 Myofilament, myofibril, muscle fiber, fascicle, muscle.
1 Dermis.
5 A threshold amount.
2 Light.
6 The calcium cannot be actively transported back to the
sarcoplasmic reticulum between nerve impulses. 3 The first pathway can be the same as any other sensory input
from the skin:
7 More motor units are recruited when an egg is crushed.
8 Isometric—muscles tensed but no motion resulted. Unipolar neuron → spinal cord → medulla oblongata → pons →
midbrain → thalamus → parietal lobe.
9 Jessica’s muscles have a higher ratio of fast-twitch fibers
adapted for anaerobic respiration. Jennifer’s muscles have a In the second pathway, the signal travels from the spinal cord
higher ratio of slow-twitch fibers adapted for aerobic respiration. to the reticular formation in the brainstem. The reticular formation
Answers may vary for additional events. Jennifer’s events should filters the sensory signals and passes important pain messages
require endurance. Jessica’s events should require quick bursts to the parietal lobe directly for a physical response and to the
of energy. hypothalamus and limbic system for an emotional response to pain
10 Vegetarian. A nonvegetarian diet has more complete protein such as nausea and fear.
sources.
4 Yes, other sensory input such as texture, smell, temperature,
11 The posture becomes more stooped.
and pain are perceived by the brain along with taste to produce
12 Electromyography involves inserting a needle, which contains an flavors.
electrode, into the muscle. The electrode is able to measure the
activity of the nerve supplying the muscle. 5 You would still be able to detect the taste but probably not the
flavor of the food due to the impaired sense of smell because of
13 A sprain is a tear in the ligament. A strain is a tear in muscle the cold.
tissue or tendons.
6 The people who cannot smell garlic are missing a receptor for
14 Discussion question; answers may vary.
garlic.
7 Perilymph is the fluid within the tube in the cochlea. Endolymph
Chapter 6: The Nervous System is the fluid inside of the cochlear duct. Both are necessary for
1 Multipolar. hearing because vibrations of the oval window cause a series of
waves in the perilymph and endolymph that eventually cause the
2 Astrocytes prevent many medications from crossing the blood-
hair cells to bend. The pitch and volume of sound are determined
brain barrier. Microglia will seek out and fight the pathogen.
by which hair cell is bent and by how much.
3 It will rise.
8 The ossicles are used to amplify the vibration 20 times by the
4 The hypothalamus regulates temperature, autonomic functions time they reach the oval window. The arthritis may dampen the
(heart rate, blood vessel diameter, release of urine from the size of the vibrations reaching the oval window and, therefore,
bladder, endocrine functions (ADH and oxytocin production and decrease hearing.
secretion of hormones that stimulate hormone production from
the pituitary gland), monitors blood glucose and amino acid 9 Dynamic equilibrium; semicircular canals.
levels, hunger, sexual development, and sexual arousal. 10 The lateral corner of the eye so that the drops will wash over the
entire surface of the eye before being drained at the lacrimal
5 Interneurons.
punctum.
6 Smile: CN VII; stick out tongue: CN XII; move head from side to 11 Excess tears are being drained to the nose.
side: CN XI.
12 The medial and lateral rectus muscles move the eye side-to-
7 Olfactory, optic, and auditory. side. The medial rectus muscle is stimulated by the oculomotor
8 The synaptic knob of the preganglionic neuron synapses with the nerve (CN III), and the lateral rectus muscle is stimulated by the
dendrite of the postganglionic neuron. abducens nerve (CN VI).

A-6 APPENDIX C
13 It would be easier to determine the shape. Rods can be used 20 Positive feedback.
in low light conditions to determine shape. Cones are used to 21 Discussion question; answers may vary.
determine color, but they require more light. 22 Type 1 diabetes mellitus is caused by an attack by the immune
14 Answers will vary, but activities mentioned should require depth system on the islet cells of the pancreas. Type 2 diabetes
perception. mellitus is cause by an inability to respond to insulin produced
15 The Rinne test involves placing a vibrating tuning fork close to by the pancreas. Patients with type 1 diabetes must use insulin to
the ear. Sound waves produced by the fork are received by the regulate their blood glucose levels. Patients with type 2 diabetes
ear normally through the air to the outer ear, and then vibrations can be treated with medications that increase cells’ sensitivity
should be conducted to the middle ear. The Weber test involves to insulin, dietary changes that moderate blood glucose levels,
placing the base of a vibrating tuning fork on the bone of the and exercise, which encourages up-regulation of receptors
skull behind the ear, causing the inner ear to vibrate directly. and insulin. Both types of this disease have similar symptoms
16 Both hyperopia and presbyopia affect near vision. Hyperopia, or including glucosuria, polyuria, polydipsia, and polyphagia.
farsightedness, is a condition in which the cornea and lens focus 23 Hypothyroidism can be caused by Hashimoto’s disease or
the image behind the retina; presbyopia involves ciliary muscles treatment of hyperthyroidism by radiation or surgical removal of
and suspensory ligaments that are not as able to accommodate part of the thyroid gland. Hyperthyroidism can be caused by a
the shape of the lens with age. goiter or Graves’ disease.
24 Addison’s disease: degeneration of the adrenal cortex,
which results in hyposecretion of glucocorticoid hormones,
Chapter 8: The Endocrine System mineralocorticoid hormones, and androgens.
1 Receptors for insulin. Diabetes insipidus: a disorder in which the posterior pituitary does not
release sufficient ADH to cause water reabsorption in the kidney.
2 No, the insulin will travel throughout the body in the bloodstream
and will affect all cells that have a receptor for it. Diabetes mellitus: a disorder that results from insufficient insulin pro-
duced by the pancreas or an insufficient response to the insulin that
3 Mineralocorticoids (aldosterone) promote sodium and water
is produced.
reabsorption; promote potassium excretion; maintain blood
volume and pressure. Hashimoto’s disease: an autoimmune disorder characterized by hypo-
secretion of thyroid hormone from the thyroid gland.
PTH (parathyroid hormone) stimulates reabsorption of calcium by the
kidneys to maintain blood calcium levels. Pituitary dwarfism: hyposecretion of GH from the anterior pituitary gland,
which happens during childhood, resulting in unusually short stature.
ADH (antidiuretic hormone) increases water retention.
4 They are called releasing hormones.
Chapter 9: The Cardiovascular System—Blood
5 No, it is not likely because they have opposite functions.
Calcitonin functions to stimulate the deposition of calcium in the 1 It is cells in a matrix. The cells are the formed elements. The
bone while PTH stimulates the reabsorption of calcium from the matrix is plasma.
bone. 2 Answers will vary. The answer should include a hormone, the
6 Both hormones speed the production of sebum by sebaceous endocrine gland that produced it, and its target tissue.
glands and speed the deposition of bone by osteoblasts. 3 Less than 1%.
7 Steroids. 4 They are stained so that they can be seen and differentiated
8 Autocrine hormones are secreted by the same tissue that they from one another.
target. Pheromones are chemicals that cause a response outside 5 Basophils and eosinophils.
of the body in another individual.
6 The Denver player would have a higher RBC count because of
9 A hormone stimulating a gland. the increased altitude.
10 It is important to have epinephrine when it is needed to 7 The Miami Heat player probably has a higher RBC count because
complement the sympathetic nervous system. It helps prepare of the increased demand for oxygen due to the level of exercise
for fight or flight. A long half-life of epinephrine during restful of a professional athlete.
times would not be an advantage because it would put a strain
on the heart. 8 Low iron levels will result in a decrease in the amount of oxygen
needed for red blood cells to function. Red blood cells carry
11 A substance other than a hormone. In this case, it was glucose.
oxygen from the lungs to the tissues; decreased iron will affect
12 Negative feedback. the transport of oxygen to tissues.
13 No. Hormones are secreted when there is a need. Insulin and 9 Lymphocytes spend much of their lives in tissues, not in
glucagon have opposite effects, so they would not be used in circulation.
response to the same need.
10 The extrinsic pathway is initiated by damaged tissues, while the
14 Breast development, start of menstruation, greater deposition of intrinsic pathway is initiated by platelets. Both pathways require
fat, axillary and pubic hair growth. calcium and their own set of clotting factors. There are fewer steps
15 FSH and LH would target the testes instead of the ovaries, in the extrinsic pathway, so it is faster (15 seconds). The intrinsic
resulting in the production of testosterone and male secondary pathway involves more steps, so it is slower (3 to 6 minutes).
sex characteristics. 11 Platelets secrete vasoconstrictors in vascular spasm, form
16 Axillary, facial, and pubic hair; skeletal and muscle development; platelet plugs, and start the intrinsic pathway of coagulation.
deeper voice; aggression; sperm production. 12 A type-A person would have A antigens on the surface of the
17 Sodium and potassium. blood cells and anti-B antibodies dissolved in plasma.
18 Her sex drive would be reduced. She does not have an 13 No, because the Rh antigen is present on the Rh+ person’s cells.
alternative source for androgens. It is not foreign. Antibodies are produced only to respond to
19 Neural stimulation of a gland. foreign antigens.

APPENDIX C A-7
14 Type B− could donate to blood types B−, B+, AB−, and AB+. Chapter 11: The Lymphatic System
Type B− could receive blood from types B− and O−. You would
not want to expose an Rh-negative person to Rh antigens to 1 The left subclavian vein.
promote an immune response. 2 The thoracic duct.
15 During the pregnancy, fetal blood and maternal blood do not mix. 3 Without a sufficient number of healthy T cells, a person’s immune
At delivery, the placenta tears away from the wall of the uterus so system will have deficiencies in nonspecific defense and specific
that it can be delivered after the baby. Mixing of some of the fetal immunity. The immune system will not be able to recognize
blood cells with the mother’s blood is likely during this process. foreign pathogens and activate cells to fight them. T cells will
As a result, the mother is exposed to fetal blood that contains not be able to directly kill cells infected by viruses and cancer in
the Rh antigen. At this point, after delivery, the mother begins to specific immunity; they will not be able to remember pathogens
make anti-Rh antibodies. that have been introduced to the body; and they will not be able
16 100. They are percentages. to suppress an immune response.
17 Smoking can cause secondary polycythemia, which results in 4 It produces the cells used in this system (leukocytes and,
more formed elements in the blood than normal for the amount specifically, lymphocytes).
of plasma. This makes the blood thicker and harder for the heart 5 The cervical lymph nodes.
to pump the blood in the vessels. As a result, this increases the
heart’s workload and elevates blood pressure.
6 Increased heat from increased blood flow raises the local
metabolic rate to promote cell division.
18 Leukocytosis is a normal response to a challenge to the immune
system; it does not always indicate the presence of disease. 7 Increased amount of lymph washes away debris, and increased
vessel permeability allows macrophages to have easier access
to the area of damage for phagocytosis.
Chapter 10: The Cardiovascular System—Heart and 8 Increased vessel permeability allows leukocytes to have access
Vessels to the area, and chemotaxis draws leukocytes to the site of the
damaged tissues and pathogens so that they can be destroyed.
1 The apex of the heart.
9 An antigen-presenting cell phagocytizes an antigen, processes
2 The left ventricle has a thicker outer wall because it has a larger it, and displays a fragment of the antigen on an MHC protein on
workload.
the surface of the cell. If the MHC displays a foreign epitope, a
3 Myoglobin stores oxygen so that cardiac muscle can continue to specific immune response is initiated.
perform aerobic respiration. 10 The antibodies agglutinate the antigens.
4 The right ventricle. 11 The B cell in humoral immunity is safe and secure in lymphoid
5 Aortic valve. tissue while antibodies attack the pathogen anywhere in the
6 SA node, AV node, AV bundle, AV bundle branches, Purkinje fibers. body. In cellular immunity, the Tcytotoxic cell is at the site of the
pathogen delivering a direct and lethal cell-to-cell hit.
7 All chambers.
12 Artificial passive immunity. Rhogam is Rh antibodies.
8 All the chambers are filling with blood. The heart is at rest.
13 In humoral immunity, Thelper cells bind to B cells displaying foreign
9 Eight liters per minute. epitopes and direct them to clone themselves, producing plasma
10 The heart rate would likely increase because of the caffeine and B cells and memory B cells. In cellular immunity, a Thelper cell
nicotine. reacts by binding to the APC that it recognizes as foreign. It
11 Arteries have a thick tunic media layer composed mostly of verifies that the epitope is foreign by binding to a costimulation
smooth muscle, which provides enough force for the blood to protein on the APC, if there is one. The T cell then releases
be transported away from the heart to parts of the body. Veins interleukin-1 to cause cloning, forming many Tcytotoxic cells,
have a tunica interna with valves that help direct the flow of blood Thelper cells, and Tmemory cells that all recognize this antigen as
to the heart by preventing backflow. Capillaries have thin walls foreign. The Thelper cells of the clone secrete interleukins to
composed of endothelium, which allows fluids and other materials attract neutrophils and NK cells to the area, attract and activate
to be exchanged between the tissues and the capillary blood. macrophages to clean up any debris, and further activate more
Tcytotoxic and B cells.
12 Afterload.
14 Answers will vary but should mention the ability of imaging tests
13 It would be greater in the aorta because the aorta has a greater
to view internal structures of the body.
diameter than the femoral artery and it is closer to the heart.
15 Hypersensitivities or allergies involve an overreaction of the
14 Pulse pressure = 54 mmHg; MAP = 96 + 1/3(54) = 114 mmHg.
immune system to an allergen. Immunodeficiency disorders are
15 Damage to the vasomotor and cardiac centers of the medulla characterized as immune disorders that cause a deficiency in the
oblongata may result in an inability of the baroreflex, chemoreflex, immune system’s ability to defend the body. Autoimmune disorders
and medullary ischemic reflex to regulate blood pressure and flow. are characterized as an inability of the immune system to distinguish
16 Answers will vary. Some examples may include: regular exercise between its own tissues (self) and foreign tissue or cells (nonself).
to promote efficient myocardium and collateral circulation, a
healthy diet low in sodium to avoid hypertension, and healthy
lifestyle choices such as not smoking, which may lead to
Chapter 12: The Respiratory System
polycythemia and high blood pressure. 1 It is a stronger, more durable tissue to withstand probing fingers.
17 Discussion question; answers may vary. 2 The cilia in the nasopharynx move the debris down to the
18 Patients with heart failure experience decreased stroke oropharynx, while the cilia of the trachea move the debris up
volume due to the inability of the heart to sufficiently pump toward the pharynx.
blood. Preload is increased to compensate for a decrease in 3 The air should be warmed and moistened because it has
contractility. Afterload is decreased. bypassed much of the mucous membranes of the upper
19 Discussion question; answers may vary. respiratory tract.

A-8 APPENDIX C
 4 The washer will travel to the nasal cavity, to the nasopharynx, to for lipid digestion. If lipids are not digested, they cannot be
the oropharynx, to the laryngopharynx, through the glottis to the absorbed. Fat-soluble vitamins’ absorption would also be
larynx, to the trachea, to a main bronchus, and—depending on diminished because they are absorbed with digested lipids.
the size of the washer—to the bronchial tree. 11 The discharge from an ileostomy would be similar to diarrhea
5 The metal washer will most likely go down the right bronchus because water would not have been absorbed in the colon. The
into the right lung because the right bronchus is more vertical absorption of water, vitamin K, and electrolytes such as Cl− would
than the left bronchus. The washer is more likely to follow a be diminished.
straight line than make a turn at the left bronchus.
6 The vessel does not have a single layer to its wall, so it cannot Chapter 14: The Excretory/Urinary System
be a capillary. The tube does not have any cartilage, so it cannot
1 The parietal peritoneum.
be a bronchus.
2 The renal corpuscle (glomerulus and glomerular capsule), the
7 PCO2 = 0.26 mmHg, PO2 = 133.7 mmHg.
proximal convoluted tubule, the nephron loop, and the distal
8 The relevant gas is O2. Although the partial pressure of O2 is less convoluted tubule, which leads to a collecting duct.
in Grace’s expired air than partial pressure of O2 in her inspired air,
3 The peritubular capillaries.
the PO2 of expired air from Grace is still greater than the PO2 of
the victim’s blood at the alveoli, so O2 will diffuse into the victim’s 4 No. High blood pressure is pushing materials out of the capillaries
blood at the alveoli until the partial pressures of O2 are equal. in the renal corpuscle during filtration. This must happen before
some of these materials are reabsorbed back into the capillaries.
9 New York City. The partial pressures of each gas are greater in
New York City because the total pressure is greater than that in 5 Losing sweat that is less concentrated than his extracellular fluid
Breckenridge. So there is a greater concentration of each gas in means that water will leave Jake’s blood to the extracellular fluid
New York City. compartment, making the concentration of his blood higher.
Jake’s hypothalamus will recognize the increased concentration
10 Answers will vary but can include exposure to a work
of his blood and respond by increasing his thirst and stimulating
environment that contains polluted air or water, lack of exercise,
his posterior pituitary to release ADH. ADH will increase water
and drug abuse.
reabsorption in his nephrons and allow excess solutes to go out
11 Obstructive sleep apnea may cause a decrease in blood pH and with urine.
O2 levels and an increase in CO2 levels.
6 The juxtaglomerular apparatus must first notice the fall in
12 Discussion question; answers may vary.
blood pressure. It then secretes renin, which changes a protein
13 Acute respiratory distress syndrome is respiratory distress in from the liver to angiotensin I. ACE converts angiotensin I to
patients who are already experiencing illness or have had major angiotensin II. Angiotensin II travels to the adrenal cortex,
trauma. Hyaline membrane disease is respiratory distress in causing it to secrete aldosterone. Once aldosterone is received
premature infants due to the collapse of alveoli from the lack of by the kidneys, more sodium is actively transported from the
surfactant. tubule to the peritubular capillaries, and water follows sodium
through osmosis.
Chapter 13: The Digestive System 7 Glomerular filtration can be increased by increasing the
1 Mechanical digestion of a complex carbohydrate results in small diameter of the afferent arteriole leading to the renal corpuscle,
pieces of complex carbohydrates, while chemical digestion of a decreasing the diameter of the efferent arteriole exiting the renal
complex carbohydrate results in monosaccharides. corpuscle, or a combination of both.

2 Answers will vary. 8 ADH will conserve water without conserving sodium.
3 Caries form when acids from bacteria erode a tooth’s enamel. 9 ANH will be released by cells in the right atrium in response to
Lysozymes and antibodies in saliva inhibit bacteria growth. the increased blood pressure as a direct result of the increased
Chewing sugarless gum increases the amount of saliva, and blood volume.
therefore lysozymes and antibodies, without contributing to the 10 Intravenous pyelography is an X-ray of the kidneys and
feeding of bacteria. the urinary tract that involves using contrast dye injected
intravenously.
4 The bolus travels from the oral cavity to the oropharynx, to the
laryngopharynx, to the esophagus, and to the stomach. 11 Fluid intake adds to blood volume. Increased blood volume
means increased blood pressure. Fluid intake would have to be
5 The lingual lipase and gastric lipase would digest cell membranes,
monitored closely as excess fluids would be cleared from the
and the pepsin that forms in the stomach would begin to
system only three times a week.
chemically digest the proteins of the smooth muscle walls.
6 Bile flows through the cystic duct. Bile flows through the common
bile duct. Bicarbonate ions and enzymes for carbohydrate, Chapter 15: The Male Reproductive System
protein, and lipid digestion flow through the pancreatic duct. 1 The testes are too warm in the abdominal cavity to produce
7 3 mL. viable sperm.
8 Cholecystokinin causes the hepatopancreatic sphincter to relax 2 The least number is based on 1 seminiferous tubule per 250
so that the bicarbonate ions and enzymes from the pancreas can lobules = 250 seminiferous tubules. The greatest number
enter the duodenum. is based on 4 seminiferous tubules per 300 lobules = 1,200
seminiferous tubules.
9 Answers will vary. The larger diameter and lack of villi would
suggest that the large intestine is not designed for nutrient 3 The dartos muscle, the cremaster muscles, and the pampiniform
absorption. plexus that is in each spermatic cord.
10 The liver produces bile necessary for lipid digestion from 4 Semen is approximately 10% sperm, 60% nourishing fluid from
cholesterol, a fat commonly found in the diet. A fat-free diet the seminal vesicles, 30% alkaline fluid from the prostate, and
would limit the liver’s ability to produce the bile necessary trace amounts of a lubricating fluid from the bulbourethral glands.

APPENDIX C A-9
 5 The acrosome cap contains enzymes to penetrate the egg. The during orgasm. The vestibular bulbs also tighten around the
23 chromosomes in the head are the genetic material to fertilize penis, and the vestibular glands secrete a lubricant to make
the egg. The large mitochondria are needed to make use of intercourse easier.
available oxygen to perform cellular respiration. This supplies the 4 Their body fat is too low, and they have insufficient cholesterol to
necessary ATP to move the tail that propels the sperm to where produce estrogen.
they have to go—the egg.
5 A follicle cares for the primary and secondary oocyte by
6 FSH targets sustentacular cells, and LH targets interstitial cells. providing nutrients, removing wastes, and protecting it from the
7 Each spermatid has a set of 23 chromosomes, but each set of 23 woman’s immune system.
chromosomes differs from the other sets. 6 A woman’s eggs are as old as she is, whereas a man’s sperm are
8 It is reabsorbed in the epididymis. at most 40 to 60 days old once they are mature.
9 If the blood-testis barrier is damaged, immune system cells 7 If we assume she ovulated 1 egg per cycle and had 28-day
will recognize spermatocytes as foreign and will mount a cycles (13 per year), she would have ovulated 520 eggs over the
specific immune response to attack them. Because a specific 40 years between ages 13 and 53. She likely had 400,000 eggs
immune response involves memory cells, the attacks against at puberty, and few if any after menopause.
spermatocytes will be lifelong, which would lead to sterility. 8 The egg is ovulated on day 14. If the egg is fertilized on that day,
10 None, because it has no effect on LH production. 8 or 9 days from then would be day 22 or day 23. However, the
11 (a) The effect of anabolic steroids on the body in general would egg can remain viable for 24 hours and still be fertilized. So it
be that male secondary sex characteristics would be more could also be fertilized on day 15. Then early detection would
pronounced. occur as soon as day 23 or day 24.
(b) The hypothalamus would produce less GnRH due to negative 9 All of her follicles and oocytes were produced before she was
feedback effects from the anabolic steroids. born. Many have died through atresia, and many others have
(c) The anterior pituitary’s sensitivity to GnRH would be reduced. been developed, ovulated, and been discharged from her body
(d) Because the anterior pituitary is less sensitive to decreased with menstruation. Still others began development each month
amounts of GnRH, the anterior pituitary would produce little or and underwent atresia before being ovulated. She does not
no FSH and LH. continue to develop any more follicles after birth.
(e) Without the stimulation of FSH and LH, the testes have little to 10 Beneficial bacteria feed off glycogen, provided by the stratified
do and would decrease in size. squamous epithelial lining of the vagina. This results in a low pH
(f) Decreased FSH would result in little or no sperm production. in the vagina that discourages the growth of microorganisms,
12 An erection may be stimulated as a reflex by stimulating the including yeast. Atrophy of the lining decreases the support for
penis, or it may be initiated because of sound, smell, sight, or the beneficial bacteria.
thought. 11 They would cease due to the lack of estrogen and progesterone.
13 The artery delivering blood to the penis dilates, the erectile 12 The vagina.
tissues fill with blood, and the veins become compressed so that
the excess blood cannot leave the penis. 13 Assuming the female ovulates sometime on day 14, her egg
would remain viable until sometime on day 15. Sperm on the
14 A male should perform self-testicular exams starting in his other hand can remain viable in her body up to 6 days, so
teens to detect testicular cancer, and have regular digital rectal sperm deposited sometime on day 9 could still fertilize an egg
exams and PSA screenings later in life to detect benign prostatic on day 14. The window of opportunity for an egg to be fertilized
hyperplasia and prostate cancer, respectively. He should practice is days 9–15 of her sexual cycle. The problem is not knowing
safe sex to avoid sexually transmitted diseases. ahead of time the exact day of ovulation for each cycle.
14 Answers will vary, but the menu should be balanced and include
Chapter 16: The Female Reproductive System all of the essential nutrients—folic acid, calcium, protein, and
1 Ovaries produce gametes (ova) and hormones. iron—without a high caloric intake.
2 Mucous glands in the cervix produce a thick mucus to block the 15 This would affect a woman’s fertility only each time an egg
entrance to the uterus. is released from the ovary on the side from which the tube
was removed. She would still be able to conceive if the egg is
3 The vagina constricts around the penis during plateau in the
released from the ovary on the same side as the remaining tube.
sexual response, and along with the uterus rhythmically contracts

A-10 APPENDIX C
 D

Appendix
PREFIXES, SUFFIXES, AND ADDITIONAL WORD ROOTS

Anatomy and physiology and all health care fields rely on language that includes medical terminolgy. Word roots with their definitions
are listed in each of the system chapters of this text. Here, common prefixes, suffixes, and additional word roots are listed with their
definitions. Some of the word roots listed in system chapters are repeated here if they might be used to answer chapter review questions
outside the system chapters in which the word roots were introduced.

a-, an- no; without; lack of eu- good; normal -osis condition, usually abnormal
ab- away from ex- out; away from -ous pertaining to
-able capable extra- outside ox/o oxygen
acr- extremity -ferent to carry par- other than; abnormal
-ad toward fibr/o fiber para- near; beside
-al pertaining to -form resembling -paresis weakness
-algia pain -genesis origin -pathy disease
-an pertaining to ger/o old age ped/o child; foot
-ant thing that promotes; thing -graphy process of recording -penia deficiency
acted upon hem/o blood -pepsia digestion
anti- against; reversed hemi- half per- through
-ar pertaining to home/o same peri- surrounding
arthr/o- joint hydr/o water -phage eat; swallow
-ary associated with hyper- above; excessive -pheresis removal
-asthenia lack of strength hypo- under; deficient -plasia development; formation;
auto- self -ia condition growth
bi- two -ic pertaining to -plasm formation; structure
bi/o life -ile pertaining to -poiesis formation
carcin/o cancerous; cancer im- not poly- many; much
cardi/o heart in- into; in post- after; behind
-cele hernia inter- between pre- before
-centesis surgical puncture to remove intra- within; inside pro- before; forward
fluid pseudo- false
-ion process
-ceptor taker; receiver re- back; again
-ism process; condition
chem/o drug; chemical retro- behind; back
-itis inflammation
chron/o time -rrhea flow; discharge
-kinesia movement
-cide killing -scope instrument for visual
lapar/o abdominal wall; abdomen
-clast to break examination
-lapse slide; fall
con- together with -scopy visual examination
-logist person who studies or is an
-constriction narrowing expert in the field semi- half
-crit separate -logy study of -sis state of; condition
cyt/o cell -lysis breakdown; destruction -stenosis tightening
-cyte cell macro- large -stomy new opening
de- away from mal- bad sub- under; below
dia- through medi/o middle -suppressant agent that reduces or
-dilation widening; expanding diminishes activity
-megaly enlargement
dist/o far; distant sym- together; with
meta- change; beyond
-duct- leading -tic pertaining to
-metry process of measuring
-dynia pain -tomy process of cutting
mort/o death
dys- bad; abnormal -tory pertaining to
mut/a genetic change
-eal pertaining to trans- across; through
my/o muscle
ec- out; outside -trophy nourishment; development
necr/o death (condition of)
-ectomy removal; cut out neo- new -tropin stimulate; act on
-edema swelling -oid resembling; derived from -um structure; tissue
-emia blood condition -oma tumor; mass; fluid collection uni- one
endo- in; within onc/o tumor -us structure; thing
epi- above; upon; on -opia vision condition -verse to turn
erythr/o red -or one who -y condition; process
eti/o cause -ose full of; pertaining to; sugar

A-11
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 Endnotes
Chapter 2 3. Time. (2009, November 16). A brief history of heart transplants.
Available from http://content.time.com/health/article/0,8599,
1. Kerem, B., Rommens, J.M., Buchanan, J.A., Markiewicz, D., Cox, 1939493,00.html.
T.K., Chakravarti, A., Buchwald, M., et al. (1989, September 8).
Identification of the cystic fibrosis gene: Genetic analysis. Science
Magazine, 245, 1073–1080.
Chapter 12
1. National Human Genome Research Institute. (2010, July 2). Learning
Chapter 3 about cystic fibrosis. Retrieved September 22, 2010, from http://www
1. Smith, R.R., & Kennedy, J. (1991). Instructor’s resource manual .genome.gov/10001213.
and test bank to accompany essentials of anatomy and physiology.
St. Louis, MO: Mosby-Year Book.
2. American Academy of Dermatology. (n.d.). How to examine your Chapter 14
skin. Retrieved from http://www.aad.org/skin-conditions/skin-cancer 1. Beers, M.H., Porter, R.S., Jones, T.V., Kaplan, J.L., & Berkwits, M.
-detection/about-skin-self-exams/how-to-examine-your-skin. (Eds.). (2006). The Merck manual of diagnosis and therapy (18th ed.).
Whitehouse Station, NJ: Merck Research Laboratories.
Chapter 4
1. Centers for Disease Control and Prevention. (2010, April 15). Chapter 15
Arthritis. Retrieved April 29, 2010, from http://www.cdc.gov/arthritis/.
1. Beers, M.H., Porter, R.S., Jones, T.V., Kaplan, J.L., & Berkwits, M.
(Eds.). (2006). The Merck manual of diagnosis and therapy (18th ed.).
Chapter 7 Whitehouse Station, NJ: Merck Research Laboratories.
2. American Academy of Pediatrics. (2012). Policy statement: HPV
1. University of Maryland Medical Center. (2009, February 19). Aging vaccine recommendations. Pediatrics, 129(3), 602–605.
changes in the senses—overview. Retrieved June 3, 2010, from Available from http://pediatrics.aappublications.org/content
http://www.umm.edu/ency/article/004013.htm. /120/3/666.full.
Centers for Disease Control and Prevention. (2011). Vaccines
Chapter 8 and preventable diseases: HPV vaccine—questions & answers.
Available from http://www.cdc.gov/vaccines/vpd-vac/hpv/vac
1. Centers for Disease Control and Prevention. (2011). National diabetes -faqs.htm.
fact sheet: National estimates and general information on diabetes
and prediabetes in the United States, 2011. Atlanta, GA: U.S.
Department of Health and Human Services. Chapter 16
1. National Cancer Institute. (2010, September 7). For women with
Chapter 11 BRCA mutations, prophylactic surgery reduces cancer risk. NCI
1. Organ Procurement and Transplantation Network. (2016, January 9). Cancer Bulletin, 7(17).
More than 30,000 transplants performed annually for first time in 2. Mayo Clinic. (2010, December 8). Pregnancy diet: Essential
United States. Available from https://optn.transplant.hrsa.gov/news nutrients when you’re eating for two. Retrieved December 8, 2010,
/more-than-30-000-transplants-performed-annually-for-first-time-in from http://www.mayoclinic.com/health/pregnancy-nutrition
-united-states/. /PR00110.
2. History.com Staff. (1967, December 3). First human heart transplant. 3. Beers, M.H., Porter, R.S., Jones, T.V., Kaplan, J.L., & Berkwits, M.
Available from www.history.com/this-day-in-history/first-human (Eds.). (2006). The Merck manual of diagnosis and therapy (18th ed.).
-heart-transplant. Whitehouse Station, NJ: Merck Research Laboratories.

