RHODES UNIVERSITY

Anatomy and
Physiology 2
Semester 1
Kelly Brand

Summary of all the sections covered in first semester.

BODY FLUIDS
THE BASICS

The human body is made up of 60% water.

Maintaining the body water balance is important.
Note that 1 kg of body weight is equivalent to 1 liter of water.
to calculate total body water the following formula is used:

Totalbody weight=Mass of person

60
100

The normal amount of body fluid is 42l.

The body fluid consists of two different kinds;
o Intracellular fluid (ICF)
Makes up 2/3 of the total body water
Found inside of cells.
o Extracellular Fluid (ECF)
Makes up 1/3 of the total body water
Split into 3 parts:
Tissue fluid just under 1/6
Plasma 1/6
o Made up of 90 % water
o Used to transport blood cells
o If more than 1 liter of blood is lost then the person needs
medical attention. Only 500ml is given during a
donation.
Transcellular fluid
o Intra Ocular fluid in the eye
o Cerebrospinal Fluid in the brain and spine
o Synovial Fluid in joints
o Peritoneal Fluid in the abdominal cavity, causes Ascites
o Pleural Fluid in the lungs
Found in capillaries, veins and around cells

Water is the only molecule that can move freely between cells and ECF.
This is called osmotic equilibrium, which is the way water moves from a high
concentration to a low concentration.
Some Normal Values:
1. Lung Volume = 6 l
2. Total Body Water = 42 l
3. Heart Rate = 60 100 bpm
4. Body Temp = 37 C
Sometimes there may be an abnormal distribution of body fluids;
o Edema, where there is too much ECF around the cells (tissue Fluid).
o Dehydration, where there is too much plasma and not enough ICF and tissue
fluid.
Factors that can cause Edema and Dehydration
o Blood Pressure
Hypertension (systemic Edema)
Shock
o Plasma Colloid Osmotic Pressure (less or more proteins then there should be)
Hepatitis (viral)
Cirrhosis (drinking damage)
Starvation (not enough proteins), Kwashiorkor
o Hypertension (dehydration)
o Lymphatic Problems
Blockages
Elephantitis

DIFFUSION, OSMOSIS AND PLASMA COLLOID PRESSURE

Substances to move into and out of cells need to cross a cell membrane, in order to do this
there are two mechanisms that are used:

Diffusion
o Spontaneous movement of substances down its concentration gradient, from
a high to a low concentration.
o The rate at which this occurs is determined by:
Difference in concentration
Size of a substance

Temperature
Solubility

Osmosis
o Movement of water down its concentration gradient.

Active and passive transport

o Active transport consists of proteins that
are embedded into the cell membrane
and needs something like ATP to bind to a
receptor to cause the movement of a
substance across the membrane.
o Passive transport occurs in the same way as
active but no ATP is required.
Tonicity; refers to solutes
o Isontonic = the same
o Hypotonic = lower (lysis in cells, in RBCs haemolysis)
o Hypertonic = higher (crenation in cells)
Osmolarity:

Measure of concentration
Osmolarity is the actual NUMBER of particles in a solution
It does not say anything about the composition of particles JUST THE NUMBER

Osmolality:

Osmoles of solutes per kilogram of water, number of particles in solution.

Osmolality is used in clinical settings because it is easy to estimate a persons total
body water by weighing them

Osmotic Pressure:

For every 1 mOsm difference in solute concentration there is an osmotic pressure of

19.3 mmHG

Plasma Colloid Osmotic Pressure:

Blood Plasma is slightly hypertonic compared to interstitial fluid because it contains

proteins. There is a pressure difference between plasma and interstitial fluid of +/- 20
mmHg
The concentration of protein in the blood is about 7% (7g of protein per 100ml of
blood)

Capillary Hydrostatic Pressure:

Refers to blood pressure in the capillaries

Larger the pressure, the more plasma is pushed out of the capillaries

ELECTROLYTES IN BODY FLUID COMPARTMENTS

Distribution of electrolytes in different body compartments:

