Prof. Prof.

Prof.

Z.U
Histology 1
 CARDIOVASCULAR SYSTEM 1
 The wall of the heart is formed of:

1. Myocardium: the cardiac muscle fibers.

2. Pericardium: a serous membrane covering the
myocardium from outside.
3. Endocardium: the lining endothelium of the
myocardium from inside.

 Cardiac muscle fibers are striated and involuntary.

Cardiac Muscle Fiber

LM:
 Cardiac muscle cells (or fibers) have the same structure as the skeletal
muscle with some differences:

 The fibers are about 15 µm in diameter and 80 µm long.

 Each fiber is surrounded by a delicate C.T sheath rich in blood
capillaries.
 The fibers branch and anastomose with each other.
 Each fiber contains large central oval nucleus (sometimes two
nuclei are seen) (Fig 1.1).
 The fibers exhibit a highly specialized end to end junction known
as intercalated disks, which appears as dark transverse line between
the cardiac muscle fibers.
 The cytoplasm is granular acidophilic, and contains glycogen
granules, lipid droplets and some lipofuscin pigments which
increase with age.
 N.B: No satellite cells
i.e.no stem cells are
present.

Fig. (1.1): Cardiac muscle

EM:

1-Myofibrils &
Myofilaments:

2
 o Cardiac myofibers are branching and anastomosing.
o Their cross striation is not regular as the skeletal muscle.
o Thin (actin) and thick (myosin) myofilaments are present
resulting in striated appearance.
o They show dark A bands with H bands and M lines.
o I bands are bisected by Z lines.
o They also show the functional unit; sarcomere between two
successive Z disks.

2-Sarcoplasmic reticulum SR and T-tubules system:

o SR is poorly defined and less organized than that of the

skeletal muscle.
o T tubules are wide in diameter than those of the skeletal
muscle.
o T-tubules occur at the Z line (instead of A-I junction in the
skeletal muscle).
o Each T-tubule is associated with a single cisternum of the
sarcoplasmic reticulum forming diad (instead of triad of the
skeletal muscle).

3-Intercalated disks:

o Step-like junctions forming end to end attachments between

adjacent cardiac muscle cells.
o Intercalated disk is formed of transverse portion and lateral
portion (Fig 1.2).
 Transverse portion formed of:
 2 junction specializations:
a) Fascia adherens
b) Maculae adherens (desmosomes).

 Lateral portion formed of :

 Gap junctions.

N.B.
1. Fasciae adherents: It serves as anchoring sites for actin
filaments of the terminal sarcomere
2. Maculae adherents desmosomes: It prevents detachment of
the cardiac muscle fibers from one another during
contraction

3
 3. Gap junction: which facilitates ionic coupling between cells
and

Conducting System of the Heart

o This consists of SA node (the pace maker) AV node and the A-V
bundle of His with its two branches and their finer ramification.

Moderator Band

 It is the right branch of the AV bundle of His.

 It is formed of special type of cardiac muscle fibers called Purkinje
fibers, surrounded by CT rich with blood capillaries.

Purkinje muscle fibers differ from the cardiac muscle fibers in:

 Each Purkinje fiber is formed of separate, short, thick elongated

cylindrical cell. (Fig 1.3).
 They are larger in diameter.
 They are paler in colour with peripheral few myofibrils
 They are vacuolated because they are rich in glycogen
 They have fewer intercalated discs.
 They have a high conductivity (5 times the cardiac muscle).
 They have no diad.
 They are richly supplied by nerves.
 They are usually grouped into bundles, surrounded by C.T sheath.

4-Mitochondria
o More abundant than in skeletal muscle.

5-Golgi complex
o Present in association with the nuclei.
6-Inclusions
o Present at either pole of the nucleus.
o Glycogen granules, lipofuscin pigment and lipid droplets.

4
Fig. (1.2): Cardiac muscles& intercalated discs

Fig. (1.3): Purkinje fibers

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 SMOOTH MUSCLE
 Smooth muscle fibers are non-striated and involuntary.
 They are present in:

o The wall of blood vessels.

o The viscera of various systems (digestive, respiratory and
genitourinary, etc.).

LM: (Fig 1.4)

 Fusiform in shape with single central nucleus.
 They have the smallest diameter of all muscle fibers (about 3 m).
 Their length varies from 30 m as in the wall of blood vessels to
500 µm in the wall of pregnant uterus.
 Their cytoplasm appears homogeneous and acidophilic except for
some dark patches called dense bodies.
 They are arranged in layers, which may be circular, longitudinal,
oblique or spiral.
 Each smooth muscle fiber is surrounded by own external lamina.
EM:
 Mitochondria
 Golgi complex
 Rough endoplasmic reticulum
 Ribosomes
o They are involved in the synthesis of type III collagen,
elastin, glycosaminoglycan, the external lamina and growth
factors.

 Contractile filaments: they are (Fig 1.5)

a) Actin
b) Myosin
c) Intermediate filaments (vimentin and desmin)

 The bundles of myofilaments are arranged obliquely through

the cell forming a lattice like network.
 Dense Bodies
o Located in both cytoplasm and sarcolemma.
o They may be similar to Z line in its function.
o They formed of  actinin.
o Intermediate filaments and thin filaments are inserted into it.
 Sarcolemmal vesicles (caveoli)

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 o Present along the periphery of the cell and termed caveoli.
o They are invagination of cell membrane (Similar to T
tubules).
o They might function to take up and release calcium ions.
 Smooth endoplasmic reticulum
o Less developed and sparse but closely associated with
sarcolemmal vesicles.
 Gap Junction
o Between smooth muscle fibers to facilitate the spread of
excitation.
 Glycogen granules.
 No satellite cells in spite of their capability of mitosis and
regeneration.

Innervations of Smooth Muscle

 Sympathetic (noradrenergic) nerves and parasympathetic
(cholinergic).
Contraction of Smooth Muscle
 Occurs more slowly and lasts longer than contraction of skeletal
and cardiac muscle because the rate of ATP hydrolysis is slower.
Thus smooth muscle contraction is not only prolonged but also
requires less energy.

Fig. (1.4): diagram showing smooth muscle

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 Fig. (1.5): Molecular structure of smooth muscle

BLOOD VESSELS
Blood vessels are:
A. Arteries
B. Blood Capillaries
C. Veins
General structure of blood vessels (except capillaries)
 The wall of blood vessels composed of three main coats (Fig. 1.6):
1. Tunica intima
2. Tunica media
3. Tunica adventitia
1. Tunica intima (innermost layer) is composed of:
o Endothelium (simple squamous epithelium).
o Subendothelial layer of C.T.
o Internal elastic lamina formed of elastin.
2. Tunica media (middle layer) is composed of:
o Circular smooth muscle fibers.
o Connective tissue in between muscle fibers.
o External elastic lamina that separate media from
adventitia.
3. Tunica adventitia (outermost layer) is composed of
o Connective tissue, collagen and elastic fibers.
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 o In this layer, large blood vessels contain vasa
vasorum "vessels of the vessels" which is a network
of small blood vessels to supply their walls with
blood.