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 Glossary
The following terms are defined in the context in which they were used in this text.

a
anaphylaxis: systemic vasodilation (system wide dilation of
blood vessels) that occurs within a few minutes of exposure to
an allergen and can cause a drop in blood pressure and even
abdominal: pertaining to the belly region.
cardiac failure.
abdominal hernias: protrusions of the abdomen’s contents
anastomoses: circulatory routes that involve vessels merging
through a weak portion of the abdominal wall.
together.
absorption: the process of putting something into the blood for
the first time. For example, the small intestine absorbs calcium anatomy: the study of body structures.
from the diet, increasing blood calcium levels. androgens: hormones produced by the adrenal cortex that are
accommodation: the ability of the eye to change the shape of the responsible for male secondary sex characteristics and for sex
lens to keep an image in focus with a change in distance. drive in both genders.
acetylcholine (ACh): neurotransmitter released to stimulate a aneurysm: a weakness in an arterial wall that can balloon out and
contraction of skeletal muscle tissue. rupture.
acid: a molecule that releases a hydrogen ion (H+) when added to angiogenesis: new blood vessel growth.
water. antagonist: a muscle that has an opposite action.
acidosis: condition in which the pH of blood is less than 7.35. antibody: a dissolved protein in plasma that carries out an
acne: condition in which sebaceous ducts become plugged, immune response to a specific antigen.
bacteria grow in the plugged ducts causing inflammation, hair antigen: any molecule whose shape promotes an immune
follicle walls break down due to the increased inflammation, response.
and the pus formed causes pimples. antigen-presenting cell (APC): a cell that samples its
acquired immune deficiency syndrome (AIDS): the final stage environment and posts what it finds. Examples are B cells and
of an HIV infection, in which the immune system fails to macrophages.
provide protection against pathogens. aphasia: any language deficit resulting from damage to either
acquired immunity: term that refers to how the forms of specific Wernicke’s or Broca’s area.
immunity are acquired. Examples are natural active immunity, apoptosis: programmed cell death.
natural passive immunity, artificial active immunity, and appendicular: pertaining to the body region that includes the
artificial passive immunity. arms and legs.
acromegaly: an endocrine disorder resulting from too much appendicular skeleton: the bones of the arms, legs, and girdles
growth hormone in adulthood. Bones become more massive (the bones that attach the arms and legs to the trunk).
through excessive appositional bone growth. appositional bone growth: type of growth that occurs in all bones
action potential: the flow of electricity along an axon of a neuron to make them more massive.
in one direction—from the trigger zone to the synaptic knob. arrhythmia: an abnormal heart rhythm.
active transport: movement of materials across a cell membrane arthritis: inflammation of a joint.
from areas of low concentration to areas of high concentration; articular cartilage: a hyaline cartilage covering over the
requires energy. epiphyses of long bones.
acute: having rapid onset with severe symptoms and a short articulation: joint formed where two or more bones meet.
duration. astigmatism: a condition caused by an irregular curvature of the
aerobic respiration: type of cellular respiration requiring oxygen cornea or the lens of the eye that results in images not being
that results in enough energy to generate 36 ATP molecules from clearly focused on the retina.
every glucose molecule and produces carbon dioxide and water. atherosclerosis: the buildup of fatty deposits within arterial walls,
afferent: in the direction toward the brain or spinal cord in the which causes the walls to roughen and project to the lumen
nervous system. (open space) within the vessel.
afterbirth: the placenta and its associated membranes delivered atom: the smallest piece of an element still exhibiting the
after the baby. element’s unique set of chemical properties.
afterload: the pressure in the pulmonary trunk and aorta during atresia: process in which oogonia and primary oocytes
diastole. degenerate.
agglutination: an immune response in which antibodies clump atrophy: shrinkage of tissue due to a decrease in cell size or
cells with specific antigens. number.
alimentary canal: the gastrointestinal tract that begins at the autocrine: term that refers to the secretion of a hormone by the
mouth and ends at the anus. cells of the same tissue that it targets.
alkalosis: condition in which the pH of blood is greater than 7.45. autonomic: type of nerve message that goes to glands, the cardiac
alveoli: tiny air sacs in the lung at which gas exchange takes place. muscle of the heart, or the smooth muscle of hollow organs and
anaerobic respiration: type of cellular respiration in the absence blood vessels.
of oxygen that results in enough energy to generate 2 ATP axial: pertaining to the body region that includes the head, neck,
molecules from every glucose molecule and produces lactic and trunk.
acid. axial skeleton: the bones of the head, neck, and trunk.

G-1
axon: portion of a neuron that carries electrical impulses along chemical reaction: interaction between molecules that results in
its length from the cell body to the synaptic knobs at the end products.
of the neuron. chemotaxis: process in which WBCs move to where the
concentration of chemicals from damaged tissues is the greatest.
b chondrocyte: cartilage cell that produces a cartilage matrix of
proteoglycans and water.
baroreceptors: sensors located in the aorta and carotid arteries chromosomes: tightly bundled packages of DNA that are present
that detect changes in blood pressure. in a cell only for cell division.
base: a molecule that will accept a hydrogen ion, often by chronic: having slow progression and long duration.
releasing a hydroxide ion (OH−) when added to water. chronic obstructive pulmonary disorders (COPDs): disorders
benign: the inability of a tumor to spread or metastasize to other that cause a long-term decrease in ventilation of the lungs.
areas of the body. chronotropic factor: anything that changes the heart rate.
bilirubin: a waste produced from the breakdown of worn-out red
chyme: the liquefied contents of the stomach.
blood cells.
cleft palate: a common craniofacial congenital defect
bipolar neuron: type of sensory neuron with one dendrite and
characterized by the failure of the hard or soft palate to fuse
one axon; found in the nasal cavity, the retina of the eye, and
during gestation.
the inner ear.
climacteric: a period of life for men and women, usually
blood flow: the amount of blood flowing to an area in a given
beginning about age 50, in which reproductive hormone levels
amount of time, usually expressed in mL/min.
change. This period is typically called andropause in the male
blood-testis barrier (BTB): a barrier formed by sustentacular cells
and menopause in the female.
to isolate spermatocytes from the immune system in the male.
closed reduction: procedure that sets the edges of a fracture in
bolus: a chewed bite of food mixed with saliva.
proper alignment by manipulating the bone without surgery.
bronchial tree: series of ever-decreasing-size tubes branching
clotting factor: an inactive chemical in the blood that, when
from the bronchi and ending with bronchioles in the lungs.
activated, promotes a reaction cascade to form a clot.
bronchitis: inflammation of the bronchial tubes.
buffer: something that resists a change in pH. coagulation: blood clotting; the third step in hemostasis.
colostrum: a thin, watery fluid containing protein, lactose (milk

c sugar), and many antibodies but one-third less fat than breast milk.
comminuted: a fracture in which the bone is broken into three or
calcitriol: active vitamin D. more pieces.
callus: collagen and fibrocartilage deposited in a fracture by communicable diseases: infectious diseases that spread from
periosteum stem cells. person to person.
cancellous bone: bone connective tissue that has a spongy compact bone: bone connective tissue arranged in a series of
appearance and is characterized by plates and slivers called osteons. It is found in the shafts of long bones and the surfaces
trabeculae. It is found in the end of long bones and in the of flat and irregular bones.
middle of flat and irregular bones. complement system: 20 inactive proteins (always present in the
capacitation: process in which the acids of the vagina and blood) that, when activated by the presence of a pathogen,
other fluids of the female reproductive tract break down the initiate one of several pathways to ensure pathogen destruction.
cholesterol of the sperms’ cell membrane and stimulate the complete proteins: proteins in the diet that contain all the amino
sperm to swim faster so that, after 10 hours, the sperm are able acids necessary for the human body.
to release the enzymes of the acrosome cap to penetrate an egg. compliance: measurement of how well the lungs can expand and
carcinogen: chemical or environmental agent that causes cancer. return to shape.
cardiac cycle: one complete contraction and relaxation of the heart. concentration gradient: difference in chemical concentration from
cardiac output: the amount of blood ejected by each ventricle of one ___location to another, such as the two sides of a cell membrane.
the heart each minute. congenital: present at birth.
cardiac reserve: the difference between the cardiac output of a heart conjugation: process performed by the liver in which water-
at rest and the maximum cardiac output the heart can achieve. soluble molecules are bound to a hormone so that it will be
caries: an erosion through the enamel of a tooth into the dentin. excreted at a faster rate.
cataract: a clouding of the lens of the eye that causes a conjunctivitis: an inflammation of the conjunctiva.
progressive, painless loss of vision. connective tissues: tissues that have cells and fibers in a matrix
cellular immunity: form of specific immunity that involves (a background substance).
Tcytotoxic cells directly attacking cells with a foreign antigen. constipation: condition in which defecation is difficult because
Also called cell-mediated immunity. too much water has been removed from the feces.
cellular respiration: important chemical reaction performed contact inhibition: the end of keratinocyte lateral growth because
by mitochondria in cells to release energy. (Glucose + edges of stratum basale cells are in contact with each other.
oxygen yields carbon dioxide + water + energy, cornification: process in which keratinocytes fill with keratin and
C6H12O6 + 6O2 → 6CO2 + 6H2O + energy.) die as they move toward the surface of the epidermis.
cerebrospinal fluid (CSF): fluid surrounding the brain and spinal covalent bond: formation of a molecule that occurs when two or
cord that is made by ependymal cells lining cavities in the brain more atoms bind by sharing their electrons to fill their outer shells.
called ventricles. cranial: pertaining to the cavity in the head that houses the brain.
cerebrovascular accident (CVA): a condition that happens when part crossing-over: an event in meiosis in which chromatids break and
of the brain dies due to a lack of blood supply. Also called stroke. exchange parts.
chemical digestion: the breakdown of complex molecules to their crowning: the appearance of the baby’s head at the vaginal
building blocks so that they can be absorbed. opening during birth.

G-2 GLOSSARY
cryptorchidism: a condition in which a male infant is born with endocytosis: movement of materials into the cell in bulk.
undescended testes. epidemiology: the study of how disease affects the overall health
cutaneous: pertaining to the skin. and well-being of a population.
cystectomy: surgical removal of the urinary bladder. epidermis: superficial layer of the skin that is subdivided into four
cystitis: an inflammation of the urinary bladder, usually caused by or five general layers called strata.
a bacterial infection. epiphyseal plate: zone of cartilage between the epiphysis and
cystoscopy: procedure in which the urinary bladder is viewed by diaphysis in an immature long bone; commonly called the
using an endoscope. growth plate.
epiphyses: clubby ends of long bones.
d episiotomy: an incision made in a female’s perineum to widen the
vaginal opening during birth.
decremental: decrease with distance. epithelial tissues: tissues that cover and line all body surfaces and
defecation: the process of removing feces from the body. have a basement membrane.
deglutition: the process of swallowing. epitope: antigen fragment.
dementia: the loss of cognitive function such as thinking, erection: a stage in the male sexual response in which the erectile
remembering, and reasoning. tissues of the penis become engorged with blood, causing the
dendrite: portion of a neuron that receives information. penis to become enlarged, rigid, and erect.
depolarize: to change the charge across the cell membrane of a erythrocyte: red blood cell.
neuron by the flow of Na+ into the cell. erythropoietin (EPO): chemical produced by the kidneys to
deposition: the process of putting calcium phosphate crystals into stimulate red blood cell production when the oxygen blood
the bone. level is low.
dermatitis: a disorder that is characterized by inflammation of etiologies: causes.
the skin and that may also show symptoms of oozing, crusting, excretion: the removal of metabolic wastes from the body.
scaling, pimples or vesicles, and itching. exfoliate: to shed dead keratinocytes from the stratum corneum.
diagnosis: the process of determining by examination the nature exocrine glands: glands, such as sebaceous and sweat glands,
and circumstances of a diseased condition. that produce and secrete products that are delivered to the
dialysis: a treatment for renal failure in which a machine filters appropriate locations through ducts.
out excess fluid, salt, and nitrogenous wastes in the blood. exocytosis: movement of materials out of the cell in bulk.
diapedesis: process in which WBCs crawl through vessel walls. expiration: movement of air out of the lungs.
diaphysis: the shaft of a long bone. expiratory reserve volume: the amount of air that can be forcefully
diarrhea: condition of a runny stool. expired beyond the amount expired in a normal breath at rest.
diastole: relaxation of a heart chamber; usually refers to the action extensibility: the ability to be stretched.
of the ventricles. extension: action that bends a part of the body posteriorly, such as
disease: an abnormal functioning of organs or organ systems straightening the arm at the elbow.
resulting from a disruption in the normal state of the body’s
internal environment (homeostasis).
diuretic: a type of drug often prescribed for hypertensive patients f
to reduce their blood pressure by increasing urine production. facilitated diffusion: passive membrane transport method used
diverticula: small pouches in the lining of the large intestine that for molecules that cannot diffuse through the selectively
commonly develop with age. permeable membrane on their own and therefore require help
down-regulation: a decrease in the number of receptors for a crossing the membrane through a channel protein.
given hormone, causing the cell to become less sensitive to fascicle: group of muscle fibers surrounded by perimysium.
the hormone. fatigue: the inability of a muscle to fully respond to a nerve impulse.
dynamic equilibrium: equilibrium perceived when the head is feces: the contents of the large intestine, composed of 75% water
rotating. and 25% solids.
fibrin: a solid protein fiber necessary for blood clot formation.

e fibrinogen: protein dissolved in plasma that is the precursor to

fibrin.
effacement: the thinning of the cervix in preparation for birth. fibrosis: wound healing with scar tissue; normal function is not
efferent: in the direction away from the brain or spinal cord in the returned.
nervous system. filtration: passive transport method that moves materials across a
ejaculation: the discharge of semen. cell membrane using force but no energy.
elasticity: the ability to come back to shape after being stretched. first-degree burn: a burn that involves only the epidermis and
electrolyte: an ion in solution capable of conducting electricity. whose symptoms include redness, pain, and swelling; the most
embolus: a moving, unnecessary clot. common type of burn.
emission: a stage in the male sexual response in which sperm are flatus: gas that is produced by bacteria and causes bloat,
moved by peristaltic contractions through the ductus deferens discomfort, and an unpleasant odor when released.
to its ampulla and the prostate and seminal vesicles add their flexion: action that bends a part of the body anteriorly, such as
secretions to semen. flexing the elbow.
emulsify: to break lipids into smaller droplets. fluid compartments: the two locations for water in the body—
endocarditis: inflammation of the endocardium. intracellular and extracellular.
endochondral ossification: process that forms long bones. folliculogenesis: the changes in a follicle during oogenesis.
endocrine: term that refers to hormones that travel through the fontanelle: membranous area between flat bones of the skull,
blood to get to their target tissue. eventually replaced by a suture.

GLOSSARY G-3
foramen magnum: a large opening in the occipital bone that humoral immunity: form of specific immunity that involves B
allows the spinal cord to exit the cranial cavity. cells making antibodies to attack a foreign antigen. Also called
formed elements: the cells and cell parts found in blood. antibody-mediated immunity.
functional residual capacity (FRC): the amount of air remaining hydrocele: a condition in which fluid has accumulated and caused
in the lungs after the expiration of a normal breath at rest. swelling in the scrotum.
hydrocephalus: a condition resulting in the buildup of excess
g cerebrospinal fluid in the brain.
hydroxyapatite: calcium phosphate mineral salt that makes up the
gamete: a sex cell; a sperm or egg. mineral matrix of bone connective tissue.
gangrene: tissue necrosis resulting from an insufficient blood hypercapnia: condition of increased carbon dioxide in the blood.
supply, often associated with an infection. hyperkalemia: condition in which the level of potassium in the
gas exchange: the movement of oxygen and carbon dioxide that blood is too high.
occurs between capillary blood and the alveoli in the lungs and hyperopia: farsightedness caused by the cornea and lens focusing
between capillary blood and the tissues of the body. an image behind the retina.
gas transport: the movement of gases in the blood to and from hyperplasia: the growth of tissue through the production of more cells.
the lungs and tissues. hypersensitivity: an overreaction of the immune system to an
gene: the amount of DNA that must be read for the directions to allergen. Also called allergy.
make one specific protein. hypertension: a resting blood pressure greater than 140/90 mmHg.
gestation: the time from fertilization to birth. hypertrophy: the growth of tissue through the growth of existing cells.
gland: a structure on its own or groups of cells within an organ hyperuricemia: an excess of uric acid in the blood.
that function to produce hormones. hypodermis: see subcutaneous layer.
glaucoma: a condition characterized by increased intraocular hyponatremia: condition in which the level of sodium in the
pressure. blood is too low.
glomerulonephritis: an inflammation of the filtration membrane hypospadias: a congenital defect in which the urethra opens on the
in the glomerulus of the nephron. ventral side or base of the penis instead of on the tip of the glans.
glucocorticoids: hormones produced by the adrenal cortex that hypoxemia: condition of low blood oxygen.
stimulate the breakdown of protein and fat to make glucose,
suppress the immune system, and reduce inflammation.
goiter: an enlargement of the thyroid gland. i
gomphosis: fibrous joint holding a tooth in its socket. immunodeficiency: a disorder that causes a deficiency in the
gonads: the ovaries in women and the testes in men. immune system’s ability to defend the body.
granulation tissue: tissue with many collagen fibers produced by incidence: the rate and range of the occurrence of a disease.
fibroblasts to fill in a wound’s clot. incomplete proteins: proteins in the diet that are missing one or
granulocyte: any of three types of leukocytes—neutrophils, more of the necessary amino acids for the body.
basophils, and eosinophils—containing small granules that infarction: the sudden death of tissue, which often results from a
differ in color when stained. loss of blood supply.
greater omentum: an extension of the visceral peritoneum that infertility: the inability to fertilize an egg.
looks like a fatty apron lying over all the abdominal viscera and inflammation: the body’s normal immune response to injury and
extends from the inferior margin of the stomach. disease; characterized by redness, heat, swelling, and pain.
gustation: the sense of taste. ingestion: the intake of food into the mouth.
insertion: the attachment of a muscle to a bone or structure that
h does move when the muscle contracts.
inspiration: movement of air into the lungs.
half-life: the length of time it takes for one-half of a substance to inspiratory capacity: the maximum amount of air that can be
be eliminated from the cardiovascular system. inspired after the expiration of a normal breath at rest.
hematocrit: a test that measures the percentage of erythrocytes to inspiratory reserve volume (IRV): the amount of air that can
whole blood. be forcefully inspired beyond the amount inspired in a normal
hemocytoblast: starting cell for the production of all the formed breath at rest.
elements; stem cell. integumentary system: body system that includes the skin, hair,
hemoglobin: a red, complex protein that is made of four chains of nails, and cutaneous glands.
amino acids found in red blood cells and that functions to carry intercalated disks: specialized junctions between cardiac muscle
oxygen. cells that enable the fast transmission of electrical impulses
hemopoiesis: blood production. from one cell to another.
hemostasis: three-step process—vascular spasm, platelet plug interferons: chemicals that are released by virally infected cells
formation, and coagulation—that stops bleeding. and encourage surrounding healthy cells to make antiviral
heredity: a combination of the genetic codes from both parents proteins so that the virus will not invade them.
that can be a major predisposing factor for disease. interleukins: chemicals used by lymphocytes to communicate
histology: the study of tissues. with one another.
homeostasis: an internal environment that the body must maintain interstitial fluid: extracellular fluid in the tissues.
for normal functioning. intramembranous ossification: process that forms flat bones.
hormone: chemical used in the endocrine system to carry messages. intussusception: a condition that occurs when a portion of the
humor: fluid found in the eye. Aqueous humor is found in the intestines folds back into itself, similar to a telescope, resulting
anterior portion of the eye, and vitreous humor is found in the in obstruction of the intestines and possible ischemia.
vitreous chamber of the eye lined with the retina. ion: a charged atom.

G-4 GLOSSARY
ionic bond: formation of a molecule that occurs when two or mastoiditis: an infection of the mastoid bone in the skull.
more atoms bind by giving up or receiving electrons from each mean arterial pressure (MAP): the average pressure arteries
other to fill their outer shells. must be able to withstand.
ischemia: the lack of blood flow. mechanical digestion: the breakdown of large pieces of complex
isometric: a type of contraction in which the length of the muscle molecules to smaller pieces of complex molecules.
remains constant while the tension in the muscle increases. mediastinum: the space between the pleural cavities that contains
isotonic: a type of contraction in which the tension in the muscle the heart, esophagus, trachea, thymus, and major vessels.
remains constant and motion is the result. meiosis: a two-division process, used to create sperm and eggs,
that starts with a parent cell of 46 chromosomes (23 pairs). It
j results in four daughter cells, each having 23 chromosomes. The
set of chromosomes in each daughter cell is different from the
jaundice: indicator of liver malfunction caused by added bilirubin sets in the other daughter cells due to independent assortment
in the blood that gives a yellow appearance to the skin and eyes. and crossing-over.
melanocytes: cells found in the stratum basale that produce skin
k pigments called melanin.
membrane transport: movement of ions and molecules across
keratin: a hard, waterproof protein found in epidermal cells, hair, the cell membrane.
and nails. meninges: three layers of membrane surrounding the brain and
spinal cord.
l meniscus: fibrocartilage pad found between the femur and the
tibia in the knee that serves as a shock absorber.
labor: uterine contractions to bring about birth. menopause: cessation of menstrual periods for at least a year.
lacrimal: pertaining to tears. menstrual cycle: part of the female sexual cycle of events that
lactation: milk production. affects the uterine lining.
lacteals: small lymphatic vessels that are located in the villi of the small mesenteries: sections of the peritoneal membrane where the
intestine and into which the products of lipid digestion are absorbed. parietal peritoneum comes back parallel to itself.
leukocyte: white blood cell. metabolic acidosis: condition in which there is decreased
leukocytosis: a high white blood cell count. elimination of hydrogen ions by the kidneys or increased
leukopenia: a low white blood cell count. production of acidic substances through metabolism.
lever: a rigid object that can be used to lift something. Bones act metabolic alkalosis: a relatively rare condition that can occur if
as levers in lever systems that muscles use to move the body. there is prolonged vomiting, which results in the repeated loss
lingual: pertaining to the tongue. of stomach acids.
lithotripsy: a procedure in which sound waves are used to break metabolic waste: waste produced by cells.
up a kidney stone. metabolic water: water formed in the cells through cellular
lobectomy: a surgical procedure that removes part of a lung. respiration.
local potential: the flow of electricity begun by stimulating the metabolism: the sum of all chemical reactions that occur in the
dendrite of a neuron. body.
lymph: fluid that is derived from blood and is similar to plasma metaplasia: the change of a tissue from one type to another.
but has fewer proteins. metastasize: to spread malignant cells to other parts of the body.
lymphadenitis: condition in which a pathogen is under attack metatarsophalangeal joint: a joint between a metatarsal bone
by a lymph node’s lymphocytes, resulting in the lymph node and a phalanx.
becoming swollen and painful to the touch. micturition: the passing of urine out of the body.
lymphoid: type of hemopoiesis that produces lymphocytes in milk-ejection reflex: a reflex that is initiated by suckling on
lymphoid tissues outside the red bone marrow. a breast and results in myoepithelial cells in the mammary
lymphoma: a type of cancer that affects white blood cells and can lobules contracting to release milk to the lactiferous ducts in the
develop in the organs of the lymphatic system. breast.
mineralocorticoids: hormones produced by the adrenal cortex
m that promote sodium and water reabsorption and potassium
excretion in the kidney to maintain blood volume and pressure.
major histocompatibility complex (MHC): protein molecule mitosis: the cell division process that creates all body cells other
used by antigen-presenting cells to display an epitope. than sperm and eggs.
malabsorption: the inability to absorb the appropriate nutrients molecular mimicry: a situation in which one molecule is so
needed by the body. similar in structure to another molecule that it is mistaken for
malaise: a feeling of general discomfort or uneasiness. the other molecule.
malignant: the ability of a tumor to spread or metastasize to other molecule: two or more atoms bonded together.
parts of the body. motor unit: a single nerve cell and all the muscle cells it stimulates.
mammography: an X-ray examination of the breast used to detect multipolar neuron: the most common type of neuron in the brain
breast cancer. and spinal cord; has multiple dendrites and an axon that may or
margination: process in which WBCs stick to the walls of dilated may not have a collateral branch.
vessels in an inflamed area. muscle tissue: tissue whose cells have a high concentration of
mass movement: the movement of feces from the transverse proteins, which allow the cells to contract.
colon to the sigmoid colon to the rectum; initiated by distension muscle twitch: the contraction of one muscle cell due to one
of the stomach. nerve impulse.
mastication: the process of chewing. mutagen: an agent capable of causing a genetic mutation.

GLOSSARY G-5
mutation: a change in the DNA of a cell that is carried to the next osteoporosis: condition characterized by a severe lack of bone
generation of cells. It often results in a change in structure or density.
function. otoliths: calcium carbonate and protein granules located in the
myalgia: muscle pain. saccule and utricle of the inner ear.
myelin: a lipid-rich intermittent covering over the axons of some ovarian cycle: part of the female sexual cycle of events that
neurons. Gaps in the myelin sheath are called nodes of Ranvier. occurs in the ovary.
myeloid: type of hemopoiesis that produces all the formed ovulation: the release of an egg from an ovary.
elements in the red bone marrow. oxygen debt: the amount of oxygen needed to remove the lactic
myopia: nearsightedness caused by the cornea and lens focusing acid produced through anaerobic respiration.
an image ahead of the retina.
p
n palliative: a type of treatment whose goals are to make a patient more
necrosis: the premature death of tissue; caused by disease, comfortable and to improve the quality of life during a disease.
infection, toxins, or trauma. pampiniform plexus: a network of small veins surrounding the
negative feedback: the process the body uses to reverse the testicular artery.
direction of movement away from homeostasis. pancreatic islets: 1 to 2 million groups of endocrine cells in the
neoplasia: the uncontrolled growth and proliferation of cells of pancreas that produce the hormones insulin and glucagon.
abnormal or nonfunctional tissue. papillae: (1) bumps on the superficial edge of the dermis that are
nephron: the functional unit of a kidney; composed of a renal in contact with the epidermis; (2) bumps on the tongue that
corpuscle, proximal convoluted tubule, nephron loop, and distal house the taste buds.
convoluted tubule that drains into a collecting duct. paracrine: term that refers to hormones that work on neighboring cells
nervous tissue: tissue whose cells communicate through electrical without having to go through the blood to get to the target tissue.
and chemical signals. This tissue is composed of nerve cells paralysis: a loss of muscle function due to an interruption in the
called neurons and many more support cells called neuroglia pathway between the brain and muscles.
that protect and assist neurons in their function. parasite: an organism that lives on or in another organism (the
neuroglia: cells that aid neurons in their function. host) and obtains its nourishment there.
nitrogenous wastes: wastes removed from the blood by the parasympathetic: division of the autonomic nervous system that
kidneys; include ammonia, urea, uric acid, and creatinine. sends electrical messages to carry out functions for vegetative
nociceptor: pain receptor that detects tissue injury or potential activities such as digestion, defecation, and urination.
tissue injury. parietal: the part of a serous membrane not in direct contact with
noncommunicable diseases: infectious diseases that are caused an organ.
by pathogens but are not contagious. partial pressure: the amount of pressure an individual gas
nonspecific resistance: type of defense that works to fight a contributes to the total pressure of a mixture of gases.
variety of pathogens without the need for prior exposure; parturition: the process of birth.
consists of two lines of defense. pathogens: disease-causing foreign invaders.
pathology: the study of disease.

o pectoral girdle: the bones—clavicle and scapula—that connect

the arm to the axial skeleton.
olfactory: pertaining to the sense of smell. pelvic: cavity in the inferior trunk that houses the urinary bladder,
oncogenes: potential cancer-causing genes that code for rectum, and reproductive organs.
uncontrolled production of cellular growth factors stimulating pelvic girdle: the bones—ilium, ischium, and pubis—that connect
mitosis or the receptors for the growth factors. the leg to the axial skeleton.
oogenesis: egg production. pelvic inflammatory disease (PID): an infection of the
open reduction: procedure that sets bones in proper alignment reproductive tract, including the uterus and uterine tubes,
through surgery. that can cause damage to the reproductive tract, resulting in
opportunistic infection: an infection normally fought off by infertility, ectopic pregnancies, abscess formation, and chronic
healthy immune systems. pain in the lower abdomen.
opsonization: the coating of a pathogenic cell to make it easier for perilymph: fluid found in the cochlea of the inner ear.
a macrophage to phagocytize it. peristalsis: wavelike contractions used to move materials along
organelles: specialized, membrane-bound structures of cells (e.g., the digestive system.
mitochondria, ribosomes, rough endoplasmic reticulum, and peritoneum: serous membrane located in the abdominopelvic cavity.
Golgi complexes). pharynx: an area—commonly called the throat—that is divided
organic molecules: molecules that come from life and contain into three sections based on ___location and anatomy—the
carbon and hydrogen (e.g., carbohydrates, lipids, proteins, and nasopharynx, the oropharynx, and the laryngopharynx.
nucleic acids). pheromone: term that refers to chemicals that cause a response
origin: the attachment of a muscle to a bone or structure that does outside the body, in another individual.
not move when the muscle contracts. phimosis: a condition of the penis characterized by tight foreskin
osmosis: passive movement of water across a cell membrane to that cannot be pulled back over the glans penis.
equalize the concentrations on both sides of the membrane. physiology: study of how the body’s structures function.
osteocyte: bone cell. placenta previa: a condition in which the placenta is positioned
osteomyelitis: a bone infection. over the cervix, blocking the opening to the uterus.
osteon (Haversian system): targetlike arrangement of bone placental abruption: a condition in which the placenta becomes
connective tissue found in compact bone. prematurely detached from the uterine wall.

G-6 GLOSSARY
plasma: the fluid matrix of blood connective tissue. resolution: a stage in the male sexual response in which the penis
plasma protein: transport protein (made by the liver) that binds to decreases in size and becomes flaccid again.
a hormone in the blood to extend its half-life. respiratory acidosis: condition in which the respiratory system
pleura: serous membrane surrounding a lung. cannot eliminate sufficient CO2.
pluripotent: the ability to become cells of differing types. respiratory alkalosis: condition in which the respiratory system
For example, a hemocytoblast can become any one of eight eliminates too much CO2.
different formed elements. respiratory membrane: a membrane that is composed of a thin
pneumonectomy: a surgical procedure that removes an entire lung. layer of water with surfactant in the alveoli, a single squamous
pneumothorax: a condition in which air is introduced in the cell alveolar wall, and a single cell capillary wall and across
pleural cavity between the pleural membranes; commonly which gas exchange takes place in the lung.
called a collapsed lung. resting membrane potential: a difference in charge across the
polycythemia: a condition of too many cells in the blood. cell membrane of a neuron created by the presence of many
polydipsia: a condition of excessive thirst. large negative ions inside the cell and many positive sodium
portal route: a circulatory route that contains two capillary beds ions outside the cell.
before blood is returned to the heart.
positive feedback: the process the body uses to increase
movement away from homeostasis.
s
preeclampsia: a pregnancy-induced hypertension accompanied sarcomere: section of a myofibril extending from one Z line to
by protein in the urine that usually occurs after 20 weeks in the the next.
pregnancy. scales: silvery white patches on the skin; indicative of psoriasis.
preload: the amount of tension in the myocardium of the sebum: a very oily, lipid-rich substance produced by the
ventricular walls. sebaceous gland to moisturize the skin and hair.
presbyopia: a decreased ability of the eye to accommodate. second-degree burn: a burn involving the epidermis and dermis.
prevalence: a term that refers to how widespread the occurrence Symptoms include redness, pain, swelling, and blisters.
of a disease may be. second messenger: chemical created by the binding of a hormone
prognosis: a predicted outcome. in a receptor on the cell membrane. The second messenger
prolapse: an effect of aging in the female reproductive system in which then carries the information to where it is needed in the cell to
organs such as the urinary bladder and vagina drop out of position. initiate the function of the hormone.
secondary sex characteristics: gender-specific characteristics
protein synthesis: production of proteins in a cell through the
developed at puberty due to the action of estrogen (in the
processes of transcription and translation.
female) and testosterone (in the male). Female secondary sex
proximal: closer to the connection to the body.
characteristics include breast development, axillary and pubic hair
puberty: the first few years of adolescence that begins with the
growth, menstruation, and fat deposition. Male secondary sex
production of FSH and LH.
characteristics include muscle and skeletal development, deeper
pulse pressure: the surge of pressure that small arteries must
voice, aggression, and facial, axillary, and pubic hair growth.
withstand with each ventricular contraction.
secretion: the third process of urine production in the nephron; removes
pyrogen: chemical that initiates a fever.
remaining wastes and excess hydrogen ions from the blood.

r segmentation: a stationary constriction of the smooth muscle of the

small intestine in ringlike patterns to further churn chyme and
mix in bile and digestive enzymes to finish chemical digestion.
reabsorption: the process of putting something into the blood
again, not the first time. For example, osteoblasts reabsorb semen: a fluid—composed of 10% sperm, 60% nourishing fluid
calcium from the bone, raising the blood calcium level. from the seminal vesicles, 30% alkaline fluid from the prostate,
reactants: molecules that come together to interact in a chemical and trace amounts of a lubricating fluid from the bulbourethral
reaction. glands—that is ejaculated from the penis during orgasm.
receptive field: an area in which a single neuron is responsible for sensorineural: type of hearing loss caused by a problem with the
detecting a stimulus. organ of Corti or the auditory nerve.
receptor: shape-specific binding site for a hormone. sepsis: the presence of bacteria in the bloodstream.
recruitment: the process of getting more and more motor units septicemia: a systemic infection of the blood.
involved in a contraction to create a larger motion. For example, serous membrane: double-layered membrane that contains fluid
there is rapid recruitment in a boxer’s punch. between the two layers.
reflex: an involuntary, predictable, motor response to a stimulus serum: plasma with the fibrinogen and clotting factors removed.
without conscious thought. shock: a serious, life-threatening condition characterized by the
refraction: the bending of light as it passes through materials of body’s organ systems not getting enough blood flow to sustain
different densities. normal function.
regeneration: wound healing with the same tissue that was signs: objective signals that can be measured.
damaged; normal function is returned. simple diffusion: the passive movement of materials across
renal corpuscle: part of a nephron; composed of a glomerulus a selectively permeable membrane from areas of high
and glomerular capsule. concentration to areas of low concentration until the
renal tubule: part of a nephron; composed of a proximal concentrations are equal.
convoluted tubule, nephron loop, and distal convoluted tubule. sliding filament theory: an explanation of a muscle contraction
replication: the process of copying DNA before cell division. that involves thick myofilaments grabbing thin myofilaments
repolarize: to change the charge across the cell membrane of a and pulling them toward the center of the sarcomere.
neuron by the opening of K+ channels to allow the flow of K+. smegma: a waxy substance produced by the sebaceous glands of
residual volume: the amount of air in the lungs that cannot be moved. the male prepuce.

