Human Anatomy and Physiology

UNITED REPUBLIC OF TANZANIA
Ministry of Health, Community

Development, Gender, Elderly and
Children
PST 04103: Human

Anatomy and Physiology
NTA Level 4 Semester 1
Facilitator Guide
December 2016
PST 04103 Human Anatomy and Physiology NTA Level 4 Semester 1 Facilitator Guide
ii
Copyright © Ministry of Health, Community Development, Gender, Elders and Children – 2016
Table of Contents
Background ................................................................................................................v
Acknowledgement ................................................................................................... vi
Introduction ............................................................................................................ viii
Abbreviations/Acronym .............................................................................................x
Session 1: Introduction to Human Anatomy and Organization of Organism ...........2
Session 2: Structure, Types and Functions of Cells ................................................13
Session 3:Common Disorders of Human Cells .......................................................21
Session 4: Structure and Functions of Epithelial Tissues ........................................26
Session 5: Structure and Functions of Connective Tissues .....................................34
Session 6:Structure and Functions of Bone Tissues ................................................46
Session 8:Structure and Functions of Muscle Tissues .............................................57
Session 9:Structure and Functions of Nervous Tissues ...........................................65
Session 10: Structure and Functions of Ear .............................................................72
Session 11: Structure and Functions of Skin ...........................................................84
Session 12: Structure, Functions and disorders of Eye ............................................91
Session 13:Introduction to Gastrointestinal System ................................................98
Session 14:Structure and Functions of Stomach and Intestines ............................115
Session 15: Accessory Organs of Digestive System .............................................132
Session 16: Common Disorders of Gastrointestinal System .................................151
Session 17: Composition and Functions of Blood .................................................158
Session 18: The ABO Blood Grouping System and Rhesus Factors ....................168
Session 19: Common Disorders of Blood Cells ....................................................174
Session 20: Body Fluids and Electrolytes Imbalance ............................................180
Session 21: Acid - Base Balances and Common Electrolyte Disorders ................188
Session 22: Structure and Functions of Cardiovascular System ...........................196
Session 23: Common Disorders of the Cardiovascular System ............................210
Session 24: Structure and Functions of the Respiratory System ...........................216
Session 25: Common Disorders of the Respiratory System ..................................223
Session 26: Structure and Functions of the Male Reproductive System ...............229
Session 27: Common Disorders of the Male Reproductive System ......................237
Session 28: Structure and Functions of the Female Reproductive System ...........241
Session 29: Common Disorders of the Female Reproductive System ..................250
Session 30: Structure and Functions of the Urinary System .................................257
Session 31: Common Disorders of the Urinary System ........................................265
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Session 32:Structure and Functions of Endocrine System ....................................270
Session 33: Common Disorders of Endocrine System ..........................................278
Session 34: Structures and Functions of the Central Nervous System ..................283
Session 35: Structure and Functions of the Autonomic Nervous System .............294
Session 36: Common Disorders of the Nervous System .......................................298
Session 37: Structure, Functions and Common Disorders of Lymphatic System .306
Session 38: Cardinal Signs of Inflammation .........................................................313
iv
Background
There is currently an ever increasing demand for pharmaceutical personnel in Tanzania.

This is due to expanding investment in public and private pharmaceutical sector. Shortage of
trained pharmaceutical human resource contributes to poor quality of pharmaceutical
services and low access to medicines in the country (GIZ, 2012).
Through Public-Private-Partnership (PPP) the Pharmacy Council (PC) together with
Development Partners (DPs) in Germany and Pharmaceutical Training Institutions (PTIs)
worked together to address the shortage of human resource for pharmacy by designing a
project named “Supporting Training Institutions for Improved Pharmaceutical Services in
Tanzania‖ in order to improve quality and capacity of PTIs in training, particularly of lower
cadre pharmaceutical personnel.
The Pharmacy Council formed a Steering committee that conducted a stakeholder‘s
workshop from18th to 22ndAugust 2014 in Morogoro to initiate the implementation of the
project.
Key activities in the implementation of this project included carrying out situational analysis,
curriculum review and harmonization, development of training manual/facilitators guide,
development of assessment plan, training of trainers and supportive supervision.
After the curricula were reviewed and harmonized, the process of developing standardised
training materials was started in August 2015 through Writer‘s Workshop (WW) approach.
The approach included two workshops (of two weeks each) for developing draft documents
and a one-week workshop for reviewing, editing and formatting the sessions of the modules.
The goals of Writers Workshops were to build capacity of tutors in the development of
training materials and to develop high-quality, standardized teaching materials.
The training package for pharmacy cadres includes a Facilitator Guide, Assessment plan and
Practicum. There are 12 modules for NTA level 4 making 12 Facilitator guides and one
Practicum guide.
v
Acknowledgement
The development of standardized training materials of a competence-based curriculum for
pharmaceutical sciences has been accomplished through involvement of different
stakeholders.
Special thanks go to the Pharmacy Council for spearheading the harmonization of training
materials in the pharmacy after noticing that training institutions in Tanzania were using
different curricula and train their students differently.
I would also like to extend my gratitude to St. Luke Foundation (SLF)/Kilimanjaro School of
Pharmacy –Moshi for their tireless efforts to mobilize funds from development partners.
Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür Internationale

Zusammenarbeit (Giz), Merck Kgaa, BoehringerIngelheimGmbhand Bayer Pharma Ag and
action medeor.V for the financial and technical support.
Particular thanks are due to those who led this important process to its completion, Mrs Stella
M. Mpanda Director, Childbirth Survival International, and Members from the secretariat of
National Council for Technical Education (NACTE) for facilitating the process.
Finally, I very much appreciate the contributions of the tutors and content experts
representing PTIs, hospitals, and other health training institutions. Their participation in
meetings and workshops, and their input in the development of this training
manual/facilitators guide have been invaluable.
These participants are listed with our gratitude below:

Mr.Wilson A.Mlaki Director Saint Luke Foundation
Mr.Samwel M. Zakayo Pharmacy Council
Mr. Amour Idd Pharmacy Council
Mr. Selemani Majindo NACTE
Mr. Dennis Busuguli MoHCDGEC
Mr. Amani Phillip HKMU
Mr. Karol J. Marwa CUHAS
Mr. John M. Bitoro CUHAS
Mr. Omary S. Mejjah CUHAS
Mr. Sixbert M.Nkwenge LZHRC
Ms. Ester A. Tuarira MUHAS
Mr. Rajabu I. Amiri MUHAS
Mr. Peter J. Njalale MUHAS
Ms. Tumaini H. Lyombe MUHAS
Mr. Oswald Paschal KSP
Mr. Peter Benedict KCMC
Mr, Wensaa E. Muro KSP
Ms. Dilisi J. Makawia KSP
Mr. Nsabo Y. Kihore KSP
Mr Kolonjoi Olekiyapi KSP
Ms. JuliethKoimerek KSP
Rev.Baraka A.M. Kabudi MEMS
vi
Mr. Kelvin E. Mtanililwa Royal Pharmaceutilcal Training Institute
Mr. George Kilimanjaro Royal Pharmaceutilcal Training Institute
Ms. Rose Bulilo CEDHA
Ms. Diana H. Gamuya CEDHA
Dr.Melkiory C. Masatu CEDHA
Dr.Benny Mboya CEDHA
Mr. Jackson Shayo CEDHA
Dr. Peter A. Sala CEDHA
Mr. Goodluck Mdugi RuCU
Mr. Gaspar Baltazary RuCU
Mr. Silvester Andrew St. Peter College
Mr. Emanuel Mayunga St. Peter College
Mr. Habel A. HabelCity College of Health and Allied Sciences
Ms. Zaina Msami Meru District Council
Mr. John Paschal Mount Meru Regional Hospital
Mr. Mugisha G. Wilson JSI
Mr. Matiko M. Machage JSI
Mr. Dickson N. Mtalitinya SIBS
Mr. Nemes P. Uisso Moshi District Council
Dr. O. Gowele
Director of Human Resources Development
Ministry of Health, Community Development, Gender, Elders and Children
vii
Introduction
Module Overview
This module content is a guide for tutors of Pharmaceutical schools for training of students.
The session contents are based on sub-enabling outcomes and their related tasks of the
curriculum for Basic Technician Course in Pharmaceutical Sciences. This module content is
for anatomy and physiology. The module sub-enabling outcomes and their related task are
indicated in the basic technician certificate in pharmaceutical science (NTA level 4)
curriculum.
Target Audience
This module is intended for use primarily by tutors of pharmaceutical schools. The module‘s
sessions give guidance on the time, activities and provide information on how to teach the
session. The sessions include different activities which focus on increasing students‘
knowledge, skills and attitudes.
Organization of the Module

The module consists of thirty eight (38) sessions; each session is divided into several parts as
indicated below:
 Session Title: The name of the session
 Total Session Time: The estimated time for teaching the session, indicated in minutes
 Pre-requisites: A module or session which needs to be covered before teaching the session.
 Learning Tasks: Statements which indicate what the student is expected to learn by the end
of the session
 Resources Needed: All resources needed for the session are listed including handouts and
worksheets
 Session Overview: The session overview box lists the steps, time for each step, the activity
or method used in each step and the step title
 Session Content: All the session contents are divided into steps. Each step has a heading and
an estimated time to teach that step as shown in the overview box. Also, this section includes
instructions for the tutor and activities with their instructions to be done during teaching of
the contents
 Key Points: Key messages for concluding the session contents at the end of a session This
step summarizes the main points and ideas from the session, based on the learning tasks of
the session
 Evaluation: The last section of the session consists of short questions based on the learning
tasks to check the understanding of students.
 Handouts: Additional information which can be used in the classroom while teaching or
later for students‘ further learning. Handouts are used to provide extra information related to
the session topic that cannot fit into the session time. Handouts can be used by the students to
study material on their own and to refer to them after the session. Sometimes, a handout will
have questions or an exercise for the participants including the answers to the questions.
viii
Instructions for Use and Facilitators Preparation
 Tutors are expected to use the module as a guide to train students in the classroom and skills
laboratory
 The contents of the modules are the basis for teaching and learning human anatomy and
physiology.
 Use the session contents as a guide
 The tutors are therefore advised to read each session and the relevant handouts and
worksheets as preparation before facilitating the session
 Tutors need to prepare all the resources, as indicated in the resource section or any other item,
for an effective teaching and learning process
 Plan a schedule (timetable) of the training activities
 Facilitators are expected to be innovative to make the teaching and learning process effective
 Read the sessions before facilitation; make sure you understand the contents in order to
clarify points during facilitation
 Time allocated is estimated, but you are advised to follow the time as much as possible, and
adjust as needed
 Use session activities and exercises suggested in the sessions as a guide
 Always involve students in their own learning. When students are involved, they learn more
effectively
 Facilitators are encouraged to use real life examples to make learning more realistic
 Make use of appropriate reference materials and teaching resources available locally
Preparation with Handouts and Worksheets

 Go through the session and identify handouts and worksheets needed for the session
 Reproduce pages of these handouts and worksheets for student use while teaching the
session. This will enable students to refer to handouts and worksheets during the session in
the class. You can reproduce enough copies for students or for sharing
 Give clear instructions to students on the student activity in order for the students to follow
the instructions of the activity
 Refer students to the specific page in the student manual as instructed in the facilitator guide
Using Students Manual When Teaching

 The student manual is a document which has the same content as the facilitator guide,
without facilitator instructions and answers for exercises.
 The student manual is for assisting students to learn effectively and acts as a reference
document during and after teaching the session.
 Some of the activities included in facilitator guide are in the student manual without
facilitator instructions.
ix
Abbreviations/Acronym
ADP Adenosine Diphosphate
ATP Adenosine Triphosphate
CD4 Cluster of Differentiation type 4
CEDHA Centre for Educational Development in Health Arusha
CNS Central Nervous System
CUHAS Catholic University of Health and Allied Science
DNA Deoxyribonucleic acid
ECF Extracellular Fluid
ER Endoplasmic reticulum
Giz Deutsche GesellschftFür Internationale Zusammenarbeit
GI Gastrointestinal
HIV Human Immunodeficiency Virus
ICF Intracellular Fluid
ISF Interstitial Fluid
JSI John Snow Inc
MoHCGEC Ministry of Health, Community development, Gender, Elderly and children
MUHAS Muhimbili University of Health and Allied Science
NACTE National Council For Technical Award
NK cells Natural Killer Cells
NTA National Technical Award
PNS Peripheral Nervous System
RBC Red Blood Cells
Rh Rhesus
RNA Ribonucleic acid
RUQ Right Upper Quadrant
RuCU Ruaha Catholic University
SIBS Spring Institute of Business and Science
x
Session 1: Introduction to Human Anatomy and
Organization of Organism
Total Session Time: 120 minutes
Prerequisites
 None
Learning Tasks
By the end of this session students are expected to be able to:
 Define the Terms: Anatomy, Cytology, Histology and Physiology
 Describe Anatomical Position and Planes
 Explain Terms of Relationship and Comparison
 Identify Structural Organization Levels of Organism
 Identify Characteristics of Living Things
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
 Charts, OHP, Multimedia Projector, Computer, Pointer
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction of Learning Tasks
Definition of Terms Used in Anatomy and
2 10 minutes Presentation Physiology
35 minutes Presentation Anatomical Position and Planes
3
Demonstration
4 25 minutes Presentation Terms of Relationship and Comparison
15 minutes Presentation Structural Organization Levels of Organism
5
20 minutes Presentation Characteristics of Living things
6
Brainstorming
7 05 minutes Presentation Key Points
8 05 minutes Presentation Evaluation
2
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)
READ or ASK students to read the learning tasks and clarify
ASK students if they have any questions before continuing
 STEP 2: Definition of Terms Used in Anatomy and Physiology

(10 minutes)
 Anatomy: It is a study of structure of the body and physical relationship involved in
between body system.
 Is generally divided into three components
o Gross anatomy
 It is the study of structure as they appear in human body.
o Developmental anatomy
 It is the study of the structural changes that occur between conception and
adulthood.
o Surface anatomy
 It is the study of the external form of the body and its relation to deeper structures.
 Cytology: The study of the structural features of cells using microscope.
 Histology: The study of tissues, which are cells and the material surrounding them.
 Physiology: The science of the mechanical, physical, and biochemical functions of
humans in good health, their organs and the cells of which they are composed.
 Pathology: The medical science dealing with all aspects of disease, with an emphasis on
the cause and development of abnormal conditions as well as the structural and functional
resulting from disease.
STEP 3: Anatomical Position and Planes (35 minutes)
Anatomical Position
 All anatomical descriptions are expressed in relation to the anatomical position.
 The anatomical position refers to people regardless of the actual position they may be in as
if they were standing erect, with their:
o Head, eyes (gaze), and toes directed anteriorly (forward)
o Upper limbs by the sides with the palms facing anteriorly
o Lower limbs close together with the feet parallel and the toes directed anteriorly
3

Source: Moore, K. L., & Agur, A. M. R. (2007)
Figure 1.1: Anatomical Position and Body Regions
Anatomical Planes
 Anatomical descriptions are based on four imaginary planes that intersect the body in the
anatomical position.
 There are many sagittal, frontal, and transverse planes, but there is only one median plane
 Median (median sagittal) plane is the vertical plane passing longitudinally through the
centre of the body, dividing it into right and left halves
 Sagittal planes are vertical planes passing through the body parallel to the median plane.
 It is helpful to give a point of reference to indicate the position of a specific plane for
example, a sagittal plane through the midpoint of the clavicle
 A plane parallel and near the median plane may be referred to as a Para median plane
 Frontal (coronal) planes are vertical planes passing through the body at right angles to the
median plane, dividing it into anterior (front) and posterior (back) portion for example, a
frontal plane through the heads of the mandible
4
 Transverse planes are planes passing through the body at right angles to the median and
frontal planes. A transverse plane divides the body into superior (upper) and inferior
(lower) part for example, a transverse plane through the umbilicus
5
Activity: Demonstration (10 minutes)
SHOW students how to stand in anatomical position.
REFER students to figure 1.1: Anatomical Position and Body Regions
SELECT three students and tell them to stand in anatomical position.
ASK other students to observe and comment who is correct and give reason.
ALLOW students to respond

.
STEP 4: Terms of Relationship and Comparison (20 minutes)
 The following terminologies describe the relationship of parts of the body in the
anatomical position and compare the position of two structures relative to each other
Table 1: Terms of anatomical direction
Term Meaning
Anterior In front of, front
Posterior After, behind, following, toward the rear
Distal Away from, farther from the origin
Proximal Near, closer to the origin
Dorsal Near the upper surface, toward the back
Ventral Toward the bottom, toward the belly
Superior Above, over
Inferior Below, under
Lateral Toward the side, away from the mid-line
Medial Toward the mid-line, middle, away from

the side
Rostral Toward the front
Caudal Toward the back, toward the tail
6
Figure 1.3: Terms of relationship and comparison
7
Table 2: Combined terms describing intermediate positional arrangements
Combined Terms Meaning
Inferomedial Nearer to the feet and closer to the

median plane for example, the anterior
parts of the ribs run inferomedially
Superolateral Nearer to the head and farther from the
median plane
Proximal and distal Directional terms used when describing

positions for example, whether structures
are nearer to the trunk or point of origin
(i.e. proximal)
Dorsum Superior or dorsal (back) surface of any

part that protrudes anteriorly from the
body, such as the dorsum of the foot,
hand, penis, or tongue
Terms of Laterality
 Paired structures having right and left members (e.g., the kidneys) are bilateral, whereas
those occurring on one side only (e.g., the spleen) are unilateral. Ipsilateral means
occurring on the same side of the body e.g. the right thumb and right great toe.
Contra-lateral means occurring on the opposite side of the body e.g. the right hand and
the left hand
STEP 5: Structural Organization Levels of Organism (15 minutes)

 The body has six structural levels:
o Chemical level
o Cell level
o Tissue level
o Organ level
o Organ system level
o Organism level
o Chemical level
 The chemical level involves the interactions between atoms, which combine to
form] molecules such as sugar, water, fats and proteins
o Cell level
 Cells are the basic units of all living things.
 Molecules combine to form organelles, which are the small structure that make up
cells
 The plasma membrane forms the outer boundary of the cell and the nucleus
contains the cell‘s hereditary information.
8
o Tissue level
 A tissue is a group of similar cells and the material surrounding them.
 The characteristic of the cells and surrounding material determine the functions of
the tissue
The numerous different tissues that make up the body are classified into four basic
types: epithelial, connective, muscle and nervous.
o Organ level
 An organ is composed of two or more tissue types that perform one or more
common functions
The urinary bladder, heart, skin, and eye are examples of organ
o Organ system level
 An organ system is a group of organs that have a common function or set of
functions
 An organ system are therefore viewed as a unit
For example. urinary system consists of the kidney, ureter, urinary bladder and
urethra
o Organism level
 An organism is any living thing considered as a whole, whether composed of one
cell such as bacterium or of trillions of cells such as human
STEP 6: Characteristics of Living Organism (20 minutes)

Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
 What are the characteristics of living organisms?
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
 Human are organisms that share common characteristics with other organisms.
 The most important common feature of all organisms is life.
 The following are the characteristics of life.
o Organization, metabolism, responsiveness, growth, development and reproduction are

life‘s essential characteristics
o Organization:
 Is the condition in which the parts of an organism have specific relationship to each
other and the parts interact to perform specific functions
 For example organism is composed of cells which in turn have specialized
organelles which depend on the precise organization of large molecules.
9
 The disruption of this organized state may lead to loss of function of a cell or cell
death.
o Metabolism
 Are all chemical reactions taking place in an organism
 It includes the ability of an organism to break down food molecules (digestion) and
absorption into the body, where are used as a source of energy and raw material for
organism to synthesize the organism‘s own molecules
o Responsiveness
 The ability of an organism to sense changes in its external or internal environment
and adjust to those changes
Other characteristics includes

o Growth: increase in body size without change in shape
o Reproduction: production of new organism and new cell
o Respiration: obtaining oxygen, removing carbon dioxide and releasing energy from
foods
o Excretion: removal of wastes produced by metabolic reactions
o Circulation: movement of substances from place to place in body fluid
 Life depend upon the following environmental factors
o Water: is the most abundant substance in the body. It is required for a variety of
metabolic processes and it provides the environment in which most of them take place
o Food: refers to substances that provide organisms with necessary chemical (nutrients)
in addition to water
o Oxygen: is a gas used in the process of releasing energy from nutrients
o Heat: is a form of energy from metabolic reactions and it also controls the rate at
which these reactions occur.
o Pressure: is an application of force on an object or substance.
o In human the pressure plays role in breathing, circulation (heart action produces blood
pressure which keeps blood flowing through blood vessels)
10
STEP 7: Key Points (5 minutes)
 Anatomy is a study of structure of the body and physical relationship involved in between
body system.
 Physiology is the scientific investigation of the process or functions of living things
 The anatomical position refers to people regardless of the actual position they may be in as
if they were standing erect.
 The body has six structural levels which are Chemical level, Cell level, Tissue level,
Organ level, Organ system level and Organism level
 All anatomical descriptions are expressed in relation to the anatomical position
 Organization, metabolism, responsiveness, growth, development and reproduction are
life‘s essential characteristics
STEP 8: Evaluation (10 minutes)
 Define the terms: anatomy, cytology, histology and physiology

 What are the anatomical position and planes
 What are the Structural levels of the human body
 What are the characteristics of life
11
References
Kumar, A. et al (2004). Robbins Basic Pathology. WB: Saunders.
Spector, T.D. & Axford, J. S. (1999). Introduction to General Pathology. Edinburgh:
Seeley, R. R., Stephens, T. D.& Tate, P. (2003). Anatomy and Physiology. New York:
McGraw-Hill
Shier, A., Butler, J., & Lewis, R. (2004). Hole’s Human Anatomy & Physiology. New York:
McGraw-Hill
Standring, S. (2008). Grays’s Anatomy The anatomical basis of clinical practice. United
Kingdom: Churchill Livingstone Elservier.
Thibodeau, G. A., & Patton, K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby,
Von Hoffman Press, Inc.
Tortora, G.J & Derrickson, B (2009). Principles of Anatomy and Physiology 12th Edition,
USA, John Wiley & Sons Inc, USA
Walter, J.B, & Talbot, I. C. (1996). General Pathology. New York: Churchill Livingstone
Waugh, A. & Grant, A. (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier
12
Session 2: Structure, Types and Functions of Cells
Total Session Time: 120 minutes + 60 minutes take home assignment
Prerequisites
 None
Learning Tasks
 Define the Cell
 Mention Types of Cells
 Describe the Structure of the Generalized Animal Cell
 Describe Characteristics of the Animal Cell
 Outline Functions of the Animal Cell
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Presentation Definition of the Cell
2
Brainstorming
Presentation
3 Types of Cells
15 minutes Buzzing
Presentation
4 50 minutes Small group Structure of the Generalized Animal Cell
discussion
5 10 minutes Presentation Characteristics of the Animal Cell
6 10 minutes Presentation Functions of the Animal Cell
9 10 minutes Presentation Take home assignment
13
SESSION CONTENTS

STEP 2: Definition of the Cell (10 minutes)
 What is a cell?
 A cell:
o Is the smallest living structural and functional unit of life
 It is the smallest unit of an organism that is classified as living, and is often called
building block of life
 All cells come from pre-existing cells
 Most cells are microscopic and can replicate independently
 Some organisms are unicellular (consist of a single cell) e.g. some bacteria
 Other organisms are multicellular(consist of many cells) e.g. humans
 Vital functions of an organism occur within cells, and all cells contain the hereditary
information necessary for regulating cell functions and for transmitting information to
the next generation of cells
 Cells of the body perform specific functions, and therefore their structures vary
greatly
14
STEP 3: Types of Cells (15 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the following question for 5 minutes
 What are the types of cells?
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
 There are two types of cells:

o Eukaryotic
o Prokaryotic
Eukaryotic Cells
 Cells in higher animals (mammals) are eukaryotic, that is they have membrane bound
nucleus, which is well protected, inside the cell
 Eukaryotic cells are often found in multicellular organisms
 Eukaryote is an organism whose cells contain complex structures inside the membranes
 Most eukaryotic cells also contain other membrane-bound organelles such a
mitochondria, and the Golgi apparatus
 Eukaryotes do have "true" nuclei containing DNA
 Eukaryotic organisms may be unicellular, as in amoebae, or multicellular, as in humans
 Cell division in eukaryotes is different from that in organisms without a nucleus
(prokaryotes)
Prokaryotic Cells
 Do not contain membrane bound organelles and genetic material is scattered in the
cytoplasm
 The simple forms of life like bacteria are made up entirely of single cell are prokaryotic,
the nucleus is not membrane bound it is scattered in the protoplasm and is vulnerable
 Prokaryotic cells are usually independent
 Prokaryotes generally lack membrane-bound cell compartments: such as mitochondria
and chloroplasts.
 Instead processes such as oxidative phosphorylation and photosynthesis take place across
the prokaryotic plasma membrane.
 However, prokaryotes do possess some internal structures, such as cytoskeletons.
 Prokaryotes also differ from eukaryotes in that they contain only a single loop of stable
chromosomal DNA stored in an area named the nucleoid, while eukaryote
 DNA is found on tightly bound and organized chromosomes
15
STEP 4: Structure of a Generalized Animal Cell (50 minutes)
Activity: Small Group Discussion ( 30 minutes)
DIVIDE students into small manageable groups
ASK students to discuss on the following task:

 Draw and label major parts of a generalized animal cell by using various resources
ALLOW students to do the task for 20 minutes
ALLOW few groups to present and the rest to add points not mentioned
CLARIFY and SUMMARIZE by using the contents below
Structure of a generalized animal cell
 The cell is divided into three main parts namely: plasma membrane, cytoplasm and
nucleus
 The plasma membrane: Forms the cell‘s outer surface separating the cell‘s internal
environment from the external environment. It regulates the flow of material into and out
of the cell
 The cytoplasm: It is the fluid-filled cell interior. It has two components: cytosol and
organelles.
o The cytosol is the liquid portion containing water and dissolved solutes.
o The organelles are small structures with highly specialized functions, many of which
are contained within a membrane.
 They include nucleus, mitochondria, ribosomes, endoplasmic reticulum (ER),
Golgi apparatus, cell membrane, microfilaments and microtubules.
 The Nucleus: It is the large organelle that stores genetic information as DNA. It controls
all the activities of the cell.
16
Source: EnchantedLearning.com (2015)
Figure 1.1: The Generalized Animal Cell
STEP 5: Characteristics of the Cell (10 minutes)

 Certain processes distinguish living things from non-living things
 The following are six most important characteristics of the cell:
o Metabolism-are the sum of all chemical processes that occur in the body including
anabolism and catabolism.
o Responsiveness- ability to detect and respond to changes like temperature, pressure,
sound etc.
o Movement- includes motion of the whole cell and tiny structures inside the cell.
o Growth- is the increase in the size and number of the existing cells.
o Differentiation- the development of a cell from unspecialized to specialized state
o Reproduction- the formation of new cells for tissue growth, repair and replacement or
to the production of a new individual.
STEP 6: Functions of the Human Cell (15 Minutes)

The functions of animal cell are all carried out by the different cell organelles
These cell organelles function as a unit and regulate the activities of the cell on the whole.
Cell nucleus
 The nucleus is referred to as the heart of the cell
 The nucleus houses the genetic material of the organism which is the DNA.
17
 DNA replication and RNA synthesis occurs in the nucleus.
Mitochondria
 The mitochondria is also referred to as the power house of the cell
 It is a double membrane organelle
 It helps in energy production for the cell.
 The energy is generated in the form of ATP from the glucose.
 This occurs in the process called cellular respiration.
Endoplasmic Reticulum
 The endoplasmic reticulum is a network for transportation of certain critical substances in
and out of the nucleus.
 There are two kinds of ER namely
o Rough ER a
o Smooth ER.
 Rough ER has ribosome molecules attached to its surface
 Smooth ER does not have ribosome molecules attached to its surface
Golgi apparatus
 Is involved with processing and packaging of the molecules synthesized by the cell
mainly the proteins ready for secretion
 The ER transports the proteins in their crude form to the golgi apparatus
Ribosomes
 Is involved in protein synthesis. It consists of two sub units
 Protein synthesis primarily occurs in the ribosomes
 The ribosomes may be found freely floating in the cytoplasm or may be found attached to
the ER
Lysosomes
 Are referred to as suicide bags of the cell.
 They are involved in clearing the unwanted and waste materials from the cell
 The lysosomes contain hydrolytic enzymes that are destructive.
 They kill the toxic materials of the cell time to time.
 They engulf materials like damaged organelles, virus, bacteria and food particles
Vacuole
 The vacuole is a large empty storage organelle.
 They store excess water or food. It is present in many numbers within the cell floating in
the cytoplasm
18
 Cell is the smallest living structural and functional unit of life
 The cell is divided into three main parts namely plasma membrane, cytoplasm and nucleus
 There are two types of cells: Eukaryotic and Prokaryotic
 There are six most important characteristics of the cell
 The functions of animal cell are all carried out by the different cell organelles
STEP 8: Evaluation (5 hours)

 What is a cell?
 What are the three main parts of the animal cell?
 What are the functions of nucleus?
 Mention types of cell?
 What are the functions of animal cell?
Step 9: Assignment (10 minutes)

Activity: Take Home Assignment (10 minutes)
DIVIDE learners in groups or individual.
ASK the learners to work on the following assignment
 Explain function of animal cell organelle
ALLOCATE time for learners to do the assignment and submit
REFER learners to recommended references
19
References
Enchanted Learning (2015). Animal Cell. Retrieved from:
http://www.enchantedlearning.com/subjects/animals/cell/. Retrieved September 2015

McGraw-Hill
McGraw-Hill
20
Session 3: Common Disorders of Human Cells
Prerequisites
 None
Learning Tasks
 Define Terminologies Associated With Cellular Changes
 Define the Terms Cancer, Tumour and Neoplasm
 List Common Types of Cancer
 Explain the Characteristics of Benign and Malignant Tumours
 Explain the Aetiology and Associated Factors for Tumours/Cancers
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning tasks
Definition of Terminologies Associated with
Presentation
2 10 minutes Cellular Changes
10 minutes Presentation
3 Definition and Common Types of Cancers
Brainstorming
10 minutes Presentation Characteristics of Malignant and Benign
4
Tumours
15 minutes Presentation Aetiology and Associated Factors for
5 Buzzing Tumours
21
SESSION CONTENTS

STEP 2: Definition of Terminologies Associated with Cellular Changes (5

minutes)
 Anaplasia refers to the loss of tissue differentiation and function that is characteristic of
most malignancies
 Atrophy refers to a decrease in the size of cells, with a subsequent decrease in the size of
the affected tissue or organ; wasting away
 Dysplasia refers to alteration in the size, shape, and organization of cells due to chronic
irritation or inflammation; may progress to neoplasia (tumour formation, usually
malignant) or revert to normal if the irritation is removed
 Hyperplasia refers to an increase in the number of cells of a tissue due to an increase in the
frequency of cell division
 Hypertrophy is the increase in the size of cells without cell division
 Metaplasia is the transformation of one type of cell into another
STEP 3: Definition and Common Types of Cancers (15 minutes)
 What is Cancer?
 Cancer is a group of diseases characterized by uncontrolled or abnormal cell proliferation

o When cells in a part of the body divide without control, the excess tissue that develops
is called a tumour or neoplasm
o The study of tumours is called oncology
o Tumours may be cancerous and often fatal, or they may be harmless
o A cancerous neoplasm is called a malignant tumour or malignancy
o One property of most malignant tumours is their ability to undergo metastasis , the
spread of cancerous cells to other parts of the body
o A benign tumour is a neoplasm that does not metastasize, an example is a wart
22
o Most benign tumours may be removed surgically if they interfere with normal body
function or become disfiguring
o Some benign tumours can be inoperable and perhaps fatal
Common types of cancers

 The name of a cancer is derived from the type of tissue in which it develops
 Most human cancers are carcinomas, malignant tumours that arise from epithelial cells
 Melanomas, for example, are cancerous growths of melanocytes, skin epithelial cells that
produce the pigment melanin
 Sarcoma is a general term for any cancer arising from muscle cells or connective tissues.
 For example, osteogenic sarcoma, the most frequent type of childhood cancer, destroys
normal bone tissue
 Leukaemia is a cancer of blood-forming organs characterized by rapid growth of abnormal
leukocytes (white blood cells)
 Lymphoma is a malignant disease of lymphatic tissue––for example, of lymph nodes
STEP 4: Characteristics of Benign and Malignant Tumours(10 minutes)
FACTOR BENIGN MALIGNANT
1 Growth rate Slow Rapid

2 Mitoses Few Many
3 Differentiation Good Poor
4 Nuclear chromatin Normal Increased
5 Local growth Expansible Infiltrative
6 Encapsulation Present Absent
7 Destruction of tissue Negligible Wide spread
8 Vascular invasion None Frequent
9 Metastasis None Frequent
STEP 5: Aetiology and Associated Factors for Tumours /Cancers (15

minutes)
 What are causes of cancers?
 Several factors may trigger a normal cell to lose control and become cancerous
23
 One cause is environmental agents: substances in the air we breathe, the water we drink,
and the food we eat
 A chemical agent or radiation that produces cancer is called a carcinogen
Three classes of carcinogenic agents are:

 Chemicals carcinogens
 Radiant energy carcinogens
 Microbial agents carcinogens
Chemical Carcinogens
o Chemical carcinogens have highly reactive electrophile groups that directly damage DNA,
leading to mutations and eventually cancer
o Direct-acting agents do not require metabolic conversion to become carcinogenic, while
indirect-acting agents are not active until converted to an ultimate carcinogen by endogenous
metabolic pathways
o Polymorphisms of endogenous enzymes like cytochrome P-450 may influence carcinogenesis
o Following exposure of a cell to a mutagen or an initiator, tumour-genesis can be enhanced by
exposure to promoters, which stimulate proliferation of the mutated cells
o Examples of human carcinogens include:
 Direct-acting (example alkylating agents used for chemotherapy)
 Indirect-acting (example benzo pyrene, azo dyes, and aflatoxin)
 Promoters/agents that cause pathologic hyperplasia of liver and endometrium
Radiation Carcinogenesis
o Ionizing radiation causes chromosome breakage, translocations, and less frequently, point
mutations, leading to genetic damage and carcinogenesis
o UV rays (UVR-Ultra violet rays), induce the formation of pyrimidine dimers within DNA,
leading to mutations
o UV rays can give rise to squamous cell carcinomas and melanomas of the skin
Microbial agents
o Oncogenic Viruses
 HTLV-1 causes T-cell leukaemia
 Human papilloma virus (HPV) has been associated with benign warts, as well as cervical
cancer
 Epstein Barr virus (EBV) has been implicated in the pathogenesis of: Burkitt lymphomas
 Lymphomas in immunosuppressed (individuals with HIV infection or organ
transplantation)
 Some forms of Hodgkin lymphoma
 Nasopharyngeal carcinoma.
 Between 70% and 85% of hepatocellular carcinomas worldwide are due to infection with:
Hepatitis B virus (HBV) or Hepatitis C virus (HCV)
 The oncogenic effects of HBV and HCV are multifactorial
24
 Dominant oncogenic effects of HBV and HCV: immunologically mediated chronic
inflammation, hepatocellular injury, stimulation of hepatocyte proliferation, and
production of reactive oxygen species that can damage DNA
o Bacteria
 Helicobacter pylori is strongly associated with development of gastric cancer
 Tumour marker is a substance introduced into circulation by tumour cells that indicates the
presence of a tumour, as well as the specific type
 Tumour markers may be used to screen, diagnose, make a prognosis, evaluate a response to
treatment, and monitor for recurrence of cancer.

 Cancer is a group of diseases characterized by uncontrolled or abnormal cell proliferation.
 When cells in a part of the body divide without control, the excess tissue that develops is
called a tumour or neoplasm
 Three classes of carcinogenic are:
o Chemicals
o Radiant energy
o Microbial agents
STEP 7: Evaluation (5 hours)

 What is cancer?
 What are the common types of cancer?
 What are the characteristics of benign and malignant tumours?
 What are the factors associated with tumours/cancers?
25
References
McGraw-Hill
McGraw-Hill
26
Session 4: Structure and Functions of Epithelial Tissues
Total Session Time: 120 minutes+60 minutes assignment
Prerequisites
 None
Learning Tasks
 Define Epithelial Tissue
 Describe the Structure of Epithelial Tissues
 Classify Epithelial Tissues
 Explain Functions of Epithelial Tissues
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
15 minutes Presentation Definition of Epithelial Tissues
2
Brainstorming
3 15minutes Presentation Structure of Epithelial Tissues
4 Classification of Epithelial tissue
Brainstorming
25 minutes Presentation General Functions of Epithelial
5
Buzzing Tissues
8 10 minutes presentation Take home assignment
27
SESSION CONTENTS

STEP 2: Definition of epithelial Tissues (15 minutes)
Ask students to brainstorm on the following questions:
 What is epithelial tissue?
Epithelial tissues are linings of the various passages inside the body.
STEP 3: Structure of Epithelial Tissues (15minutes)

General Structure of Epithelial Tissues
 Epithelium is a group of closely associated cells with scanty intercellular materials that cover
external and internal surfaces of the body
 They form the covering of all body surfaces, line body cavities and hollow organs, and are
the major tissue in glands
 Epithelial tissues are widely spread throughout the body
 The cells in epithelial tissue are tightly packed together with no intercellular material between
the cells or very little intercellular materials
 It also forms all glands including endocrine and exocrine glands
 The cells are attached to the underlying connective tissue known as the basement membrane
 The basement membrane is a connective tissue structure where the epithelial cells are
attached
 Cells of epithelial tissue appear in different shapes and structure
 These differences reflect the functions of the epithelium
28
STEP 4: Classification of Epithelial Tissues (40minutes)
Activity: brainstorming (20 minutes)
Ask students to brainstorm on the following questions.
 What are the classes of epithelial tissues?
ALLOW few students to respond?
Classification according to the cell shape

 Squamous cells: are flat cells with an irregular flattened shape
 Cuboidal cells: have a shape similar to a cube, meaning its width is the same size as its
height
 Columnar cells: are taller than they are wide
Classification based on number of layers (Stratification)

o Simple epithelia
o Stratified epithelia
o Pseudostratified epithelia
Simple Epithelium
 Cells are organized in a single layer and therefore all cells are attached to the basement
membrane
 Because the shapes of the cells include possible function, they are found in different organs
depending on their function:
 There are three types of simple epithelium: Simple squamous epithelium, Simple cuboidal
epithelium, Simple columnar epithelium
Simple Squamous Epithelium

 All Squamous cells are flat cells with an irregular flattened shape
 It is a one-cell layer of simple squamous epithelium
 Forms a thin membrane and therefore it is found in places where exchange of material from
one compartment to the other occurs.
 Squamous cells can be found in the heart, blood vessels, lymph vessels and alveoli of the
lung
29
 They allow free diffusion
Simple Cuboidal Epithelium

 This consists of cube-shaped cells fitting closely together lying on a basement membrane.
 Forms secretory cells, lining of the small ducts of the gland sand it covers the outer surfaces
of organs such as the ovaries and in the kidney tubules
 Are actively involved in secretion, absorption and excretion
Simple Columnar Epithelium

 This is formed by a single layer of cells, rectangular in shape lying on a basement membrane.
 It is found lining the organs of the alimentary tract.
 Consists of mixture of cells, some absorb the products of digestion and others secrete mucus.
Stratified Epithelia
 Consists of several layers of cells of various shapes
 The superficial layers grow up from below
 Basement membranes are usually absent
 The main function of compound epithelium is to protect underlying structures
 There are two types: Stratified and transitional
Stratified squamous epithelium

 Consists of several layers of cells of different shapes
 The cells are arranged into superficial, intermediate and basal (deep) layers
 In the deepest layers the cells are mainly columnar and, as they grow towards the surface,
they become flattened.
 It is the main protective epithelium of the body external surface for example in the skin it
forms the epidermis
 There are two types: Non keratinized stratified epithelium and Keratinized stratified
epithelium
o Keratinized stratified epithelium
 Refers to cells that has become hardened and died.
 The cells have a tough fibrous protein called keratin that helps protect the skin and
underlying tissues from heat, microbes and chemicals.
 It is found on dry surfaces that are subject to wear and tear such as skin, hair and
nails.
o Non keratinized stratified epithelium

 Does not contain keratin and consists of cells which are not dead
 It is found on wet surfaces that may be subjected to wear and tear but are protected
from drying, for example conjunctiva of the eyes, and lining of the mouth, pharynx,
the oesophagus and vagina. It provides mechanical protection from injury
30
Sour
ce: SEER Training Modules, 2003
Figure 4.1: Types of epithelium
STEP 5: General Functions of Epithelial Tissues (25 minutes)
 What are the functions of epithelial tissues?
General Functions of Epithelial Tissue
 Protection
o Epithelial cells from the skin protect underlying tissue from mechanical injury, harmful
chemicals, invading bacteria and from excessive loss of water
 Sensation
o Sensory stimuli penetrate specialized epithelial cells
o Specialized epithelial tissue containing sensory nerve endings is found in the skin, eyes,
ears, nose and on the tongue
31
 Secretion
o In glands, epithelial tissue is specialized to secrete specific chemical substances such as
enzymes, hormones and lubricating fluids
 Absorption
o Certain epithelial cells lining the small intestine absorb nutrients from the digestion of
food
 Excretion
o Epithelial tissues in the kidney excrete waste products from the body and reabsorb needed
materials from the urine
o Sweat is also excreted from the body by epithelial cells in the sweat glands
 Diffusion
o Simple epithelium promotes the diffusion of gases, liquids and nutrients

 The term "epithelium" refers to layers of cells that line hollow organs and glands
 It is also those cells that make up the outer surface of the body.
 Cells of epithelial tissue appear in different shapes and structure.
 General functions of epithelial tissue include signal transduction, protection, secretion,
absorption ,excretion, filtration, diffusion and sensory reception
 What is an epithelial tissue?