Fig. (1.6): General organization of blood vessels

Functional Significances:
1. Endothelium provides smooth surface for blood flow to
avoid clotting.
2. Elastic fibers allow easy expansion and recoil during
cardiac systole, and prevent occlusion during diastole.
3. Collagen fibers prevent over expansion and limit shortening
of the vessel if it is cut.
4. Muscle fibers regulate blood flow and pressure by
contraction and relaxation.

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Blood supply

 Small blood vessels (thin walled) receive oxygen and nutrients

from the blood passing in their lumen by diffusion.
 In medium and large vessels, the layers near the lumen receive
oxygen and nutrients from the blood in their lumen by diffusion
whereas the outer layers of media and adventitia receive blood
from vasa vasorum.

Innervation

 Vasomotor nerves of sympathetic component of the autonomic

nervous system supplies smooth muscle cells of blood vessels and
is responsible for vasoconstriction of the vessel walls.

A. Arteries
 Conduct oxygenated blood from the heart to the tissues of the
body.

1. Large Elastic Arteries

 They are the largest arteries connected to the heart including the
aorta and its large branches.
 They are characterized by wide lumen and thick wall.
 Their wall is composed of: (Fig. 1.7):
1. Tunica intima: endothelium, thin layers of C.T with smooth
muscle and internal elastic lamina (not prominent).
2. Tunica media: thick and elastic layer consists of
fenestrated sheets of elastin, separated by collagen fibers and
many smooth muscle cells. External elastic lamina is also
present.
3. Tunica adventitia: elastic C.T. is nourished by vasa-
vasorum.

2. Medium Sized Muscular Arteries

 They are muscular arteries distributing blood to the different

organs of the body, they are the most numerous type (so, they are
also called muscular or distributing arteries).
 Their wall is composed of (Fig. 1.8):

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1. Tunica intima: endothelium, thin subendothelial layer of
thin C.T with smooth muscle and thick fenestrated internal
elastic lamina.
2. Tunica media: smooth muscle cells, few elastic fibers and
external elastic lamina.
3. Tunica adventitia: C.T rich in collagen and elastic fibers.

Fig. (1.7): Histological structure of the aorta (H&E)and diagram

Fig. (1.8): Comparison between medium sized artery and vein

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 3. Special Medium Sized Arteries

a. Basilar Arteries:

o They supply the brain.

o They have wide lumen and thin wall with well-
developed internal elastic lamina.
o Tunica media and adventitia.

b. Coronary Arteries:

o They supply the heart and have a thick wall.

o The subendothelial layer contains longitudinal
smooth muscle cells.
o They have well-developed three elastic laminae
(internal, middle and external).

c. Umbilical Arteries:

o They have no internal elastic lamina.

o Tunica media composed of inner longitudinal and
outer circular muscle layer.
o Tunica adventitia contains mucoid connective tissue.

Fig. (1.9): Diagram showing arterioles, metarterioles and blood capillaries

B. Blood Capillaries
 Very numerous delicate anastomosing tubes of 4 – 10 um in
diameter
 They are low pressure vessels that permit passive diffusion across
their walls.
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 Have single layer of endothelium on basal lamina and pericytes
(Fig. 1.10).
 Endothelium: permit exchanges of gases, enzymes, fluid and
metabolites via small and large pores.
 Pericytes: surround capillaries at irregular pattern, they have
contractile function due to the presence of myosin and tropomyosin
in their cytoplasm (Fig. 1.10& 11).

Fig. (1.10): Structure of fenestrated blood capillary.

Fig. (1.11): Pericyte surrounds blood capillary

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Types of Blood Capillaries

1- Continuous Capillaries

o Formed of one layer of endothelium forming a tube,

tight junction between endothelial cells which are
rest on basal lamina are present (Fig. 1.12 a).
o They contain pinocytic vesicles that permit transport
in both directions.
o They are found in muscle, C.T., nervous tissue and
gonads.
o Junctions are responsible for formation of blood
brain barriers.

2- Fenestrated Capillaries

o Have pores or fenestrae in the endothelial wall,

sometimes covered by diaphragm (Fig. 1.12 b).
o Their morphology helps to exchange fluid and
macromolecules.
o Found in G.I.T., endocrine gland and renal
glomeruli.

3- Discontinuous Capillaries (Blood Sinusoids)

o They are large spaces with irregular thin easily
collapsed wall.
o Endothelial cells and phagocytic cells line them.
o The walls reveal small distinct gaps between
adjacent cells (Fig. 1.12 c).
o The basal lamina is incomplete or absent.
o Sites: Spleen, liver, endocrine glands and red bone
marrow.
Function
1. Permeable to O2, CO2 and metabolites.
2. The endothelial cells secrete vasoconstrictor, vasodilator and
mitotic agents.
3.
4. Storage and passage of blood elements and filtration of
blood by phagocytosis.

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 Fig. (1.1): Types of blood capillaries.

C. Veins
 They return un-oxygenated blood from the organs to the heart.
 Begins as venules then increase in size to continue with small
medium sized vein and finally large veins.

1. Medium Sized Veins

 The most common type of veins in the body.

 It has a thin wall and wide lumen and more likely to contain blood
in histological sections.
 Its wall is composed of:

1. Tunica intima contains endothelial cells, subendothelial

connective tissue and are devoid of elastic fibers, intimal
valves are prominent
2. Tunica media consists of 3-5 layers of smooth muscle cells.
3. Tunica adventitia is the thickest layer and composed of
longitudinally arranged collagen and elastic fibers.

 Valves: semilunar projections of tunica intima composed of fibro-

elastic tissue lined by endothelium, and have two leaflets. They are
present only in veins of diameter more than 1 mm particularly in
extremities to prevent back flow of blood against gravity.

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 2. Large Muscular Veins

 They include renal vein, venae cavae, pulmonary vein and femoral
vein.
 Its wall is composed of:

1. Tunica intima well developed, contains few elastic fibers,

and valves are always present.
2. Tunica media several layers of circular smooth muscle
(longitudinal in vena cava), separated by collagenous C.T.
and penetrated by vasa-vasorum, lymphatics.
3. Tunica adventitia a thick layer of C.T. contains vasa-
vasorum, nerves, lymphatics and longitudinal smooth
muscle.

Table (1): Comparison between medium sized artery and vein (Fig.11.3)

Medium Sized Artery Medium Sized Vein

Thick wall Thin wall

Narrow lumen Wide lumen

Well-developed internal elastic lamina No internal elastic lamina

Thick media Thin media

Thin adventitia Thick adventitia

No valves Have valves

NB. Some veins show exceptional variations in their structure:

 Cerebral, retinal and osseous veins have no valves or T. media.
 Umbilical vein is very muscular.