GLOSSARY G-7
solution: a substance that is composed of solutes dissolved in a solvent. tetany: a sustained contraction brought about by a high frequency
somatomotor: type of nerve message used to stimulate skeletal of nerve impulses.
muscles to move the body. thick skin: epidermis that contains stratum lucidum and lacks hair
specific immunity: a line of defense that requires a prior exposure follicles.
to a specific pathogen so that the system can recognize, react, thin skin: epidermis that contains hair follicles and lacks stratum
and remember the pathogen to fight it off faster and stronger if lucidum.
the pathogen ever occurs in the body again. third-degree burn: a burn involving the epidermis, dermis, and
spermatic cord: a composite of several structures, which include hypodermis. Symptoms include charring and no pain due to the
the cremaster muscle, pampiniform plexus, testicular artery, and destruction of nerve endings.
ductus deferens. thoracic: cavity in the superior trunk; commonly called chest.
spermatogenesis: the first process in sperm production; produces threshold: minimum amount of a neurotransmitter necessary to
spermatids (each with 23 chromosomes) from a specialized stimulate a response.
stem cell (germ cell) with 46 chromosomes. thrombocyte: one type of formed element of the blood;
spermiogenesis: the second process in sperm production; commonly called platelet.
transforms spermatids to functional sperm. thrombus: a stationary, unwanted clot.
spirometry: measurement of lung volumes and capacities. thyroid hormone: collective term for both T3 and T4.
splenomegaly: an enlargement of the spleen that can be caused tidal volume (TV): the amount of air moved in a normal breath
by any number of pathological conditions, including anemia, (inspired or expired) at rest.
cancers, and certain infections. total lung capacity: the maximum amount of air the lungs can hold.
sprain: a tear in a ligament. trabeculae: sliverlike or platelike arrangement of bone connective
static equilibrium: equilibrium perceived when the head is tissue found in cancellous bone.
stationary or moving in a straight line. tunics: layers of vessel walls.
strain: a tear in muscle tissue or tendons.
stratum basale: the deepest layer of the epidermis and the only
one with cells that actively grow and divide to produce new
u
umami: a meaty taste derived from some amino acids binding to
epidermis.
taste hairs.
stroke volume: the amount of blood ejected from each ventricle
unipolar neuron: type of sensory neuron that appears to have
per beat.
one process that serves as dendrite and axon with the cell body
subcutaneous layer: the layer, technically not part of skin, that
pushed off to the side.
is deep to the dermis and attaches skin to the rest of the body.
up-regulation: an increase in the number of receptors for a given
Also called hypodermis.
hormone, causing the cell to become more sensitive to the
surfactant: fluid secreted by great alveolar cells in the lungs that
hormone.
reduces the surface tension of water.
urticaria: a skin disorder, commonly called hives, that is often
suture: fibrous joint found between cranial bones of the skull.
caused by insect bites or by contact with substances that cause
sweat glands: four types of exocrine glands—merocrine, apocrine,
an allergic reaction. Symptoms include raised areas of the skin,
ceruminous, and mammary—that are located in the dermis.
redness, and itching.
sympathetic: division of the autonomic nervous system that sends
electrical messages to prepare the body for physical activity
often referred to as fight or flight.
symphysis: cartilaginous joint found between the two pubic bones.
v
venous return: the process of returning blood to the heart through
symptoms: subjective signals relative to the patient that indicate veins.
something is wrong but cannot be measured. ventilation: airflow to the lungs.
synapse: junction formed by the neuron’s synaptic knob with ventilation-perfusion coupling: the matching of airflow to blood
another cell—gland cell, muscle cell, or dendrite of another flow in the lungs.
neuron. vesicles: fluid-filled blisters that burst and crust over.
synchondrosis: cartilaginous joint found between the epiphysis vestibular apparatus: anatomy used to perceive equilibrium;
and diaphysis of long bones in children. includes the saccule, utricle, and semicircular canals of the
syndesmosis: fibrous joint formed by an interosseus membrane inner ear.
between the radius and the ulna or between the tibia and the fibula. visceral: the part of a serous membrane in direct contact with an
synergists: muscles that have the same action. organ.
synovial joint: class of joint characterized by a joint capsule lined visual acuity: ability to discern visual detail. The best visual
by a synovial membrane that produces synovial fluid. acuity is the sharpest vision.
synovial membrane: membrane lining the joint space of a vital capacity (VC): the maximum amount of air that can be
synovial joint. moved.
systole: contraction of a heart chamber; usually refers to the action
of the ventricles.
w
t wound contracture: scab formation that pulls the edges of the
wound closer together as it dries.
target tissue: cells of a tissue that have receptors for a specific
hormone.
telomeres: sequences of nucleotides that provide a protective cap z
on the ends of chromosomes. zygote: a fertilized egg.

G-8 GLOSSARY
 Index
Note: Page numbers followed by f and t indicate figures and tables, respectively.

a
ABCDEs, of skin cancer, 102
Action potentials, 255–256, 257f
all-or-nothing effect of, 256
local potentials vs., 255
Air, composition of, 476
Airflow, pulmonary, 470–473, 473f
Albumin, 339, 339f, 403
Abdomen reflex arc, 256–258 Alcohol consumption
muscles of, 184–187, 186f–187f, 186t threshold for, 255 and cerebellar function, 241
quadrants of, 2, 6f Active immunity, 443–444 and laryngeal cancer, 493
regions of, 2–6, 6f Active sites, of actin, 198, 199f, 201, 202f and urine volume, 561
Abdominal cavity, 8, 8t, 9f Active transport, 53, 201, 321, 552 Aldosterone, 309t, 324–325, 324t
Abdominal hernias, 531, 537t Acute bronchitis, 492, 495t in blood flow/pressure control, 406
Abdominal lymph nodes, 430f, 431 Acute disease, 15 in pregnancy, 633
Abdominal region, 2–6, 5f, 5t Acute glomerulonephritis, 569–570 in renal regulation, 557–558, 559f, 560
Abdominopelvic cavity, 8, 8t, 9f Acute lymphoblastic leukemia (ALL), 362, 363f, 366t Alimentary canal, 502–503, 502f; see also Digestive
organs and mesenteries of, 12, 12f, 13f Acute myeloid leukemia (AML), 362, 363f, 366t system
serous membrane of, 10, 11f Acute respiratory distress syndrome (ARDS), 493, 495t Alkaline substance, 39, 39f
Abducens nerve (CN VI), 246f, 247t, 289 Adam’s apple, 463, 463f Alkalosis, 39, 552–553
Abduction, 177, 178f Addison’s disease, 324–325, 333t metabolic, 553
Abduction of vocal cords, 463f, 464 Adduction, 177, 178f respiratory, 486, 496t, 553
ABO blood group, 355–357, 355f, 356f Adduction of vocal cords, 463f, 464 ALL; see Acute lymphoblastic leukemia
Abortion, induced, 639 Adductor longus, 181f Allergens, 22, 449–450
Abortion, spontaneous, 639, 641t Adenine, 43, 43f Allergies, 22, 449–450, 452t
ABP; see Androgen-binding protein Adenocarcinoma All-or-nothing response, 200, 256
Abruption placentae, 640 kidney, 570 Alopecia, 93, 109t
Abscess, tooth, 506 lung, 494 Altitude, and erythropoiesis, 347
Absorption, 156 Adenoids, 433, 433f Alveolar cells, great, 468f, 469
nutrient, 520, 526, 528 Adenosine diphosphate (ADP), 46, 46f Alveolar gas exchange and transport, 484–485, 485f
disorders of, 536, 537t Adenosine triphosphate (ATP) Alveolar ventilation, 481
large intestine, 524–525, 526, 528 in active transport, 53 Alveoli (alveolus)
mineral (electrolyte), 524, 526 as energy currency for cell, 46 of lung
small intestine, 520, 522, 526, 528 production of, 45–46, 46f, 206–208, 207f, 207t aging and, 488
vitamin, 526 in skeletal muscle contraction, 201, 202f airflow to, 481, 482f
water, 524–525, 529 ADH; see Antidiuretic hormone anatomy of, 459, 468–470, 468f, 469f
Accessory glands, of male reproductive system, Adipose tissue, 66–67, 67f blood flow to, 481, 482f
583–585, 584f aging and, 101 disorders affecting, 480, 480f
Accessory nerve (CN XI), 246f, 247t female puberty and, 613 of lung, 399
Accessory pancreatic duct, 516f subcutaneous, 83, 84f physiology of, 476–481, 477f, 479f, 480f
Accessory structures ADP; see Adenosine diphosphate of teeth, 504, 505f
of digestive system, 503, 503f, 514–518 Adrenal cortex, 309t, 314, 314f Alzheimer’s disease, 262–263, 265t
of eye, 290–291, 290f, 291f in childbirth, 635, 636f AMD; see Age-related macular degeneration
Accommodation, visual, 296f, 297 degeneration of, 324–325 Amenorrhea, 614
ACE (angiotensin-converting enzyme), hormones of, 309t, 314, 324–325, 324t Amino acids, 41, 42f
406, 558 Adrenal glands, 308f, 314, 314f; see also Adrenal cortex absorption of, 522, 526, 528
ACE inhibitors, 558 Adrenal medulla, 309t, 314, 314f essential, 210, 210t
Acetabulum, 133, 134f, 147 Adrenocorticotropic hormone (ACTH), 309t, 310f, 315 hormones derived from, 315
Acetylcholine (ACh) adrenal cortex degeneration and, 325, 325t in muscle physiology, 210, 210t
in myasthenia gravis, 203 in childbirth, 635, 636f nonessential, 210, 210t
in neuronal transmission, 226 hypersecretion of, 332–333, 333f protein digestion to, 521
in skeletal muscle, 200, 200f, 201, 202f in pregnancy, 632 renal processing of, 551–552, 554f
Acetylcholinesterase, 201, 203 Aerobic respiration, 207–208, 207f, 207t, 378 translation to, 54, 55–57, 56f
ACh; see acetylcholine Afferent arterioles, 547–549, 548f–550f, 550–551, 554f AML; see Acute myeloid leukemia
Achilles tendon, 136, 182f, 195, 195f Afferent (sensory) nerves, 246 Ammonia, 545, 545f
Acid(s), 37–39 Afferent (sensory) neurons, 223, 246, 256–258 Amniotic sac, rupture of, 636
Acid mantle, 90, 436 Afterbirth, 636 Ampulla
Acid–base balance, 39 Afterload, 390, 408 of ductus deferens, 583, 584f
bone physiology and, 159–160 Age, as predisposing factor, 15–17 of ear, 287, 288f
hemoglobin in, 349 Age spots, 101 of uterine tubes, 607f, 609
renal regulation of, 552–553, 553f, 565 Age-related macular degeneration (AMD), 299, 301t Amygdala, 238, 239f, 279
respiratory regulation of, 488 Agglutination, 355–356, 356f Amylase, 506, 507, 514
Acidic substance, 39, 39f Aging, 17 Anabolic steroids, 593
Acidosis, 39 and cardiovascular system, 408 Anaerobic respiration, 207, 207f, 207t, 208
bone physiology and, 159–160 and cells, 60–61, 61f Anal canal, 522–524, 523f
metabolic, 553 and digestive system, 528–529 Anal sphincters, 212, 522–524, 523f
respiratory, 486, 496t and disease, 17 Anaphylaxis, 450
Acne, 89, 89f, 109t and endocrine system, 326–327 Anastomoses, 400–402
Acquired hydrocephalus, 264 and excretory/urinary system, 566 Anatomical cavities, 8, 8t, 9f
Acquired immune deficiency syndrome (AIDS), 22, and female reproductive system, 623–624 Anatomical positions, 6–8, 8t
451–452, 599–600, 601t, 628 and integumentary system, 100–101, 623 prone, 6–8, 8t
Acquired immunity, 443–445 and lymphatic system, 447 standard, 2, 2f, 6
Acquired immunodeficiency disorders, 451 and male reproductive system, 596 supine, 6–8, 8t
Acromegaly, 329–330, 330f, 333t and muscular system, 212 Anatomical terms, 2–12
Acromion process, 129, 129f and nervous system, 261 cavities, 8, 8t, 9f
Acrosomal enzymes, 620–621, 621f and respiratory system, 488–489 directional, 2, 3f–4f, 3t
Acrosome, 586, 586f, 591f and senses, 298–299 planes, 6, 6t, 7f
ACTH; see Adrenocorticotropic hormone and skeletal system, 160–161, 623 regions of body, 2–6, 5f, 5t
Actin, 198, 199f, 201, 202f Agranulocytes, 343, 345f, 346 Anatomy, definition of, 2

I-1
Androgen(s), 309t, 314, 324–325, 324t, 577 Arm Autonomic reflexes, 256, 258
Androgen-binding protein (ABP), 587, 592 bone of, 129–131, 130f Autorhythmicity, of cardiac muscle, 209t, 220, 382
Androgen-insensitivity syndrome, 577 muscles of, 189, 189f, 189t Autosomes, 364
Andropause, 596 Arousal Axial region, 2, 5t
Anemia, 364, 366t; see also specific types in female sexual response, 621, 622f Axial skeleton, 114, 115f, 117–128
Anesthesia, 241 in male sexual response, 594, 595f Axillary hair, 587, 613
Aneurysms, 404, 418t Arrector pili, 90–91, 91f Axillary lymph nodes, 430f, 431, 432, 433f
Angina pectoris, 414, 418t Arrhythmias, 386–387, 417t Axillary region, 5f, 5t
Angiogenesis, 72, 405 Arterial anastomosis, 401–402 Axis (C2 vertebra), 123f, 126, 126f
Angiogram, pulmonary, 489t Arterial blood gas, 489t Axon(s), 71f, 225, 225f, 226–227
Angiography, CT, 409t Arteries, 392–396 myelinated, 225f, 226–227, 256
Angioplasty, 412 aging and, 408 transmission along, 255–256, 257f
Angiotensin I, 558, 560 blood flow and pressure in, 402–406 trigger zone of, 225f, 226, 255–256
Angiotensin II, 406, 558, 560 conducting, 395 unmyelinated, 227, 256
Angiotensin-converting enzyme (ACE), 406, 558 disorders of, 408, 410–412, 411f, 418t Axon hillock, 225f, 226
ANH; see Atrial natriuretic hormone distributing, 396 Axonal transport, 226
Ankylosis, 150 major systemic, 393f Azotemia, 570
ANS; see Autonomic nervous system pressure points, 389, 390f
Antagonist muscles, 176 resistance, 396
Anterior, 3f, 3t
Anterior chamber, of eye, 292–293, 293f
Anterior crest, of tibia, 136, 136f
structure of, 392, 395f
Arterioles, 396, 396f
afferent, 547–549, 548f–550f, 550–551, 554f
b
B cells, 428–429
Anterior cruciate ligament, 147–149, 148f–149f efferent, 547–549, 548f–550f, 550–551, 554f aging and, 447
Anterior interventricular sulcus, 375, 375f renal, 401f cloning and differentiation of, 440, 441f
Anterior pituitary, 308–310, 309t Arteriosclerosis, 411, 418t in humoral immunity, 440–442, 441f
adrenal cortex degeneration and, 325, 325t Arteriovenous anastomosis, 401 in lymphoma, 448–449
in childbirth, 635, 636f Arthritis, 27t, 150, 151f, 161, 168t, 450 memory, 429, 441–442, 441f
disorders of, 329–331 Articular cartilage, 142–144, 143f in multiple myeloma, 449
female reproductive control by, 618–620, 623 Articulation, 144–151; see also Joint(s) plasma, 428, 440, 441f, 449
hormones of, 309t, 310, 310f Artificial active immunity, 444 production of, 346
hypothalamic control of, 308t, 310, 310f, 312f Artificial immunity, 444–445 Back, muscles of, 187–189, 187f–188f, 188t
in male reproductive control, 592, 593f Artificial passive immunity, 445 Background substance (matrix), 65
melatonin and, 323, 323t Arytenoid cartilages, 463–464, 463f, 488 Bacterial infections, skin, 104, 104f
negative feedback inhibition of, 319, 319f Ascending colon, 503f, 519f, 522–524, 523f Balanced equations, chemical, 44–45
Antibodies Ascending tracts, of spinal cord, 242–243, 244f Baldness (alopecia), 93, 109t
in acquired immunity, 443–445 ASD; see Atrial septal defect Ball-and-socket joints, 146t, 150
in blood types, 355–357 Aspirin, 20 Barium swallow, 529t
in humoral immunity, 441, 441f Association areas, 235–237, 238f Baroreceptors, 390–391, 391f, 406
in saliva, 507 Asthma, 449, 474, 493, 495t Baroreflex, 406
Antibody-mediated immunity, 439–442, 441f Astigmatism, 296, 301t Barrier defenses, 436–437
Anticoagulants, 343, 354 Astrocytes, 228, 228t, 229, 229f Basal cell(s), 276f, 277, 278
Anticodons, 55–57, 56f Atherosclerosis, 408, 410–412, 411f, 418t Basal cell carcinoma, 102, 102f
Antidepressants, 226 Athletes Base(s)
Antidiuretic hormone (ADH), 309t, 311, 312f, 315 bursitis in, 147 chemical, 37–39
aging and, 566 injuries in, 22–23, 22f nitrogenous, 43
in blood flow/pressure control, 406 sports injuries in, 22–23, 22f Base of heart, 371, 372f
in renal regulation, 557, 558f Athlete’s foot, 105 Base pairs of nucleotides, 43, 43f
Antigen(s) Atlas (C1 vertebra), 123f, 126, 126f Basement membrane, 61, 62f
in blood types, 354–357 Atmospheric pressure, 471–473, 473f, 476 Basic (alkaline) substance, 39, 39f
in cellular immunity, 442, 443f, 445, 446f Atom(s), 33–36, 34f Basilar membrane, 282, 282f, 283f, 284, 284f
in humoral immunity, 439–442, 441f Atomic mass, 33–34 Basophils, 339f, 341t, 342–343
Antigen-presenting cells (APCs), 428–429, 439–442, Atomic number, 33 in inflammatory response, 437, 438
440f, 441f, 443f Atopic dermatitis, 107, 107f production of, 345f
Antihistamines, 20 ATP; see Adenosine triphosphate test for (count), 360t, 448t
Antihypertensive drugs, 558, 561 Atresia Bedsores (decubitus ulcers), 107, 109t
Anti-inflammatory agents, 20 heart valve, 416 Bends (decompression sickness), 481
Antimicrobial proteins, 436, 437–438 oocyte, 614–616 Benign prostatic hyperplasia (BPH), 566, 571t, 596
Anti-rejection drugs, 442 Atria, of heart Benign tumors, 72
Antithrombin, 354 anatomy of, 375–376, 375f, 377f Benzoyl peroxide, 89
Anus, 502f, 503, 503f, 522–524 blood flow through, 379, 380f Bicarbonate ions
Aorta, 371, 393f, 395, 399f, 401f contraction and relaxation of, 383–386 in digestion, 517–518, 518t, 520–521
blood flow in, 379, 380f Atrial diastole, 383–384 in respiration, 482–485, 483f, 484f
overriding, 416 Atrial fibrillation, 386, 417t Biceps brachii, 181f, 189, 189f, 189t, 190f
Aortic valve, 376, 377f, 379, 380f, 385f Atrial natriuretic hormone (ANH), 314, 560, 560f Biceps femoris, 182f, 193, 194f, 194t
APCs; see Antigen-presenting cells Atrial septal defect (ASD), 316f, 416, 418t Bicuspid (mitral) valve, 376, 377f, 379, 380f, 384–386, 385f
Apex Atrial systole, 384 Bicuspid valve prolapse, 410, 410f
of heart, 371, 372f, 375f Atrioventricular (AV) bundle, 383, 383f, 386 Bilateral, 3t
of lung, 466f Atrioventricular (AV) node, 383, 383f, 386, 390 Bilayer, of cell membrane, 49, 49f
Aphasia, 259 Atrioventricular (AV) valves, 376, 377f, 379, 380f, Bile, 350–351, 350f, 515–517, 518t, 521, 543
Aplastic anemia, 364, 366t 384–386, 385f Bile acids, 515–516, 522, 526
Apnea, 489 Atrophy, 73, 216, 217f, 217t Bile ducts, 503, 503f, 516f, 517
Apocrine sweat glands, 90, 90t Attachment Bilirubin, 340, 350–351, 350f, 516, 542
Apoptosis, 73 of muscles, 176 Binocular vision, 297, 297f
Appendicitis, 522, 536t of ribs, 126, 126f, 128f Biologic disease-modifying antirheumatic drugs
Appendicular region, 2, 5t Auditory canal, 280–281, 280f, 281, 282f DMARDS, 450
Appendicular skeleton, 114, 115f, 129–138 Auditory meatus, external, 280–281, 280f Biopsy, 24
Appendix, 502f, 519f, 523f Auditory ossicles, 280f, 281, 282f, 283, 284f bone marrow, 448t
Appositional bone growth, 155, 156f Auditory tube, 280f, 281, 282f excretory/urinary system, 567t
Arachnoid mater, 231–232, 231f, 233f, 243f Auricles, of heart, 375, 375f female reproductive system, 624t
Arachnoid villi, 232, 233f Autoantibodies, 332 lymph node, 448t
Arbor vitae, 241, 242f Autocrine hormones, 318 respiratory system, 489t
Arches of foot, 137, 138f Autoimmune disorders, 22, 450, 452t skin, 24f, 102t, 103
ARDS; see Acute respiratory distress syndrome Autonomic nervous system (ANS), 224, 224f, Bipolar cells, of retina, 293, 294f
Areola, 612, 612f 250–252 Bipolar neurons, 227, 227t
Areolar connective tissue, 65, 66f in cardiovascular regulation, 390–392 Birth; see Childbirth
Areolar glands, 612, 612f in digestive regulation, 527 Birth control, 629

I-2 INDEX
Birth control patch, 315 neural, 406 Bone cancer, 165, 168t
Bisphosphonates, 165 renal, 544, 558–560, 565 Bone marrow, 142–144, 160, 430f
Bitter taste, 277 Blood tests, 327t, 359–361, 360t, 624t hemopoiesis in, 346–350, 428–429
Black hair, 92f Blood transfusions, 356–357 leukocyte storage in, 346
Bladder; see Gallbladder; Urinary bladder Blood types, 354–357, 356f stem cells of, 346
Blastocyst, 631–632, 631f ABO, 355–357, 355f, 356f Bone marrow aspiration, 448t
Blonde hair, 92f maternal-fetal compatibility in, 357, 358f Bone marrow biopsy, 448t
Blood, 67, 337–369 Rh, 355, 356, 357, 358f Bone marrow transplantation, 160
anatomy of, 338–344 transfusion compatibility of, 356–357 Bone mineral density, 160–161, 164–165, 165f, 623
cancers of, 72, 361–363, 363f, 366t Blood-urea nitrogen (BUN), 570 Bony labyrinth, 281
centrifuging, 338, 339f Blood-vessels, 338, 392–408 Botulism, 535
chemoreceptors monitoring, 486, 487f aging and, 408 Bowman’s (glomerular) capsule, 547, 548f–550f, 554f
composition of, 67, 67f, 338, 339f anatomy of, 392–397 BPH; see Benign prostatic hyperplasia
formed elements of, 67, 67f, 338, 340–344, 341t–342t constriction of, 344, 403, 405–406, 462 Brachial artery, 390f, 393f
as percentage of whole blood, 338, 339f diagnostic tests for, 408–410, 409t Brachial region, 5f, 5t
production of, 344–350, 344t, 345f dilation of, 343, 403, 405, 407, 437, 437f, 450 Brachialis, 189, 189f, 189t, 190f
tests for (counts), 360t, 361 disorders of, 408–417, 417t–418t, 418t Brachioradialis, 181f, 189, 189f, 189t, 190f
functions of, 358–359 length of, 403 Bradycardia, 389, 417t
gender and, 359 major systemic, 393f–394f Brain, 234–241, 234f–235f
oxygen-poor, 379, 381f, 399, 478 overview of, 371 aging and, 261
oxygen-rich, 379, 381f, 399, 478 physiology of, 397–408 barrier around, 229
percentage of body weight, 338 pressure, resistance, and flow in, 402–406 buoyancy of, 232
pH of, 39, 159–160, 349, 359, 485–486, 552–553, radius of, 403 disorders of, 262–265, 265t
553f, 565 structure of, 392, 395f gray matter of, 235, 241, 242f
physiology of, 344–359 Blood volume, 338, 402–403, 544 lobes of, 234f–235f, 235–238, 236t
plasma, 67, 67f, 338–340 Blood-brain barrier, 229 meninges of, 231–232, 231f, 233f
composition of, 339–340, 339f Blood-testis barrier, 589–590, 590f subdivisions of, 223, 224f, 234, 234f–235f, 236t–237t
gases in, 339f, 340 Body (anatomical feature) ventricles of, 232, 233f
homeostatic role of, 340 of nail, 93, 93f white matter of, 235, 241, 242f
ions in, 339f, 340 of neuron, 225, 225f, 226 Brain injury (concussion), 232, 265t
lymph derived from, 424, 427 of pancreas, 516f Brain tumors, neuroglia and, 229, 265t
nutrients in, 339f, 340 of sternum, 127, 127f Brainstem, 223, 224f, 234f–235f, 236t–237t,
as percentage of whole blood, 339f of stomach, 510f–511f, 511 239–240, 240f
regulatory substances in, 339f, 340 of uterus, 607f, 608f, 609 Braxton Hicks contractions, 635
as solution, 340 of vertebra, 125, 125f BRCA1 and BRCA2 genes, 626
tonicity of and osmosis, 52–53, 53f Body (human body); see also specific anatomy, Breast(s), 612, 612f
volume of, 359 functions, and disorders aging and, 623
waste products in, 339f, 340 cavities of, 8, 8t, 9f development of, 613
pregnancy and, 634 major elements of, 33t function of, 612
production of, 344–350, 344t, 345f organizational levels of, 31–81, 32f, 46–50 lactating, 637–638, 638f
transport in, 359 cellular, 32, 32f, 50–61 lymphatics of, 432, 433f
carbon dioxide, 348–349, 350, 399, 482–484, 483f chemical, 32–46, 32f pregnancy and, 632
hormone, 307, 320, 320f organ, 32, 32f, 73–75 sexual response of, 621, 622f
oxygen, 348–350, 379, 381f, 399, 482–484, 483f organelle, 32, 32f Breast cancer, 24, 432, 625–626, 625f, 640t
viscosity of, 403 organism, 32, 32f Breast self-exams, 626
word roots and combining forms of, 338 systems, 32, 32f, 75t–76t, 76, 77f–78f Breastfeeding, 612, 637–638, 638f
Blood cells, 67, 67f, 338, 340–344, 341t–342t; see also tissue, 32, 32f, 61–73 Breathing; see Ventilation
specific types regions of, 2–6, 5f, 5t Brittle bones (osteogenesis imperfecta), 139, 168t
osmosis and, 52–53, 53f Body surface area, in burns, 100, 100f Broad ligament, 607–608, 607f, 608
as percentage of whole blood, 338, 339f Bodybuilders, muscle growth in, 72 Broca’s area, 237, 238f, 259
production of, 344–350, 344t, 345f Bolus, 507 Bronchi (bronchus), 459, 459f, 464f, 466–468, 466f–467f
tests for (counts), 360t, 361 digestion of Bronchial tree, 459, 459f, 464f, 466–468, 466f
Blood clot, 351–354, 351f–353f mouth to stomach, 509–510, 509f Bronchioles, 466f, 468, 468f, 469f
Blood clotting studies, 360t in stomach, 513–514 Bronchitis
Blood disorders, 361–365, 366t Bone(s), 68–69, 69f, 113–173; see also specific bones acute, 492, 495t
clotting disorders, 364–365, 366t aging and, 160–161, 623 chronic, 474, 492, 495t
diagnostic tests for, 359–361, 360t appendicular skeleton, 114, 115f, 129–138 Brush border, 518, 519f
erythrocyte, 362–364, 366t axial skeleton, 114, 115f, 117–128 Buccinator, 183, 183f, 184t, 507, 507f
leukocyte, 361–362, 363f, 366t cancellous, 139, 140f, 141 Budding yeast, 106
Blood flow, 402–406 cells of, 139, 141, 152 Buffers
alternative routes of, 400–402 classification of, 115–117 hemoglobin, 349, 359, 483
to alveoli, 481, 482f compact, 139–141, 140f phosphate, 160
to capillary bed, 396f, 397, 400 composition of, 139 Building blocks
definition of, 402 connections with body systems, 169 of carbohydrates, 40, 40f, 40t
in inflammatory response, 437, 437f development of, 152–154 of lipids, 40t, 41, 41f
to lungs, 379–380, 381f, 399, 400f diagnostic tests for, 164, 164t of nucleic acids, 40t, 43
to nephron, 550–551, 550f disorders of, 164–168, 168t of organic molecules, 39, 40t
portal, 400, 401f dynamic nature of, 139 of proteins, 40t, 41, 42f
regulation of, 404–406 fractures (see Fractures) Bulb
resistance to, 403 functions of, 159–160 hair, 91f, 92
through heart, 379–382, 380f, 381f, 398–399, gross anatomy of, 142–144, 143f olfactory, 278–279, 278f
398f, 399f growth of, 154–155, 155f, 156f penis, 584f
venous return in, 402, 403f, 407 histology of, 139–143, 140f vestibular, of vagina, 611, 611f, 621, 622f
Blood gases, 485–486, 487f, 489t hormonal regulation of, 157–158, 158f Bulbospongiosus muscle, 585
Blood pressure, 402–406 lower limb, 134–138 Bulbourethral glands, 583, 584f, 585, 594
aging and, 408 mineral deposition in, 152, 156–158, 159t, 161 Bulbous corpuscle, 273t
definition of, 402 nutritional requirements of, 157, 157f Bulk transport, 54, 54f
disorders of, 404, 407, 408, 417t–418t ossification of, 152–154, 153f, 153t, 154f BUN (blood urea nitrogen), 570
high (hypertension), 404, 408, 417t, 558, 561 physiology of, 152–160 Buoyancy, of brain, 232
low (hypotension), 404, 417t process of, 131 Burns, 99–100, 109t
measurement of, 403–404 reabsorption of, 156–158, 159t degrees of, 99, 99f
in pregnancy (preeclampsia), 640, 641t remodeling of, 156–158 rule of nines in, 100, 100f
regulation of, 404–406 shape of, 115–116 Bursa, 147, 147f
hormonal, 406 tuberosities of, 130 Bursitis, 147, 168t
local, 405 upper limb, 130–132 Buttocks, muscles of, 187f–188f, 188t, 189