Monovalent Cations
Divalent Cations
Negatively Charged
anions

ICF
K+
Mg++

ECF
Na+
Ca++
Cl-

PO34
Negatively Charged Proteins

Quantifying electrolytes in different body fluid compartments:

HCO3

HOMEOSTASIS
Sodium and its associated anions make up about 90% of the solute content of extracellular
fluid, and hence contribute an equivalent proportion of the ECF osmolarity. The osmotic
activity of extracellular sodium means that the regulation of the ECFV is basically equivalent
to the regulation of salt (NaCl) balance.
A) Over Hydration
a. Excessive intake of fluid
b. Reduced fluid output
i. ADH hypersecretion
ii. renal failure
c. Excessive salt intake
d. Reduced salt output
B) Dehydration
a. Reduced fluid intake
b. Increased fluid output
c. Salt intake and output increased

BLOOD
THE BASICS
The fluid found inside blood vessels and the heart, it makes up 6-8% of the total body mass
which is 60-80 ml per kg! A 70kg person has approximately 5 l of blood, this blood consists
of 55% plasma and 45% Red and white blood cells and platelets. Serum is fluid from clotted
blood. If there is less than 15-20 % RBCs then the patient will be aniemic, if there are over

60% the patient could have polysytiemiaveura, which is the over production of RBCs, this
could also occur when living at a high altitude to compensate for oxygen.
There are many cells in the blood, namely Red Blood
Cells aka Erythrocytes, White blood Cells aka leukocytes
and platelets. All of these cells are made from
haematopoietick stem cells in bone marrow.

ERYTHROCYTES
They are a biconcave disc in shape and have a diameter
of 7-8 micrometers, and a height of 2 micrometers.
Each red blood cell consists of water, electrolytes,
hemoglobin and metabolic enzymes; they have no nucleus or organelles. They are used to
carry oxygen from lungs to the tissues and carbon dioxide from tissues back to lungs.
Eyrthropoiesis is the making of new red blood cells. The cell starts off having a nucleus and
the it is ejected from the cell.

REGULATION OF RED BLOOD CELL PRODUCTION

Production is stimulated by Erythropoietin (Epo), which is released into the kidneys in
response to hypoxia aka the lack of oxygen being delivered to tissues. This can also be
stimulated by testosterone, growth hormone and thyroid hormone. There is then a
production of erythrocytes in the bone marrow in order to increase the oxygen carrying
capacity in the blood.
There are many ways to assess haematological parameters:

Red blood count

Haemoglobin
o At birth heamoglobin is high, but the fetal haemoglobin has a higher oxygen
affinity.
o Adult males have +/- 20g/l higher than females due to androgens effect on
erythropoiesis.
Haematocrit
Mean cell volume

CARBON DIOXIDE TRANSPORT

Carbonic anhydrase in red blood cells catalyses the following reaction:

++HCO3

CO2 +H 2 O H 2 C O 3 H
Haemoglobin in red blood cells and proteins in plasma bind to the carbon dioxide forming
carboamino compounds.

RED CELL MEASUREMENTS

Red cell count (RBC) in males is

510

12 /l, and in females is

4.810

12 /l.

Haemogolbin concentration in males is 150g/l, and in females is 135g/l.

Packed cell volume (PCV) or Haematocrit is 0.45 in males, and 0.42 in females.