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 D. A-V anastomosis
 They are direct connection between arterioles and venules (Fig.
1.13).
 They are characterized by absence of elastic tissue in their walls
and presence of abundant muscle fibers.
 Sites: skin, thyroid and digestive tract.

Types:

1. Simple connection: without structural changes in its wall,

they are either straight or tortuous.
2. Organized connections (glomus body):

o It is a small organ present in nail beds, tip of fingers

and toes, and auricle of the ear.
o It has connective tissue capsule that is penetrated by
an arteriole with no internal elastic lamina.
o It has thick richly- innervated muscle layer and small
lumen.
o Function: regulation of temperature and venous
o
o p
r
e
s
s
u
r
e
.

Fig. (1.13): Types of A-V anastomosis.

17
RESPIRATORY SYSTEM 2
 The respiratory system is designed to perform two basic functions:

1. Conducting air to the lung (conducting portion).

2. Gas exchange (respiratory portion) (Fig 2.1).

Fig. (2.1): Respiratory system

I. Conducting portion consists of :

1. Nasal cavity. 5. Bronchi.

2. Nasopharynx. 6. Bronchiole.
3. Larynx. 7. Terminal bronchiole.
4. Trachea.
II. Respiratory portion consists of:

1. Respiratory bronchiole. 3. Alveolar sacs.

2. Alveolar ducts. 4. Alveoli.
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 CONDUCTING PORTION
Function:

1. Conducting air so it is kept patent by the presence of cartilage,

bone, fibrous elements and muscles.
2. Conditioning of air through regulation of temperature of inspired
air by numerous blood vessels in its wall.
3. Regulation of the humidity of the inspired air by the seromucous
secretion.
4. Filtration of the inspired air from the coarse particles by vibrissae
and from the fine particles by the combined action of the cilia and
seromucous secretion.
5. Competition of antigens and allergens carried by air with lymphoid
elements in the lamina propria of the wall through production of
IgA and IgE by plasma cells.

Nasal Cavity
 Anatomically, it is divid by the nasal septum into right and left
halves.
 Each half communicates with the outside anteriorly by the nares
(nostrils) and posteriorly with the nasopharynx by the concha.
 Four paranasal sinuses (frontal, maxillary, sphenoid, and ethmoid)
drain into the nasal cavities.
 Histologically, it is divided into:

I- Vestibule
II- Nasal fossa

I. Vestibule:

 It is the anterior dilated part of the nose.

 It is lined with thin skin that contains short thick hairs called
vibrissae (trap large dust particles) and numerous sweat and
sebaceous glands.
 Its wall is formed of hyaline cartilage and mucosa which is formed
of:
 Epithelium:
oAnteriorly, it is keratinized stratified squamous

1
 epithelium, which changes into non-keratinized stratified
squamous epithelium then becomes respiratory epithelium
(peudostratified columnar ciliated epithelium with goblet
cells).
oPosteriorly, it is respiratory epithelium.
 Lamina propria:
o Connective tissue rich in blood vessels, many seromucous
glands and abundant lymphoid elements.

II. Nasal Fossa: (Fig 2.2).

 It is the posterior part of the nasal cavity.
 Its medial wall is the nasal septum covered by respiratory
epithelium; the lateral wall has 3 bony projections called
conchae.
 The middle and inferior are covered by respiratory
epithelium while the superior is covered by olfactory epithelium.
 Within the lamina propria of the conchae are large venous plexus
known as “swell bodies”, mucous and serous glands, plasma
cells and macrophages.
 The nasal fossa can be divided into:

1. Respiratory area.
2. Olfactory area.

NB. Swell bodies become engorged with blood in one side of the nose to
permit air to pass in the other side. This process is continuous and
alternating to allow rest and recovery of the respiratory epithelium. This
explains why in common cold one side of the nose is obstructed, then, the
other follows. NB. Nasal bleeding usually occurs from the anterorinferior
area of the nasal septum where arterial anastomosis of the mucosa occurs.

2
 Fig. (2.2): Nasal cavity and frontal sinus
1. Respiratory area:
 It is formed from :

a) Epithelium: pseudostratified columnar ciliated epithelium with

goblet cells (Respiratory epithelium) which contains 6 types of
cells:

1. Columnar ciliated cell 4.Brush cell

2. Goblet cell 5.Small granule cells (DNES)
3. Basal cell 6.Serous cell

1. Columnar ciliated cell:

 The most numerous type.

 Tall cell with basal oval nucleus and acidophilic brush
border (ciliated).
 It is rich in mitochondria and has Golgi and some RER.

2. Goblet cell:

 It is less abundant than the columnar cells.

 Its apical part is expanded with mucous and appears pale
and foamy in H&E sections and show positive PAS
reaction.
 Its basal cylindrical part contains oval nucleus, RER,
mitochondria and Golgi.

3
  They secrete mucinogen which is hydrated in the
aqueous medium on the cell surface and named “mucin”
which traps bacteria and other foreign materials from air.
 The cilia of the columnar cells seep out this mucus
towards the oral cavity.

3. Basal cell:

 Short cell rests on basement membrane but does not

reach the lumen.
 It is rich in free ribosomes and has basophilic cytoplasm.
 It acts as stem cell for other types of cells.

4. Brush cell:

 Columnar cell with basal oval nucleus.

 The apex is covered by microvilli (acidophilic brush
border).
 The basal surface of the cells is in contact with afferent
nerve ending it is believed to be a receptor cell.

5. Small granule cell (DNES) or (Kulchitsky cell):

 Likes basal cell but contains small granules (contain

amines, peptides, acetylcholineand ATP).
 These are enteroendocine cells of APUD system.

6. Serous cell:
 Columnar cell with apical microvilli and electron dense
granules.
 It is believed to produce a secretion of lower viscosity
than that of the mucous cells.

b) Lamina propria:
 Loose connective tissue rich in blood vessels.

4
 Fig. (2.3): Olfactory epithelium

2. Olfactory area:

 It is characterized by its yellowish color in living condition.

 It is lined by olfactory epithelium.

A. Olfactory epithelium is modified pseudostratifid columnar

epithelium formed of 3 types of cells (Fig 2.3):

1. Olfactory cell (neuron)

2. Supporting or sustentacular cell
3. Basal cell

1. Olfactory cell (neuron):

 Bipolar neuron; the apex is modified to form bulb

(olfactory vesicle) from which 6-8 non-motile cilia arise.
 The microtubules forming the cilia begin as 9 peripheral
doublets of microtubules surrounding 2 central singlets
but distally continue as 9 peripheral singlets surrounding
2 central singlets.
 The nucleus is lower third of the cell.
 The axons of the cells pierce the basal lamina and join
each other to form the olfactory nerve.

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  Although these axons are unmylinated, they are
ensheathed by an olfactory glial cell similar to Schwann
cells.
 These fibers pierce the cribriform plate in the roof of the
nasal cavity to reach the olfactory area in the brain.

2. Supporting or sustentacular cell:

 Tall columnar cell with broad apex and narrow base.

 The upper surface is provided with microvilli and the
cytoplasm in the apical region contains secretory
granules housing a yellow pigment ( lipofuscin granules)
which gives a characteristic color to the olfactory
mucosa.
 The nucleus is located in the upper third at a level higher
to that of the olfactory cells.
 The lateral border joins the neighboring cells with
adhering junction.
 It provides support, nourishment and insulation of the
sensory cells.

3. Basal cell:

 Small pyramidal cell with few organells and dark nuclei

 Its apices do not reach the epithelial surface.
 It acts as stem cell to replace both sustenticular and olfactory
cells.

B. lamina propria
 It is highly vascular loose to dense connective tissue rich
in lymphoid elements and large serous glands (olfactory
glands.)
 The olfactory glands (of Bowman's) produce a constant
flow of fluid surrounding olfactory cilia and facilitate the
access of new odoriferous substances.

N.B.
The olfactory neurons are the best- known neurons to be replaced
regularly because of regenerative activity of the basal cells. For this
reason, loss of the sense of smell due to toxic fumes or physical injury to
the olfactory mucosa itself is usually temporary.

Paranasal sinuses
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  They are spaces within the skull, communicating with the nasal
cavity, named frontal, ethmoid, sphenoid, and maxillary.
 They are lined with mucosa which is adherent to the periosteum. .
 Mucosa is formed of:

a) Epithelium: respiratory epithelium

b) Lamina propria: vascular connective tissue that houses
seromucous glands and lymphoid elements as lymph nodules
and plasma cells.

N.B. Sinusitis is an inflammatory process of the sinuses that may persist

for long periods of time, mainly due to obstruction of drainage orifices.
Chronic sinusitis and bronchitis are components of primary ciliary
dyskinesia, or Katagener syndrome, an inherited genetic disorder
characterized by defective ciliary action.

Nasopharynx
 Begins at the concha and extends to the opening of the pharynx.
 Its wall is formed of:

a) Epithelium respiratory epithelium.

b) Lamina propria; vascular connective tissue houses seromucous
glands and some lymphoid elements. It also houses pharyngeal
tonsils.

NB. The enlargement of pharyngeal tonsils is called adenoid.

Larynx
 Short tube connects the pharynx and trachea.
 Its mucosa is formed of:

a) Epithelium:
 Respiratory epithelium except on the lingual surface of the
epiglottis and true vocal cords which are covered by non
keratinized stratified squamous epithelium.
b) Lamina propria:
 Connective tissue containing blood vessels, serous and mucous
glands and cartilage.
 The cartilage may be:

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 i. Hyaline (thyroid, cricoid and most of arytenoids).
ii. Elastic (corniculate, cuneiform and tips of arytenoids).

Function:
1. Phonation.
2. Prevent entry of food and fluids into the respiratory passages.

N.B Laryngitis (inflammation of the larynx and vocal cords) prevents

the vocal folds from vibrating freely. Persons suffering from laryngitis
sound hoarse or can only whisper.

Epiglottis
 It projects from the wall of the larynx into the pharynx (Fig 2.4).
 During respiration, it takes vertical position to allow flow of air.
 During swallowing, it is in horizontal position to close the larynx.
 Below the epiglottis the mucosa form two pairs of fold; the upper is
called vestibular fold or false vocal cord while the lower is true
vocal cords.

N.B. Benign reactive polyps, called Singer's nodules, are frequent in

the stratified squamous epithelium of the vocal cords affecting the
voice.

Fig. (2.4): Structure of larynx

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 Trachea
 It is a thin walled tube begins at cricoid cartilage and ends when it
bifurcates to form primary bronchi.
 It is formed of 3 layers (Fig 2.5):

1. Mucosa:
a) Epithelium: respiratory epithelium (Fig 2.6).
b) Lamina propria: loose connective tissue rich in blood vessels,
lymphoid elements as well as serous and mucous glands.
c) Elastic lamina: dense layer of elastic fibers.

2. Submucosa

 It is dense irregular fibroelastic connective tissue rich in blood

and lymphatic vessels, lymphoid elements and numerous
tracheal glands (mucous and seromucous glands).

3. Cartilage

 Characteristically, the trachea contains from 10 to 12 C-shaped

ring of hyaline cartilage embedded in fibroelastic connective
tissue.
 The rings open posteriorly to be completed by ligaments and
trachealis muscle.
 The ligament prevents over distension of the cartilage while the
muscle regulate
the diameter of the
trachea.

4. Adventitia fibro
elastic connective
tissue.

Fig. (2.1) Structure

of trachea

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 Fig. (2.5): layers of trachea

Bronchial tree
 The trachea is divided into 2 extrapulmonary primary bronchi (right
and left) which enter the lung to form intrapulmonary secondary
bronchi (decrease in diameter with each division) (Fig 2.7).
 They enter the lung at the hilum then give rise to three secondary
bronchi in the right lung and two in the left lung, each supplies a
pulmonary lobe.
 The secondary bronchi divide repeatedly forming tertiary or
segmental bronchi which divide until they form bronchioles with
diameter less than 0.5 mm called terminal bronchiole.

Extrapulmonary bronchus:

 Its structure is similar to trachea.

Intrapulmonary bronchus:

1. Mucosa:

a) Epithelium: respiratory epithelium with few goblet cells.

b) Lamina propria: loose connective tissue with elastic fibers as
well as serous and mucous glands.
c) Muscle: spirally arranged smooth muscle
d) Cartilage: irregular plates of hyaline cartilage separated by

11
 connective tissue
e) Adventitia: thin layer of fibroelastic connective tissue.

NB. With continuous division of the bronchi, the wall gets thinner and lumen becomes
narrower with decrease amount of cartilage.

Fig. (2.6): Bronchial tree

Bronchioles
 They are tubes with diameter less than 1 mm. (Fig 2.8).
 They have thin wall rich in elastic fibers no cartilage and no
glands.

 They formed of:

1. Mucosa:

a. Epithelium:

 Simple columnar ciliated then simple cuboidal ciliated

which change into simple cuboidal non-ciliated in
smaller bronchioles.

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  In terminal bronchioles, it is simple cuboidal alternating
with clara cells.

N.B Bronchioles constitute the air passages affected most often,

especially in young children, by measles virus or adenovirus, both of
which can cause bronchiolitis.

Clara cells:

 Tall columnar cells with dome shaped apices.

 The upper surface contains microvilli.
 Numerous secretory granules are present in the
apical cytoplasm.
 The cytoplasm houses abundant RER, SER,
mitochondria and Golgi apparatus.
 Function:

1. Production of surfactant-like substance.

2. Detoxification of inhaled xenobiotic
compounds by enzymes of SER.
3. Secretion of antimicrobial peptides and
cytokines for local immune defense.
4. Act as stem cell as they can divide to
regenerate the bronchiolar epithelium.

b. lamina propria: It contains connective tissue without glands.

2. Musculosa loose spirally arranged layers of smooth muscle

surrounded by
fibroelastic
C.T. The latter
maintain the
patency of
bronchioles.
3. Adventitia
fibroelastic
C.T

Fig. (2.7): Lung and

bronchioles

12
 RESPIRATORY PORTION
Respiratory bronchioles
 Their wall is not complete as they communicate with alveoli.
 They are lined by cuboidal cells and clara cells.
 Their lamina consist of fibroelastic C.T surrounded by one or two
layers of smooth muscle
 As the bronchioles branch, the diameter decrease and the number of
alveoli that open into it increases resulting in the formation of
alveolar ducts. (Fig 2.8).

Alveolar ducts
 Alveolar ducts are just linear arrangement of alveoli (has no special
wall) so are lined by type I pneumocyte.
 Their lamina propria contains smooth muscle especially at the rims
of alveoli and disappears distally.
 Usually the ducts end as blind out pouch composed of 2 or more
small clusters of alveoli.
 Each cluster is called alveolar sac which opens into common space
i.e. atrium.

N.B Asthma is a common condition produced by chronic inflammation

within the bronchial tree of the lung. The disorder is characterized by
sudden constriction of the smooth muscle in bronchioles called
bronchospasm. Constriction is caused by mast cell degranulation trigged
by the presence of specific antigen.

Alveoli
 They are considered the structural and the functional units of the
respiratory system. (Fig 2.8).
 Their number is about 300 million (so, the lung is sponge-like).
 They are small air spaces or sacs (about 200um).
 Their walls are thin enough to permit gas exchange (Co2 andO2)
between their lumina and capillary blood.
 They are separated by thin septa and surrounded by basal lamina.
 The alveoli may communicate with each other by alveolar pores
(of Kohn). They equalize air pressure in these alveoli and permit
collateral circulation of air when a bronchiole is obstructed.(Fig
2.9).

13
  They are lined by 2 cell types (Alveolar epithelium):

1. Type I pneumocyte.
2. Type II pneumocyte.

Fig. (2.8): Respiratory portion of the lung

Alveolar epithelium:

 It formed of two types which are joined together by desmosome

and occludens junction.

1. Type I pneumocyte

 These cells cover about 95% of the alveolar surface.

 They are flat squamous cell that rest on basal lamina.
 They contain elongated central nuclei.
 Most of the cytoplasm surrounds the nucleus and contains few
organelles mainly mitochondria, few RER and Golgi apparatus.
 They are very thin cells (allow easy gaseous exchange).
 They form occluding junctions with each other (prevent passage of
extracellular fluid into the alveolar lumina).
 They are rich in pinocytic vesicles.

2. Type II pneumocyte or (great alveolar or septal cell ):

 They are more numerous, they cover only 3-5%of the alveolar
surface.
 They are cuboidal cells with rounded nuclei.
 Their free surface bulges into the lumen and contains microvilli and
14
 the adluminal surface rests on the alveolar basal lamina.
 They are present in groups of 2-3 cells (usually located where
alveoli are separated by septum, so named septal cell)
 They have central nuclei and abundant organelles (mitochondria,
RER, Golgi apparatus) as well as lamellar bodies that contain
surfactant (the most distinguishing feature).

Function

1. They secrete surfactant which covers the surface of the alveolar

cells to prevent alveolar collapse.
2. They phagocytose and recycle the surfactant.
3. They divide to regenerate themselves as well as type I
pneumocyte.

Blood-Air Barrier

 Thin walled structure which separates the lumen of alveoli from

capillary blood.
 It is formed from (Fig 2.10):

1. Surfactant on alveolar epithelium

2. Type I pneumocyte
3. Fused basal lamina of blood capillaries and type 1
pneumocyte
4. Endothelium of continuous blood capillaries

Inter-alveolar septum:
1. Thin delicate partitions between the alveoli.
2. They are lined on both sides by alveolar epithelium with
their basal laminae on both sides.
3. They may be thick and contain capillaries, elastic and
reticular fibers and some connective tissue cells (fibroblasts,
macrophages, mast cells and lymphocytes) or may be
extremely thin containing only continuous capillaries.
4. No smooth muscle fibers in the wall of alveoli or in the
inter-alveolar septum

15
 Fig. (2.9): Blood air barrier

Alveolar Macrophage:
Origin: blood monocytes

Types:

1. Dust cells that engulf dust particles

2. Heart failure cells that engulf RBCs escaping from
capillaries due to over load of the circulation.

Fate: expectorated, swallowed or drained by lymphatic.

16
URINARY SYSTEM 3
URINARY SYSTEM
 Urinary system consists of:
o Two kidneys.
o Excretory passages (ureters, urinary bladder and urethra).

KIDNEY
 Site:
1. It lies in the posterior abdominal wall retroperitoneally.
 Shape:
1. It has a bean shape with a concavity on the medial border
called hilum where arteries, nerves, lymphatic vessels and
veins are located.
 Size:
 Each kidney is about 11cm long, 4-5cm wide and 2-3cm
thick.
 It is a compound, tubular, excretory and endocrine gland.

Main function:
- Filtration of blood from a large amount of waste products
through its uriniferous tubules to form urine.
- After collecting urine, it is excreted outside the body
through the urinary passages.

General structure:

1. Cortex:

 It is the outer dark granular area just beneath the

capsule.
 It contains renal corpuscles convoluted tubules,
peritubular capillaries and medullary rays (collecting
tubules).

Medullary rays:

 They represent the collecting tubules while they leave

the cortex and enter the medulla at the base of
medullary pyramids (Fig 3.1).

17
 Renal lobule:

 It consists of central medullary ray and the

corresponding cortical tissue.
2. Medulla:
 It consists of 10-18 medullary pyramids.
 Each pyramid shows striation that is due to presence
of collecting tubules, loop of Henle and vasa recta.
 The base of the pyramid directs to the cortex while the
apex projects in the minor calyx.

Renal lobe

 It composed of renal pyramid and overlying cortical

tissue, in human kidney there is from 8- 18 lobes.

Cortical columns of Bertini:

 The cortical tissue between the medullary pyramids
(blood vessels).
3. Calyces:
 Medullary collecting ducts open in the minor calyces
as papillary duct of Bellini that perforates the apex of
each pyramid; this sieve- like region is known as the
area cribrosa. The apex is surrounded by a cup- like
minor calyx. Evey 2-3 minor calyces open into one
major calyx (each kidney has 2-3 major calyces).

4. Renal pelvis:
 It is the upper dilated end of the ureter in which the
major calyces open.

Histological structure:

Stroma:

 Capsule:
1. The kidney is covered with a connective tissue capsule
consisting mainly of dense, irregular collagen fibers with
elastic fibers and smooth muscle cells.
2. These cells help resisting volume and pressure variations of
the kidney.

18
 3. The capsule is surrounded by perirenal fat that is protective
to the kidney.

Fig. (3.1): General structure of the kidney

N.B Polycystic kidney disease is an inherited disorder in which normal

cortical organization of both kidneys is lost due to the formation of
multiple, large, fluid- filled cysts. The cysts may arise from any epithelial
cells of the nephron and can lead to gross kidney enlargement and loss of
renal function.

Parenchyma:

 The kidney is a large compound tubular gland.

 It consists of structural units called uriniferous tubules
 The nephrons and the collecting tubules perform 2 different
functions and are of different embryological origin.

URINIFEROUS TUBULES
 It consists of (Fig 3.2):

I. Nephron.
II. Collecting system.
19
 Fig. (3.2): Structure of parenchyma (nephron and collecting duct)

I. Nephron
 It is the functional unit of the kidney arises in the cortex and
descends into the medulla than return back to the cortex.
 Each nephron is composed of:

1- Renal Malpighian corpuscle.

2- Proximal convoluted tubule.
3- Loop of Henle.
4- Distal convoluted tubule.

1- Renal Corpuscle (Malpighian Corpuscle)

 Its diameter is about 150-200um.

 The renal corpuscle has two poles:
o Vascular pole: where the afferent and efferent arterioles
enter and exit.
o Urinary pole: where the proximal convoluted tubule begins.

21
  It is formed of:
A- Bowman's capsule.
B- Glomerulus.
C- Mesangial cells (Intraglomerular).

A- Bowman's Capsule

 It is a double walled cup-shaped top of the nephron, formed of a

double-walled epithelial layer that encloses the glomerulus (tuft of
capillaries).
 The external parietal layer is composed of simple squamous
epithelium which is continuous with the cuboidal epithelium of the
proximal convoluted tubules.
 The internal visceral layer, is in contact with glomerular capillary
and is formed by modified simple squamous epithelium;
“Podocytes”.

Podocytes
LM:

 They are large flat modified stellate simple squamous epithelial

cells with large oval nuclei.
 Their cytoplasmic processes are of two types:
1. Primary (major) processes: arise directly from the cell body
and is directed towards the capillary loop.
2. Secondary (minor or feet) processes or pedicles: each
primary process gives rise to many processes which envelop
the fused basement membranes of both the capillary
endothelium and podocytes.
 Their basement membranes are well developed and can be
demonstrated by PAS as a positive line.
EM:

 The cytoplasm contains small Golgi, RER, abundant free

ribosomes, intermediate filaments and microtubules.
 The cell bodies are separated from the underlying capillary by a
space of 1-3 µm called subpodocytic space.
 Major (primary) processes are large cytoplasmic processes
extending from the cell body and contain microfilaments and
microtubules.

21
 Minor (secondary) processes are small processes extend from the
major process to grasp the glomerular capillaries by little feet or
pedicles (Fig 3.3).
 The feet tightly attached to the basement membrane of fenestrated
blood capillaries.
 The adjacent pedicles leave spaces in between called filtration slits
(20- 40nm) which is covered by slit diaphragm.
 The basal lamina of both podocyte and glomerular capillary
endothelium fuse together and form a thick basal lamina.
 It is formed of three layers:
1. Central electron- dense layer called lamina densa
2. Two electron-lucent layer called lamina lucida or lamina
rara (lamina rara interna adjacent to the endothelium and
lamina rara externa adjacent to the podocytes)

Fig. (3.3): Podocyte surrounds glomerular capillary

22
 B- Glomerulus
 It is the vascular portion of the renal corpuscle.
 The afferent arteriole divides into several capillary loops
(Glomerulus) where blood enters under pressure and recollects
forming the efferent arteriole (vascular pole of the nephron).
 Glomerular capillary wall is lined by fenestrated endothelium with
pores of 70-90 nm in diameter.
 The endothelium has well developed basal lamina.
 NB. The afferent arteriole has a thick wall; thick media and thick elastic lamina
with juxtaglomerular cells in its media. The efferent arteriole has a thin wall; thin
media and thin elastic lamina.

Blood Renal- Barrier

 It is a filtration membrane separating blood in glomerular
capillaries from glomerular filtrate in the lumen of Bowman's
capsule.
 It is formed of:

1. Fenestrated endothelium of glomerular capillary without

diaphragm (Fig 3.4).
2. Fused continuous (not fenestrated) basal laminae of both
podocytes and endothelial cells
3. The slits between the pedicles of podocytes with their slit
diaphragm.

Function:

 It filters the blood plasma in the renal corpuscle by filtration

selectivity, permits small molecules to enter capsular space, and
prohibits large one.

Clinical Note:
 Glomerulonephritis is an inflammation of the kidney especially of
glomerular capillary, which become damaged leads to appearance
erythrocytes and protein in urine.
 Glomerulosclerosis: is characterized by hyaline deposits within the
glomeruli.

C- Mesangial Cells
 There are two types:
1. Extraglomerular mesangial cells:

23
  Share the formation of juxtaglomerular apparatus
(will be discussed).
2. Intraglomerular mesangial cells: (Fig 3.4).
 Present between adjoining glomerular blood
capillaries.
 They are branched (stellate) cells with basophilic
cytoplasm and dark nuclei.
 They are enclosed in the basal lamina of the
glomerular capillaries (positioned as the pericytes).
 Function:
1. They are phagocytic cells.
2. They synthesize and maintain glomerular basal lamina.
3. They regulate blood flow through the glomerular capillaries
4. They support capillaries in the areas where the basement
membrane is absent or
incomplete.

Fig. (3.4): Blood renal barrier and mesangium

2- Proximal Convoluted Tubule

 It is the longest segment of the nephron (15mm) which begins at

the urinary pole of the renal corpuscle in the cortex and ends at the
loop of Henle.

24
LM: (Fig 3.5).
 In cross section, the tubule has a diameter of about 60µm with
relatively narrow lumen.
 Lining cells:
1. Pyramidal cells with round basal nuclei.
2. They have apical acidophilic brush border (microvilli).
3. They rest on distinct basement membrane.
4. They have basal acidophilic striations (mitochondria and
basal infoldings)
5. They have indistinct lateral membrane (interdigitations with
adjacent cells).
EM:
 The apical surface has many microvilli (increase the surface for
absorption from the lumen).
 Numerous canaliculi and pinocytotic vesicles are seen in the apical
cytoplasm.
 The basal region has many long mitochondria and basal infoldings
(associated with active transport).
 The lateral surface has many interdigitations.

Function:

1- Reabsorption of glucose, proteins, amino acids, phosphorous,

calcium.
2- Reabsorption of sodium, potassium and chloride ions.
3- Reabsorption of most water (63%).
4- Secretion of creatinineiodine and some drugs.

3- Loop of Henle

 It is a U shape tubule extends from proximal convoluted tubule in

the cortex and dips into medulla and returns back to the cortex to
end with distal convoluted tubule. (Fig 3.5).
 Two types can be distinguished:

1. Long loop: in juxtamedullary nephrons (nephron near the

medulla).
2. Short loop: in cortical nephrons.

 It is composed of two parallel limbs and each limb consists of two

segments (thick and thin segments)

25
  The thick segments of both limbs are lined by simple cuboidal
epithelium, and are about 60 µm in diameter.
 The thin segments of both limbs are lined by simple squamous
epithelium, and are about 15 µm in diameter.

Function:

1. The descending limb is highly permeable to water, urea and

sodium.
2. The ascending limb is impermeable to water through counter
current mechanism to produce hypertonic urine.

4- Distal Convoluted Tubules

 It is shorter (5mm) and less convoluted than proximal tubule and

begins at the thick part of ascending loop of Henle in cortico-
medullary zone and ends in the collecting tubule in the cortex
(Table 3.1).

LM: (Fig 3.5).

 In cross section, the tubule has a diameter of about 20 µm with
relatively wide lumen.
 Lining cells
1. Simple cuboidal cells with round central nuclei.
2. They have no apical acidophilic brush border.
3. They have basal acidophilic striations.
4. They have distinct lateral membrane.
EM:
 The apical surface contains few microvilli.
 No apical canaliculi nor pinocytotic vesicles
 The basal region has many long mitochondria and basal infoldings
(associated with active transport).
 The lateral surface has few interdigitations.
Function:
1- Reabsorption of water and Na+.
2- Secretion of potassium, hydrogen and ammonium.
3- Macula densa cells act as receptors to control Na+ ion level.

26
 Fig. (3.5): Nephron and collecting duct structure (diagram)
Table 4.1: The main differences between the proximal and the distal
convoluted tubules
Proximal convoluted tubule
Long about 15mm. in length
More convoluted
60 µm in diameter.
More abundant in the section
Narrow lumen
Lined by few (3-5) pyramidal cells
Basal nucleus
The cells have indistinct lateral
boundaries
Acidophilic cytoplasm with many
granules
Apical microvilli (brush border)
Numerous mitochondria and basal
infolding
Numerous pinocytic vesicles
Distal convoluted tubule
Short about 5mm. in length
Less convoluted
20 µm in diameter.
Less abundant in the section
Wide lumen
Lined by more (5-8) cuboidal cells
Central nucleus
They have distinct lateral boundaries
Less acidophilic cytoplasm with few
granules
Few microvilli ( no brush border)
Numerous mitochondria and basal
infolding
No pinocytic vesicles
27
 Fig. (3.6): Juxtaglomerular Apparatus

Juxtaglomerular Apparatus (JGA)

 When the distal convoluted tubule comes in contact with the
vascular pole of the renal corpuscle, JGA is found.
 At this location, the distal convoluted tubule fits between the
afferent and efferent arterioles.
 This system controls blood pressure and electrolyte balance.
 It is composed of three components:

1. Macula densa.
2. Juxtaglomerular cells.
3. Extraglomerular mesangial (Lacis) Cells.

1. Macula densa
 It is a modified part of distal convoluted tubules present near
the afferent glomerular arteriole of the nephron (Fig 3.6).
 The lining cells become columnar and crowded, the nuclei
become packed together and intensely stained and are called
macula densa because they appear as dark spots.

28
  These cells have numerous microvilli and a single central
cilium with basal Golgi complex.
 They are sensitive to Na+ concentration to detect any
decrease of blood pressure and stimulate renin secretion.
 No basement membrane, so the cells come in contact with
Juxtaglomerular cells cells
2. Juxtaglomerular cells (JG cells)
 They are specialized (modified) smooth muscle cells in the
tunica media of afferent arteriole.
 They are large cells with rounded nuclei.
 Their cytoplasm contains prominent Golgi complex, well-
developed RER, and secretory granules (renin hormone)
which are PAS positive.
 Renin is secreted in response to decrease of blood pressure.
 Renin converts angiotensinogen to angiotensin I then to
angiotensin II which raises blood pressure by
vasoconstriction and stimulates aldosterone secretion from
adrenal cortex.
3. Extraglomerular mesangial (Lacis Cells, polkissen or pole
cushion cells):
 They are conical mass of small cells continuous with
intraglomerular mesangial cells.
 They occupy an area between the macula densa and the
afferent and efferent arterioles.
 They are cubical cells with pale nuclei.
 They have the same function of intraglomerular mesangial
cells

II. COLLECTING SYSTEM

1. Collecting tubule
 They are straight and not convoluted.
 They are not parts of the nephrons because they have
different embryologic origins.
 Each tubule is about 20mm in length.
 They are formed of three parts:

1. Cortical: present in the medullary rays.

2. Medullary: formed by the union of some collecting
tubules.

29
 3. Papillary: some collecting tubules join to form larger
tubule and open in the renal papillae, then in the
minor calyces.

 One collecting tubule drains many nephrons (up to 10).

 Its diameter varied from 40 -200 µm.
 It is lined with simple cubical or columnar cells with pale
acidophilic cytoplasm and central nuclei.
 Its lumen is wide with clear cell borders.
 There is no lateral interdigitation, no microvilli and no basal
infoldings.
 There are two types of cells:
a) Principal cells (light cells):
 These are the most numerous types.
 They contain few mitochondria and few short
microvilli.
 They reabsorb water and secrete potassium.
b) Intercalated cells (dark cells):
 This type is less numerous and have dark
cytoplasm with numerous mitochondria.
Function:

 Collecting tubules concentrates urine

(hypertonic) by increased permeability of
water and urea under the effect of antidiuretic
hormone (ADH) (vasopressin).

2. Collecting ducts (large ducts of Bellini)

 These are the papillary collecting ducts.
 The lumen measure 200 - 300 µm in diameter.
 Lined by simple columnar epithelium (principal cells).
 The collecting ducts open in the area cribrosa where urine is
transported without further modification into special
excretory passages.

III. RENAL INTERSTITIUM

 It lies between the kidney tubules and vessels.
 It is formed of ground substances, fibroblast, and reticular fibers.
 The medulla is richer in interstitial elements than the cortex.

31
 Fig. (3.7): Blood distribution in the kidney

Blood Supply:
Arterial supply:
 Renal artery enters through hilum and branches to form segmental
arteries that branch to interlober arteries.
 They penetrate the medulla to the cortico-medullary junction
where they branch to give arcuate arteries (Fig 3.7).
 Interlobular arteries arise from arcuate arteries and ascend into the
cortex.
 Interlobular arteries give afferent arteriole to glomerular
capillaries.
 Efferent arteriole exits the renal glomerulus.
1. In cortical nephrons it gives peritulular capillaries that
supply PCT and DCT. (portal circulation)
2. In juxtamedullary nephrons it gives vasa-recta associated
with loop of Henle, which participates in the counter-
current exchange.
 Venous drainage: blood collected in interlobular and arcuate
veins follow the same course as the arterial pathway to drain into
renal vein.

31
Nerve supply:
 Nerve fibers forming the renal plexus are derived from the
sympathetic division of the autonomic nervous system.
 They cause contraction of vascular smooth muscles leading to
vasoconstriction.
1. Constriction of glomerular afferent arterioles reduces
filtration rate to decrease amount of urine.
2. Constriction of glomerular efferent arterioles increases
filtration rate to increases urine production.