INDEX I-3
c
Caffeine, 392, 561
solubility of, 480
transport in blood, 348–349, 350, 399,
482–484, 483f
Cell (plasma) membrane, 47t, 48–50, 48f
channels of, 49, 49f, 53
composition of, 49, 49f
Calcaneal (Achilles) tendon, 136, 182f, 195, 195f Carbon monoxide fluid mosaic model of, 49
Calcaneus, 136, 137f, 138f poisoning, 347, 366t, 485 functions of, 47t, 49–50
Calcitonin, 157, 158f, 309t, 311, 315 smoking and, 487, 488f hormone receptors on, 316
Calcitriol, 157 Carbonic acid, 482–484, 483f potentials of, 253–261
Calcium Carcinomas, 72 selective permeability of, 52–53, 52f
absorption of, 156, 526 Cardiac accelerator center, 390, 407 transport across, 50–54, 51f, 52f, 54f
body percentage of, 33t Cardiac catheterization, 409t Cell wall, 49
in bone physiology, 156–160 Cardiac conduction system, 382–383, 383f Cellular (cell-mediated) immunity, 442, 443f, 444f,
in coagulation, 353 Cardiac cycle, 383–386 445, 446f
ion or electrolyte, 35 heart sounds in, 386 Cellular level, of body organization, 32, 32f, 50–61
metabolism of, 156–158 phases of, 384–386, 385f Cellular respiration, 44–46
parathyroid hormone and, 157–158, 158f, 311, 526 Cardiac inhibitory center, 390 aerobic, 207–208, 207f, 207t, 378
vitamin D and, 95, 156–157, 210 Cardiac muscle, 70, 71f, 73–74, 175–176, 373–374, anaerobic, 207, 207f, 207t, 208
in muscle contraction, 201, 202f 374f, 378, 378f ATP production in, 45–46, 46f, 206–208, 207f, 207t
in muscle health, 210 aerobic respiration in, 378 in cardiac muscle, 378
nutritional requirements for, 210, B-1 autorhythmicity of, 209t, 220, 382 in skeletal muscle, 206–208
in pregnancy, 156, 156f, 634 comparison with skeletal and smooth muscle, Cellulitis, 104, 104f, 109t
reabsorption of, 156 209–210, 209t Cellulose, 49
Calcium phosphate, 152, 156, 159–160 contractility of, 390 Centers for Disease Control and Prevention (CDC), 26
Calcium supplements, 156, 156f, 634 contraction and relaxation of, 373–374, 383–386 Central nervous system (CNS), 223, 224f, 231–245; see
Callus, in fracture healing, 162, 163f refractory period for, 378 also Brain; Spinal cord
Calyces, 546f, 547, 562f striations of, 70, 71f, 378, 378f cells of
cAMP second messenger, 317f Cardiac output (CO), 389–390 neurons, 224–228 (see also Neurons)
Canal of Schlemm, 293 aging and, 408 supporting, 228–229, 228t, 229f
Canaliculi, of bone, 140f, 141 exercise and, 407–408 disorders of, 262–265, 265t
Cancellous bone, 139, 140f, 141 regulatory function in blood pressure, 402 drugs as depressants of, 241
Cancer, 21 Cardiac reserve, 389, 408 myelin/myelination in, 228, 229f
bladder, 570, 571t Cardiac rhythm, 386–388 nuclei of, 241
blood, 72, 361–363, 363f, 366t Cardiac sphincter, 510f, 511 Cephalic region, 5f, 5t
breast, 24, 432, 625–626, 625f, 640t Cardiac suction, 402 Cerebellum, 223, 224f, 234f–235f, 237t, 241, 242f
cell proliferation in, 72 Cardiac tamponade, 373, 418t alcohol consumption and, 241
cellular immunity against, 442, 444f Cardiac veins, 398–399, 398f equilibrium function of, 289
cervical, 626, 640t Cardiogenic shock, 407 Cerebral cortex, 235, 486
colon, 529, 536t Cardiomyopathy, 374 Cerebral hemispheres, 234f, 235
epidemiology of, 27t Cardiovascular system, 75, 75t, 76, 77f, 338, 338f; see Cerebral palsy, 265, 265f, 265t
kidney, 570, 571t also Blood; Blood vessels; Heart Cerebrospinal fluid (CSF), 232–234
laryngeal, 493–494, 494f, 496t aging and, 408 abnormal accumulation of, 264, 264f, 265t
lung, 474, 494, 494f, 496t components of, 338 chemoreceptors monitoring, 486
lymphatic system, 448–449, 452t connections with other body systems, 419 circulation of, 232, 233f
metastasis in, 72 diagnostic tests for, 359–361, 360t, 408–410, 409t functions of, 232
mutations causing, 72 fluid exchange with lymphatic system, 427, 427f production of, 228, 232
ovarian, 626, 640t pregnancy and, 634 sampling and analysis of, 242, 262, 262t, 360t, 448t
palliative treatment in, 25, 25f terminology for, 338, 371 Cerebrovascular accident (CVA), 262, 265t
prostate, 597, 601t Carditis, 374–375, 376, 418t Cerebrum, 223, 224f, 234–238, 235f, 236t
screening for, 24 Caries, dental, 506, 536t functional regions of, 235–238, 238f
skeletal system, 165, 168t Carotid arteries, 390f, 393f, 395 gray matter of, 235
skin, 102–103, 103f Carpal bones, 115f, 132, 133f lobes of, 234f–235f, 235–238, 236t
telomerase and, 61 Carpal ligament, 190f, 191, 192f surface area of, 235
testicular, 598, 598f, 601t Carpal region, 5f, 5t white matter of, 235
tissues of origin, 72 Carpal tunnel syndrome, 191, 192f, 217t Cerumen, 281
Capacitation, of sperm, 629–631, 630f Carpi radialis, 181f, 190, 190f, 191t Ceruminous glands, 90, 281
Capillaries, blood, 392, 397 Carpi ulnaris, 190, 190f, 191t Cervical cancer, 626, 640t
Capillaries, lymphatic, 424–427, 425f, 427f Cartilage, 67–68, 141–142 Cervical curvature, 123f
Capillaries, peritubular, 550–551, 550f aging and, 161 Cervical lymph nodes, 429, 430f
Capillary beds, 396f, 397, 400 articular, 142–144, 143f Cervical nerves, 243f, 247, 248f
Capitate, 132, 133f cancers affecting, 165, 168t Cervical region, 5f, 5t
Capitulum, 130f, 131 elastic, 67–68, 68f, 141–142, 143f Cervical vertebrae, 122, 123f, 126, 126f
Capsule endochondral ossification in, 153–154, 153t, 154f Cervix of uterus, 607f–609f, 609
glomerular, 547, 548f–550f, 554f fibrocartilage, 67–68, 69f, 141–142, 143f dilation of, 636
joint, 147, 147f histology of, 141, 143f effacement of, 636
lymph node, 431f hyaline, 67–68, 68f, 141, 143f CFTR (cystic fibrosis transmembrane regulator) gene, 490
perirenal fat, 546 laryngeal, 463–464, 463f, 464f, 488 Channel(s), 49, 49f, 53, 253–255, 253f
renal, 545f, 546–547, 546f nasal, 460, 460f, 461f Channel proteins, 49, 49f
Carbohydrates, 39–41, 40t tracheal, 463f, 464–465, 464f Chemical bonds, 35, 36f
absorption of, 522, 526, 528 Cartilaginous joints, 145t, 147 Chemical digestion, 503, 528
building blocks of, 40, 40f, 40t Catalysts, 44 in liver, gallbladder, and pancreas, 515–518, 518t
digestion of, 504, 521, 528 Cataracts, 301, 301f, 301t in mouth, 507
energy from, 41 Cauda equina, 242, 243f, 248f in small intestine, 521
nutritional requirements for, B-1 Caudate lobe, of liver, 514, 515f in stomach, 512–514, 513t
Carbon Cavities, anatomical, 8, 8t, 9f Chemical equations, 44–45
atomic mass of, 34, 34f CBC (complete blood count), 489t Chemical level, of body organization, 32–46, 32f
atomic number of, 33, 34f Cecum, 502f, 503f, 519f, 522, 523f Chemical reactions, 44–46
atomic structure of, 34f Cell(s), 32 arrow direction in, 44
body percentage of, 33t aging and, 60–61, 61f catalyst for, 44
covalent bonding of, 35, 36f ATP as energy currency for, 46 definition of, 44
Carbon dioxide cytoplasm of, 46 speed or rate of, 44
air content of, 476 cytoskeleton of, 46, 48f Chemoreceptors
alveolar exchange and transport of, 484–485, 484f organelles of, 32, 46–50, 48f in cardiovascular physiology, 390–392, 391f, 406
atomic structure of, 36f programmed death of (apoptosis), 73 central, 486
excess of (hypercapnia), 486, 496t protein synthesis in, 54–58 peripheral, 486, 487f
partial pressure of, 476 Cell body, of neuron, 225, 225f, 226 in respiratory physiology, 486, 487f
respiratory exchange of, 476–485, 477f, 479f, 487 Cell division, 58–60 Chemoreflex, 406, 407

I-4 INDEX
Chemotaxis, 437, 437f Clot retraction, 353 Computed tomography (CT) angiography, 409t
Chewing (mastication), 507 Clotting (coagulation), 351–354, 352f Concentration
Chicken pox, 16, 16f, 105, 423, 447 Clotting disorders, 364–365, 366t reactant, 44
Chief cells, of stomach, 512–514, 512f, 520 Clotting factors, 339–340, 352f, 353 solution, 37
Childbirth, 635–636 Clotting studies, 360t Concentration gradient, 51–53, 52f, 477, 478–480
hormonal regulation in, 325–326, 325t, 326f, 635, 636f Club soda, 481, 481f Conchae, nasal, 118f, 120f, 121, 122, 460, 460f–461f
initiation of process, 635, 636f Clubbed fingers, 94 Concussion, 232, 265t
positive feedback in, 14–15 CML; see Chronic myeloid leukemia Conducting arteries, 395
process of, 636, 637f CNS; see Central nervous system Conduction system, cardiac, 382–383, 383f
Children CO; see Cardiac output Conductive hearing loss, 300, 301t
diseases affecting, 16–17 Coagulation, 351–354 Conductivity, muscle, 199
immunization of, 17, 17f clot elimination in, 354 Condyles, 131
Chlamydia, 600, 601t, 628, 640t clot retraction in, 353 femoral, 135, 135f
Chlamydia trachomatis, 600 disorders of, 364–365, 366t tibial, 135, 136f
Chlamydial conjunctivitis, 291 inappropriate, prevention of, 354 Cones, 294–295, 294f, 298
Chloride ions, absorption of, 524, 526 pathways of, 352–353, 352f Congenital disorders, 16–17, 16f
Cholecystectomy, 517 reaction cascade in, 353 definition of, 16
Cholecystitis, 517, 536t tests/studies of, 360t prenatal diagnosis of, 17
Cholecystokinin, 520–521 Coccygeal nerve, 243f, 247, 248f spinal, 124
Cholelithiasis, 517, 536t Coccyx, 115f, 122, 123f, 127, 127f Congenital heart defects, 414–416, 416f, 417f, 418t
Cholesterol Cochlea Congenital hydrocephalus, 264
biological function of, 315 anatomy of, 280f, 282, 282f, 283f Congenital immunodeficiency disorders, 451
in cell membrane, 49, 49f hearing function of, 282–284, 284f Congestive heart failure (CHF), 414, 415f, 418t
dietary, 315 Cochlear duct, 282, 282f, 283–284, 283f Conjugation, hormone, 321
elimination of, 522 Codons, 43, 55–57, 56f Conjunctiva, 291, 291f, 293f
familial combined hyperlipidemia and, 17 Cognition, aging and, 261 Conjunctivitis, 291
gallstones, 517 Cold (common cold), 490, 495t Connective tissue, 65–69
steroid synthesis from, 315 Colic flexures, 522, 523f adipose, 66–67, 67f
Chondrocytes, 68f, 69f, 141, 143f, 154–155 Collagen areolar, 65, 66f
Chondrosarcomas, 165, 168t in aging, 101 blood as, 67, 67f
Chordae tendineae (tendinous cords), 376, 377f, 385, 385f in bone, 68–69, 69f bone as, 68–69, 69f
Choroid layer, of eye, 292, 293f, 294, 294f in dense regular connective tissue, 65–66, 66f cartilage as, 67–68, 68f
Choroid plexus, 232, 233f in dermis, 87, 88f dense irregular, 66
Chromatin, 58 in fibrocartilage, 68, 69f, 142, 143f dense regular, 65–66, 66f
Chromosomes, 58–59 in heart, 374, 383 loose, 65, 66f
meiosis and, 587–589, 588f in hemostasis, 351–352 in scleroderma, 108, 109f
mitosis and, 58–60, 59f, 60f, 587 in hyaline cartilage, 68, 141 Conservation of matter, 44–45
sex, 364, 577, 578f, 606 in scleroderma, 108 Constipation, 525, 529, 536t
telomeres of, 60–61, 61f in wound healing, 97, 98f Constriction, of blood vessels, 344, 462
Chronic bronchitis, 474, 492, 495t Collapsed lung, 472, 496t Contact dermatitis, 107
Chronic disease, 15, 27, 27t Collateral axon, 225f Contact hypersensitivities, 450
Chronic glomerulonephritis, 570 Collecting ducts Contact inhibition, 97, 98f
Chronic lymphoblastic leukemia (CLL), 362, 363f, 366t lymphatic, 424, 426f, 430f, 433f Contagious diseases, 21
Chronic myeloid leukemia (CML), 362, 363f, 366t renal, 548, 548f, 550, 554f Contraception, 629
Chronic obstructive pulmonary disorders (COPDs), Colliculi, 241, 242f, 284 Contractility; see also Muscle contraction
474, 492–493, 492f, 495t Colon (large intestine), 502f, 503, 503f, 522–525 cardiac muscle, 390
Chronotropic factors, 390–392, 391f absorption in, 524–525, 526, 528 skeletal muscle, 199
Chyme, 513–514 aging and, 529 Contraction phase, 203, 203f
gastric, 513–514 anatomy of, 522–524, 523f Contracture, physiological, 208
large intestine, 524 digestion, 524, 528 COPDs; see Chronic obstructive pulmonary disorders
small intestine, 520–522 disorders of, 525, 529, 530–531, 530f, 531f, 536t Copper, 349, B-1
Cialis (tadalafil), 596 epithelial tissue of, 524 Coracoid process, 129, 129f
Cigarette smoking, 73, 465, 487–488, 488f, 493 mass movement of, 524, 528 Cornea, 291f, 293f, 295–296
Cilia, 47t, 48f Colon cancer, 529, 536t Corniculate cartilages, 463–464, 463f, 464f, 488
Ciliary body, 292–293, 293f Colonoscopy, 529, 529t Cornification, 85
Ciliary muscles, 296f, 297, 299 Colony-stimulating factors (CSFs), 344t, 346 Coronal plane, 6t, 7f
Circular folds, intestinal, 518–520, 519f Color blindness, 294, 301t Coronary arteries, 393f, 398–399, 398f, 399f
Circulation, 379–382, 380f, 381f Colostrum, 638 Coronary artery disease (CAD), 411–412, 418t
alternative routes of, 400–402 Colposcopy, 624t Coronary bypass surgery, 412
coronary, 398–399, 398f, 399f Columnar cells, 62f Coronary circulation, 398–399, 398f, 399f
fetal, 380–381, 382f Columnar epithelial tissue Coronary sinus, 398–399, 398f
portal, 400, 401f pseudostratified ciliated, 62, 64f Coronary sulcus, 375, 375f
pulmonary, 380, 381f, 399, 400f simple, 61, 64f Corpora cavernosa, 584f, 585, 585f, 611f
systemic, 380, 381f, 399 Columns, spinal cord, 243, 244f Corpus albicans, 615f, 616, 617f, 618f, 620
Circumcision, 585 Comedo, 89 Corpus callosum, 235, 235f, 239f
Circumduction, 179, 179f Comminuted fractures, 161f, 162 Corpus luteum, 615f, 616, 617f, 618f, 619–621, 631–632
Cirrhosis, 532, 536t Common bile duct, 516, 516f, 517 Corpus spongiosum, 584f, 585, 585f
Classification of disease, 21–23 Common carotid artery, 390f, 393f, 395 Cortex
Clavicle, 115f, 129, 129f Common cold, 490, 495t of adrenal glands (see Adrenal cortex)
Cleavage, 631, 631f Common hepatic duct, 516, 516f of cerebrum, 235, 486
Cleft lip, 16, 16f Common pathway, of coagulation, 352f, 353 of hair, 91f, 92, 92f
Cleft palate, 166–167, 167f, 168t Common warts, 104–105 of kidney, 546f, 547, 550f
Climacteric Communicable diseases, 21 Corti, organ of (spiral organ), 282, 282f, 283f
female, 623 Communication Corticotropin-releasing hormone (CRH), 308t, 310f,
male, 596 integumentary system and, 96 325, 325t, 635, 636f
Clitoris, 609f, 611, 611f muscular system and, 212 Cortisol, 309t, 324, 324t
aging and, 623 nonverbal, 96 elevated levels of, 332–333
sexual response of, 621–622, 622f Compact bone, 69f, 139–141, 140f reduced levels of, 324–325, 325t
CLL; see Chronic lymphoblastic leukemia Compartment syndrome, 197, 217t Costal cartilage, 127f, 128f
Cloning Complement system, 438, 440–441 Costal facets, 126, 126f
of B cells, 440, 441f Complete blood count (CBC), 489t Covalent bonds, 35, 36f
of T cells, 442, 443f Compliance, pulmonary, 474, 488 Cowper’s (bulbourethral) glands, 583, 584f, 585, 594
Closed fractures, 161 Compound (open) fractures, 161 Cramp, 213, 217t
Closed reduction, 162 Compression fractures, 162 Cranial bones (cranium), 115f, 116, 117–122, 118f–122f
Clostridium tetani, 204 Computed tomography (CT), 327t, 409t, 448t, 529t, 567t Cranial cavity, 8, 8t, 9f

INDEX I-5
Cranial nerves, 246–247, 246f, 247t; see also specific Dense irregular connective tissue, 66 in small intestine, 518, 520–521, 528
nerves Dense regular connective tissue, 65–66, 66f in stomach, 513–514
mnemonics for, 246 Dental caries, 506, 536t Digestive juices
in olfaction, 278–279, 278f Dentin, 505f, 506 from liver, gallbladder, and pancreas, 515–518, 518t
in pain pathway, 274 Deoxyhemoglobin, 483–484, 483f from mouth, 507
in taste, 277 Deoxyribonucleic acid; see DNA from pancreas, 520–521
Cranial region, 5f, 5t Depolarization from stomach, 512–514, 513t
Creatine phosphate (CP), 208 of cardiac muscle, 384–385 Digestive system, 76, 76t, 78f, 501–541, 502f
Creatinine, 545, 545f of membrane, 253f, 254 accessory structures of, 503, 503f, 514–518
Cremaster muscle, 581f, 582 Deposition, bone, 152, 156, 161 aging and, 528–529
Crenation, 53 Depressed fractures, 161 anatomy of, 502–503, 502f, 503f
Crepitus, 150 Depression, mood, 226, 265t connection with other body systems, 538
CRH; see Corticotropin-releasing hormone Depression, movement, 180, 180f diagnostic tests for, 529, 529t
Cribriform plate, 119–121, 120f–122f, 278, 278f, 460f Depth perception, 297 disorders of, 529–536, 536t–537t
Cricoid cartilage, 463f Dermal papilla, 86f, 87, 88f, 90, 91f functions of, 527–528
Crista ampullaris, 287, 288f Dermatitis, 106–107, 107f, 109t overview of, 502–504
Crohn’s disease, 531, 536t Dermatomes, 249, 249f pregnancy and, 633
Cross-bridge, 198, 199f, 201, 202f Dermis, 83, 84f, 87–91, 88f regulation of, 527
Crossing-over, 588f, 589 aging and, 100–101 word roots and combining forms for, 502
Croup, 491, 495t connective tissue of, 65, 66f Digital rectal exam (DRE), 597, 597t, 598f
Crown, of tooth, 505f, 506 fibers of, 87, 88f Dilation
Crowning, 636, 637f glands of, 83, 88f, 89–90 of blood vessels, 343, 403, 405, 407, 437, 437f, 450
Cruciate ligaments, of knee, 147–149, 148f–149f nerve endings in, 88f, 89, 96 of cervix, in childbirth, 636
Crus of clitoris, 611f as “true skin,” 87 Diploid number (2n), 587–589, 614
Crus of penis, 584f, 585 Descending colon, 503f, 522–524, 523f Directional terms, 2, 3f–4f, 3t
Cryptorchidism, 579, 593, 601t Descending tracts, of spinal cord, 242–243, 244f Disaccharides, 40, 40f
Crypts, tonsillar, 433, 433f Detrusor muscle, 562, 563f, 565 Disease
CSF; see Cerebrospinal fluid Developmental disorders, 16–17 acute, 15
CT scans; see Computed tomography DEXA scan, 164t, 165, 327t childhood, 16–17
Cubital region, 5f, 5t DHEA; see Dehydroepiandrosterone chronic, 15
Cuboid (bone), 136, 137f, 138f Diabetes insipidus, 329, 333t classification of, 21–23
Cuboidal cells, 62f, 84 Diabetes mellitus, 328–329, 333t definition of, 15
Cuboidal epithelial tissue, simple, 61, 63f epidemiology of, 27t diagnosis of, 23–24
Cultures, 489t, 529t gestational, 632, 641t epidemiology of, 25–27
Cumulus oophorus, 619, 619f type 1, 22, 328 predisposing factors of, 15–18
Cuneiforms, 136, 137f, 138f type 2, 328–329 prognosis of, 23
Cupula, of ear, 287, 288f Diagnosis, 23–24 signs and symptoms of, 18–21
Curly hair, 92, 92f definition of, 23 treatment of, 24–25
Curvatures, of spinal column, 123–124, 123f, differential, 24 Disease-modifying antirheumatic drugs (DMARDs), 450
124f, 168t flowchart of, 23 Displaced fractures, 161, 161f
Cushing’s syndrome, 332–333, 333f, 333t prenatal, 17 Disseminated intravascular coagulation (DIC), 365, 366t
Cutaneous glands, 83, 88f, 89–90 radioisotopes in, 35 Distal, 3t
Cuticle Diagnostic tests, 24, 24f Distal convoluted tubule (DCT), 547–549, 548f–550f, 554f
of hair, 91f, 92, 92f for blood disorders, 359–361, 360t Distance vision, 296–297, 296f
of nail, 93, 93f for digestive system, 529, 529t Distributing arteries, 396
CVA; see Cerebrovascular accident for endocrine system, 327, 327t Diuretics, 561
Cyanosis, 94 for excretory/urinary system, 566–567, 567t Diverticula, 530, 530f
Cyclic adenosine monophosphate (cAMP), 317f for female reproductive system, 624, 624t Diverticular disease, 530–531, 530f, 531f, 536t
Cystectomy, 570 for heart and blood vessels, 408–410, 409t Diverticulitis, 530
Cystic duct, 516f, 517 for integumentary system (skin), 24f, 101, 102t DMARDs (disease-modifying antirheumatic drugs), 450
Cystic fibrosis, 43, 490, 496t for lymphatic system, 447–448, 448t DNA
Cystic fibrosis transmembrane regulator (CFTR) for male reproductive system, 597, 597t cell division and, 58–60
gene, 490 for muscular system, 204, 213, 213t errors in, 60
Cystitis, 567–568, 571t for nervous system, 256, 262, 262t genetic code, 43
Cystoscopy, 567t, 570 for respiratory system, 489–490, 489t hydrogen bonds of, 36
Cytolysis, 438 for senses, 299–300, 300t nucleotides of, 43
Cytoplasm, 46 for skeletal system, 164, 164t replication of, 59–60
Cytosine, 43, 43f Dialysis, 570 structure of, 43, 43f
Cytoskeleton, 46, 48f Diapedesis, 437, 437f transcription of, 54–55, 55f
Cytotoxic T cells, 428, 442, 443f, 444, 444f, 445 Diaphragm (muscle), 185, 185f, 186t, 459f, 470–471, DNA analysis, forensic, leukocytes in, 58, 342
471f–473f Dopamine, in Parkinson’s disease, 263

d
Dartos muscle, 581, 581f
Diaphysis, 142–144, 143f
Diarrhea, 525, 536t
Diastole, 384–386, 385f
Dorsal, 3t
Dorsal cavity, 8, 8t, 9f
Dorsal pedal artery, 390f
Daughter cell, 58–60, 59f, 60f, 587–589, 616 Diastolic pressure, 403–404 Dorsal root, 244f, 248f, 249
Deciduous teeth, 504, 505f DIC; see Disseminated intravascular coagulation Dorsal root ganglion, 244f, 248f, 249
Decompression sickness, 481 Diencephalon, 223, 224f, 235f, 236t, 238–239 Dorsiflexion, 177, 178f
Decongestants, 462 Differential diagnosis, 24 Double helix of DNA, 43, 43f
Decremental potentials, 254 Differential WBC count, 360t, 448t Down a concentration gradient, 51
Decubitus ulcers, 107, 109t Differentiation Down-regulation, 320, 321f
Deep, 3t, 4f of B cells, 440, 441f DPT vaccine, 492
Defecation, 522, 528, 542 of T cells, 442, 443f DRE; see Digital rectal exam
Defecation reflex, 524, 525f, 528 Diffusion Drug(s)
Defenses, 435–436; see also Immunity facilitated, 51, 52f aging and metabolism of, 529
Defervescence, 438, 439f simple, 51, 51f anabolic steroids, 593
Defibrillator, 387 Digestion, 528 anticoagulant, 354
Deglutition (swallowing), 509–510, 509f carbohydrate, 504, 521, 528 antidepressant, 226
Dehydroepiandrosterone (DHEA), 309t, chemical, 503, 528 antihypertensive, 558, 561
324–325, 324t control of, 527 anti-inflammatory, 20
Delayed hypersensitivities, 450 fat (lipid), 504, 513–516, 521, 528 biologic disease-modifying antirheumatic, 450
Deltoid, 181f–182f, 187f, 189f, 189t in large intestine, 524, 528 CNS depressants, 241
Deltoid tuberosity, 130, 131f mechanical, 503–504, 507, 528 decongestant, 462
Dementia, 262–263 in mouth, 507, 528 diuretic, 561
Dendrites, 71f, 225, 225f mouth to stomach, 509–510, 509f erectile dysfunction, 596
Dendritic cells, 86, 86f, 429, 446 protein, 504, 513–514, 521, 528 immunosuppressant, 442

I-6 INDEX
 osteoporosis, 165 Endemic goiter, 331, 331f stratified, 61, 62f
renal clearance of, 554, 566 Endocarditis, 374–375, 418t squamous, 61, 63f
Dual-energy X-ray absorptiometry (DEXA) scan, Endocardium, 373f, 374 transitional, 62, 65f
164t, 165, 327t Endochondral growth, 154–155, 155f Epitopes, 439–442, 440f, 441f
Duchenne muscular dystrophy, 214 Endochondral ossification, 153–154, 153t, 154f EPO; see Erythropoietin
Ductus arteriosus, 382, 382f Endocrine cells, of stomach, 512, 512f Eponychium, 93, 93f
Ductus arteriosus, patent, 414–416, 416f, 418t Endocrine glands, 307–315, 308t–309t Epstein-Barr virus, 530
Ductus deferens, 580f, 581f, 582, 583, 584f, 594 Endocrine hormones, 318; see also Hormone(s) Equilibrium (sense), 279, 285–289
Duodenal ulcers, 532 Endocrine system, 75t, 76, 77f, 305–336 aging and, 299
Duodenum, 502f, 514, 516f, 518–520, 519f aging and, 326–327 anatomy of, 285–287, 286f, 287f
Dura mater, 231–232, 231f, 233f, 243f anatomy of, 307–318, 308f dynamic, 285, 285f, 287
Duration, sensory information on, 274 in blood flow/pressure control, 406 pathway for, 289
Dwarfism, pituitary, 330–331, 330f, 333t communication with nervous system, 306–307, 306f physiology of, 287–289
Dynamic equilibrium, 285, 285f, 287 connections with other body systems, 334 static, 285
Dysmenorrhea, 614, 627 diagnostic tests for, 327, 327t Erectile dysfunction, 596
Dystrophin, 214 disorders of, 328–333, 333t Erectile tissue
negative feedback in, 318–319, 319f, 325 female, 611, 621

e
Ear, 279–289
overview of, 306–307
physiology of, 318–326
target tissues of, 307, 308t–309t, 316–318, 326
penis, 585
Erection of penis, 585, 594–596
Erector spinae, 187f–188f, 188, 188t
aging and, 299 word roots and combining forms for, 306 Erythroblast(s), 345f
anatomy of, 280–282, 280f, 282f, 283f Endocytosis, 54, 54f Erythrocytes, 68, 68f, 340–342, 341t
disorders of, 281, 299, 300, 301t Endolymph, 282, 283–284, 284f, 287, 288f agglutination of, 355–356, 356f
equilibrium function of, 279, 285–289, 286f–288f Endometriosis, 627–628, 627f, 641t blood typing and, 355–357
hair cells of, 282, 283f, 284, 284f, 286–287, 286f–288f Endometrium, 607f, 609, 619–620, 620f crenation of, 53
hearing function of, 279, 282–285, 284f Endomysium, 196, 196f death and disposal of, 350–351, 350f, 434, 542
Ear infections, 281, 301t Endoneurium, 245–246, 245f disorders of, 362–364, 366t
Eardrum; see Tympanic membrane Endoplasmic reticulum, 47, 47t, 48f, 198 functions of, 341t, 342, 346–347, 350
Earwax, 281 Endosteum, 140f, 143f, 144 gender and, 359
ECF; see Extracellular fluid Endothelium, 392, 395f hemolysis of, 53, 364
ECG; see Electrocardiography Environment life cycle of, 342, 350, 350f
Echocardiography, 409t and metaplasia, 73 nucleus and DNA lacking in, 58, 342
Ectopic focus, 386 as predisposing factor, 18 as percentage of whole blood, 338, 339f
Ectopic pregnancy, 639, 639f, 641t Eosinophils, 339f, 341t, 342–343 plasma tonicity and, 52–53, 53f
Eczema, 107, 107f in immune response, 438 production of, 344t, 345f, 346–350, 364, 544
Effacement, 636 production of, 345f structure of, 341t, 342
Effector, 256–258, 258f test for (count), 360t, 448t test for (count), 360t
Efferent arterioles, 547–549, 548f–550f, 550–551, 554f Ependymal cells, 228, 228t, 229f, 232 volume of (hematocrit), 338, 360t, 361f
Efferent ductules, 580f, 583, 584f Epicardium (visceral pericardium), 10, 11f, 372–373, Erythropoiesis, 344t, 345f, 346–350
Efferent lymphatic vessels, 431f 372f–373f altitude and, 347
Efferent (motor) nerves, 246 Epicondyles, 131 blood loss and, 348
Efferent (motor) neurons, 223–224, 246, 256–258 femoral, 135, 135f carbon monoxide and, 347
Effort, in lever system, 205–206, 206f humeral, 130f, 131 exercise and, 347
Eggs; see Ova Epidemics, 26 gender and, 359
Ejaculation, 595, 595f Epidemiology, 25–27 inadequate, 364
Ejaculatory duct, 583, 584f definition of, 25 nutritional requirements for, 349
EKG; see Electrocardiography impact on health care, 26–27 renal function in, 346–348, 544
Elastic cartilage, 67–68, 68f, 141–142, 143f influenza and influenza vaccines, 26 Erythropoietin (EPO), 344t, 346–348, 544, 634
Elastic fibers, 68, 68f, 87, 88f, 101, 142, 143f, 374 Spanish flu of 1918, 26, 26f Esophageal ulcers, 531
Elasticity, 88, 199 trends, in chronic diseases, 27, 27t Esophagus, 459f, 460f–461f, 502f, 503, 503f, 508, 508f
Elastin, 87, 88f Epidermis, 83–86, 84f digestive function of, 509–510, 509f, 513
Elderly; see also Aging aging and, 100–101 epithelial tissue of, 61, 63f, 508, 508f
diseases affecting, 17 cells of, 85–86, 86f Essential amino acids, 210, 210t
Electrocardiography (ECG, EKG), 387–388, 387f, strata of, 84, 85f, 86f Estradiol, 613, 618f
388f, 409t Epididymis, 580f, 581f, 583, 584f, 591 Estriol, 613
Electrolyte(s), 35 Epididymitis, 599, 601t Estrogen(s), 309t, 314, 315
absorption of, 524, 526 Epidural space, 231f, 232 aging and, 326–327
channels for, 53 Epigastric region, 2–6, 6f bone effects of, 157, 159t, 160
definition of, 35 Epiglottis, 459f, 460f–461f, 463, 463f, 464f, 508, 509, 509f in childbirth, 636f
plasma, 340 Epilepsy, 265, 265t in female reproductive cycle, 618–620, 618f
Electrolyte balance, 35, 555–556 Epimysium, 196, 196f forms of, 613
bone physiology and, 160 Epinephrine, 309t, 315 melatonin and, 323, 323t
renal regulation of, 556–561, 565 in blood flow/pressure control, 406 in menopause, 327, 623
sodium-potassium pump in, 53 in cardiac physiology, 392 in postpartum, 637–638
Electromyography (EMG), 204, 213, 213t injection of, 316 in pregnancy, 620, 632
Electrons, 33–34, 34f Epineurium, 245f, 246 in puberty, 613
sharing, in covalent bonds, 35, 36f Epiphyseal fractures, 162 skin effects of, 89, 100
shells or orbits of, 34, 34f Epiphyseal plates, 143f, 154–155, 154f, 155f Estrone, 613
transfer, in ionic bonds, 35, 36f Epiphyses, 142, 143f, 154–155 Ethmoid bone, 118f–122f, 119–122, 460, 461f
Elements, 33 Episiotomy, 636 Ethmoid sinus, 123f
isotopes of, 34–35 Epithelial cells, 61, 62f Etiologies, 22
major, of human body, 33t Epithelial tissue, 61–64; see also specific anatomical sites Eustachian (auditory) tube, 280f, 281, 282f
periodic table of, 33, 34f cancers of, 72 Eversion, 177, 178f
Elephantiasis, 428, 452t distribution of, 61 Excitability, muscle, 199–200, 200f
Elevation, 180, 180f metaplasia of, 73 Excitatory potentials, 254–255
Ellipsoid joints, 146t, 150 nomenclature for, 61 Excretion, 321, 544
Embolus/embolism, 354, 366t, 412 pseudostratified, 61, 62f Excretory/urinary system, 76t, 78f, 542–575, 543f
Embryo, 615f, 631 pseudostratified ciliated columnar, 62, 64f aging and, 566
Emetic center, 534 simple, 61, 62f cancers of, 570–571
EMG; see Electromyography columnar, 61, 64f connections with other body systems, 572
Emission, in male sexual response, 594, 595f cuboidal, 61, 63f diagnostic tests for, 566–567, 567t
Emphysema, 474, 480, 480f, 492–493, 492f, 495t, 552 squamous, 61, 62f disorders of, 566–570, 571t
Emulsification, 515–516, 518t, 521 squamous functions of, 565–566
Enamel, of teeth, 505f, 506, 528 simple, 61, 62f organs of, 543–544, 543f, 561, 562f
Encephalitis, 240, 265t stratified, 61, 63f overview of, 544–545