RED CELL INDICES

There are many diseases relating to the below or above average count for red blood cells.
The important ones are to follow.
1. Anemia
a. Anaemia means without blood
b. There is a lack of red blood cells and hemoglobin.
c. This reduces the ability of blood to transfer oxygen.
d. Symptoms are:
i. Yellowing of eyes
ii. Pale and cold skin
iii. Shortness of breath
iv. Weak muscles
v. Fatigue, dizziness and fainting
vi. Low blood pressure
vii. Heart Palpitations, rapid heart rate, chest pain, angina, heart attack
viii. Stool colour change
ix. Spleen enlargement
e. It can be caused by numerous things such as:
i. Lack of iron (vit B12)/ folate

f.

ii. Hypoplasia
iii. Invasion of malignant cells
iv. Blood loss
v. Haemolysis
vi. Hypersplenism
It is classified in 3 ways
i. Normal mean cell volume -> acute blood loss or chronic disease
ii. Low mean cell volume -> iron deficiency or Thalassaemia
iii. High mean cell volume -> Vit B12/folate

IRON DEFICIENCY ANAEMIA

Most common of the three. Iron loss can be due to bleeding, inadequate diet and
malabsorption.
Children: Breast milk is a poor source of protein, due to prolonged weaning mild anaemia
can occur, this can be resolved by giving the child a normal diet. It can also occur in a
premature baby or haemorrage from the cord at birth, depriving the infant from a normal
store, iron deficiency can set in earlier.
Adolescents: it can occur during growth spurts where they can outstrip the supply.
Women: menstruation can cause a loss of 30 mg per month where the daily requirement is 1
mg per day. During pregnancy a mother requires iron for the fetus, placenta, and own
increased red blood cell mass. Blood loss during this or after parturition, pregnancy requires
3.5mg per day.
Older men & woman: Gastrointestinal bleeding and erosions associated with antiinflammatory drugs can cause peptic ulcers and cause a loss of blood.
Another common cause is an infestation with hookworm and poor diet.
Clinical Features:

often no symptions accidental discovery

Tiredness
brittle finger nails
Reduced haemoglobin microcytosis then hypochromia
Low mean cell volume less than 76 ferritin per liter.

MEGALOBLASTIC ANAEMIA
Megaloblastic cells are abnormally large cells, called macrocytosis. Due to them being
abnormally large and misshapen red cells they are well haemoglobinised. This inhibits DNA
synthesis and thus cells do not divide, they just keep growing larger. This is caused by a
deffiencie of vitamin B12 and folate which is essential for DNA synthesis. Or there can be no
absorption facilitated by intrinsic factors which are secreted by specialized cells from
stomach lining. Lastly the loss of stomach cells by gastrectomy addisonian pernicious
anaemia, which is an auto immune disease, can cause antibodies against intrinsic factors. A
rare cause could be a poor diet, and lack of meat and animal products, present in vegan
diets.

HEMOLYTIC ANAEMIA
Various abnormalities may shorten the normal red cell life span of 120 days. Anaemia
develops when marrow output does not compensate for cell death. An increased output of
new erythrocytes will be reflected in a raised reticulocyte output which gives an indication of
severity. Normoblasts may be released under extreme stress. Catabolic pathways for
haemoglobin degredation when overloaded create a modest increase in unconjugated
bilirubin in the blood and increased reabsorption of urobilinogen from the gut and excreted
in the urine. Mild jaundice develops.
There are 2 types of Hemolytic Aneamia:
1. Congenital
a. Caused by membrane abnormailtys
b. Haemoglobin synthesis problems
i. sickle cell anaemia
ii. Thalassaemia
2. Acquired
a. Immune system
b. non-immune
c. mechanical (burns)
d. infections (malaria, drugs)

SICKEL CELL ANAEMIA

Alteration in amino acid structure of the polypeptide chains of the globin fraction of
haemoglobin. (HaemoglobinS) When haemoglobin S is deoxygenated, the molecules of
haemoglobin polymerise to form pseudo-crystalline structures ( tactoids). These distort
the red cell membrane and produce characteristic sickle shaped cells Sickled cells increase
blood viscosity, have difficulty getting through capilaries, obstruct flow
1.
2.
3.
4.
5.