NB. The extrinsic nerve supply is not vital for normal kidney function. Transplanted
kidney performs its normal function although its nerve fibers are cut during the
operation.

Lymph Vessels:
1. The first is present in the outer region of the cortex and drains in
large vessels in the capsule.
2. The second lies deeper and drains into large lymph vessels in the
kidney substance.

Kidney function
 Osmoregulation:
1. It maintains acid base balance and electrolyte balance.

 Counter Current-system:
1. Filtration of blood plasma.
2. Selective reabsorption of water, inorganic ions and organic
molecules from filtrate.
3. Excretion of waste product (uric acid, urea, creatinine).
4. Secretion of some products into the blood stream as dyes
and drugs.

 Endocrine function:
1. Fibrocytes in the cortex release erythropoietin hormone that
stimulate RBCs formation.
2. Modified fibrocytes of the medulla secrete prostaglandins
that decrease blood pressure.
3. Secrete renin hormone to increase blood pressure.
4. Secrete medullolipin I hormone by interstitial cells,
converted in the liver to medullolipin II (potent vasodilator).

32
 EXCRETORY PASSAGES
 Urine formed in the kidney is collected and transported into; minor
and major calyces, renal pelvis, ureters and then to the urinary
bladder where it is stored until conducted by the urethra to outside
the body.

 The wall of these passages is formed of three layers:

1. Mucosa.
2. Musculosa.
3. Adventitia.

 The transitional epithelium is the main lining of the urinary

passages (so called urotheluim). It is characterized by:

 It is a type of stratified epithelium.

 Its number of layers is changeable according to the state of
distension (3-8 layers).
 It acts as an osmotic barrier against hypertonic urine.
 The surface cells are called" facet cells” characterized by:
a) They are large, dome-shaped with thick apical cell
membranes, called “plaques”.
b) Some cells are binucleated.
c) They have occluding junction in-between.
d) The apical border also contains small vesicles
continuous with the cell membrane (represent inward
folds of the membrane) to help accommodation
during distension (become unfolded).

1- Ureter
 It is a hollow long tube (25-30cm long and 3-4mm in diameter)
extending from the renal pelvis to the urinary bladder.
 It's wall formed from 3 layers: (Fig 3.8).

Mucosa:
 It is composed of transitional epithelium.
 Corium of connective tissue contains blood vessels and
lymphatics.
 The lumen appears narrow and stellate due to infolding of the
mucosa.

33
Musculosa:
 The upper 2/3 formed of inner longitudinal and outer circular
layers.
 The lower 1/3 formed inner longitudinal, middle circular and outer
longitudinal layers.
 The contraction of these muscle layers produces peristaltic waves
that push urine along to enter the urinary bladder.

Adventitia:
 Fibrous connective tissue containing blood vessels, nerves and
lymphatic cells.

Clinical note:
Nephrolithiasis: a condition in which stones consisting of uric acid,
calcium salts concentrate within the kidney; these stone can block the
ureter causing radiating pain to the side.

Fig. (3.8): Section in ureter

34
 2- Urinary Bladder
 It is a distensible reservoir of urine.
 Its wall is thicker than ureteric wall.
 It has 3 openings, two for the ureters and one for the urethra.
These 3 openings form a triangular smooth area (not folded) and
constant in thickness (has different embryological origin).
 It's wall formed from 3 layers: (Fig 3.9).

.Mucosa:
 Lined by transitional epithelium which has a remarkable ability to
change its morphology in relaxed and distended states:
1. In empty state, it is 6-8 layers.
2. In distended state, it is about 3 layers.
 Lamina propria: Connective tissue with abundant elastic fibers.

Musculosa:
 The smooth muscle forming the wall is the detruser muscle.
 It forms the involuntary internal urethral sphincter at the urethral
opening.
 The bundles of detruser muscle are less regularly arranged as in the
tubular excretory passages.
 It consists of 3 main coats: inner longitudinal, middle circular and
outer longitudinal, but they are irregular and randomly mixed with
collagen fibers.

Adventitia:
 It has a fibro-elastic connective tissue except in the upper surface
replaced by serosa (simple squamous epithelium).

Clinical Note: Cystitis, or inflammation of the bladder mucosa, is the

most frequent problem involving this organ. Retention of urine invites
infection in urinary bladder.

35
 Fig. (3.9): Section in Urinary bladder.

3- Male Urethra
 It is divided into: (Fig 3.10).
 Prostatic urethra: in the prostate (3-4cm), surrounded by the
internal urethral sphincter.
 Membranous urethra: extends from the apex of the prostate to
the bulb of the penis (1cm), surrounded by the external urethral
sphincter formed by the pelvic muscles.
 Cavernous (penile) urethra: extends in the corpus spongiosum
(12-15cm).
 It's wall is formed from:

Mucosa:
 It is covered by transitional epithelium in prostatic part,
pseudostratifid columnar or stratified columnar in membranous
part and stratified squamous in terminal part (penile part).

Lamina propria:
 It is a corium of connective tissue rich in elastic fibers with
branched tubular gland (Littre's gland lined by columnar mucous
cells).

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 Fig. (3.10): Parts of male urethra.

4- Female Urethra
 It is much shorter than male urethra. (4cm)
 It extends from the bladder and ends in the vestibule.
 It has a skeletal muscle sphincter at its terminus.
 It's wall is formed from:

Mucosa
 Contains longitudinal folds.
 The lining epithelium is transitional and stratified or
pseudostratified columnar from urinary bladder outwards. At the
orifice, it changes to stratified squamous epithelium.

Lamina propria
 It is a corium of connective tissue with mucus secreting cells like
litter's gland and plexus of veins.

Musculosa:
 It formed of smooth muscle fibers inner longitudinal and outer
circular, striated muscle fibers in external sphincter at its end.

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 Table 3.2: The main differences between the female and the male urethra

FEATURES FEMALE URETHRA MALE URETHRA

Length 3-4 cm 15-20 cm
Functions Passage for urine only. Passage for urine and semen.
Parts  One part Three parts:

 Prostatic
 Membranous
 Penile (spongiosus)

Course Traverses: Traverses:

 Urogenital diaphragm  The prostate gland

 Perineal membrane  Urogenital diaphragm
 Perineal membrane
 Corpus spongiosus

External At the vestibule (vulva) At the glans penis

urethral
orifice
Lining  Pelvic: Transitional or  Prostatic: Transitional
epithelium Pseudostratified epithelium.
columnar.  Membranous:
 Perineal: Stratified Pseudostratified columnar
squamous. epithelium.
 Penile: Stratified squamous
epithelium

Associated  Paraurethral (Littre)  Prostatic gland.

glands glands  Seminal vesicles.
 (Bartholin glands)  Urethral glands of Littre.
 Bulbourethral glands
(Cowper’s glands).
Internal Not present Present
sphincter

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