INDEX I-7
Excretory/urinary system (Continued) Feces, 524, 528, 542 Fluid mosaic, of cell membrane, 49
physiology of Feedback, 13–15, 14f; see also Negative feedback; Focus, in vision, 295–297, 296f
micturition in, 563–565, 564f Positive feedback Folic acid, 349, 634, B-2
urine production in, 551–561, 554f Female reproductive cycle, 617–621, 618f Follicle(s)
pregnancy and, 634 Female reproductive system, 76, 76t, 78f, 605–645, 606f hair, 83, 84, 88f, 90–91, 91f, 101
word roots and combining forms for, 544 aging and, 623–624 ovarian, 606, 607f, 614–616, 615f
Exercise anatomy of, 606–613, 607f–609f Follicle-stimulating hormone (FSH), 309t, 310f, 315
and aging, 408 birth in, 14–15, 325–326, 325t, 326f, 635–636, 636f, 637f in female puberty, 613
and cardiac output, 389 complexity of, 605 in female reproductive cycle, 618–620, 618f
and erythropoiesis, 347 connections with other body systems, 642 in folliculogenesis, 616
and lung volumes/capacities, 474 diagnostic tests for, 624, 624t in males, 587, 592, 593f, 596
and muscular system, 212 disorders of, 624–628, 639–640, 640t–641t melatonin and, 323, 323t
Exfoliation, 84, 85f, 86f hormonal control of in menopause, 327, 623
Exocrine glands, 89 in adult, 617–621 in oogenesis, 616
Exocytosis, 54, 54f in puberty, 613–614 in pregnancy, 632
Exophthalmos, 331 oogenesis and folliculogenesis in, 614–617, 615f, 617f secretion of, 318
Expiration, 458, 470–473, 473f, 485–486 overview of, 606 Follicular phase, of ovarian cycle, 618–619, 618f
Expiratory reserve volume (ERV), 474, 475f, 475t physiology of, 613–622 Folliculogenesis, 615f, 616, 617f
Extensibility, 88, 199–200 pregnancy in, 628–640 Fontanelles, 152–153, 153f
Extension, 177, 177f secondary organs and structures of, 608–612 Food poisoning, 21, 534–535, 537t
Extensor carpi radialis, 190, 190f, 191t word roots and combining forms for, 606 Foot
Extensor carpi ulnaris, 190, 190f, 191t Female sexual response, 621–622 arches of, 137, 138f
External abdominal oblique, 181f–182f, 185f–186f, Femoral artery, 390f, 393f bones of, 136–137, 137f, 138f
186t, 187, 187f, 189f Femoral neck, 134, 135f Foramen magnum, 119, 120f
External anal sphincter, 523f, 524 Femoral region, 5f, 5t Foramen ovale, 380–381, 382f
External auditory meatus, 280–281, 280f Femur, 115f, 134–135, 135f, 140f Foramina
External barriers, 436–437 Fertilization, 616, 620, 629–631, 630f of skull, 119, 120f
External (outer) ear, 280–281, 280f Fertilization membrane, 630f, 631 vertebral, 125–126, 125f, 126f
External genitalia, male, 580–581, 581f, 584f, 585, 585f Fetus, 631 Force, in filtration, 50
External intercostal muscle, 185f, 186t, 188f, apoptosis in, 73 Forced expiration, 471
470–471, 471f birth process, 645–646, 646f, 647f Forearm
External occipital protuberance, 119, 120f circulation of, 380–381, 382f bones of, 131–132, 131f
External urethral orifice, 563, 563f, 585, 585f full-term, 633f muscles of, 190–191, 190f, 191t
External urethral sphincter, 563, 563f ossification in, 152–154 supination and pronation of, 179, 179f
Extracellular fluid (ECF), 49, 253–255, 253f, 555 sex determination in, 586–587, 587f, 606 Forensics
Extrinsic muscles, 176 thymus gland of, 434, 434f hyoid fracture in, 128
Extrinsic pathway, of coagulation, 352f, 353 Fever, 18–19, 436, 437–438, 439f leukocytes in, 58, 342
Eye(s), 289–298 Fiber (cellulose), 49 Foreskin (prepuce), 584f, 585, 585f
accessory structures of, 290–291, 290f, 291f Fibers Formed elements, of blood, 67, 67f, 338, 340–344,
aging and, 299 collagen, 68–69, 68f, 87, 88f 341t–342t
anatomy of, 290–295, 290f–295f dermal, 87, 88f as percentage of whole blood, 338, 339f
chambers of, 292–293 elastic, 68, 68f, 87, 88f, 101, 142, 143f, 374 production of, 344–350, 344t, 345f
disorders of, 293, 296, 299, 300, 301, 301f, 301t muscle (see Muscle fibers) tests for (counts), 360t, 361
muscles of, 291–292, 291f–292f, 296f, 297, 299 Fibrin, 352–354, 352f Fossa ovalis, 376, 377f, 382
ophthalmoscopic examination of, 294–295, 295f Fibrinogen, 339–340, 339f, 352–354, 352f Fovea centralis, 295, 295f
photoreceptors of, 289, 293–295, 294f, 298 Fibrinolysis, 354 Fractures, 161–163, 168t
vision function of, 295–298, 296f Fibroblasts, 65–66, 66f, 87, 97, 98f aging and, 160
Eye movements, 289, 292 Fibrocartilage, 67–68, 69f, 141–142, 143f closed reduction of, 162
Eyeball, 292–295, 293f Fibroids, 626, 627f, 641t epiphyseal, 162
Eyebrows, 290, 290f Fibromyalgia, 215, 216f, 217t healing of, 162, 163f
Eyelashes, 290, 290f Fibrosis, 97, 98f hyoid bone, 128
Eyelids, 290, 290f Fibrous joints, 144, 145t open reduction of, 162, 162f
Fibrous skeleton, of heart, 73, 373 types of, 161–162, 161f

f
FACES Pain Rating Scale, 19
Fibula, 115f, 136, 136f, 138f
Fibularis (peroneus), 181f–182f, 195, 195f, 195t
Fight-or-flight, 250
Frank-Starling law of the heart, 390
Freckles, 85
Frenulum, lingual, 504f, 506, 507f
Facial bones, 115f, 118f–120f, 122 Filtrate, 549, 551–552 Frequency of sound, 279, 280f, 284, 284f
Facial nerve (CN VII), 246f, 247t, 274, 277, 509 Filtration Frontal bone, 117, 118f–121f, 122
Facial region, 5f, 5t glomerular, 551, 554, 554f Frontal lobe, 234f–235f, 236t, 237
Facilitated diffusion, 51, 52f membrane transport via, 50–51 in equilibrium, 289
Falciform ligament, 514, 514f–515f Fimbriae, of uterine tube, 607f, 609, 619 in olfaction, 279
Fallen arches, 138 First-degree burns, 99, 99f Frontal plane, 6t, 7f
Fallopian tubes; see Uterine tubes Fixator muscles, 176 Frontal sinus, 120f, 123f, 459f, 460f–461f, 462
False ribs, 127f, 128 Flagellum, of sperm, 586, 586f, 591f Frontalis, 181f, 183, 183f, 184t
Familial combined hyperlipidemia, 17b Flank pain, 570 FSH; see Follicle-stimulating hormone
Family planning, 629 Flat bones, 116 Fulcrum, 205–206, 206f
Farsightedness, 296 Flat feet, 138 Full-thickness burns, 99, 99f
Fascia, 197, 197f Flat warts, 104–105 Functional murmur, 410
Fascia, renal, 545f, 546 Flatus, 524 Functional residual capacity (FRC), 475f, 475t
Fascicles Flavors, 277 Fundus
muscle, 196, 196f Flexion, 177, 177f of stomach, 510f, 511
nerve, 245f, 246 Flexor carpi radialis, 181f, 190, 190f, 191t of uterus, 607f, 608f, 609
Fast-twitch fibers, 209, 212 Flexor carpi ulnaris, 190, 190f, 191t Fungal infections
Fat(s) Floaters, 299 nail, 101, 109t
absorption of, 526, 528 Floating ribs, 127f, 128 skin, 105, 105f

g
digestion of, 504, 513–514, 515–516, 521, 528 Flow
emulsification of, 515–516, 518t, 521 blood (see Blood flow)
nutritional requirements for, B-1 pulmonary airflow, 470–473, 473f
Fatigue, 208–209 syringe illustration of, 384, 384f, 470 Gallbladder, 502f, 503, 503f, 516f, 517, 521
Fat-soluble vitamins, 526 Fluid balance, 555–556, 555f, 556f Gallstones, 517, 536t
Fatty acid tail, of phospholipids, 49, 49f kidneys and, 556–561, 565 Gametes, 578, 605, 606; see also Ova; Sperm
Fatty acids, 41, 41f lymphatic system and, 446 Ganglia, 228, 241, 244f, 248f, 249
absorption of, 526, 528 osmosis in, 52–53 parasympathetic, 250–252, 252f
lipid digestion to, 521, 526, 528 plasma in, 359 sympathetic chain, 250, 251f
Fecal occult blood test, 529t sodium-potassium pump in, 53 Ganglion cells, 294, 294f

I-8 INDEX
Gangrene, 73 Glottis, 463, 463f, 464f, 509 Gubernaculum, 578, 579f
Gas(es); see also specific gases Glucagon, 309t, 311, 315 Gum (gingiva), 504–506, 505f, 528
air composition, 476 functions of, 309t, 322–323, 322t Gustation, 276; see also Taste
blood, 485–486, 487f, 489t target tissues of, 309t, 322t Gyrus (gyri), 234–235, 234f
partial pressure of, 476 Glucocorticoids, 309t, 314, 315, 324–325, 324t
in plasma, 339f, 340
properties of, 476
solubility of, 480
in childbirth, 635, 636f
Glucometer, 329f
Glucose, 40
h
Hair, 91–93
Gas exchange, 458, 476–485, 477f, 487 blood levels, in diabetes mellitus, 328–329, 552 aging and, 101
alveolar, 484–485, 485f glucagon and, 322–323 axillary, 587, 613
concentration gradient and, 477, 478–480 insulin and, 318, 322–323, 328–329 color of, 90, 92, 92f
factors influencing, 478–480, 480f membrane transport of, 51, 52f growth and loss of, 92–93
gas solubility and, 480 metabolism of layers of, 92
inspired vs. expired air in, 478, 479f in aerobic respiration, 207–208, 207f, 207t pubic, 587, 613
membrane area and, 480, 480f in anaerobic respiration, 207, 207f, 207t, 208 structure of, 91f, 92, 92f
membrane thickness and, 480, 480f in cellular respiration, 44–46, 206–208, 207f, 207t texture of, 92, 92f
systemic, 482–484, 483f in glycolysis, 207–208, 207f types of, 91
Gas transport, 482–485 in skeletal muscle, 206–208, 207f, 207t Hair bulb, 91f, 92
alveolar, 484–485, 485f pregnancy and, 632 Hair cells of ear, 282, 283f
in blood, 348–350, 482–484, 483f regulation of equilibrium function of, 286–287, 286f–288f
systemic, 482–484, 483f homeostasis in, 14, 14f, 51, 322–323 hearing function of, 284, 284f
Gastric glands, 511–512, 512f, 513t negative feedback in, 14, 14f, 51 Hair cycle, 92–93
Gastric juices, 512–514, 513t renal, 551–552, 554f Hair follicle, 83, 84, 88f, 90–91, 91f, 101
Gastric lipase, 512–514, 513t in urine, 328, 552 Hair matrix, 90, 91f
Gastric pits, 511–514, 512f, 513t Glucosuria, 328 Hair receptors, 273t, 274
Gastric rugae, 510f–511f, 511 Gluteus maximus, 182f, 187f, 188t, 189 Hair root, 91f, 92
Gastric ulcers, 532, 532f Gluteus medius, 182f, 187f, 188t, 189 Hair shaft, 91f, 92
Gastrin, 512–514, 513t Glycerol, 41, 41f, 521, 526, 528 Hairline fractures, 161
Gastrocnemius, 181f–182f, 195, 195f, 195t Glycerol head, of phospholipids, 49, 49f Hairy leukoplakia, 530, 536t
Gastroenteritis, 530, 536t Glycogen, 40–41, 378, 610 Half-life, of hormones, 322
Gastroesophageal reflux disease (GERD), 511, 537t Glycolysis, 207–208, 207f Hamate, 132, 133f
Gastrointestinal (GI) tract, 502–503, 502f Glycoprotein(s), in cell membrane, 49, 49f Hamstring muscles, 182f, 193, 194f, 194t
Gender (sex), 17 GnRH; see Gonadotropin-releasing hormone Hand, bones of, 116f, 132, 133f
and blood values, 359 Goblet cells, 62, 64f, 464f, 465, 465f, 518, 519f Haploid number (n), 589, 614
and body fluids, 555 Goiters, 331, 331f Hard keratin, 92, 94
determination of, 577, 578f, 586–587 Golgi complex, 47t, 48f Hard palate, 459f, 460f–461f, 504, 504f
and heart rate, 389 neuronal, 225f, 226 Hashimoto’s disease, 332, 333t
and iron requirements, 349 protein processing and secretion in, 57, 57f Haustra, 523f, 524
and lung volumes/capacities, 474 Gomphoses, 144, 145t Haversian canal, 139–141, 140f
and pelvic structure, 134, 134f Gonad(s), 309t, 314; see also Ovaries; Testes Haversian systems (osteons), 69f, 139–141, 140f
as predisposing factor, 17 Gonadotropin-releasing hormone (GnRH), 307, 308t, hCG; see Human chorionic gonadotropin
and urinary structures, 562–563, 563f 310f, 318 HCS; see Human chorionic somatomammotropin
Gene(s), 43 in female puberty, 613 HDN; see Hemolytic disease of the newborn
Gene therapy, for cystic fibrosis, 490 in male puberty, 587 Head, of body, 5f, 5t; see also Skull
General senses, 271–275 in male reproductive function, 592, 593f, 596 muscles of, 180–184, 183f, 184t
aging and, 298 Gonorrhea, 600, 601t, 628, 640t Head (anatomical feature)
receptors for, 271 Gonorrheal conjunctivitis, 291 of epididymis, 580f, 583, 584f
General sensory areas, 235–237, 238f Gout, 166, 166f, 168t of femur, 134, 135f, 140f
Genetic code, 43 Graafian (mature) follicle, 615f, 616, 617f of fibula, 136f
Genetic disorders, 16–17, 22 Gracilis, 181f–182f, 193, 193f, 194t of humerus, 130, 130f
Genetic testing, 17 Graded potentials, 254 of pancreas, 516f
Genital herpes, 105, 599–600, 601t, 628, 640t Granulation tissue, 97, 98f of radius, 131, 131f
Genital warts, 104–105, 600, 601t Granulocytes, 343 of sperm, 586, 586f, 591f
Genitalia, external, male, 580–581, 581f, 584f, 585, 585f marrow storage of, 346 Headache
GERD; see Gastroesophageal reflux disease production of, 345f, 346 sinus, 462
Germ cells, 589, 590f, 592f, 614 Granulosa cells, 630, 630f as symptom, 18–19
Germinal centers, 429, 431f Graves’ disease, 331, 333t, 450 Healing
Gestation, 631 Gravity fracture, 162, 163f
Gestational diabetes, 632, 641t and equilibrium, 286, 287f wound, 97, 98f
GFR; see Glomerular filtration rate and swallowing, 510 Hearing, 279–285
GH; see Growth hormone and venous return, 402 aging and, 299
GHRH; see Growth hormone–releasing hormone Gray hair, 92, 92f, 101 anatomy of, 280–282, 280f, 282f
Giardia, 535 Gray matter, 227 brain function in, 237, 238f, 241
Gigantism, 329–330, 333t brain, 235, 241, 242f pathway for, 284–285
Gingiva, 504–506, 505f, 528 spinal cord, 242–243, 244f physiology of, 282–285
Gingivitis, 506, 536t Great alveolar cells, 468f, 469 range of, 279, 280f
Glands; see also specific glands Great cardiac vein, 398–399, 398f tests of, 300, 300t
cutaneous, 83, 88f, 89–90 Great vessels, 371 Hearing acuity, 299
endocrine, 307–315, 308t–309t Greater curvature, of stomach, 510f, 511 Hearing loss, 299, 300, 301t
exocrine, 89 Greater omentum, 12, 13f Heart, 73–75, 74f, 338, 370–392
Glans of clitoris, 611, 611f Greater trochanter, 134–135, 135f anatomy of, 371–378, 372f–375f
Glans of penis, 584f, 585, 585f Greater tubercle, of humerus, 130, 130f internal, 376, 377f
Glaucoma, 293, 300, 301t Greenstick fractures, 161, 161f surface, 375, 375f
Glenoid cavity, 129, 129f Growth apex of, 371, 372f, 375f
Gliding joints, 146t, 150 bone, 154–155, 155f, 156f base of, 371, 372f
Gliomas, 229, 265t hair, 92–93 blood flow through, 379–382, 380f, 381f, 398–399,
Globins, 348, 348f, 350, 350f nail, 94 398f, 399f
Globulins, 339, 339f tissue, 72 chambers of, 73, 74f, 375–376, 375f, 377f
Glomerular capsule, 547, 548f–550f, 554f Growth disorders, 329–331 conduction system of, 382–383, 383f
Glomerular filtration, 551, 554, 554f Growth hormone (GH), 309t, 310f, 315 contractility of, 390
Glomerular filtration rate (GFR), 551, 566 hypersecretion of, 329–330, 330f, 333t electrical and contractile activity of, 387–388,
Glomerulonephritis, 569–570, 571t hyposecretion of, 330–331, 333t 387f, 388f
Glomerulus, 547, 548f, 549f, 550, 550f, 554f Growth hormone–releasing hormone (GHRH), 308t, 310f electrocardiogram of, 387–388, 387f, 388f, 409t
Glossopharyngeal nerve (CN IX), 246f, 247t, 274, Guanine, 43, 43f endocrine function of, 75, 314
277, 509 Guard hairs, 460 epithelial tissue of, 73, 371–374, 372f–373f

INDEX I-9
Heart (Continued) Heparin, 343, 354 Hormone(s), 306–307, 308t–309t, 315–316; see also
exercise and, 407–408 Hepatic artery, 396, 401f, 514–515, 515f, 526 specific hormones and hormone types
fibrous skeleton of, 73, 373 Hepatic ducts, 516, 516f aging and, 326–327
Frank-Starling law of, 390 Hepatic (colic) flexures, 522, 523f amino acid derivatives, 315
___location of, 371, 372f–373f Hepatic lobules, 514, 515f autocrine, 318
overview of, 371 Hepatic portal route, 400, 401f, 526, 527f in blood flow/pressure control, 406
physiology of, 379–392 Hepatic portal vein, 400, 401f, 514–515, 515f, 526, in bone physiology, 157–158, 158f
regulation of, 390–392, 391f 527f, 528 chemistry of, 315–316
rhythm of, 386–387 Hepatic screening, 529t in childbirth, 325–326, 325t, 326f
serous membrane of, 10, 11f Hepatic vein, 394f, 400, 401f communication with nervous system, 306–307, 306f
word roots and combining forms for, 371 Hepatic veins, 515, 515f, 527f conjugation of, 321
Heart attack (myocardial infarction), 414, 418t Hepatitis, 533–534, 536t diagnostic tests for, 327, 327t
Heart block, 386 Hepatitis A virus, 533 disorders of, 328–333, 333t
Heart disorders (disease), 408–417, 417t–418t Hepatitis B vaccine, 534 elimination of, 321–322
congenital, 414–416, 416f, 417f, 418t Hepatitis B virus, 534 excretion of, 321
diagnostic tests for, 408–410, 409t Hepatitis C virus, 534 female reproductive, 309t, 314, 617–621
epidemiology of, 27t Hepatitis D virus, 534 in childbirth, 325–326, 325t, 326f, 635, 636f
inflammatory, 374–375, 376, 418t Hepatitis E virus, 534 in menopause, 623
rheumatic, 376, 418t Hepatocytes, 514–516, 515f in pregnancy, 620–621, 632–633
Heart failure, congestive, 414, 415f, 418t Hepatopancreatic sphincter, 516f, 517, 521 in puberty, 613–614
Heart murmurs, 410, 417t Heredity, 18 functions of, 308t–309t, 322–326
Heart rate, 389 Hering-Breuer reflex, 485 half-life of, 322
aging and, 408 Hernia, 213, 217t homeostatic role of, 305, 306–307, 318
disorders of, 389, 417t abdominal, 531, 537t male reproductive, 309t, 314, 592–593, 593f
exercise and, 407–408 hiatal, 213 in puberty, 587
regulation of, 390–392 incisional, 531 in sex determination, 577, 586–587
Heart sounds, 386, 410 inguinal, 213, 214f, 531, 599 metabolism of, 321
Heart valves, 375–376, 377f umbilical, 531 paracrine, 318
blood flow through, 379, 380f Herniated disk, 125, 125f, 168t physiology of, 318–326
disorders of, 410, 416, 417t, 418t Herpes simplex virus (HSV), 105, 109t, 599–600, production of, 307
operation in cardiac cycle, 383–386, 385f 601t, 628, 640t in puberty, 314, 323–324, 587, 613–614
prolapsed, 410, 417t Herpes varicella-zoster virus, 105, 105f, in sebum production, 89
regurgitation of, 374–375, 416 423, 447 second messengers for, 316, 317f
sounds from closing of, 386, 410 Hertz (Hz), 279 secretion of, 307, 318–320
stenosis of, 376, 416, 417t Hiatal hernia, 213 stimulating, 318
Heart wall, 373–374 Hilum target tissues of, 307, 308t–309t, 316–318, 326
Heartbeat, 382 of kidney, 546–547, 546f transport of, 307, 315–318, 317f, 320, 320f, 321
Heartburn, 511 of lung, 466, 466f Hormone receptors, 307, 316–318, 317f
Heat, in inflammation, 437 Hinge joints, 146t, 150 down-regulation of, 320, 321f
Heat production, by muscles, 212 Hippocampus, 238, 239f ___location of, 316, 317f
Heat receptors, 89, 96 Histamine, 20, 343, 438 regulation of, 320
Helper T cells, 428, 445, 446f Histology, 61 up-regulation of, 320, 321f
aging and, 447 HIV/AIDS, 22, 451–452, 451f, 599–600, 601t, 628 Hormone replacement therapy (HRT), 624
in cellular immunity, 442, 443f, 445, 446f Hives, 107–108, 108f, 109t Horns, 242, 243f, 244f
in HIV/AIDS, 451–452 Hodgkin lymphoma, 448–449 Hot flashes, 623
in humoral immunity, 440, 441f, 445, 446f Holter monitor, 409t HPV; see Human papillomavirus
in immunization, 445 Home pregnancy tests, 621, 628, 628f HRT (hormone replacement therapy), 624
Hematocrit, 338, 360t, 361f Homeostasis, 13–15 HSV; see Herpes simplex virus
Hematuria, 570 acid–base balance in, 39, 159–160, 349, 488, Human chorionic gonadotropin (hCG), 621, 632
Heme, 348, 348f, 350, 350f 552–553, 553f Human chorionic somatomammotropin (HCS), 632
Hemiplegia, 264 adrenal cortex in, 324–325 Human immunodeficiency virus (HIV), 22, 451–452,
Hemispheres, cerebral, 234f, 235 antidiuretic hormone in, 557 451f, 599–600, 601t, 628
Hemocytoblast (stem cell), 344t, 345f, 346–348 baroreceptors in, 391 Human papillomavirus (HPV), 104–105, 599–600,
Hemoglobin, 348–351, 483–484, 483f blood in, 359 601t, 626, 640t
as buffer, 349, 359, 483 blood pressure and flow in, 406 Human papillomavirus (HPV) vaccine, 600
carbon monoxide and, 347, 485, 487 bone physiology in, 152, 156, 159–160 Humerus, 115f, 129–131, 130f
insufficient, 364 calcium/vitamin D metabolism in, 95, Humor, vitreous, 293, 293f, 295
measurement of, 360t 156–158, 158f Humoral immunity, 439–442, 441f, 445, 446f
processing and disposal of, 350–351, 350f, 542 cerebrospinal fluid in, 232 Hunchback, 124, 124f
sickle-cell (HbS), 349, 349f chemoreceptors in, 486 Hunger, hypothalamus and, 239
structure of, 348, 348f cholesterol in, 315 Huntington’s disease, 263, 265t
Hemoglobin A1c test, 329 digestion in, 514, 520–521 Hyaline cartilage, 67–68, 68f, 141, 143f
Hemolysis, 53, 364 endocrine system in, 305, 306–307, 318, 406 of nose, 460, 460f
Hemolytic anemia, 364, 366t female reproductive system in, 619 of trachea, 463f, 464–465, 464f
Hemolytic disease of the newborn (HDN), 357, 358f, 366t fluid and electrolyte balance in, 35, 52–53, 555–561, Hyaline cartilage model, 153–154, 153t, 154f
Hemophilia, 364, 366t 555f, 556f Hyaline membrane disease, 470, 496t
Hemopoiesis, 344–350, 344t, 345f glucose regulation in, 14, 14f, 51, 322–323 Hydrocele, 599, 599f, 601t
altitude and, 347 hemoglobin in, 349, 483 Hydrocephalus, 264, 264f, 265t
blood loss and, 348 hypothalamus in, 239 Hydrochloric acid, 512–514, 513t
carbon monoxide and, 347 insulin and glucagon in, 322–323 Hydrogen, body percentage of, 33t
exercise and, 347 iodine in, 311 Hydrogen bonds, 36
gender and, 359 iron in, 349 Hydrogen ions, 38–39, 348–349, 482–485, 483f, 484f
lymphoid, 346, 428–429 labor and birth in, 14–15 Hydronephrosis, 568, 568f, 571t
myeloid, 346 male reproductive system in, 591–593 Hydrophilic heads, of phospholipids, 49
nutritional requirements for, 349 muscle physiology in, 210 Hydrophobic tails, of phospholipids, 49
renal function in, 346–348, 544 nutrient absorption in, 526 Hydroxide ions, 38–39
Hemopoietic factors, 344t, 346 nutrition in, 49, 261 Hydroxyapatite, 139, 152
Hemorrhagic anemia, 364, 366t plasma in, 340 Hymen, 610, 611f
Hemorrhoids, 525, 537t renal regulation in, 552–553, 553f Hyoid bone, 115f, 128, 128f, 461f, 463f
Hemostasis, 351–354, 351f renin in, 558 Hyoid fracture, 128
coagulation in, 351–354, 351f–353f skin health in, 89, 90 Hyperbaric chamber, 347
definition of, 351 spleen in, 434 Hypercapnia, 486, 496t
platelet plug formation in, 351–352, 351f vitamin K in, 353 Hyperemia, reactive, 405
vascular spasm in, 351, 351f water absorption in, 524 Hyperglycemia, 329
Hemothorax, 472, 496t Horizontal plane, 6t, 7f Hyperkalemia, 557

I-10 INDEX
Hyperlipidemia, familial combined, 17 Incisional hernia, 531 Interleukin-1, 442, 443f
Hyperopia, 296, 301t Incontinence, urinary, 566, 571t, 623 Interleukin-2, 440, 441f
Hyperplasia, 72 Incus, 280f, 281, 283, 284f Internal abdominal oblique, 185f–186f, 186t, 187
Hypersensitivities, 22, 449–450 Independent assortment, 588f, 589 Internal anal sphincter, 522–524, 523f
Hypertension, 404, 408, 417t, 558, 561 Infarction, 73 Internal intercostal muscle, 185f, 186t
in pregnancy, 640 Infarction, myocardial, 414, 418t Internal jugular vein, 394f, 397, 426f, 433f
Hyperthyroidism, 331 Infections Internal urethral sphincter, 562, 563f
Hypertonic solution, 37, 38f bone, 165, 167, 167f, 168t Interneurons, 242–243, 243f, 244f
Hypertrophy, 72 childhood, 16, 16f Interosseous membrane, 131f, 132
muscle, 72, 212 definition of, 16 Interstitial cells, 580, 580f, 592f
right ventricular, 416 ear, 281, 301t Interstitial fluid, 424–427, 425f, 555f
Hyperuricemia, 166, 166f opportunistic, 452 Interventricular septum, 376, 377f
Hyperventilation, 486, 553, 553f parasite, 535, 535f, 537t Interventricular sulcus, 375, 375f
Hyphae, 106 respiratory, 490–492, 495t Intervertebral disks, 125, 125f, 168t
Hypochondriac region, 2–6, 6f sexually transmitted, 599–600, 601t, 628, 640t Intestinal lymph nodes, 430f, 432
Hypodermic needle, 84f skin, 104–106 Intestines; see Large intestine; Small intestine
Hypodermis, 83, 84f, 101 urinary tract, 567–568, 571t Intracellular fluid (ICF), 49, 555
Hypogastric region, 6, 6f Infectious diseases, 21 Intrapulmonary pressure, 471–473, 473f
Hypoglossal nerve (CN XII), 246f, 247t, 509 Infectious mononucleosis, 489t, 491, 495t Intravenous pyelography, 567t
Hyponatremia, 557 Inferior, 3t, 4f Intrinsic factor, 512, 513, 513t, 526, 528
Hypoplastic anemia, 364, 366t Inferior colliculi, 241, 242f, 284 Intrinsic muscles, 176
Hypospadias, 599, 601t Inferior nasal conchae, 118f, 120f, 122 Intrinsic pathway, of coagulation, 352f, 353
Hypotension, 404, 417t Inferior vena cava, 375f, 379, 380f, 394f, 401f Intussusception, 532, 533f, 537t
Hypothalamus, 223, 235f, 236t, 238–239, 308–311, Infertility, male, 595, 601t Inversion, 177, 178f
308f, 308t Inflammation, 19–21, 20f Involution, of corpus luteum, 618f, 620
adrenal cortex degeneration and, 325, 325t in blood flow/pressure regulation, 405 Iodine, 311
autonomic functions of, 239 in nonspecific immunity, 436, 437–438, 437f Iodine, radioactive, 35
in childbirth, 325–326, 326f, 635, 636f Inflammatory cardiac disorders, 374–375, 376, 418t Iodized salt, 311
endocrine functions of, 239 Inflammatory chemicals, 437, 437f Iodopsin, 294
female reproductive control by, 613–614 Influenza, 26, 26f, 489t, 490, 495t Ion(s), 35
hormones of, 308t, 310–311, 310f, 312f Influenza vaccines, 26 in action potential, 257f
male reproductive control by, 592, 593f Infundibulum in membrane potentials, 253–255, 253f
melatonin and, 323, 323t of pituitary, 239, 310–311 in plasma, 339f, 340
negative feedback inhibition of, 318–319, 319f of uterine tubes, 607f, 609 Ion channels, 253–255, 253f
in olfaction, 279 Ingestion, 506, 527 Ionic bonds, 35, 36f
in pain pathway, 275, 275f Inguinal canal, 578, 579f, 581f Iris, 292–293, 293f, 299
pituitary regulation by, 308t, 310–311, 310f, 312f Inguinal hernia, 213, 214f, 531, 599 Iron
in temperature regulation, 239, 438, 439f Inguinal ligament, 191, 193f absorption of, 526
Hypothyroidism, 332 Inguinal lymph nodes, 430f, 432, 432f hemoglobin metabolism to, 350, 350f
Hypotonic solution, 37, 38f Inguinal region, 5f, 5t, 6, 6f nutritional requirements for, 349, B-1
Hypovolemic shock, 407 Inhibin, 592, 593f in pregnancy, 349, 635
Hypoxemia, 347, 347f Inhibitory potentials, 254–255 recycling of, 350, 542
Hypoxic drive, 486 Injury, 22–23 Iron deficiency anemia, 364, 366t
Hysterectomy, 626 fractures, 161–163, 168t Irregular bones, 116, 117f
Hysteroscopy, 624t skin, 97–100 Irritable bowel syndrome (IBS), 531, 537t
spleen, 434 Ischemia, 414

i
IBS (irritable bowel syndrome), 531
sports, 22–23, 22f
Inner ear
aging and, 299
Ischium, 132–134, 133f
Ishihara test, 294, 300, 300t
Islets of Langerhans, 311, 313f, 328
ICF; see Intracellular fluid anatomy of, 280–282, 280f, 282f, 283f, 285–287, 286f Isometric contraction, 205
Ileocecal junction, 519f, 520 equilibrium function of, 285–289, 286f–288f Isotonic contraction, 205
Ileocecal sphincter, 522, 523f hair cells of, 282, 283f, 284, 284f, 286–287, 286f–288f Isotonic solution, 37, 38f
Ileum, 502f, 518, 519f, 520, 523f hearing function of, 282–284, 284f Isotopes, 34–35
Iliacus, 191, 193f, 194t Insertion, of muscle, 176 Isthmus, of uterine tubes, 607f, 609
Iliopsoas, 191, 193f, 194t Inspiration, 458, 470–473, 473f, 485–486
Ilium, 132–134, 133f
Immediate hypersensitivities, 449
Immediate memory, 259
Inspiratory capacity (IC), 475f, 475t
Inspiratory reserve volume (IRV), 474, 475f, 475t
Insula, 235, 236t, 238
j
Jaundice, 351
Immune system; see also Immunity Insulin, 309t, 311, 315
Jaw
development of, 16 in diabetes mellitus, 328–329
bones of, 118f–120f, 122
disorders of, 21–22, 451–452, 452t facilitated diffusion of, 51, 52f
movements of, 177, 178f, 180
Immunity functions of, 309t, 322–323, 322t
Jejunum, 502f, 518, 519f, 520
acquired, 443–445 glucose and, 318, 322–323, 328–329
Jock itch, 105
active, 443–444 injection of, 316, 316f
Joint(s), 144–151; see also specific joints
aging and, 447 negative feedback and, 14, 14f
aging and, 161
artificial, 444–445 pregnancy and, 632
cartilaginous, 145t, 147
barrier defenses in, 436–437 secretion of, 318
classification of, 144
cellular (cell-mediated), 442, 443f, 444f, 445, 446f target tissues of, 309t, 322t
disorders of, 150–151, 168t
humoral, 439–442, 441f, 445, 446f Integumentary system, 75t, 76, 77f, 82–112, 83f
fibrous, 144, 145t
importance of helper T cells in, 445, 446f aging and, 100–101, 623
synovial, 146t, 147–151, 147f
inflammatory response in, 436, 437–438, 437f anatomy of, 83–94
Joint capsule, 147, 147f
lymphatic system and, 423, 435–447 connections with other body systems, 110
Joint replacement, 151, 151f
natural, 444 diagnostic tests for, 24f, 101, 102t
Jugular vein
nonspecific, 436–438, 445 disorders of, 102–109, 109t
external, 394f
organ transplantation and, 442 injuries to, 97–100
internal, 394f, 397, 426f, 433f
passive, 443–445 overview of, 83
Juxtaglomerular apparatus, 549, 549f, 557
specific, 436, 439–445 physiology of, 94–96, 95f
Juxtaglomerular cells, 549, 549f
vaccines and, 17, 17f, 423, 445, 447 pregnancy and, 634
Immunization (vaccines), 17, 17f, 423, 445, 447 word roots and combining forms for, 83
Immunodeficiency disorders, 22, 451–452, 452t
Immunosuppressant drugs, 442
Impetigo, 104, 109t
Intensity, sensory information on, 274
Interatrial septum, 376, 377f
Intercalated disks, 70, 71f, 209t, 378, 378f
k
Kaposi sarcoma, 452, 452f
Implantation, 631, 631f Intercostal muscles, 185f, 186t, 188f, 470–471, 471f Keloid, 97
Impotence, 596 Interferons, 438 Keratin, 85, 85f, 92, 94
Incidence, 26 Interleukin(s), 440, 442 Keratinocytes, 85, 86f, 90, 92, 95, 97, 98f