Thrombosis
Severe pain
Swelling
Tenderness
Haemolyse

HAEMOLYTIC DISEASE OF THE NEWBORN

Mom doesnt have any Rh-antibodies. Only at birth with 1st Rh+ blood, moms body get in
contact with Rh+ blooddevelops antibodies Anti + now
circulate in mom. 2nd Rh+ babymoms blood with antibodies
circulate through fetus Antibodies attack Rh+ blood in baby
Anti+ Baby anaemic, oxygen to the baby's organs and tissuesbaby's body responds -make more red blood cells very quickly
in the bone marrow and the liver and spleen. This causes these
organs to get bigger. The new red blood cells, often immature
and are not able to do the work of mature red blood cells.
Bilirubin. Babies are not easily able to get rid of the bilirubin hyperbilirubinemia- yellowing
of the baby's skin and tissues = Jaundice.

THALASSAEMIA
Thalassaemia is an Inherited disorder causing the impairment of haemoglobin production or
partial or complete failure to synthesize a specific type of globin chain.
Beta Thalassaemia
1. Failure to synthesis beta chains (people from the Mediterranean)
2. Minor (1 copy of faulty gene, heterozygote), few symptoms, can appear as iron
deficiency anaemia.
3. Major (inherited both faulty genes, homozygote) anaemia = crippling, chances of
survival without blood transfusion low Bone marrow transplant Genetic testing early
in pregnancy
Alpha-Thalassaemia:
1. Reduction/ Absence of alpha chain synthesis (people form South East Asia)
2. Two alpha gene loci on chromosome 16 (4 alpha genes). 1 deletion no symptoms, 2
deletions mild hypochromic anaemia, 3 deletions haemoglobin H disease, 4
deletions baby is stillborn

ERYTHROCYTOSIS
A raised haemoglobin usually, but not always, indicates and absolute increase in the number
of circulating red cells. In patients an apparently high haemoglobin level may be due to a
reduction in plasma volume. Dehydration can occur, unknown mechanisms associated with
stress.

POLYCYTHEMIA
Mainly found in patients over the age of 40 and is more common amongst men. Diagnosis
can be incidentally. Symptoms include: lassitude, loss of concentration, headaches,
dizziness, blackouts, pruritis, epistaxis and indigestion. It can be managed by venesection.

HEMOSTASIS
Blood needs to stand still in order to clot. Blood needs to be fluid, and must coagulate at the
appropriate time. This needs to be rapid, localized, and reversible. Thrombosis is
inappropriate coagulation. There are three major systems involved they are the vessel wall
(endothelium), platelets and coagulation cascade (coagulation factors/proteins).
Antithrombogenic favors fluid blood, properties of the endothelium:

Anti-platelet properties
o Covers highly thrombogenic basement membrane
o PGI2 (prostacyclin) and NO from uninjured endothelium inhibit platelet
binding
Anticoagualant properties
o Hairpin like molecules, activate antithrombin III
o Thrombomodulin, changes specificity of thrombin

Endothelial cells produce tPA which activates fibrinolysis via plasminogen to

plasmin

Prothrombotic favors clotting, properties of the endothelium:

Synthesis of von Willebrand Factor

Release of tissue Factor
Production of plaminogen activator inhibitors (PAI)
Membrane phospholipids bind and facilitate activation of clotting factors via Ca
bridges.

vWF =
Von Willebrandt
factor- inhibits blood clot as it has binding sites to collagen. Attacks platelets to change
shape and stick to the factor and release ADP and TXA which calls more platelets.

Coagulation Cascade

Enzymatic cascade (amplification)

Several serine proteases
o Produced by liver (most)
o Require Vit K (several)
3 protein cofactors (not enzymes)
Requires Ca 2+
Localized to site of injury
Reversible (via production of plasmin)

TF = Tissue Factor
Xa= Factor 10, turns prothrombin
to thrombin
Hemophilia A- Deviancy
of/nonfunctional VIII
Hemophilia B Defiency of /
nonfunctional IX
Fibrogen can only become fibrin if
there is Thrombin.
Prothrombin is broken down by Xa
to thrombin.
Non-Physiological inhibitors of Coagulation:

Vitamin k antagonists (in vivo only)

Ca chelators ( in vitro only)

CLOT

o EDTA
o Citrate
o Oxalate
Heparin ( in vivo and in vitro)

REMOVAL

Called fibrinolysis. It is inhibited by plasminogen activator inhibitors (PAIs), and 2

sntiplasmin (serpin).

