NAME : SATRIA MANDALA PUTRA

NIM : J011221096

CIRCULATION AND CARDIOVASCULAR SYSTEM

1. Describe the basic components of the circulatory system!

Answer :

The circulatory system has three basic components:

1) The heart functions as a pump that exerts pressure on the blood to produce the
pressure gradient needed to circulate blood to the tissues. Like all fluids, blood flows
down a pressure gradient from areas of high pressure to areas of low pressure.

2) Blood vessels are channels for distributing blood from the heart to all parts of the
body and then returned to the heart. The smallest blood vessels are designed for the
rapid exchange of materials between surrounding cells and the blood within the vessels.

3) Blood is a transport medium where dissolved or suspended materials (eg, O2, CO2,
nutrients, wastes, electrolytes, and hormones) will be transported long distances in the
body.

2. Explain about pulmonary circulation and systemic circulation.

Answer :

The pulmonary/pulmonary (pulmonary) circulation consists of a closed loop of vessels

that transport blood between the heart and lungs. The pulmonary circulation system
begins when deoxygenated blood originating from all over the body, which flows
through the superior vena cava and inferior vena cava then to the right atrium and then
to the right ventricle, leaves the right heart through the pulmonary arteries to the lungs
(right and left). Within the lungs, blood flows into the pulmonary capillaries where
exchange of substances and fluids occurs resulting in oxygenated blood. Oxygen is
 taken from the exhaled air. This oxygenated blood then flows through the pulmonary
veins (right and left), goes to the left atrium and then enters the left ventricle through
the mitral (bicuspid) valve.

Systemic circulation is the circuit of vessels that transports blood between the heart and
other body systems. The systemic circulation system begins when oxygen-rich blood
originating from the lungs is pumped out by the heart through the left ventricle to the
aorta, then throughout the body through the arteries until it reaches the blood vessels of
the smallest diameter (capillaries).

3. Explain about the types of blood vessels and their functions!

Answer :

1) Artery
Serves as a fast-transit channel for blood from the heart to various organs
(because of its large radius, arteries do not pose much resistance to blood flow).
Arteries that carry blood from the ventricles to the tissues.
2) vein
Function to return blood from the tissues to the atria. It has big fingers so that
its resistance to blood flow is low.
3) Capillary
Serves as a place of exchange of materials between blood and tissue cells.
Exchange materials penetrate the capillary walls to diffuse.
4) arterioles
Serves to determine the distribution of cardiac output.

4. Explain systole and distole

Answer :

Alternate systole (contraction and emptying) and diastole (relaxing and filling).
Contraction occurs due to the spread of excitation throughout the heart. While
relaxation follows cardiac repolarization. The atria and ventricles carry out systole and
diastole cycles separately. Unless otherwise stated, the words systole and diastole refer
to what's happening in the ventricles.
5. Explain about blood flow in the brachial artery in relation to cuff pressure and sounds
when measuring blood pressure!

Answer :

The pressure on the sphygmomanometer (inflatable cuff) can be varied to block or

allow the brachial artery below. The pressure generated by these arteries can be
determined using a stethoscope. The relationship between blood flow in the brachial
artery with cuff pressure and the sound when blood pressure is measured when blood
pressure is in the range of 120/80 mm Hg:

1. When the cuff pressure is >120 mm Hg and exceeds the pressure throughout the
cardiac cycle:

- No blood flowing through the veins

- No sound is heard because there is no flow

2. When the cuff pressure is between 120 - 80 mm Hg:

- Blood flowing through the veins is turbulent whenever the blood pressure exceeds the
cuff pressure

- The first heart sound (sound 1) is heard at the peak of the systolic pressure

- Intermittent sound is heard due to turbulent flow bursts when the blood pressure
cyclically exceeds the cuff pressure

3. When the cuff pressure is <80 mm Hg and is below blood pressure throughout the
cardiac cycle:

- Blood flows through the vessels in a smooth laminar flow

- The last sound is heard at minimal diastolic pressure

- No sound after that because the flow is laminar, smooth, and uninterrupted.

6. Be able to explain the electrical activity of the heart

Answer :
 Contraction of the cardiac muscle to squirt blood is triggered by an action potential that
sweeps across the muscle cell membrane. The heart contracts or beats rhythmically as
a result of its own generated action potentials. The source of this electrical activity is
the cardiac muscle fibers, which are specially named autorhythmic fibers. Where this
autorhythmic fiber functions to work as a pacemaker (trigger) and builds the cardiac
conduction system. There are two special types of cardiac muscle cells: contractile cells
and autorhythmic cells. Contractile cells perform mechanical work, namely pumping
and autorhythmic cells specialize in triggering and conducting action potentials that are
responsible for contraction of the cells.

Then there is the conduction system in the heart which is located in the following
places:

1) Sinoatrial Node (SA Node)

It is located on the wall of the right atrium near the entrance to the superior vena
cava and is the earliest electrical trigger in the heart.
2) Atrioventricular Node (AV Node)
Located at the base of the right atrium near the septum. Just above where the atria
and ventricles meet.
3) His File (Bundle of His)
Located in the interventricular septum, divides into 2 right and left bundle branches
that descend down the septum.
4) Purkinje Fibers
Terminal fine fibers that extend from the bundle of His and spread throughout the
ventricular myocardium.

7. Able to explain about heart rate, cardiac output, and stroke volume!

Answer :

Heart Rate is the number of heart beats per minute, heart rate varies for each person,
during rest the heart beats normally 60-80 times/minute.

Cardiac Output (cardiac output) is the amount of blood by the ventricles per minute,
Cardiac output = stroke volume × heart rate.
 Stroke volume is the volume of blood pumped by each ventricle per second. About two-
thirds of the volume of blood in the ventricles at the end of diastole (end-diastolic
volume) is expelled during systole. The amount of blood ejected is called the ejection
fraction, while the volume of blood remaining in the ventricles at the end of systole is
called the end-systolic volume.

8. Be able to explain the factors that affect heart rate!

Answer :

The following are the factors that affect Heart Rate.

1) Age.
During the growth period, the pulse rate will gradually settle down to meet oxygen
needs. Maximum Heart Rate in the elderly decreases by 50% from adolescence
when a person reaches the age of 80 years. This is due to reduced muscle mass, and
the maximum muscle power achieved is greatly reduced. In children aged 5 years,
the resting pulse rate is between 90-100 beats per minute, at the age of 10 it reaches
80-90 beats per minute, and in adults it reaches 60-100 beats per minute.
2) Gender.
The heart rate frequency in women is higher than in men. This is caused by changes
in the hormone estrogen that often occur in women which causes women to be more
likely to have high blood pressure, where hypertension is known to interfere with
heart rate control so that the heart rate frequency in women is higher.
3) Body Mass Index (BMI).
The relationship between body weight and pulse is directly proportional, while
body weight is related to body mass index. The higher the body weight, the higher
the BMI and conversely the lower the weight, the lower the BMI. So, the higher
the BMI, the higher a person's resting pulse rate will be.
4) Physical Activity
Not only does it increase the risk of being overweight, lack of physical activity also
causes a person to tend to have a higher heart rate frequency. This is caused by the
heart muscle working hard with each contraction, where the harder and more often
the heart muscle pumps, the higher the pressure that is imposed on the arteries.
5) Cigarettes and Caffeine
 Cigarettes and caffeine also affect the increase in pulse rate. People who smoke
before work are found to have an increase in pulse rate of 10 to 20 beats per minute
compared to people who work without smoking. This is caused by the
vasoconstriction of blood vessels due to smoking.

NERVOUS SYSTEM

1. Describe the central nervous system

Answer:
Central Nervous System The central nervous system (CNS), namely the brain
(encephalon) and spinal cord, which is the center of integration and control of all body
activities. The functional part of the central nervous system is the axon neuron as a
connection and electrical transmission between neurons, and is surrounded by glial cells
that support it mechanically and metabolically.
A. Brain
The brain is a very important organ of the body and as the regulatory center of all human
activities which is located in the cavity of the skull. The main parts of the brain are
cerebrum, cerebellum and midbrain. The cerebrum is the control center for conscious
bodily activities. The cerebrum is divided into two hemispheres, namely the right and
left hemispheres. Each hemisphere is divided into 4 lobes namely frontal, parietal,
occipital, and temporal. While the disenfalon is part of the cerebrum which consists of
the thalamus, hypothalamus, and epithalamus. Hindbrain / cerebellum is divided into
two subdivisions, namely the metencephalon and myelencephalon.
The metencephalon gives rise to the brainstem (pons) and cerebellum. Meanwhile, the
myelencephalon will become the medulla oblongata. The midbrain/limbic system
consists of the hippocampus, hypothalamus, and amygdala. In the brain there is a fluid
known as cerebrospinal fluid. This cerebrospinal fluid surrounds the subarachnoid
space around the brain and spinal cord. This fluid also fills the ventricles of the brain.
This fluid resembles blood plasma and interstitial fluid and is produced by the choroid
plexuses and secreted by epindemal cells that surround the cerebral vessels and line the
central canal of the spinal cord. The function of this fluid is as a cushion for soft
 examination of the brain and spinal cord, it also acts as a medium for exchanging
nutrients and waste substances between the blood and the brain and spinal cord.
B. Spinal Medulla
The spinal cord is located lengthwise in the spinal cavity, starting from the cervical
vertebrae to the second lumbar vertebrae. The spinal cord is divided into two layers,
namely a white outer layer (white area) and a gray inner layer (gray area). The outer
layer contains nerve fibers and the inner layer contains nerve bodies. Within the spinal
cord are sensory nerves, motor nerves and connecting nerves. Its function is as a
conductor of impulses from the brain and to the brain as well as a center for regulating
reflexes.

2. Describe the Peripheral Nervous System

Answer:
The peripheral nervous system (PNS), namely the cranial nerves and spinal nerves, are the
lines of communication between the CNS and the body. The PNS is composed of all the
nerves that carry messages to and from the CNS. Based on its function SST is divided into
2 parts, namely:
A. Somatic Nervous System
The somatic nervous system consists of 12 pairs of cranial nerves and 31 pairs of spinal
nerves. Processes in somatic nerves are influenced by consciousness
1. Cranial Nerves
12 pairs of cranial nerves arise from different parts of the brainstem. Some of these
nerves are composed only of sensory fibers, but most are composed of both sensory
and motor fibers.
Cranial Nerves consist of:
• Sensory (1, 2 and 8)
• Motor (3, 4, 6, 11 and 12)
• Sensory and Motor (5, 7, 9 and 10)
2. Spinal Nerves
There are 31 pairs of spinal nerves originating from the cord via dorsal (posterior)
and ventral (anterior) roots. The spinal nerves are the combined motor and sensory
nerves, carrying information to the cord via afferent neurons and leaving via
 efferents. Nerves are named and numbered according to the region of the vertebral
column where they arise.
B. Autonomic Nervous System
The autonomic nervous system regulates the unconscious tissues and organs of the
body. The tissues and organs controlled by the autonomic nervous system are the blood
vessels and the heart. This system consists of the sympathetic nervous system and the
parasympathetic nervous system. The functions of the two nervous systems are
reversed.
SST based on its division is also divided into two parts, namely:
The sensory division (afferent) is the peripheral nervous system starting from receptors
on the skin or muscles (effector) into the plexuses, roots, and so on the central nervous
system. So it is ascending.
Motor division (efferent) that connects impulses from the CNS to effectors (Muscle and
Glands) which are descending to respond to impulses received from receptors in the
skin and muscles from the surrounding environment.

3. Explain about the Somatosensory System

Answer:
The somatosensory system is a diverse sensory system consisting of receptors and
processing centers to produce sensory modalities such as touch, temperature,
proprioceptive (body position) and nociceptive (pain). Sensory receptors cover the skin
and epithelium, skeletal muscles, bones and joints, organs and the cardiovascular system.
Proprioceptive information is transmitted to the brain via the dorsal column of the spinal
cord. Most of the proprioceptive input goes to the cerebellum, but some goes to the cerebral
cortex via the medial lemniscus and thalamus.
In the brain, the part that functions as a balance control center is the cerebellum. The
cerebellum contains more individual neurons than in any other part of the brain, indicating
the importance of these structures. The nervous system uses the cerebellum to coordinate
motor control functions at three levels, as follows:
 ➢ Vestibulocerebellum
It consists principally of the small cerebral flocculonodular lobe (which lies beneath
the posterior cerebellum) and the adjacent vermis. This section provides the neuron
circuits for most of the body's balance movements.
➢ Spinocerebellum
It consists mostly of the vermis of the posterior and anterior cerebellum plus the
adjacent zona intermedia on either side of the vermis. This section is primarily a circuit
for coordinating movements of the distal parts of the body, especially the hands and
fingers.
➢ Cerebrorebellum
It consists of the large lateral zone of the cerebellar hemisphere, lateral to the zona
intermedia. This section actually receives all of its input from the motor cerebral
cortex and the premotor cortex as well as the adjacent somatosensory cerebral cortex.
successive limbs, planning all of this as quickly as a tenth of a second before
movement occurs. This is called "motor discussion" of the movement to be performed.

4. Explain about chronic pain and acute pain and the difference
Answer:
Chronic pain is defined as pain that lasts beyond the course of an acute illness, persists
beyond the time required for trauma to heal, and occurs repeatedly at intervals of several
months or several years. Acute pain is defined as a complex unpleasant experience related
to sensory, cognitive and emotional related to tissue trauma, disease process, or abnormal
function of muscles or viscera.
 Table of differences between chronic pain and acute pain

Aspect Acute Pain Chronic Pain

Location Clear Spread
Description Easy Difficult
Duration Short Keep going
Physiological alert condition Pain peaks appear
Rest Reducing pain Worsening pain
Profession under control questionable
Relation Help Tired, deterioration
Financial under control Decrease
moods Afraid Depression, guilt
Doctor's response Giving hope Feel blamed
Treatment Looking for causes Focus on management

5. Explain about pain pathways

Answer:
DEFINITIONS / TYPES OF PAIN LINES
Neuropathic pain is defined as pain associated with a lesion or disease of the
somatosensory nervous system, which can result from surgery and a variety of
conditions, including diabetes, herpes zoster infection, stroke, multiple sclerosis, and
spinal cord lesions. Neuropathic pain is a common problem in clinical practice.

NEUROPATHIC PAIN SYMPTOMS

a. Burning and electric shock sensation

b. Pain from non-painful stimuli
c. Sleep disturbances, anxiety and depression are common

CAUSES OF NEUROPATHIC PAIN

Neuropathic pain, which occurs due to damage to nerve tissue, peripheral neuropathy,
for example due to diabetes mellitus, hematological malignancy, rheumatoid arthritis,
alcoholism, drug abuse, trauma, central pain, for example, pain accompanying stroke,
spinal cord injury, and idiopathic neuropathy.

6. Describe the pain inhibition system

Answer:
Transmission of nociceptive input in the spinal cord can be inhibited by activity in the
spinal cord itself, that is, by descending neural activity from supraspinal centers.
a. segmental inhibition
Activation of large afferent fibers that provide epicritic sensation inhibits the
activity of WDR neurons and the spinothalamic tract. Likewise, activation of
noxious stimuli in noncontiguous parts of the body inhibits WDR neurons in other
parts of the body. So that it can be concluded that pain in one part can inhibit pain
in other parts. These two observations support the "gate" theory for pain in the
spinal cord
Glycine and γ-aminobutyric acid (GABA) are amino acids that function as
inhibitory neurotransmitters. These two amino acids have an important role in
segmental inhibition in the spinal cord.
b. Supraspinal inhibition
Several supraspinal structures send fibers down the spinal cord to inhibit pain in
the posterior horn. Parts important for this descending pathway include the
periaqueductal gray matter, the reticular formation, and the nucleus raphe magna
(NRM). Stimulation of the periaqueductal gray matter area in the brainstem
produces extensive analgesia in humans. The axons of the tract act presynaptically
on primary afferent neurons and postsynaptically on secondary neurons (or
interneurons).

7. Describe pain receptors

Answer:
Receptors that receive pain stimuli are called nociceptors. Nociceptors are free nerve
endings in the skin that respond only to strong, potentially damaging stimuli. The
stimulus is mechanical, thermal, chemical. Pain receptors are complex, multidirectional
pathways. These nerve fibers branch very close to their origin in the skin and send their
branches to local blood vessels, mast cells, hair follicles and sweat glands. Stimulation
of these fibers causes the release of histamine from mast cells and results in
vasodilation. The cutaneous fibers lie more centrally from the more distant branches
and communicate with the paravertebral sympathetic chain of the nervous system and
with the larger internal organs. As a result of the connections between these nerve
fibers, pain is often accompanied by a vasomotor effect, autonomic and visceral. there
are 3 nociceptors that receive the origin of each stimulus, namely:
a. Mechanical Nociceptors
Mechanical nociceptors respond to mechanical damage such as cutting, crushing
or pinching.
b. Thermal Nociceptor
Thermal nociceptors respond to extreme temperatures, especially heat.
c. Polymodal/Chemical Nociceptors
Polymodal/chemical nociceptors respond equally to all types of damaging stimuli,
including irritating chemicals released from injured tissue