INDEX I-11
Kidney(s) Lateral epicondyle bile secretion by, 515–516, 518t, 543
aging and, 566 of femur, 135, 135f clotting factor production in, 353
anatomy of, 545–551, 546f of humerus, 130f, 131 disorders of, 351, 353, 532–534, 537t
blood flow to, 550–551, 550f Lateral excursion, 177, 178f excretory function of, 543, 543f
blood pressure and, 544, 558–560, 565 Lateral longitudinal arch of foot, 138f hemoglobin processing in, 350, 350f, 542
diagnostic tests for, 566–567, 567t Lateral sulcus, 234f lobes of, 514, 514f–515f
disorders of, 566–570, 571t Latissimus dorsi, 182f, 187f–188f, 188, 188t “Liver spots,” 101
drug clearance by, 554, 566 Learning, brain function in, 238 Lobar bronchi, 466–468, 467f
epithelial tissue of, 61, 63f Left, as anatomical term, 3t Lobectomy, 494
excretion by, 543–544, 543f Left atrium, 375–376, 375f, 377f Lobes
functional unit of (nephron), 547–561 Left colic (hepatic) flexure, 522, 523f of brain, 234f–235f, 235–238, 236t
functions of, 544–545 Left coronary artery, 398, 398f, 399f of breast, 612, 612f
hemopoietic role of, 346–348, 544, 634 Left lower quadrant, of abdomen, 2, 6f of liver, 514, 514f–515f
hormonal regulation of, 557–560, 558f–560f Left lung, 466, 466f, 467f of lung, 466, 466f
neural regulation of, 560–561 Left upper quadrant, of abdomen, 2, 6f Lobules
pH (acid–base) control by, 552–553, 553f, 565 Left ventricle, 375–376, 375f, 377f of breast, 612, 612f
physiology of, 551–561 Leg of liver, 514, 515f
pregnancy and, 634 bones of, 115f, 135–136, 136f, 138f of lung, 468
reabsorption in, 552, 554, 554f muscles of, 195, 195f, 195t of testes, 579–580, 580f
retroperitoneal position of, 545, 545f Length, metric units of, A-1 Local potentials, 254–255, 255f
urine production in, 544, 547, 551–561, 554f Lens, 293f, 295–297 action potential vs., 255
water conservation in, 555–556 accommodation of, 296f, 297 reflex arc, 256–258
Kidney cancer, 570, 571t aging and, 299 Location, sensory information on, 272–274
Kidney failure, 570, 571t clouding of (cataracts), 301, 301f, 301t Lockjaw (tetanus), 204
Kidney stones, 569, 569f, 571t Lesser curvature, of stomach, 510f, 511 Long bones, 115–116, 142–144, 143f
Kissing disease (mononucleosis), 489t, 491 Lesser omentum, 12, 13f aging and, 161
Knee, 147–149, 148f–149f Lesser trochanter, 134–135, 135f endochondral ossification of, 153–154, 153t, 154f
ligaments of, 147–149, 148f–149f Lesser tubercle, of humerus, 130, 130f Longitudinal arches, of foot, 137, 138f
menisci of, 142, 148f–149f, 149 Leukemia, 72, 361–362, 363f, 366t Longitudinal fissure, 234f, 235
Kneecap; see Patella Leukocyte(s), 67, 67f, 340, 341t–342t, 342–343, Long-term memory, 259
Kyphosis, 124, 124f, 168t 428–429; see also Lymphocytes Loop of Henle (nephron loop), 547–548, 548f–550f, 554f
aging and, 447 Loose connective tissue, 65, 66f

l
Labia majora, 609f, 610, 611f
chemotaxis of, 437, 437f
diapedesis of, 437, 437f
disorders of, 361–362, 363f, 366t
Lordosis, 124, 124f, 168t
Loudness, 279, 280f, 284
Lower esophageal sphincter, 510f, 511
Labia minora, 609f, 610, 611f forensic use of DNA, 58, 342 Lower limb
Labor, 635–636 functions of, 341t–342t, 343, 359 bones of, 134–138
Lacrimal bone, 118f–119f in inflammatory response, 437–438, 437f muscles of, 191–195, 193f, 194f, 194t, 195f, 195t
Lacrimal canal, 290, 290f life cycle of, 346 Lower respiratory tract, 458
Lacrimal glands, 290, 290f margination of, 437, 437f Lubb-dupp, 386
Lacrimal punctum, 290, 290f organelles of, 48 Lumbar curvature, 123f, 124
Lacrimal sac, 290, 290f as percentage of whole blood, 338, 339f, 344 Lumbar nerves, 243f, 247, 248f
Lactation, 612, 637–638, 638f phagocytosis by, 48, 54, 54f, 343, 429, 437f, 438–441 Lumbar puncture, 242, 262, 262t, 360t, 448t
Lacteals, 519f, 520, 526, 528 production of, 344t, 345f, 346 Lumbar region, 6, 6f
Lactic acid, in muscle metabolism, 207f, 208 storage of, 346, 434 Lumbar vertebrae, 122, 123f, 126f, 127
Lactiferous ducts, 612, 612f structure of, 341t–342t, 342–343 Lumpectomy, 626
Lactiferous sinuses, 612, 612f test for (count), 360t, 361, 448t Lunate, 132, 133f
Lacunae types of, 341t–342t, 342–343 Lung(s), 459f, 466–470, 466f–467f
of bone, 69f, 140f, 141 Leukocytosis, 361, 366t aging and, 488–489
of cartilage, 141, 143f Leukopenia, 361, 366t blood flow to and from, 379–380, 381f, 399, 400f
Lamella(e), 68–69, 69f, 140f, 141 Leukoplakia, 530, 530f, 536t collapsed, 472, 496t
Lamellar corpuscles, 88f, 89, 272f, 273t Leukopoiesis, 344t, 345f, 346 compliance of, 474, 488
Language, 259–260 Lever, 205–206, 206f cross section of, 467, 467f
aging and, 261 Levitra (vardenafil), 596 epithelial tissue of, 61, 62f
brain function in, 237, 238, 259–260 Leydig cells, 580, 580f excretion via, 543, 543f
disorders of, 259 LH; see Luteinizing hormone gas exchange in, 476–485, 477f, 479f, 487
Lanolin, 89 Libido, 587, 592, 613, 624 histology of, 469–470, 469f
Lanugo, 91 Lifestyle, 17 perfusion of, 481, 482f
Laparoscopy, 529t, 624t Ligaments; see also specific ligaments surfactant of, 468f, 469–470
Large arteries, 395 connective tissue of, 65–66, 66f ventilation of, 458, 470–473, 473f
Large intestine, 502f, 503, 503f, 522–525 function of, 116 ventilation-perfusion coupling in, 481, 482f
absorption in, 524–525, 526, 528 Light, and vision, 289, 295, 298 volumes and capacities of, 474, 474f, 475f, 475t
aging and, 529 Limbic system, 238, 239f, 275, 275f Lung cancer, 474, 494, 494f, 496t
anatomy of, 522–524, 523f Linea nigra, 634 Lunula or lunule, 93–94, 93f
cancer of, 529, 536t Lingual frenulum, 504f, 506, 507f Luteal phase, of ovarian cycle, 618f, 619
digestion in, 524, 528 Lingual lipase, 506, 507, 513–514 Luteinizing hormone (LH), 309t, 310f, 315
disorders of, 525, 529, 530–531, 530f, Lingual papillae, 276–277, 276f, 506 in female puberty, 613
531f, 536t Lingual tonsils, 433, 433f, 461f in female reproductive cycle, 619
epithelial tissue of, 524 Lip, cleft, 16, 16f in males, 587, 592, 593f, 596
mass movement of, 524, 528 Lipase melatonin and, 323, 323t
Large veins, 397 gastric, 512–514, 513t in menopause, 623
Laryngeal cancer, 493–494, 494f, 496t lingual, 506, 507, 513–514 in pregnancy, 632
Laryngeal prominence, 463, 463f pancreatic, 521 secretion of, 318
Laryngitis, 491, 495t Lipid(s), 39, 40t, 41 Lymph, 424–428
Laryngopharynx, 460f–461f, 462–463, 508 absorption of, 446, 526, 528 flow and drainage of, 424–427, 426f, 427f, 432, 433f
Laryngoscope, 464f in adipose tissue, 66–67, 67f functions of, 424
Larynx, 459f, 460f–461f, 463–464, 463f building blocks of, 40t, 41, 41f Lymph node(s), 427f, 429–432, 431f
cartilages of, 463–464, 463f, 464f, 488 in cell membrane, 49, 49f abdominal, 430f, 431
endoscopy of, 464f digestion of, 504, 513–516, 521, 528 axillary, 430f, 431, 432, 433f
muscles of, 463–464, 463f, 488 emulsification of, 515–516, 518t, 521 cervical, 429, 430f
in swallowing, 509, 509f nutritional requirements for, B-1 functions of, 429
Latent phase, of muscle contraction, 202, 203f Lipid bilayer, 49, 49f inguinal, 430f, 432, 432f
Lateral, 3t, 4f Lithotripsy, 569 intestinal, 430f, 432
Lateral condyle Liver, 503, 503f, 514–516, 514f–515f mesenteric, 430f, 432
of femur, 135, 135f aging and, 529 pelvic, 431
of tibia, 135, 136f antithrombin production in, 354 popliteal, 432

I-12 INDEX
 structure of, 429, 431f Malleus, 280f, 281, 283, 284f resting, 253f, 254, 255f, 257f
swollen, 432 MALT (mucosa-associated lymphoid tissue), reversible, 254
thoracic, 426f, 431 429, 503 Membrane surface area, 51
Lymph node biopsy, 448t Mammary glands, 90, 612, 612f; see also Breast(s) Membrane transport, 50–54
Lymph nodules, 429, 431f, 433, 433f, 520 Mammography, 24, 624t, 625–626, 625f by active transport, 53, 321
Lymphadenitis, 432 Mandible, 118f–120f, 122, 507f by bulk transport, 54, 54f
Lymphatic capillaries, 424–427, 425f, 427f Mantoux test, 489t, 492 by facilitated diffusion, 51, 52f
Lymphatic ducts, 424, 426f, 430f, 433f, 522 Manubrium, 127, 127f by filtration, 50–51
Lymphatic organs, 429–434, 430f Margination, 437, 437f of hormones, 315–318, 317f, 320, 320f, 321
Lymphatic system, 75t, 76, 78f, 423–456 Marrow; see Bone marrow by osmosis, 52–53, 52f
aging and, 447 Marrow (medullary) cavity, 142, 143f by passive transport, 50–53
anatomy of, 424–434 Mask of pregnancy, 634 by simple diffusion, 51, 51f
cells of, 428–429 Mass movement, 524, 528 Membranous urethra, 563, 563f
connections with other body systems, 453 Masseter, 181f, 183–184, 183f, 184t, 507, 507f Memory, 259
diagnostic tests for, 447–448, 448t Mastectomy, 626 aging and, 261
disorders of, 428, 447–452 Mastication, 507 brain function in, 238, 259
fluid exchange with cardiovascular system, 427, 427f Mastoiditis, 167, 167f, 168t immediate, 259
functions of, 446–447 Matrix long-term, 259
immune function of, 423, 435–447 bone, 68–69, 69f, 139–141, 152 reflexive, 241
overview of, 424 cartilage, 141 short-term, 259, 261
physiology of, 435–447 connective tissue, 65 Memory B cells, 429, 441–442, 441f
tissues and organs of, 429–434, 430f hair, 90, 91f Memory T cells, 428, 442, 443f
word roots and combining forms for, 424 nail, 93–94, 93f Meninges, 8, 8t, 231–232, 231f, 233f, 243f
Lymphatic tissue, 429–434, 430f Matter, 33 Meningitis, 242, 265t
Lymphatic vessels, 424–428, 425f, 427f, 430f, 431f conservation of, 44–45 Meniscus (menisci), 142, 148f–149f, 149
Lymphoblastic leukemia, 362, 363f, 366t Mature ovarian follicle, 615f, 616–617, 617f Menopause, 327, 596, 623–624
Lymphoblasts, 345f Maxilla, 118f–120f, 122, 504 Menses, 610
Lymphocytes, 339f, 342t, 343, 428–429 Maxillary sinus, 123f Menstrual cycle, 617–621, 618f
aging and, 447 Mean arterial pressure (MAP), 404 Menstrual disorders, 614, 627
in cancer response, 442, 444f Measurements, metric, 211, A-1–A-2 Menstrual phase, 618, 618f
in cellular immunity, 442, 443f, 444f, 445, 446f Mechanical digestion, 503–504, 507, 528 Menstruation, 610, 613
in HIV/AIDS, 451–452, 451f Mechanoreceptors, 271, 284, 286–287 Mental disorders, 22, 226
in humoral immunity, 440–442, 441f, 445, 446f Medial, 3t Merocrine glands, 90, 90t
in immunization, 445 Medial condyle Mesenteric arteries, 393f, 401f, 523f
life cycle of, 346 femoral, 135, 135f Mesenteric lymph nodes, 430f, 432
in lymphoma, 448–449 tibial, 135, 136f Mesenteries, 12, 12f, 13f, 518, 519f
in multiple myeloma, 449 Medial epicondyle Messenger RNA (mRNA)
production of, 345f, 346 of femur, 135, 135f DNA transcription to, 54–55, 55f
test for (count), 360t, 448t of humerus, 130f, 131 errors in, 57–58
Lymphoid hemopoiesis, 346, 428–429 Medial excursion, 177, 178f translation of, 54, 55–57, 56f
Lymphoid organs, 429–434, 430f Medial longitudinal arch of foot, 138f Metabolic acidosis, 553
Lymphoid tissues, 429–434, 430f Medial malleolus, 136, 136f Metabolic alkalosis, 553
Lymphoma, 448–449, 452t Mediastinum, 8, 9f Metabolic wastes, 543, 565
Lymphomas, 72 Mediators of inflammation, 20 Metabolic water, 555
Lysis, 53 Medium arteries, 396 Metabolism, 44; see also specific processes
Lysosomes, 47t, 48f Medium veins, 397 Metacarpals, 115f, 132, 133f
Lysozymes, 281, 290, 343, 437, 506, 507 Medulla Metaplasia, 73, 465, 610
of adrenal glands (see Adrenal medulla) Metastasis, 72

m
Macrophages, 343, 429
of hair, 91f, 92, 92f
of kidney, 546f, 547, 550f
of ovary, 607f
Metatarsal bones, 115f, 137, 137f, 138f
Metatarsophalangeal joint, 166, 166f
Metric system, 211, A-1–A-2
agglutination as marker for, 356 Medulla oblongata, 223, 234f–235f, 237t, 242f MHC protein, 439–442, 440f, 441f, 443f
as antigen-presenting cells, 439, 440f in blood flow/pressure control, 406 Microglia, 228, 228t, 229, 229f
in fever, 438 cardiac centers of, 390, 407 Microvilli, 47t, 48f, 518, 519f
formation of, 346 emetic center of, 534 Micturition, 563–565, 564f
microglia, 229 respiratory centers of, 485–486, 486f Micturition reflex, 564–565
phagocytosis by, 438, 440–441 in swallowing, 509 Midbrain, 223, 235f, 236t, 241, 242f
Macula densa, 549, 549f vasomotor center of, 406 Middle cardiac vein, 398–399, 398f
Macula lutea, 295, 295f, 299 Medullary (marrow) cavity, 142, 143f Middle ear
Macular degeneration, age-related, 299, 301t Medullary ischemic reflex, 406 anatomy of, 280–282, 280f
Macule of ear, 286, 286f, 287f Megakaryoblasts, 345f hearing function of, 282–283, 284f
Magnetic resonance imaging (MRI), 448t, 529t Megakaryocytes, 345f, 346 ossicles of, 280f, 281, 282f, 283, 284f
Main bronchus, 466, 466f–467f Meiosis, 58, 587–589, 588f Middle nasal concha, 118f
Major calyx, 546f, 547, 562f in oogenesis, 614–616, 615f Midpiece, of sperm, 586, 586f, 591f
Major histocompatibility complex (MHC), 439–442, in spermatogenesis, 590, 590f Milk ejection reflex, 638
440f, 441f, 443f Meiosis I, 587–589, 588f Mineral(s)
Malabsorption, 536, 537t Meiosis II, 588f, 589 absorption of, 526
Malaise, 19 Melanin, 85–86, 87f, 92, 92f, 95, 100–101, 634 nutritional requirements for, B-1
Malaria, 349, 364 Melanocytes, 85–86, 86f, 90, 95 Mineral deposition, 152, 156, 161
Male reproductive system, 76, 76t, 78f, 576–604, 577f aging and, 100–101 Mineralocorticoids, 309t, 314, 315, 324–325, 324t
accessory glands of, 583–585, 584f pregnancy and, 634 Minor calyx, 546f, 547, 562f
aging and, 596 skin cancer and, 102 Miscarriage, 639, 641t
anatomy of, 578–586, 584f Melanoma, 102, 102f Mitochondria, 47t, 48f
connections with other body systems, 602 Melanosomes, 85, 86f cardiac muscle, 378
diagnostic tests for, 597, 597t Melatonin, 307, 308t, 315 neuron, 225f
disorders of, 597–601, 601t effects of, 323t skeletal muscle, 206–209
hormonal control of, 587, 591–593, 593f reduced, at puberty, 323–324 sperm, 586, 586f, 591f
overview of, 577 Membrane(s); see also specific membranes Mitosis, 58–60, 59f, 60f, 587, 589
physiology of, 586–596 selectively permeable, 52–53, 52f in oogenesis, 614, 615f
puberty in, 587 serous, 8–12 in spermatogenesis, 589, 590f
secondary organs and structures of, 580–585, 584f Membrane potentials, 253–261 in zygote, 631
word roots and combining forms for, 577 decremental, 254 Mitral (bicuspid) valve, 376, 377f, 379, 380f
Male sexual response, 594–596, 595f excitatory, 254–255 Mitral valve prolapse, 410, 410f
Malignant melanoma, 102, 102f graded, 254 Mohs, Frederick, 103
Malignant tumors, 72 inhibitory, 254–255 Mohs micrographic surgery, 103
Malleolus, medial, 136, 136f local, 254–255, 255f Mole (skin), 85, 102

INDEX I-13
Molecular mimicry, 450 Muscle contraction Nail root, 93, 93f
Molecular weight, 51 cardiac muscle, 373–374, 383–386 Nares (nostrils), 459f, 460, 461f
Molecules, 35–36 skeletal muscle, 201–206 Nasal bones, 118f–120f, 122
organic, 39–43 contraction phase of, 203, 203f Nasal cartilage, 460, 460f, 461f
Monoblasts, 345f isometric, 205 Nasal cavity, 458–459, 459f, 460–462
Monocytes, 339f, 341t, 343; see also Macrophages isotonic, 205 Nasal conchae, 118f, 120f, 121, 460, 460f–461f
life cycle of, 346 latent phase of, 202, 203f Nasal septum, 460, 460f, 461f
marrow storage of, 346 lever system and, 205–206, 206f Nasolacrimal duct, 290, 290f
production of, 345f, 346 refractory phase of, 203, 203f Nasopharynx, 433, 460f–461f, 462, 508
test for (count), 360t, 448t relaxation phase of, 203, 203f Natural active immunity, 444
Mononucleosis, infectious, 489t, 491, 495t sliding filament theory of, 201, 202f Natural immunity, 444
Monosaccharides, 40, 40f sustained (tetany), 203–204, 203f Natural killer (NK) cells, 428, 442, 443f
absorption of, 522, 526, 528 types of, 201–204 Natural passive immunity, 444
carbohydrate digestion to, 521, 528 Muscle fibers, 196–199, 196f, 198f Nausea
Monospot test, 489t aging and, 212 in pregnancy, 633
Mons pubis, 609f, 610, 611f fast-twitch, 209, 212 as symptom, 18–19
Morning sickness, 633 slow-twitch, 208–209, 212 Navicular, 136, 137f, 138f
Motor (efferent) nerves, 246 Muscle metabolism, 206–208 NCS; see Nerve conduction studies
Motor (efferent) neurons, 223–224, 246, aerobic respiration in, 207–208, 207f, 207t Near vision, 296f, 297
256–258 anaerobic respiration in, 207, 207f, 207t, 208 Nearsightedness, 296
Motor recruitment, 204 definition of, 206 Neck muscles, 180–184, 183f, 184t, 187f–188f, 188t
Motor unit, 204 Muscle strain, 215, 217t Neck of femur, 134, 135f
Mouth (oral cavity), 459f, 502f, 504–506, 504f Muscle tissue, 69–70; see also specific types Necrosis, 73
aging and, 528 atrophy of, 73, 216, 217f, 217t Negative feedback, 13–14, 14f
digestion in, 507, 528 cancers of, 72 in digestion, 514, 520
disorders of, 506, 530, 530f, 536t comparison of types, 209–210, 209t in endocrine system, 318–319, 319f, 325
epithelial tissue of, 61, 63f hyperplasia of, 72 in erythropoiesis, 346–347, 347f
Movement hypertrophy of, 72, 212 in female reproductive system, 619, 623
brain function in, 237, 238f, 241 Muscle tone, 211 in glucose regulation, 14, 14f, 51
muscular system in, 211 Muscle twitch, 202–204, 203f in male reproductive system, 592, 593f, 596
skeletal system in, 159 Muscular dystrophy, 214, 217t Negative feedback inhibition, 318–319, 319f
MRI; see Magnetic resonance imaging Muscular system, 75t, 76, 77f, 174–221, 175f   ; see also Neisseria gonorrhoeae, 600
MS; see Multiple sclerosis Muscle(s) Neonatal conjunctivitis, 291
Mucociliary escalator, 464f, 465, 488 aging and, 212 Neoplasia, 72
Mucosa-associated lymphoid tissue (MALT), anatomical terms for, 176 Neoplasm, 72
429, 503 anatomy of, 176–199 Nephrectomy, 570
Mucous cells, of stomach, 511, 512f connections with other body systems, 218 Nephron(s), 547–561
Mucous membranes, 436–437, 462, 503 diagnostic tests for, 204, 213, 213t aging and, 566
Mucus, gastric, 513t disorders of, 213–217, 217t anatomy of, 547–549, 548f, 549f
Multiple myeloma, 449, 449f, 452t functions of, 211–212, 211f blood flow to, 550–551, 550f
Multiple sclerosis (MS), 263–264, 265t overview of, 175–176 flow of urine components through, 548f, 549–550
Multipolar neurons, 227, 227t physiology of, 199–212 urine production in, 547, 551–561, 554f
Murmurs, heart, 410, 417t word roots and combining forms for, 175 Nephron loop, 547–548, 548f–550f, 554f
Muscle(s), 174–221; see also specific muscles Musculocutaneous nerve, 248f Nerve(s), 245–249
actions of, 177–180, 177f–180f Mutagen, 22 anatomy of, 245–246, 245f
aging and, 212 Mutations, 22, 60, 72 dermatomes of, 249, 249f
all-or-nothing response of, 200 Myalgia, 215, 217t motor, 246
anatomical terms for, 176 Myasthenia gravis, 203–204, 217t, 450 sensory, 246
anatomy of, 196–197, 196f–197f Mycobacterium tuberculosis, 491–492 Nerve conduction studies (NCS), 262, 262t
antagonist, 176 Myelin sheath, 225f, 226–227 Nerve endings, in skin, 88f, 89, 96, 273t
arm, 189, 189f, 189t Myelin sheath disorders, 263–264 Nerve impulse, 226–227, 253–256
attachments of, 176 Myelinated axons, 225f, 226–227, 256 Nervous system, 75t, 76, 77f, 222–269, 223f
back, 187–189, 187f–188f, 188t Myelination aging and, 261
diagnostic tests for, 204, 213, 213t in CNS, 228, 229f anatomy of, 223–252
disorders of, 213–217, 217t in PNS, 230, 230f, 245f cells of, 224–230
excitability of, 199–200, 200f Myeloblasts, 345f connections with other body systems, 266
extrinsic, 176 Myeloid hemopoiesis, 346 diagnostic tests for, 256, 262, 262t
eye, 291–292, 291f–292f, 299 Myeloid leukemia, 362, 363f, 366t disorders of, 262–265, 265t
facial, 181f Myeloma, multiple, 449, 449f endocrine communication with, 306–307, 306f
fatigue of, 208–209 Myocardial disorders, 414, 418t nutritional requirements of, 261
fixator, 176 Myocardial infarction, 414, 418t organization of, 223, 224f
forearm, 190–191, 190f, 191t Myocarditis, 374, 418t overview of, 223–224
functions of, 211–212, 211f Myocardium, 373–374, 373f pathways of, 260–261
head, 180–184, 183f, 184t Myoepithelial cells, 612, 612f, 638 physiology of, 253–261
heat production by, 212 Myofibrils, 196f, 198, 198f renal regulation by, 560–561
insertion of, 176 Myofilaments, 198, 198f, 199f, 201, 202f word roots and combining forms for, 223
intrinsic, 176 Myoglobin, 378 Nervous tissue, 71, 71f
laryngeal, 463–464, 463f, 488 Myometrium, 607f, 608 Neurogenic shock, 407
leg, 195, 195f, 195t Myopia, 296, 301t Neuroglia, 71, 71f, 228–230
lever system and, 205–206, 206f Myosin, 198, 199f, 201, 202f and brain tumors, 229, 265t
metabolism of, 206–208 Myxedema, 332, 333t of CNS, 228–229, 228t, 229f
neck, 180–184, 183f, 184t, 187f–188f, 188t comparison of types, 228t
nutritional requirements of, 210–211, 210t
origin of, 176
physiologic characteristics of, 199–200
n
Nail(s), 93–94
of PNS, 228, 228t, 230, 230f
Neurolemma, 230, 230f
Neuromuscular junction, 200, 200f, 203
physiological contracture of, 208 aging and, 101 Neurons, 71, 71f, 224–228
physiology of, 199–212 functions of, 94 action potentials of, 255–256, 257f
prime mover, 176 growth of, 94 afferent (sensory), 223, 246, 256–258
respiratory, 470–473, 471f–473f as indicator of health, 94 aging and, 261
study technique for, 180 structure of, 93–94, 93f apoptosis of, 73
superficial, 180, 181f–182f Nail bed, 93, 93f bipolar, 227, 227t
synergist, 176 Nail body, 93, 93f efferent (motor), 223, 246, 256–258
thigh, 191–193, 193f, 194f, 194t Nail fold, 93, 93f gland stimulation by, 318
thorax and abdomen, 184–187, 186f–187f, 186t Nail groove, 93, 93f interneurons, 242–243, 243f, 244f
threshold for, 200 Nail matrix, 93–94, 93f multipolar, 227, 227t
Muscle cells; see Muscle fibers Nail plate, 93, 93f pathways of, 260–261

I-14 INDEX
 postganglionic, 250–252, 251f, 252f Olfaction, 278–279 Osteocytes, 69f, 141
preganglionic, 250–252, 251f, 252f aging and, 298–299 Osteogenesis imperfecta, 139, 168t
receptive field of, 272–274, 274f anatomy of, 278, 278f Osteomalacia, 156, 168t
reflex arc, 256–258, 258f pathways of, 279 Osteomyelitis, 165, 168t
retinal, 293–294, 294f physiology of, 279 Osteons, 69f, 139–141, 140f
structure of, 224–227, 225f smoking and, 488 Osteoporosis, 164–165, 165f, 168t, 326, 623
types of, 227–228, 227t Olfactory bulb, 278–279, 278f Osteosarcomas, 165, 168t
unipolar, 227–228, 227t Olfactory cells, 278–279, 278f Otitis externa, 281, 301t
Neurotransmitters, 200, 200f, 226 Olfactory hairs, 278, 278f Otitis media, 281, 301t
Neutrons, 33–34, 34f Olfactory mucosa, 278 Otolith(s), 286, 286f
Neutrophils, 339f, 341t, 342–343 Olfactory nerve (CN I), 246f, 247t, 278–279, 278f Otolithic membrane, 286, 286f
in immune response, 437, 437f, 438 Olfactory receptors, 278–279, 278f Outer ear, 280–281, 280f
marrow storage of, 346 Oligodendrocytes, 228, 228t Ova (eggs), 606
production of, 345f, 346 Omentum, 12, 13f fertilization of, 616, 620, 629–631, 630f
test for (count), 360t, 448t Onychomycosis, 101, 109t production of, 614–617
Nevus (mole), 85, 102 Oocytes, 614–616, 617f release of, 613, 615f, 616, 619, 619f
Nipple, 612, 612f primary, 614–616, 615f, 617f sperm pathway to, 629
sexual response of, 621, 622f secondary, 615f, 616 Oval window, 281, 282, 282f, 283, 283f, 284f
Nitrogen Oogenesis, 614–617, 615f Ovarian cancer, 626, 640t
air content of, 476 Oogonium, 614, 615f Ovarian cycle, 617–621, 618f
partial pressure of, 476 Oophorectomies, 626 Ovarian follicles, 606, 607f
solubility of, 480–481 Open fractures, 161 aging and, 623
Nitrogenous bases, 43 Open reduction, 162, 162f development and stages, 614–621, 615f, 617f, 618f
Nitrogenous wastes, 340, 543–544, 545f, Ophthalmoscope, 294–295, 295f Ovarian ligament, 607f, 608, 608f, 617f
551–554, 554f Opportunistic infections, 452 Ovaries, 308f, 606–608, 607f–609f
NMRI (nuclear magnetic resonance imaging), 448t Opposition, 180, 180f aging and, 326–327, 623
Nociceptors, 271, 274–275, 275f Opsonization, 438 endocrine function of, 309t, 314
Nodal rhythm, 386 Optic chiasm, 297f, 298 melatonin and, 323, 323t
Nodes of Ranvier, 225f, 226–227, 245f, 256 Optic disc, 295, 295f oogenesis in, 614–617, 615f
Nodules, lymph, 429, 431f, 433, 433f, 520 Optic nerve (CN II), 246f, 247t, 293f, 294, 294f, 297f, 298 Oviduct; see Uterine tubes
Noncommunicable diseases, 21 Optic tracts, 297f, 298 Ovulation, 613, 615f, 616, 619, 619f
Nondisplaced fractures, 161, 161f Oral cavity, 459f, 502f, 504–506, 504f Oxygen
Nonessential amino acids, 210, 210t aging and, 528 air content of, 476
Non-Hodgkin lymphoma, 448–449 digestion in, 507, 528 alveolar exchange and transport of, 484–485, 484f
Noninfectious diseases, 21 disorders of, 506, 530, 530f, 536t body percentage of, 33t
Nonspecific resistance, 436–438, 445 epithelial tissue of, 61, 63f erythropoiesis and, 346–347, 347f
Nonverbal communication, 96 Orbicularis oculi, 181f, 183f, 184t, 291f hyperbaric, 347
Norepinephrine, in cardiac physiology, 392 Orbicularis oris, 181f, 183, 183f, 184t, 507 partial pressure of, 476
Nose, 458–459, 460–462, 460f Orbital region, 290–291, 290f respiratory exchange of, 476–485, 477f, 479f, 487
Nostrils, 459f, 460, 461f Orbits, electron, 34, 34f solubility of, 480
Nuclear heart scan, 409t Organ level, of body organization, 32, 32f, 73–75 transport in blood, 348–350, 379, 381f, 399,
Nuclear magnetic resonance imaging (NMRI), 448t Organ of Corti (spiral organ), 282, 282f, 283f 482–484, 483f
Nuclei of CNS, 241 Organ systems, 32, 32f, 75t–76t, 76, 77f–78f Oxygen debt, 208
Nucleic acids, 39, 40t, 43; see also DNA; RNA Organ transplantation, 442 Oxygen saturation test, 489t
Nucleotides, 43 Organelle(s), 32, 46–50, 48f; see also specific organelles Oxygen-poor blood, 379, 381f, 399, 478
base pairs of, 43, 43f definition of, 46 Oxygen-rich blood, 379, 381f, 399, 478
DNA, 43, 43f functions of, 46, 47t Oxyhemoglobin, 483, 483f
RNA, 43 Organelle level, of body organization, 32, 32f, 46–50 Oxytocin, 309t, 311, 312f, 315
in transcription, 54–55, 55f Organic, definition of, 39 in breastfeeding, 638
in translation, 55–57, 56f Organic molecules, 39–43 in childbirth, 325–326, 325t, 326f, 635, 636f
Nucleus of cell, 47t, 48f building blocks of, 39, 40t
Nucleus of neuron, 225, 225f, 226
Nutrient(s)
absorption of, 526, 528
definition of, 39
types of, 39, 40t
Organism level, of body organization, 32, 32f
p
P wave, 387, 387f, 388f
disorders of, 536, 537t Organization levels, of body, 31–81, 32f Pacemaker, 382–383
large intestine, 524, 526 cellular, 32, 32f, 50–61 Pain, 19–20
small intestine, 520, 522, 526, 528 chemical, 32–46, 32f flank, 570
circulation of, 526, 527f organ, 32, 32f, 73–75 in inflammation, 437
plasma transport of, 339f, 340 organelle, 32, 32f, 46–50 pathway for, 274–275, 275f
Nutrient artery, of bone, 143f, 144 organism, 32, 32f Pain rating scales, 19
Nutrition systems, 32, 32f, 75t–76t, 76, 77f–78f Pain receptors, 271, 274–275, 275f
and erythropoiesis, 349 tissue, 32, 32f, 61–73 Palate
measurements in, 211 Orgasm cleft, 166–167, 167f, 168t
and muscle health, 210–211, 210t female, 621, 622, 622f hard, 459f, 460f–461f, 504, 504f
and pregnancy, 156, 156f, 349, 634–635 male, 594–595, 595f soft, 459f, 504, 504f
and skeletal health, 157, 157f Origin, of muscle, 176 Palatine bones, 120f, 122, 504
and skin health, 88–89 Oropharynx, 433, 460f–461f, 462, 508 Palatine tonsils, 430f, 433, 433f, 461f, 504f
Nutrition tables, B-1–B-2 Osmosis, 52–53, 52f, 552, 555 Palliative treatment, 25, 25f
plasma tonicity and, 52–53, 53f Palmar region, 5f, 5t

o
Oat cell carcinoma, 494
Ossa coxae, 133
Ossicles, auditory, 280f, 281, 282f, 283, 284f
Ossification, 152–154
Palmaris longus, 190f, 191, 191t
Pampiniform plexus, 581f, 582, 582f
Pancreas, 308f, 309t, 311, 313f, 502f, 503, 503f, 516f,
Obesity, epidemiology of, 27t endochondral, 153–154, 153t, 154f 517–518
Objective signals (signs), of disease, 18–21 intramembranous, 152–153, 153f, 153t cellular organelles of, 46
Oblique fractures, 162 Osteoarthritis, 150, 161, 168t in diabetes mellitus, 328–329
Oblique muscles, of eye, 292, 292f Osteoblasts, 139, 141, 152 endocrine function of, 309t, 311, 517, 520–521, 313f
Obstructive sleep apnea, 489 in appositional growth, 155 exocrine function of, 517
Occipital bone, 117–119, 118f–121f in endochondral growth, 155 intestinal regulation of, 520
Occipital lobe, 234f–235f, 236t, 238 in endochondral ossification, 153–154, 153t, 154f Pancreatic duct, 516f, 517–518
in vision, 296, 297–298, 297f in fracture healing, 162, 163f Pancreatic ducts, 313f
Occipitalis, 183, 183f, 184t hormonal regulation of, 157–158, 158f Pancreatic islets, 311, 313f, 328
Occupational therapy, 25 in intramembranous ossification, 152–153 Pancreatic lipase, 521
Oculomotor nerve (CN III), 246f, 247t, 289 Osteoclasts, 139 Pap smear, 624t, 626, 627f
Odontoid process, 126, 126f bisphosphonates and, 165 Papillae
Olecranon, 130f, 131f, 132 in bone remodeling, 156–158 dermal, 86f, 87, 88f, 90, 91f
Olecranon fossa, 130f, 131 hormonal regulation of, 157–158, 158f lingual, 276–277, 276f, 506