BLOOD GROUPS
There are 2 ways to classify blood groups:
1. ABO
a. ABO works on the fact that all red blood cells have antigens, which are small
proteins that sit on the cells surface, allowing the body to identify that the cell
belongs to itself.
b. Different cells have different antigens.
c. There is blood groups A, B, AB and O
d. Blood group A has antibodies B, B has antibodies A, AB has no antibodies and
O has A and B antibodies.
e. Antibodies in the ECF, which are secreted by white blood cells are made to
attack antigens that are not expressed on the RBCs.
2. Rhesis factor
a. There is either a rhesis factor on a red blood cell or not.
b. The ones with a rhesis factor are denoted with A +, and without A

HAEMOGLOBIN

Haemoglobin is a protein found on red blood cells that allows oxygen

to bind reversibly to the iron on it. Each haemoglobin consists of 4
subunits, each consisting of:
a polypeptide (globin) chain
a haem unit (one iron and one protpporphyrin
molecule)
One haemoglobin has 2 and 2 globin chains
When oxygen binds to the one unit, a conformational
change occurs, causing the other unit to be exposed, allowing oxygen to
bind to it.
This is influenced by temperature, pressure and pH.

HAEMOGLOBINOPATHIES
Genetic defect that results in abnormal structure of one of the globin chains of the
haemoglobin molecule.
Inherited single gene disorders
Haemoglobinopathies are most common in ethnic populations from Africa, the
Mediterranean basin and Southeast Asia
Haemoglobinopathies imply structural abnormalities in the globin proteins
themselves
Common haemoglobinopathies include:
Sickle - cell disease
o 7 % of world's population (420 million) are carriers

o 60 % of total in Africa.
Thalassemias
o underproduction of
normal globin proteins

PLASMA
Plasma is a straw colored fluid found in our
capillaries, veins and arteries.
Plasma is made up of the following:

Water (90% by weight)

Plasma Proteins (7% by weight)
Salts (Na+, Cl-, HCO3-)
Nutrients (glucose, amino acids, fatty
acids)
Wastes (urea, uric acid, bilirubin)
Dissolved gasses (Oxygen, carbon
dioxide)
~20% of ECF is in plasma

Functions of Plasma:

Maintenance of the internal

environment
Rapid transport system for nutrients, wastes, hormones, lipo-proteins and heat
Colloid osmotic pressure (especially albumin)
pH buffering
Immunity ( immunoglobulins)
Blood Coagulation (Fibrinogen -> fibrin)

PLASMA PROTEINS
There are many different proteins in plasma; there are a few important ones that we need to
know:

1- Globulins
o Lipoprotein (HDL), transports lipids such as cholesterol to the liver
o Prothrombin, coagulation factor II, thrombin precursor
-Globulins
o Lipoprotein (LDL), transports lipids such as cholesterol to the vessel wall
o Transferrin, transport of iron ions
o Fibrogen, Coagulation factor I
-Globulins
o IgG, late antibodies, attack bacteria and viruses
o IgA, mucosa protecting antibodies