 What are the types of epithelial tissues?
 What are the functions of epithelial tissue?

 Explain structure of epithelial tissue
32
References
National Cancer Institute. SEER Training Modules. Retrieved
From:http://training.seer.cancer.gov/anatomy/cells_tissues_membranes/tissues/epithelial.
html . September 2015
McGraw-Hill
McGraw-Hill
33
Session 5: Structure and Functions of Connective Tissues
Prerequisites
 None
Learning Tasks
 Define connective tissue
 Outline Type of Cells Found in Connective Tissues
 Outline Type of Fibres Found in Connective Tissue
 Explain Classification and Functions of Connective Tissues
 Identify Specialized Connective Tissue
Resources Needed:
 Worksheet 5.1 : Different Types of Connective Tissue
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
05 minutes Presentation, Definition of Connective Tissue

2
Buzzing
10 minutes Presentation,
3 Type of cells found in connective tissues
Brainstorming
4 30 minutes Presentation Type of fibres found in connective tissue
30 minutes Presentation Classification and Functions of Connective
5 Tissues
6 30minutes Presentation/Brainstorming Specialised connective tissue
34
SESSION CONTENTS

STEP 2: Definition of Connective Tissue (5 minutes)
Activity: buzzing (5 minutes)
Ask students to buzz on the following question:
 What is the connective tissue?
 Connective tissue is the medium which surrounds and supports the other tissues of the
body.
o Composed predominantly of intercellular material (extracellular matrix) which is

secreted mainly by the connective tissue cells, cells and fibres
STEP 3: Types of Cells Found in Connective Tissue (10 minutes)
 Which types of cells are found in the connective tissues?‘
There are two types of cells:

 Resident cells (fixed cells)
 Wondering cells
35
Resident Cells
 Resident Cells are cells always found residing in the connective tissue
These include:
o Fibroblasts:
o Macrophages (histiocytes)
o Mast cells
o Adipocytes
o Pigment cells (melanocytes)
o Undifferentiated mesenchymal cells
Fibroblasts
o Are flat, spindle shaped cells with branching of cytoplasmic processes with elliptical and
have elongated nucleus
o The shape differs depending on activity
o Fibroblasts are found in nearly all types of tissues
o Active fibroblasts have abundant cytoplasm
o Inactive fibroblasts (fibrocytes) are smaller and have diminished cytoplasm
Functions of fibroblasts
o Synthesis
o Secretes connective tissue fibres, these include collagen, elastic and reticular fibres.
o They also secrete substances such as glycosaminoglycans and glycoproteins found in the
extracellular matrix (ground substance).
o Differentiation into other cells: Fibroblasts are capable of changing into a variety of cell types
depending on the body need.
o Fibroblasts secrete connective tissue elements which help in remodelling the extracellular matrix,
which is important in wound healing and tissue repair.
Histiocytes (Tissue Macrophages)

o They are polymorphic cells and can be ovoid or irregular with short and blunt
processes.
o They are derived from blood monocytes, which migrate into the tissues and transform
become histiocytes.
o Main role in tissue is phagocytosis and antigen presentation.
Mast cells
o Are large cells, round or oval in shape
o Play an important role in allergic reactions
o Mast cells are filled with secretory granules that are filled with substances of inflammation
such as histamine and heparin
o Heparin, is an anticoagulant and histamine, is released by the cells under allergic conditions
give rise to oedema, bronchospasm and other forms of allergic reactions to the surrounding
tissues
36
Wondering cells
 These are the cells which are temporarily found within the connective tissues depending on the
needs of the body, example during infection. They include monocytes, lymphocytes and
granulocyte
STEP 4: Types of Fibre Found in Connective Tissue (25 minutes)

There three types of fibres found in connective tissue:
 Collagen fibres: Most abundant fibres formed by the union of many collagen fibrils that are
made up of collagen proteins
 Elastic fibres: These are fine fibres made up of elastin protein (tropoelastin)
 They allow some degree of distention and stretching
 Reticular fibres: Smaller fibres that branch and anastomose to form a netlike supporting
framework known as reticulum
Collagen Fibres
o Most abundant fibres formed by the union of many collagen fibrils that are made up of
collagen proteins
o They are tough, inextensible and possess a high tensile strength and therefore stretching is
restricted
o They appear white in fresh sections
o Form major part of tendons, ligaments, cartilage, teeth (Dentin and cementum) and bones
o There are many types of collagen fibres but the most important are type I, II, III, and IV
Elastic Fibres
o These are fine fibres made up of elastin protein (tropoelastin)
o They allow some degree of distention and stretching
o When stretched they usually recover the original form and dimension when the force is
eliminated and the elastic limit is not exceeded
o Elastic fibres changes as the age advances where it loses its resilience
o Appear yellow in fresh sections
o Elastic fibres exist as accompanying structure of collagen fibres in the capsule of many
organs, vascular walls and the elastic cartilage
o Also in ligamentum nuchae and ligamentum flava of the spinal cord
Reticular Fibres
o Smaller fibres that branch and anastomose to form a netlike supporting framework known
as reticulum
o They are closely related to the collagen fibres because they contain collagen fibrils and
they show cross-banding pattern, and are sometimes continuous with collagen fibres
o Reticular fibres form the supporting framework in the hemopoietic (Bone marrow) and
lymphoid organs such as the thymus, lymph node, spleen
o In these organs the reticular fibres are produced by reticular cells
37
o Also found in endocrine glands, small blood vessels, veins, muscle cells, fat tissue, and in
spaces between the epithelium with connective tissue
o In these locations the reticular fibres are produced by fibroblasts, smooth muscle cells,
and the Schwann cells produce reticular fibres that surround the nerve fibres
 In wound healing the reticular fibres are the first to be formed and as the wound
improves they gradually change to become collagenous
STEP 5: Classification and Function of Connective Tissue (25 minutes)
Classification of Connective Tissues

 Proper Connective tissue, which consists of:
o Loose connective tissue

o Dense connective tissue
 Specialized connective tissue, which consists of:
o Adipose tissue
o Blood tissue
o Cartilage
o Bone tissue
o Lymphoid tissue
 Proper connective tissue
o Loose Connective Tissue (Areolar Tissue)

 Contains more cells than fibres and the fibres are thinner, delicate, sparse and loosely
arranged
 Found around vessels, between muscle fibres, lamina propria of the intestine and in
fascial spaces
 It forms the essential medium for the nutrients and waste materials exchange between
tissues and blood, and also maintains osmotic pressure
 Dense Connective Tissue
o Contains more fibres than the cellular component

o Fibres are densely packed with little space for ground substance
o Based on the fiber arrangement and direction dense Connective tissue is divided into:
 Irregular dense connective tissue
 Regular dense connective tissue
 Dense Irregular connective tissue
o Fibres are irregularly arranged

o Fibres are mainly collagen but in some made up of elastic fibres e.g. walls of elastic
arteries, and elastic ligaments e.g. ligamentum flavum and ligamentum nuchae
o It forms the dermis of the skin, superficial fascia, fibrous capsule of organs, tunica
 Albuginea of the testis,
38
 Periosteum,
 Perichondrium,
 Ppimysium,
 Dura matter,
 Septae and
 Trabeculae in various glands
 Dense regular connective tissue

o Predominant fibres are the collagen fibres
o The fibres are densely packed and regularly arranged parallel to each other
o Its arrangement gives rise to a strong structure that withstands tension exerted in one
direction
o Comprises tendons, ligaments and aponeuroses
STEP 6: Specialized Connective Tissues (30 minutes)
Adipose Tissue
 Formed by aggregation of fat cells (adipocytes) with few other cells such as
macrophages, fibroblasts, and leukocytes
 Basically it is a storage tissue that stores nutritive material in the form of natural fat
that can be used to produce energy when the need arises
 Other functions includes; protection and insulation
 There are two types which include white adipose tissue and brown adipose tissue
White Adipose Tissue

 Is made up of unilocular adipocytes i.e. each cell contains one large lipid vacuole,
which fills the entire cells
 When fat cells aggregate together they appear yellow
 This is due to the presence of lipofuscin pigment in fat cells
Brown Adipose Tissue

 Made up of aggregation of multilocular adipocytes, i.e. one cell contains numerous
vacuoles (fat droplets)
 Richly supplied with blood vessels which makes it appear light brown in colour
when viewed in fresh conditions
 Present in the infants and new-born, and decreases with age and may be replaced by
white adipose tissue
 Main function is to protect new-born from cold
Cartilage
 It is a tough specialized connective tissue made up of cells, fibres and ground
substances
 It is avascular and consists of cells called Chondroblasts and Chondrocytes
39
 Ground substance (matrix) is homogenous and surrounds the lacunae in which the
cartilage cells lie
 Fibres present are either collagen or elastic fibres
 Perichondrium is a specialized membrane that covers the cartilage
 It is made up of dense regular connective tissue with many blood vessels and nerve
fibres
 There are three types of cartilage based on the types of fibres it contains and the
composition of the ground substance
o Hyaline cartilage
o Elastic cartilage
o Fibro cartilage
Hyaline Cartilage
o Most abundant type of cartilage in human body
o It is solid but flexible and can be cut with a knife
 Hyaline cartilage is Respiratory tract including nose, larynx, trachea and bronchi
 On the sternal ends of ribs, (costal cartilages)
 Covers the articular surfaces of joints
 During embryonic life it forms the cartilage skeleton, from which the long bones develop
Functions of Hyaline Cartilage

 Facilitation of joint movement as it lines the articular surfaces of all the synovial joints,
making them to be smooth.
 Support to the airways because of its firmness and does not collapse hence it assists in
keeping the tubes patent.
 Growth; it forms nearly all bones of the foetal skeleton; these are replaced by bone tissue
except at the distal ends of long bones where they form the epiphyseal cartilage.
Elastic Cartilage
 Contains elastic fibres as major component but few collagen type II fibres.
 It is more flexible and elastic.
 Elastic cartilage found in epiglottis, auditory tube, pinna of the ear (external ear), and
theconiculate, cuneiform and arytenoids cartilages of the larynx.
 Functions of the elastic cartilage are to provide support and also to maintain the shape and
flexibility of the organs.
Fibro Cartilage
 Has an opaque appearance and fibrous texture and does not have perichondrium.
 Has numerous visible type I collagen fibres and sparse ground substance.
 Found in areas where firm support and tensile strength are required e.g. the intervertebral
discs, pubic symphysis, articular discs in joints, the cartilaginous lining of bony grooves in
which tendons are lodged and rims of certain articular cartilages.
 Fibrocartilage functions as shock absorber and joint stability
40
REFER students to Worksheet (5.1): Different Types of Connective Tissue.
PROVIDE each student one worksheet 5.1.
ASK students to look at the diagrams on the worksheet and fill in what types of connective tissue
they see and give the examples on where they can be found in the body.
GIVE the worksheet answers after completing or review their answers using answer guideline of
the worksheet.

 Connective tissue is the medium which surrounds and supports the other tissues of
the body.
 Components of connective tissue are cells, fibres and ground substance
 Connective tissue cells are divided into resident cells (fixed cells) and wondering
cells
 Resident cells are found residing in the connective tissue
 Wondering cells are temporarily found within the connective tissues

 What is connective tissue?
 What are the type of fibres found in connective tissue
 What are the types of cells found in the connective tissue?
 What are the functions of the connective tissue?
41
References
Drake, R.L., Vogl, W., & Mitchell, A. W. M. (2007). Gray’s Anatomy for Students,
United Kingdom: Churchill Livingstone Elservier.
Moore, K. L., & Agur, A. M. R. (2007). Essential Clinical Anatomy, (3rd ed.).Lippincott:
Williams & Wilkins.
Seeley, R. R., Stephens, T. D., & Tate, P. (2003). Anatomy and Physiology. New York:
McGraw-Hill.
Shier, A., Butler, J., & Lewis, R. (2004). Hole’s Human Anatomy & Physiology. New
York: McGraw-Hill.
Thibodeau, G. A.,& Patton, K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby,
Von Hoffman Press, Inc
Waugh, A., & Grant. A. (2006). Ross and Willson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elservier.
42
Worksheet 5.1: Different Types of Connective Tissue
Name the following types of connective tissue
1. This is ----------------------------------------------
Answer: Dense regular connective tissue in a tendon
Source: Standring, S., 2008.
2. This is ----------------------------------------------
Answer: Elastic fibres
43
3. This is ----------------------------------------------
Answer: loose connective tissue
4. This is ----------------------------------------------
Answer: Adipose tissue
44
5. This is ----------------------------------------------
Answer: Fibrous connective tissue
45
Session 6: Structure and Functions of Bone Tissues
Prerequisites
 None
Learning Tasks
By the end of this session, students are expected to be able to:
 Define the Bone
 Identify the Types of Bone
 Describe the Bone Formation
 Explain the Functions of Bones
Resources Needed:
 Black/white board , chalk and whiteboard markers
 Overhead Projector, Transparencies, Anatomy Atlas and Models, LCD and Computer
 Handout 6.1: Long bone
SESSION OVERVIEW
Activity/
Step Time
Method Content
15minutes Definition of Bone

Presentation,
2
Brainstorming
20minutes Types of Bones

3 Presentation
30 minutes
4 Presentation
Bones Formation
5 Small group Functions of Bones
discussion
46
SESSION CONTENTS

STEP 2: Definition of bone (15 minutes)

 What is a bone?
 Bone is a hard and rigid tissue that forms the bony skeleton of the body.
o Bone supports the body weight,
o It provides attachment to muscles,
o Acts as lever for movements, and provides protection to organs.
o Inside the bone there are spaces, which are filled with the bone marrow that produce
red blood cells, platelets and cells of the immune system.
 Cells of the immune system produced in bone marrow include monocytes,
lymphocytes, mast cells, neutrophils, eosinophils and basophils
 The only difference with other connective tissues is that its ground substance is made
up of inorganic salts, mostly calcium ions
 The bone is highly vascularized, and in living conditions the bone appears pinkish in
colour
 Bone consists of:
o Cells
o Fibers
o Ground substances
 Bone Cells; The bone contains four types of cells namely the osteoprogenator cells,
osteoblasts, osteocytes, and the osteoclasts
 Bone Matrix (Intercellular substance);It is made up of the collagen fibers
(osteocollagenous fibers), amorphous ground substance and inorganic salts which
constitute about 74% of bone mass
47
STEP 3: Types of Bones (20 minutes)
 Long bones e.g. femur, tibia and fibula
 Short bones e.g. carpals (wrist bones)
 Flat bones e.g. sternum, ribs and most skull bones (skull)
 Irregular bones e.g. vertebrae and some skull bones
 Sesamoid bones e.g. patella (kneecap)
Parts of the long bone

 A long bone is one that has greater length than width.
 A typical long bone consists of the following parts:
 The diaphysis is the bone‘s shaft or body—the long, cylindrical, main portion of the
bone
Source: http://www.teachpe.com/images/anatomy/skeleton2.jpg(2015) Figure 6.1: Parts of a Long Bone
Parts of the long bone

 A long bone is one that has greater length than width.
 A typical long bone consists of the following parts:
o The diaphysis is the bone‘s shaft or body—the long, cylindrical, main portion of the
bone.
o The epiphyses (singular is epiphysis) are the proximal and distal ends of the bone.
o The metaphyses (singular is metaphysis) are the regions between the diaphysis and the
epiphyses.
48
STEP 4: Bones Formation (30 minutes)
 Bones formation is commonly referred to as ossification and it occurs in two processes
o Intramembranous Ossification
 The bones that form by this process include most of skull bones such as frontal,
parietal, maxilla, mandible, clavicle and parts of occipital and temporal bones.
o Endochondral Ossification
 In endochondral ossification bone is formed from the pre-existing hyaline
cartilage that has the shape that closely resembles the bone to be formed.
 Most long and irregular bones form via endochondral ossification, such as the
base of the skull, vertebral column, the pelvis and bones of the extremities (limbs).
 During this process the cartilage is gradually replaced by bone.
 Only a small amount of cartilage remains covering the articular surfaces of the
joints.
 During endochondral ossification the bone also grows in length and width.
 Generally flat bones develop by intramembranous ossification while long bones
develop by intra cartilaginous ossification
 Bones formation occurs in four main stages which are
o Development of the ossification canters (special membrane)
o Formation of bone matrix
o Deposition of minerals or calcification
o Formation of trabeculae and appearance of periosteum
STEP5: Functions of Bones (40 minutes)
ASK students to discuss on the following question

 What are the functions bones?
ALLOW students to discuss for 15 minutes
 Support
o The skeleton serves as the structural framework for the body by supporting soft
tissues providing attachment points for the tendons of most skeletal muscles
49
 Protection; The skeleton protects the most important internal organs from injury for
example, cranial bones protect the brain, vertebrae (backbones) protect the spinal cord, and
the ribcage protects the heart and lungs.
 Movement; when muscles contract, they pull on bones to produce movement.
 Mineral homeostasis (storage and release);Bone tissue stores several minerals,
especially calcium and phosphorus, which contribute to the strength of bone
 Blood cell production; bone marrow produces red blood cells, white blood cells, and
platelets, a process called hemopoiesis

 Bone is a hard and rigid connective tissue that forms the bony skeleton of the body
 Bone is a hard and rigid tissue that forms the bony skeleton of the body.
 Functions of bones
o Bone supports the body weight,
o It provides attachment to muscles,
o Acts as lever for movements, and provides protection to organs.
o Inside the bone there are spaces, which are filled with the bone marrow that produce
red blood cells, platelets and cells of the immune system.
o production of body cells: monocytes, lymphocytes, mast cells, neutrophils,
eosinophils and basophils

 What is bone tissue?
 What are the types of bones?
 What are the functions of bones?
50
References
Seeley, R. R., Stephens, T. D., &Tate, P. (2003). Anatomy and Physiology. (5th ed.).Boston:
McGraw-Hill.
Standring, S. (2008). Grays’s Anatomy; the anatomical basis of clinical practice. (40th ed.).
Elservier: Churchill Livingstone.
Thibodeau, G. A., & Patton, K. T. (1999). Anatomy & Physiology. Mosby: Hoffman Press,
Inc.
USA, John Wiley & Sons Inc., USA
Waugh, A., & Grant, A. (2006). Ross and Willson Anatomy and physiology in Health and
illness. China: Churchill Livingstone Elservier
51
Session 7: Common Disorders of Connective Tissues
Prerequisites
 Session 5 & 6: Structure and function of connective tissue and bone tissue
Learning Tasks
 Define Connective Tissue Diseases
 Mention Common Types of Connective Tissue Diseases
 Explain Common Connective Tissue Diseases
Resources Needed:
 Overhead projector
 Computer
SESSION OVERVIEW
Activity/
Step Time Content
Method
05 minutes Presentation Definition of Connective Tissue Diseases
2
Buzzing
Presentation Common types of Connective Tissue
3 05 minutes Diseases
Brainstorming
Presentation
4 35 minutes Small Group Common Connective Tissue Diseases
Discussion
52
SESSION CONTENTS
STEP 2: Definition of Connective Tissue Diseases (5 minutes)
Activity: buzzing(5 minutes)
Ask students to buzz on the following question:
 What are connective tissue diseases?
ALLOW students to buzz
 A connective tissue diseases are diseases that affect the joints (parts of the body that connect
the structures of the body together).
o It is presented by the inflammation of the joints (arthritis)
o It may be infective or non-infective.
o In most cases, all signs of inflammation are present (swollen joints, hot, tender and red)
and there is limitation of movements.
STEP 3: Common Types of Connective Tissue Diseases ( 5 minutes)

 Acute pyrogenic arthritis
 Gout
 Chronic joint disease
 Osteoarthritis
 Generalized bone disease
o Osteomalacia
o Osteoporosis
53
STEP 4: Common Connective Tissue Diseases (35 minutes)

 What are the common of connective tissue diseases?
 Acute pyrogenic arthritis

o This is the infection of the joints by pus-producing bacteria
o It is caused by any pyrogenic bacteria like staphylococci.
o The infection may start suddenly without any obvious cause or may occur from other
septic focus nearby like osteomyelitis
o The patients complain of pain, swelling and reduced movement of the joint
 Gout
o This is arthritis due to congenital abnormality of uric acid metabolism, leading to
abnormal high uric acid in the blood.
o Uric acid is deposited in joints and also around the joints and in the ear cartilages.
o The kidney may be damaged and kidney stones may form in them.
o The disease is commonest in men over 40 years.
o The acute episodes may be precipitated by alcohol excess, surgery, infections or treatment
with thiazide diuretics which raise serum uric acid even in normal people.
o Patients experience irritability and malaise a day or two before acute attack of gout and
sudden severe pain starts in one joint especially that of big toe.
 Chronic joint disease
o Rheumatoid arthritis
 The cause is thought to be abnormal immunological reactions.
 Women are affected then men at the age between 20 - 40 years and psychological
factors are often involved.
 The patient notices pain and stiffness of a joint, then swollen joints and finally radiate
to the wrist, knee and hips.
o Osteoarthritis
 This is due to a degeneration of the articular cartilage of joints.
 It is common to older people.
 The exact cause is not certain but it comes with age particularly in people who have
done heavy work.
54
 It also occurs after injuries that have involved a joint or bone.
 The only symptom is aching pain in the joints, worse at the end of the day and
relieved by rest.
 Generalized bone disease
o Osteoporosis
 It is a condition in which the bones are thinned though their composition is normal.
 It can be caused by immobilization; when a limb is put in plaster or stay in bed for a
long time, menopause in women, old age, Cushing‘s syndrome and steroid treatment.
 The pain occurs only when there is bone fracture.
o Osteomalacia
 This is a different form of weakening of bones due to vitamin D deficiency.
 It is common in adults.
 There are bone pains, often muscular weakness and may be tetany.
 The weakened bones may collapse and deform.

 A connective tissue disease is any disease that affects the joints and is presented by the
inflammation of the joints.
 Connective tissue diseases include acute pyrogenic arthritis, gout, rheumatoid arthritis,
osteoarthritis, osteoporosis and osteomalacia.
STEP 5: Evaluation (5minutes)

 What are connective tissue diseases?
 What are the common connective tissue diseases?
55
References
Nicholson, N.W. (1988). Non communicable diseases in adults. Nairobi, Kenya: African
Medical and Research Foundation
Scalon, V.C., & Sanders, T. (2007). Essentials of anatomy and physiology (5th ed.).
Philadelphia,NY: F.A Davis
Tortora, J.G., & Derrickson, B. (2009). Principles of anatomy and physiology (12th
ed.).Danvers, MA:John Wiley & Sons
Waugh,A.,& Wilson, J.W.K. (2001): Anatomy and Physiology in Health and Illness(9th
ed.). Totternham, London: Churchill Livingstone
56
Session 8: Structure and Functions of Muscle Tissues
Prerequisites
None
Learning Tasks
 Define Muscle and Cell Tissues
 Mention types of Muscle Tissues
 Describe Structure of Muscle Tissues
 Describe Functions of Muscle Tissues
Resources Needed:
 figure 8.1: The Muscle Fibres
 figure8.2:
o 8.2 a Skeletal,
o 8.2 b Cardiac,
o 8.2 c Smooth Muscle
 Figure 8.3: The Neuron
SESSION OVERVIEW
Activity/
Step Time
Method Content
2 Definition of Muscle and cell Tissues
Brainstorming
3 10minutes Presentation Types of Muscle Tissues
4 Structure of Muscle Tissues
5 20 minutes Presentation Function of Muscle Tissues
SESSION CONTENTS
57
STEP 2: Definition of Muscle and cell Tissues (5 minutes)
 What is a muscle tissue?

 What is a muscle cell?
ALLOW few students to respond and let other pairs to add on points not mentioned
Muscle tissue: specialized to contracts when it is stimulated and thus to exert a physical
force on other tissue.
o When a skeletal muscle contracts pulls on a bone and enhance movement, the heart
muscle contracts and expel blood.
o Other processes like digestion, waste elimination, breathing speech and blood circulation
depends on muscular tissue.
o The muscles are also an important source of body heat
o As any other tissue, muscular tissue is made up of cells
Muscle Cells
 Referred to as myocytes or muscle fibres
o Muscle cells are usually grouped into bundle
o Muscle cells are usually elongated and spindle-shaped
o They function by shortening their length, approximating the two opposite points,
which are attached to connective tissue structures such as septa, trabeculae, fasciae,
tendons, periosteum or bone
o The shortening of the muscle cell is called contraction
o The structural unit of a muscle is a muscle fibre
o The muscle fibres are made up of fibrils are divisible into individual filaments
o The contractile property of muscle cells is determined by the presence of the
filamentous contractile proteins, actin and myosin
STEP 3: Types of Muscle Tissues (10 minutes)
58
Types of Muscle Tissues
 There are three types of muscle tissues which can be distinguished basing on both
structure and functions,
o Skeletal muscle tissues (striated voluntary muscle)
o Cardiac muscle tissues (striated involuntary muscle)
o Smooth muscle tissues (smooth involuntary muscle)
Figure 8.1: Muscle Fibres
STEP4: Structure of Muscle Tissues (10 minutes)
59
Cardiac Muscle Tissue
 This is a unique tissue found only in the walls of the heart.
 Cardiac (Heart) Muscle Tissue shows some of the characteristics of smooth muscle
and some of skeletal muscle tissue.
 Its fibres, like those of skeletal muscle, have cross-striations and contain numerous
nuclei.
 However, like smooth muscle tissue, it is involuntary.
 Cardiac muscle forms the muscular wall of the heart the myocardium.
 Some cardiac muscle is also present in the walls of the aorta, pulmonary vein, and
Superior vena cava cardiac muscle contractions are not under voluntary control.
 Heart rate is regulated intrinsically by a pacemaker, composed of special cardiac
muscle fibres that are influenced by the autonomic nervous system.
Figure 8.2 a. Cardiac muscle
Source: Moore, K. L., &Agur, A. M. R. (2007)
Smooth Muscle Tissue

 This type is also called non-striated or involuntary muscle.
 Each cell has many myofibrils which lie parallel to one another in the direction of the
long axis of the cell.
 They are not arranged in a definite striped (striated) pattern, as in skeletal muscles,
hence
 This muscle is mainly visceral in distribution, forming the contractile portion of the
wall of the digestive tract from the mid-oesophagus to anus, including the ducts of
glands associated with the system.
 It is found in the respiratory, urinary and genital system; in arteries, veins and larger
lymphatics, in the dermis and in the iris and ciliary body of the eye.
 In these locations, it functions in moderating and maintaining lumen diameter of the
hollow viscera.
 Smooth muscle is composed of long spindle-like cells, which in cross-section appear
as narrow circular profiles.
 Each cell possesses a characteristic centrally located elongated nucleus.
 In contracted cells, these nuclei are frequently folded or pleated.
 At the poles of the nucleus lie numerous mitochondria, well-developed rough
endoplasmic reticulum, and a large golgi apparatus.
Figure 8.2 b. Smooth muscle
60
Skeletal Muscle Tissue

 This type is described as skeletal because it forms those muscles that form movement
of the skeleton; it is also known as striated or voluntary muscles.
 Striated because striations can be seen on microscopic examination, and voluntary as it
is under conscious control.
 It consists of bundles of very long cylindrical, multinucleated cells called muscle
fibres.
 The oval nuclei are usually found at the periphery of the cell under the cell membrane.
 This characteristic nuclear location is helpful in distinguishing skeletal muscle from
cardiac muscle, which has centrally located nuclei.
 Connective tissue covering individual muscle fibres is called endomysium, a group of
fibres (fibre bundles) is invested by perimysium, and the entire muscle is surrounded by
epimysium.
 The functional unit of a muscle, consisting of a motor neuron and the muscle fibres it
controls, is a motor unit.
 When a motor neuron in the spinal cord is stimulated, it initiates an impulse that causes
all the muscle fibres supplied by that motor unit to contract simultaneously.
 The sarcoplasm also has many alternating light and dark bands, giving the fibre a
stripedor striated appearance (hence the name striated muscle).
 The contraction of skeletal muscle tissue is very quick and forceful.
 The initiation and execution of muscle contraction occur in the following sequential
steps.
o An action potential travels along a motor nerve to its endings on muscle fibres.
o At each ending, the nerve secretes a small amount of the neurotransmitter substance
acetylcholine.
o The acetylcholine acts on a local area of the muscle fibre membrane to open multiple
"acetylcholine-gated" channels through protein molecules floating in the membrane.
o Opening of the acetylcholine-gated channels allows large quantities of sodium ions to
diffuse to the interior of the muscle fibre membrane.
o This initiates an action potential at the membrane.
o The action potential depolarizes the muscle membrane, and much of the action
potential electricity flows through the centre of the muscle fibre.
o Here it causes the sarcoplasmic reticulum to release large quantities of calcium ions
that have been stored within this reticulum.
o The calcium ions initiate attractive forces between the actin and myosin filaments,
causing them to slide alongside each other, which is the contractile process.
61
o After a fraction of a second, the calcium ions are pumped back into the sarcoplasmic
reticulum by a Ca++ membrane pump, and they remain stored in the reticulum until a
new muscle action potential comes along; this removal of calcium ions from the
myofibrils causes the muscle contraction to cease.
Figure 8.2 c, Skeletal Muscle
STEP 5: Function of Muscle Tissues (20 minutes)
 What are the functions of skeletal muscle tissue?
Muscles serve specific functions in moving and positioning the body.

 The same muscle may act as a prime mover, antagonist, synergist, or fixator under
specific conditions.
 The functions include.
o A prime mover or agonist is the main muscle responsible for producing a specific
movement of the body (e.g. concentric contraction).
o Fixators steady the proximal parts of a limb while movements are occurring in distal
parts.
o A synergist complements the action of prime mover for example, by preventing
movement of the intervening joint when a prime mover passes over more than one
joint.
o An antagonist is a muscle that opposes the action of a prime mover.
o As a prime mover contracts, the antagonist progressively relax, producing a smooth
movement.
62
 Muscular tissue consists of cells called muscle fibers that are specialized for
contraction. It provides motion, maintenance of posture, heat production, and protection.
 Structurally the muscle tissue is divided into skeletal, smooth and cardiac muscle
tissue.
 Smooth muscle tissue is found in the walls of hollow internal structures (blood vessels
and viscera) and is non striated and involuntary

 Define muscle tissues
 What are the structure of muscle tissues
 What are the functions of muscle tissues
63
References
Seeley, R. R., Stephens, T. D., &Tate, P. (2003). Anatomy and Physiology. (5thed.).Boston:
McGraw-Hill.
Standring, S. (2008). Grays’s Anatomy; the anatomical basis of clinical practice.(40th ed.).
Thibodeau, G. A., & Patton, K. T. (1999). Anatomy & Physiology. Mosby: Hoffman
Press, Inc.
Tortora, G.J &Derrickson, B (2009). Principles of Anatomy and Physiology 12th Edition,
illness. China: Churchill Livingstone Elservier.
64
Session 9: Structure and Functions of Nervous Tissues
Prerequisites
 None
Learning Tasks
 Define Nervous Tissue
 Identify Components of Nervous Tissue
 Distinguish Different Types of Neurons
 Distinguish Different Types of Neuroglia and their Functions
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time
Method Content
Presentation
2 05 minutes Definition of Nervous Tissue
Brainstorming
05minutes
3 Presentation Components of Nervous Tissue
4 Types of Neurons
25 minutes Presentation,
5 Types of Neuroglia and their Function
Buzzing
65
SESSION CONTENTS

STEP 2: Definition of Nervous Tissue (5minutes)

 What is nervous tissues?
Nervous tissue or nerve tissue:

 Is the main tissue component of the two parts of the nervous system; the brain and
spinal cord of the central nervous system (CNS), and the branching
peripheral nerves of the peripheral nervous system (PNS), which regulates and
controls bodily functions and activity.
o Nervous tissue is distributed throughout the body as an integrated

communications network.
STEP 3: Components of Nervous Tissue (5minutes)
 Structurally, nerve tissue consists of two classes of cell types.
o Neurons, the nervous tissue is made up of billions of cells called neurons that are
specialized to respond to stimuli and to transmit a signal to activate other cells.
o Glial cells or neuroglia, non-excitable supporting cells, participate in neural

activity, neural nutritional and defence processes of the central nervous system.
 A Typical Neuron Consist of:
o Cell body, which has many radiating processes called dendrites, which are
specialized to receive signals from other neurons.
o Axon, a single long process, which is capable of generating a nerve impulse and
conducting it over a long distance to stimulate other neurons in the CNS, or
muscular or secretory cells elsewhere in the body.
o Neurons usually receive information through dendrites; the information is
integrated in the cell body and transmitted onwards via axons.
66
 STEP 4 : Types of Neuron (10 minutes)
 Unipolar neurons, these neurons have single processes, the axon arising from the cell
body.
 Unipolar neurons have no dendrites.
 Bipolar neurons, have two processes (both axons) emerging directly and oppositely
from the cell body.
 Bipolar neurons are found in the cochlear and vestibular ganglia as well as retina and
olfactory mucosa.
 Multipolar neurons, has one axon and many dozens of dendrites.
 Most neurons in the CNS are multipolar.
 Pseudo unipolar neurons, has a single short process (an axon) with a T-shaped
branching, one branch extending towards the CNS, and the other extending to a periphery
ending.
 In typical pseudo unipolar neurons, both branches are axons on both structural and
electrophysiological grounds.
Classification of Neurons according to their Functional Roles

 Motor neurons are involved in stimulating muscles or glands (effector organs) in the
periphery.
 Sensory neurons, sensory neurons receive sensory stimuli from the environment or
from tissues and organs of the body.
 Interneurons, maintain connection between neurons in the CNS, forming complex
functional chains or circuits
67
Source: Strandring, (2005) Figure 9.3: A Neuron
68
STEP 5: Neuroglia and their Functions (25 minutes)
ASK students to pair up and buzz on the question for 2 minutes
 What is neuroglia?
Neuroglia (Glial Cells)

 These are supporting cells found in the central nervous system and peripheral nervous
system
 There are six types of supporting cells
 Four are found in the CNS and two are found in the PNS
 Neuroglia found in central nervous system are
o Astrocytes
 Star-shaped, abundant, and versatile
 Guide the migration of developing neurons, they are found in large numbers
adjacent to blood vessels
They form a blood-brain barrier, i.e. the blood is separated from neurones by capillary
wall and a layer of astrocytes foot process
o Microglia
 Specialized immune cells that act as the macrophages of the CNS
 They derived from monocytes
o Ependymal Cells
 These cells form the epithelial lining of the ventricles of the brain and the central
canal of the spinal cord
o Oligodendrocytes,
 These are found in clusters around cell bodies
 They form and maintain the myelin, having the same functions as schwann cells in
peripheral nerves
 These cells have clinical importance as most tumours of the brain are arising from
them
Glia Cells Found in the Peripheral Nervous System
 Satellite cells, surround clusters of neuronal cell bodies in the PNS, they are of
unknown function
 Schwann cells, form myelin sheaths around the larger nerve fibers in the PNS, they are
for neuronal regeneration
69
 The nervous system is composed of neurons (nerve cells) and neuroglia (protective and
supporting cells)
 Neurons are sensitive to stimuli, convert stimuli into electrical signals called action
potentials (nerve impulses), and conduct nerve impulses.
 Neuroglia (Glial Cells) are supporting cells found in the central nervous system and
peripheral nervous system

 What is nervous tissue?
 What are the components of nervous tissue?
 What are the types of neuron types of neurons?
 What are the types of neuroglia and their functions?
 What are the function of neuroglia?
70
References
Seeley, R. R., Stephens, T. D., &Tate, P. (2003). Anatomy and Physiology. (5thed.).Boston:
McGraw-Hill.
Standring, S. (2008). Grays’s Anatomy; the anatomical basis of clinical practice. (40th ed.).
Press, Inc.
Tortora, G.J &Derrickson, B (2009). Principles of Anatomy and Physiology 12th Edition,
USA, John Wiley & Sons Inc., USA
illness. China: Churchill Livingstone Elservier.
71
Session 10: Structure and Functions of the Ear
Total Session Time: 120 minutes + 60 minutes assignment
 None
Learning Tasks
 Define Ear
 Describe Structure and Function of the Ear
 Explain Mechanism of Hearing and Balance
Resources Needed:
 Black/white board and chalk/whiteboard markers
 Overhead Projector and Transparencies or Slide Projector/LCD and Computer
 Handout 10.2: External and Middle Ear
 Handout 10.3:Position of the Middle Ear
 Handout 10.4: The Inner Ear
SESSION OVERVIEW
Activity/
Step Time Content
Method
05minutes Presentation Definition of the Ear
2
Buzzing
50minutes Presentation
3 Small group Structure and Functions of the Ear
discussion
50minutes Presentation Mechanism of Hearing and Physiology of
4 Brainstorming Balance
7 60 minutes Presentation Take Home Assignment
72
SESSION CONTENTS

STEP 2: Definition of the Ear (5minutes)

 What is the ear?
 Ears are paired sensory organs comprising of:

o The auditory system, involved in the detection of sound.
o The vestibular system, involved with maintaining body balance/ equilibrium.
STEP 3: Structure and Functions of the Ear (50minutes)
 What are the Structure and Functions of the Ear
 The ear divides anatomically and functionally into three regions

o The external ear
o The middle ear
o The inner ear
 All three regions are involved in hearing.
 Only the inner ear functions in the vestibular system.
 The external ear (or pinna, the part you can see) serves to protect the tympanic
membrane
73
 (eardrum), as well to collect and direct sound waves through the ear canal to the
eardrum.
 About 1¼ inches long, the canal contains modified sweat glands that secrete cerumen,
or earwax. Too much cerumen can block sound transmission
External Acoustic Meatus (External Ear)

 The external acoustic meatus extends from the deepest part of the concha to the
tympanic membrane (eardrum), a distance of approximately 1 inch (2.5 cm).
 Its walls consist of cartilage and bone.
 The lateral one-third is formed from cartilaginous extensions from some of the
auricular cartilages and the medial two-thirds is a bony tunnel in the temporal bone.
 Throughout its length the external acoustic meatus is covered with skin, some of
which contains hair and modified sweat glands producing cerumen (earwax).
 Its diameter varies, being wider laterally and narrow medially.
 The external acoustic meatus does not follow a straight course.
 From the external opening it passes upwards in an anterior direction, then turns
slightly posteriorly still passing in an upwards direction, and finally, turns again in an
anterior direction with a slight descent.
Tympanic Membrane
 The tympanic membrane separates the external acoustic meatus from the middle ear.
 It is at an angle, sloping medially from top to bottom and posteriorly to anteriorly.
 It consists of a connective tissue core lined with skin on the outside and mucous
membrane on the inside.
 Around the periphery of the tympanic membrane a fibrocartilaginous ring attaches it
to the tympanic part of the temporal bone.
 At its center, a concavity is produced by the attachment on its internal surface of the
lower end of the handle of malleus, part of the malleus bone in the middle ear.
Refer to Handout 10.2: External and Middles Ear
The Middle Ear

 The middle ear is an air-filled, mucous membrane-lined space in the temporal bone
between the tympanic membrane laterally and the lateral wall of the internal ear medially.
 It is described as consisting of two parts:
o The tympanic cavity immediately adjacent to the tympanic membrane
o The epitympanic recess superiorly
 It connects to the throat/nasopharynx via the Eustachian tube.
 This ear-throat connection makes the ear susceptible to infection (otitis media).
 The eustachian tube functions to equalize air pressure on both sides of the eardrum.
 Normally the walls of the tube are collapsed.
 Swallowing and chewing actions open the tube to allow air in or out, as needed for
equalization.
 Equalizing air pressure ensures that the eardrum vibrates maximally when struck by
sound waves.
 The middle ear communicates with the mastoid area posteriorly.
74
 Adjoining the eardrum are three linked, movable bones called ossicles, which convert
the sound waves striking the eardrum into mechanical vibrations.
 The smallest bones in the human body, the ossicles are named for their shape.
o The hammer (malleus) connected to the tympanic membrane.
o The anvil (incus), the middle bone, connects to the hammer.
o The stirrup (stapes) connected to the incus and the lateral wall of the internal ear at the
oval window.
o The base of the stirrup, the footplate, fills the oval window which leads to the inner
ear.
 Its basic function is to transmit vibrations of the tympanic membrane across the cavity
of the middle ear to the internal ear.
o It accomplishes this through three interconnected but movable bones that bridge the
space between the tympanic membrane and the internal ear.
 Posterior to the epitympanic recess of the middle ear is the aditus to mastoid antrum,
which is the opening to the mastoid antrum.
 The mastoid antrum is a cavity continuous with collections of air-filled spaces (the
mastoid cells), throughout the mastoid part of the temporal bone, including the mastoid
process.
 The mastoid antrum is separated from the middle cranial fossa above by only the thin
tegmen tympani.
 The mucous membrane lining the mastoid air cells is continuous with the mucous
membrane throughout the middle ear.
 Therefore, infections in the middle ear can easily spread into the mastoid area.
Auditory Ossicles
 The bones of the middle ear consist of the malleus, incus, and stapes.
 They form an osseous chain across the middle ear from the tympanic membrane to the
oval window of the internal ear.
 Muscles associated with the auditory ossicles modulate movement during the
transmission of vibrations.
Malleus
 The malleus is the largest of the auditory ossicles and is attached to the tympanic
membrane.
 Identifiable parts include the head of malleus, neck of malleus, anterior and lateral
processes, and handle of malleus.
 The head of malleus is the rounded upper part of the malleus in the epitympanic
recess.
 Its posterior surface articulates with the incus.
 Inferior to the head of malleus is the constricted neck of malleus, and below this are
the anterior and lateral processes:
o The anterior process is attached to the anterior wall of the middle ear by a ligament.
o The lateral process is attached to the anterior and posterior malleolar folds of the
tympanic membrane.
Incus
75
 The second bone in the series of auditory ossicles is the incus.
 It consists of the body of incus, and long and short limbs:
o The enlarged body of incus articulates with the head of malleus and is in the
epitympanic recess.
o The long limb extends downward from the body, paralleling the handle of the
malleus, and ends by bending medially to articulate with the stapes.
o The short limb extends posteriorly and is attached by a ligament to the upper posterior
wall of the middle ear.
Stapes
 The stapes is the most medial bone in the osseous chain and is attached to the oval
window.
 It consists of the head of stapes, anterior and posterior limbs, and the base of stapes:
o The head of stapes is directed laterally and articulates with the long process of the
incus.
o The two limbs separate from each other and attach to the oval base.
Handout 10.3: Position of the Middle Ear
The Inner Ear

 The internal ear consists of a series of bony cavities (the bony labyrinth) and
membranous ducts and sacs (the membranous labyrinth) within these cavities.
 All these structures are in the petrous part of the temporal bone between the middle
ear laterally and the internal acoustic meatus medially.
 The bony labyrinth consists of the vestibule, three semi-circular canals, and the
cochlea.
 These bony cavities are lined with periosteum and contain a clear fluid (the
perilymph).
 •This membranous labyrinth contains the actual hearing cells, the hair cells of the
organ of Corti.
Bony Labyrinth
 The vestibule, which contains the oval window in its lateral wall, is the central part of
the bony labyrinth.
 It communicates anteriorly with the cochlea and poster superiorly with the
semicircular canals.
 A narrow canal (the vestibular aqueduct) leaves the vestibule, and passes through the
temporal bone to open on the posterior surface of the petrous part of the temporal bone.
 Semi-circular canals projecting in a poster superior direction from the vestibule are
the anterior, posterior, and lateral semi-circular canals.
 Each of these canals forms two-thirds of a circle connected at both ends to the
vestibule
Cochlea
 Projecting in an anterior direction from the vestibule is the cochlea, which is a bony
structure that twists on itself two and one-half to two and three-quarter times around a
central column of bone (the modiolus).
76
 This arrangement produces a cone-shaped structure with a base of cochlea that faces
posteromedially and an apex that faces anterolaterally.
 This positions the wide base of the modiolus near the internal acoustic meatus, where
it is entered by branches of the cochlear part of the vestibulocochlear nerve [VIII].
Refer to Handout 10.4: The Inner Ear
STEP 4: Mechanism of Hearing and Physiology of Balance (50minutes)
Physiology of hearing
 The following events are involved in hearing
o The auricle directs sound waves into the external auditory canal.
o 2When sound waves strike the tympanic membrane, the alternating high- and low-
pressure of the air causes the tympanic membrane to vibrate back and forth. The
distance it moves, which is very small, depends on the intensity and frequency of
the sound waves. The eardrum vibrates slowly in response to low-frequency (low-
pitched) sounds and rapidly in response to high-frequency (high-pitched) sounds.
o The central area of the eardrum connects to the malleus, which also starts to vibrate.
The vibration is transmitted from the malleus to the incus and then to the stapes.
o As the stapes moves back and forth, it pushes the membrane of the oval window in
and out. The oval window vibrates about 20 times more vigorously than the
eardrum because the ossicles efficiently transmit small vibrations spread over a
large surface area (eardrum) into larger vibrations of a smaller surface (oval
window).
o The movement of the oval window sets up fluid pressure waves in the perilymph of
the cochlea. As the oval window bulges inward, it pushes on the perilymph of the
scalavestibuli.
o Pressure waves are transmitted from the scalavestibuli to the scala tympani and
eventually to the round window, causing it to bulge outward into the middle ear.
o As the pressure waves deform the walls of the scalavestibuli and scala tympani, they
also push the vestibular membrane back and forth, creating pressure waves in the
endolymph inside the cochlear duct.
o The pressure waves in the endolymph cause the basilar membrane to vibrate, which
moves the hair cells of the spiral organ against the tectorial membrane. This leads to
bending of the hair cell stereo cilia, which produces receptor potentials that
ultimately lead to the generation of nerve
Physiology of Balance
 The semi-circular canals and vestibule function to sense movement (acceleration and
deceleration) and static position.
 The three semi-circular canals lie perpendicular to each other, one to sense movement
in each of the 3 spatial planes.
 At the base of the canals are movement hair cells, collectively called the crista
ampullaris.
77
 Depending on the plane of movement, the endolymph flowing within the semicircular
canals stimulates the appropriate movement hair cells.
 Static head position is sensed by the vestibule, specifically, its utricle and saccule,
which contain the position hair cells.
 Different head positions produce different gravity effects on these hair cells.
 The utricle, or utriculus, along with the saccule is one of the two otolith organs
located in the vertebrate inner ear.
 These use small stones and a viscous fluid to stimulate hair cells to detect motion and
orientation.
 While the semi-circular canals respond to rotations, the otolithic organs sense linear
accelerations.
 We have two on each side, one called utricle, and the other saccule.
 The utricle contains mechanoreceptors called hair cells that distinguish between
degrees of tilting of the head, thanks to their apical cilia set-up.
 These are covered by otolith which, due to gravity, pull on the cilia and tilt them.
 The hair cells for both position and movement create nerve impulses.
 These impulses travel over the vestibular nerve to synapse in the brain stem,
cerebellum, and spinal cord.
 No definite connections to the cerebral cortex exist.
 Instead, the impulses produce reflex actions to produce the corrective response.
 For example, a sudden loss of balance creates endolymph movement in the semi-
circular canals that triggers leg or arm reflex movements to restore balance.
 The cavity of the utricle communicates behind with the semi-circular ducts by five
orifices.
 The ductus utriculosaccularis comes off of the anterior wall of the utricle and opens
into the ductus endolymphaticus.
STEP 5: Key Points (05minutes)

 Ears are paired sensory organs comprising of:
o The auditory system, involved in the detection of sound.
o The vestibular system, involved with maintaining body balance/ equilibrium.
 The external ear meatus extends from the deepest part of the concha to the tympanic
membrane (eardrum), a distance of approximately 1 inch (2.5 cm).
 The middle ear is an air-filled, mucous membrane-lined space in the temporal bone
between the tympanic membrane laterally and the lateral wall of the internal ear medially.
 The internal ear consists of a series of bony cavities (the bony labyrinth) and membranous
ducts and sacs (the membranous labyrinth) within these cavities.

 What is ear
 What are the structure of the ear
 What are the functions of the ear
78
 Explain mechanism of hearing and physiology of balance
79
References
Seeley, R. R., Stephens, T. D., &Tate, P. (2003). Anatomy and Physiology. New York:
McGraw-Hill.
McGraw-Hill.
Thibodeau, G. A., & Patton, K. T. (1999). Anatomy & Physiology. Saint Louis: Mosby, Von
Hoffman Press, Inc.
80
Handout 10.2:External and Middles Ear
Source: Drake, 2005
81
Handout 10.3: Position of the Middle Ear
Source: Source: Drake, 2005
82
Handout 10.4: The inner Ear
Source: Source: Drake, 2005
83
Session 11: Structure and Functions of Skin
 None
Students Learning Tasks

 Define Skin
 Describe the Structure of the Skin
 Explain the Functions of the Skin
Resources Needed:
 Handout 11.1: Layers of the Skin
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation
2 05 minutes Definition of the skin
buzzing
15 minutes Presentation Structure of the Skin
3
25 minutes Functions of the Skin

Presentation
4
Brainstorming
84
SESSION CONTENTS

STEP2: Definition of the Skin (05minutes)
 What is the skin?
Skin:
 Is the thin layer of tissue forming the natural outer covering of the body of a person or
animal
o The body's outer covering, which protects against heat and light, injury, and infection.
o Skin regulates body temperature and stores water, fat, and vitamin D.
o The skin, which weighs about 6 pounds, is the body's largest organ.
STEP 3: Structure of the Skin (15minutes)
 Integumentary means covering, it covers the outside of the body.

 The integumentary system consists of the skin and the accessory structures such as
hair nails and glands.
 The appearance of the integumentary system can indicate physiological imbalances in
the body.
 Disorders of other parts of the body can be reflected there.
Structure of the skin
 The skin is made up of the two major tissue layers
o Dermis
o Epidermis
Dermis
 The dermis is divided into two layers
85
o The deeper reticular layer, is dense irregular connective tissue, is the main layer of the
dermis consisting of layers of interlacing collagen fibers
o This layer is of elastic and collagens are oriented more in some areas than others
creating tension lines (cleavage lines) and wrinkle lines in the skin
o The more superficial papillary is called from projections called papillae that extend
toward the epidermis
o It is less dense than reticular and sometimes called loose connective tissue, it also
contain large number of blood vessels
o These fibers provide skin tone and account for the strength and toughness of the skin
o The pattern of collagen fibers in a particular region determines the characteristic
o The deep layer of the dermis contains hair follicles, with their associated smooth
arrector muscles and sebaceous glands
o Contraction of the arrector muscles erects the hairs (causing goose bumps), thereby
compressing the sebaceous glands and helping them secrete their oily product onto
the skin
o The dermis composed of , nerve endings, hair follicles, smooth muscles, glands, and
lymphatic vessels
o Skin ligaments, consisting of numerous small fibrous bands, extend through the
subcutaneous tissue and attach the deep surface of the dermis to the underlying deep
fascia
o The length and density of these ligaments determine the mobility of the skin over
deep structures
Handout 11.1: Layers of the Skin
Epidermis:
 A keratinized stratified (layered) epithelium with a tough outer surface composed of
keratin (a fibrous protein).
 The epidermis is made up of several layers (strata of cells) which extends from the
deepest germinative layer to the surface stratum corneum namely:
o Basal layer (stratum basale)
o Spinous or prickle cell layer (stratum spinosum)
o Granular layer (stratum granulosum)
o Clear layer (stratum lucidum)
o And cornified layer (stratum corneum)
 The outer layer of the epidermis is continuously or rubbed away with replacement of
new cells from the basal layer.
 The cells of epidermis include:
o Most of the cells are called keratinocytes because they produce protein called keratin
o Melanocytes which contribute to skin colour
o Langerhans‘ cells which are part of immune system
o Merkel‘s which are specialized epidermal cells associated with nerve endings
responsible for detecting light touch and superficial pressure
o This process renews the epidermis of the entire body every 25 to 45 days
o The epidermis is avascular (no blood vessels or lymphatics) and is nourished by the
vessels in the underlying dermis
o The skin is supplied by afferent nerve endings that are sensitive to touch, irritation
(pain), and temperature
86
o Most nerve terminals are in the dermis, but a few penetrate the epidermis
Source: Standring, 2005

Figure 11.1: The Epidermis
STEP 4: Functions of the Skin (25minutes)
 What are the functions of the skin?
 Protection for the body from environmental effects, such as:

o Abrasions
o Melanin absorb ultraviolet light and protect underlying tissue
o Skin prevent the entry of microorganisms and other harmful substances
o Prevent dehydration by reducing water loss from the body because its lipids act as
barrier to the diffusion of water
o Nail protect the ends of the digits from damage and can be used in defence
o Hair follicles act as insulator and protect from ultraviolet light
 Temperature regulation through sweat glands, blood vessels and fat deposits
87
 Sensation , the integumentary system has sensory receptors that can detect heat, cold,
pain, touch, temperature and pressure)
 Synthesis and storage of vitamin D when exposed to ultraviolet light, the skin
produces a molecule that can be transformed into vitamin D
 Excretion of small amount of waste products are lost through the skin and in gland
secretions
 The integumentary system consists of the skin and the accessory structures such as
hair nails and glands
 The functions of the skin includes synthesis and storage of vitamin D when exposed
to ultraviolet light and excretion of small amount of waste products are lost through the
skin and in gland secretions
 Skin is the thin layer of tissue forming the natural outer covering of the body of a
person or animal
 The cells of epidermis include: keratinocytes because they produce protein called
keratin, Melanocytes which contribute to skin colour, Langerhans‘ cells which are part of
immune system and Merkel‘s which are specialized epidermal cells associated with
nerve endings responsible for detecting light touch and superficial pressure
 What is the skin?

 What are the structure of the skin?
 What are the functions of the skin?
88
References
McGraw-Hill.
McGraw-Hill.
Hoffman Press, Inc.
89
Handout 11.1: Layers of the skin
Source: Standring, 2005
90
Session 12: Structure, Functions and disorders of the Eye

 None

 Define the Eye
 Describe Structure and Function of the Eye
 Mention Common Disorders of the Eyes
 Explain the Common Disorders of the Eye
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
05minutes Presentation Definition of the Eye
2
Buzzing
3 Small group Structure and Functions of the Eye
discussion
50minutes Presentation Common disorders of the Eye
4
91
SESSION CONTENTS

STEP 2: Definition of the Ear (10minutes)

 What is the eye?
 The eye is the peripheral organ of sight

o Is situated in the cavity of the orbit the wall which protect it from injury
o The following are the accessory structures of the eyeball:
 Muscles
 Fascie
 Eyebrows
 Conjunctiva
 Lacrimal apparatus
STEP 3: Structure and Functions of the Eye (50minutes)
 What are the Structure and Functions of the Eye?
Structure and functions of the eye:

 Iris:
o Regulates the amount of light that enters your eye
o It forms the coloured, visible part of your eye in front of the lens.
92
o Light enters through a central opening called the pupil.
 Pupil:
o The circular opening in the centre of the iris through which light passes into the
lens of the eye
o The iris controls widening and narrowing (dilation and constriction) of the pupil
 Cornea:
o Contains no blood vessels and is extremely sensitive to pain
 Lens:
o A transparent structure situated behind your pupil
o It is enclosed in a thin transparent capsule and helps to refract incoming light and
focus it onto the retina
o A cataract is when the lens becomes cloudy,
 Choroid:
o The middle layer of the eye between the retina and the sclera
o It also contains a pigment that absorbs excess light so preventing blurring of vision
 Ciliary body:
o The part of the eye that connects the choroid to the iris
 Retina:
o A light sensitive layer that lines the interior of the eye
o It is composed of light sensitive cells known as rods and cones
o The human eye contains about 125 million rods, which are necessary for seeing in
dim light
o Cones, on the other hand, function best in bright light
o There are between 6 and 7 million cones in the eye and they are essential for
receiving a sharp accurate image and for distinguishing colours
o The retina works much in the same way as film in a camera.
 Macula:
o A yellow spot on the retina at the back of the eye which surrounds the fovea.
 Fovea:
o Forms a small indentation at the centre of the macula and is the area with the greatest
concentration of cone cells
o When the eye is directed at an object, the part of the image that is focused on the
fovea is the image most accurately registered by the brain
 Optic disc:
o The visible (when the eye is examined) portion of the optic nerve, also found on the
retina
93
o The optic disc identifies the start of the optic nerve where messages from cone and
rod cells leave the eye via nerve fibres to the optic centre of the brain. This area is
also known as the 'blind spot‘.
 Optic nerve:
o Leaves the eye at the optic disc and transfers all the visual information to the
brain.
 Sclera:
o The white part of the eye, a tough covering with which the cornea forms the
external protective coat of the eye.
 Rod cells
o Are one of the two types of light-sensitive cells in the retina of the eye
o There are about 125 million rods, which are necessary for seeing in dim light.
 Cone cells
o Are the second type of light sensitive cells in the retina of the eye
o The human retina contains between six and seven million cones
o They function best in bright light and are essential for acute vision (receiving a sharp
accurate image)
o It is thought that there are three types of cones, each sensitive to the wavelength of a
different primary colour – red, green or blue
o Other colours are seen as combinations of these primary colours
94
Figure 12.1: Structure of the eye
STEP 4: Common Disorders of the Eye (50 minutes)
The common disorders of the eye are grouped into:

 Age-related Macular Degeneration (AMD)
 Cataract
 Diabetic retinopathy
 Glaucoma refractive error
Age-related Macular Degeneration (AMD)

o A chronic degenerative condition that affects the central vision.
o Progression of the condition is likely
o Ten per cent of people with macular degeneration have the ―wet form‖ which may
respond to treatment
o The majority of people have the ―dry form‖
o Two out of three people will be affected by AMD in their lifetime.
Cataract
o A cataract is the clouding of the lens inside the eye.
o With a cataract, light is scattered as it enters the eye, causing blurred vision
o the population over the age of 55 has a cataract
o Long term use of corticosteroids can increase risk of cataracts
o Exposure to UV light can also increase the risk
o Ageing, smoking and having diabetes can increase the risk of developing cataract
95
Diabetic retinopathy
o This condition is a complication of diabetes
o It affects the small blood vessels of the retina
o Blood vessels begin to leak and bleed inside the eye
Glaucoma
o It is a disease that affects the optic nerve at the back of the eye
o Relieving pressure on the nerve reduces progression of the disease
o Early detection and treatment can slow the vision loss
Refractive error
o Refractive error is a focusing disorder of the eye

o Most common cause of vision impairment
o Is associated with ageing the age of 40 years, 22 per cent of the population has refractive
error
o It is correctable by wearing glasses or contact lenses or refractive laser surgery (selected
cases)

 The eye is the peripheral organ of sight
 Is situated in the cavity of the orbit the wall which protect it from injury
 The common disorders of the eyes are:
o Age-related Macular Degeneration (AMD) – 10 per cent
o Cataract - 15 per cent
o Diabetic retinopathy - 2 per cent
o Glaucoma - 5 per cent
o Under-corrected or uncorrected refractive error - 59 per cent

 What is the eye?
 What are the structures of the eye?
 What are the functions of the structure of the eye?
 What are the common disorders of the eye?
96
References
McGraw-Hill.
McGraw-Hill.
Hoffman Press, Inc.
97
Session 13: Introduction to Gastrointestinal System
Prerequisites
 None
Learning Tasks
 Define Gastrointestinal System
 Explain Gastrointestinal System Overview
 Explain Functions of the Gastrointestinal System
 Describe Structure of the Oral Cavity
 Describe Structure and Functions of the Tongue
 Explain Constituents of Salivary Glands
 Explain Mechanism of Swallowing
Resources Needed:
 Handout 13.1: The overview of alimentary canal
 Handout 13.2: General structure of the alimentary canal
 Handout 13.3: The Teeth
 Handout 13.4: The Tongue
 Handout 13.5: The Salivary glands
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation, Definition and Overview of Gastrointestinal

2 20 minutes System
Brainstorming
15 minutes Presentation, Functions of the Gastrointestinal System
3
Brainstorming
4 20minutes Presentation Structure of the Oral Cavity
5 Structure and Functions of the Tongue
Buzzing
6 10 minutes Presentation Salivary Glands and its Constituents
7 15 minutes Presentation Mechanism of Swallowing
10 10 minutes presentation Take home assignment
98
SESSION CONTENTS

STEP 2: Definition and Overview of Gastrointestinal System (20 minutes)
 What is digestive system?

 What are the organs of digestive system?
 Digestive system consists of the digestive tract(alimentary canal) which is a tube

extending from the mouth, pass through the thorax, abdomen and pelvis and ends at the
anus and its associated accessory organs
 Organs of the digestive tract include:

o The mouth or oral cavity, which has salivary glands and tonsils as accessory organs
o The pharynx, or throat , with tubular mucous glands
o The oesophagus, with tubular mucous glands
o The stomach, which contains many tube like glands
o The small intestine, consisting of the duodenum, jejunum and ileum, with the liver,
Gallbladder and pancreas as major accessory organs
o The large intestine, including the cecum, colon, rectum and anal canal, with mucus
glands
o The anus
 The digestive system also consists of accessory organs which include the teeth,
tongue, salivary glands, liver, gallbladder, and pancreas
 Teeth aid in the physical breakdown of food, and the tongue assists in chewing and
swallowing.
 The other accessory digestive organs produce or store secretions that flow into the GI
tract through ducts to aid in the chemical breakdown of food
99
Figure 13.1: Alimentary Canal and Accessory Organs
Refer students to Handout 13.1: The Overview of Alimentary Canal
The gastrointestinal tract is made of four layers of tissues:

o Mucosa is the innermost layer made up of three layers
 The inner epithelium
 Lamina propria
 Muscularis mucosae
o Submucosa this layer is composed of connective tissue, it contains numerous small glands,
blood vessels, and parasympathetic nerves that form the submucosal plexus
(Meissner plexus)
o Muscular is thick layer of smooth muscle tissue which consists of inner circular
layerand outer longitudinal layer
o Between the two layers of muscles there is a nervous plexus called myenteric
plexus (Auerbach plexus)
o Serosa is the outermost layer of made up loose connective tissue (visceral
peritoneum)
 Layers of the GI tract have various modifications to enable it to perform various
functions
100
Refer students to Handout 13.2: General Structure of the Alimentary Canal
STEP 3: Functions of the Gastrointestinal System (15 minutes)
 What are the functions of the digestive tract?
Overall, the digestive system performs six basic processes:

 Ingestion. This process involves taking foods and liquids into the mouth (eating)
 Secretion. Each day, cells within the walls of the GI tract and accessory digestive
organs secrete a total of about 7 litres of water, acid, buffers, and enzymes into the lumen
(interior space) of the tract
 Mixing and propulsion. Alternating contractions and relaxations of smooth muscle in
the walls of the GI tract mix food and secretions and propel them toward the anus
 This capability of the GI tract to mix and move material along its length is called
motility
 Digestion. Mechanical and chemical processes break down ingested food into small
molecules
o In mechanical digestion the teeth cut and grind food before it is swallowed, and then
smooth muscles of the stomach and small intestine churn the food
o As a result, food molecules become dissolved and thoroughly mixed with digestive
enzymes
o In chemical digestion the large carbohydrate, lipid, protein, and nucleic acid
molecules in food are split into smaller molecules by hydrolysis
o Digestive enzymes produced by the salivary glands, tongue, stomach, pancreas, and
small intestine catalyse these catabolic reactions. A few substances in food(vitamins,
ions, cholesterol, and water).can be absorbed without chemical digestion
 Absorption. The entrance of ingested and secreted fluids, ions, and the products of
digestion into the epithelial cells lining the lumen of the GI tract is called absorption.
 Defecation. Wastes, indigestible substances, bacteria, cells sloughed from the lining
of the GI tract, and digested materials that were not absorbed in their journey through the
digestive tract leave the body through the anus in a process called defecation and the
eliminated material is termed faeces
101
STEP 4: Structure of the Oral Cavity (20 minutes)
 The oral cavity or mouth is that part of the digestive tract bounded by the lips
anteriorly, the fauces throat; opening into the pharynx posteriorly, cheeks laterally, the
palate superiorly, and a muscular floor inferiorly
 The oral cavity is lined throughout with mucus membrane consisting of stratified
squamous epithelium containing small mucus secreting glands.
 The oral cavity is divided into two regions:
o The Vestibule; part of the mouth between Gums and Cheeks
o The oral cavity proper; which lies medial to the alveolar processes (gums)
Structure of the Oral Cavity (The Buccal Cavity)

 Lips:
o Are muscular structure formed mostly by the orbicularis oris muscles
o They are covered externally by skin and internally by mucous membrane
o The junction between skin and mucous membrane is highly sensitive
o When lips are closed, line of contact is oral fissure
o Cheeks
o The cheeks are formed in large part by buccinator muscles covered by adipose tissue
o They form the lateral boundaries of the oral cavity, they are continuous with lips and
lined by mucous membrane
o They contain mucus secreting glands which are placed between mucous membrane and
buccinator muscle
o Their ducts open opposite the last molar teeth
 Hard and soft palates; forms the roof of mouth consists of two parts:
o The anterior bony part the hard palate consists of portions of four bones, two maxillae
and two palatine bones
o The posterior non bony part the soft palate forms partition between the mouth and
nasopharynx and is made of muscles arranged in an arch
 Suspended from midpoint of the posterior border of the arch is the uvula
 The opening from the mouth into the oropharynx is called fauces
Teeth
 The teeth are hard conical structures set in the dental alveoli (tooth sockets) of the
upper and lower jaws and are used in mastication (chewing) and assisting in articulation
 These are organs of mastication
 Humans have two generations of teeth:
o The deciduous (primary) dentition
o The permanent (secondary) dentition
Deciduous Teeth
 They are temporary teeth, twenty in number, and ten on each jaw
 They start to emerge at 6 months after birth
 They should all be present at 24-36 months
102
Permanent Teeth
 They are thirty two in number, they begin to replace deciduous teeth at 6 years of age,
and become complete when the third molars erupt at 18 - 24 years of age
 Of these 32 teeth there are 8 incisors, 4 canines, 8 Premolars and 12 Molars
 Incisors and Canines are for cutting and Premolars and molars for grinding of food
o There are two incisors, a central and a lateral, in each half jaw or quadrant
o Behind each lateral incisor is a canine tooth with a single cusp
o Distal to the canines are two premolars, each with a buccal and lingual cusp
o Posterior to the premolars are three molars whose size decreases distally
 A typical tooth has the following parts:

o Crown; exposed portion of a tooth, covered by enamel; ideally suited to withstand
abrasion during mastication
o Neck; narrow portion that joins the crown to the root; surrounded by the gingiva
o Roots fits into the socket of the alveolar process and is suspended by fibrous
o periodontal membrane
o In the centre of the tooth there is pulp cavity containing blood vessels, lymph vessels
and nerves
o Surrounding the pulp cavity there is hard ivory like substance called dentine
o Outside the dentine of the crown is the thin layer of the very hard substance called
enamel
o The root of the tooth on the other hand is covered by substance resembling the bone
called the cement which secures the tooth in its socket
Refer students to Handout 13.3: The Teeth
STEP 5: Structure and Functions of the Tongue (15 minutes)

 The tongue is a highly muscular organ of deglutition, taste and speech
 It is made up of skeletal muscles covered by a mucous membrane
 It has the root, tip and the body
 It is attached by its base to the hyoid bone and by the lingual frenulum to the floor of
the mouth
 There are two types of muscles forming the tongue;
o Intrinsic muscles; they originate and insert in the tongue itself
o An example of the intrinsic muscles includes Genioglossus
o They are responsible for changing the shape of the tongue such as flattening and
elevating the tongue during drinking and swallowing
o Extrinsic muscles are those muscles that insert into the tongue but originate from
mother structures such as hyoid bone
o An example of the muscles includes hyoglossus
o They are responsible for protruding and retract the tongue, move it from side to side
and change its shape
 The dorsal mucosa is covered by numerous papillae; tiny projections, some of which
bear taste buds
 There are three types of papillae; vallate, fungiform and filariform
103
o Circumvallate papillae, arranged in an inverted V shape at the base of the tongue
are the largest papillae
o Fungiform papillae; are situated mainly at the tip ad the edge of the tongue
o Filiform papillae; are the smallest of all three
o numerous on the surface of the anterior two-thirds of the tongue
Refer students to Handout 13.4: The Tongue
There are four basic taste sensations

o Sweetness; apex (tip)
o Saltiness; lateral margins
o Sourness; posterior part of the tongue
o Bitterness; posterior part of the tongue
 Although it is commonly stated that particular areas of the tongue are specialized to
detect these different tastes, evidence indicates that all areas of the tongue are responsive
to all taste stimuli
 Each afferent nerve fibre is connected to widely separated taste buds and may respond
to several different chemical stimuli
 Some respond to all four classic categories, others to fewer or only one
 Blood supply of the tongue is by lingual branch of the external carotid artery and
venous drainage is by lingual veins, which joins the internal jugular vein
 Nerve innervations of the tongue is through:
o The hypoglossal nerve (12th cranial nerves)
o The lingual branch of the mandibular nerves
o The facial and glossopharyngeal nerves (7th and 9th CN) the nerves of taste
o The parasympathetic innervation of the various glands of the tongue is from the
chorda tympani branch of the facial nerve
o The postganglionic sympathetic supply to lingual glands and vessels arises from the
carotid plexus
STEP 6: Salivary Glands and its Constituents (10 minutes)

 Salivary glands are compound, tubulo- alveolar exocrine glands, whose ducts open
into the oral cavity
 They secrete saliva, a fluid which lubricates food to assist deglutition, moistens the
buccal mucosa, which is important for speech, and provides an aqueous solvent necessary
for taste and a fluid seal for sucking and suckling
 They also secrete digestive enzymes, e.g. salivary amylase and antimicrobial agents
e.g.
IgA, lysozyme and lacto ferrin, into saliva
 Conditions where there is a significant decrease in the production of saliva
(xerostomia) may result in periodontal inflammation and dental caries
 Three pairs of compound tubulo-alveolar glands secrete approximately 1 litre of
saliva each day
 The major salivary glands are the paired parotid, submandibular and sublingual glands
 In addition, there are numerous minor salivary glands scattered throughout the oral
mucosa and submucosa
104
o Parotid glands – largest of the paired salivary glands produce watery saliva containing
enzymes
o Submandibular glands – compound glands that contain enzymes and mucous
producing element
o Sublingual glands – smallest of the salivary glands produce a mucous type of saliva
o Buccal glands are important for hygiene and comfort of oral tissue
 In the unstimulated state, the parotid gland contributes 20%, the submandibular gland
65%, and the sublingual and minor salivary glands 15% of the daily output of saliva
 When stimulated, the parotid contribution rises to 50%
Refer students to Handout 13.5: The Salivary Glands
STEP 7: Mechanism of Swallowing (15 minutes)

Swallowing: A mechanism used to accomplish primary function of digestive system
 Deglutition: A process for swallowing
o It is a complex process requiring coordinated and rapid movement
 Swallowing transports the chewed food into the oesophagus, passing through the
oropharynx and hypopharynx
 The mechanism for swallowing is coordinated by the swallowing center in the
medulla oblongata and pons
 The reflex is initiated by touch receptors in the pharynx as the bolus of food is pushed
to the back of the mouth
 This occurs in three stages after mastication is completed and the bolus has been
formed
 It is initiated voluntarily but completed by a reflex action
o Oral stage (mouth to oropharynx), voluntarily controlled
 Formation of food bolus in the middle of the tongue; The mouth is closed, tongue
presses bolus against the palate, and the voluntary muscles of the tongue and
cheeks push the bolus backwards into the oropharynx
o Pharyngeal stage (oropharynx to oesophagus) involuntary contraction of muscles of
the pharynx
 Propels the bolus down into the oesophagus
 It begins with the elevation of the soft palate, which closes the passage between
the nasopharynx and oropharynx
 This is controlled by the medulla and lower pons in the brain stem
 The presence of the bolus in the pharynx stimulates a wave of peristalsis that
propelsthe bolus through the oesophagus to the stomach
 Movement; contractions and gravity moves bolus through oesophagus and into
stomach
 So the function of the oesophagus is to convey food from the pharynx to the
stomach
 The chewed food is pushed down the oesophagus to the stomach through
peristaltic contraction of these muscles
105
 It takes only about seven seconds for food to pass through the oesophagus and no
digestion takes place
 Peristalsis; wave like ripple of the muscle layer of a hollow organ progressive
motility that produces forward movement of matter along the GI tract

 The gastrointestinal system is the portal through which nutritive substances, vitamins,
 minerals, and fluids enter the body
 The gastrointestinal tract is made of four layers of tissues: the mucosa, submucosa,
 muscular and serosa
 The tongue is a highly muscular organ of deglutition, taste and speech
 There are four basic taste sensation; sweetness, saltiness, sourness and bitterness
 Teeth are organs of mastication and humans have two generations of teeth; the
deciduous and permanent
 The oesophagus has 4 constrictions where adjacent structure produce impression

 What is gastrointestinal system?
 What are the structures of the gastrointestinal tract?
 What are the functions of digestive system?
 What are the functions of salivary glands?
 What are the structure of the tongue?

 Describe structure and function of the tongue
106
References
Gastrointestinal tract image. (2015). Retrieved September, 27, 2015 from http://www.freeed.
net/sweethaven/MedTech/NurseCare/fig91801.
McGraw-Hill
McGraw-Hill
107
Handout 13.1: Overview of Alimentary Canal
Source: Sweet Haven, 2015
108
Handout 13.2: General Structure of the Alimentary Canal
109
Handout 13.3: The Teeth
110
111
Handout 13.4: The Tongue
Source: Standring, S., 2008
112
Handout 13.5: The Salivary Glands
113
114
Session 14: Structure and Functions of Stomach and
Intestines
Prerequisites
 None
Learning Tasks
 Identify structure and Functions of Pharynx and Oesophagus
 Describe Structure and Functions of the Stomach
 Describe Structure and Functions of the Small Intestines
 Describe Structure and Functions of the Large Intestines
Resources Needed:
 Handout 14.1: The Oesophagus
 Handout 14.2: General Structure of Stomach
 Handout 14.3: Blood Supply to the Stomach
 Handout 14.4: The duodenum
 Handout 14.5: Structure of Small Intestine
 Handout 14.6: Large Intestine
 Worksheet 14.1: Large Intestine
SESSION OVERVIEW
Activity/
Step Time Content
Method
15 minutes Structure of the Pharynx and Oesophagus

2 Presentation
25 minutes Presentation, Structure and Functions of the Stomach
3
Brainstorming
30 minutes Presentation Structure and Functions of the Small
4
Brainstorming Intestines
Structure and Functions of the Large
5 Individual
Intestines
Assignment
115
SESSION CONTENTS

STEP 2: Structure of the Pharynx and Oesophagus (15 minutes)
 Pharynx: A tube through which a bolus passes when moved from the mouth to the
oesophagus by the process of deglutition
 The pharynx is divided into three parts namely
o Nasopharynx
o Oropharynx
o Laryngopharynx
 The Oropharynx is important for digestive system

 The wall of the pharynx consists of three layers
 These are the Mucosa, Middle layer (Fibrous tissue) and Outer layer consisting of
Smooth muscles involved in swallowing
 When food enters the pharynx swallowing is no longer under voluntary control
 The oesophagus is a narrow muscular tube about 25 centimetres long diameter of
2cm, which starts at pharynx at the back of the mouth
 It passes through the thoracic diaphragm, and ends at the cardiac orifice of the
stomach
 It lies in the median plane in the thorax in front of the vertebral column behind the
trachea and the heart
 The oesophagus has 4 constrictions where adjacent structure produce impression
o At the beginning approximately 15cm from the incisor teeth and caused by the
cricopharyngeus muscles – upper oesophageal sphincter
o Where it crossed by the arch of aorta 22.5cm from the incisor teeth
o Where it crossed by the left main bronchus 27.5cm from the incisor
o Where it passes through the diaphragm – lower oesophageal sphincter
 At the top of the oesophagus, is a flap of tissue called the epiglottis that closes during
swallowing to prevent food from entering the trachea (windpipe)
 It has four layers; from outside:
o The adventitia
o Muscular layer; the muscles are striated (voluntary) in the upper third and mixed
(striated & smooth) in the middle and smooth (involuntary) in the lower third
o There are two layers:
 The inner is circular
 The outer is longitudinal
o Sub-mucosa layer
o Mucosa layer which is made up of stratified squamous epithelium
 Arterial blood supply of the oesophagus is through oesophageal arteries, branches of

thoracic aorta, inferior phrenic arteries and the left gastric branch of the celiac artery
116
 Venous drainage is through the azygos and hemiazygos veins
Refer students to Handout 14.1: The Oesophagus
STEP 3: Structure and Functions of the Stomach (25 minutes)
 What is a stomach?
 The stomach: The most dilated part of the gastrointestinal tract

 Has a J-like shape
 Positioned between the abdominal oesophagus and the small intestine, the stomach is
in the epigastric, umbilical and left hypochondrium regions of the abdomen
 Its shape and size varies from person to person; even within the same individual its
size and shape change from time to time depending on its food contents and the moisture
of the body and in adult capacity range from 1.0 to 1.5 litre
Structure of the Stomach

 The stomach is divided for descriptive purposes into four regions by arbitrary lines
drawn on its external surface which are
o The outlet of the stomach (pyloric orifice) is marked on the surface of the organ by
the pyloric constriction and surrounded by a thickened ring of gastric circular muscle
(the pyloric sphincter)
 The pyloric orifice is just to the right of midline in a plane that passes through the
lower border of vertebra LI (the trans pyloric plane)
 Other features of the stomach include:
o The greater curvature, which is a point of attachment for the gastro splenic ligament
and the greater omentum
o The lesser curvature, which is a point of attachment for the lesser omentum
o The cardial notch, which is the superior angle created when the oesophagus enters the
stomach
o The angular incisure, which is a bend on the lesser curvature
117
 The stomach is lined with simple columnar epithelium
 The epithelium forms numerous tube like gastric pits, which are the opening of the
gastric glands
 The epithelial cells of the stomach are of five types
 The first type is surface mucous cells which produce mucus, is on the surface and
lines the gastric pits
 The remaining four cell types are in the gastric glands
 They are mucous neck cells which produce mucus; parietal (oxyntic) cells which
secrete hydrochloric acid and intrinsic factor needed for vitamin B12 absorption; Chief
(zymogenic) cells which produce pepsinogen and endocrine cells, which produce
regulatory hormones
Refer students to Handout 14.2: General Structure of Stomach

 Blood supply of the stomach; a rich arterial supply, arise from the celiac trunk and its
branches.
 Most of the blood is supplied by anastomoses formed along the lesser curvature by the
right and left gastric arteries and, along the greater curvature, by the right and left gastro
omental artery (gastroepiploic artery)
 The fundus and upper body of stomach receive blood from the short and posterior
gastric arteries branches of the splenic artery
 Venous drainage is through gastric veins parallel the arteries in position and course
Refer students to Handout 14.3: Blood Supply to the Stomach
Functions of the Stomach

 Reservoir for food until it is partially digested and moved further along the GI tract
 Secrete gastric juice to aid in digestion of food
 Breaks food into small particles and mixes them with gastric juice
 Secrete intrinsic factor
 Carries limited absorption
 Produces gastrin hormone
 Helps protect body from pathogenic bacteria swallowed with food
STEP 4: Structure and functions of the Small Intestines (30 minutes)
 Where is small intestines found?

 What are the functions of small intestines?
118
 The small intestine extends from the pyloric sphincter to the ileocecal valve
 It is highly adapted for digestion and absorption
 Its glands produce enzymes and mucus
 The walls of small intestine are composed of four layers of tissues and there are some
modifications of the peritoneum and mucous membrane
 The surface area of the mucosa is greatly increased by permanent circular folds, villi
and microvilli
 Villi are tiny finger like projections of the mucosa layer into intestinal rumen about
0.5 too 1mm long, the function of villi is for absorption
 It consists of three parts:
o The duodenum
o The jejunum
o The ileum
 Duodenum is the first section of the small intestine
 It begins with the duodenal bulb and ends at the ligament of Treitz
o The duodenum also regulates the rate of emptying of the stomach via hormonal
pathways; Secretin and cholecystokinin which are released from cells in the duodenal
epithelium in response to acidic and fatty stimuli present there when the pylorus
opens and releases gastric chyme into the duodenum for further digestion
o The duodenum is divided into four sections for the purposes of description
o The first three sections curve in a "C" loop concavity in which the head of the
pancreas lies
o Only the first 2 cm of the superior part is mobile (not covered by peritoneum), the
distal 3cm of the first part along with the rest of the duodenum is retroperitoneal
(immobile)
 The first (superior) part begins as a continuation of the duodenal end of the
pylorus
 The second (descending) part of the duodenum begins at the superior duodenal
flexure
 It passes inferiorly to the lower border of vertebral body L3, before making a
sharp turn medially into the inferior duodenal flexure
 The third (inferior/horizontal) part of the duodenum begins at the inferior
duodenal flexure and passes transversely to the left, crossing the inferior vena
cava, aorta and the vertebral column
 The fourth (ascending) part passes superiorly, either anterior to, or to the right of,
the aorta, until it reaches the inferior border of the body of the pancreas
 Then, it curves anteriorly and terminates at the duodenojejunal flexure where it
joins the jejunum
Refer students to Handout 14.4: The Duodenum

 The jejunum is the middle section of the small intestine
o In adult humans, the small intestine is usually between 5.5-6m long, 2.5m of which is
the jejunum
o The inner surface of the jejunum, its mucous membrane, is covered in projections
called villi, which increase the surface area of tissue available to absorb nutrients from
the gut contents
119
o The epithelial cells which line these villi possess even larger numbers of microvilli
o The villi in the jejunum are much longer than in the duodenum or ileum
o The jejunum contains very few Brunner's glands (found in the duodenum) or Peyer's
patches (found in the ileum)
o It has many large circular folds in its submucosa called plicae circulares which
increase the surface area for nutrient absorption
 The ileum is the final section of the small intestine

 It is separated from the cecum by the ileocecal valve
o The function of the ileum is mainly to absorb vitamin B12 and bile salts and whatever
products of digestion which were not absorbed by the jejunum
o The wall itself is made up of folds, each of which has many tiny finger-like
projections known as villi on its surface
o In turn, the epithelial cells which line these villi possess even larger numbers of
microvilli.
o Therefore the ileum has an extremely large surface area both for the adsorption
(attachment) of enzyme molecules and for the absorption of products of digestion
o There is no line of demarcation between the jejunum and the ileum
o There are, however, subtle differences between the two
 The ileum has more fat inside the mesentery than the jejunum
 The ileum is a paler colour, and tends to be of a smaller caliber as well
 While the length of the intestinal tract contains lymphoid tissue, only the ileum
has abundant Peyer's patches, un-encapsulated lymphoid nodules that contain
large amounts of lymphocytes and other cells of the immune system
Refer students to Handout 14.5: Structure of Small Intestine
STEP 5: Structure and Functions of the Large Intestine (35 minutes)

 The large intestine extends from the ileocecal valve to the anus
 Its subdivisions include the cecum, colon, rectum, and anal canal
 The mucosa contains numerous goblet cells and the muscular is consists of taeniae
coli
 The large intestine is the second to last part of the digestive system, the final stage of
the alimentary canal is the anus
 It starts in the right iliac region of the pelvis, just at or below the right waist, where it
is joined to the bottom end of the small intestine
 From here it continues up the abdomen, then across the width of the abdominal cavity,
and then it turns down, continuing to its endpoint at the anus
 Its length is about 1.5 metres long, which is about one-fifth of the whole length of the
intestinal canal
 The following are the parts of the large intestine:

o The cecum or caecum (from the Latin caecus meaning blind), is a pouch, connecting
the ileum with the ascending colon of the large intestine
120
o It is separated from the ileum by the ileocecal valve is considered to be the beginning
of the large intestine
o It is also separated from the colon by the cecocolic junction
o The ascending colon is smaller in caliber than the cecum, with which it is contiguous
o It passes upward, from its commencement at the cecum, opposite the colic valve, to
the under surface of the right lobe of the liver, on the right of the gall-bladder, here it
bends abruptly forward and to the left, forming the right colic flexure (hepatic)
 Hepatic (or the right colic) flexure is the sharp bend between the ascending and
the transverse colon
 The right colic flexure is adjacent to the liver, and is therefore also known as the
hepatic flexure
 The left colic flexure is also known as the splenic flexure (as it is close to the
spleen)
o The transverse colon the longest and most movable part of the colon, passes with a
downward convexity from the right hypochondrium region across the abdomen,
opposite the confines of the epigastric and umbilical zones, into the left
hypochondrium region, where it curves sharply on itself beneath the lower end of
the spleen, forming the splenic or left colic flexure
o Toward its splenic end there is often an abrupt U-shaped curve which may descend
lower than the main curve
o The descending colon passes downward through the left hypochondrium and lumbar
regions, along the lateral border of the left kidney
o At the lower end of the kidney it turns medial-ward toward the lateral border of the
psoas muscle, and then descends, in the angle between psoas and quadratus
lumborum, to the crest of the ilium, where it ends in the sigmoid colon
o It is smaller in caliber and more deeply placed than the ascending colon
o The sigmoid colon (pelvic colon; sigmoid flexure) is the part of the large intestine that
is closest to the rectum and anus
o It forms a loop that averages about 40 cm. in length, and normally lies within the
pelvis, but on account of its freedom of movement it is liable to be displaced into
the abdominal cavity
o It begins at the superior aperture of the lesser pelvis, where it is continuous with the
iliac colon, and passes transversely across the front of the sacrum to the right side of
the pelvis (The name sigmoid means S-shaped.)
o It then curves on itself and turns toward the left to reach the middle line at the level of
the third piece of the sacrum, where it bends downward and ends in the rectum
o The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final
straight portion of the large intestine and terminating in the anus
o Its length is about 12 cm long
o Its caliber is similar to that of the sigmoid colon at its commencement, but it is dilated
near its termination, forming the rectal ampulla
 The rectum intestinum acts as a temporary storage site for faeces
 As the rectal walls expand due to the materials filling it from within, stretch
receptors from the nervous system located in the rectal walls stimulate the desire
to defecate
 If the urge is not acted upon, the material in the rectum is often returned to the
colon where more water is absorbed
121
 If defecation is delayed for a prolonged period, constipation and hardened faeces
results
 The rectum shortens as material is forced into the anal canal and peristaltic
waves propel the faeces out of the rectum
 The internal and external sphincters allows the faeces to be passed by muscles
pulling the anus up over the exiting faeces
o The anus is an opening at the opposite end of the digestive tract from the mouth
o Its function is to control the expulsion of faeces, unwanted semi-solid matter
produced during digestion
o Flow of substance through the anus is typically controlled by the anal sphincter
muscle
 The peritoneum covers the ascending and descending colon on the anterior surface
and sides, and therefore they are described as retroperitoneal
 The transverse colon and sigmoid colon are intraperitoneal
Refer students to Handout 14.6: Large Intestine
Activity: Individual Assignment (10 minutes)
PROVIDE each student with a Worksheet 14.1: Large Intestine.
ASK the students to work on the following assignment
 Label the diagram present on worksheet 14.1
REVIEW with them the correct answers using Handouts of this session.

 The stomach is the most dilated part of the gastrointestinal tract and has a J-like
shape.
 The small intestine extends from the pyloric sphincter to the ileocecal valve.
 Small intestine consists of three parts the duodenum, the jejunum and the ileum.
 Subdivisions of large include the cecum, colon, rectum, and anal canal.

 What are the parts of the stomach?
 What are the parts of the small intestine?
 What are the functions of the stomach?
 What are the functions of pharynx and oesophagus
122
References
McGraw-Hill
McGraw-Hill
123
Handout 14.1: The Oesophagus
124
Handout 14.2: General Structure of Stomach
125
126
Handout 14.3: Blood Supply to the Stomach
127
Handout 14.4: The Duodenum
128
Handout 14.5: Structure of Small Intestine
Source: Medical-Look
129
Handout 14.6: Large Intestine
130
Worksheet 14.1: Large Intestine
131
Session 15: Accessory Organs of Digestive System
Learning Tasks
 Describe the Accessory Organs of Digestive System
 Describe the Structure and Functions of the Liver
 Describe the Structure and Functions of Gallbladder
 Explain Organization of the Biliary System
 Explain Bile Production, Circulation and Functions
 Identify Structure of Pancreas
Prerequisites
 None
Resources Needed:
 Black/white board ,chalk and whiteboard markers
 Handout 15.1: Macroscopic Structure of the Liver
 Handout 15.2: Microscopic Structure of the Liver
 Handout 15.3: Blood Supply to the Liver and Gallbladder
 Handout 15.4: Structure of Gallbladder
 Handout 15.5: The Biliary System
 Handout 15.6: The pancreas
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation Accessory Organs of Digestive

2 10 minutes System
Brainstorming
35 minutes Presentation, Structure and Functions of the Liver
3
Buzzing
4 15minutes Presentation Structure and Functions of the Gallbladder
5 10 minutes Presentation Organization of the Biliary System
6 15 minutes Presentation Bile Production, Circulation and Functions

7 Structure and Functions of Pancreas
Brainstorming
132
SESSION CONTENTS

STEP 2: Overview of Accessory Organs of Digestive System (10 minutes)
 What are the accessory organs of the digestive system?
 Accessory organs of gastrointestinal tract: The organs which are not directly part of
gastrointestinal tract but their products are essential for the digestive system to accomplish its
primary function
 These organs include:
o The liver
o Gallbladder and bile duct
o Pancreas
 These are essential for the digestive system as they either produce or store secretions
essential the digestion to take place
STEP 3: Structure and Functions of the Liver (35 minutes)
 Liver is the largest gland in the body, weighing between 1 and 2.3Kg
 In adults the liver weighs 2% of body mass
 Occupying the greater part the right hypochondriac, part of the epigastric and frequently
extending into the left hypochondriac regions as far as the left lateral line
 The liver is divided into right and left lobes by fossae for the gallbladder and the inferior
vena cava
 The right lobe of liver is the largest lobe, whereas the left lobe of liver is smaller
wedge shaped
 The quadrate and caudate lobes are described as arising from the right lobe of liver, but
functionally are distinct these are seen on the posterior side of the liver making it to have four
lobes:
o The quadrate lobe
133
 It is visible on the upper part of the visceral surface of the liver
 It is bounded on the left by the fissure for ligamentum teres and on the right by the
fossa for the gallbladder
 Functionally it is related to the left lobe of the lever
o The caudate lobe

 It is visible on the lower part of the visceral surface of the liver
 Itis bounded on the left by the fissure for the ligamentum venosum and on the right by
the groove for the inferior vena cava
 Functionally, it is separate from the right and the left lobes of the live
 Surfaces of the liver include a diaphragmatic surface in the anterior, superior, posterior
directions and a visceral surface in the inferior direction
o The diaphragmatic surface of the liver, which is smooth and domed, lies against the
inferior surface of the diaphragm
o Associated with it are the sub phrenic and hepatorenal recesses
 The sub phrenic recess separates the diaphragmatic surface of the liver from the
diaphragm and is divided into right and left areas by the falciform ligament, a
structure derived from the ventral mesentery in the embryo
 The hepatorenal recess is a part of the peritoneal cavity on the right side between the
liver and the right kidney and right suprarenal gland
 The sub phrenic and hepatorenal recesses are continuous anteriorly
o The visceral surface of the liver is covered with visceral peritoneum except in the fossa
for the gallbladder and at the porta hepatic (gateway to the liver)
 Structures Related to Liver
o The right anterior part of the stomach

o The superior part of the duodenum
o The lesser omentum
o The gallbladder
o The right colic flexure
o The right transverse colon
o The right kidney
o The right suprarenal gland
Refer students to Handout 15.1: Macroscopic Structure of the Liver Structure
 The porta hepatic serves as the point of entry into the liver for the hepatic arteries and the
portal vein, and the exit point for the hepatic ducts
 The liver is attached to the anterior abdominal wall by the falciform ligament and, except
for a small area of the liver against the diaphragm (the bare area), the liver is almost
completely surrounded by visceral peritoneum
 Additional folds of peritoneum connect the liver to the stomach (hepatogastric ligament),
the duodenum (hepatoduodenal ligament), and the diaphragm (right and left triangular
ligaments and anterior and posterior coronary ligaments)
134
 The connective tissue septa divide the liver into hexagon-shaped lobules with a portal
triad at each corner
 The triad are so named because three vessels – the hepatic portal vein, hepatic artery and
hepatic duct are commonly located in them
 Hepatic nerves and lymphatic vessels often too small to be easily seen in light
micrographs are also located in these areas
 Liver lobules are hexagonal in outline and are formed by cubical-shaped cells; the
hepatocytes arranged in pair, between them are columns of cells called sinusoids
 Hepatic macrophages (Kupffer cells) are also present which function in destroy and ingest
worn out cells and foreign particles in the liver
 A central vein is in the centre of each lobule
 Central veins unite to form hepatic veins, which exit the liver on its posterior and superior
surface and empty into the inferior vena cava
 Hepatic cord radiate out from the central vein of each lobule like the spokes of a wheel
 The hepatic cords are composed of hepatocytes, the functional cells of the liver
 The spaces between the hepatic cords are blood channels called hepatic sinusoids
 The sinusoids are lined with a very thin, irregular squamous epithelium consisting of two
cell populations; endothelial cells and Hepatic phagocytic cells (kupffer cells)
 A cleft-like lumen, the bile canaliculus lie between the cells within each cord
Refer students to Handout 11.2: Microscopic Structure of the Liver
Functions of hepatocytes
 What are the functions of hepatocytes?
 Hepatocytes have six major functions, which are:

o Bile production
o Storage
o Interconversion of nutrients
o Detoxication
o Phagocytosis
o Synthesis of blood components
Main Functions of the Liver

 Nutrient and vitamin metabolism and storage
o Glucose and other sugars
135
o Amino acids (Deamination of amino acids),the end product is urea which is then excreted
in the urine)
o Lipids
o Fatty acids
o Cholesterol
o Lipoproteins
o Fat-soluble vitamins
o Water-soluble vitamins
 Breakdown of erythrocytes and defence against microbes

 Detoxification of drugs and noxious substances
 Inactivation of hormones such as Steroids
 Production of heat
 Formation and Secretion of biles
 Synthesis of plasma proteins
o Acute-phase proteins
o Albumin
o Clotting factor
o Steroid-binding and other hormone-binding proteins
 Immunity; by Kupffer cells
Vascular Supply and Lymphatic Drainage

 The vessels connected with the liver are the portal vein, hepatic artery and hepatic veins
 The portal vein and hepatic artery ascend in the lesser omentum to the porta hepatis,
where each bifurcates
 The hepatic bile duct and lymphatic vessels descend from the porta hepatis in the same
omentum
 The hepatic veins leave the liver via the posterior surface and run directly into the inferior
vena cava
Refer students to Handout 15.3: Blood Supply to the Liver and Gallbladder
STEP 4: Structure and functions of the Gallbladder (15 minutes)
 The gallbladder is a pear-shaped sac lying on the visceral surface of the right lobe of the
liver in a fossa between the right and quadrate lobes
 It is about 8 cm long and 4 cm wide
 The gallbladder has the following structures
o A rounded end (fundus of gallbladder), which may project from the inferior border of the
liver
o A major part in the fossa (body of gallbladder), which may be against the transverse colon
and the superior part of the duodenum
o A narrow part (neck of gallbladder) with mucosal folds forming the spiral fold
 The walls of the gallbladder is formed by three tunics which are

o Inner mucous layer which folded into reggae and this allows it to expand
o The muscular layer which contains smooth muscles that allows the gallbladder to contract
136
o The outer covering layer of the serosa
 Function of the gallbladder
o It stores and concentrates the bile which is secreted by the liver
o Concentration of the bile by up to 10 or 15 fold by absorption of water through the walls
of the gall bladder
o Release of stored bile
 Gallbladder receives many small vessels from hepatic bed and cystic arteries a branch of
right hepatic artery
 Venous drainage is through the multiple small veins from the gallbladder bed
Refer students to Handout 11.4: The Gallbladder
STEP 5: Organisation of the Biliary System (10 minutes)
Biliary system
 Is the duct system for the passage of bile extends from the liver, connects with the
gallbladder, and empties into the descending part of the duodenum
 The coalescence of ducts begins in the liver parenchyma and continues until the right and
left hepatic ducts are formed
 These drain the respective lobes of the liver
 The two hepatic ducts combine to form the common hepatic duct, which runs, near the
liver, with the hepatic artery proper and portal vein in the free margin of the lesser omentum
 As the common hepatic duct continues to descend, it is joined by the cystic duct from the
gallbladder
 This completes the formation of the bile duct
 At this point, the bile duct lies to the right of the hepatic artery proper and usually to the
right of, and anterior to, the portal vein in the free margin of the lesser omentum
 The omental foramen is posterior to these structures at this point
 The bile duct continues to descend, passing posteriorly to the superior part of the
duodenum before joining with the pancreatic duct to enter the descending part of the
duodenum at the major duodenal papilla
 Therefore the bile either empties directly into the duodenum or is diverted for minutes up
to several hours through the cystic duct into the gallbladder
 The clinical importance of this system is if there is a tumour of the head of pancrease will
cause obstruction to the bile duct and cause a condition known as obstructive jaundice
Refer students to Handout 15.5: The Biliary System
STEP 6: Bile Production, Circulation and Functions (15 minutes)
 The liver produces and secretes about 600-1000ml of bile each day
 Continuous bile formation is an important function of the liver
 Bile is used as a vehicle for the secretion of bile acids
 Bile salts are quantitatively the major constituents of bile and are circulated in the
enterohepatic circulation between the liver and the small intestine with high efficiency
 Synthesis of bile acids is a major route of cholesterol metabolism
 Bile is synthesised through a series of chemical reactions in hepatocytes then secreted
into minute bile canaliculi that originate between the hepatic cells
137
 The mechanism involved in the transcellular movement of bile salts across hepatocytes is
poorly understood
 The body produces about 800 mg of cholesterol per day and about half of that is used for
bile acid synthesis
 90% of excreted bile acids are reabsorbed by active transport in the ileum and recycled in
what is referred to as the enterohepatic circulation which moves the bile salts from the
intestinal system back to the liver and the gallbladder
 Clinical significance is, since bile acids are made from endogenous cholesterol, the
enterohepatic circulation of bile acids may be disrupted to lower cholesterol
 Bile circulation.
o Bile is produced by hepatocytes in the liver
o Bile draining through the many bile ducts that penetrate the liver
o During this process, the epithelial cells add a watery solution that is rich in bicarbonates
that dilutes and increases alkalinity of the solution
o Bile then flows into the common hepatic duct, which joins with the cystic duct from the
gallbladder to form the common bile duct
o The common bile duct in turn joins with the pancreatic duct to empty into the duodenum
o If the sphincter of Oddi is closed, bile is prevented from draining into the intestine and
instead flows into the gallbladder, where it is stored and concentrated to up to five times
its original potency between meals
o This concentration occurs through the absorption of water and small electrolytes, while
retaining all the original organic molecules
o Cholesterol is also released with the bile, dissolved in the acids and fats found in the
concentrated solution.
o When food is released by the stomach into the duodenum in the form of chyme, the
duodenum releases cholecystokinin, which causes the gallbladder to release the
concentrated bile to complete digestion
o Most bile salts are absorbed in ileum and carried in the blood back to liver
o The concentration of bile salts in bile is 0.8%, however the gall bladder removes water
from the bile, concentrating it between meals
o It concentrates it up to 5 times
 Bile has no enzyme but plays a role in the digestion by neutralize and diluting stomach
acids and emulsifying fat
 Bile constitutes of :
o Water
o Mineral salts
o Mucous
o Bile pigment (bilirubin),
o Bile salts which are derived from the primary bile acids
o cholesterol
 Bile plays an important role in fat digestion and absorption due to the presence of bile
acids by do the following;
o They help to emulsify the large fat particles of the food into many minute particles, the
surface of which can then be attacked by lipase enzymes secreted in pancreatic juice.
o They aid in absorption of the digested fat end products through the intestinal mucosal
membrane.
 Bile serves as a means for excretion of several important waste products from the blood.
138
 These include especially bilirubin, an end product of haemoglobin destruction, and
excesses of cholesterol.
Composition of Bile
 Water constitute 97.0%, in the gall bladder the amount is reduced 5 folds
 Bile pigments 0.2%
 Cholesterol0.06%
 Inorganic salts 0.7% such as Na+, K+& Ca2+ salts Cl- HCO3 & Phosphorus
 Fatty acids 0.15%
 Lecithin 0.1%
 Fat 0.1%
 Alkaline phosphatase
 Proteins
STEP 7: Structure and Functions of Pancreas (20 minutes)
 What are the functions of the pancreas?
 The pancreas lies mostly posterior to the stomach

 It extends across the posterior abdominal wall from the duodenum, on the right, to the
spleen, on the left
 It is 12 to 15 cm long; weighs approximately 60gm
 Composed of endocrine and exocrine glandular tissue
o Exocrine portion makes up majority of pancreas; has a compound acinar arrangement and
tiny ducts which unite to form the main pancreatic duct, which empties into the
duodenum
o It secretes pancreatic juice which consists of pancreatic enzymes
o Endocrine portion – embedded between exocrine units; called pancreatic islets; constitute
only 2% of the total mass of the pancreas; made up of alpha cells and beta cells which
produce glucagon and insulin respectively and pass its secretions into capillaries
 The pancreas is (secondarily) retroperitoneal except for a small part of its tail and consists
of a head, uncinate process, neck, body, and tail:
o The head of pancreas lies within the C-shaped concavity of the duodenum
o Projecting from the lower part of the head is the uncinate process, which passes posterior
to the superior mesenteric vessels
139
o The neck of pancreas is anterior to the superior mesenteric vessels, and, posterior to the
neck of the pancreas, the superior mesenteric and the splenic veins join to form the portal
vein
o The tail of pancreas ends as it passes between layers of the spleno-renal ligament.
 The pancreatic duct begins in the tail of the pancreas
 It passes to the right through the body of the pancreas and, after entering the head of the
pancreas, turns inferiorly
 In the lower part of the head of pancreas, the pancreatic duct joins the bile duct
 The joining of these two structures forms the hepatopancreatic ampulla (Ampulla of
Vater), which enters the descending part of the duodenum at the major duodenal papilla
 Surrounding the ampulla is the sphincter of ampulla (sphincter of Oddi), which is a
collection of smooth muscle
 The accessory pancreatic duct empties into the duodenum just above the major duodenal
papilla at the minor duodenal papilla
 If the accessory duct is followed from the minor papilla into the head of the pancreas, a
branch point is discovered
o One branch continues to the left, through the head of the pancreas, and may connect with
the pancreatic duct at the point where it turns inferiorly
o A second branch descends into the lower part of the head of pancreas, anterior to the
pancreatic duct, and ends in the uncinate process
 The main and accessory pancreatic ducts usually communicate with each other
 The presence of these two ducts reflects the embryologic origin of the pancreas from
dorsal and ventral processes
 The blood supply; the arterial supply is through pancreatic arteries the branches of splenic
artery, gastro-duodenal and superior mesenteric arteries
 Venous drainage follows arterial supply
 Splenic vein drains the body and tail
 Innervation of Pancreas is from sympathetic and parasympathetic nerves of coelic and
superior mesenteric ganglion of thoracic plexus and vagus nerve
 Note: Digestive enzymes produced by pancreas will be discussed in Session: 24 of this
module
Refer students to Handout 15.6: The Pancreas
140
 Accessory organs of the gastrointestinal tract are the liver, gallbladder, bile duct and
pancreas
 The liver is divided into right and left lobes by fossae for the gallbladder and the inferior
vena cava
 Bile contains water, bile pigments, cholesterol ,inorganic salts such as Na+, K+& Ca2+
salts Cl- HCO3 & Phosphorus ,fatty acids, lecithin, fat ,Alkaline phosphatase, proteins
 Pancreas composed of endocrine and exocrine glandular tissue

 What are the accessory organs of digestive system?
 What are the components of bile?
 What are the functions of the pancreas?
 What are the functions of gallbladder?
141
References
McGraw-Hill
McGraw-Hill
142
Handout 15.1: Macroscopic Structure of the Liver
143
144
Handout 15.2: Microscopic Structure of the Liver
145
Handout 15.3: Blood Supply to the Liver and Gallbladder
Source: Moore, K. L., & Agur, A. M. R.

(2007)
Source: Moore, K. L., & Agu, A. M. R. (2007
146
Handout 15.4: Structure of Gallbladder
147
Handout 15.5: The Biliary System
148
.
Handout 15.6: The pancreas
149
Source: Brooks Cole Thomson learning, 2001
150
Session 16: Common Disorders of Gastrointestinal System
Prerequisites
 None
Learning Tasks
 List the Common Features of Gastrointestinal Pathologies
 Explain Common Features of Gastrointestinal Pathologies
 Explain Gastrointestinal Bleeding
 Describe Disorders of Gastrointestinal Motility
 Explain Functional Gastrointestinal Disorder
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
2 Common features of Gastrointestinal Pathologies
Brainstorming
05 minutes
3 presentation Disorder of gastrointestinal bleeding
4 Brain storming Disorders of Gastrointestinal Motility
5 Functional Gastrointestinal Disorders
05 minutes
6 Presentation Key Points
05 minutes
7 Presentation Evaluation
10 minutes
8 presentation Take home assignment
151
SESSION CONTENTS

STEP 2: Features of Gastrointestinal Pathologies (10 minutes)
 What are the features of gastrointestinal pathologies?
Regardless of the cause and type of a disease Gastrointestinal (GI )pathologies have the
following presenting features:
 Abdominal pain
 GI bleeding
 Diarrhoea
 Steatorrhea
 Constipation
 Nausea
 Vomiting
 Dysphagia
 Odynophagia
 Gastroesophageal reflux
 Anorexia
 Weight loss
Abdominal pain
 Pain originates from tissue injury, distention, contraction, inflammation, and direct chemical
injury.
 Visceral pain is often poorly localized and loosely corresponds to the spinal segment that
innervates the involved viscus.
 Examples include peptic ulcer disease in which pain is localized to the epigastrium, and early
appendicitis, in which pain is localized around the periumbilical region.
o Somatoparietal pain arises from noxious stimulation of the parietal peritoneum.
 This type of pain is more localized and intense and corresponds to the dermatomal
distribution that innervates the injured portion of the peritoneum.
152
 Somatoparietal pain is aggravated by movement such as coughing or a bumpy car
ride.
 Examples of somatoparietal pain include appendicitis, with localized right lower
quadrant pain attributable to localized peritonitis, and an abscess, with localized pain
over the perforated viscus and inflammatory collection.
 Referred pain is perceived by the patient in areas that are remote from the diseased organ.
Diarrhoea
 An increased number or fluidity of stools is usually due to an excess of water in stool.
 Most people have experienced loose stools for a day or two (e.g. viral gastroenteritis), but
other causes, such as inflammatory bowel disease, can be chronic and cause intermittent
symptoms for a patient's entire lifetime.
 Diarrhoea results from
o An increase in secretion
o Decrease in absorption, or both
 It is classified as : secretory or osmotic diarrhoea
 Although there may be overlap, osmotic diarrhoea usually ceases when a patient takes
nothing by mouth, whereas secretory diarrhoea continues
 Large-volume diarrhoea generally originates from the small intestine
 Small-volume diarrhoea generally originates from the colon
 Blood in the stool always implies an underlying organic abnormality
 Bloody diarrhoea occurs with mucosal inflammation or erosions or ulcerations secondary
to infectious, inflammatory, or ischemic enterocolitis.
Steatorrhea
 Steatorrhea, or fatty stools, arises from disruption of fat solubilisation, digestion, or
absorption in the small intestine.
 Mal digestion, or inadequate luminal breakdown of fats, occurs with pancreatic exocrine
deficiency or lack of bile.
 Malabsorption, or inadequate transport of the products of digestion, occurs with mucosal
diseases such as celiac sprue or during impaired lymphatic transport.
Constipation
 Occurs most commonly in the elderly
 Often used to describe more than one symptom, including:
o Infrequent stools
o Difficult passage of stool
o A sense of incomplete evacuation
o Abdominal bloating or discomfort
 The causes of constipation are as varied as the complaints and include:

o Inadequate stool water or faecal material,
o Decreased colonic motility
o Reduced mobility
o Chronic illness
o Medication use
o Psychological factors
o Functional outlet obstruction
153
 Treatment plans vary, but the simplest and most common starting point is to increase the
patient's daily fibre and fluid intake.
Nausea and Vomiting

 Nausea and vomiting may be manifestations of GI diseases or primary non-GI diseases
and may lead to fluid and electrolyte imbalances, nutritional deficiencies, aspiration
pneumonia and oesophageal rupture
 Nausea is the unpleasant sensation of the desire to vomit
 Retching, or ‗dry heaves,‘ is coordinated voluntary muscle activity of the abdomen and
chest without discharge of stomach contents into the mouth
 Vomiting, or the act of emesis, occurs as gastric contents are forcefully ejected out of the
mouth
 Nausea and vomiting may be acute, such as with acute obstruction, inflammation, or
ischemia, other acute infections, medication, pregnancy or head trauma.
 Nausea and vomiting that are chronic in nature are usually associated with pregnancy,
medications, and motility disorders such as diabetic, gastroparesis, partial obstruction,
intracranial disease, psychogenic disorders, or an underlying metabolic or endocrine
disturbance.
Dysphagia
 Dysphagia, or the sensation of solids or liquids not passing from the mouth into the
stomach,
 It is a common symptom and can be divided into: oropharyngeal dysphagia and
oesophageal dysphagia.
o The former may be caused by: neuromuscular disease, mechanical obstruction, skeletal
muscle disorders, depression, or dementia
o Patients are unable to propel their food from the hypopharynx into the upper oesophagus
specifically localize their symptoms to the upper cervical region.
o Coughing or aspiration during meals indicates that food has passed into the
tracheobronchial tree
 Oesophageal dysphagia is caused by either :
o Motility disorder, such as achalasia, diffuse oesophageal spasm, or scleroderma, or
o Mechanical obstruction, such as a benign stricture, ring, or neoplasm.
Gastroesophageal Reflux Disease (GERD)

 The terms heartburn, acid regurgitation, sour stomach, and bitter taste are all used to
describe GERD symptoms
 Reflux occurs when the oesophageal epithelium is exposed to gastric secretions
 Some degree of gastric reflux is considered normal, but symptoms occur when the
mucosa's tolerance to acid is exceeded
 In addition to the typical symptoms of heartburn or chest pain, extra-oesophageal
manifestations of GERD include laryngitis, asthma, and chronic cough
 GERD develops when acidic gastric contents reflux into the oesophagus and remain there
long enough to overcome the resistance of the oesophageal epithelium.
Anorexia and Early Satiety

 Anorexia is loss of the desire to eat,
154
 Is a major symptom in many GI and non-GI diseases, including central nervous system,
systemic, and psychological disorders.
 Anorexia may be acute, such as that caused by inflammatory GI processes, or chronic,
such as that caused by depression.
 Chronic anorexia may lead to significant weight loss, especially in patients with
hypermetabolic states such as malignancy
 Early satiety may be acute or chronic, but it is usually insidious in onset
 Patients report that they are simply not hungry at meal time, must often ‗force‘
themselves to eat, yet still eat far less than they had in the past
 Common causes include
o Delayed gastric emptying such as occurs in long-term diabetes mellitus
o Decreased gastric distention secondary to gastric malignancy
o Gastric outlet obstruction caused by peptic ulcer disease
STEP3: Disorders of Gastrointestinal Motility (05 minutes)

 GI bleeding can be either acute or chronic, and it can be massive or occult
 Acute upper GI bleeding, which may be manifested as
o Hematemesis
o Melena
o Haematochezia, is three times more common than acute lower GI bleeding
 The two most common causes of acute lower GI bleeding are diverticulosis and
arteriovenous malformations
 Occult bleeding is defined as the detection of asymptomatic blood loss from the
gastrointestinal tract, generally by routine faecal occult blood testing or the presence of iron
deficiency anaemia
STEP4: Disorders of Gastrointestinal Motility (10 minutes)
 What are the disorders of gastrointestinal motility?
 Motility disorders result from impaired control of the neuromuscular apparatus of the
gastrointestinal tract
 Associated symptoms include:
o Recurrent or chronic nausea and vomiting
o Bloating and abdominal discomfort
o Constipation or diarrhoea in the absence of intestinal obstruction
 Gastrointestinal motility disturbances result from disorders of the extrinsic nervous
system, enteric nervous system, intestinal pacemakers, or smooth muscle
155
 Combined disorders occur in systemic sclerosis, amyloidosis and mitochondrial
cytopathy, which initially can manifest with neuropathic patterns and later displaymyopathic
characteristics with disease progression.
 Genetic defects that result in congenital dysmotilities include abnormalities of
transcription factors which enhances maturation of neural precursors, are associated with the
phenotypic picture recognized as Hirschsprung's disease, hypertrophic pyloric stenosis and
congenital megacolon
 Extrinsic neuropathic processes include vagotomy, trauma, Parkinson's disease, diabetes
amyloidosis and a para-neoplastic syndrome usually associated with small cell carcinoma of
the lung
STEP 5: Functional Gastrointestinal Disorders (10 minutes)

 The most widely recognized functional gastrointestinal disorders are
o Irritable bowel syndrome (IBS)
o Functional (or non-ulcer) dyspepsia
 Dyspepsia refers to persistent or recurrent epigastric pain or meal-related upper
abdominal discomfort that may be characterized by early satiation or postprandial fullness
 Heartburn (typically a burning pain or discomfort that rises up the retro sternum) is
distinct from dyspepsia
 Helicobacter pylori infection is the most common cause of histologic gastritis in humans
and is causally linked to peptic ulcer disease and gastric
o Reflux of bile into the stomach is not more frequent in patients with functional dyspepsia
than in healthy controls
 The role of major life stresses, such as bereavement or divorce, in the pathogenesis of
functional dyspepsia is controversial
 Coffee may induce symptoms in approximately 50% of patients with functional dyspepsia
versus one in five healthy controls, perhaps because coffee acts as a direct irritant, stimulates
acid secretion, or precipitates gastroesophageal reflux.
 Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) cause asymptomatic
mucosal lesions in 30 to 60% of chronic users and can cause dyspepsia, but symptoms do not
correlate with mucosal damage scores.
o Typical ulcer symptoms, such as epigastric pain related to meals or waking the patient
from sleep (ulcer-like dyspepsia).

 Common disorders of the gastrointestinal system and accessory organs include
ulcerations, hernia, pancreatitis, jaundice and haemorrhoids, constipation
 Diarrhoea results from an increase in secretion, decrease in absorption, or both

 Dysphagia, or the sensation of solids or liquids not passing from the mouth into the
stomach, is a common symptom and can be divided into oropharyngeal dysphagia and
oesophageal dysphagia.
 Anorexia must be distinguished from the fear of eating because of associated discomfort,
such as occurs in intestinal angina or inflammatory bowel disease.

 What are common features of gastrointestinal system?
 What are the common disorders of gastrointestinal system?
 What are the causes of constipation?
156
 What is steatorrhea?
 What are the causes of gastrointestinal bleeding?

 Describe disorders of gastrointestinal motility
157
References
Seeley, R. R., Stephens, T. D. & Tate, P. (2003). Anatomy and Physiology. New York:
McGraw-Hill
McGraw-Hill
158
Session 17: Composition and Functions of Blood
Prerequisites
 None
Learning Tasks
 List the Components of Blood
 Describe Functions of Blood
 Describe Blood Plasma
 Describe Erythrocytes, Leucocytes and Platelets
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Presentation Components of Blood
2
Brainstorming
3 Functions of Blood
Buzzing
4 Blood Plasma and Platelets
5 Brainstorming Production and Functions of Red Blood Cells
6 Small Group Production and Functions of White Blood Cells
Discussion
05 minutes
05 minutes
159
SESSION CONTENTS

STEP 2: Components of Blood (10 minutes)

 What are the components of blood?
 Blood is the specialized bodily fluid that delivers necessary substances to the body's cells
such as nutrients, oxygen and transports waste products away from those same cells
 Blood accounts for 7% of the human body weight
 By volume the red blood cells constitute about 45% of whole blood, the plasma
constitutes about 55%
 The average adult has a blood volume of roughly 5 litres, composed of:
o Plasma
o Formed elements
 These formed elements of the blood are
o Erythrocytes (red blood cells)
o Adult humans have roughly 2–3 × 1013 red blood cells
o Leukocytes (white blood cells) and 4,000–11,000 white blood cells
o Thrombocytes (platelets). 150,000–400,000 platelets in each microliter
 Women have about 4 to 5 million erythrocytes per microliter (cubic millimeter) of blood
and men about 5 to 6 million; people living at high altitudes with low oxygen tension will
have more
STEP 3: Functions of Blood (10minutes)

 What are the functions of blood?
Functions of blood
160
 Supply of oxygen to tissues (bound to haemoglobin which is carried in red cells) bound to
plasma proteins (e.g. blood lipids)
 Removal of waste such as carbon dioxide, urea and lactic acid
 Immunological functions, including circulation of white cells, and detection of foreign
material by antibodies
 Coagulation, which is one part of the body's self-repair mechanism
 Messenger functions, including the transport of hormones and the signalling of tissue
damage
 Regulation of body pH (the normal pH of blood is in the range of 7.35 - 7.45)
 Regulation of core body temperature
STEP 4: Blood Plasma and Platelets (15minutes)

Blood Plasma
 Is the fluid portion of the blood,
 The plasma, is a remarkable solution containing an immense number of ions, inorganic
molecules, and organic molecules that are in transit to various parts of the body or aid in the
transport of other substances
 The normal plasma volume is about 5% of body weight, or roughly 3500 mL in a 70kg
man
 Plasma clots on standing, remain fluid only if an anticoagulant is added
 If whole blood is allowed to clot and the clot is removed, the remaining fluid is called
serum
 Serum has essentially the same composition as plasma except that its fibrinogen an
clotting factors II, V, and VIII have been removed and it has higher serotonin content because
of the breakdown of platelets during clotting
 The plasma consist of protein; albumin, globulin, and fibrinogen fractions
 The capillary walls are relatively impermeable to the proteins plasma, and the proteins are
therefore exerting an osmotic force of about 25 mm Hg across the capillary wall (oncotic
pressure) that pulls water into the blood
Blood Platelets
 Platelets or thrombocytes are minute fragment of cells consisting of a small amount of
cytoplasm surrounded by a plasma membrane
 Platelets are roughly disk-shaped and an average about 3μm in diameter.
 They play an important role in controlling blood loss by forming platelets plugs which
seal holes in small vessels
 The life expectancy of platelets is about 5 - 9 days
 Platelets arise in a unique manner by the shedding of thousands of cytoplasmic fragments
from the tips of processes of megakaryocytes in the bone marrow
 The first detectable cell of this line is the highly basophilic megakaryoblast, followed by a
promegakaryocyte stage, in which synthesis of granules begins
 Finally, the fully differentiated megakaryocyte, a giant cell with a large, dense, polyploid,
multilobed nucleus, appears
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STEP 5: Production and Functions of Red Blood Cell (35 minutes)
 What is the red blood cell?

 What are the functions of Red blood cells?

Red Blood Cells

 Red blood cells (Erythrocytes) are the most common type of blood cell
 The cells are filled with haemoglobin, a biomolecule that can bind to oxygen
 They take up oxygen in the lungs and release it while squeezing through the body's
capillaries.
 The blood's red colour is due to the colour of haemoglobin.
 In humans, red blood cells develop in the bone marrow, take the form of flexible
biconcave disks, lack a cell nucleus, subcellular organelles and the ability to synthesize
protein,
 It takes about 7 days for erythrocytes to mature and live a total of about 120 days
 Erythropoiesis is the process by which red blood cells (erythrocytes) are produced
o In human adults, this usually occurs within the bone marrow
o In the early foetus, erythropoiesis takes place in the mesodermal cells of the yolk sac.
o By the third or fourth month, erythropoiesis moves to the spleen and liver
o In humans with certain diseases, erythropoiesis also occurs outside the bone marrow,
within the spleen or liver
o This is termed extramedullary erythropoiesis
 The tibia and femur cease to be important sites of haematopoiesis by about age 25; the
vertebrae, sternum, pelvis and ribs, and cranium bones continue to produce red blood cells
throughout life.
 Erythrocytes and granulocytes belong to the myeloid lineage.
 The earliest identifiable erythroid stem cells are capable of rapid bursts of cell division to
form numerous daughter cells.
 In the process of red blood cell maturation, a cell undergoes a series of differentiations.
 The following stages of development all occur within the bone marrow.
o Pluripotent haematopoietic stem cell is cells which are capable of giving rise to all
blood cell types.
o The first readily identifiable cell of the erythroid series is the proerythroblast, a large cell
with a large euchromatic nucleus and moderately basophilic cytoplasm
o It also responds to erythropoietin
o The proerythroblast contains small amounts of ferritin and bears some of the protein
spectrin on its plasma membrane
o Proerythroblasts proliferate to produce smaller basophilic erythroblasts, rich in
ribosomes, in which haemoglobin-RNA synthesis begins
o The cytoplasm becomes partially, and then uniformly, eosinophilic (the polychromatic
erythroblast and orthochromatic erythroblast respectively).
162
o The nucleus becomes intensely pyknotic and is finally extruded from the cell, leaving an
anucleate reticulocyte, which enters a sinusoid
o Its reticular staining pattern, visible using special stains, results from residual cytoplasmic
RNA which is lost within 24 hours of entering the peripheral blood circulation
o Reticulocyte numbers in peripheral blood are therefore a good indicator of the rate of red
cell production
o The whole process of erythropoiesis takes 5-9 days
 After these stages, the cell is released from the bone marrow, and ultimately becomes an
‗erythrocyte‘ or matures red blood cell circulating in the peripheral blood
Regulation of Erythropoiesis
 Erythropoietin is a glycoprotein (protein-sugar conjugate) that serves as the primary
regulator of red blood cells (erythrocytes).
 It stimulates bone marrow stem cells to differentiate into red blood cells and controls
haemoglobin synthesis and red blood cell concentration.
 Erythropoietin production is stimulated by reduced oxygen content in arterial blood in
the kidneys.
 Circulating erythropoietin binds to receptors on the surface of erythroid progenitor cells
that in turn mature into red blood cells.
 In infants, erythropoietin is produced mostly in the liver, but the kidneys become the
primary site of erythropoietin synthesis shortly after
Functions of Red Blood Cells

 Red blood cells are highly specialized for their oxygen transport function.
 Because mature RBCs have no nucleus, all their internal space is available for oxygen
transport.
 Because RBCs lack mitochondria and generate ATP anaerobically (without oxygen), they
do not use up any of the oxygen they transport
 Even the shape of an RBC facilitates its function. A biconcave disc has a much greater
surface area for the diffusion of gas molecules into and out of the RBC than would, say, a
sphere or a cube
 Each RBC contains about 280 million haemoglobin molecules
 A haemoglobin molecule consists of a protein called globin, composed of four
polypeptide chains (two alpha and two betachains); a ring like non protein pigment called a
heme is bound to each of the four chains
 At the center of eachheme ring is an iron ion (Fe2_) that can combine reversibly with one
oxygen molecule, allowing each haemoglobin molecule to bind four oxygen molecules.
 Each oxygen molecule picked up from the lungs is bound to an iron ion
 As blood flows through tissue capillaries, the iron–oxygen reaction reverses.
 Haemoglobin releases oxygen, which diffuses first into the interstitial fluid and then into
cells.
 Haemoglobin also transports about 23% of the total carbon dioxide, a waste product of
metabolism.
 Blood flowing through tissue capillaries picks up carbon dioxide, some of which
combines with amino acids in the globin part of haemoglobin.
 As blood flows through the lungs, the carbon dioxide is released from haemoglobin and
then exhaled.
 In addition to its key role in transporting oxygen and carbon dioxide, haemoglobin also
plays a role in the regulation of blood flow and blood pressure.
163
 The gaseous hormone nitric oxide (NO), produced by the endothelial cells that line blood
vessels, binds to haemoglobin.
 Under some circumstances, haemoglobin releases NO. The released NO causes
vasodilation, an increase in blood vessel diameter that occurs when the smooth muscle in the
vessel wall relaxes.
 Vasodilation improves blood flow and enhances oxygen delivery to cells near the site of
NO release.
STEP 6 : Production and Functions of White Blood Cells (35minutes)

ASK students to discuss on the following questions

 What are the white blood cells?
 What are the functions of white blood cells?
ALLOW each groups to present for 5 minutes
 White blood cells, or leukocytes, are cells of the immune system defending the body
against both infectious disease and foreign materials
 Five different and diverse types of leukocytes exist, but they are all produced and derived
from a multipotent cell in the bone marrow known as a hematopoietic stem cell
 Leukocytes are found throughout the body, including the blood and lymphatic system.
 The number of leukocytes in the blood is often an indicator of disease
 There are normally between 4×109 and 11×109 white blood cells in a litre of blood,
making up approximately 1% of blood in a healthy adult
 In conditions such as leukaemia, the number of leukocytes is higher than normal, and in
leukopenia, this number is much lower
Types of White Blood Cells

 There are several different types of white blood cells
 They all have many things in common, but are all different
 One primary technique to classify them is to look for the presence of granules, which
allows the differentiation of cells into the categories granulocytes and granulocytes
Granulocytes (Polymorphonuclear Leukocytes)

 Leukocytes characterised by the presence of differently staining granules in their
cytoplasm when viewed under light microscopy
 These granules are membrane-bound enzymes which primarily act in the digestion of
endocytosed particles
 There are three types of granulocytes: neutrophils, basophils, and eosinophils, which are
named according to their staining properties
Agranulocytes (Mononuclear Leucocytes)

164
 Leukocytes characterized by the apparent absence of granules in their cytoplasm
 Although the name implies a lack of granules these cells do contain non-specific
azurophilic granules, which are lysosomes
 The cells include monocytes, macrophages and lymphocytes
Functions of White Blood Cells

Neutrophil
 Neutrophils defend against bacterial or fungal infection and other very small
inflammatory processes that are usually first responders to microbial infection; their activity
and death in large numbers forms pus.
 Neutrophils are very active in phagocytosing bacteria and are present in large amount in
the pus of wounds.
 These cells are not able to renew their lysosomes used in digesting microbes and die after
having phagocytosed a few pathogens
Eosinophil
 Eosinophils primarily deal with parasitic infections and an increase in them may indicate
parasitic infection
 They are also the predominant inflammatory cells in allergic reactions
 The most important causes of eosinophilia include allergies such as asthma, hay fever,
and hives; and also parasitic infections
 Basophils are chiefly responsible for allergic and antigen response by releasing the
chemical histamine causing inflammation
Monocyte
 They have the kidney shaped nucleus and are typically agranulated
 They also possess abundant cytoplasm
 Monocytes share the ‗vacuum cleaner‘ (phagocytosis) function of neutrophils
 Are much longer lived as they have an additional role: they present pieces of pathogens
to T cells so that the pathogens may be recognized again and killed, or so that an antibody
response may be mounted
 Monocytes eventually leave the bloodstream to become tissue macrophages which
remove dead cell debris as well as attacking microorganisms
 Neither of these can be dealt with effectively by the neutrophils
 Unlike neutrophils, monocytes are able to replace their lysosomal contents and are
thought to have a much longer active life
Macrophage
 Once monocytes move from the bloodstream out into the body tissues, they undergo
changes (differentiate) allowing phagocytosis and are then known as macrophages
Lymphocyte
 Lymphocytes are much more common in the lymphatic system
 Lymphocytes are distinguished by having a deeply staining nucleus which may be
eccentric in location
 Are relatively small amount of cytoplasm
 The blood has three types of lymphocytes.
o B cells; which make antibodies that bind to pathogens to enable their destruction
o T cells; these include CD4+ (helper) T cells co-ordinate the immune response (they are
what become defective in an HIV infection).
o CD8+ (cytotoxic) are able to kill virus-infected and tumour cells.
165
o T cells are crucial to the immune response because they possess a unique 'memory'
system which allows them to remember past invaders and prevent disease when a similar
invader is encountered again.
o Natural Killer Cells (NK cells).
o Natural killer cells are able to kill cells of the body that are infected by a virus or have
become cancerous.
STEP 7:Key Points (5minutes)
 Blood is a specialized bodily fluid that delivers necessary substances to the body's cells
such as nutrients, oxygen and transports waste products away from those same cells
 The fluid portion of the blood is called the plasma.
 White blood cells, or leukocytes, are cells of the immune system defending the body
against both infectious disease and foreign materials.
 Platelets play an important role in controlling blood clotting.
 What are the components of blood?

 What are the functions of blood?
 What is blood plasma?
 What are the functions of leukocytes and erythrocytes?
166
References
McGraw-Hill.
Press, Inc.
167
Session 18: The ABO Blood Grouping System and Rhesus
Factors
Prerequisites
 None
Learning Tasks
 Describe the ABO System of Blood Grouping
 Describe Rhesus Factors in Relation to Blood Grouping
 Describe Blood Clotting Mechanism
 Explain the Role of Vitamin K in Clotting
Resources Needed:
 Computer
 Projector
SESSION OVERVIEW
Activity/
Step Time Content
Method
40 minutes Presentation The ABO System of Blood Grouping
2
Brainstorming
3 Rhesus Factors in Relation to Blood Grouping
Brainstorming
Presentation
Blood Clotting Mechanism and Role of Vitamin
4 40 minutes Small Group
K in Clotting
Discussion
05 minutes
05 minutes
168
SESSION CONTENTS

STEP 2: The ABO System of Blood Grouping (40 minutes)

 What is ABO system of blood grouping?
 Blood type (group)

o A classification of blood based on the presence or absence of inherited antigenic
substances on the surface of red blood cells (RBCs).
o These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending
on the blood group system, and some of these antigens are also present on the surface of
other types of cells of various tissues.
o Several of these red blood cell surface antigens, collectively form a blood group system
o Blood types are inherited and represent contributions from both parents.
 ABO system
o The ABO system is the most important blood group system in human blood transfusion.
o It is associated with anti- A antibodies and anti-B antibodies
o Blood group AB individuals have both A and B antigen on the surface of their RBCs, and
their blood serum does not contain any antibodies against either A or B antigen.
o An individual with type AB blood can receive blood from any group (with AB being
preferable), but can donate blood only to another group AB individual
o Blood group A individuals have the A antigen on the surface of their RBCs, and blood
serum containing IgM antibodies against the B antigen
o A group A individual can receive blood only from individuals of groups A or O (with A
being preferable), and can donate blood to individuals with type A or AB.
o Blood group B individuals have the B antigen on the surface of their RBCs, and blood
serum containing IgM antibodies against the A antigen
o A group B individual can receive blood only from individuals of groups B or O (with B
being preferable), and can donate blood to individuals with type B or AB.
o Blood group O individuals do not have either A or B antigens on the surface of their
RBCs, but their blood serum contain IgM anti-A antibodies and anti-B antibodies against
the A and B blood group antigens.
169
o A group O individual can receive blood only from a group O individual, but can donate
blood to individuals of any ABO blood group (i.e. A, B, O or AB) if anyone needs a
blood.
STEP 3: Rhesus Factors in Relation to Blood Grouping (25 minutes)

 What are Rhesus factors in relation to blood grouping?
 Rhesus Blood Group System

o The Rhesus system is the second most significant blood group system in human blood
transfusion.
o The term Rhesus (Rh) blood group system refers to the 5 main Rhesus antigens (C, c, D,
E and e) as well as the many other less frequent Rhesus antigens
o The most significant Rhesus antigen is the Rh D antigen because it is the most
immunogenic of the five main rhesus antigens
o The terms "positive" or "negative" refer to either the presence or absence of the Rh D
antigen irrespective of the presence or absence of the other antigens of the Rhesus system
o If an Rh-negative person receives Rh-positive blood by mistake, antibodies will be
formed just as they would be to bacteria or viruses
o A first mistaken transfusion often does not cause problems, because antibody production
is slow upon the first exposure to Rh-positive RBCs
o A second transfusion, however, when anti-Rh antibodies are already present, will bring
about a transfusion reaction, with haemolysis and possible kidney damage
170
STEP 4: Blood Clotting Mechanism (40 minutes)

 What is blood clotting mechanism?
Blood clotting mechanism

 It involves vascular spasm, platelet plug formation, and blood clotting (coagulation)
 In vascular spasm, the smooth muscle of a blood vessel wall contracts, which slows blood
loss
 Platelet plug formation involves the aggregation of platelets to stop bleeding.
 A clot is a network of insoluble protein fibers (fibrin) in which formed elements of blood are
trapped
 The chemicals involved in clotting are known as clotting (coagulation) factor
 Blood clotting involves a cascade of reactions that may be divided into three stages:
o Formation of prothrombinase
o Conversion of prothrombin into thrombin
o Conversion of soluble fibrinogen into insoluble fibrin.
 Clotting is initiated by the interplay of the extrinsic and intrinsic pathways of blood clotting
 Normal coagulation requires vitamin K and is followed by clot retraction (tightening of the
clot) and ultimately fibrinolysis (dissolution of the clot)
The role of Vitamin K in clotting

 Normal clotting depends on adequate levels of vitamin K in the body
 Although vitamin K is not involved in actual clot formation, it is required for the synthesis of
four clotting factors
 Normally produced by bacteria that inhabit the large intestine,
 vitamin K is a fat-soluble vitamin that can be absorbed through the lining of the intestine and
into the blood if absorption of lipids is normal
 People suffering from disorders that slow absorption of lipids (for example, inadequate
release of bile into the small intestine) often experience uncontrolled bleeding as a
consequence of vitamin K deficiency

171
 Blood type (group) is a classification of blood based on the presence or absence of inherited
antigenic substances on the surface of red blood cells (RBCs).
 Rh D is the most important rhesus antigen
 Blood clotting involves vascular spasm, platelet plug formation, and blood clotting
(coagulation).
 Although vitamin K is not involved in actual clot formation, it is required for the synthesis of
four clotting factors

 What is ABO system of blood grouping?
 What are Rhesus factors in relation to blood grouping?
 What are the three stages of blood clotting?
 What is the role of Vitamin K in blood clotting?
172
References
Moore, K. L., & Agur, A. M. R. (2007). Essential Clinical Anatomy. (3rd ed.). Lippincott:
Williams & Wilkins.
McGraw-Hill.
York: McGraw-Hill.
173
Session 19: Common Disorders of Blood Cells
Prerequisites
 Session 14, Blood grouping and ABO system
Learning Tasks
 Define the Term Blood Cell Disorder
 Explain the Common Disorders of the Blood Cells
 Explain Thrombosis and Embolism
Resources Needed:
 Computer
 Projector
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation
2 05 minutes Definition of Blood Cells Disorders
Brainstorming
Presentation
3 20 minutes Small Group Common Blood Disorders of Blood Cells
Discussion
10 minutes Thrombosis and Embolism
4 Presentation
05 minutes
05 minutes
10 minutes
7 Presentation Take home assignment
174
SESSION CONTENTS

STEP 2: Definition of Blood Cell Disorder (5 minutes)


 What is a blood cell disorder?
 Blood cell disorder is a disorder which affects the red blood cells, white blood cells and
smaller circulating cells called platelets
STEP 3: Common Disorders of the Blood Cells (20 minutes)


 What are the common blood cells disorders?
Classification of Common Disorders of the Blood Cells

 Anaemia
o Iron-deficiency anaemia
o Sickle-cell disease (anaemia)
o Aplastic anaemia
o Haemolytic anaemia
 Haemophilia
 Leukaemia
 Vitamin K deficiency
175
Anaemia
 Anaemia is a deficiency of red blood cells, or insufficient haemoglobin within the red blood
cells.
 There are many different types of anaemia.
o Iron-deficiency anaemia
 It is caused by a lack of dietary iron, and there is not enough of this mineral to form
sufficient haemoglobin.
 A person with this type of anaemia may have a normal RBC count and a normal
haematocrit, but the haemoglobin level will be below normal.
 A deficiency of vitamin B12, which is found only in animal foods, leads to pernicious
anaemia, in which the RBCs are large, misshapen, and fragile.
 Another cause of this form of anaemia is lack of the intrinsic factor due to
autoimmune destruction of the parietal cells of the stomach lining.
o Sickle-cell disease (anaemia)
 It is a genetic disorder of haemoglobin (Hb-S), which causes RBCs to sickle, clog
capillaries, and rupture.
 Even though erythropoiesis is stimulated by the loss of the cells, it cannot keep pace
with haemolysis.
o Aplastic anaemia
 It is suppression of the red bone marrow, with decreased production of RBCs, WBCs,
and platelets.
 This is a very serious disorder that may be caused by exposure to radiation, certain
chemicals such as benzene, or some medications.
o Haemolytic anaemia
 It is any disorder that causes rupture of RBCs before the end of their normal life span.
 Sickle-cell anaemia and Rh disease of the new-born are examples.
 Another example is malaria, in which a protozoan parasite reproduces in RBCs and
destroys them.
 Haemolytic anaemias are often characterized by jaundice because of the increased
production of bilirubin.
Haemophilia
 Haemophilia is an inherited deficiency of clotting in which bleeding may occur
spontaneously or after only minor trauma.
 It is the oldest known hereditary bleeding disorder
 Different types of haemophilia are due to deficiencies of different blood clotting factors and
exhibit varying degrees of severity, ranging from mild to severe bleeding tendencies
Leukaemia
 The term leukaemia refers to a group of red bone marrow cancers in which abnormal white
blood cells multiply uncontrollably
 The accumulation of the cancerous white blood cells in red bone marrow interferes with the
production of red blood cells, white blood cells, and platelets
 As a result the oxygen-carrying capacity of the blood is reduced, an individual is more
susceptible to infection, and blood clotting is abnormal
 The cause of most types of leukaemia is unknown
176
Vitamin K deficiency
 Vitamin K is not involved in actual clot formation but it is required for the synthesis of four
clotting factors.
 It is a fat-soluble vitamin that can be absorbed through the lining of the intestine and into the
blood if absorption of lipids is normal
 People suffering from disorders that slow absorption of lipids (for example, inadequate
release of bile into the small intestine) often experience uncontrolled bleeding as a
consequence of vitamin K deficiency
STEP 4: Thrombosis and Embolism (10 minutes)
Thrombosis
 It is the formation of a clot in the blood that either blocks, or partially blocks a blood vessel.
 The thrombus may lead to infarction, or death of tissue, due to a blocked blood supply.
 The pathologic form of haemostasis is thrombosis. It involves blood clot (thrombus)
formation in uninjured vessels or thrombotic occlusion of a vessel after relatively minor
injury.
 Both haemostasis and thrombosis involve three components, the vascular wall, platelets, and
the coagulation cascade.
o Age (as the age increases so the risk)
o Obesity
o Varicose veins
o Immobility
o Pregnancy
o High estrogenic levels
o Previous history of DVT
o Surgery and trauma of the pelvis, lower limbs
o Heart failure
o Recent myocardial infarction
o Lower limb paralysis
o Cigarette smoking
Embolism
 An embolism is an obstruction in a blood vessel due to a blood clot or other foreign matter
that gets stuck while travelling through the bloodstream.
 Emboli have moved from the place where they were formed through the bloodstream to
another part of the body, where they obstruct an artery and block the flow of blood.
 The emboli are usually formed from blood clots but are occasionally comprised of air, fat, or
tumour tissue.
 Embolic events can be multiple and small, or single and massive.
 They can be life-threatening and require immediate emergency medical care
177
 Anaemia is a deficiency of red blood cells, or insufficient haemoglobin within the red blood
cells.
 It is divided into iron deficiency anaemia, sickle cell anaemia, aplastic anaemia and
haemolytic anaemia
 Haemophilia is inherited deficiency of clotting factors
 What is blood cells disorder?

 What is the cause of iron deficiency anaemia?
 What is the consequence of vitamin K deficiency?

 Classify common disorders of the blood cell
178
References
McGraw-Hill
McGraw-Hill
Tortora, G.J & Derrickson, B (2009).Principles of Anatomy and Physiology 12th Edition,
179
Session 20: Body Fluids and Electrolytes Imbalance
Prerequisites
 None
Learning Tasks
 Identify Major Body Fluid Compartment
 Differentiate Between Intracellular and Extracellular Fluids
 Explain Mechanism that Maintain Homeostasis of Body Fluid
 Describe Body Fluid Electrolyte Levels and their Functions
 Explain Electrolyte Imbalance
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
15 minutes Major Body Fluid Compartment

2 Presentation
35 minutes Presentation Mechanism that Maintain Homeostasis of

3 Buzzing Body Fluid
Brainstorming
4 Body Fluid Electrolytes and their Functions
Brainstorming
5 Electrolyte Imbalance
05 minutes
05 minutes
SESSION CONTENTS
180
STEP 2: Major Body Fluid Compartment (15 minutes)

 In the human body there are several major fluid compartments each of which is subject to
homeostatic regulation.
 Fluid content of the human body ranges from 40% to 60% of bodyweight.
 The following are the major fluid compartments found in human body.
o Intracellular Fluid (ICF) water inside the cell comprises 2/3 of the body's water.
o Its main function is to facilitate intracellular chemical reactions that maintain life
 Is the largest compartment.
 ICF is about 40% of the body weight.
 The ICF is primarily a solution of potassium and organic anions, proteins etc.
 The cell membranes and cellular metabolism control the constituents of this ICF.
o Extracellular Fluid (ECF) is the remaining 1/3 of the body's water, any fluid not contained
inside a cell therefore comprises the extracellular compartment.
 ECF is about 20% of the body weight, it consists mainly of plasma and lymph fluid
(circulating compartment) and interstitial fluid (the spaces between the cells).
 The ECF is further subdivided into three sub-compartments.
o Interstitial Fluid (ISF)
 surrounds the cells, but does not circulate
 It comprises about 3/4 of the ECF.
o Plasma circulates as the extracellular component of blood.
 It makes up about 1/4 of the ECF.
o Transcellular fluid
 It is a set of fluids that are outside of the normal compartments.
 These 1-2 litres of fluid make up the Cerebrospinal Fluids (CSF), Digestive Juices,
Mucus, specialized joint fluids aqueous; humour and vitreous humour the fluids in the
eyeball
 The ECF provide a relatively constant environment for cells and transport substances to
and from the cells.
 Example; A 70 kg man contains about 40-45 litres of water divided into the different
compartments as follow
 Out of 45 total litres of body fluid
o Intracellular fluid 27litres
o Extracellular 18 litres, which are further, subdivided as follows; interstitial 13 litres,
plasma 3.5litres and lymph 1.5litres.
STEP 3: Mechanism that Maintain Homeostasis of Body Fluid (35 minutes)

181
 What are the factors that cause fluid and electrolyte imbalance?
 Under normal conditions homeostasis of the total volume of the water in the body is
maintained or restored primarily by adjusting output urine volume and secondarily by fluid
intake
 Regulation of fluid intake; When dehydration begins to develop, salivary secretion
decreases, producing the sensation of thirst; individual increased fluid intake to offset
increased output tends to restore fluid balance
 Regulation of urine volume; two factors determine urine volume
o Glomerular filtration rate, except under abnormal conditions remain fairly constant
o Rate of tubular reabsorption of water fluctuates considerably; normally adjusts urine
volume to fluid intake influenced by hormonal mechanisms
 Some of the factors that alter fluid loss under abnormal conditions are increased rate of
respiration and volume of sweat secreted, certain abnormal conditions such as vomiting,
diarrhoea, or intestinal drainage can produce fluid and electrolyte imbalance
 The volume of extracellular fluid can increase or decrease, even if the osmolality of the
extracellular fluid is maintained within a narrow range of values
 The following are the major mechanisms that regulate extracellular fluid volume
o Neural mechanism
 Neural mechanism changes the frequency of action potentials carried by sympathetic
neurons to the afferent arterioles of the kidney in response to change in blood pressure
 When baroreceptors detect an increase in arterial and venous pressure, the frequency
of action potential carried by sympathetic neuron to the afferent arteriole decreases.
 Consequently the afferent arteriole dilates
 This increases glomerular capillary pressure, resulting in an increase in the glomerular
filtration rate, an increase in filtrate volume and an increase in urine volume
 When the baroreceptors detect a decrease in arterial and venous pressure the action
potential carried by sympathetic neuron causes constriction of afferent arteriole and
the opposite occurs
o Renin-angiotensin-aldosterone mechanism
 The Renin angiotensin-aldosterone mechanism responds to small changes in the blood
volume
 Increased blood pressure results from increased blood volume
 Juxtaglomerular cells detect increase in blood pressure in the afferent arteriole and
decrease the rate of renin secretion
 The decrease in renin secretion results in a decreased conversion of angiotensinogen
to angiotensin II
 Reduced angiotensin II causes a decrease in the rate of aldosterone secretion from the
adrenal cortex
 Decreased aldosterone level reduces the rate of sodium (Na+) reabsorption from the
distal renal tubules and collecting ducts
182
 Consequently more Na+ remains in the filtrate and fewer are reabsorbed
 The effect is to increase the osmolality of the filtrate, which reduces the ability of the
kidney to reabsorb water
 The water remains with the excess Na in the filtrate
 Thus the volume of urine produced increases and extracellular fluid volume decreases
 The opposite occur in case of decreased in blood volume
o Atrial natriuretic hormone (ANH) mechanism
 The ANH mechanism is most important in responding to increases in extracellular
fluid volume
 An increase in pressure in the atria of the heart, which usually results from an increase
in blood volume, stimulates the secretion of ANH, which decreases Na+ reabsorption
in the distal and collecting ducts
 This increase the rate of Na+ and water loss in the urine
 Thus increased ANH secretion decreases extracellular fluid volume
 ANH does not appear to respond strongly to decreases in blood volume however a
decrease in pressure in the atria of the heart inhibit the secretion of ANH
o Antidiuretic hormone (ADH) mechanism
 The ADH mechanism plays an important role in regulating extracellular fluid volume
in response to large changes in the blood pressure
 An increase in blood pressure results in a decrease in ADH secretion
 As a result, the reabsorption of water from the lumen of the distal tubule and
collecting ducts decreases, resulting in a large volume of dilute urine
 This response helps to decrease extracellular fluid volume and blood pressure
 A decrease in blood pressure results in an increase in ADH secretion and the opposite
occurs.
 How water enters and leaves the body?
 Water enters the body via the digestive tract water is also added to the total fluid volume
from each cell as it catabolizes food and the resulting water enters the bloodstream
 Water leaves the body via four exits
o As urine through the kidney
o As water in expired air through the lungs
o As sweat through the skin
o As faeces from the intestine
183
STEP 4: Body Electrolytes and their Functions (30 minutes)
 What are the body electrolytes?
 Electrolytes are ionized molecules found throughout the blood, tissues,

and cells of the body.
 An electrolyte balance exists when the quantities of electrolytes (molecules that release
ions in water) the body gains equal those lost.
 The electrolytes of greatest importance to cellular functions are sodium, potassium,
calcium, magnesium, chloride, sulphate, phosphate, bicarbonate and hydrogen ions.
 Sodium ions are predominant extracellular cations.
 Because of their abundance in the extracellular fluid, they exert substantial osmotic
pressure.
 The kidneys are the major route by which Na+ is excreted.
 The predominant anion in extracellular fluid is chloride ions.
 The extracellular concentration of Potassium ions K+ must be maintained within narrow
range.
 The concentration gradient of K across the plasma membrane has a major influence on
the resting membrane potential, and cells that are electrically excitable are highly sensitive to
slight changes in that concentration gradient.
 Therefore Potassium is important in maintaining the nerve impulse conduction and
cardiac muscles fibre contractions.
 Abnormal potassium (K+) levels may cause these cells to function abnormally. Kidneys
are the primary site for potassium regulation.
 The extracellular concentration of calcium ions like that of K+ is regulated within a
narrow range they are important for electrical properties of excitable tissue.
 Parathyroid hormone increases extracellular Ca+ level and reduces extracellular
phosphate levels.
 Most of the phosphate ions are found inside the cells forming covalent bond with organic
molecules.
 Most of the magnesium in the body is stored in the bones or in the intracellular fluid as it
is used as cofactor for intracellular enzymes.
 Sulphur is an important element in protein synthesis; mostly are found inside the cell.
 These electrolytes primarily obtained from foods, but they may also be found in drinking
water and other beverages.
 Some electrolytes are by-products of metabolic reactions.
 The body loses some electrolytes by perspiring or through kidney during urine production
 The kidney alters renal electrolyte losses to maintain the proper composition of body
fluids
184
 Plasma and interstitial fluid are almost identical in chemical make-up, with intracellular
fluid showing striking differences
 The table below shows the approximate values of electrolytes in different body fluid
compartments
Summary Table of electrolytes constituents in different body fluid compartments

Constituent mmol/L Plasma Interstitial Fluid Intracellular Fluid
Na+ 142 145 12
K+ 4 4.1 150
Ca2+ 1-2 1-2 <10-6 mol/l
Mg2+ 0.75-1.5 1.3 34
Cl- 104 117 4
HCO3- 24 27 12
Protein 14 0.0 54
 Note: The above values are approximate values; each textbook has its own set of
approximate values that may vary from these by one or two mmol/l.
 The overall osmolality of all three compartments is identical at about 300 mOsmol/l
STEP 5: Electrolyte Imbalance (25 minutes)

Disturbances of Water and Sodium Balance
 Pure water deficiency
o This is direct deprivation or loss of water without a corresponding depletion of
electrolytes.
o The condition is uncommon but may occur in few clinical following water deprivations
especially in people who fail to swallow due to oesophageal obstruction, patients in coma
or starvation.
 Effect of pure water deficiency
o Increased osmolality of the extracellular compartment
 When osmolality of the extracellular compartment increases the intracellular fluid is
transferred to the extracellular with consequent cellular dehydration.
 Water excretion in urine is reduced to minimum.
 Clinically patient presents with oliguria and very concentrated urine.
 Plasma changes include increase in concentration of sodium, proteins and urea.
 Combined sodium and water deficiency
o In this situation sodium and chlorides are being lost in equal proportions.
o But in vomiting due to gastric disease and in the diuresis that follows the use of some
diuretics, the chloride loss exceeds that of sodium.
 This does not in itself affect the volume of extracellular fluid appreciably as chloride
is replaced by carbonate.
Effects of Water and Salt Depletion

 Osmotic pressure of extracellular fluid decreases
 Osmolality of intracellular fluid increases compared to that of extracellular fluid
 Water leaves extracellular space to enter the cells to try to balance the osmotic pressure of
the two compartments
 Therefore cells become over hydrated and they swell
 This results into extracellular dehydration
Causes of Disturbances of Water and Sodium Balance
 Loss from gastrointestinal tract due to excessive vomiting and diarrhoea
 Excessive sweating
185
 Excessive urination
 Conditions like diabetes mellitus, thiazide diuretic administration, Addison‘s disease
 Extensive haemorrhage and severe burn

 Fluid content of the human body ranges from 40% to 60% of bodyweight
 Intracellular Fluid (ICF) water inside the cell comprises 2/3 of the body's water
 Extracellular Fluid (ECF) is the remaining 1/3 of the body's water
 Mechanisms that regulate extracellular fluid volume are neural mechanism, Renin
angiotensin-aldosterone mechanism, atrial natriuretic hormone (ANH) mechanism and
Antidiuretic hormone (ADH) mechanism
 Electrolytes are primarily obtained from foods, but they may also be found in drinking
water and other beverages
 Water and Salt Depletion leads to extracellular dehydration

 What are the types of fluid compartment?
 What are the four mechanisms of extracellular fluid regulation?
 What are the possible causes of water and sodium imbalance?
 What is the electrolyte imbalance?
186
References
McGraw-Hill.
Press, Inc.
187
Session 21: Acid - Base Balances and Common Electrolyte
Disorders
Prerequisites
 None
Learning Tasks
 Define Acidity ,Alkalinity and pH
 Describe Acid Base Balance
 Describe Acidosis and Alkalosis
 Describe Electrolyte Disorders
 Describe Oedema and Ascites
Resources Needed:
 Hand out 17.1:Oedema and Ascites
SESSION OVERVIEW
Activity/
Step Time Content
Method
25 minutes Presentation Acid, Base and Acid Base Balance

2
Brainstorming
15 minutes
3 Presentation Acidosis and Alkalosis
4 Common Electrolyte Disorders
Small Group
15 minutes
5 Presentation Oedema and Ascites
05 minutes
05 minutes
188
SESSION CONTENTS

STEP 2: Acid Base Balance (25 minutes)
 What is acidity?
 What is alkalinity?
 What is pH?
 Acidity is the term which expresses the concentration of Hydrogen ion (H+) of any
substance in aqueous solution or the body fluids.
 Alkalinity is the term used to express the concentration of Hydroxyl ions (OH-) or the
salinity of any substance in aqueous solution or the body fluids.
 pH is the scale used to determine the acidity or the alkalinity of the body fluids
 The higher the pH the less the acid the substance is and lower the pH the more the acid
the substance is.
The Body pH
 Optimum pH is maintained by keeping the balance between acids and bases produced by
the body cells.
 There is an inbuilt mechanism which ensures that excess acid or alkali is safely
eliminated from the body, better known as the buffer system.
 The organs most active in this activity are the lungs and the kidneys.
 In order to maintain normal blood pH the cells of the proximal convoluted tubules secret
hydrogen ions. In the filtrate hydrogen ions combine with buffers
o Bicarbonate forming carbonic acid
o Ammonia forming ammonium ions
o Hydrogen phosphate forming dihydrogen phosphate
 Carbonic acid is converted to carbon dioxide (CO2) and water (H2O), carbon dioxide is
reabsorbed, maintaining the buffering capacity of the blood.
 Hydrogen ions are lost through urine as ammonium salts and hydrogen sulphate.
 Other buffer systems include body proteins and phosphates which absorb excess
hydrogen ions (H+).
 The lungs regulate the blood pH by either increasing or decreasing the amount of carbon
dioxide lost (increased or decreased respiration).
189
 Carbon dioxide combine with water to form carbonic acid, which eventually dissociates
to bicarbonates and hydrogen ions thus lowering the body pH.
 Therefore any condition which retains carbon dioxide in the body will increase the blood
acidy and vice versa.
 Kidneys regulate blood pH by controlling the amount of hydrogen ion lost through urine.
 The normal blood pH ranges from 7. 35 to 7.45.
STEP 3: Acidosis and Alkalosis (15 minutes)
 The buffer systems described above compensate for most of pH fluctuations, but these
reserves are limited and in extreme cases, can become exhausted
 When the blood pH falls below 7.35 and all the reserves of alkaline buffers are consumed,
the condition of acidosis exists
 In the opposite manner when the pH rises above 7.45, the increased alkali uses up all the
acid reserve and the state of alkalosis ensues
 Acidosis and alkalosis are both injurious to the body, particularly to the central nervous
and cardiovascular systems. In practice acidotic states are more common than alkalotic ones,
because the body tends to produce more acid than alkali
 Acidosis may follow respiratory problems, if lungs are not excreting CO2 as efficiently as
normal, or if the body is producing excess acid as in diabetic ketoacidosis or in renal diseases
when kidneys are not excreting H+ as normal
 Alkalosis may be caused by loss of basic substances as in vomiting or diarrhoea, and
rarely through hyperventilation (excess CO2 loss)
STEP 4: Electrolyte Disorders (50 minutes)

 What are the common electrolyte disorders?
 An electrolyte disorder is an imbalance of certain ionized salts( which

include bicarbonate, calcium, chloride, magnesium, phosphate, potassium, and sodium) in
the blood
Sodium
 Hypernatremia refers to a high sodium concentration in the blood than normal.
 Hypernatremia can be caused by inadequate water intake, excessive fluid loss kidneydise
ase, severe burns, and prolonged vomiting or diarrhea), or sodium retention (caused by excess
ive sodium intake oraldosteronism).
 Hyponatremia refers to low sodium concentration in the blood.
190
 Low sodiumlevels may also be triggered by inadequate dietary intake of sodium, excessiv
e perspiration, water intoxication, and impairment of adrenal gland or kidney function.
Potassium
 Hyperkalaemia refers to high potassium level in the blood than normal.
 Hyperkalemia may be caused by ketoacidosis (diabetic coma), myocardial infarction (hea
rtattack), severe burns, kidney failure, fasting, bulimia nervosa, gastrointestinal bleeding, adre
nal insufficiency, oraddison's disease.
 Hypokalaemia refers to low potassium level in the blood.
 It can occur due to:
o Severe dehydration
o Aldosteronism
o Cushing's syndrome
o Kidney disease
o Long term diuretic therapy
o Certain penicillins
o Laxative abuse
o Congestive heart failure
o Adrenal gland impairments
Calcium
 Hypercalcemia refers to high level of calcium in the blood than normal
 Blood calcium levels may be elevated in cases of :
o Thyroid disorder,
o Multiple myeloma,
o Metastatic cancer,
o Multiple bone fractures,
o Milk alkali syndrome,
o Paget's disease.
 Hypocalcaemia refers to low calcium level in the blood
 It can occur due to:
o Thyroid disorders
o Kidney failure
o Severe burns
o Sepsis
o Vitamin d deficiency,
o Medications such as heparin and glucogan
Magnesium
 Hypermagnesemia refers to excessive magnesium levels in the blood.
 It may occur with endstage renal disease,addison's disease, or an overdose of magnesium
salts
 Hypomagnesemia refers to low level of magnesium in the blood it can occur due to
inadequate dietary intake of magnesium, often caused by chronic alcoholism or malnutrition.
 Other causes include malabsorption syndromes, pancreatitis,aldosteronism, burns, hypera
thyroidism, digestive system disorders, and diuretic use
191
Chloride
 Hyperchloremia refers to high chloride level in the blood than normal.
 It can occur due to
severe dehydration, kidney failure, hemodialysis, traumatic brain injury,and aldosterone
 Hypochloremia usually occurs as a result of sodium and potassium depletion
(i.e.hyponatremia,hypokalemia)severe depletion of serum chloride levels causes metabolic al
kalosis.
Phosphorus
 Hyperphosphatemia: high level of phosphorus in the blood than normal
 Causes of phosphate retention and build up in the blood are :
 Skeletal fractures or disease, kidney failure, hypoparathyroidism, hemodialysis, diabetic k
etoacidosis, acromegaly, systemic infection, and intestinal obstruction serum phosphate levels
of 2 mg/dl or below may be caused by hypomagnesemia and hypokalemia.
 It can be caused by severe burns, alcoholism, diabetic
ketoacidosis, kidney disease, hyperparathyroidism,hypothyroidism, cushing's syndrome, maln
utrition, hemodialysis, vitamin d deficiency, and prolonged diuretic therapy
STEP 5: Oedema and Ascites (15 minutes)

Oedema
 Oedema is swelling caused by fluid retention
 Signifies increased fluid in the interstitial tissue spaces or body cavities.
 Fluid collections in different body cavities are variously designated depending on the site
where it accumulates.
 It occurs through:-
o Increased hydrostatic pressure,
o Reduced plasma oncotic pressure,
o Lymphatic obstruction and
o Water and sodium retention
 Oedema caused by malnutrition defines kwashiorkor, an acute form of childhood protein-
energy malnutrition characterized by oedema, irritability, anorexia, ulcerating dermatoses,
and an enlarged liver with fatty infiltrates.
 There are many types of oedema. The most common ones are:
o Peripheral oedema - in the feet (pedal oedema), ankles, legs, hands and arms.
o Cerebral oedema - in and around the brain (cerebral oedema).
192
Figure 21.1 a: Oedema
Ascites (peritoneal cavity fluid)
 It is an accumulation of fluid in the peritoneal cavity

 Most commonly occur due to liver cirrhosis or metastatic cancer and kidney disorders
Source: Standring, S., 2008 Figure 21.1 b: Ascites
193
 The normal body physiology requires optimum pH environment

 When the blood pH falls below 7.35 and all the reserves of alkaline buffers are consumed the
condition of acidosis exists but when the pH rises above 7.45, the increased alkali uses up all
the acid reserve and the state of alkalosis
 Some of the common electrolyte disorders include hypernatremia, hyponatremia,
hypokalaemia, hypercalcemia, hypocalcaemia, oedema, ascites
 Oedema is swelling caused by fluid retention while ascites is an accumulation of fluid in
the peritoneal cavity

 What are the components of buffer system?
 What is acidosis
 What is alkalosis?
 What are the common electrolyte disorders?
 What are the causes of Oedema?
194
References
Anne, W. & Grant, A. (2006). Ross and Wilson Anatomy and Physiology in Health and
Illness, (10th ed.). UK: Churchill Livingstone.
Kumar, V., Abbas, A.K., Fausto, N. & Mitchell, R. (2007). Robins Basic Pathology (8th
ed.). Philadelphia: Saunders Elsevier.
Tortora, G.J & Derrickson, B (2009) Principles of Anatomy and Physiology 12th Edition,
Walter, J.B. & Tabot, I.C. (1996). General Pathology (7th ed.). Edinburg: Churchill
Livingstone.
195
Session 22: Structure and Functions of Cardiovascular
System
Prerequisites
 None
Learning Tasks
 Define Circulatory and Cardiovascular System
 Explain Organization of the Cardiovascular System
 Describe Structure of the Heart
 Describe Blood Supply to the Heart
 Describe Conducting System of the Heart
 Describe Foetal Circulation
Resources Needed:
 Handout 22.1: The Human Heart
 Handout 22.2: The Surface Anatomy of The Heart
 Handout 22.3: Blood Supply of the Heart
 Handout 22.4: Conducting System of The Heart
 Handout 22.5: Foetal Circulation
SESSION OVERVIEW
Activity/
Step Time Content
Method
15minutes Definition Circulatory system and

Presentation,
2 Cardiovascular System
Brainstorm
15 minutes Organization of the cardiovascular system
3 Presentation
20minutes Presentation, Structure of the Human Heart

4
Buzzing
15minutes
5 Presentation Blood Supply to the Heart
6 Conducting System of the Heart
7 Foetal Circulation
Buzzing
05 minutes
05 minutes
196
SESSION CONTENTS

STEP 2: Definition and Organization of Cardiovascular System

(15minutes)
 What is circulatory system?

 What is cardiovascular system?
Circulatory system:
 An organ system that passes nutrients (such as amino acids and electrolytes), gases (such
as oxygen and CO2) , hormones, blood cells, , etc. to and from cells/tissue in the body, and
help stabilize body temperature and pH to maintain homeostasis.
o The main role of the circulatory system is to transport nutrients, gases, to/from
cells/tissues of the body.
o Circulatory system is composed of the cardiovascular system, which distributes blood and
the lymphatic system, which distributes lymph.
o Humans, have a closed cardiovascular system (meaning that the blood never leaves the
network of arteries, veins and capillaries).
Cardiovascular system:
 The system that include the heart and the blood vessels.
STEP 3: Organisation of the Cardiovascular System (15 minutes)

 The main components of the cardiovascular system are the heart, the blood, and the blood
vessels
 Blood circulates within a fast, high capacity system made up of:
o The heart, which is the central pump and main motor of the system;
o Arteries, which lead away from the heart and carry the blood to the peripheral parts of
the body
o Veins which return the blood to the heart
 The heart can be thought of as a pair of following muscular pumps:

197
o One pump feeding a minor loop (pulmonary circulation), which serves the lungs and
oxygenates the blood,
o The other pump feeding a major loop (systemic circulation), which serves the rest of
the body
o With limited exceptions, each loop is a closed system of tubes, so that blood by itself
does not usually leave the circulation
 From the centre to the periphery, the vascular tree shows three main modifications.
 The arteries increase in number by repeated bifurcation and by sending out side branches,
in both the systemic and the pulmonary circulation.
o The aorta, which carries blood from the heart to the systemic circulation, gives rise to
about 4 × 106 arterioles and four times as many capillaries.
o The arteries also decrease in diameter, although not to the same extent as their increase in
number, so that a hypothetical cross-section of all the vessels at a given distance will
increase in total area with increasing distance from the heart.
o The blood flow is faster near the heart than at the periphery.
 Venules are vessels which return blood from the periphery, converge on each other
forming a progressively smaller number of veins of increasingly larger size.
 As with arteries, the hypothetical total cross-sectional area of all veins at a given level
reduces nearer to the heart.
 Eventually, only the two largest veins, the superior and inferior vena cava, open into the
heart from the systemic circulation.
 A similar pattern is found in the pulmonary circulation, but here the vascular loop is
shorter and has fewer branch points, and consequently, the number of vessels is smaller than
in the systemic circulation.
STEP 4: Structure of the Human Heart (20 minutes)

 What is the heart?
 The heart is a roughly cone-shaped hollow muscular organ

 It is about 10 cm long and it is about the size of the owner‘s fist
 It weighs about 300g
Location of the Heart

 Lies in the mediastinum, behind the body of the sternum; approximately two thirds of its
mass is to the left of the midline of the body and one third to the right
 Posteriorly the heart rests on the bodies of thoracic vertebrae five through eight
 Apex lies on the diaphragm, pointing to the left
 Base lies just below the second rib
 Boundaries of the heart are clinically important as an aid in diagnosing heart disorders
Covering of the Heart
198
 Heart is made up of three distinct layers
o Epicardium: the outer layer of heart which provides protection against friction which is
divided into
 Fibrous pericardium: a tough, loose – fitting inextensible sac
 Serous pericardium: parietal layer lies inside the fibrous pericardium, and visceral
layer (pericardium) adheres to the outside of the heart pericardial fluid separates the
two layers
o Myocardium: thick, contractile middle layer
o Endocardium: delicate inner layer of endothelial tissue
Chambers of the Heart

 The heart is divided into four chambers, the two atria and the two ventricles
 Atria
o Two superior chambers (the atria), known as receiving chambers, since they receive
blood from veins
o Myocardial wall of each atrium is not very thick, since little pressure is needed to move
blood such a small distance
o The right atrium receives venous blood from the body through inferior and superior vena
cava, then pumps it the right ventricle
o The left atrium receive oxygenated blood from pulmonary veins and pumps it to the left
ventricle
 Ventricles
o Two lower chambers(Ventricles)are known as pumping chambers, since they push blood
into the large network of vessels
o Ventricular myocardium is thicker than the myocardium of the atria, since great force
must be generated to pump blood outside the heart
o Since the left Ventricle pumps blood via Aorta to the whole body, its walls are thicker
than those of right Ventricle (which pumps blood to the lung)
Valves of the Heart

 These are mechanical devices that permit the flow of blood in one direction only.
 Atrioventricular (AV) valve: This prevent blood from flowing back into the atria from the
ventricles when the ventricles contract which includes
o Tricuspid valve (right AV valve) guards the right atrioventricular orifice
o Bicuspid or mitral, valve (left AV valve) similar in structure to tricuspid valve except
only two flaps
 Semilunar (SL) valve.
o These are half-moon-shaped flaps growing out from the lining of the pulmonary artery
and aorta; prevents blood from flowing back into the ventricles from the aorta and
pulmonary artery.
 Pulmonary semilunar valve, located at the entrance of the pulmonary artery
 Aortic semilunar valve, located at the at entrance of the aorta
Refer students to Handout 22.1: The Human Heart
STEP 5: Blood Supply to the Heart (15 minutes)
 The heart, like all tissues in the body, requires oxygen to function
199
 Indeed, it is the only muscle in the body that never rests
 Thus, the heart has reserved for itself its own blood supply
 This blood flows to the heart muscle through a group of arteries that begins less than one
half inch from where the aorta begins
 These are known as the coronary arteries, the first branch to come off the aorta they are
two, the right and left coronary artery
 These arteries deliver oxygen to both the heart muscle and the nerves of the heart
 Both ventricles receive their blood supply from branches of the right and left coronary
arteries
 Each atrium, in contrast, receives blood only from a small branch of the corresponding
coronary artery
 The most abundant blood supply goes to the myocardium of the left ventricle, since the
left ventricle does the most work and so needs the most oxygen and nutrients delivered to it
 Anastomoses exist between the large branches of coronary arteries
 These provide detours in which arterial blood can travel if the main route becomes
obstructed i.e. they provide collateral circulation to a part
 This phenomenon is important in cases of coronary artery diseases; when the interruption
of coronary blood flow lasts only a few minutes, the symptoms are called angina, and there is
no permanent damage to the heart
 When the interruption lasts longer, that part of the heart muscle dies
 This is referred to as a heart attack (myocardial infarction)
 Most of the venous drainage of the heart is through the coronary sinuses which open into
the right atrium
 The remainder passes directly into heart chambers through the little venous channels
Refer students to Handout 22.2: Blood Supply of the Heart
STEP 6: Conducting System of the Heart (20 minutes)
 Cardiac plexuses located near the arch of the aorta made up the combination of
sympathetic and parasympathetic fibres
o Fibres of the cardiac plexus accompany the right and left coronary artery and enter the
heart
o Most fibres ends in the sinoatrial node (SA), but some end in the atrioventricular node
(AV) and in the atrial myocardium
o Sympathetic nerves, accelerator nerves
o Vagus fibres, inhibitory or depressor nerves
 The heart contains special tissue that produces and sends electrical impulses to the heart
muscle. It is these impulses that trigger the heart to contract
 Each time the heart beats, it sends out an electric-like signal
 The heart's electrical signals can be measured with a special machine called an
electrocardiogram (ECG)
 The sinoatrial node (SAN), located within the wall of the right atrium (RA), normally
generates electrical impulses that are carried by special conducting tissue to the
atrioventricular node (AVN)
 AVN is located between the atria and ventricles; the electrical impulse from AVN is
relayed down the conducting tissue (Bundle of His) that branches into pathways that supply
the right and left ventricles
200
 These paths are called the right bundle branch (RBB) and left bundle branch (LBB)
respectively
 Electrical impulses generated in the SAN cause the right and left atria to contract first
 All heart cells muscle and conducting tissue are capable of generating electrical impulses
that can trigger the heart to beat
 The SAN is known as the "heart's pacemaker" because electrical impulses are normally
generated here
 At rest the SAN usually produces 60-70 signals a minute t is the SAN that increases its'
rate due to stimuli such as exercise, stimulant drugs, or fever
 Should the SAN fail to produce impulses, the AVN can take over
 The resting rate of the AVN is slower; generating 40-60 beats a minute
 The AVN and remaining parts of the conducting system are less capable of increasing
heart rate due to stimuli previously mentioned than the SAN
Refer students to the handout 22.3 Conducting System of the Heart
STEP6: Foetal Circulation (25 minutes)
 What is the importance of foetal circulation?
 Foetal circulation in the body before birth differs from circulation after birth for one
main reason
 Foetal blood secures oxygen and food from maternal blood instead of from foetal lungs
and digestive organs
 Foetal blood reaches the placenta via two umbilical arteries and returns by one umbilical
vein
 Blood from the placenta is carried to the foetus by the umbilical vein
o About half of blood enters the foetal ductus venosus
(the ductus venosus, arises and ascends posterior to the liver to join the left hepatic
vein near its termination in the inferior vena cava) and is carried to the inferior vena
cava)
o Other half of blood enters the liver proper from the inferior border of the liver
 The branch of the umbilical vein that supplies the right lobe of the liver first joins with
the portal vein
 The blood then moves to the right atrium of the heart
 In the foetus, there is an opening between the right and left atrium (the foramen ovale),
 Most of the blood flows through this hole directly into the left atrium from the right
atrium, thus bypassing pulmonary circulation
201
 The continuation of this blood flow is into the left ventricle, and from there it is pumped
through the aorta into the body
 Some of the blood moves from the aorta through the internal iliac arteries to the umbilical
arteries,
 and re-enters the placenta, where carbon dioxide and other waste products from the foetus
are taken up and enter the woman's circulation
 Some of the blood entering the right atrium does not pass directly to the left atrium
through the foramen ovale but enters the right ventricle and is pumped into the pulmonary
artery
 In the foetus, there is a special connection between the pulmonary artery and the aorta,
called the ductus arteriosus, which directs most of this blood away from the lungs (which
aren't being used for respiration at this point as the foetus is suspended in amniotic fluid).
 At birth, when the infant breathes for the first time, there is a decrease in the resistance in
the pulmonary vasculature, which causes the pressure in the left atrium to increase relative to
the pressure in the right atrium.
 This leads to the closure of the foramen ovale, which is hence referred to as the fossa
ovalis.
 Additionally, the increase in the concentration of oxygen in the blood leads to a decrease
in prostaglandins, causing closure of the ductus arteriosus.
 These closures prevent blood from bypassing pulmonary circulation, and therefore allow
the neonate's blood to become oxygenated in the newly operational lungs.
 After closure, the duct becomes the ligamentum arteriosum, which connects the left
pulmonary artery (near its origin) with the aortic arch.
 The ductus venosus shuts down by an unknown mechanism, its fibrous remnant is the
ligamentum venosum.
 If these opening persist after birth may lead to a serious conditions known as congenital
heart diseases
Refer students to the Handout 22.4: Foetal Circulation
202
 The cardiovascular system consists of the heart, blood vessels, blood, and lymph
 The heart is a hollow muscular organ consisting of the myocardium, pericardium, and
endocardium.
 Four valves control blood flow into and out of the heart
 Coronary arteries provide blood flow and nutrients to the heart muscle itself
 The largest of the blood vessels are the arteries, which carry oxygenated blood away from
the heart to the capillaries.
 The pulmonary arteries are the exceptions; they carry deoxygenated blood from the heart
to the lungs.

 What is circulatory system?
 What is cardiovascular system?
 What are the components of cardiovascular system?
 What is foetal circulation?
203
References
McGraw-Hill.
McGraw-Hill.
Hoffman Press, Inc.
204
Handout 22.1: The Human Heart
The Anterior View

Moore, K. L., & Agur, A. M. R. (2007)
205
Posterior View
Moore, K. L., & Agur, A. M. R. (2007)
Front View
Moore, K. L., & Agur, A. M. R. (2007)
206
Handout 22.2: Blood Supply of the Heart
Arterial supply to the heart
Venous return to the heart

207
Handout 22.3: Conducting System of The Heart
208
Handout 22.4: Foetal Circulation
209
Session 23: Common Disorders of the Cardiovascular
System
Prerequisites
 None
Learning Tasks
 Define Common Terms in Cardiovascular Disorders
 List Common Cardiovascular Disorders
 Explain Common Cardiovascular Disorders
 Identify Common Risk Factors Associated with Cardiovascular Disorders
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Presentation, Definition of the Cardiovascular disorders

2
Brainstorming
25 minutes Presentation, Common Disorders of Cardiovascular System
3
Brainstorming
10 minutes
4 Presentation Hypertension and its Risk Factors
05 minutes
05 minutes
210
SESSION CONTENTS

STEP 2: Definition of the Cardiovascular Disorder (10 minutes)
 What is the cardiovascular disorder?
 Cardiovascular disorders are the disorders of the heart and blood vessels
o Vascular disease is responsible for more morbidity and mortality than any other
category of human disease
o Cardiovascular disorders are due to ,such as age, genetics, and lifestyle
STEP 3: Common Disorders of Cardiovascular System (25 minutes)
 What are the common disorders of cardiovascular system?
The common disorders of the cardiovascular system include:

 Hypertension
 Hypotension
 Cardiac failure
 Ischaemic heart diseases
 Angina pectoris
211
 Myocardial infarction
 Arrhythmias
 Shock
 Varicose veins
 Aaneurisms
 Arteriosclerosis
 Atherosclerosis
Arteriosclerosis
 Arteriosclerosis literally means hardening of the arteries
 Is the term used to describe degenerative changes in small arteries, commonly occurring
in older individuals and diabetics
 Elasticity is lost, and the walls become thick and hard
 The lumen gradually narrows and may become obscured
 This leads to diffuse ischemia and death in various tissues such as those of the: heart,
kidneys, or brain
Atherosclerosis
 It is the condition in which an artery wall thickens as the result of a build-up of fatty
 materials such as cholesterol( accumulation of lipids in blood vessels causing occlusion)
 Is differentiated by the presence of atheromas (plaques consisting of lipids, cells, and cell
debris, often with attached thrombi, which form inside the walls of large arteries)
 Atheromas form primarily in large arteries such as the aorta and the coronary arteries
Angina pectoris
 It is an episodic, reversible oxygen insufficiency
 This condition is the most common form of IHD
 Angina pectoris is applied to varying forms of transient chest pain that are attributable to
insufficient myocardial oxygen
 Atherosclerotic lesions that produce a narrowing of the coronary arteries are the major
cause of angina
 However, tachycardia(increased heart rate), anaemia, hyperthyroidism, and hypotension
can cause an oxygen imbalance
Myocardial Infarction
 Myocardial infarction (MI) is an area of dead cardiac muscle tissue, with or without
haemorrhage
 Myocardial infarction is produced by an obstruction of the coronary artery, which results
in a lack of oxygen to the tissue
 For those who survive an myocardial infarction, there is a notably greater risk of a second
myocardial infarction, congestive heart failure, or a stroke occurring within a short time
Cardiac Arrhythmias (dysrhythmias)

 They are deviations from the normal cardiac rate or rhythm
 They may result from damage to the heart‘s conduction system or from systemic causes
such as electrolyte abnormalities, fever, hypoxia, stress, and drug toxicity
212
Congestive heart failure (CHF)
 Is one of the most common cardiovascular disorders
 This condition occurs when the heart is not able to pump enough blood to meet the body‘s
metabolic demands.
 Heart failure may be caused by any disorder that affects the heart‘s ability to receive or
eject blood
Aneurysm
 It is a localized abnormal dilation of a blood vessel or the heart
 When an aneurysm involves all three layers of the arterial wall (intima, media, and
adventitia) or the attenuated wall of the heart, it is called a true aneurysm
o Atherosclerotic, syphilitic, and congenital aneurysms, and ventricular aneurysms that
follow transmural myocardial infarctions, are examples of this type
STEP 4: Hypertension and its Risk Factors (10 minutes)

Hypertension is elevation of blood pressure (B.P) usually systolic blood pressure is ≥
140mmHg and/or diastolic blood pressure is ≥ 90mmHg measured on three separate
occasions.
There are three classifications of hypertension:
Primary or essential hypertension

 It is idiopathic (occurring spontaneously from an unknown cause)
 Essential hypertension develops when the blood pressure is consistently above 140/90
mmHg
Secondary hypertension
 It results from renal (e.g., nephrosclerosis) or endocrine (e.g., hyperaldosteronism)
disease, or pheochromocytoma, a benign tumor of the adrenal medulla
 In this type of hypertension, the underlying problem must be resolved
Malignant hypertension
 It is an uncontrollable, severe, and rapidly progressive form of hypertension with many
complications
Hypertension is sometimes classified as systolic or diastolic depending on the measurement

that is elevated
For example, elderly persons with loss of elasticity in the arteries frequently have high
systolic pressure and a low diastolic value
Risk Factors for Hypertension

 Risk factors for hypertension include:-
o Family history,
o Stress,
o Obesity,
o Smoking,
o Life style,
o Diabetes mellitus and
213
o Excessive lipid blood levels.
 Hypertension must be diagnosed in early stages
 When it is not properly treated, the risk of stroke, coronary artery disease, congestive
heart failure, and renal failure increases

 The common disorders of the cardiovascular system includes hypertension, hypotension,
cardiac failure, ischaemic heart diseases, angina pectoris, myocardial infarction, arrhythmias,
shock, varicose veins, aneurisms, arteriosclerosis, atherosclerosis
 There are many factors that contribute to heart disease, such as age, genetics, and lifestyle.
 Proper diet, exercise, avoiding cigarette smoking, and getting enough rest can do a lot to keep
the heart functioning for a long time
 Hypertension is elevation of blood pressure (B.P) usually systolic blood pressure is ≥

140mmHg and/or diastolic blood pressure is ≥ 90mmHg measured on three separate
occasions
 What is cardiovascular disorders?

 Identify common cardiovascular diseases?
 What is congestive heart failure?
 What are the risk factors of hypertension?
214
References

McGraw-Hill
McGraw-Hill
215
Session 24: Structure and Functions of the Respiratory
System
Prerequisites
 None
Learning Tasks
 Define the Respiratory System
 Explain the Structure and Function of the Upper Respiratory Tract
 Explain the Structure and Function of the Lower Respiratory Tract
Resources Needed:
 Overhead projector and computer
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation
2 05 minutes Definition of Respiratory System
Brainstorming
Presentation Structure and Functions of the Upper
3 60 minutes Small Group Respiratory System
Discussion
Presentation
Structure and Functions of the Lower Respiratory
System
Discussion
05 minutes
05 minutes
216
SESSION CONTENTS

STEP 2: Definition of Respiratory System (5 minutes)


 What is respiratory system?
 The respiratory tract is the part of the anatomy that is responsible with the process of
respiration in human body
 Primarily, oxygen is absorbed from the atmosphere into the body and carbon dioxide is
expelled from the body
 The respiratory system may be divided into the upper respiratory tract and the lower
respiratory tract.
STEP 3: Structure and Functions of the Upper Respiratory System

(60 minutes)

 What are the structures and functions of upper respiratory system?
 The organs of the upper respiratory system are located outside of the thorax and consists of
the nose, pharynx and larynx
217
 Nose
o Is made up of bone and cartilage covered with skin, and lined with hairs within the
nostrils. The hairs help to block dusts entry
o The two nasal cavities are within the skull, separated by the nasal septum, which is a bony
plate made of the ethmoid bone and vomer
o The nasal mucosa is ciliated epithelium with goblet cells which produce mucus
o The mucus produced help to trap bacteria and particles from the air
o There are three shelve like bones called conchae project from the lateral wall of each
nasal cavity
o In the upper nasal cavities are the olfactory receptors, which detect vaporized chemicals
that have been inhaled.
o Paranasal sinuses:
 Air cavities in the maxillae, frontal, sphenoid, and ethmoid bones
 Are lined with ciliated epithelium, and the mucus produced drains into the nasal
cavities.
 The functions of the paranasal sinuses are to lighten the skull and provide more
vibrating air for the voice.
 Functions of the nose
o Respiration (breathing)
 The nose humidify, warm, filter and clean the air
o Reception and elimination of secretions from the nasal mucosa, paranasal sinuses, and
nasolacrimal ducts
o Olfaction (smelling) - is the organ of sense of smell
o It aids speech- this is enhanced by the presence of paranasal sinuses
 Pharynx
o It is a muscular tube posterior to the nasal and oral cavities and anterior to the cervical
vertebrae.
o It is divided into nasopharynx, oropharynx and laryngopharynx.
o Nasopharynx lies behind the nasal cavity.
 It is continuous with lining of the nose and consists of ciliated columnar epithelium
and the intermediate layer is fibrous tissue.
o Oropharynx; lies behind the oral cavity.
 It is lined with stratified squamous epithelium which is continuous with lining of the
mouth and oesophagus.
o Laryngopharynx also known as the hypopharynx, this is also lined with moist stratified
squamous epithelium.
 Functions of the pharynx
o Passageway for air and food
o Warming and humidifying air
o Protection
o Taste
o Facilitates Hearing
o The pharynx is also important in vocalization and Speech
 Larynx
o The larynx houses the vocal folds, and is situated just below the pharynx between the root
of the tongue and upper end of the trachea.
o The larynx consists of cartilages attaches to each other by ligaments and membranes.
o The framework of the larynx is formed by nine cartilages (e.g. thyroid, epiglottis)
connected to one another by muscles, ligaments and membranes.
218
o The epiglottisis the uppermost cartilage. During swallowing, the larynx is elevated, and
the epiglottis closes over the top to prevent entry of saliva and food to the larynx
 Functions of the larynx
o Speaking (speech)
 Sound production is primarily done by the focal folds
o Respiration (is the air passageway between pharynx and the trachea)
o Swallowing
 The epiglottis and vestibular folds prevent swallowed material from moving into the
larynx
STEP 4: Structure and Functions of the Lower Respiratory System

(40 minutes)

 What are the structures and functions of lower respiratory system?
 The organs of the lower respiratory system are located inside of the thorax and consists of the
trachea, bronchial tree and lungs
 Trachea
o The trachea is about 4 to 5 inches long and extends from the larynx to the primary
bronchi.
o The wall of the trachea contains 16 to 20 C-shaped pieces of cartilage, which keep the
trachea open.
o The gaps in these incomplete cartilage rings are posterior, to permit the expansion of the
esophagus when food is swallowed.
o The mucosa of the trachea is ciliated epithelium with goblet cells.
 Bronchial Tree
o Are the branches of trachea that enters the lungs (primary bronchi)
o Their structures are like those of trachea, with C-shaped cartilages and ciliated epithelium
o Within the lungs, the primary bronchus branches to secondary bronchi that forms lobes of
each lungs (three right, two left)
o The further branching of the bronchial tube if called bronchial tree
o The smallest branches are called bronchioles and are clinically important in asthma
o Bronchioles have no cartilages and the smallest ones terminate in clusters of alveoli, the
air sacs of the lungs.
 Lungs and pleural membranes

219
o Lungs are located on either side of the heart in the chest cavity and are encircled and
protected by the rib cage
o The base of each lung rests on the diaphragm below; the apex (superior tip) is at the level
of the clavicle.
o On the medial surface of each lung there is an indentation called the hilus, where the
primary bronchus and the pulmonary artery and veins enter the lung.
o The pleural membranes are the serous membranes of the thoracic cavity.
o The parietal pleura line the chest wall, and the visceral pleura are on the surface of the
lungs.
o Between the pleural membranes is serous fluid, which prevents friction and keeps the two
membranes together during breathing.
o Alveoli
 Are the air sacs of the lungs
 Is where there is oxygen carbon dioxide exchange
 In the spaces between clusters of alveoli is elastic connective tissue, which is
important for exhalation.
 Within the alveoli are macrophages that phagocytise pathogens or other foreign
material that may not have been swept out by the ciliated epithelium of the bronchial
tree.
Source: Tortora G.J (2009)
Figure 20:1. Anterior view of respiratory system
220
 Respiratory system is responsible with exchange of gases (oxygen and carbon dioxide) in
human body
 Respiratory system is lined with mucus and cilia for trapping microorganisms and dusts
 Alveoli are functional units of lungs where exchange of gases takes place
 What are the functions of respiratory system?

 What is the main function of the alveoli?
 What are the functions of upper respiratory system?
 What are the structures of lower respiratory system?
221
References
McGraw-Hill.
Press, Inc.
222
Session 25: Common Disorders of the Respiratory System
Prerequisites
 Session 20; Structure and functions of respiratory tract.

 Define Common Respiratory System Disorder
 List Common Respiratory System Disorders
 Explain the Common Disorders of the Upper Respiratory Tract
 Explain the Common Disorders of the Lower Respiratory Tract
Resources Needed:
 Overhead projector and computer
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation
2 10 minutes Common Respiratory Disorders
Buzzing
Common Disorders of the Upper Respiratory
3 System
Brainstorming
15 minutes Presentation Common Disorders of the Lower Respiratory
4
Buzzing System
05 minutes
05 minutes
10 minutes
223
SESSION CONTENTS
STEP 2: Common Disorders of the Respiratory System (10 minutes)

Activity: buzzing (5 minutes)
 What are the common disorders of respiratory systems?
Respiratory disorders:
 A medical term that encompasses pathological conditions affecting the organs and tissues
that make gas exchange possible in higher organisms,
 It includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli,
pleura and pleural cavity, and the nerves and muscles of breathing
 Respiratory diseases range from mild and self-limiting, such as the common cold, to life-
threatening entities like bacterial pneumonia, pulmonary embolism, and lung cancer
 Upper respiratory system disorders
o Pharyngitis
o Epiglottitis
o Rheumatic fever
o Diphtheria
 Lower respiratory system disorders
o Bronchiolitis
o Pneumonia
o Pertussis
o Tuberculosis
 Obstructive lung (pulmonary) disease (OPD)
o Asthma
o Cystic fibrosis
o Lung cancer
 Chronic obstructive Pulmonary Disease (COPD)
o Chronic Bronchitis (bronchiectasis)
o Emphysema
o Chronic asthma
 Vascular disorders which are:
o Pulmonary oedema
o Pulmonary emboli
224
STEP 3: Common Disorders of the Upper Respiratory System (10 minutes)

 What are the common disorders of upper respiratory system?
 Upper respiratory tract infections are probably the most common infections in the world
 Pharyngitis
o It is an inflammation of the throat or pharynx.
o It is often referred to as a sore throat.
o Acute pharyngitis can result in very large tonsils which cause trouble swallowing and
breathing.
o Some cases are accompanied by a cough or fever.
o Most acute cases are caused by viral infections, bacterial infections, fungal infections,
or irritants such as pollutants or chemical substances.
 Epiglottitis
o A very rapidly progressive infection causing inflammation of the epiglottis and tissues
around the epiglottis
o The infection is usually caused by bacteria and is contracted through the respiratory
tract
 Rheumatic fever
o An inflammatory disease that may develop two to three weeks after
bacterial(streptococcal) infection
o It is common in children
 Diphtheria
o It is an acute bacterial disease that usually affects the tonsils, throat, nose or skin.
STEP 4: Common Disorders of the Lower Respiratory System

(15 minutes)
 What are the common disorders of lower respiratory system?
225
 Bronchiolitis
o Inflammation of the bronchioles due to infections especially viral
o More prominent in individuals with asthma history and cigarette smoking
 Pneumonia
o Inflammation of lung with accompanying fluid build up
o Much of pneumonia seen clinically is caused by bacteria (Streptococcus Pneumonia).
o Pneumocystis carinii pneumonia is most common to immune compromised patients
 Pertussis
o Pertussis, commonly known as "whooping cough," is an infection of the respiratory
tract caused by bacteria
 Tuberculosis
o Is caused by Mycobacterium tuberculosis
o It can be inactive or active
o It is most prominent to HIV/AIDS patients and other immune compromised patients.
o Is more characterised by chronic cough and night sweats
 Obstructive lung (pulmonary) disease (OPD)
o Cystic fibrosis, lung cancer and asthma belongs to OPD
o Both may cause obstruction and inflammation
o Asthma
 Periodic episodes of reversible bronchial obstruction in people with
hypersensitive airways
 Histamine and leukotriene released from mast cells due to allergens like dust and
cigarette smoke are the main cause
 Chronic Obstructive Pulmonary Disease (COPD)
o Is the irreversible progressive obstruction of air flow in lungs
o Includes:
o Chronic Bronchitis (bronchiectasis)
 Chronic inflammation of mucus membrane
 This results in a chronic, deep, productive cough
 It is due to long term smoking, certain environmental factors such as textile dust
fibers
 Sometimes is due to complication of cystic fibrosis and TB
o Emphysema
 Permanent & irreversible destructive disease of alveolar
 Is due to any chronic lung condition e.g. pollution
o Chronic asthma
 Irreversible bronchial obstruction
 Vascular disorders which are:
o Pulmonary oedema
 Fluid collection (oedema) in all lung tissues which affects gas exchange and lung
expansion
o Pulmonary emboli
 Clot of foreign matter that occludes artery in pulmonary system impact.
226
 Upper respiratory tract infections are the most common infections in the world
 Upper respiratory tract infections include pharyngitis and epiglottitis
 Lower respiratory tract disorders are:
o Bronchiolitis
o Pneumonia
o Pertussis
o Tuberculosis
 Define common disorder of respiratory system
 Identify common disorders of upper respiratory tract
 Identify common disorders of lower respiratory tract
 List organs of lower respiratory system

 What are the common disorders of the lower respiratory system
227
References
McGraw-Hill
McGraw-Hill
228
Session 26: Structure and Functions of the Male
Reproductive System
Prerequisites
 None
Learning Tasks
 Define Male Reproductive System
 Explain the Composition of Male Reproductive System
 Describe Structure and Functions of the Male Reproductive System
 Explain the Process of Spermatogenesis
Resources Needed:
 Overhead projector (OHP) and computer
 Handout 26.1:The sperm cell and semen
SESSION OVERVIEW
Activity/
Step Time Content
Method
Definition and composition of Male
Presentation
2 10minutes Reproductive System
Brain storming
Structure and Functions of the Male Reproductive
3 Small Group
System
Discussion
4 Spermatogenesis
Buzzing
05 minutes
05 minutes
229
SESSION CONTENTS

STEP 2: Composition of Male Reproductive System (10 minutes)

 What is the composition of male reproductive system?
Male reproductive system: Is the genital system, reproductive system organs and tissues
involved in the production and maturation of gametes and in their union and subsequent
development as offspring.
 The male reproductive system consists of the testes and a series of ducts and glands.
o Sperm are produced in the testes by a process of spermatogenesis and are transported
through the reproductive ducts: epididymis, ductus deferens, ejaculatory duct, and
urethra
o The reproductive glands produce secretions that become part of semen, the fluid that
is ejaculated from the urethra.
o These glands are the seminal vesicles, prostate gland, and bulbourethral glands.
STEP 3: Structures and Functions of Male Reproductive System

(55 minutes)

 What are the structures and functions of the male reproductive system?
230
Structures of the male reproductive system
 Testes
 Epididymis
 Dactus deferens (vas deferens)
 Ejaculatory ducts
 Seminal vesicles
 Prostate gland
 Bulbourethral (Cowper‘s) glands
 Urethra-penis
Functions of the male reproductive system

 Testes
o The testes are located in the scrotum, a sac of skin between the upper thighs.
o Internally is divided in to lobes
o Each lobe contains several seminiferous tubules where spermatogenesis takes place.
o Among the produced spermatogonia are sertoli cells which produce inhibin hormone
when stimulated by testosterone
o Between the loops of the seminiferous tubules are interstitial cells which produce
testosterone when stimulated by luteinizing hormone from anterior pituitary gland
o Testosterone is responsible for maturation of sperm and secondary male
characteristics.
 Epididymis
o It is a tube about 6m long that is coiled in the posterior surface of each testis.
o Within it the sperm complete the maturation and their flagella become functional.
o Smooth muscle of the wall of epididymis propels the sperm to dactus deferens
 Dactus deferens (vas deferens)

o Extends from the epididymis in the scrotum on its own side into the abdominal cavity
through the inguinal canal.
o Spermatic cord is a connective tissue sheath that contains the ductus deferens,
testicular blood vessels, and nerves
o Inguinal canal is a natural weak spot where most of hernia is formed in men.
o The smooth muscle layer of the ductus deferens contracts in waves of peristalsis as
part of ejaculation
 Ejaculatory ducts
o Each of the two ejaculatory ducts receives sperm from the ductus deferens and the
secretion of the seminal vesicle on its own side.
o Both ejaculatory ducts empty into the single urethra
 Seminal vesicles
o The paired seminal vesicles are posterior to the urinary bladder
o Their secretion contains fructose to provide an energy source for sperm and is alkaline
to enhance sperm motility.
o The duct of each seminal vesicle joins the ductus deferens on that side to form the
ejaculatory duct.
231
 Prostate gland
o A muscular gland just below the urinary bladder
o It surrounds the first inch of the urethra as it emerges from the bladder
o The glandular tissue of the prostate secretes an alkaline fluid that helps maintain
sperm motility.
o The smooth muscle of the prostate gland contracts during ejaculation to contribute to
the expulsion of semen from the urethra
 Bulbourethral (Cowper‘s) glands

o They are located below the prostate gland and empties to the urethra
o Their alkaline secretion coats the interior of the urethra just before ejaculation, which
neutralizes any acidic urine that might be present.
 Urethra-penis
o The urethra is the last of the ducts through which semen travels, and its longest
portion is enclosed within the penis.
o The penis is an external genital organ; its distal end is called the glans penis and is
covered with a fold of skin called the prepuce or foreskin which is removed by
surgical procedure of circumcision
o Within the penis are three masses of cavernous (erectile) tissue by which the flow of
blood to these masses through arteries cause penile erection.
Figure 26.1: The male reproductive system Source: Scanlon,V.C. & Sandors, T (2007).
STEP 4: Spermatogenesis (40 minutes)
232

 How sperm cells are produced?
 Spermatogenesis
o It is the process of meiosis as it takes place in the testes, the site of sperm
production.
o Within each testis are seminiferous tubules that contain spermatogonia, which are
stem cells that generate sperm.
o A spermatogonium divides by mitosis to form two cells, one of which will remain
in place as a stem cell, while the other differentiates (specializes) to become a
primary spermatocyte that will undergo meiosis.
o Gamete formation is regulated by hormones
o Follicle-stimulating hormone (FSH) from the anterior pituitary gland initiates
sperm production, and testosterone, secreted by the testes when stimulated by
luteinizing hormone (LH) from the anterior pituitary, promotes the maturation of
sperm.
o Inhibin, also produced by the testes, decreases the secretion of FSH
o For each primary spermatocyte that undergoes meiosis, four functional sperm cells
are produced.
o Sperm production begins at puberty (10 to 14years of age), and millions of sperm
are formed each day in the testes.
o Although sperm production diminishes with advancing age, there is usually no
complete cessation.
233
Source: Scanlon,V.C. & Sandors,T (2007). Figure 26.2: Spermatogenesis
Refer students to Handout 26.1: The sperm cell and semen

 The male reproductive system consists of the testes and a series of ducts and glands
 Testes produces testosterone hormone which is responsible for maturation of sperm and
secondary male characteristics
 The process of spermatogenesis is controlled by hormones and the sperm cell produced id
transported by the reproductive ducts which are epididymis, ductus deferens, ejaculatory
duct, and urethra

 Define male reproductive system
 What are the composition of male reproductive system
 What are the structure of the male reproductive system
 What are the process of spermatogenesis
234
References
McGraw-Hill.
Press, Inc.
235
Handout 26.1: The sperm cell and semen
 A sperm cell consists of several parts

o The head contains the 23 chromosomes.
o On the tip of the head is the acrosome, which is similar to a lysosome and contains
enzymes to digest the membrane of an egg cell.
o Within the middle piece are mitochondria that produce ATP.
o The flagellum provides motility, the capability of the sperm cell to move.
o It is the beating of the flagellum that requires energy from ATP.
o Sperm from the seminiferous tubules enter a tubular network called the rete testis, and
then enter the epididymis, the first of the reproductive ducts.
 Semen consists of sperm and the secretions of the seminal vesicles, prostate gland, and
bulbourethral glands
o Its average pH is about 7.4.
o During ejaculation, approximately 2 to 4 mL of semen is expelled.
o Each millilitre of semen contains about 100 million sperm cells.
Source: Scanlon,V.C. & Sandors,T (2007). Figure 26.3: Sperm cell
236
Session 27: Common Disorders of the Male Reproductive
System
Prerequisites
 Session 22; Structures and functions of the male reproductive system.
Learning Tasks
 Define Male Reproductive Disorder
 List Common Disorders of the Male Reproductive System.
 Explain the Common Disorders of the Male Reproductive System
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
Brain storming
Common Disorders of the Male Reproductive
2 20 minutes Presentation
System
25minutes Presentation. Explanation of the Common Disorders of the Male
3 Reproductive System
05 minutes
05 minutes
SESSION CONTENTS
237
STEP 2: Common Disorders of the Male Reproductive System (20 minutes)

 What are the common disorders of the male reproductive system?
Male reproductive system disorders

 Its infections that affect the reproductive tract, which is part of the Reproductive
System
o For males these infections are at the penis, testicles, urethra or the vas deferens.
o The course of these disorders could be bacterium, virus, fungus or other organism.
o Some infections are easily treatable and can be cured, some are more difficult, and
some are non-curable such as AIDS and herpes
Common disorders of the male reproductive system

 Testicular cancer
 Prostate disorders
o Prostate cancer
 Erectile Dysfunction
 Sexually transmitted diseases
STEP 3: Explanation of the Common Disorders of the Male

Reproductive System (25 minutes)
 Testicular cancer
o It is the most common cancer in males between the ages of 20 and 35.
o An early sign of
testicular cancer is a mass in the testis
 Prostate disorders
o Because the prostate surrounds part of the urethra, any infection, enlargement, or
tumour can obstruct the flow of urine.
238
o Acute and chronic infections of the prostate are common in postpubescent males,
often in association with inflammation of the urethra.
o Symptoms may include fever, chills, urinary frequency, frequent urination at
night, difficulty in urinating, burning or painful urination, low back pain, joint and
muscle pain, blood in the urine, or painful ejaculation
o Prostate cancer
 Is the leading cause of death from cancer in men
 Treatment for prostate cancer may involve surgery, cryotherapy, radiation,
hormonal therapy, and chemotherapy
 Erectile Dysfunction
o Erectile dysfunction (ED), previously termed impotence, is the consistent

inability of an adult male to ejaculate or to attain or hold an erection long
enough for sexual intercourse.
o Many cases of impotence are caused by insufficient release of nitric oxide (NO),
which relaxes the smooth muscle of the penile arterioles and erectile tissue.
o Other causes of erectile dysfunction include
 Diabetes mellitus, physical abnormalities of the penis,
 Systemic disorders such as syphilis,
 Vascular disturbances (arterial or venous obstructions),
 Neurological disorders
 Surgery
 Testosterone deficiency
 Drugs (alcohol, antidepressants, antihistamines, antihypertensive, narcotics,
nicotine, and tranquilizers).
 Psychological factors such as anxiety or depression, fear of causing
pregnancy, fear of sexually transmitted diseases
 Sexually transmitted diseases
o The sexually transmitted diseases of the male reproductive system will be
discussed with the sexually transmitted diseases of the female reproductive system

 The common disorders of the male reproductive system are testicular cancer, prostate
disorders, erectile dysfunction and sexually transmitted diseases
 Erectile dysfunction is a big problem to the society and is caused by a number of factors.

 Define male reproductive disorder
 List common disorders of the male reproductive system.
 What is the early sign of testicular cancer?
 What are the causes of erectile dysfunction?
239
References
McGraw-Hill
McGraw-Hill
240
Session 28: Structure and Functions of the Female
Reproductive System
Prerequisites
 None
Learning Tasks
 Define Female Reproductive System
 List Structures of Female Reproductive System
 Describe Structure and Functions of the Female Reproductive System
 Explain the Process of Oogenesis
Resources Needed:
 Handout 28.1 Menstrual cycle
SESSION OVERVIEW
Activity/
Step Time Content
Method
15 minutes Definition and Components to Female
Presentation
2 Reproductive System
Brainstorming
Presentation
Structures and Functions of the Female
Reproductive System
Discussion
4 Oogenesis
Buzzing
05 minutes
05 minutes
10 minutes
7 presentation Take home assignment
241
SESSION CONTENTS

STEP 2: Components of the Female Reproductive System(15 minutes)

 What is female reproductive system?
 What is fertilization?
 What are the components of the female reproductive system?
The female reproductive system:

 Made up of the internal and external sex organs that function inhuman reproduction.
 The female reproductive system is immature at birth and develops to maturity
at puberty to be able to produce gametes, and to carry a foetus to full term
Fertilization
 Is the fusion /unionofmaleandfemalegametes,duringsexualreproduction,toformazygote
 The female reproductive system consists of the:
o Paired ovaries
o Fallopian tubes
o Single uterus
o Vagina
o External genital structures
 Egg cells (ova) are produced in the ovaries and travel through the fallopian tubes to
the uterus.
 The uterus is the site for the growth of the embryo-foetus
242
STEP 3: Structures and Functions of the Female Reproductive System
(45 minutes)

 What are the structures and functions of the female reproductive system?
 Ovaries
o The ovaries are a pair of oval structures on either side of the uterus in the pelvic
cavity
o Within an ovary are several hundred thousand primary follicles, which are
present at birth.
o Each primary ovarian follicle contains an oocyte, a potential ovum or egg cell.
Surrounding the oocyte are the follicle cells, which secrete estrogen.
o Graafian follicle (matured follicle) and luteinizing hormone cause ovulation
o Ruptured follicle become corpus luteum and begins to secrete progesterone and
oestrogen
 Fallopian tubes
o There are two fallopian tubes(oviducts)
o The lateral end of a fallopian tube encloses an ovary, and the medial end opens
into the uterus.
o The smooth muscles along it propels the ovum towards the uterus
o The ovum is fertilized in the fallopian tube and swept to the uterus
 Uterus
o The uterus is shaped like an upside-down pear, superior to the urinary bladder and
between the two ovaries in the pelvic cavity
o During pregnancy the uterus increases greatly in size, contains the placenta to
nourish the embryo-foetus, and expels the baby at the end of gestation.
o It is divided in to fundus (upper part), body (central part) and cervix (lower part)
o The myometrium is the smooth muscle layer during pregnancy these cells increase
in size to accommodate the growing foetus and contract for labor and delivery at
the end of pregnancy.
o The lining of the uterus is the endometrium, forms the maternal portion of the
placenta during pregnancy
 Vagina
o The vagina is a muscular tube that extends from the cervix to the vaginal orifice
243
o The vaginal opening is usually partially covered by a thin membrane called the
hymen which ruptures after sexual intercourse
o The functions of the vagina are to receive sperm from the penis during sexual
intercourse, to provide the exit for menstrual blood flow, and to become the birth
canal at the end of pregnancy.
Source: Scanlon,V.C. & Sandors,T (2007).
 External genitals (Vulva)

The external female genitalia includes:
o Clitoris
Is a small mass of erectile tissue anterior to the urethral orifice. The only
function of the clitoris is sensory. It responds to sexual stimulation.
o Labia majora and minora
 Are paired folds of skin which covers the urethra and vagina openings
and prevent drying of their mucous membranes
o Bartholin‘s glands
 They secrete lubricant which keep the vagina moist during sexual
intercourse
244
4IN
Source:Scanlon,V.C. & Sandors,T (2007). Figure 28:2. Female external genitals
VITROFERTILIZATION
STEP 4: Oogenesis (35 minutes)
 How an egg cell is produced?
 Oogenesis
o It is the process of meiosis for egg cell formation; it begins in the ovaries and is
also regulated by hormones.
o Follicle stimulating hormone initiates the growth of ovarian follicles, each of
which contains an oogonium, a stem cell for egg cell production
o This hormone also stimulates the follicle cells to secrete estrogen, which promotes
the maturation of the ovum.
245
o For each primary oocyte that undergoes meiosis, only one functional egg cell is
produced.
o The other three cells produced are called polar bodies. They have no function, and
will simply deteriorate.
o A mature ovarian follicle actually contains the secondary oocyte; the second
meiotic division will take place if and when the egg is fertilized.
o The production of ova begins at puberty (10 to 14years of age) and continues until
menopause (45 to 55years of age), when the ovaries atrophy and no longer
respond to pituitary hormones.
Source:Scanlon,V.C. & Sandors,T (200)
Figure 28:4. Oogenesis.
Refer students to Handout 28.1: Menstrual cycle for further reading
246
 The female reproductive system consists of the paired ovaries and fallopian tubes, the
single uterus and vagina, and the external genital structures
 During pregnancy, high levels of estrogen and progesterone prepare the glands for milk
production.
 Oogonia are the stem cell for egg cell production in oogenesis.

 What is female reproductive system?
 What are the structures of female reproductive system?
 What are the functions of the female reproductive system?
 What is oogenesis?

 Describe oogenesis
247
References
McGraw-Hill
McGraw-Hill
248
Handout 28.1: Menstrual cycle
 The menstrual cycle includes the activity of the hormones of the ovaries and anterior
pituitary gland and the resultant changes in the ovaries (ovarian cycle) and uterus
(uterine cycle).
 Involves four hormones which are FSH and LH from the anterior pituitary gland,
estrogen from the ovarian follicle and progesterone from corpus luteum
 The cycle is described in three phases at an average of 28 days
o Menstrual phase
 The loss of the functional layer of the endometrium is called
menstruation or the menses.
 Although this is actually the end of a menstrual cycle and a useful
starting point.
 The average time is 3-6 days
 At this time, secretion of FSH is increasing, and several ovarian follicles
begin to develop
o Follicular phase
 FSH stimulates growth of ovarian follicles and secretion of estrogen by
the follicle cells.
 The secretion of LH is also increasing, but more slowly.
 FSH and estrogen promote the growth and maturation of the ovum, and
estrogen stimulates the growth of blood vessels in the endometrium to
regenerate the functional layer.
 This phase ends with ovulation, when a sharp increase in LH causes
rupture of a mature ovarian follicle.
o Luteal phase
 Under the influence of LH, the ruptured follicle becomes the corpus
luteum and begins to secrete progesterone as well as estrogen.
 Progesterone stimulates further growth of blood vessels in the functional
layer of the endometrium and promotes the storage of nutrients such as
glycogen.
 As progesterone secretion increases, LH secretion decreases, and if the
ovum is not fertilized, the secretion of progesterone also begins to
decrease.
 Without progesterone, the endometrium cannot be maintained and begins
to slough off in menstruation.
 FSH secretion begins to increase (as estrogen and progesterone
decrease), and the cycle begins again.
 Also secreted by the corpus luteum during a cycle are the hormones inhibin and relaxin.
o Inhibits the secretion of FSH, and perhaps LH as well, from the anterior pituitary
gland.
o Relaxin is believed to inhibit contractions of the myometrium (as does progesterone),
which would help make implantation of the early embryo successful.
249
Source: Tortora,G.J. & Derrickson,B(2009).
Figure 28:5 Hormonal changes in menstrual cycle
250
Session 29: Common Disorders of the Female
Reproductive System
Prerequisites
 Session 24; Structures and functions of the female reproductive system.
Learning Tasks
 Define Female Reproductive Disorder
 List Common Disorders of the Female Reproductive System.
 Explain the Common Disorders of the Female Reproductive System
Resources Needed:
 Overhead projector (OHP) and computer.
SESSION OVERVIEW
Activity/
Step Time Content
Method
Definition and types of female reproductive
Presentation
2 10minutes disorder
buzzing
Presentation
Common Disorders of the Female Reproductive
System
Discussion
05 minutes
05 minutes
251
SESSION CONTENTS

Step 2: Definition and Types of Female Reproductive Disorder (10 minutes)

 What are the female reproductive disorder
Female reproductive disorder

 Its infections that affect the reproductive tract which is part of the Reproductive System.
o Reproductive tract infections can be in either the upper reproductive tract
(fallopian tubes, ovary and uterus), and the lower reproductive tract (vagina,
cervix and vulva)
List common disorders of the female reproductive system.

 Premenstrual syndrome (PMS)
 Premenstrual dysphoric disorder (PMDD)
 Endometriosis
 Breast cancer
 Ovarian cancer
 Cervical cancer
 Vulvovaginal Candidiasis
 Sexually Transmitted Diseases
o Gonorrhoea
o Syphilis
o Genital Herpes
o Genital Warts
252
STEP 3: Common Disorders of the Female Reproductive System
(45 minutes)

 What are common disorders of the female reproductive system?
 Premenstrual syndrome (PMS)

o It is a cyclical disorder of severe physical and emotional distress.
o It may be presented by oedema, weight gain, breast swelling and tenderness,
abdominal distension, backache, joint pain, constipation, skin eruptions,
fatigue and lethargy, greater need for sleep, depression or anxiety
o Getting regular exercise, avoiding caffeine, salt, and alcohol may bring relief
 Premenstrual dysphoric disorder (PMDD)
o It is a more severe syndrome in which PMS-like signs and symptoms do not
resolve after the onset of menstruation.
 Endometriosis
o Is characterized by the growth of endometrial tissue outside the uterus.
o It can cause inflammation, pain, scarring, and infertility.
o Symptoms include premenstrual pain or unusually severe menstrual pain.
 Breast cancer
o Generally is not painful until it becomes quite advanced
o Any lump, no matter how small, should be reported to a physician at once
o Among the factors that increase the risk of developing breast cancer is a
family history of breast cancer, null parity (never having borne a child) or
having a first child after age 35, previous cancer in one breast, exposure to
ionizing radiation, such as x-rays, excessive alcohol intake and cigarette
smoking.
 Ovarian cancer
o Risk factors associated with ovarian cancer include age (over age 50), race
(whites are at highest risk), family history of ovarian cancer, more than 40
years of active ovulation, null parity, a high-fat and low-fibre
 Cervical cancer
o Starts with cervical dysplasia; a change in the shape, growth, and number of
cervical cells.
o The cells may either return to normal or progress to cancer.
o Increased risk is associated with having a large number of sexual partners,
having first intercourse at a young age and smoking cigarettes.
 Vulvovaginal Candidiasis
o Candida albicans commonly grows on mucous membranes of the
gastrointestinal and genitourinary tracts.
o It is the most common form of vaginitis inflammation of the vagina.
253
o Candidiasis is characterized by severe itching, a thick, yellow and cheesy
discharge, a yeasty odour and pain.
 Sexually Transmitted Diseases

o A sexually transmitted disease (STD) is one that is spread by sexual contact.
o It is in both male and female reproductive systems
o Chlamydia
 Is a sexually transmitted disease caused by the bacterium Chlamydia
trachomatis
 In males, urethritis is the principal result, causing a clear discharge,
burning on urination, frequent urination, and painful urination.
 In 70% of females with chlamydia, symptoms are absent, but chlamydia
is the leading cause of pelvic inflammatory disease.
o Gonorrhoea
 Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae.
 Males usually experience urethritis with profuse pus drainage and
painful urination
 In females, infection typically occurs in the vagina, often with a
discharge of pus
 Up to 50% of infected females may harbour the disease without any
symptoms
o Syphilis
 Syphilis, caused by the bacterium Treponema pallidum, is transmitted
through sexual contact or exchange of blood, or through the placenta to a
foetus.
 In primary stage, there may be a painless sores called chancre and a
signs and symptoms such as a skin rash, fever, and aches in the joints
and muscles usher in the secondary stage
o Genital Herpes
 Genital herpes is an incurable STD.
 Type II herpes simplex virus causes genital infections, producing painful
blisters on the prepuce, glans penis, and penile shaft in males and on the
vulva or sometimes high up in the vagina in females.
 The blisters disappear and reappear in most patients, but the virus itself
remains in the body
o Genital Warts
 Warts are an infectious disease caused by viruses.
 Human papillomavirus (HPV) causes genital warts, which is commonly
transmitted sexually.
 Patients with a history of genital warts may be at increased risk for
cancers of the cervix, vagina, anus, vulva, and penis.
 There is no cure for genital warts.
254
 Severe physical and emotional distress can cause premenstrual syndrome.
 Cigarette smoking and excess alcohol taking are the main causes of many cancers
including those of the female reproductive system.
 Avoid child bearing at older age, earlier sexual intercourse and multiple partners as may
cause cancers of the female reproductive system.

 Define female reproductive disorder
 List common disorders of the female reproductive system.
 What are the causative agents of syphilis and gonorrhoea?
255
References
McGraw-Hill
McGraw-Hill
256
Session 30: Structure and Functions of the Urinary System
Prerequisites
 None
Learning Tasks
 Define the Urinary System
 List Structures of Urinary System
 Describe the Structures of the Urinary System
 Explain the Functions of the Structures of the Urinary System
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
Definition and Type of Structures of the
2 Urinary System
Brainstorming
Presentation
3 Structures of the Urinary System
50minutes
4 Functions of the Structures of the Urinary System
Buzzing
05 minutes
05 minutes
257
SESSION CONTENTS

STEP 2: Definition of the Urinary System (25 minutes)


 What is urinary system?
 What are the structures of urinary system?
Urinary system: is the system which regulates the content of blood plasma to maintain the
homeostasis of the internal fluid environment within normal limits (control the composition
of blood and blood volume)
 It removes waste products from the blood, of which many of them are toxic
 The principal organ of the urinary system is the kidney
 The accessory organs include the ureters, urinary bladder and urethra
 The following are the structures of the urinary system:
o Kidneys
o Ureters
o Urinary bladder,
o Urethra
STEP 3: Structures of the Urinary System (50 minutes)

The kidneys
 Are bean shaped organs with a medial indentation,
 located in the upper abdominal cavity on either side of the vertebral column, behind
the peritoneum
 Are embedded in adipose tissue that acts as a cushion and is in turn covered by a
fibrous connective tissue membrane called the renal fascia, which helps hold the
kidneys in place
 The renal artery enters the kidney, and the renal vein and ureter emerge
 The outer tissue layer is called the renal cortex, which is made of renal corpuscles and
convoluted tubules
 The inner tissue layer is the renal medulla, which is made of loops of henle and
collecting tubules
258
 The renal medulla consists of wedge-shaped pieces called renal pyramids.
 The tip of each pyramid is its apex or papilla
 Renal pelvis is a cavity formed by the expansion of the ureter within the kidney at the
hilus
 Funnel shaped extensions of the renal pelvis; called calyces enclose the papillae of the
renal pyramids
 Urine flows from the renal pyramids into the calyces, then to the renal pelvis and out
into the ureter
Nephron
o Nephron is the structure and function unit of the kidney
o It is well associated with the blood vessels and the urine is formed there
o Each nephron has two major portions: a renal corpuscle and a renal tubule
Renal corpuscle
 Consists of a glomerulus surrounded by a Bowman‘s capsule.
 The glomerulus is a capillary network that arises from an afferent arteriole and
empties into an efferent arteriole.
 The diameter of the efferent arteriole is smaller than that of the afferent arteriole,
which helps maintain a fairly high blood pressure in the glomerulus.
Bowman’s capsule
 Is the expanded end of a renal tubule and encloses the glomerulus.
 The fluid that is formed from the blood in the glomerulus will eventually become
the urine
The renal tubule
o Continues from Bowman‘s capsule and consists of the proximal convoluted tubule (in the
renal cortex), loop of Henle (in the renal medulla), and distal convoluted tubule (in the
renal cortex).
o The distal convoluted tubules from several nephrons empty into a collecting tubule.
o Several collecting tubules then unite to form a papillary duct that empties urine into a
calyx of the renal pelvis.
Source: F.A.Davis (2007).

Figure 30.1: Structure of the kidney
o Blood flow and urine formation
259
o Blood enters the kidney through the renal artery and flows downstream to afferent
arterioles and emerge through efferent arterioles, flowing to upper stream to renal
veins, and finally to inferior vena cava
o The formation of urine involves three major processes
 The first is glomerular filtration, which take place in the renal corpuscles and
 The second and third are tubular reabsorption and tubular secretion, which
take place in the renal tubules.
o Accessory organs of the urinary system

o The ureters, urinary bladder, and urethra are responsible for the periodic
elimination of urine and do not change the composition or amount of urine.
o Ureter
 Each ureter extends from the hilus of a kidney to the lower, posterior side
of the urinary bladder
 The smooth muscle in the wall of the ureter contracts in peristaltic waves to
propel urine toward the urinary bladder.
 As the bladder fills, it expands and compresses the lower ends of the ureters
to prevent backflow of urine.
o Urinary bladder
 It is a muscular sac below the peritoneum and behind the pubic bones.
 In women, the bladder is inferior to the uterus; in men, the bladder is
superior to the prostate gland.
 The bladder is a reservoir for accumulating urine, and it contracts to
eliminate urine.
 The mucosa of the bladder is transitional epithelium, which permits
expansion without tearing the lining.
 The bladder wall is lined with smooth muscle called detrusor, which helps
contractions
 When the bladder is empty, the mucosa appears wrinkled.
o Urethra
 Carries urine from the bladder to the exterior
 In women, the urethra is 1 to 1.5 inches long and is anterior to the vagina
 In men it is 7 to 8 inches, the first part being surrounded by prostate gland
and the second passes through the cavernous tissue of the penis
260
Source: F.A.Davis (2007). Figure 30.2: Structure of the nephron
STEP 4: Functions of the Structures of the Urinary System (30 minutes)

 What are the functions of the structures of the urinary system?
o Functions of the kidney

o Filtering of blood
 Protein and blood cells are retained in the blood, while a large volume of
filtrate is produced
 Most of the filtrates volume is reabsorbed back into the blood along with
useful molecules and ions
261
 Small volume of water, metabolic wastes, toxic molecules, and excess ions
remain in the filtrates and the result is the formation of urine
o Regulation of blood pressure

 The kidneys regulate blood pressure by adjusting the volume of blood in the
body
o Regulation of blood volume

 The kidneys play a major role in controlling the extracellular fluid volume in
the body by producing either large volume of dilute urine or small volume of
concentrated urine
o Regulation of the plasma electrolytes;

 Examples are sodium and Potassium ions
o Regulation of the pH of the blood;

 The kidneys secrete H+ ions to help regulate blood pH and conserve HCO3- to
buffer H+
o Synthesis of Vitamin D;
 The kidneys synthesize 1, 25-dihydroxycholecalciferol, which is the active
form of vitamin D
o Production of Red blood cells

o Excretion of waste products and foreign substances
 In form urine
o Function of the Ureter
o Carries urine from the kidney to the bladder. Muscles in the ureter walls continually
tighten and relax forcing urine down this tube
o Functions of the urinary bladder
o The bladder's walls relax and expand to store urine,
o The bladder's walls contract and flatten to empty urine through the urethra.
o Functions of the Urethra
o Squeezes urine out of the bladder.
262
 Urinary system is the system which regulates the content of blood plasma to maintain
the homeostasis of the internal fluid environment within normal limits (control the
composition of blood and blood volume)
 Structures of the urinary system include:
 Kidneys
o Ureters,
o Urinary bladder,
o Urethra
 Function of the kidneys are:
o Remove liquid waste from the blood in the form of urine
o Keep a stable balance of salts and other substances in the blood
o Produce erythropoietin, a hormone that helps your body make red blood cells
 Functions of the Ureter are:
o Carries urine from the kidney to the bladder. Muscles in the ureter walls continually
tighten and relax forcing urine down this tube
o Functions of the urinary bladder
o The bladder's walls relax and expand to store urine,
o The bladder's walls contract and flatten to empty urine through the urethra.
o Functions of the Urethra
o Squeezes urine out of the bladder

 What is urinary system?
 What are the structures of urinary system?
 What are the functions of the Kidney?
263
References
McGraw-Hill.
McGraw-Hill.
Hoffman Press, Inc.
264
Session 31: Common Disorders of the Urinary System
Total Session Time: 60 minutes + 60 minutes assignment.
Prerequisites
 Session 30; Structures and functions of the Urinary system

 Define Disorders of the Urinary System
 List common Disorders of the Urinary System
 Explain the Common Disorders of the Urinary System
Resources Needed:
 Black/white board, chalk/whiteboard markers
 Overhead projector (OHP) and computer.
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation Definition and Types of Common Disorders of the
2 10 minutes
buzzing Urinary System
Presentation
3 25 minutes Small Group Common Disorders of the Urinary System
Discussion
05 minutes
05 minutes
10 minutes
265
SESSION CONTENTS
STEP 2: Definition and Types of Common Disorders of the Urinary System

(10 minutes)
What is the disorder of the urinary system?

What are the types of the urinary system?
Urinary system disorder:

A urinary tract infection (UTI) is an infection in any part of your urinary system your
kidneys, ureters, bladder and urethra.
Most infections involve the lower urinary tract — the bladder and the urethra.
The common disorders of the urinary tract disorders are:
o Urinary Incontinence and retention
o Urinary tract infections
o Inflammatory disorders
o Obstructive disorders
o Tumours
o Renal failure
o Chronic renal failure
266
Step 3: Common disorders of the urinary system (25 minutes)

 Explain the common disorders of the urinary system?
 Urinary Incontinence and retention

o Incontinence is due to loss of voluntary control of bladder
o Retention (residual urine) may be due to anatomical defects and is usually corrected
by catheterization
 Urinary tract infections

o These includes Urethritis, Cystitis and Pyelonephritis
o The common causes are:
 Ascending infection - women > men
 Prostatic hypertrophy with urinary retention
 Incomplete emptying of bladder with urinary stasis
 Pregnancy associated with stasis Blood borne pathogens
 Inflammatory disorders
o Glomerulonephritis
 Mainly is due to proteinuria, edema, oliguria and autoimmune diseases
o Nephrotic syndrome
 One loses the capacity to retain protein, especially albumin
 May be due to toxic agents like mercury, toxic drugs like aminoglycosides and diseases
like diabetes
o Obstructive disorders
o Kidney stones (Renal calculi)

 Accumulation of calcium, uric acid, urine crystals
 Mostly due to prolonged dehydration and infections
 Is presented by fever, chills, renal colic
o Tumours
 Formation of masses
 Is presented by haematuria
o Renal failure
o Acute renal failure
 Abrupt decrease in renal function
 Usually reversible
 May be caused by Glomerular disease, Severe pyelonephritis and Ischemia
267
o Chronic renal failure
 Get slow progressive loss of neurons
 Usually irreversible
 May be due to toxins, glomerular disease, hypertension
STEP4: Key Points (5 minutes)

 The common urinary tract disorders include urinary incontinence/retention, infections,
inflammatory disorders, obstructive disorders and renal failure
 Urinary tract infections are most prominent among other disorders of the urinary system
 It is important to treat urinary tract infections as early as possible to avoid the possibilities
of kidney stones.
 What is the disorder of the urinary system?

 What are the common disorders of the urinary system?
 What are the causes of the common disorders of the urinary system?

 Explain common disorders of the urinary tract system
268
References
McGraw-Hill
McGraw-Hill
269
Session 32: Structure and Functions of Endocrine System
Total Session Time: 120 minutes+ 60 minutes assignment
Prerequisites
None
Learning Tasks
 Define the Endocrine System
 Explain the Structure of Endocrine System
 Explain the Functions of Endocrine System
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
20 minutes Presentation Definition of Endocrine System
2
Brainstorming
Presentation
3 45 minutes Small Group Structure of Endocrine System
Discussion
4 Functions of Endocrine System
Buzzing
05 minutes
05 minutes
10 minutes
270
SESSION CONTENTS

STEP 2: Definition of Endocrine System (20 minutes)
 Endocrine system is the regulating system of the body by the chemical substances
called hormone, which are produced by endocrine glands
 The endocrine glands are ductless to sense that, they have no ducts to take the hormones
to specific sites
 Instead, hormones are secreted directly to the capillaries and circulate in the blood
throughout the body
 The hormones produced are divided in to three groups:
o Amines
 These simple hormones are structural variations of the amino acid tyrosine
 Examples are thyroxine from thyroid gland), epinephrine and norepinephrine (rom
adrenal medulla)
o Proteins
 These hormones are chains of amino acids
 Examples are calcitonin from thyroid gland, insulin from the pancreas, growth
hormone from anterior pituitary gland
o Steroids
 These are hormones where by cholesterol is a precursor
 Examples are cortisol from adrenal cortex and oestrogen from the ovaries.
STEP 3: Structure of Endocrine System (45 minutes)

 What are the glands which form the endocrine system?
 The endocrine system is the combination of endocrine glands which secrete hormones
 The endocrine glands are:
o Pituitary gland
o Thyroid gland
271
o Parathyroid gland
o Adrenal gland
o Pancreas
o Ovaries
o Testes
Pituitary gland
 It hangs from the hypothalamus and is enclosed by the sphenoid bone
 It is divided into posterior pituitary gland and anterior pituitary gland
o Posterior pituitary gland.

 The two hormones of the posterior pituitary gland are produced by the
hypothalamus and stored in the posterior pituitary gland until needed
 These hormones are anti-diuretic hormone (vasopressin) and oxytocin and both
are peptides.
 Antidiuretic hormone increases the reabsorption of water by kidney tubules,
which decreases the amount of urine formed.
 The water is reabsorbed into the blood, so as urinary output is decreased, blood
volume is increased, which helps maintain normal blood pressure
 Oxytocin stimulates contraction of the uterus at the end of pregnancy and
stimulates release of milk from the mammary glands.
o Anterior pituitary gland
 The hormones produced are regulated by releasing hormone from the
hypothalamus.
 The hormones produced are growth hormones (somatotropin), thyroid stimulating
hormone, adrenocorticotropic hormone, prolactin, follicle stimulating hormone
and luteinizing hormone.
 Growth hormones promote growth as increases amino acids transport and protein
synthesis.
 Thyroid stimulating hormone stimulates the normal growth of the thyroid and the
secretion of thyroxine (T4) and triiodothyronine (T3).
 Adrenocorticotropic hormone (ACTH) stimulates the secretion of cortisol and
other hormones by the adrenal cortex.
 Secretion of ACTH is increased by corticotropin-releasing hormone (CRH) from
the hypothalamus.
 Prolactin is responsible for lactation. More precisely, prolactin initiates and
maintains milk production by the mammary glands.
 Follicle stimulating hormone stimulates the growth of ovarian follicles; that is, it
initiates egg development in cycles of approximately28 days.
 Luteinizing hormone is responsible for ovulation, the release of a mature ovum
from an ovarian follicle.
Thyroid gland
 The thyroid gland is located on the front and sides of the trachea just below the larynx
 The structural units of the thyroid gland are thyroid follicles, which produce thyroxine
(T4) and triiodothyronine(T3) and iodine is necessary foe production of these hormones
o Thyroxine and T3
 Thyroxine (T4) and T3 have the same functions: regulation of energy production
and protein synthesis, which contribute to growth of the body and to normal body
functioning throughout life.
 Thyroxine and T3 increase cell respiration of all food types (carbohydrates, fats,
and excess amino acids) and thereby increase energy and heat production.
272
o Calcitonin
 Decreases the reabsorption of calcium and phosphate from the bones to the blood,
thereby lowering blood levels of these minerals.
 This function of calcitonin helps maintain normal blood levels of calcium and
phosphate and also helps maintain a stable, strong bone matrix.
Parathyroid gland
 They produce a hormone called parathyroid hormone.
 Parathyroid hormone is an antagonist of calcitonin
 It increases the reabsorption of calcium and phosphate from bones to the blood, thereby
raising their blood levels. And also increase their absorption from the intestine.
Pancreas
 It is located in the upper left quadrant of the abdominal cavity, extending from the curve
of the duodenum to the spleen.
 It is also an exocrine gland.
 The pancreatic hormones are produced by the cells called islet of Langerhans and the
hormones are insulin and glucagon.
 Glucagon stimulates the liver to change glycogen to glucose (this process is called
glycogen lysis, which literally means ―glycogen breakdown‖) and to increase the use of
fats and excess amino acids for energy production.
 The overall effect of glucagon, therefore, is to raise the blood glucose level and to make
all types of food available for energy production and is stimulated by hypoglycaemia.
 Insulin increases the transport of glucose from the blood into cells by increasing the
permeability of cell membranes to glucose.
 A deficiency of insulin or in its functioning is called diabetes mellitus.
Adrenal glands
 The two adrenal glands are located one on top of each kidney.
 Each adrenal gland consists of two parts: an inner adrenal medulla and an outer adrenal
cortex.
 The cells of the adrenal medulla secrete epinephrine and norepinephrine, which
collectively are called catecholamine sand are sympathomimetic.
 Epinephrine (Adrenalin) and norepinephrine (noradrenalin) are both secreted in stress
situations and help prepare the body for ―fight or flight.‖
 The adrenal cortex secretes three types of steroid hormones: mineralocorticoids,
glucocorticoids and sex hormones (oestrogens and androgens).
 Aldosterone is a mineralocorticoid and increases the reabsorption of sodium and the
excretion of potassium by the kidney tubules hence maintains normal blood volume and
blood pressure.
 Cortisol is a glucocorticoid and increases the use of fats and excess amino acids
(gluconeogenesis) for energy and decreases the use of glucose
 It conserves glucose for use in brain
 Cortisol also has anti-inflammatory effect as they block the effects of histamine
Ovaries
 The ovaries are located in the pelvic cavity, one on each side of the uterus.
 The hormones produced by the ovaries are the steroids estrogen and progesterone, and
the protein inhibin.
 Estrogen promotes the maturation of the ovum in the ovarian follicle and stimulates the
growth of blood vessels in the endometrium (lining) of the uterus in preparation for a
possible fertilized egg
 Also estrogen is responsible for the development of female secondary characteristics
273
 Progesterone promotes the storage of glycogen and the further growth of blood vessels
in the endometrium, which thus becomes a potential placenta.
 Inhibin helps decrease the secretion of follicle stimulating hormone.
Testes
 The testes are located in the scrotum, a sac of skin between the upper thighs
 Two hormones, testosterone and inhibin, are secreted by the testes.
 Testosterone promotes maturation of sperm in the seminiferous tubules of the testes
 Testosterone is also responsible for development of male secondary characteristics
 The function of inhibin is to decrease the secretion of FSH by the anterior pituitary
gland
 The interaction of inhibin, testosterone, and the anterior pituitary hormones maintains
spermatogenesis at a constant rate.
Source: Scanlon,V.V., & Sanders,T (2007).

Figure 32.1a: Location of endocrine glands in the endocrine system
274
Source: Scanlon,V.V., & Sanders,T (2007).
Figure 32.1b: Location of endocrine glands in the endocrine system
STEP 4: Functions of the Endocrine System (30 minutes)

 What are the functions of the endocrine system?
The functions of the endocrine system include:

 The growth and repair of tissues
 The utilization of food to produce energy
 Responses to stress
 The maintenance of the proper levels and pH of body fluids
 The continuance of the human species all depend on hormones.
275
 The hormones of endocrine glands are involved in virtually all aspects of normal body
functioning
 The hormones may belong to amines, proteins or steroids
 The glands of the endocrine system includes pituitary gland, thyroid gland, parathyroid
gland adrenal gland, pancreas, ovaries and testes

 What is endocrine system?
 What are the hormones secreted by the posterior and anterior pituitary gland?
 What are the functions of testosterone?

 Draw and label the endocrine glands in the endocrine system of a man
276
References
McGraw-Hill.
McGraw-Hill.
Kingdom: Churchill Livingstone Elsevier.
Hoffman Press, Inc.
Waugh, A., & Grant, A. (2006). Ross and Wilson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elsevier.
277
Session 33: Common Disorders of Endocrine System
Prerequisites
 Session 32:Structure and functions of endocrine system
Learning Tasks
 Define Disorders of Endocrine System
 List Common Disorders of Endocrine System
 Explain the Common Disorders of the Endocrine System
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation Definition and types of Common Disorders of
2 10 minutes
buzzing Endocrine System
Presentation
3 35minutes Small Group Common Disorders of Endocrine System
Discussion
05 minutes
05 minutes
278
SESSION CONTENTS

STEP 2: Definition and Types of Common Disorders of Endocrine System

(10minutes)
 What are endocrine system disorders

 What are the types of common disorders of endocrine system?
Common disorders of endocrine system:

Endocrine disorders may be subdivided into three groups:
 Endocrine gland hypo secretion which leading to hormone deficiency
 Endocrine gland hypersecretion which leading to hormone excess
 Tumours which benign or malignant of endocrine glands
Types of common disorders of endocrine system

 Disorders of the growth hormone:
o Dwarfism
o Giantism (Gigantism)
 Disorders of the thyroxine
o Goiter
o Cretinism
o Myxedema
o Grave‘s disease
 Diabetes Mellitus
 Disorders of the adrenal cortex
o Cushing‘s syndrome
279
STEP 2: Common Disorders of Endocrine System (35minutes)

 What are the common disorders of endocrine system?
Disorders of the Growth hormone:

 Dwarfism
o Hypo secretion of GH results in pituitary dwarfism, in which the person mayattain a
final height of only 3 to 4 feet but will have normal body proportions.
o Growth hormone can now be produced using genetic engineering and may be used to
stimulate growth in children with this disorder
 Giantism (Gigantism)
o Is the hyper secretion of growth hormone
o The long bones grow excessively and the person may attain a height of 8 feet.
o In adults, the hyper secretion of growth hormone due to pituitary tumour can result to
acromegaly, a condition where by the long bones cannot grow due to closure of
epiphyseal discs.
Disorders of the thyroxine
 Goiter
o It is caused by dietary deficiency of iodine
o In an attempt to produce more thyroxine, the thyroid cells become enlarged, and
hence the thyroid gland enlarges and becomes visible on the front of the neck.
 Cretinism
o It is a condition of hypo secretion of thyroxine in new born
o It retards both physical and mental development.
 Myxedema
o It is a condition of hypo secretion of thyroxine in adults
o This decreases metabolic rate and hence general body weakness
 Grave‘s disease
o This is autoimmune disease which result to hypersecretion of thyroxine hormone
Diabetes Mellitus
 There are two types of diabetes mellitus:
o Type 1 is called insulin-dependent diabetes and its onset is usually in childhood
(juvenile onset).
 Is characterized by destruction of the beta cells of the islets of Langerhans and a
complete lack of insulin
o Type 2 is called non–insulin-dependent diabetes, and its onset is usually later in life
(maturity onset).
 Insulin is produced but cannot exert its effects on cells because of a loss of insulin
receptors on cell membranes.
280
 Risk factors include a family history of diabetes and being overweight. Control
may not require insulin, but rather medications that enable insulin to react with the
remaining membrane receptors.
Disorders of the adrenal cortex
 Addison‘s disease
o Itis a result of hypo secretion of the adrenal cortical hormones.
o Atrophy of the adrenal cortex decreases both cortisol and aldosterone secretion.
o Deficiency of cortisol is characterized by hypoglycaemia, decreased gluconeogenesis,
and depletion of glycogen in the liver.
 Consequences are muscle weakness and the inability to resist physiological stress.
o Aldosterone deficiency leads to retention of potassium and excretion of sodium and
water in urine.
 The result is severe dehydration, low blood volume, and low blood pressure.
 Cushing‘s syndrome
o Itis a result of hypersecretion of the adrenal cortex, primarily cortisol.
o The cause may be a pituitary tumour that increases ACTH secretion or a tumour of
the adrenal cortex itself.
o Excessive cortisol promotes fat deposition in the trunk of the body, while the
extremities remain thin.
o The skin becomes thin and fragile, and healing after injury is slow.

 Dwarfism and gigantism are the disorders of the growth hormone
 Grave‘s disease is the only thyroxine disorder which is due to hyper secretion of
thyroxine
 Overweight is the main risk factor of diabetes mellitus type 2
 Addison‘s disease is a result of hypo secretion of the adrenal cortical hormones.
 Cushing‘s syndrome is a result of hyper secretion of the adrenal cortex, primarily cortisol.
 Goiter caused by dietary deficiency of iodine

 What are the Disorders of Endocrine System
 What are the Common Disorders of Endocrine System
 What is the main cause of poor sensitivity of insulin receptors?
281
References
McGraw-Hill
McGraw-Hill
282
Session 34: Structures and Functions of the Central
Nervous System
Prerequisites
 None
Learning Tasks
 Define the Nervous system, Autonomic Nervous system, Somatic nervous system,
and Nerves
 List Components of the Nervous System
 Explain the Structure of Central Nervous System.
 State Functions of Nervous System
Resources Needed:
 Handout 34.1:Synapse and synaptic transmission
SESSION OVERVIEW
Activity/
Step Time Content
Method
Definition and Components of the Nervous
2 System
Brainstorming
Presentation
3 20 minutes Small Group Nerve Tissue
Discussion
Presentation
4 35 minutes Small Group Central Nervous System
Discussion
30 Minutes
5 Presentation Functions of the Nervous System
05 minutes
05 minutes
283
SESSION CONTENTS

STEP 2: Definition and Components of the Nervous System (20minutes)


 What is the nervous system autonomic nervous system?
 What is somatic nervous system, and nerves?
 What are the components of the nervous system?
Nervous System
 Refers to the part of the body that coordinates its voluntary and involuntary actions and
transmits signals between different parts
 It is the system that conducts stimuli from sensory receptors to the brain and spinal cord
and that conducts impulses back to other parts of the body.
Autonomic Nervous System

 The part of the nervous system that regulates the involuntary activity of the heart,
intestines, and glands, including digestion, respiration, perspiration, metabolism, and
blood-pressure modulation.
Somatic Nervous System

 The part of the peripheral nervous system that transmits signals from the central nervous
system to skeletal muscle and from receptors of external stimuli, thereby mediating sight,
hearing and touch.
Nerves
 Nerves are bundles of axons in the peripheral nervous system (PNS) that act as
information highways to carry signals between the brain and spinal cord and the rest of
the body.
Components of the nervous system:

284
 The Central Nervous System
o Brain
o Spinal cord
 Peripheral Nervous system is divided into:
o Autonomic nervous system
o Peripheral nervous system
STEP 3: Nerve Tissue (20 minutes)


 What are the parts of neuron?
 Nerve tissue is made up of nerve cells called neurons or nerve fibers

 All neurons have the same physical parts.
o The cell body contains the nucleus and is essential for the continued life of the
neuron.
o Dendrites are processes (extensions) that transmit impulses toward the cell body.
o The one axon of a neuron transmits impulses away from the cell body.
o It is the cell membrane of the dendrites, cell body, and axon that carries the electrical
nerve impulse.
o Axons and dendrites are collectively called Schwann cells in the peripheral nervous
system and are covered by a membrane called myelin sheath.
o Node of Ranvier is the spaces between adjacent Schwann cells or segments of myelin
sheath.
o Neurolema are the nuclei and cytoplasm of Schwann cells.
 Synapse.
o It is the small gap or space between the axon of one neuron and the dendrites/cell
body of the next neuron.
o The synaptic knob of presynaptic axon contains chemical neurotransmitters that are
released to the synapse on the arrival of an impulse.
o Synapses ensure one way impulse transmission
o The neurotransmitter diffuses across the synapse, combines with specific receptor
sites on the cell membrane of the postsynaptic neuron, and there generates an
electrical impulse that is, in turn, carried by this neuron‘s axon to the next synapse.
o Example of neurotransmitter is acetylcholine found at the neuromuscular junction.
 Types of neurons
o Neurons are classified in to three groups which are :
285
 sensory (afferent) neuron,
 motor (efferent) neuron
 Interneuron.
o Sensory neurons
 Carry impulses from receptors to the central nervous system.
 Receptors detect external or internal changes and send the information to the CNS
in the form of impulses by way of the afferent neurons.
 The central nervous system interprets these impulses as a sensation.
o Motor neurons
 Carry impulses from the central nervous system to effectors.
 The two types of effectors are muscles and glands.
 In response to impulses, muscles contract or relax and glands secrete.
o Interneurons
 They are found entirely within the central nervous system.
 They are arranged so as to carry only sensory or motor impulses, or to integrate
these functions.
 Some interneurons in the brain are concerned with thinking, learning, and
memory.
286
Source: Scanlon,V.C. & Sandors, T (2007). Figure 34.1: Structures of sensory and motor neuron
Refer students to Handout 34.1: Synapse and synaptic transmission
STEP 4: Central Nervous System (35 minutes)


 What are the main parts of central nervous system?
287
 Central nervous system (CNS) is a part of nervous system which is made up of brain and
spinal cord
 The Spinal cord

o The spinal cord transmits impulses to and from the brain and is the integrating centre
for the spinal cord reflexes
o The spinal cord extends from the foramen magnum of the occipital bone to the disc
between the first and second lumbar vertebrae.
o The internal grey matter is shaped like the letter H
o Grey matter consists of the cell bodies of motor neurons and interneurons.
o The external white matter is made of myelinated axons and dendrites of interneurons.
o Emerging from the spinal cord are spine nerves.
o Spinal cord reflexes are those that do not depend directly on the brain, although the
brain may inhibit or enhance them.
o A reflex arc is the pathway that nerve impulses travel when a reflex is elicited, and
there are five essential parts:
 Receptors-detect a change (the stimulus) and generate impulses.
 Sensory neurons-transmit impulses from receptors to the CNS.
 Central nervous system-contains one or more synapses.
 Motor neurons-transmit impulses from the CNS to the effector.
 Effector-performs its characteristic action.
 The Brain
o The major parts of the brain are the medulla, pons, and midbrain (collectively called
the brain stem), the cerebellum, the hypothalamus, the thalamus and the cerebrum.
o Ventricles are cavities in the brain where the cerebrospinal fluid is found.
o Medulla
 The medulla extends from the spinal cord to the pons and is anterior to the
cerebellum.
 It contains cardiac centre, vasomotor centre and respiratory centre hence controls
heart rate, diameter of blood vessels and breathing respectively.
 Also there are reflex centres for coughing, sneezing, swallowing, and vomiting.
o Pons
 They bulge anteriorly from the upper part of the medulla.
 Within the pons are two respiratory centres that work with those in the medulla to
produce a normal breathing rhythm.
o Midbrain
 The midbrain extends from the pons to the hypothalamus
 Visual and auditory reflexes are integrated to the midbrain.
o Cerebellum
 It is concerned with movements like coordination, regulation of muscle tone, the
appropriate trajectory and endpoint of movements, and the maintenance of posture
and equilibrium.
o Hypothalamus
 It is located superior to the pituitary gland and inferior to the thalamus
 Their functions include:
 Production of antidiuretic hormone and oxytocin which are stored in the posterior
pituitary gland
 Regulation of releasing hormone
 Regulation of food intake
 Regulation of body temperature
 Integration of the functioning of autonomic nervous system
288
 Stimulation f visceral response during emotions
 Regulation of body rhythms like hormone secretion and sleep cycles.
o Thalamus
 It is superior to the hypothalamus and inferior to the cerebrum.
 Many of the functions of the thalamus are concerned with sensation.
o Cerebrum
 It is lined with grey matter on the surface called cerebral cortex
 The cerebral cortex has folds which enable us to read, speak, do long division, and
write and other things done by human that animals cannot do because they lack
the folds.
 The cerebral cortex is divided in to lobes which are frontal lobe, parietal lobe,
temporal lobe, and occipital lobe.
 Within the frontal lobes are the motor areas that generate the impulses for
voluntary movement, like that of hands, face, mouth in speaking and others.
 The general sensory areas in the parietal lobes receive impulses from receptors in
the skin and feel and interpret the cutaneous sensations and also from stretch
receptors in muscles for conscious muscle sense.
 The olfactory areas in the temporal lobes receive impulses from receptors in the
nasal cavities for the sense of smell.
 The olfactory association area learns the meaning of odours such as the smell of
sour milk, or fire.
 Occipital lobe contains visual association areas which interpret what has seen and
enable the thinking cerebrum to use the information.
o Basal ganglia
 These are paired masses of grey matter within the white matter of the cerebral
hemispheres
 Their functions are certain subconscious aspects of voluntary movement, and they
work with the cerebellum.
 The basal ganglia help regulate muscle tone, and they coordinate accessory
movements such as swinging the arms when walking or gesturing while speaking.
o Corpus collosum
 It connects the brain hemispheres to know what is going on to each other.
 This is especially important for people because for most of us, the left hemisphere
contains speech areas and the right hemisphere does not.
o Meninges
 These are connective tissue that covers the brain and the spinal cord.
 Between the membranes of meninges there is cerebrospinal fluid, the tissue fluid
of the central nervous system.
 Examination of the fluid can be used to diagnose certain diseases.
o Cranial nerves
 These are nerves which emerge from the brain stem or other parts of the brain and
are about twelve.
 They carry impulses for functions involving the head.
 The impulses for the senses of smell, taste, sight, hearing, and equilibrium are all
carried by cranial nerves to their respective sensory areas in the brain.
289
Source: Scanlon,V.C . & Sandors,T (2007). Figure 34.2: The brain as seen from left side
STEP 6: Functions of the Nervous System (30 minutes)
 The nervous system has 3 main functions;

o Sensory
o Integration, and
o Motor.
Sensory
 The sensory function of the nervous system involves collecting information from
sensory receptors that monitor the body‘s internal and external conditions.
 These signals are then passed on to the central nervous system (CNS) for further
processing by afferent neurons (and nerves).
Integration
 The process of integration is the processing of the many sensory signals that are passed
into the CNS at any given time.
 These signals are evaluated, compared, used for decision making, discarded or
committed to memory as deemed appropriate.
 Integration takes place in the grey matter of the brain and spinal cord and is performed
by interneurons.
 Many interneurons work together to form complex networks that provide this
processing power.
290
Motor
 Once the networks of interneurons in the CNS evaluate sensory information and decide
on an action, they stimulate efferent neurons.
 Efferent neurons (also called motor neurons) carry signals from the grey matter of the
CNS through the nerves of the peripheral nervous system to effector cells.
 The effector may be smooth, cardiac, or skeletal muscle tissue or glandular tissue.
 The effector then releases a hormone or moves a part of the body to respond to the
stimulus

 The nervous system is one of the regulating systems by which electrochemical impulses
make it possible to obtain information about the external or internal environment
 Neurons are classified in to three groups which are sensory (afferent) neuron, motor
(efferent) neuron and interneuron.
 Central nervous system is a part of nervous system which is made up of brain and spinal
cord.

 What is nervous system?
 What are the components of nervous system?
 What are the functions of nervous system?
 What are the parts of a neuron?
References
291
McGraw-Hill.
McGraw-Hill.
Hoffman Press, Inc.
292
Handout 34.1: Synapse and synaptic transmission
 The neurotransmitter diffuses across the synapse, combines with specific receptor
sites on the cell membrane of the postsynaptic neuron, and there generates an
electrical impulse that is, in turn, carried by this neuron‘s axon to the next synapse,
and so forth.
 A chemical inactivator at the cell body or dendrite of the postsynaptic neuron quickly
inactivates the neurotransmitter.
 This prevents unwanted, continuous impulses, unless a new impulse from the first
neuron releases more neurotransmitter.
 Many synapses are termed excitatory, because the neurotransmitter causes the
postsynaptic neuron to depolarize (become more negative outside as Na+ ions enter
the cell) and transmit an electrical impulse to another neuron, muscle cell, or gland.
 Some synapses, however, are inhibitory, meaning that the neurotransmitter causes the
postsynaptic neuron to hyperpolarize (become even more positive outside as K+ions
leave the cell or Cl- ions enter the cell) and therefore not transmit an electrical
impulse.
 Such inhibitory synapses are important, for example, for slowing the heart rate, and
for balancing the excitatory impulses transmitted to skeletal muscles.
 With respect to the skeletal muscles, this inhibition prevents excessive contraction and
is important for coordination.
 An example of a neurotransmitter is acetylcholine, which is found at neuromuscular
junctions, in the CNS, and in much of the peripheral nervous system.
 Acetylcholine usually makes a postsynaptic membrane more permeable to Na+ ions,
which brings about depolarization of the postsynaptic neuron.
 Cholinesterase is the inactivator of acetylcholine.
 There are many other neurotransmitters, especially in the central nervous system.
 These include dopamine, GABA, norepinephrine, glutamate, and serotonin.
 Each of these neurotransmitters has its own chemical inactivator.
 Some neurotransmitters are reabsorbed into the neurons that secreted them; this
process is called reuptake and also terminates the effect of the transmitter.
Source: Scanlon,V.C. & Sandors,T (2007). Figure 34.3: Impulse transmission at a synapse
293
Session 35: Structure and Functions of the Autonomic
Nervous System
Prerequisites
 Session 34; Structure and Functions of the Central Nervous System
Learning Tasks
 Define the Autonomic Nervous System
 Explain the Divisions of the Autonomic Nervous System
 State the Functions of Autonomic Nervous System at Different Organs
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Presentation Definition of the Autonomic Nervous System
2
Brainstorming
Presentation
3 45 minutes Small Group Divisions of the Autonomic Nervous System
Discussion
Presentation
Functions of the Autonomic Nervous System at
Different Organs
Discussion
05 minutes
05 minutes
294
SESSION CONTENTS

STEP 2: Definition of Autonomic Nervous System (10 minutes)


 What is autonomic nervous system?
 Autonomic nervous system (ANS) is a part of peripheral nervous system and consists of
motor parts of spinal nerves and cranial nerves
 The peripheral nervous system relays information to and from the central nervous system
 Autonomic nervous system is made up of visceral motor neurons to the smooth muscles,
cardiac muscles and glands of which muscles will either contract or relax and glands will
either increase or decrease secretions
STEP 3: Divisions of the Autonomic Nervous System (45 minutes)


 What are the divisions of the autonomic nervous systems?
 The ANS has two divisions which are sympathetic and parasympathetic.
o Often, they function in opposition to each other.
 Sympathetic division
o The sympathetic division brings about widespread responses in many organs.
295
o The sympathetic division is dominant in stressful situations, which include anger,
fear, or anxiety, as well as exercise.
o There are synapses between preganglionic and postganglionic neurons
o One preganglionic neuron often synapses with many postganglionic neurons to many
effectors. This anatomic arrangement has physiological importance.
 Parasympathetic division
o The parasympathetic division dominates in relaxed (non-stress) situations to promote
normal functioning of several organ systems.
o In the parasympathetic division, one preganglionic neuron synapses with just a few
postganglionic neurons to only one effector. With this anatomic arrangement, much
localized (one organ) responses are possible.
 In autonomic pathways there are two synapses: one between preganglionic and
postganglionic neurons, and the second between postganglionic neurons and visceral
effectors.
o Acetylcholine is the transmitter released by all preganglionic neurons, both
sympathetic and parasympathetic and is inactivated by cholinesterase in
postganglionic neurons.
o Parasympathetic postganglionic neurons all release acetylcholine at the synapses with
their visceral effectors.
o Most sympathetic postganglionic neurons release the transmitter norepinephrine at the
synapses with the effector cells.
o Norepinephrine is inactivated by either catechol-Methyltransferase (COMT) or
monoamine oxidase (MAO), or it may be removed from the synapse by reuptake.
STEP 4: Functions of the Autonomic Nervous System at Different Organs

(50 minutes)

 What are the functions of autonomic nervous system to different body organs?
Organ Sympathetic response Parasympathetic response

Heart (cardiac muscle) Increase rate Decrease rate (to normal)
Bronchioles (smooth muscle) Dilate Constrict (to normal)
Iris (smooth muscle) Pupil dilates Pupil constrict (to normal)
Salivary glands Decrease secretion Increase secretion to normal
Stomach and intestine (smooth Decrease peristalsis Increase peristalsis for normal
muscle) digestion
Stomach and intestine (glands) Decrease secretion Increase secretion for normal
digestion
Internal anal sphincter Contracts to prevent Relaxes to permit defecation
defecation
296
Urinary bladder (smooth muscle) Relaxes to prevent urination Contracts for normal
urination
Internal urethral sphincter Contracts to prevent Relaxes to permit urination
urination
Liver Changes glycogen to glucose None
Pancreas Secrete glucagon Secrete insulin and digestive
enzymes
Sweat glands Increase secretion None
Adrenal glands Increase secretion of None
epinephrine and
norepinephrine
 Autonomic nervous system (ANS) is a part of peripheral nervous system and consists of
motor parts of spinal nerves and cranial nerves.
 The sympathetic division is dominant in stressful situations while parasympathetic
division dominates in relaxed (non-stress) situations
 In their functions, sympathetic and parasympathetic always oppose each other.

 What is autonomic nervous system
 What are the divisions of the autonomic nervous systems?
 Which neurotransmitter is inhibited by cholinesterase?
References
McGraw-Hill.
297
Press, Inc.
Session 36: Common Disorders of the Nervous System

Prerequisites
 Session 30 and 31; Structure and Functions of the Central And Autonomic Nervous
System
298
Learning Tasks
 Define Disorder of Nervous System
 List Disorders of Nervous System
 Explain the Parkinson‘s Disease and Alzheimer‘s Disease
 Explain the Neuroleptic Disorders
 Explain the Hydrocephalus
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation
2 15 Minutes Disorders of Nervous System
Buzzing
Presentation
3 30 minutes Small Group Parkinson‘s Disease and Alzheimer‘s Disease
Discussion
Presentation
4 45 minutes Small Group Neuroleptic Disorders
Discussion
5 Hydrocephalus
Brainstorming
05 minutes
05 minutes
299
SESSION CONTENTS

STEP 2: Disorders of Nervous System (15 minutes)
ASK learners to pair and buzz on the following question for 2 minutes
 What is nervous disorder?
ALLOW few pairs to respond and let others pairs to add on points not mentioned
CLARIFY and SUMMARIZE by using content below
Nervous system disorders are the disorders of the brain, spinal cord, sensory organs, and all
of the nerves that connect these organs with the rest of the body.
The common nervous system disorders:
 Psychosis
 Depression
 Schizophrenia
 Epilepsy
 Multiple sclerosis
 Parkinson‘s disease
 Alzheimer‘s disease
 Hydrocephalus
300
STEP 3: Parkinson’s disease and Alzheimer ’s disease (30 minutes)

 What are Parkinson‘s disease and Alzheimer‘s disease?
 Parkinson‘s disease
o This is a disorder of the basal ganglia
o The cause is unknown, and though there is a genetic component in some families, itis
probably not the only factor
o The disease usually begins after the age of 60
o Neurons in the basal ganglia that produce the neurotransmitter dopamine begin to
degenerate and die, and the deficiency of dopamine causes specific kinds of muscular
symptoms.
 Tremor, or involuntary shaking, of the hands is probably the most common
symptom.
 The accessory movements regulated by the basal ganglia gradually diminish, and
the affected person walks slowly without swinging the arms.
 Alzheimer‘s disease
o This is the genetic disorder of the nervous system.
o It is due to presence of abnormal fibrous proteins in the cells of cerebral cortex in
areas important for memory and reasoning.
o The symptoms include
 Memory lapse and slight personality changes.
 As the disease progresses, there is total loss of memory, reasoning ability, and
personality, and those with advanced disease are unable to perform even the
simplest tasks or self-care.
301
STEP 4: Neuroleptic Disorders (45 minutes)

 What are neuroleptic disorders?
 Neuroleptic disorders are mixtures of symptoms, especially anxiety and depressive

ones.
 Psychosis and Depression
o They are due to imbalance of chemicals in the brain
o Psychosis is mostly presented by;
 Hallucinations
 Delusions
 Emotional withdraw
 Lack of attention to personal hygiene
o Depression is presented by:
 Feeling empty
 Inability to enjoy anything
 Hopelessness
 Loss of sexual desire
 Loss of warm feelings for family or friends
 Feelings of self-blame or guilt
 Loss of self esteem
 Schizophrenia
o It is defined by a group of characteristic positive and negative symptoms of
deterioration in social, occupational, or interpersonal relationships.
o It distorts thinking and perception capabilities.
o It is not an excess of dopamine.
o Schizophrenia can be diagnosed by the following symptoms:
 Hallucinations
 Delusions
 Disorganized speech
 Disorganized or catatonic behaviour
 Negative symptoms
 Epilepsy
o Epilepsy is a recurrent seizures of not more than 24 hours
o Seizure is a clinical manifestation of synchronized electrical discharges of neurons.
o Some seizures can be originated outside the brain due to fever, infection, syncope,
head trauma, hypoxia, toxins and cardiac arrhythmias.
o Status epileptics (SE) is the continuous convulsion lasting longer than 30 minutes or
occurrence of serial convulsions between which there is no return of consciousness
o Seizures can be due to cerebral damage or cerebral malformation like hydrocephalus
o They are mostly presented by convulsions.
302
 Multiple sclerosis
o Refers to autoimmune demyelinating disease
o It involves deterioration of the myelin sheath of neurons in the central nervous
system.
o Without the myelin sheath, the impulses of these neurons are short-circuited and do
not reach their proper destinations, and the neuron axons are damaged and gradually
die.
o The first symptoms usually appear between the ages of 20 and 40 years, and the
disease may progress either slowly or rapidly.
STEP 5: Hydrocephalus (15 minutes)

 What is hydrocephalus?
 Hydrocephalus
o Refers to the accumulation of excessive CSF within the ventricular system.
o Most cases occur as a consequence of:
 Impaired flow of CSF
 Impaired resorption of CSF,
 rare instances (e.g. tumours of the choroid plexus)
 Overproduction of CSF may be responsible.
o When hydrocephalus develops in infancy before closure of the cranial sutures, there
is enlargement of the head.
o Hydrocephalus developing after fusion of the sutures, in contrast, is associated with
expansion of the ventricles and increased intracranial pressure, without a change in
head circumference.
o If there is an obstacle to the flow of CSF within the ventricular system, then a portion
of the ventricles enlarges while the remainder does not.

 The common nervous system disorders:
o Psychosis
o Depression
o Schizophrenia
o Epilepsy
o Multiple sclerosis
o Parkinson‘s disease
o Alzheimer‘s disease
o Hydrocephalus
 A person affected by Parkinson‘s disease walks slowly without swinging the arms.
303
 Alzheimer‘s disease is a genetic disorder of the nervous system
 The neuroleptic disorders include psychosis, depression, schizophrenia, epilepsy and
multiple sclerosis
 Hydrocephalus is the accumulation of excessive CSF within the ventricular system

 What are the nervous system disorders?
 What is Parkinson‘s disease?
 What is the Alzheimer‘s?
 What are the neuroleptic disorders?
 What is the Hydrocephalus?
304
References
Philadelphia,NY: F.A Davis
ed.).Danvers, MA:John Wiley & Sons
Waugh,A.,& Wilson, J.W.K. (2001): Anatomy and Physiology in Health and Illness(9th
ed.). Totternham, London: Churchill Livingstone
Additional
www.who.int/mental health/.../neurological disorders
305
Session 37: Structure, Functions and Common Disorders
of Lymphatic System
Total Session Time: 120 minutes+ 60 minutes assignment
Prerequisites
 None

 Define Lymphatic System
 Explain the Organization of Lymphatic System
 Explain the Structures Lymphatic System
 Describe Functions of Lymph System
 List the Common Disorders of the Lymphatic System
Resources Needed:
 Projector
 Computer
SESSION OVERVIEW
Activity/
Step Time Content
Method
30 minutes Definition and Organization of Lymphatic
Presentation
2 System
Brainstorming
Presentation
3 25 minutes Small Group Structures of the Lymphatic System
Discussion
4 Functions of the Lymphatic System
Buzzing
20 minutes Presentation Common Disorders of the Lymphatic System
5
Brainstorming
05 minutes
05 minutes
10 minutes
306
SESSION CONTENTS

STEP 2: Definition and Organization of Lymphatic System (30minutes)

 What is lymphatic system?
 Lymphatic system: A network of tissue, organs, and vessels that help to maintain the
body‘s fluid balance, cleanse the body fluid of foreign matter and provide immune cells
for defence.
 Composition of Lymphatic System

o Lymph, the fluid that the system collects from the interstitial spaces of the tissue and
returns to the bloodstream.
o Lymphatic plexuses, networks of small lymphatic vessels, lymphatic capillaries, that
originate in the extracellular spaces of most tissues.
o Lymphatic vessels (lymphatics), a nearly body wide network of thin-walled vessels
with abundant valves, originating from lymphatic plexuses along which lymph nodes
are located.
o Lymph nodes, small masses of lymphatic tissue through which lymph is filtered on its
way to the venous system.
o Lymphocytes, circulating cells of the immune system that react against foreign
materials.
o Lymphoid tissue, sites that produce lymphocytes, such as that found in the walls of
the digestive tract; in the spleen, thymus, and lymph nodes; and in myeloid tissue in
red bone marrow.
o The lymphoid tissue is primarily involved in immune responses, and consists of
lymphocytes and other white blood cells enmeshed in connective tissue through
which the lymph passes.
o The lymphatic system differs from the circulatory system in that the lymphatic do not
form a closed ring or circuit.
o Instead, begin blindly in the intercellular spaces of the soft tissues of the body.
o Specialized lymphatic organs are the tonsils, thymus, and spleen.
307
Source: Tortora, G.J (2009). Figure 35.1: The lymphatic system
STEP 3: Structures of Lymphatic System (25 minutes)


 What are the structures of lymphatic system?
 The organs of the lymphatic system are tonsils, thymus and spleen.
 Tonsils
o Masses of lymphoid tissue located in a protective ring under mucous membranes in
the mouth and back of the throat.
o Help protect against bacteria that may invade tissues in the area around the openings
between the oral and nasal cavities.
o They are:
 Palatine tonsils; located on each side of the throat.
 Pharyngeal tonsils; are near the posterior openings of the nasal cavity.
 Lingual tonsils; located near the base of the tongue
o The tonsils serve as the first line of defence from the exterior and as such are subject
to chronic infection (tonsillitis).
 Thymus
308
o The thymus is located inferior to the thyroid gland.
o In the foetus and infant, the thymus is large and extends under the sternum
o The thymus hormones are necessary for immunological competence by enabling the
T-cells to participate in the recognition of foreign antigens and provide immunity.
o This capability of T cells is established early in life and then is perpetuated by the
lymphocytes themselves.
o The new-born‘s immune system is not yet fully mature, and infants are more
susceptible to certain infections than are older children and adults.
o Usually by the age of 2 years, the immune system matures and becomes fully
functional.
 Spleen
o Spleen is located in the left hypochondrium directly below the diaphragm, above the
left kidney and descending colon, and behind the fundus of the stomach
o It is roughly ovoid
o Is surrounded by a fibrous capsule with inward extensions that roughly divide the
organ into compartments
o Arteries leading into each compartment are surrounded by dense masses (nodules) of
developing lymphocytes
o Near the outer regions of each compartment is tissue called red pulp made up of fine
reticular fibres submerged in blood that comes from nearby arteries.
o After passing through the reticular meshwork, blood collects in venous sinuses and
then returns to the heart through veins.
STEP 4: Functions of Lymph System (20 minutes)

 What are the functions of lymphatic system?

 Lymphatic system plays a critical role in homeostasis.

 Importance of the lymphatic system are
o Maintenance of fluid balance in the internal environment
o Immunity
 The high degree of lymphatic capillary permeability permits large molecular weight
substances which cannot be absorbed by the blood capillary to be removed from the
interstitial spaces.
 Proteins that accumulate in the interstitial spaces can return to the blood only via
lymphatic vessels.
 Absorption and transport of dietary fat, in which special lymphatic capillaries (lacteals)
receive all absorbed fat (chyle) from the intestine and convey it through the thoracic duct
to the venous system.
 Formation of a defence mechanism for the body.
309
 When foreign protein drains from an infected area, antibodies specific to the protein are
produced by immunologically competent cells and/or lymphocytes and dispatched to the
infected area.
 Lacteals (lymphatics in the villi of the small intestine) serve an important function in the
absorption of fats and other nutrients.
 Plasma filters into the interstitial spaces from blood flowing through the capillaries.
 Much of this interstitial fluid is absorbed by tissue cells or reabsorbed by the blood before
it flows out of the tissue.
 A small amount of interstitial fluid is left behind.
 If this would continue over even a brief period of time, the increased interstitial fluid
would cause massive oedema.
 This oedema would causes tissue destruction or death.
 This problem is avoided by the presence of lymphatic vessels that act as ‗drains‘ to
collect the excess fluid and return it to the venous blood just before it reaches the heart.
STEP 6: Common Disorder of the Lymphatic System (20 minutes)


 What are the common disorders of lymphatic system?
 The most common diseases of the lymphatic system are: enlargement of the lymph nodes
(also known as lymphadenopathy), swelling due to lymph node blockage (also known
as lymphedema) and cancers involving the lymphatic system,
o The swollen nodes can sometimes be felt in the neck, underarms and groin.
o Lymphadenopathy is usually caused by infection, inflammation, or cancer.
o Infections that cause lymphadenopathy include bacterial infections such as strep
throat, locally infected skin wounds, or viral infections such as mononucleosis or
HIV infection.
o Inflammatory or autoimmune conditions occur when a person's immune system is
active, and can result in enlargement of lymph nodes. This can happen in lupus.
o Lymphoma is cancer of the lymph nodes.
 It occurs when lymphocytes grow and multiply uncontrollably.
 Lymphatic system is a network of tissue, organs, and vessels that help to maintain the
body‘s fluid balance, cleanse the body fluid of foreign matter and provide immune cells
for defence.
310
 Lymphatic system is composed of lymph, lymphatic plexus, lymphatic vessels, lymph
nodes, lymphocytes and lymphoid tissue.
 The main structures of lymphatic system are tonsils, thymus and spleen
 Functions of the lymphatic system are maintenance of fluid balance in the internal
environment and immunity
 Common disorders of the lymphatic system are: lymphadenopathy, lymphedema and
lymphomas,
 What is lymphatic system?

 What are the components of the lymphatic system?
 What are the functions of lymph system?
 What are the common disorders of the lymphatic system?

 Explain structure and functions of lymphatic system
311
References
McGraw-Hill.
York: McGraw-Hill.
Philadelphia, NY: F.A Davis
ed.).Danvers, MA: John Wiley & Sons
312
Session 38: Cardinal Signs of Inflammation
Prerequisites
 None system
Learning Tasks
 Define Inflammation
 Outline the Causes of Inflammation
 Explain the Types of Inflammation
 Explain the Features and Signs of Inflammation
Resources Needed:
 Overhead projector (OHP)
 Computer
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Presentation Definition and Causes of Inflammation
2
buzzing
3 Types of Inflammation
4 Features and Signs of Inflammation
Brainstorming
05 minutes
05 minutes
313
SESSION CONTENTS

STEP 2: Definition and Causes of Inflammation (10minutes)

 What is inflammation?
 What are the causes of the inflammation?
Inflammation
 The ability of vascularized living tissue to respond to any noxious agent or injury
 It is a local response of the living mammalian tissues to injury due to an agent.
 It is a protective response intended to eliminate the initial cause of cell injury as well as
the necrotic cells and tissues resulting from the original insult
 It is a complex reaction which involves many other systemic changes despite of what is
observed locally
 Remove the consequences of such injury (e.g. necrotic cells and tissue).
 The inflammatory process is closely intertwined with the process of repair
Causes of Inflammation
 Physical agents like :
o heat,
o cold,
o radiation
o mechanical trauma
 Chemical agents like :
o organic
o inorganic poisons
 Infective agents like:
o bacteria virus
o Bacterial toxins
 Immunological agents like:
o cell mediated reactions
o antigen antibody reactions
314
STEP 3: Types of Inflammation (15 minutes)
Depending on the different capacity of the host and duration of response, inflammation
can be classified into acute or chronic.
 Acute inflammation
o Represents the early body reaction and usually followed by repair
o Occurs on the time scale of hours to days and is characterized by the cardinal
signs of inflammation.
o It is characterized histologically by the presence of neutrophils that have
emigrated from blood vessels into the injured tissue
o It varies in in the histologic picture :
 presence of eosinophils, which may be seen in parasitic infections,
 Presence of basophils (termed mast cells when in tissue) seen in allergic
conditions
Features of active inflammation with components that are not usually appreciated
histologically include: vasodilation, increased microvascular permeability, and neural
stimulation
 Chronic inflammation
o Occurs either after the causative agent of acute inflammation persists for the long
time or the stimulus such as that which it induces chronic inflammation from the
beginning
o Occurs on the time scale of weeks to months
o It is characterized by the simultaneous presence of:
 Active inflammation
 Tissue destruction
 Attempts at repair
o Clinically, the process may be characterized by the loss of proper function of the
tissue, but is often an asymptomatic, subclinical response
o Histologically the process has been classically characterized by the presence of
large numbers of "mononuclear cells"
o Mononuclear cells which is a nonspecific term referring to lymphocytes and
macrophages (derived from peripheral blood monocytes)
STEP 4: Features and Signs of Inflammation (20 minutes)


 What are the signs and features of inflammation?
Inflammation has five cardinal features and is more prominent to the acute:
315
 Pain and tenderness (dolor)
o This is an early symptom in acute inflammation
o The pain in acute inflammation is due to direct nerve injury, tissue irritation by
chemical sand agents released by cells involved in acute inflammation and
pressure due to accumulating exudates compressing nerves
 Swelling (tumour)
o This is due to local accumulation of inflammatory exudates
o Vascular changes occur within the affected area, which cause accumulation of
fluid and white blood cells to escape from the intravascular compartment to the
interstitial tissue in the inflamed area
 Redness (rubor)
o This is due to local increase in blood flow to the inflamed zone; increased
permeability and blood flow give red coloration
o The coloration is less prominent feature among dark skinned individuals
 Heat (calor)
o Inflamed area feels warmer than the surrounding areas due to increased blood
flow to the affected area.
 Loss of function or reduced efficiency(funtiolaesa)
o Inflamed tissue or organ cannot perform its function as efficiently as a normal
tissue
o Temporary or permanent structural damage to the tissue may lead to loss of
function
 Inflammation is the ability of vascularized living tissue to respond to any noxious agent
or injury and may be caused by physical, chemical, infective or immunological agent.
 Causes of inflammation are :
o Physical agents like heat, cold, radiation and mechanical trauma
o Chemical agents like organic and inorganic poisons
o Infective agents like bacteria virus and their toxins
o Immunological agents like cell mediated and antigen antibody reactions
 Inflammation is divided into acute or chronic and there are five important features which
can identify the inflammation especially acute
 Cardinal features of inflammation are: pain, heat ,swelling, redness and loss of function
 What is inflammation?
 What are causes of the inflammation?
 Mention types of the inflammation
 What are the cardinal signs of inflammation?
316
References
McGraw-Hill
McGraw-Hill
Kingdom: Churchill Livingstone Elsevier.
Waugh, A. & Grant, A. (2006). Ross and Wilson Anatomy and physiology in Health and
illness. United Kingdom: Churchill Livingstone Elsevier
317

Human Anatomy and Physiology

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UNITED REPUBLIC OF TANZANIA

Ministry of Health, Community

PST 04103: Human

NTA Level 4 Semester 1

There is currently an ever increasing demand for pharmaceutical personnel in Tanzania.

Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür Internationale

These participants are listed with our gratitude below:

Organization of the Module

Preparation with Handouts and Worksheets

Using Students Manual When Teaching

8 05 minutes Presentation Evaluation

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

 STEP 2: Definition of Terms Used in Anatomy and Physiology

STEP 3: Anatomical Position and Planes (35 minutes)

Figure 1.1: Anatomical Position and Body Regions

SHOW students how to stand in anatomical position.

REFER students to figure 1.1: Anatomical Position and Body Regions

SELECT three students and tell them to stand in anatomical position.

ALLOW students to respond

STEP 4: Terms of Relationship and Comparison (20 minutes)

Table 1: Terms of anatomical direction

Anterior In front of, front

Posterior After, behind, following, toward the rear

Distal Away from, farther from the origin

Proximal Near, closer to the origin

Dorsal Near the upper surface, toward the back

Ventral Toward the bottom, toward the belly

Superior Above, over

Inferior Below, under

Lateral Toward the side, away from the mid-line

Medial Toward the mid-line, middle, away from

Caudal Toward the back, toward the tail

Figure 1.3: Terms of relationship and comparison

Combined Terms Meaning

Inferomedial Nearer to the feet and closer to the

Proximal and distal Directional terms used when describing

Dorsum Superior or dorsal (back) surface of any

STEP 5: Structural Organization Levels of Organism (15 minutes)

STEP 6: Characteristics of Living Organism (20 minutes)

Ask students to brainstorm on the following question:

 What are the characteristics of living organisms?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

o Organization, metabolism, responsiveness, growth, development and reproduction are

Other characteristics includes

STEP 8: Evaluation (10 minutes)

 Define the terms: anatomy, cytology, histology and physiology

6 10 minutes Presentation Functions of the Animal Cell

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

9 10 minutes Presentation Take home assignment

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

ASK students if they have any questions before continuing

STEP 2: Definition of the Cell (10 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Activity: Buzzing (5 minutes)