INDEX I-15
Papillary muscle, 376, 377f, 385, 385f Periodontitis, 506, 536t disorders of, 329–333
Paracrine hormones, 318 Periosteum, 140f, 143f, 144 posterior, 308, 309t, 311
Paralysis, 264, 265t Peripheral chemoreceptors, 486, 487f in childbirth, 325–326, 326f
Paraplegia, 264 Peripheral nervous system (PNS), 223–224, 224f, 245–252 in diabetes insipidus, 329
Parasites, 535, 535f, 537t cells of hormones of, 309t, 311, 312f, 325–326, 325t, 326f
Parasitic skin infections, 105–106, 106f neurons, 224–228 (see also Neurons) hypothalamic regulation of, 311, 312f
Parasympathetic division, of ANS, 224, 224f, supporting, 228, 228t, 230, 230f Pivot joints, 146t, 150
250–252, 252f divisions of, 223–224, 224f PKD; see Polycystic kidney disease
Parathyroid glands, 157, 158f, 308f, 309t, 311, 313f myelin/myelination in, 230, 230f, 245f Placenta, 620, 632, 636
Parathyroid hormone (PTH), 157–158, 158f, 309t, Perirenal fat capsule, 546 Placenta previa, 640, 640f, 641t
311, 315 Peristalsis Placental abruption, 640
in calcium metabolism, 157–158, 158f, 311, 526 in esophagus, 509–510, 509f, 513 Planes, anatomical, 6, 6t, 7f
in pregnancy, 632 in large intestine, 524 Plantar flexion, 177, 178f
Parent cell, 58–60, 59f, 60f, 587–589 in sexual response, 594, 595f, 622 Plantar region, 5f, 5t
Parietal bones, 117, 118f–121f in small intestine, 521, 521f Plantar warts, 104–105
Parietal cells, of stomach, 512–514, 512f, 520 in stomach, 513 Plaques
Parietal lobe, 234f–235f, 236t, 237 in swallowing, 509–510, 509f Alzheimer’s disease, 262–263
in equilibrium, 289 Peritoneal fluid, 11f, 12 atherosclerotic, 411, 411f
in pain pathway, 274–275, 275f Peritoneum, 8t, 10–12, 11f dental, 506
in taste pathway, 277 female, 609f Plasma, 67, 67f, 338–340
Parietal pericardium, 10, 11f, 371, 372f–373f parietal, 10–12, 11f composition of, 339–340, 339f
Parietal peritoneum, 10–12, 11f visceral, 10–12, 11f, 13f gases in, 339f, 340
Parietal pleura, 10, 11f, 458, 459f, 467f Peritubular capillaries, 550–551, 550f homeostatic role of, 340
Parkinson’s disease, 263, 265t Permanent teeth, 504, 505f ions in, 339f, 340
Parotid glands, 506, 507f Pernicious anemia, 364, 366t, 528 lymph derived from, 424, 427
Partial pressure of gases, 476 Peroneus (fibularis), 181f–182f, 195, 195f, 195t nutrients in, 339f, 340
Partial thromboplastin time (PTT), 360t Perpendicular plate, of ethmoid bone, 118f, 120f as percentage of whole blood, 339f
Partial-thickness burns, 99, 99f Pertussis, 492, 495t regulatory substances in, 339f, 340
Parturition, 635–636, 636f Petechiae, 362 as solution, 340
Passive immunity, 443–445 Peyer’s patches, 429, 520 tonicity of and osmosis, 52–53, 53f
Passive transport, 50–53 pH, 37–39 volume of, 359
Patella, 115f, 117, 117f, 135, 135f of blood, 39, 159–160, 349, 359, 485–486, 552–553, waste products in, 339f, 340
Patellar ligament, 149, 149f 553f, 565 Plasma B cells, 428, 440, 441f, 449
Patellar region, 5f, 5t of saliva, 507 Plasma membrane; see Cell (plasma) membrane
Patent ductus arteriosus (PDA), 414–416, 416f, 418t of small intestine, 520–521 Plasma proteins, 320, 320f, 322, 339–340, 339f
Pathogens, 21, 86 of stomach, 507, 512, 514 Plasmin, 354
external barriers to, 435–436 of sweat, 90 Plasminogen, 354
nonspecific defenses against, 436–438, 445 of vagina, 610 Plateau, in female sexual response, 621, 622f
particles, in vaccines, 445 pH scale, 38, 38f Platelet(s); see Thrombocytes
specific immunity against, 436, 438–445 Phagocytosis, 48, 54, 54f, 343, 429, 437f, 438–441 Platelet count, 360t
Pathological murmur, 410 Phalanges Platelet plugs, 351–352, 351f
Pathology of foot, 115f, 137, 137f, 138f Platysma, 181f, 183f, 184, 184t
definition of, 2 of hand, 115f, 132, 133f Pleura, 8t, 10, 11f, 458
terms of, 15–27 Pharyngeal constrictor muscles, 509f parietal, 10, 11f, 458, 459f, 467f
Peak flow meter, 489t Pharyngeal tonsils, 433, 433f, 461f separation of, 472
Pectineus, 181f Pharyngitis, 376, 490–491, 495t visceral, 10, 11f, 458, 459f, 467f
Pectoral girdle, 127, 129 Pharynx, 433, 459, 459f–461f, 462–463, 503, Pleural cavities, 8, 8t, 9f
Pectoralis major, 181f, 184, 185f, 186t, 189f, 612, 612f 503f, 508 Pleural cavity, 467f, 473f
Pectoralis minor, 184, 185f, 186t, 470–471, 471f digestive function of, 509, 509f Pleural fluid, 459f
Pelvic girdle, 115f, 129, 132–134, 133f respiratory function of, 462–463 Pleurisy, 459
Pelvic inflammatory disease (PID), 628 Pheromone, 318 Pluripotent stem cells, 346
Pelvic lymph nodes, 431 Phimosis, 599, 599f, 601t Pneumocystis pneumonia, 452
Pelvic region, 5f, 5t Phosphate buffers, 160 Pneumonectomy, 494
Pelvis, 133–134, 134f Phospholipids Pneumonia, 480, 480f, 492, 495t
male vs. female, 134, 134f in cell membrane, 49, 49f Pneumothorax, 472, 496t
widening, in female puberty, 613 hydrophilic heads of, 49 PNS; see Peripheral nervous system
Penicillin allergy, 450 hydrophobic tails of, 49 Polar body, 615f, 616
Penile urethra, 563, 585, 585f Phosphorus, body percentage of, 33t Polarization, 253f, 254
Penis, 584f, 585, 585f Photoreceptors, 289, 293–295, 294f, 298 Polycystic kidney disease (PKD), 568–569, 569f, 571t
circumcision of, 585 Physical therapy, 25, 25f Polycythemia, 362–363, 366t
erection of, 585, 594–596 Physiological contracture, 208 Polydipsia, 328, 329
Pepsin, 513–514 Physiology Polyphagia, 328
Pepsinogen, 512–513, 513t definition of, 2 Polyps, 529, 537t
Peptic ulcers, 531–532, 532f, 537t terms of, 13–15 Polysaccharides, 40–41, 40f
Perception, 277 Pia mater, 231–232, 231f, 233f, 243f Polyuria, 328, 329
Pericardial cavity, 8, 8t, 9f, 372f–373f, 373f PID; see Pelvic inflammatory disease Pons, 223, 234f–235f, 237t, 240, 242f
Pericardial fluid, 372–373 Pineal gland, 307, 308f, 308t, 323, 323t Pontine respiratory group, 486, 486f
Pericardial sac (parietal pericardium), 10, 11f, 371, Pink eye (conjunctivitis), 291 Popliteal artery, 390f, 393f
372f–373f Pinna, 280, 280f, 282–283 Popliteal lymph nodes, 430f, 432
Pericarditis, 374, 418t Pinworms, 535 Portal route, 400, 401f, 526, 527f
Pericardium, 8t, 10, 11f, 371–373 Pisiform, 132, 133f Positions, anatomical, 6–8, 8t
parietal, 10, 11f, 371, 372f–373f Pitch, 279 prone, 6–8, 8t
visceral, 10, 11f, 372–373, 372f–373f Pituitary dwarfism, 330–331, 330f, 333t standard, 2, 2f, 6
Perilymph, 282, 282f, 283, 283f, 284f Pituitary gland, 308–311, 308f supine, 6–8, 8t
Perimetrium, 607f, 608 anterior, 308–310, 309t Positive feedback, 13–15
Perimysium, 196, 196f adrenal cortex degeneration and, 325, 325t Posterior, 3t
Perinatal developmental disorders, 16 in childbirth, 635, 636f Posterior cruciate ligament, 147–149, 148f–149f
Perineal raphe, 581, 581f disorders of, 329–331 Posterior interventricular sulcus, 375, 375f
Perineum female reproductive control by, 618–620, 623 Posterior pituitary, 308, 309t, 311
female, 610–611, 611f hormones of, 309t, 310, 310f in childbirth, 325–326, 326f
male, 580, 581f hypothalamic control of, 308t, 310, in diabetes insipidus, 329
Perineurium, 245f, 246 310f, 312f hormones of, 309t, 311, 312f, 325–326, 325t, 326f
Period, 618 in male reproductive control, 592, 593f hypothalamic regulation of, 311, 312f
Periodic Table of Elements, 33, 34f melatonin and, 323, 323t Posterior tibial artery, 390f, 393f
Periodontal ligaments, 504, 505f negative feedback inhibition of, 319, 319f Postganglionic neuron, 250–252, 251f, 252f

I-16 INDEX
Postnatal developmental disorders, 16 Prostatic hyperplasia, benign, 566, 571t, 596 Quadriplegia, 264
Posttranslational modification, 57, 57f Prostatic urethra, 563, 563f, 584f Quaternary structure of protein, 42f
Potassium Protection
absorption of, 526
body percentage of, 33t
in cardiac physiology, 392
by blood, 359
by bones, 159
by cerebrospinal fluid, 232
r
Rabies virus, 226, 265t
imbalances in, 557 by skin, 94–95 Radial artery, 390f, 393f
ion or electrolyte, 35 Protein(s), 39, 40t, 41 Radial artery pulse, 389, 390f
in membrane potentials, 253–255, 253f absorption of, 522, 526, 528 Radioactivity, 35
in muscle physiology, 210 antimicrobial, 436, 437–438 Radioisotopes, 35
nutritional requirements for, 210, 261, B-1 building blocks of, 40t, 41, 42f Radius, 115f, 131, 131f
in renal (urine) regulation, 556–557 channel, 49, 49f Rapid influenza test, 489t, 490
Power stroke, 201, 202f digestion of, 504, 513–514, 521, 528 Rapid strep test, 489t, 491
Precapillary sphincters, 396, 396f, 405 hormones, 315, 316, 317f Reabsorption, bone, 156–158, 159t
Prediabetes, 329 hydrogen bonds of, 36 Reabsorption, tubular (renal), 552, 554, 554f
Predisposing factors, 15–18 membrane, 49, 49f Reactants, 44
Preeclampsia, 640, 641t MHC, 439–442, 440f, 441f, 443f Reaction cascade, 353
Prefrontal cortex, 238f nutritional requirements for, 210, B-1 Reaction time, aging and, 261
Preganglionic neuron, 250–252, 251f, 252f in pregnancy, 634 Reactive hyperemia, 405
Pregnancy, 628–640 plasma, 320, 320f, 322, 339–340, 339f Receptive field, 272–274, 274f
adjustments to, 633–634 posttranslational modification of, 57, 57f Receptors
blood-type compatibility in, 357, 358f receptor, 49, 49f hair, 273t, 274
disorders of, 639–640, 641t shape of, 41 hormone, 307, 316–318, 320, 321f
ectopic, 639, 639f, 641t structure of, 41, 42f protein, 49, 49f
hormones of, 620–621, 632–633 Protein synthesis, 54–58 reflex, 256–258
nutritional requirements in, 156, 156f, 349, 634–635 mistakes in, 57–58 sensory, 88f, 89, 96, 271–275, 272f, 273t
requirements for, 628 transcription in, 54–55, 55f (see also specific types)
Pregnancy tests, 621, 624t, 628, 628f translation in, 54, 55–57, 56f Recruitment, 204
Prehypertension, 404, 417t Proteoglycans, 141 Rectum, 503f, 522–524, 523f
Preload, 390 Prothrombin activator, 354 Rectus abdominis, 181f, 185–187, 185f–186f, 186t
Premenstrual phase, 618f, 620 Prothrombin time (PT), 360t Rectus femoris, 181f, 191–193, 193f, 194t
Premotor area, 237, 238f Protons, 33–34, 34f Rectus muscles, of eye, 291–292, 291f–292f
Prenatal care, 635 Protraction, 177, 178f Red blood cell(s); see Erythrocytes
Prenatal developmental disorders, 16 Proximal, 3t Red blood cell count, 360t
Prenatal diagnosis, 17 Proximal convoluted tubule (PCT), 547–548, 548f, Red bone marrow, 144, 160, 428–429, 430f
Prepuce 549f, 554f hemopoiesis in, 346–350
female, 610, 611f PSA (prostate-specific antigen), 597, 597t leukocyte storage in, 346
male, 584f, 585, 585f Pseudostratified epithelial tissue, 61, 62f Red hair, 92f
Presbyopia, 299, 301t ciliated columnar, 62, 64f Red pulp, of spleen, 434, 435f
Pressure Psoas major, 191, 193f, 194t Redness, in inflammation, 20, 437
and airflow (ventilation), 470–473, 473f Psoriasis, 106, 107f, 109t Reduction, fracture, 162, 162f
and cardiovascular physiology, 384 PT; see Prothrombin time Reed-Sternberg cells, 448–449
(see also Blood pressure) PTH; see Parathyroid hormone Reflex(es), 256–258; see also specific reflexes
syringe illustration of, 384, 384f, 470 Ptosis, 214 autonomic, 256, 258
Pressure gradient, 402 PTT; see Partial thromboplastin time definition of, 256
Pressure points, arterial, 389, 390f Puberty somatic, 256–258, 258f
Pressure (decubitus) ulcers, 107, 109t definition of, 587 testing of, 256
Prevalence, 26 female, 613–614 Reflex arc, 256, 258f
Preventive treatment, 25 hormones in, 314, 323–324, 587, 613–614 Reflexive memory, 241
Primary motor area, 237, 238f male, 587 Refraction, 289, 295, 298
Primary oocytes, 614–616, 615f, 617f Pubic hair, 587, 613 Refractory period/phase
Primary ovarian follicles, 615f, 617f Pubic symphysis, 134, 134f, 147 in cardiac muscle, 378
Primary polycythemia, 362, 366t Pubis, 132–134, 133f in male sexual response, 596
Primary spermatocyte, 589–590, 590f Pulmonary angiogram, 489t in skeletal muscle, 203, 203f
Primary structure of protein, 42f Pulmonary arteries, 379, 380f, 395, 399, 400f, Regeneration, 97, 98f
Prime mover muscles, 176 466f, 468f Regenerative cells, of stomach, 512
Primordial follicles, 615f, 616–617, 617f Pulmonary circuit, 380, 381f, 399, 400f Regions
Process, of bone, 131; see also specific processes Pulmonary embolism, 412 of abdomen, 2–6, 6f
Proctoscopy, 529t Pulmonary fibrosis, 474 of body, 2–6, 5f, 5t
Products, of chemical reactions, 44 Pulmonary function tests, 474, 474f, 475f, 475t Regulatory T cells, 428
Proerythroblasts, 345f Pulmonary trunk, 375f, 379, 380f, 399, 400f Regurgitation, valvular, 374–375, 416
Progesterone, 315 Pulmonary valve, 376, 377f, 379 Rejection, transplant, 442
in childbirth, 635, 636f Pulmonary veins, 379, 380f, 397, 399, 400f, 468f Relaxation phase, of muscle contraction, 203, 203f
in female reproductive cycle, 618f, 619–620 Pulp cavity, of tooth, 505f, 506 Remodeling, bone, 156–158
in menopause, 623 Pulse, 389, 390f Renal arteries, 393f, 396, 546f, 547, 550–551, 550f, 554f
in postpartum, 637–638 Pulse oximetry, 489t Renal arterioles, 401f
in pregnancy, 620, 632, 634 Pulse pressure, 404 Renal capsule, 544f, 546–547, 546f
in skin health, 89 Pupil, 293, 293f, 299 Renal cell carcinoma, 570
Prognosis, 23 Purkinje fibers, 383, 383f Renal corpuscle, 547, 548f, 549, 554f
Programmed cell death (apoptosis), 73 Pus, 438 Renal cortex, 546f, 547, 550f
Prolactin, 637–638, 638f Pyelitis, 568, 571t Renal failure, 570, 571t
Prolapse, organ, 623 Pyelonephritis, 568, 571t Renal fascia, 545f, 546
Prolapsed valve, 410, 417t Pyloric region, 510f–511f, 511 Renal hilum, 546–547, 546f
Proliferative phase, of menstrual cycle, 618f, 619 Pyloric sphincter, 510f–511f, 511, 516f Renal medulla, 546f, 547, 550f
Pronation, 179, 179f Pyramids Renal pelvis, 546f, 561
Prone, definition of, 6–8, 8t of kidney, 546f, 547 Renal pyramids, 546f, 547
Propionibacterium acnes, 89 of medulla oblongata, 240, 240f Renal sinus, 546f, 547
Proprioceptors, 390–391, 391f, 407, 486 Pyrogens, 438 Renal tubule, 547–549, 548f, 549f, 550f, 554f

q
Prostaglandins, 20, 309t, 314, 635, 636f reabsorption in, 552, 554, 554f
Prostate cancer, 597, 601t secretion by, 552–554, 554f
Prostate gland, 583, 584f Renal veins, 394f, 397, 547, 550f, 551, 554f
aging and, 596 QRS complex, 387, 387f, 388f Renin, 557–558, 559f, 560
diagnostic tests for, 597, 597t, 598f Quadrants, of abdomen, 2–6, 6f Renin-angiotensin-aldosterone (RAA) mechanism,
Prostate-specific antigen (PSA), 597, 597t Quadrate lobe, of liver, 514, 515f 557–558, 559f
Prostatic fluid, 583 Quadriceps femoris, 181f, 191–193, 193f, 194t Repetitive motion injuries, 191

INDEX I-17
Replication, DNA, 59–60 Rickets, 139, 168t Second-messenger system, 316, 317f
Repolarization Right, as anatomical term, 3t Secretin, 520
of cardiac muscle, 384–386 Right atrium, 375–376, 375f, 377f Secretion, tubular, 552–554, 554f
of membrane, 253f, 254 Right colic (hepatic) flexure, 522, 523f Secretory phase, of menstrual cycle, 618f, 620
Reposition, 180, 180f Right coronary artery, 398, 398f, 399f Secretory vesicles, 47t, 48f
Reproduction, as characteristic of life, 576 Right lower quadrant, of abdomen, 2, 6f Sedation, 241
Reproductive cycle, female, 617–621, 618f Right lung, 466, 466f, 467f Segmentation, in small intestine, 521, 521f
Reproductive hormones Right lymphatic duct, 424, 426f, 430f, 433f Seizure disorders, 265, 265t
female, 309t, 314, 617–621 Right upper quadrant, of abdomen, 2, 6f Selectively permeable membrane, 52–53, 52f
in childbirth, 325–326, 325t, 326f, 635, 636f Right ventricle, 375–376, 375f, 377f Self vs. nonself, 22, 354, 434, 439
in menopause, 623 Right ventricular hypertrophy, 416 Self-antigens, 434
in pregnancy, 620–621, 632–633 Ringworm, 105, 105f Sella turcica, 120f–122f, 121, 159, 312f
in puberty, 613–614 Rinne test, 300, 300t Semen, 583, 594–595, 595f
male, 309t, 314, 592–593, 593f Risk (predisposing) factors, 15–18 Semicircular canals, 280f, 281–282, 283f, 287, 288f
in puberty, 587 RNA Semilunar valves, 376, 377f, 379, 384–386, 385f
in sex determination, 577, 586–587 DNA transcription to, 54–55, 55f Semimembranosus, 182f, 193, 194f, 194t
Reproductive system; see Female reproductive system; errors in, 57–58 Seminal vesicles, 583, 584f
Male reproductive system nucleotides of, 43 Seminiferous tubules, 579–580, 580f, 592f
Residual volume (RV), 475f, 475t translation of, 54, 55–57, 56f Semitendinosus, 182f, 193, 194f, 194t
Resistance Rods, 294–295, 294f, 298 Sensation
to blood flow, 403 Roots cerebrum and, 235–238, 238f
in lever system, 205–206, 206f of hair, 91f, 92 information on type of, 272
nonspecific immune, 436–438, 445 of nail, 93, 93f medulla oblongata and, 239–240
Resistance arteries, 396 of penis, 584f, 585 skin, 96
Resistance exercise, 212 of spinal nerves, 244f, 248f, 249 thalamus and, 239
Resolution of tooth, 505f, 506 Senses, 270–304; see also specific senses
in female sexual response, 621, 622, 622f Rotation, 179, 179f aging and, 298–299
in male sexual response, 595f, 596 Rough endoplasmic reticulum, 47, 47t, 48f diagnostic tests for, 299–300, 300t
Respiratory acidosis, 486, 496t, 552 Round ligament disorders of, 300–301, 301t
Respiratory alkalosis, 486, 496t, 553 of liver, 514, 514f general, 271–275, 298
Respiratory centers, 485–486, 486f of uterus, 607f, 608, 608f overview of, 271
Respiratory distress syndrome, 470, 474, 493, 495t–496t Round window, 280f, 282, 282f, 283, 283f, 284f word roots and combining forms for, 271
Respiratory infections, 490–492, 495t Roundworms, 428, 535, 535f Sensorineural hearing loss, 300, 301t
Respiratory membrane Ruffini (bulbous) corpuscles, 273t Sensory areas, general, 235–237, 238f
anatomy of, 468f, 470 Rugae Sensory (afferent) nerves, 246
area of, 480 of stomach, 510f–511f, 511 Sensory (afferent) neurons, 223, 246, 256–258
disorders affecting, 480, 480f of urinary bladder, 562, 563f Sensory receptors, 88f, 89, 96, 271–275, 272f, 273t
gas exchange at, 476–485, 477f, 479f, 487 of vagina, 609f, 610, 621 duration information for, 274
thickness of, 480, 480f Rule of nines, 100, 100f intensity information for, 274
Respiratory muscles, 470–473, 471f–473f Ruptured (herniated) disk, 125, 125f, 168t ___location information for, 272–274
Respiratory system, 75t, 76, 78f, 457–500 olfactory, 278–279, 278f
aging and, 488–489
anatomy of, 458–470, 459f
cancers of, 493–494, 496t
s
Saccule, 285–286, 286f
sensation information for, 272
taste, 276–277, 276f
Sepsis, 493
connections with other body systems, 497 Sacral curvature, 123f Septal defects, 316f, 416, 418t
diagnostic tests for, 489–490, 489t Sacral nerves, 243f, 247, 248f Septic shock, 407
disorders of, 489–495, 495t–496t Sacroiliac joint, 133–134, 134f Septicemia, 365
epithelial tissue of, 62, 64f, 462 Sacrum, 115f, 122, 123f, 127, 127f Serous membranes, 8–12; see also specific membranes
functions of, 487–488 Saddle joints, 146t, 150 water balloon analogy for, 10, 10f
gas exchange in, 458, 476–485, 477f, 479f, 487 Sagittal plane, 6t, 7f Serratus anterior, 181f, 184, 185f, 186t, 189f
gas transport in, 482–485, 483f, 484f Salicylic acid, for acne, 89 Sertoli (sustentacular) cells, 587, 589–592, 590f, 592f, 593f
overview of, 458 Saliva, 506–507 Serum, 340
passage of air through, 458–460 Salivary ducts, 504f, 506, 507f blood typing in, 356–357, 356f
physiology of, 470–488 Salivary glands, 503, 503f, 506, 507f Sesamoid bones, 116–117, 117f
pregnancy and, 634 Salmonellosis, 534 Sex cells, 578; see also Ova; Sperm
regulation of, 485–486, 486f, 487f Salty taste, 277 Sex characteristics, secondary, 314
ventilation in, 458, 470–473, 473f Sarcolemma, 196f, 197–198, 198f Sex chromosomes, 364, 577, 578f, 606
word roots and combining forms for, 458 Sarcomas, 72 Sex determination, 577, 578f, 586–587, 606
Rest-and-veg effect, 250 Sarcomeres, 198, 198f, 201, 202f Sex drive (libido), 587, 592, 613, 624
Resting membrane potential (RMP), 253f, 254, 255f, 257f Sarcoplasmic reticulum, 196f, 198, 198f, 201, 202f Sex-determining region of the Y (SRY), 577, 606
Rete testis, 579–580, 580f, 584f Sartorius, 181f, 193f, 194t Sex-linked disease, 364, 365f
Reticular formation, 223, 237t, 241, 275, 275f Satellite cells, 228, 228t, 230 Sex-linked trait, 294
Reticulocytes, 345f Scabies, 105–106, 106f, 109t Sexual response
Retina, 293–295, 293f Scales, in psoriasis, 106, 107f female, 621–622
aging and, 299 Scaphoid, 132, 133f male, 594–596, 595f
image formation in, 295–296 Scapula, 115f, 129, 129f Sexually transmitted diseases (STDs), 599–600, 601t,
ophthalmoscopic examination of, 294–295, 295f Scar tissue, 97, 98f 628, 640t
photoreceptors of, 289, 293–295, 294f, 298 Schlemm, canal of, 293 Shaft
Retinoids, 89 Schwann cells, 225f, 228, 228t, 230, 230f, 245f of hair, 91f, 92
Retraction (movement), 177, 178f Sclera, 292, 293f of long bone, 142, 143f
Retrograde axonal transport, 226 Scleroderma, 108, 109f, 109t of penis, 584f, 585, 585f
Retroperitoneal organs, 10, 11f, 517, 545, 545f, 561 Sclerosis, 229 Shells, electron, 34, 34f
Reversible potentials, 254 Scoliosis, 124, 124f, 168t Shin splints, 216, 217t
Rh blood group, 355, 356, 357, 358f Screenings, 24 Shingles, 105, 105f, 423, 447
Rheumatic heart disease, 376, 418t Scrotum, 580–581, 580f, 581f, 584f Shingles vaccine, 423
Rheumatoid arthritis (RA), 150, 151f, 168t, 450 Scuba diving, 480–481 Shock, 407
Rhinovirus, 490 Sebaceous glands, 88f, 89, 91f, 100 Short bones, 115–116
Rhodopsin, 294 Sebum, 89, 100 Short-term memory, 259, 261
Rhythm, cardiac, 386–388 Secondary oocyte, 607f, 615f, 616 Shoulder, movements of, 180, 180f
Ribosomes, 47t, 48f, 54–57, 56f Secondary ovarian follicles, 615f, 617f Shunt
Ribs, 115f, 116, 116f, 127f, 128 Secondary polycythemia, 362–363, 366t arteriovenous, 396f, 401
attachments of, 126, 126f, 128f Secondary sex characteristics, 314, 587, 613 for hydrocephalus, 264
false, 127f, 128 Secondary spermatocyte, 590, 590f Sickle cell disease, 349, 349f, 364, 366t
floating, 127f, 128 Secondary structure of protein, 42f Sickle cell trait, 349
true, 128 Second-degree burns, 99, 99f Sigmoid colon, 503f, 522–524, 523f

I-18 INDEX
Sigmoidoscopy, 529t as barrier defense, 436 Solvents, 37
Signs, of disease, 18–21 communication role of, 96 Somatic reflexes, 256–258, 258f
Sildenafil (Viagra), 596 connective tissue of, 65, 66f Somatomotor division, of PNS, 223–224, 224f
Simple diffusion, 51, 51f diagnostic tests for, 24f, 101, 102t Sound
Simple epithelial tissue, 61, 62f disorders of, 102–109, 109t frequency of, 279, 280f, 284, 284f
columnar, 61, 64f excretion via, 543, 543f nature of, 279, 280f
cuboidal, 61, 63f functions of, 94–96, 436 physiology of hearing, 282–284, 284f
squamous, 61, 62f glands of, 83, 88f, 89–90 Sound waves, 279, 282–284, 284f
Simple (closed) fractures, 161 healing of, 97, 98f Sour taste, 277
Sinoatrial (SA) node, 382–383, 383f, 386, 390 healthy, 88–89 Spanish flu of 1918, 26, 26f
Sinus headache, 462 injuries to, 97–100 Specific immunity, 436, 439–445
Sinus rhythm, 386 layers of, 83, 84f antigen-presenting cells in, 440, 441f
Sinuses, 120f, 122, 123f, 459f, 460f–461f, 462 percentage of body weight, 83 cellular (cell-mediated), 442, 443f, 444f, 445, 446f
Sinusitis, 462, 496t pregnancy and, 634 humoral, 439–442, 441f, 445, 446f
Skeletal muscle, 69, 70f, 174–221 sensory receptors in, 88f, 89, 96, 271–275, 272f, 273t importance of helper T cells in, 445, 446f
actions of, 177–180, 177f–180f temperature regulation by, 96 vaccines and, 445
aging and, 212 thick, 84 Speech, 463–464, 488
anatomical terms for, 176 thin, 84 Sperm
anatomy of, 196–197, 196f–197f ultraviolet radiation and, 95, 102 anatomy of, 586, 586f
antagonist, 176 vitamin D production in, 95, 157 capacitation of, 629–631, 630f
arm, 189, 189f, 189t water retention in, 96 fertilization by, 616, 620, 629–631, 630f
atrophy of, 73, 216, 217f, 217t Skin biopsy, 24f, 102t, 103 maturation of, 583, 591
attachments of, 176 Skin cancer, 102–103, 103f oxygen supply of, 582
back, 187–189, 187f–188f, 188t Skin color, 86, 87f pathway for, 594
comparison with cardiac and smooth muscle, Skin grafts, 100 pathway to meet egg, 629
209–210, 209t Skin infections, 104–106, 104f–106f production of, 578, 580, 587–592, 590f, 591f
diagnostic tests for, 204, 213, 213t Skin scraping, 24f, 102t, 106, 107f storage of, 583
disorders of, 213–217, 217t Skull, 115f, 117–122 Sperm count, 595
extrinsic, 176 anterior view of, 118f Spermatic cord, 580f, 581f, 582
fatigue of, 208–209 cranial floor of, 121f Spermatic ducts, 583, 584f
fixator, 176 foramina of, 119, 120f Spermatids, 590–591, 590f, 592f
forearm, 190–191, 190f, 191t inferior view of, 120f Spermatocytes
functions of, 211–212, 211f intramembranous ossification of, 152–153, 153f, 153t primary, 589–590, 590f
head, 180–184, 183f, 184t lateral view of, 119f secondary, 590, 590f
heat production by, 212 medial view of, 120f Spermatogenesis, 589–590, 590f
hyperplasia of, 72 superior view of, 121f Spermatogonia, 589–591, 590f
hypertrophy of, 72, 212 sutures of, 121f, 144, 152–153, 153f, 153t Spermiogenesis, 590f, 591, 591f
insertion of, 176 Sleep apnea, 489 Sphenoid bone, 118f–122f, 119–122
intrinsic, 176 Sliding filament theory, 201, 202f Sphenoidal sinus, 120f, 123f, 459f, 460f–461f, 462
leg, 195, 195f, 195t Slipped (herniated) disk, 125, 125f, 168t Sphincters, 212; see also specific sphincters
lever system and, 205–206, 206f Slow-twitch fibers, 208–209, 212 Sphygmomanometer, 403–404
metabolism of, 206–208 Small arteries, 396 Spinal column, 115f, 122–127
neck, 180–184, 183f, 184t, 187f–188f, 188t Small intestine, 502f, 503, 503f, 518–522 aging and, 160
nutritional requirements of, 210–211, 210t absorption in, 520, 522, 526 bones of, 115f, 116, 117f, 122–127, 123f, 125f
origin of, 176 anatomy of, 518–520, 519f curvatures of, 123–124, 123f, 124f, 168t
physiological contracture of, 208 digestion in, 520–521, 528 Spinal cord, 223, 242–245, 243f–244f
physiology of, 199–212 endocrine function of, 314–315 ascending and descending tracts of, 242–243, 244f
prime mover, 176 epithelial tissue of, 61, 64f, 518, 519f columns of, 243, 244f
study technique for, 180 peristalsis in, 521, 521f in equilibrium, 289
superficial, 180, 181f–182f segmentation in, 521, 521f gray matter of, 242–243, 244f
synergist, 176 Small veins, 397 horns of, 242
thigh, 191–193, 193f, 194f, 194t Smallpox vaccine, 423 meninges of, 231–232, 231f, 233f, 243f
thorax and abdomen, 184–187, 186f–187f, 186t Smegma, 585 in pain pathway, 274–275
Skeletal muscle contraction, 201–206 Smell (olfaction), 278–279 white matter of, 242–243, 244f
contraction phase of, 203, 203f aging and, 298–299 Spinal cord injuries, 264
isometric, 205 anatomy of, 278, 278f Spinal nerves, 242, 243f, 247–249, 248f
isotonic, 205 brain function in, 238f roots of, 244f, 248f, 249
latent phase of, 202, 203f pathways of, 279 study hint on, 249
lever system and, 205–206, 206f physiology of, 279 Spinous process, 125–126, 125f, 126f
refractory phase of, 203, 203f smoking and, 488 Spiral fractures, 162
relaxation phase of, 203, 203f Smoker’s hack, 73, 465 Spiral organ, 282, 282f, 283f
sliding filament theory of, 201, 202f Smoking, 73, 465, 487–488, 488f, 493 Spirometry, 474, 474f, 489t
sustained (tetany), 203–204, 203f Smooth endoplasmic reticulum, 47t, 48f, 198 Spleen, 430f, 434, 435f
types of, 201–204 Smooth muscle, 70, 70f, 175–176, 209–210, 209t blood cell storage in, 346, 434
Skeletal muscle pump, 402, 403f, 427 Snellen test, 296, 300t hemopoiesis in, 346
Skeletal system, 75t, 76, 77f, 113–173; see also Bone(s); Sodium immune function of, 434
specific bones absorption of, 524, 526 RBC (hemoglobin) processing in, 350–351, 350f,
aging and, 160–161, 623 in action potential, 257f 434, 542
anatomy of, 114–139, 115f imbalances in, 557 trauma to, 434
connections with other body systems, 169 ion or electrolyte, 35 Splenomegaly, 449, 452t
diagnostic tests for, 164, 164t in membrane potentials, 253–255, 253f Splinter, inflammatory response to, 19–21, 20f,
disorders of, 164–168, 168t nutritional requirements for, 261, B-1 437–438, 437f
functions of, 159–160 in renal (urine) regulation, 556–557, 560 Spontaneous abortion, 639, 641t
histology of, 139–143, 140f Sodium chloride (NaCl), 35, 36f Sports injuries, 22–23, 22f
nutritional requirements of, 157, 157f Sodium-potassium pump, 53, 253–254, 253f, Sprains, 214, 217t
overview of, 114 255f, 257f Sputum analysis, 489t
physiology of, 152–160 Soft palate, 459f, 504, 504f Squamous cell(s), 62f
word roots and combining forms for, 114 Soleus, 181f–182f, 195, 195f, 195t Squamous cell carcinoma
Skeleton Solubility, of gases, 480 lung, 494
appendicular, 114, 115f, 129–138 Solutes, 37 skin, 102, 102f
axial, 114, 115f, 117–128 Solution(s), 37 Squamous epithelial tissue
Skin composition of, 37 simple, 61, 62f
adipose tissue of, 67, 67f concentration of, 37 stratified, 61, 63f
aging and, 100–101, 623 tonicity of, 37, 38f Stability, muscles for, 211
anatomy of, 83–91 plasma, 52–53, 53f Stacking, 593

INDEX I-19
Stadium, 438, 439f Supporting cells Tarsal region, 5f, 5t
Standard anatomical position, 2, 2f in ear, 283f, 286f Tartar, 506
Stapes, 280f, 281–282, 282f, 283, 284f in nervous system, 71, 71f, 228–230, 228t Taste, 275–277
Staphylococcal food poisoning, 534 in taste, 276f, 277 aging and, 298, 528
Staphylococcal infections, skin, 104 Surfactant, 468f, 469–470 anatomy of, 276–277, 276f
Static equilibrium, 285 Suspensory ligaments olfaction and, 278
STDs; see Sexually transmitted diseases of breast, 612, 612f pathway for, 277
Stem cells, 263 of eye, 293f, 296f, 297, 299 physiology of, 277
gastric, 512 of ovaries, 607f, 608, 608f, 617f Taste buds, 276–277, 276f, 506
hemopoietic, 344t, 345f, 346–348 Sustentacular cells, 587, 589–592, 590f, 592f, 593f Taste cells, 276–277, 276f
in Parkinson’s disease, 263 Sutures, 121f, 144, 145t, 152–153, 153f, 153t Taste hairs, 276–277, 276f
pluripotent, 346 SV; see Stroke volume Taste pore, 276–277, 276f
Stenosis, valvular, 376, 416, 417t Swallowing, 509–510, 509f T-cell count, 451–452
Stents, for arteries, 412 Swayback, 124, 124f Tears, 290, 299
Sternocleidomastoid, 176, 181f, 183f, 184, 184t, 187f, Sweat glands, 88f, 89–90, 90t, 96, 101 Tectorial membrane, 282, 282f, 283f, 284
470–471, 471f Sweet taste, 277 Teeth, 503, 503f, 504–506, 505f, 528
Sternum, 115f, 116, 116f, 127, 127f Swelling, in inflammation, 437 Telomerase, 61
Steroid hormones, 315 Swimmer’s ear, 281 Telomeres, 60–61, 61f
half-life of, 322 Swollen lymph nodes, 432 Temperature
receptors for, 316, 317f Sympathetic chain ganglia, 250, 251f and simple diffusion, 51
transport of, 315, 316, 317f, 320, 320f Sympathetic division, of ANS, 224, 224f, 250, 251f and testes, 579, 581, 582, 582f
Steroids, anabolic, 593 Symphyses, 145t, 147 Temperature regulation
Stethoscope, 386 Symptoms, of disease, 18–21 blood and, 359
Stimulating hormones, 318 Synapses, 200, 200f, 226 fever and, 438, 439f
Stomach, 502f, 503, 503f Synaptic cleft, 200, 200f hypothalamus and, 239, 438, 439f
aging and, 528 Synaptic knob, 200, 200f, 225, 225f, 226 muscular system and, 212
anatomy of, 510–512, 510f–512f Synaptic transmission, 226–227, 253–256 skin and, 96
capacity of, 510 Synaptic vesicles, 226 water and, 37
cells of, 511–512, 512f Synchrondoses, 145t, 147 Temporal artery, superficial, 390f, 393f
digestion in, 513–514 Syndesmoses, 144, 145t Temporal bones, 117, 118f–121f, 280–281, 280f
endocrine function of, 314–315, 512, 513t Synergist muscles, 176 Temporal lobe, 234f–235f, 236t, 238, 239f
muscular wall of, 510f, 511, 513 Synovial fluid, 147, 147f in hearing, 285
pH of, 507, 512, 514 Synovial joints, 146t, 147–151, 147f in olfaction, 279
protective mechanisms of, 512 Synovial membrane, 147, 147f Temporalis, 176, 181f–182f, 183–184, 183f,
smooth muscle of, 70f Syphilis, 600, 600f, 601t, 628, 640t 184t, 507
Stool culture, 529t Syringe, volume, pressure, and flow in, 384, 384f, 470 Tendinitis, 215, 217t
Straight hair, 92, 92f Systemic circuit, 380, 381f, 399 Tendinous cords, 376, 377f, 385, 385f
Strain, muscle, 215, 217t Systemic gas exchange and transport, 482–484, 483f Tendons
Stratified epithelial tissue, 61, 62f Systems level, of body organization, 32, 32f, calcaneal (Achilles), 136, 182f, 195, 195f
squamous, 61, 63f 75t–76t, 76, 77f–78f connective tissue of, 65–66, 66f
Stratum basale, 84, 85f, 86f, 87f Systole, 384–385, 385f function of, 116
Stratum basalis, 609, 620f Systolic pressure, 403–404 Tensor fasciae latae, 181f, 193f, 194t
Stratum corneum, 84, 85f, 86f, 87f Terminal arborization, 225f, 226
Stratum functionalis, 609, 618, 620, 620f
Stratum granulosum, 84, 85f, 86f
Stratum lucidum, 84, 85f, 86f
t
T3, 309t, 311
Terminal bronchioles, 466f
Terminal hairs, 91, 101
Terminology
Stratum spinosum, 84, 85f, 86f T4, 309t, 311 anatomical, 2–12
Strep throat, 376, 491, 495t T cell(s), 428 cardiovascular system, 338, 371
Streptococcal infections aging and, 447 digestive system, 502
pharyngitis, 376, 491, 495t in cancer response, 442, 444f endocrine system, 306
rapid test for, 489t in cellular immunity, 442, 443f, 444f, 445, 446f excretory/urinary system, 544
rheumatic fever, 376 classes of, 428 female reproductive system, 606
skin, 104, 104f cloning and differentiation of, 442, 443f integumentary system, 83
Stress test, 409t cytotoxic, 428, 442, 443f, 444, 444f, 445 lymphatic system, 424
Stretch marks, 634 helper, 428, 440, 441f, 442, 443f, 445, 446f, 447, male reproductive system, 577
Stretch receptors, in respiratory regulation, 485 451–452 muscular system, 175, 176
Striations in HIV/AIDS, 451–452, 451f nervous system, 223
cardiac muscle, 70, 71f, 378, 378f in humoral immunity, 440, 441f, 445, 446f pathologic, 15–27
skeletal muscle, 69, 70f in immunization, 445 physiologic, 13–15
Stroke (CVA), 262, 265t maturation of, 428, 434 prefixes, suffixes, and word roots, D-1
Stroke volume (SV), 389–390, 407–408 memory, 428, 442, 443f respiratory system, 458
Styloid process in natural active immunity, 444 senses, 271
of radius, 131, 131f production of, 346 skeletal system, 114
of ulna, 131f, 132 regulatory, 428 Tertiary structure of protein, 42f
Subarachnoid space, 231f, 232, 233f, 243f self-antigens of, 434 Testes, 308f, 577–580, 580f, 584f
Subclavian veins, 394f, 424, 426f, 427f, 430f, 433f, T wave, 387, 387f, 388f barrier for, 589–590, 590f
522, 526 Tachycardia, 389, 417t descent of, 578–579, 579f
Subcutaneous layer, 83, 84f Tactile cells, 86, 86f development of, 578, 579f
Subjective signals (symptoms), of disease, Tactile corpuscles, 88f, 89, 272f, 273t endocrine function of, 309t, 314, 578
18–21 Tactile disks, 273t histology of, 591, 592f
Sublingual glands, 503f, 506, 507f Tadalafil (Cialis), 596 sperm production in, 578, 587–592, 590f, 591f
Submandibular glands, 503f, 506, 507f Taenia coli, 523f, 524 temperature and, 579, 581, 582, 582f
Sulci (sulcus), 234–235, 234f Tail undescended, 579, 593, 601t
Sulfur, body percentage of, 33t of epididymis, 580f, 583, 584f Testicles; see Testes
Sun exposure, 95, 101 of pancreas, 516f Testicular artery, 581f, 582, 582f
Superficial, 3t, 4f of sperm, 586, 586f, 591f, 592f Testicular cancer, 598, 598f, 601t
Superficial muscles, 180, 181f–182f   ; see also specific Talus, 136, 137f, 138f Testosterone, 309t, 314, 315, 324
muscles Tapeworms, 535, 535f aging and, 326, 596
Superficial temporal artery, 390f, 393f Target tissue, 307, 308t–309t, 316–318 anabolic steroids and, 593
Superior, 3t aging and, 326 bone effects of, 157, 159t, 160
Superior colliculi, 241, 242f ___location of, 316–318 and erythropoiesis, 359
Superior vena cava, 372f, 375f, 379, 380f, 394f, up-regulation and down-regulation in, 320, 321f in male puberty, 587
401f, 426f Tarsal bones, 115f, 136, 137f, 138f in male reproductive physiology, 592–593, 593f
Supination, 179, 179f Tarsal glands, 290, 291f production of, 578, 580, 587
Supine, definition of, 6–8, 8t Tarsal plate, 290, 290f, 291f in sex determination, 577, 586–587

I-20 INDEX
Testosterone injections, 579 Tight junctions Triiodothyronine (T3), 309t, 311
Tetanus, 204 in blood-testis barrier, 589, 590f Triquetrum, 132, 133f
Tetany, 203–204, 203f in small intestine, 520 Trochanters, of femur, 134–135, 135f
Tetraiodothyronine (T4, thyroxine), 309t, 311 in stomach, 512 Trochlea, 130f, 131
Tetralogy of Fallot, 416, 417f, 418t Tinea infections, 101, 105, 105f, 109t Trochlear nerve (CN IV), 246f, 247t, 289
Thalamus, 223, 235f, 236t, 238–239 Tinea unguium, 101 Trochlear notch, 131f, 132
in equilibrium, 289 Tinnitus, 299 Tropomyosin, 198, 199f, 201, 202f
in hearing, 284–285 Tissue(s); see also specific types Troponin, 198, 199f, 201, 202f
in pain pathway, 274–275, 275f changes in, 73 True ribs, 128
in vision, 297f, 298 classification of, 61 Trunk, muscles of, 184–187, 186f–187f, 186t
Thalassemia, 364 growth of, 72 TSH; see Thyroid-stimulating hormone
Therapeutic treatment, 25, 25f shrinkage and death, 73 Tubercle of humerus, 130, 130f
Thermoreceptors, 89, 96, 271 study of (histology), 61 Tuberculosis, 489t, 491–492, 492f, 495t
Thick filaments, 198, 198f, 199f, 201, 202f Tissue level, of body organization, 32, 32f, 61–73 Tuberosities, 130
Thick skin, 84 Toilet training, 565 deltoid, 130, 131f
Thigh Tongue, 460f–461f, 502f, 503, 503f, 504f, 506, 507f tibial, 135, 136f
bone of, 115f, 134–135, 135f, 140f digestive function of, 506, 509, 509f Tubular reabsorption, 552, 554, 554f
muscles of, 191–193, 193f, 194f, 194t taste buds of, 276–277, 276f, 506 Tubular secretion, 552–554, 554f
Thin filaments, 198, 198f, 199f, 201, 202f Tonicity, 37, 38f Tumor (neoplasm), 72
Thin skin, 84 plasma, 52–53, 53f Tunica albuginea
Third-degree burns, 99, 99f Tonometer, 293, 300t of ovaries, 606, 607f
Thoracentesis, 489t Tonsil(s), 433 of testes, 579–580, 580f
Thoracic cavity, 8, 8t, 9f lingual, 433, 433f, 461f Tunica externa, 392, 395f
cross section through, 467f palatine, 430f, 433, 433f, 461f, 504f Tunica interna, 392, 395f
serous membrane of, 10, 11f pharyngeal, 433, 433f, 461f Tunica media, 392, 395f, 397
Thoracic curvature, 123f Tonsillar crypts, 433, 433f Tunics, of blood vessels, 392, 395f, 397
Thoracic duct, 424, 426f, 430f, 522 Total lung capacity (TLC), 475f, 475t Two-point discrimination test, 274f
Thoracic lymph nodes, 426f, 431 Touch, sense of Tympanic membrane
Thoracic muscles, 184–187, 186f–187f, 186t brain function in, 237, 238f aging and, 299
Thoracic nerves, 243f, 247, 248f two-point discrimination test of, 274f anatomy of, 280f, 281, 282f
Thoracic pump, 402 Toxic goiter, 331 hearing function of, 283, 284f
Thoracic region (chest), 5f, 5t Trabeculae, 140f, 141 Tympanic tubes, 281, 281f
Thoracic vertebrae, 122, 123f, 126, 126f Trabecular muscle, 584f, 585
Thorax, position of heart in, 371, 372f–373f
Threshold
for action potential, 255
Trachea, 459f, 460f–461f, 463f, 464–466, 464f
cartilage of, 463f, 464–465, 464f
epithelial tissue of, 465, 465f
u
Ulcers
for muscle excitation, 200 metaplasia of, 73, 465 decubitus, 107, 109t
Throat; see Pharynx mucociliary escalator of, 464f, 465 peptic, 531–532, 532f, 537t
Thrombin, 354 Tracheostomy, 466 Ulna, 115f, 131f, 132
Thrombocytes, 67, 67f, 340, 342t, 343 Transcription, 54–55, 55f Ultrasound, 409t, 489t, 529t, 567t, 597t, 624t
disorders of, 364–365, 366t Transfer RNA (tRNA), 55–58 Ultraviolet radiation, and skin, 95, 102
functions of, 344 Transfusion, blood types and, 356–357 Umami, 277
in hemostasis, 351–354, 351f Transfusion reaction, 357 Umbilical hernias, 531
as percentage of whole blood, 338, 339f, 344 Transitional epithelial tissue, 62, 65f Umbilical region, 5f, 5t, 6, 6f
production of, 344t, 345f, 346 Translation, 54, 55–57, 56f Underwear, and male fertility, 582
repulsion of, 354 Transplantation, organ, 442 Undescended testes, 579, 593, 601t
storage of, 346 Transport, 50–54 Unipolar neurons, 227–228, 227t
test for (count), 360t active, 53, 201, 321, 552 Unmyelinated axons, 227, 256
Thrombocytopenia, 364–365, 366t axonal, 226 Up a concentration gradient, 53
Thrombophlebitis, 412, 413f, 418t bulk, 54, 54f Upper GI series, 529t
Thrombopoiesis, 344t, 345f, 346 gas, 348–350, 482–485 Upper limb
Thrombopoietin, 344t, 346 alveolar, 484–485, 485f bones of, 130–132
Thrombosis, 412 systemic, 482–484, 483f muscles of, 189–191, 189f, 189t, 190f, 191t
Thrombus, 354, 366t hormone, 315–318, 317f, 320, 320f, 321 Upper respiratory tract, 458, 460f–461f
Thumb, movements of, 180, 180f passive, 50–53 Up-regulation, 320, 321f
Thymine, 43, 43f Transrectal ultrasound, 597t Uracil, 43, 43f
Thymus gland, 430f, 434 Transverse abdominal, 185f–186f, 186t, 187 Urea, 545, 545f
aging and, 447 Transverse arch of foot, 137, 138f Uremia, 570
fetal vs. adult, 434, 434f Transverse colon, 503f, 522–524, 523f Ureters, 546f, 547, 561, 563f
hemopoiesis in, 346 Transverse fractures, 162 Urethra, 561–562, 562f
lymphocyte maturation in, 428, 434 Transverse plane, 6t, 7f congenital defect of, 599, 601t
Thyroid cartilage, 463, 463f Transverse process, 125–126, 125f, 126f female, 563, 563f, 609f, 610–611, 611f
Thyroid disorders, 331–332, 331f Trapezium, 132, 133f male, 563, 563f, 584f, 585, 585f, 595
Thyroid gland, 308f, 311 Trapezius, 182f, 187–188, 187f–188f, 188t Urethral sphincters, 562, 563f
negative feedback from, 318–319, 319f Trapezoid (bone), 132, 133f Urethritis, 567, 571t
pregnancy and, 633, 634 Trauma, 22–23 Uric acid, 545, 545f
Thyroid hormone, 309t, 311, 315 causes of, 23 Uric acid, in gout, 166, 166f
in cardiac physiology, 392 definition of, 22 Urinalysis, 327t, 567t, 597t, 624t
deficiency of, 332 fractures, 161–163, 168t Urinary bladder, 561–562, 562f, 563f
elevated levels of, 331 skin, 97–100 cancer of, 570, 571t
half-life of, 322 spleen, 434 epithelial tissue of, 62, 65f, 562
negative feedback and, 318–319, 319f sports injuries, 22–23, 22f Urinary incontinence, 566, 571t, 623
in pregnancy, 632 Treatment, 24–25; see also specific diseases and Urinary sphincter, 212
transport of, 320, 320f treatments Urinary system, 545; see also Excretory/urinary system
Thyroid scan, 35 palliative, 25, 25f Urinary tract infections (UTIs), 567–568, 571t
Thyroid-stimulating hormone (TSH), 309t, 310f, preventive, 25 Urine
315, 319, 319f therapeutic, 25, 25f aging and, 566
Thyrotropin-releasing hormone (TRH), 308t, Treponema pallidum, 600 blood in, 570
310f, 319, 319f TRH; see Thyrotropin-releasing hormone flow of components through nephron, 548f, 549–550
Thyroxine (T4), 309t, 311 Triceps brachii, 182f, 189, 189f, 189t, 190f glucose in, 552
Tibia, 115f, 135–136, 136f, 138f Tricuspid valve, 376, 377f, 379, 380f, 384–386 passing of (micturition), 563–565, 564f
Tibial artery, posterior, 390f, 393f Trigeminal nerve (CN V), 246f, 247t, 274, 509 production of, 544, 547, 551–561, 554f
Tibial tuberosity, 135, 136f Trigger zone, 225f, 226, 255–256 glomerular filtration in, 551, 554, 554f
Tibialis anterior, 181f, 195, 195f, 195t Triglycerides, synthesis of, 41f hormonal control of, 557–560, 558f–560f
Tidal volume (TV), 474, 475f, 475t Trigone, 562, 563f nervous system control of, 560–561

INDEX I-21
Urine (Continued) Ventilation-perfusion coupling, 481, 482f Vitamin K, 353, 524, 526, B-2
reabsorption in, 552, 554, 554f Ventral, 3t Vitreous chamber, 293, 293f
regulation of, 556–561 Ventral root, 244f, 248f, 249 Vitreous humor, 293, 293f, 295
secretion in, 552–554, 554f Ventricles Vocal cords, 463–464, 463f, 464f, 488
water conservation in, 555–556 of brain, 232, 233f, 235f Volume
storage of, 562 of heart and airflow (ventilation), 470–473, 473f
volume and concentration of, 556–561 anatomy of, 375–376, 375f, 377f and blood pressure, 402–403
Urticaria (hives), 107–108, 108f, 109t blood flow through, 379, 380f metric units of, A-2
Uterine contractions, 635–636 contraction and relaxation of, 383–386 syringe illustration of, 384, 384f, 470
Uterine fibroids, 626, 627f, 641t Ventricular diastole, 385f, 386 Volume of sound, 279, 280f, 284
Uterine tubes, 607f–609f, 608, 609 Ventricular hypertrophy, right, 416 Volumes, lung, 474, 475t
aging and, 623 Ventricular septal defect (VSD), 316f, 416, 418t Vomer, 118f, 120f, 122, 460, 461f
ectopic pregnancy in, 639, 639f, 641t Ventricular systole, 385, 385f Vomiting, 534, 537t
epithelial lining of, 609, 610f Venules, 397 VSD; see Ventricular septal defect
fertilization in, 620 Vertebrae, 115f, 116, 117f, 122–127, 123f Vulva, 608, 610–611
fimbriae of, 607f, 609, 619 aging and, 160

w
Uterus, 607f, 608–609, 608f cervical, 122, 123f, 126, 126f
aging and, 623 lumbar, 122, 123f, 126f, 127
endocrine function of, 314 structure of, 125, 125f
Warts, 104–105, 109t
fetal expulsion from (birth), 635–636, 636f, 637f thoracic, 122, 123f, 126, 126f
Warts, genital, 104–105, 600, 601t
implantation in, 631, 631f Vertebral cavity, 8, 8t, 9f
Waste, 542–544
reproductive cycle and, 617–621, 618f, 620f Vertebral column; see Spinal column
excretion of, 544, 565
sexual response of, 621–622, 622f Vertebral foramen, 125–126, 125f, 126f
filtration of, 551, 554f
UTIs; see Urinary tract infections Vesicles
metabolic, 543, 565
Utricle, 285–286, 286f impetigo, 104
nitrogenous, 340, 543–544, 545f, 551–554, 554f
Uvea, 292–293 phagocytic, 54, 54f
plasma transport of, 340
Uvula, 460f, 504, 504f secretory, 47t, 48f
products in bile, 516
seminal, 583, 584f
tubular secretion of, 552–554, 554f
synaptic, 226

v
Water, 37
Vestibular apparatus, 285–289, 286f
absorption of, 524–525, 529
Vestibular bulbs, 611, 611f, 621, 622f
body composition of, 37
Vaccines, 17, 17f, 423, 445, 447; see also specific vaccines Vestibular folds, 463f, 464, 464f
body functions of, 37
Vagal tone, 386, 390 Vestibular glands, 611, 611f, 621, 622f
daily intake and output of, 555–556, 556f
Vagina, 607f–609f, 608, 610 Vestibular membrane, 282f, 283–284, 283f, 284f
excretory role of, 544
aging and, 623 Vestibule
hydrogen bonds of, 36
epithelial tissue of, 610 of ear, 280f, 282, 283f
metabolic, 555
fetal passage through, 636, 637f of nasal cavity, 460, 461f
osmosis of, 52–53, 52f, 552, 555
functions of, 610 of vagina, 610–611, 611f
Water conservation, renal, 555–556
metaplasia of, 73 Vestibulocochlear nerve (CN VIII), 246f, 247t, 280f,
Water retention, in skin, 96
pH of, 610 281–287, 282f–284f, 288f
Water vapor, 476
sexual response of, 621, 622f Viagra (sildenafil), 596
Water-soluble vitamins, 526
Vaginal orifice, 609f Villi, arachnoid, 232, 233f
Wavy hair, 92, 92f
Vaginal rugae, 609f, 610 Villi, intestinal, 518–522, 519f, 528
Weber test, 300, 300t
Vagus nerve (CN X), 246f, 247t, 274, 277, 386, 390, 527 Viral infections, skin, 104–105, 105f
Weight, metric units of, A-1
Valves Viruses
Wernicke’s area, 238, 238f, 259
heart (see Heart valves) cellular immunity against, 442
White blood cell(s); see Leukocyte(s)
lymphatic vessels, 424, 425f retrograde axonal transport of, 226
White blood cell count, 360t, 448t
Vardenafil (Levitra), 596 Visceral pericardium, 10, 11f, 372–373, 372f–373f
White hair, 92
Varicella-zoster vaccine, 423 Visceral peritoneum, 10–12, 11f, 13f
White matter, 227
Varicella-zoster virus, 105, 105f, 423, 447 Visceral pleura, 10, 11f, 458, 459f, 467f
brain, 235, 241, 242f
Varicose veins, 412–413, 413f, 418t Viscosity, blood, 403
spinal cord, 242–243, 244f
Vas (ductus) deferens, 580f, 581f, 582, 583, 584f, 594 Vision, 289–298
White pulp, of spleen, 434, 435f
Vascular spasm, 351, 351f accommodation in, 296f, 297
Whooping cough (pertussis), 492, 495t
Vasectomy, 594 aging and, 299
Withdrawal reflex, 258, 258f
Vasoconstriction, 344, 403, 405–406, 462 anatomy of, 290–295, 290f–295f
Wong-Baker FACES Pain Rating Scale, 19
Vasodilation, 343, 403, 405, 407, 437, 437f, 450 binocular, 297, 297f
Wood’s light, 24f, 102t
Vasomotor center, 406 brain function in, 238, 238f, 241
Word roots, D-1; see also Terminology
Vasopressin; see Antidiuretic hormone color, 294, 301t
Wound contracture, 97
Vastus intermedius, 181f, 191–193, 193f, 194t depth perception in, 297
Wound healing, 97, 98f
Vastus lateralis, 181f, 191–193, 193f, 194t disorders of, 293, 296, 299, 300, 301, 301f, 301t
Wrist, bones of, 116f
Vastus medialis, 181f, 191–193, 193f, 194t distance, 296–297, 296f
Vegetation, 374–375 focus in, 295–297, 296f
Veins, 392, 397
disorders of, 418t
large, 397
light and, 289, 295, 298
near, 296f, 297
pathway for, 297f, 298
x
X chromosome, 364, 577, 578f, 606
major systemic, 394f physiology of, 295–298, 296f Xiphoid process, 127, 127f
medium, 397 testing of, 296, 300, 300t X-linked disease, 364, 365f
small, 397 Visual acuity, 294, 296, 300t X-linked trait, 294
structure of, 392, 395f, 397 Visual pigments, 294 X-ray, 164t, 327t, 448t
varicose, 412–413, 413f, 418t Vital capacity (VC), 474, 475f, 475t
Vellus hairs, 91 Vitamin(s)
Venae cavae, 371, 397
inferior, 375f, 379, 380f, 394f, 401f
superior, 372f, 375f, 379, 380f, 394f, 401f, 426f
absorption of, 526
fat-soluble, 526
nutritional requirements for, B-2
y
Y chromosome, 364, 577, 578f, 606
Venography, 409t water-soluble, 526 Yeast, budding, 106
Venous anastomosis, 402 Vitamin A, 88–89, 526, B-2 Yellow bone marrow, 142–144
Venous return, 402, 403f, 407 Vitamin A derivatives, for acne, 89
Ventilation, 458, 470–473, 473f Vitamin B, 526
alveolar, 481
gas exchange in, 476–485, 477f, 479f, 487
mechanical, 466
Vitamin B12, 349, 513, 526, 528, B-2
Vitamin B12 deficiency, 364, 528
Vitamin C, 88–89, 349, 526, B-2
z
Z lines, 198, 198f, 201, 202f
pregnancy and, 634 Vitamin D, 95, 156–158, 526, B-2 Zygomatic bone, 118f–120f, 122
regulation of, 485–486, 486f, 487f Vitamin E, 526, B-2 Zygote, 59, 577, 606, 615f, 631, 631f

I-22 INDEX