o
o
o

IgM, early antibodies

IgD, lymphocyte receptors
IgE, regains, acts on allergens

NERVOUS SYSTEM
THE ORGANIZATION OF THE NERVOUS SYSTEM
The nervous system is a regulating system that regulates and maintains the bodys
homeostasis through nerve impulses. Although the nervous system functions as a whole unit
we will break it down into more simple components for the purpose of explaining the work
better.
To get a broad picture of the functioning of the nervous system consider Figure 1 below.
Consider the following example; you are walk ing past a construction site. Suddenly you feel
a sharp pain in your foot. You jerk your foot up and away from the original point at which the
sharp pain was experienced. You examine your foot and realize that you stepped on a sharp
nail.
Considering the above mentioned example and figure 1, the following occurs: When you
stepped in the nailand the nail was causing injury to the skin of your foot, your sensory
receptors in the skin of your foot sent sensory information in the form of a nerve impulse
through the afferent nerve to the Central Nervous system, interneurons in the Central
Nervous System then processed the sensory information into motor information. The motor
information that travelled in the form of a nerve impulse through the efferent nerve,
signalled to the effector (skeletal muscle in the leg) to jerk back the foot.

Before we unpack the organization of the Nervous System, take note of the schematic figure
that illustrates the breakdown of the various components of the Nervous System that will be
discussed in the literature. We will refer back to this schematic figure throughout the
literature to keep the nervous system in context as a system that functions as a whole with
a variety of functions to fulfill one main purpose and that is to regulate and maintain body
homeostasis.

If we consider the structural classification of the Nervous System we can define it into two
distinct sub divisions. Namely the Central Nervous System (CNS) and the Peripheral Nervous
System (PNS).

1. The Central Nervous System (CNS) consists of the brain and the spinal cord. The CNS is
responsible for interpreting incoming sensory information and then giving instructions in the
form of motor information for an appropriate response.
2. The Peripheral Nervous System (PNS) is the section of the nervous system that is situated
outside the CNS. It consists of nerves that extend from the brain and spinal cord. There are
two types of nerves that arise from this system. The first type of nerve is known as the
spinal nerves and 31 pairs arise from the spinal cord. The second type of nerve is the 12
pairs of cranial nerves which arise from the brain. Now, the functional classification is only of
concern to the PNS. It can be divided into two main divisions:
1. The sensory or afferent division constantly keeps the CNS informed as to what is going on
inside and outside of the body. This is accomplished by sensory receptors located in the
various body parts which send nerve impulses to the CNS.
Sensory or afferent fibres that send nerve impulses from the skeletal muscles, skin and
joints to the CNS is known as somatic sensory (afferent) fibres. Whereas sensory or afferent
fibres which supply nerve impulses from visceral (internal) organs to the CNS are known as
visceral sensory fibres or visceral afferents.
2. The motor or efferent division carries nerve impulses from the CNS to the effector organs
(muscles and glands). These nerve impulses bring about a motor (movement) response in
the effector organs. The motor or efferent division is furthermore divide into two
subdivisions:
i) The somatic or voluntary nervous system which allows a person to control his/her skeletal
muscles. However not all skeletal muscle activity is controlled by this system, such as
skeletal muscle reflex.
ii.) The autonomic nervous system (ANS) regulates involuntary activity such as smooth
muscle s, cardiac muscles and glands. The autonomic nervous system is further divided into
two parts known as the:
1. Sympathetic system
2. Parasympathetic system

THE STRUCTURE AND FUNCTION OF NERVOUS TISSUE

There are two main types of cells which nervous tissue is made up of:
1. Supporting cells
2. Neurons
1. Supporting cells in the CNS, collectively lump together known as neuroglia (meaning
nerve glue). Neuroglia consists of a variety of cells which support, insulate and protect fine
neurons. Each different types of neuroglia are referred to asglia. Types of Neuroglia Figure
Description Astrocytes These are star shaped and account for almost half of the neural
tissue. These cells have lots of projections with swollen ends which help them cling to
neurons. Astrocytes are a living barrier between blood capillaries and neurons and help
make exchanges between the two bodies. In this way, astrocytes prevent harmful
substances that might be in the blood from entering the neuron.

Dorsal horn: connects to dorsal root, pathway for somatosensory information, carries
information about temp, pain, touch, vibration from periphery to the spinal cord.
Ventral Horn: Contains motor neurons, thus loss in movement will occur and all control if it is
damaged. From brain to the muscle via the ventral root.
Central canal: