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469 Cards in this Set
- Front
- Back
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conditions of the extracellular fluid are maintained by
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the lymphatic & cardiovascular systems
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lymphatic & cardiovascular systems rely on
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other systems to interchange materials w/ the external environment
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one's internal environment consists of
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blood inside blood vessels, interstitial fluid around body cells & lymph inside lymph vessels
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cardiovascular system is made up of
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blood, heart & blood vessels
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lymphatic system consists of
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lymph, lymphatic vessels (transport), structures/organs containing lymphatic tissue (lymphocytes)
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hematology
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study of blood, blood-forming tissues & disorders associated w/them
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blood transports
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oxygen, carbon dioxide, nutrients, heat, wastes & hormones
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blood helps regulate
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pH, body temp & water content of cells
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blood prevents
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blood loss thru clotting & combats toxins/microbes thru phagocytic wbc or specialized plasma proteins
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physical characteristics of blood
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viscosity greater then water, temp- 38 C/ 100.4 F & pH- 7.35/7.45
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blood constitutes about
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8% of body weight; volume- 4 to 6 liters
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blood samples for testing can be obtained by
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venipuncture, finger-stick & arterial stick
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blood consists of
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55% plasma (extracellular) & 45% formed elements (cells)
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plasma consists of
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91.5% water & 8.5% solutes
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plasma solutes include
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proteins, nutrients, enzymes, hormones, resp. gases, electrolytes & wastes
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plasma solute proteins are
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albumins, globulins & fibrinogens
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formed elements in the blood include
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erythrocytes, leukocytes & thrombocytes
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erythrocytes
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red blood cells
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leukocytes
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white blood cells
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thrombocytes
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platelets
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blood cells are formed from
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pluripotent hematopoietic stem cells
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pluripotent hematopoietic stem cells
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hemocytoblasts
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process of hemopoiesis/hematopoiesisis stimulated by
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hematopoietic growth factors
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hematopoietic growth factors stimulate
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differentiation & proliferation of various blood cells
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red bone marrow
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myeloid tissue
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red bone marrow is responsible for
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producing rbc, granular leukocytes & platelets
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lymphoid & myeloid tissue produce
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agranular leukocytes
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granular leukocytes are
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basophils, eosinophils & neutrophils
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agranular leukocytes are
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monocytes & lymphocytes
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erythrocytes (rbc) are
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biconcave discs w/out nuclei that contain hemoglobin
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the function of hemoglobin in rbc
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transport oxygen & some carbon dioxide
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hemoglobin molecules are specialized components of
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rbc plasma membrane that combine w/ oxygen or carbon dioxide in the transport process
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oxyhemoglobin
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hemoglobin combined w/ oxygen; oxygen attaches to heme
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carbaminohemoglobin
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hemoglobin combined w/ carbon dioxide; carbon dioxide attaches to globin
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life of rbc lasts
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120 days b/c of wear & tear on their plasma membranes as the squeeze thru blood capillaries
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amt of rbc in a healthy males
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5.4 million rbc/mm3 of blood
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amt of rbc in a healthy female
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4.8 million/mm3
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rbc life cycle (after phagocytosis of worn-out rbc by macrophages)
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hemoglobin is recycled; globin portion is split from heme w/ amino acids being reused for protein systhesis
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rbc life cycle (hemoglobin is recycled)
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iron in heme portion is reclaimed by w/ rest of heme molecule; the rest b/comes a component of bile digestion
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erythropoiesis
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erythrocyte formation; occurs in adult red bone marrow of certain bones
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erythropoiesis is stimulated by
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hypoxia; stimulates release of erythropoietin release by kidneys
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reticulocyte count
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average 0.5-1.5% of all rbc; a test that indicates rate of erythropoiesis- useful in diagnosing/treating anemia
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hematocrit (Hct)
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measures % of rbc in whole blood
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female Hct (average)
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42%; range 38- 46%
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male Hct (average)
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47%; range 40-54%
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leukocytes (wbc) are
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nucleated cells & do not contain hemoglobin
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leukocytes & erythrocytes have
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surface proteins
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major histocompatibility antigens (MHC)
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surface proteins; unique for each person & can be used to identify a tissue
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tissue typing (histocompatibility testing)
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performed to determine tissue compatibility btw donor & recipient before organ transplant
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general function of leukocytes
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combat inflammation & infection
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neutrophils & wandering/fixed macrophages do so thru
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phagocytosis
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macrophages develop from
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monocytes
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eosinophils combat
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effects of histamine in allergic reactions, phagocytize antigen-antibody complexes & combat parasitic worms
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basophils develop into
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mast cells that liberate heparin, histamine & serotonin in allergic reactions that intensify inflammatory response
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b lymphocytes in response to
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presence of foreign substances called antigens; differentiate into tissue plasma cells that produce antibodies
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antibodies attach to
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antigens & make them harmless
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antigen-antibody response
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combats infections & provides immunity
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t lymphocytes
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destroy foreign invaders directly
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differential white blood cell count
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test; specific wbc are enumerated; each type of wbc plays a different role- determining % of each type in blood assists in diagnosing a condition
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wbc live
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a few hours or days
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normal blood contains (wbc)
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5,000- 10,000 leukocytes/mm3
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bone marrow transplants
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treat several types of anemia, leukemia & other blood disorders
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thrombocytes or platelets
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disc-shaped structures w/out nuclei
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thrombocytes are formed
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as fragments from meta-megakaryocytes; help repair damaged blood vessels & promote blood clotting
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normal blood contains (thrombocytes)
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250,000- 400,000 platelets/mm3
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platelet life-span
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5 to 9 days
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aged/dead platelets are removed by
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fixed macrophages in the spleen & liver
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complete blood count (cbc) is used
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determine blood cell counts, hemoglobin, hematocrit, wbc count, differential wbc count & platelet count
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hemostasis refers to
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stoppage of bleeding
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hemostatic response (blood vessels damaged/ruptured) must be
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quick, localized to region of damage & carefully controlled
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hemostasis involves
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vascular spasms, platelet plug formation & blood coagulation (clotting)
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in vascular spasm
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smooth muscle of blood vessel wall contracts to stop bleeding
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platelet plug formation involves
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clumping of platelets around damage to stop bleeding
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a clot is
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gel consisting of network of insoluble protein fibers; formed elements of blood are trapped
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protein fibers are
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fibrin
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coagulation (clotting) factors
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chemicals involved in clotting
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clotting (coagulation) factors are in
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blood plasma, some are released by platelets & one is released from damaged tissue cells
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3 stages of blood clotting
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formation of prothrombinase, conversion of prothrombin to thrombin, conversion of soluble fibrinogin into insoluble fibrin
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formation of prothrombinase is initiated by
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interplay of 2 mechanisms; extrinsic & intrinsic pathways of blood clotting
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hemophilia
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hereditary deficiencies of coagulation; bleeding can occur spontaneously or after only minor trauma
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normal coagulation requires
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vitamin K & involves clot retraction (syneresis) & fibrinolysis
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clot retraction (syneresis)
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tightening of clot
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fibrinolysis
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dissolution of clot
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thrombolytic (clot-dissolving) agents are
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chemicals injected into body to dissolve clots to restore circulation; most common in treatment of clots in coronary arteries of heart
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clot-dissolving agents (thrombolytic) chemicals
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streptokinase & tissue plasminogen activator (t-PA)
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anticoagulants are
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inhibit coagulation; present in blood; ex. heparin
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thrombosis
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clotting in an unbroken blood vessel
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thrombus
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clot
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embolus
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clot, bubble of air, fat from broken bones or piece of debris transported by bloodstream that moves from its site of origin
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agglutinogens or isoantigens
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genetically determined blood group antigens on surface of rbc
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agglutinins or isoantibodies
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plasma contains genetically determined antibodies; against blood group antigens ppl don't have
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ABO & Rh blood grouping systems are based on
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antigen-antibody responses
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in ABO system
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agglutiongens A & B determine blood type
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agglutinogens
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antigens
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plasma contains
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agglutinins (antibodies) a & b; react w/ agglutinogens that are foreign to person
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in Rh system
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ppl whose erythrocytes have Rh agglutinogens are Rh+; those who don't have antigen are Rh-
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Rh & ABO blood groups can be detected by
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blood typing- blood sample is mixed w/ serum containing agglutinins to each major agglutinogens (A, B & Rh)
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hemolytic disease of newborn (HDN) or erythroblastosis fetalis
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Rh incompatibility btw mother & fetus; treatable & preventable
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anemia
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oxygen-carrying capacity of blood is reduced; a sign, not diagnosis; decreased erythrocyte count or hemoglobin deficiency
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types of anemia
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nutritional, pernicious, hemorrhagic, hemolytic, aplastic & sickle-cell (SCA)
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polycythemia
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abnormal increases in number of erythrocytes (Hct > 55%); increased viscosity of blood causes rise in blood pressure & contributes to thrombosis & hemorrhage
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infectious mononucleosis (IM)
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contagious disease effects lymphoid tissue; elevated wbc count, high % of lympocytes; cause is epstein-barr virus (EBV)
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leukemia
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disease of blood-forming tissues; uncontrolled production of wbc that interferes w/ normal clotting & vital body activities
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leukemia is classified based on
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duration & character of disease & according to identity & site of origins of predominant cell involved
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origin cells of leukemia
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myelocytic, lymphocytic or monocytic
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acute leukemia
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uncontrolled prduction & accumulation of immature leukocytes
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chronic leukemia
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accumulation of mature leukocytes in bloodstream b/c they don't die @ end of their normal life span
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cardiology
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study of heart & diseases associated w/ it
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systemic circulation
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once blood has been oxygenated in lungs it passes thru a series of channels via heart & body before returning to heart
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systemic circulation includes
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pulmonary veins, left atrium/ventricles, aorta/smaller arterial branches, capillaries, venules, larger veins & vena cava
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pulmonary circulation
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where deoxygenated blood containing high levels of carbon dioxide from tissues returned to right heart passes thru
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pulmonary circulation includes
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right atrium/ventricle, pulmonary artery, arteries & capillaries of lungs
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the heart
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btw lungs in mediastinum; 2/3 of its mass is left of midline; 12 cm long, 9 cm wide & 6 cm thick
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pericardium
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heart is enclosed & held in place
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pericardium consists of
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outer fibrous pericardium & inner serous pericardium
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serous pericardium is composed of
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parietal layer & viseral layer
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pericardial cavity
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btw parietal & viseral layers of serous pericardium; space filled w/ pericardial fluid- reduces friction btw membranes
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pericarditis
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inflammation of pericardium
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cardiac tamponade
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associated bleeding into pericardial cavity compresses the heart & is potentially lethal
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wall of heart has 3 layers
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epicardium, myocardium & endocardium
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epicardium consists of
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mesothelium & connective tissue
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myocardium consists of
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cardiac muscle tissue
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endocardium consists of
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endothelium & connective tissue
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chambers of the heart include
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2 upper atria & 2 lower ventricles
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interatrial septum
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separates atria
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interventricular septum
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separates ventricules
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atrioventricular valves (AV)
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btw atria & their ventricles; tricuspid valve on right side of heart & bicuspid (mitral) valve on left
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chordae tendineae & their papillary muscles
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keep flaps of valves pointing in direction of blood flow & stop blood from backing into atria
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semilunar valves prevent
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blod from flowing back into heart as it leaves heart for lungs (pulmonary semilunar valve) or rest of body (aortic semilunar valve)
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rheumatic fever
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precipitated by infection w/ group A, alphahemolytic strains of streptococcus pyogenes bacteria; damage to heart valves- bicuspid & aortic semilunar
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blood flows thru the heart
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superior/inferior venae cavae & coronary sinus to right atrium thru tricuspid valve to right ventricle thru pulmonary trunk & arteries to lungs thru pulmonary veins into left atrium thru bicuspid valve to left ventricle & out thru aorta
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divisions of aorta
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ascending aorta, arch of aorta, thoracic aorta & abdominal aorta
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coronary (cardiac) circulation
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flow of blood thru many vessels that pierce myocardium of heart; delivers oxygenated blood & nutrients to myocardium & remove carbon dioxide & wastes from it
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right & left coronary arteries
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principal arteries branching from ascending aorta & carrying oxygenated blood
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coronary sinus
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deoxygenated blood returns to right atrium via principle vein
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heart problems result from
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faulty coronary circulation due to blood clots, fatty atherosclerotic plaques or spasms of smooth muscle in coronary atery walls
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angina pectoris
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severe pain that accompanies reduced blood flow (ischemia) to myocardium
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myocardial infarction (MI or heart attack)
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death of an area of myocardium dur to interruption of blood supply; result from thrombus or embolus
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reperfusion
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disease or injury deprives a tissue of oxygen, reestablishing blood flow may damage tissue further due to formation of oxygen free radicals; can destabilize structure of proteins, NT, nucleic acids & phospholipids of plasma membranes
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conduction system consists of
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tissue specialized for generation & conduction of spontaneous action potentials that stimulate cardiac muscle fibers (cells) to contract
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components of conduction system are
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sinoatrial(SA) node (pacemaker), atrioventricular (AV) node, atrioventricular (AV) bundle (bundle of His), right/left bundle branches & conduction myofibers (purkinje cells)
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signals from the ANS & hormones (epinephrine)
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modifies heartbeat (rate & strength of contraction); does not establish fundemental rhythm
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artificial pacemaker
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used to restore cardiac rhythm due to disruption of conduction system
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impulse in ventricular contractile fiber is characterized by
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rapid depolarization, plateau & repolarization
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refractory period of cardiac muscle fiber is
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longer than contraction itself
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impulse conduction thru the heart generates
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electrical currents can be detected at surface of body
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electrocardiogram (ECG or EKG)
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recording of electrical changes that accompany each cardiac cycle (heartbeat)
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a normal ECG/EKG consists of
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P wave, QRS complex & T wave
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P wave
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atrial depolarization; spread of impulse from SA node over atria
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QRS complex
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ventricular depolarization; spread of impulse thru ventricles
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T wave
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ventricular repolarization
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P-Q (PR) interval represents
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conduction time from beginning of atrial excitation to beginning of ventricular excitation
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S-T segment represents
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time when ventricular contractile fibers are fully depolarized; during plateau phase of impulse
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cardiac cycle consists of
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systole & diastole of both atria followed by systole & diastole of both ventricles
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systole
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contraction
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diastole
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relaxation
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phases of cardiac cycles
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relaxation or quiescent period, ventricular filling & ventricular systole
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average heart rate
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75 beats/min
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complete cardiac cycle requires
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0.8 seconds
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auscultation
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listening to sounds within body; done w/ stethoscope
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sounds of a heartbeat comes from
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turbulence of blood flow from closure of valves; not from contraction of heart muscle
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S1-lubb (1st heart sound) is created by
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blood turbulence associated w/ closing of atrioventricular valves; after ventricular systole begins
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S2-dupp (2nd heart sound)
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closing of semilunar valves close to end of ventricular systole
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heart murmur is
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abnormal sound consists of flow noise that is heard before, btw or after lubb-dupp or that masks sounds entirely
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murmurs caused by
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turbulent blood flow around valves due to abnormal anatomy or increased volume of flow
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valvular disorders that contribute to murmurs
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mitral stenosis, mitral insufficiency, aortic stenosis, aortic insufficiency & mitral valve prolapse (MVP)
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cardiac output CO)
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amt of blood ejected by left ventricles (or right) into aorta (or pulmonary trunk) per minute
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cardiac output calculated
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CO= stroke volume x beats per minute
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stroke volume (SV)
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amt of blood ejected by ventricle during each systole
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stroke volume depends on
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how much blood enters ventricle during diastole
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end-diastolic volume (EDV) aka preload
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the stretch on heart before it contracts
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end-systolic volume (ESV)
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how much blood left in ventricle following systole
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EDV averages
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120-130 ml
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SV averages
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70 ml
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ESV averages
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50-60 ml
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stroke volume is related to
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contractibility & afterload; factors that increase SV or heart rate tend ti increase CO & vice versa
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contractibility
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forcefulness of contraction @ any given time
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afterload
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pressure that must be exceeded before ventricular ejection can begin
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cardiac reserve
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ratio btw maximum cardiac output person can achieve & cardiac output @ rest
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frank-starling law of the heart
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a greater preload (stretch) on cardiac muscle fibers just before they contract increases force of contraction during systole
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congestive heart failure (CHF)
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heart caanot supply oxygen demands of body; diminished blood flow to tissues, accumulation of excess blood in organs b/c heart is unable to pump out blood returned by great veins
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causes of CHF
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chronic hypertension & MI (heart attack)
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cardiac output depends on
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heart rate & stroke volume
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changing heart rate is
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body's principal mechanism of short-term control over cardiac output & blood pressure
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cardiovascular center in medulla
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where nervous system control of cardiovascular system comes from
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sympathetic impulses
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increase heart rate & force of contraction
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parasympathetic impulses
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decreases heart rate
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baroreceptors are
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pressure receptors; nerve cells respond to changes in blood pressure & relay info to cardiovascular center;located in arch of aorta & carotid arteries
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heart rate is affected by
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hormones (epi, NE, thyroid), ions (Na, K, Ca), age, gender, phy fitness & temp
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3 classes of lipoproteins
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LDL-low-density lipoproteins, HDL-High-density lipoproteins, VLDL- very low-density lioproteins
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HDL's
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remove excess cholestorol from circulation
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LDL's
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associated w/ formation of fatty plaque formation
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VLDL's
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contribute to increased fatty plaque formation
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two sources of cholesterol in the body
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foods we digest & synthesized in the liver
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desirable cholesterol levels for adults
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TC (total cholesterol) under 200 mg/dl
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desirable LDL levels for adults
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under 130 mg/dl
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desirable HDL levels for adults
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over 40 mg/dl
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triglyceride range for adults
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10-190 mg/dl
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heart develops from
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mesoderm before end of 3rd week of gestation
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endothelial tubes develop into
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4 chambered heart & great vessels of heart
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coronary artery disease (CAD) or coronary heart disease (CHD) is a condition
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heart muscles receive inadequate amt of blood due to obstruction of blood supply
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principles causes of narrowing arteries are
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atherosclerosis, coronary artery spasm & clot in coronary artery
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artherosclerosis is a process
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smooth muscles cells proliferate & fatty substances, cholesterol & triglycerides (neutral fats), accumulate in walls of medium & large arteries in response to certain stimuli; endothelial damage
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treatment of coronary artery disease
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drug therapy (beta blockers, nitroglycerin & thrombolytic agents), surgical/non-surgical procedures
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coronary artery spasm is a condition
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smooth muscle of a coronary artery undergoes a sudden contraction, resulting in narrowing of a blood vessel
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congenital defect is
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defect that exists at birth & usually before birth
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congenital defects of the heart include
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coarctation of aorta, patent ductus arteriosus, septal defects (interatrial & interventricular), valvular stenosis & tetralogy of fallot
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arrhythmia is
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abnormality/irregularity in heart rhythm resulting from disturbance in conduction system of heart; due to faulty production of electrical impulses or poor conduction of impulses as the pass thru system
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examples of arrhythmias
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heart block (atrioventricular block), flutter, fibrilliation (atrial & ventricular) & premature ventricular contraction (PVC)
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some arrhythmias are caused by the effects of
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caffeine, nicotine, alcohol, anxiety, drugs, hyperthyroidism, potassium deficiency & heart disease
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arteries carry
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blood away from heart to tissues
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wall of artery consists of
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tunica interna, tunica media (maintains elasticity & contractility), tunica externa
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large arteries are
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elastic (conducting)
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medium arteries are
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muscular (distributing)
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many arteries
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anastomose- distal end of two or more vessels unite
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anastomose btw arteries provide
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alternative routes for blood to reach a tissue or organ
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collateral circulation
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alternate blood route from anastomose
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end arteries
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arteries that don't anastomose
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occlusions of an end artery
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interrupts blood supply to whole segment of organ; producing necrosis (death) of that segment
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arterioles are
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very small, almost microscopic arteries that deliver blood to capillaries
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thru vasoconstiction & vasodialation arterioles play a key role in
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regulating blood flow from arteries into capillaries & in altering arterial blood pressure
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capillaries are
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microscopic blood vessels thru which materials are exchanged btw blood & tissues cells
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capillareies connect
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arterioles & venules
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capillary walls are composed of
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a single layer of cells (endothelium) & a basement membrane
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capillaries branch to form
|
extensive network thru out the tissue; it increases surface area, allowing a rapid exchange of a large amt of materials
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flow of blood thru capillaries is regulated by
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vessels w/smooth muscle in their walls
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precapillary sphincters
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rings of smooth muscle fiber (cells) that regulate blood flow thru true capillaries
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some capillaries are, while others are
|
continous & fenestrated
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sinusoids
|
microscopic blood vessels in organs such as liver, spleen & bone marrow
|
|
|
sinusoids are
|
wider than capillaries, more tortuous & specialized for functions of specific organs
|
|
|
venules are
|
small vessels formed from the union of several capillaries; merge to form veins & drain blood from capillaries into veins
|
|
|
veins consists of
|
same 3 tunics are arteries- have thinner tunica interna/ media & thicker tunica externa; less elastic tissue & smooth muscle; thinner-walled than arteries
|
|
|
veins contain
|
valves to prevent backflow of blood & weak valves lead to varicose veins
|
|
|
vascular (venus) sinuses are
|
veins w/ very thin walls & no smooth muscle to alter diameter
|
|
|
blood reservoirs
|
largest portion of blood is in systemic veins & venules (at rest)
|
|
|
blood reservoirs store
|
blood & thru venus vasoconstriction- can move blood to other parts of body as needed
|
|
|
in case of hemorrhage (blood pressure & volume decrease)
|
vaso-constriction of veins in venuous reservoirs helps to compensate blood loss
|
|
|
principal reservoirs are
|
veins of abdominal organs (liver & spleen) & skin
|
|
|
substances enter & leave capillaries by
|
diffusion, vesicular transport (endocytosis & exocytosis) & bulk flow (filtration & absorption)
|
|
|
movement of water & dissolved substances (except proteins) thru capillaries is dependant upon
|
hydrostatic & osmotic pressures
|
|
|
starling's law of capillaries
|
the near equalibrium at arterial & venous ends of a capillary by which fluids exit & enter
|
|
|
edema
|
abnormal increase in interstitial fluid
|
|
|
factors causing edema (increased)
|
blood hydrostatic pressure in capillaries due to increased venous pressure, permeability of capillaries- allowing greater amts of plasma proteins to leave blood & enter tissue fluid & extracellular fluid vol as result of fluid retention
|
|
|
factors causing edema (decreased & blockage)
|
concentration of plasma proteins that lower blood colloid osmotic pressure & blockage of lymphatic vessels postoperatively or due to filarial worm infection
|
|
|
blood flow
|
vol that flows thru any tissue in a given period of time
|
|
|
velocity of blood flow is
|
inversely related to cross-sectional area of blood vessels; flows more slowly where cross-sectional area is greatest
|
|
|
blood flow decreases from
|
aorta to arteries to capillaries & increases as it returns to the heart
|
|
|
blood flow is determined by
|
blood pressure & resistance
|
|
|
blood flows from
|
regions of higher to lower pressure; higher resistance, lower blood flow
|
|
|
cardiac output (CO)=
|
mean aortic blood pressure (MABP) divided by total resistance (R)
CO= MABP/R |
|
|
blood pressure (BP) is
|
pressure exterted on walls of blood vessels; clinical use- pressure in arteries
|
|
|
factors that affect BP include
|
cardiac output, blood vol, viscosity, resistance & elasticity of arteries
|
|
|
as blood leaves the aorta & flows thru systemic circulation
|
its pressure progressively falls to 0mm Hg by the time it reaches right atrium
|
|
|
resistance refers to
|
oppostion to blood flow as result of friction btw blood & walls of blood vessels
|
|
|
resistance depends upon
|
blood viscosity, blood vessel length & blood vessel radius
|
|
|
systemic vascular resistance (SVR) aka total peripheral resistance
|
all the vascular resistances offered by systemic blood vessels; most resistance in arterioles, capillaries & venules (due to small diameters)
|
|
|
a number of factors aid venous return
|
vol of blood flowing back to heart from systemic veins, increasing magnitude of pressure gradient btw venules & right atrium
|
|
|
blood returned to the heart is maintained by
|
skeletal muscular contractions, valves in veins (esp in extremities) & pressure changes associated w/ breathing
|
|
|
cardiovascular center (CV) is
|
a group of neurons in medulla that regulates heart rate, contractibility & blood vessel diameter
|
|
|
CV center receives input from
|
higher brain regions & sensory receptors (baroreceptors & chemoreceptors)
|
|
|
output from CV center flows along
|
sympathetic & parasympathetic fibers
|
|
|
sympathetic impulses along
|
cardioaccelerator nerves increases heart rate & contractibility
|
|
|
parasympathetic impulses along
|
vagus (X) nerves decreases heart rate
|
|
|
sympathetic division continually sends impulses to
|
smooth muscle in blood vessel walls via vasomotor nerves
|
|
|
vasomotor tone
|
moderate state of tonic contraction or vasoconstriction
|
|
|
baroreceptors (pressure receptors)
|
important pressure-sensitive sensory neurons; monitor stretching of blood vessel walls & atria
|
|
|
cardiac sinus reflex
|
maintaining normal BP in the brain & initiated by baroreceptors in walls of carotid sinus
|
|
|
aortic reflex
|
general systemic BP & initiated by baroreceptors in wall of arch of aorta or attached to it
|
|
|
if BP falls
|
baroreceptor reflexes accelerate heart rate, increase force of contraction & promote vasoconstriction
|
|
|
right heart (atrial) reflex
|
responds to increases in venous BP & initiated by baroreceptors in right atrium & vena cavae
|
|
|
chemoreceptors
|
receptors sensitive to chemicals
|
|
|
chemoreceptors monitor
|
blood levels of oxygen, carbon dioxide, & hydrogen ion concentration
|
|
|
several hormones affect BP & flow by
|
acting on the heart, altering blood vessel diameter or adjusting total blood vol
|
|
|
hormones that regulate BP
|
epi, NE, ADH, angiotensin II, ANP, histamine & kinins
|
|
|
autoregulation
|
local, automatic adjustments of blood flow in a region to match needs of the tissue
|
|
|
in most body tissues
|
oxygen is principle (not direct) stimulus for autoregulation
|
|
|
2 types of stimuli that causes autoregulatory changes in blood flow
|
physical & chemical
|
|
|
shock is
|
inadequate cardiac output; results in failure of cardiovascular system to deliver adequate amts of oxygen & nutrients to meet metabolic needs of body cells
|
|
|
as a result of shock
|
cellular membranes dysfunction, cellular metabolism is abnormal & celluar death may occur w/out treatment
|
|
|
signs & symptoms of shock
|
clammy cool pale skin, systemic tachycardia; weak rapid pulse; sweating; hypotension (systemic pressure < 90 mm Hg); altered mental state; decreased urinary output, thirst & acidosis
|
|
|
stages of shock are
|
characterized by inadequate perfusion of tissues
|
|
|
hypovolemic shock
|
decreased blood vol from blood or plasma loss due to hemorrhage or excessive fluid loss (vomiting, diarrhea, sweating, dehydration, urine production & burns
|
|
|
stage I shock is
|
compensated (nonprogressive)- negative feedback systems restore homeostasis; if cause doesn't get any worse, recovery follows
|
|
|
stage I shock compensatory adjustments include
|
activation of sympathetic division of ANS, renin angiotensin pathway, release of ADH & release of vasodilator factors in response to hypoxia
|
|
|
stage II shock is
|
decompensated (progressive) shock; positive feedback cycles intensify shock & immediate medical attention is required
|
|
|
stage II shock occurs when
|
a reduction in blood vol of 15-20%
|
|
|
stage II shock positive feedback cycles
|
contribute to decreased CO & BP are depressions of cardiac activity, vasoconstriction & increased permeability of capillaries intravascular clotting, cellular destruction & acidosis
|
|
|
stage III shock is
|
irreversible; rapid deterioration of cardiovascular system that cannot be helped by compensatory mechanisms or medical intervention
|
|
|
pulse is
|
alternate expanson & elastic recoil of an artery wall w/ each heartbeat
|
|
|
pulse can be
|
felt in any artery near the surface or over hard tissue & is strongest in arteries closest to heart; radial is most commonly used
|
|
|
normal resting pulse (heart) rate is
|
btw 70 & 80 beats per minute
|
|
|
tachycardia
|
rapid resting heart rate or pulse rate (>100 beats/min)
|
|
|
bradycardia
|
slow resting heart or pulse rate (<60 beats/min)
|
|
|
BP is
|
pressure exerted by blood on wall of an artery when left ventricle undergoes systole then diastole
|
|
|
BP is measured by
|
sphygmomanometer in one of the brachial arteries
|
|
|
systolic BP (SBP)
|
force of blood recorded during ventricular contraction
|
|
|
diastolic BP (DBP)
|
force of blood recorded during ventricular relaxation
|
|
|
korotkoff sounds
|
various sounds heard while taking blood pressure
|
|
|
normal BP
|
male- 120/80 mm Hg
female- 8-10 mm Hg less; range of average values varies |
|
|
pulse pressure (PP)
|
difference btw systolic & diastolic pressure; normally about 40 mm Hg & provides info about conditions of arteries
|
|
|
blood vessels are organized into
|
parallel routes that deliver blood thru out the body
|
|
|
systemic circulation
|
the largest circulatory route
|
|
|
coronary (cardiac) circulation- subdivision of systemic circulation
|
supplies myocardium of the heart
|
|
|
cerebral circulation- subdivision of systemic circulation
|
supplies the brain
|
|
|
hepatic portal circulation- subdivision of systemic circulation
|
extends from GI tract to liver
|
|
|
other routes include
|
pulmonary & fetal circulation
|
|
|
systemic circulation takes
|
oxygenated blood from left ventricle thru aorta to all parts of body, including some lung tissue & returns deoxygenated blood to right atrium
|
|
|
aorta is divided into
|
ascending, arch & descending
|
|
|
each section of aorta
|
gives off arteries that branch to supply whole body
|
|
|
blood returns to the heart thru
|
systemic veins
|
|
|
all veins of systemic circulation flow into
|
superior/inferior vena cavae or coronary sinus- in turn empties into right atrium
|
|
|
hepatic portal circulation
|
collects blood from veins of pancreas, spleen, stomach, intestines & gallbladder & directs it into hepatic portal vein of liver before returning to heart
|
|
|
portal system
|
carries blood btw 2 capillary networks, (in this case) from capillaries of GI tract to sinusoids of liver
|
|
|
pulmonary circulation
|
takes deoxygenated blood from right ventricle to air sacs of lungs & returns oxygenated blood from lungs to left atrium; allows blood to be oxygenated for systemic circulation
|
|
|
fetal circulation
|
exchange of materials btw mother & fetus
|
|
|
fetus derives
|
oxygen, nutrients & eliminates carbon dioxide/ wastes thru maternal blood supply by means of placenta
|
|
|
fetal circulation is no longer needed
|
at birth, when pulmonary (lung), digestive & liver functions are established
|
|
|
changes associated w/ age & cardiovascular system
|
loss of compliance (extensibility) of aorta, reduction in cardiac muscle fiber (cell) size; progressive loss of cardiac muscular strength, reduced CO, decline in max heart rate & increased systolic BP
|
|
|
incidences of these increase w/ age
|
coronary artery disease (CAD), congestive heart failure (CHF) & atherosclerosis
|
|
|
blood vessels develop from
|
isolated masses of mesenchyme in mesoderm called blood islands
|
|
|
blood islands
|
spaces appear in islands & b/come lumens of blood vessels
|
|
|
some mesenchymal cells immediately
|
around spaces give rise to endothelial lining of blood vessels
|
|
|
blood plasma & cells are produced by
|
endothelial cells of BV- function later assumed by liver, spleen, bone marrow & lymph nodes
|
|
|
hypertension or high BP
|
most common disease affecting heart & BV; classified as primary (essential) or secondary
|
|
|
primary (essential) hypertension
|
90-95% of all cases; persistently elevated BP that cannot be attributed to any specific cause
|
|
|
secondary hypertension
|
has identifiable causes; kidney disease & adrenal hypersecretion
|
|
|
aneurysm
|
thin weakened section of artery wall or vein; bulges outward forming a balloonlike sac on BV
|
|
|
if aneurysm is left untreated
|
it may burst causing massive hemorrhage w/ shock, severe pain, cardiovascular accident (CVA/stroke) or death; some may be surgically repaired
|
|
|
lymphatic system consists of
|
lymph (fluid) flowing w/in lymphatic vessels (lymphatics);several structures/organs that contain lymphatic tissue (specialized reticular tissue containing large # of lymphocytes) & bone marrow- site of lymphocyte production
|
|
|
lymphatic systems fuctions to
|
drain interstitial fluid, return leaked plasma proteins to blood, transport dietary fats & protect against invasion by nonspecific defenses & specific immune responses
|
|
|
lymphatic vessels begin as
|
blind-ended lymph capillaries in tissue spaces btw cells
|
|
|
lymphatic capillaries
|
interstitial fluid drains into forming lymph
|
|
|
lymph capillaries merge to form
|
larger vessels called lymphatic vessels
|
|
|
lymphatic vessels convey
|
lymph into & out of structures called lymph nodes
|
|
|
the passage of lymph is from
|
arteries & blood capillaries (blood) to interstitial spaces (fluid) to lymph capillaries (lymph) to lymphatic vessels to lymph trunks to thoracic duct or right lymphatic duct to subclavain veins (blood)
|
|
|
lymph flows as a result of
|
milking action of skeletal muscle contraction & respiratory mvmts; aided by lymphatic vessels valves that prevent backflow of lymph
|
|
|
thoracic duct is
|
main collecting duct of lymphatic system; receives lymph from left side of head, neck, chest, left upper extremity & entire body below ribs
|
|
|
right lymphatic duct
|
drains lymph from upper right side of body
|
|
|
lymphatic (lymphoid) tissue-containing components of lymphatic system are
|
diffuse lymphatic tissue, nodules & organs (lymph nodes, spleen & thymus gland)
|
|
|
thymus gland lies
|
btw sternum & heart; functions in immunity as site of T cell maturation
|
|
|
lymph nodes are
|
encapsulated oval structures located along lymphatic vessels; scattered thru out body in groups
|
|
|
lymph enters (1) nodes thru & exits (2) thru
|
(1)afferent lymphatic vessels, is filtered to remove damaged cells & microrganisms (2)efferent lymphatic vessels
|
|
|
foreign substances filtered by lymph nodes are
|
trapped by nodal reticular fibers
|
|
|
macrophages (1)
lymphocytes (2) |
(1)destroy some foreign substances by phagocytosis
(2)bring about destruction of others by immune response |
|
|
lymph nodes are the site of
|
proliferation of plasma cells & T cells
|
|
|
spleen is
|
largest mass of lymphatic tissue in body & is found in left hypochondriac region btw fundus of stomach & diaphragm
|
|
|
spleen is site of
|
B cell proliferation into plasma cells, phagocytosis of bacteria & worn-out or damaged rbc & platelets & storage of blood
|
|
|
spleenectomy (removal of spleen)
|
required to prevent death from blood loss from ruptured spleen
|
|
|
ruptured spleen
|
caused by abdominal trauma; due to capacity for blood storage; can cause severe intraperitoneal hemorrhage & shock
|
|
|
tonsils are
|
multiple aggregations of large lymphatic nodules embedded in mucous membrane at junction of oral cavity & pharynx
|
|
|
tonsils include
|
pharyngeal (adenoid), palantine & lingual
|
|
|
tonsils are situated strategically to
|
protect against invasion of foreign substances & participate in immune responses by producing lymphocytes & antibodies
|
|
|
lymphatic vessels develop from
|
lymph sacs; develop from veins; derived from mesoderm
|
|
|
lymph nodes develop from
|
lymph sacs that b/come invaded by mesenchymal cells
|
|
|
resistance
|
ability to ward off disease using a # of defenses
|
|
|
susceptibility
|
lack of resistence
|
|
|
nonspecific resistance refers to
|
variety of body responses against range of pathogens (disease-producing organisms) & their toxins
|
|
|
1st line of defense against pathogens
|
skin & mucous membranes; mechanical & chemical factors involved
|
|
|
mechanical protection includes
|
intact epidermis layer of skin, mucous membranes, lacrimal apparatus, saliva, mucus, cilia, epiglottis & flow of urine; also defecation & vomiting
|
|
|
chemical protection is
|
localized on the skin, in loose connective tissue, stomach & vagina
|
|
|
skin produces
|
sebum- has low pH due to unsaturated fatty acids & lactic acid
|
|
|
lysozyme is
|
enzyme component of sweat; has anti-microbial properties
|
|
|
hyaluronic acid
|
in areolar (loose) connective tissue; helps to contain infections to localized area
|
|
|
gastric juice
|
renders the stomach nearly sterile b/c of its low pH (1.5-3.0) kills most bacteria & destroys their toxins
|
|
|
antimicrobial substances- transferring, interferon,complement & properdin
|
work against colonization by viruses & bacteria; provide 2nd line of defense should microbes penetrate skin and mucous membranes
|
|
|
interferons (IFNs)
|
body cells infected w/ viruses produce proteins
|
|
|
once produced & released from virus-infected cells IFNs
|
diffuse to uninfected cells & bind to surface receptors, inducing them to synthesize antiviral proteins that interfere w/ or inhibit viral replication
|
|
|
IFNs also
|
enhance activity of phagocytes & natural killer cells, inhibit cell growth & supress tumor formation
|
|
|
complement system
|
20 proteins present in blood plasma & on cell membrane; when activated they "complement" or enhance immune, allergic & imflammatory reactions
|
|
|
natural killer cells (NK)
|
type of lymphocyte; kill a variety of infectious microbes & certain spontaneously arising tumor cells; action & target recognition poorly understood
|
|
|
phagocytosis (3rd line of defense)
|
ingestion & destruction of microbes of foreign particulate matter by cells called phagocytes
|
|
|
phagocytes participate in
|
nonspecific defenses & in immunity
|
|
|
phagocytes fall into 2 categories
|
granulocytes (microphages- neutrophils & eosinophils & macrophages (fixed & wandering)
|
|
|
4 phases of phagocytosis
|
chemotaxis, adherence, ingestion & killing
|
|
|
inflammation occurs when
|
cells are damaged by microbes, phy or chem agents; injury a form of stress
|
|
|
4 sysmptoms of inflammation
|
redness, heat, swelling, pain; loss of function may be 5th depending on site & extent of injury
|
|
|
inflammatory response serves a
|
protective & defensive role by eliminating microbes, toxins or foreign materials from site of injury, preventing spread to other organs & preparing site for tissue repair; attempt to restore tissue homeostais
|
|
|
stages of inflammatory response are
|
vasodilation (increase in BV diameter), increased permeability of BV, phagocyte migration & repair
|
|
|
substances that contribute to vasodilation, increased permeability & other aspects of inflammatory response are
|
histamine, kinins, prostaglandins, leukotrienes & complement
|
|
|
pus
|
pocket of dead phagocytes & damaged tissue; must drain out of body
|
|
|
abscess
|
when pus accumulates in a confined space
|
|
|
ulcer may result
|
prolonged inflammatory response to continuosly injured tissue; stomach lining & tissue of the legs
|
|
|
fever
|
infection from bacteria (& their toxins) & viruses; high body temp inhibits microbial growth & speeds up body reactions that aid repair
|
|
|
immunity
|
resistance to disease involves production of specific lymphocytes or antibodies (Ab) against specific antigen (Ag)
|
|
|
T & B cells derive from
|
stem cells in bone marrow
|
|
|
T cells
|
complete their maturation & develop immunocompetence in the thymus
|
|
|
immunocompetence
|
ability to carry out immune responses if properly stimulated
|
|
|
before T cells leave thymus & B cells leave bone marrow
|
they acquire distinctive surface proteins;some function as antigens receptors- molecules capable of recognizing specific antigens
|
|
|
cell-mediated immunity (CMI)
|
destruction of antigens by T cells; effective against intracellular pathogens (fungi, parasites, viruses, cancer cells & foreign tissue transplant; always involves cells attacking cells
|
|
|
antibody-mediated (humoral) immunity (AMI)
|
destruction of antigens by antibodies; works against antigens dissolved in body fluids & extracellular pathogens, bacteria- multiply in body fluids but rarely enter body cells
|
|
|
antigens are
|
chem substances that are recognized as foreign by antigen receptors when introduced into body; both immunogenic & reactive
|
|
|
antigens
|
large complex molecules; proteins, but sometimes nucleoproteins, lipoproteins, glycoproteins & large polysaccharides
|
|
|
antigenic determinants or epitopes
|
specific portions of antigen molecules that trigger immune response
|
|
|
antigen receptors exhibit
|
great diversity due to genetic recombination
|
|
|
major histocompatibility complex (MHC) antigens aka human leucocyte associated (HLA) antigens
|
unique to each persons body cells; self-antigens aid in in detection of foreign invaders; all cells (except rbc) display MHC class I antigens; some display MHC class II
|
|
|
for an immune response to occur
|
B & T cells must recognize that a foreign antigen is present
|
|
|
B cells can
|
recognize & bind to antigens in extracellular fluid
|
|
|
T cells can
|
only recognize fragments of antigenic proteins that 1st have been processed & presented in association w/ MHC self-antigens
|
|
|
peptide fragments from
|
foreign antigens help stimulate MHC molecules
|
|
|
cells of body can process & present endogenous antigens
|
antigens synthesized in a body cell (viral proteins from virus infected cells)
|
|
|
antigen-presenting cells (APCs)
|
process exogenous antigens & present them together w/ MHC class II molecules to T cells; include macrophages, B cells & dendritic cells
|
|
|
exogenous antigens
|
formed outside of the body
|
|
|
steps in processing & presenting an exogenous antigen by APC are
|
phagocytosis/endocytosis of antigen, partial digestion, fusion of vesicles, binding of peptide fragments to MHC-II molecules & exocytosis
|
|
|
cytokines
|
small protein hormones needed for many normal cell functions; some regulate immune responses
|
|
|
antibody (Ab)
|
protein that can combine specifically w/ antigenic determinant on the antigen that triggered its prodection
|
|
|
antibodies consists of
|
heavy (H) & light (L) chains & variable & constant portions
|
|
|
antibodies are grouped into 5 principal classes
|
based on chemistry & structure w/ specific biological roles; IgG, IgA, IgM, IgD & IgE
|
|
|
in a cell-mediated immune response
|
antigen is recognized (bound), a small # of specific T cells proliferate & differentiate into clone of effector cells & the antigen (intruder) is eliminated
|
|
|
clone of effector cells
|
a population of identical cells that can recognize the same antigen & carry out some aspect of immune attack
|
|
|
T cell receptors (TCRs)
|
recognize antigen fragments assocated w/ MHC molecules on the surface of a body cell
|
|
|
proliferation of T cells requires
|
co-stimulation by cytokines such as interleukin I & II (IL-1&2) or by pairs of plasma membrane molecules; one on surface of T cell & APC
|
|
|
helper T (Th) cells or T4 cells
|
display CD4 protein, recognizes antigen fragments associated w/ MHC-II molecules & secrete cytokines- interleukin-II
|
|
|
interleukin-II acts as
|
co-stimulator for tother helper T cells, cytotoxic T cells & B cells
|
|
|
cytotoxic T (Tc) cells or T8
|
develop from T cells that display CD8 protein & recognize antigen fragments associated w/ MHC-I molecules
|
|
|
delayed-type hypersensitivity T cells
|
produce cytokines & important in hypersensitivity (allergic) responses
|
|
|
suppressor T (Ts) cells
|
class of T cells distinct from Th & Tc cells; downregulate immune responses by producing cytokines; such as TGF beta- inhibits proliferation of B & T cells
|
|
|
memory T cells
|
programmed to recognize original invading antigen, allowing initiation of a much swifter reaction should a pathogen invade the body later
|
|
|
cytotoxic T cells
|
leave the lymphoid & migrate to site of invasion, infection or tumor formation; recognize & attach to target cell that bears same antigen as the one that stimulated their activation & proliferation
|
|
|
cytotoxic T cells then
|
eliminate invader cells by secreting perforin or lymphotoxin (LT); secrete gamma inferons- attracts neutrophils/macrophages & increases their phagocytic activity; detach from target cell & can seek out & destroy another invader that displays the same antigen
|
|
|
perforin
|
causes cytolysis
|
|
|
lymphotoxin (LT)
|
causes fragmentation of the DNA of a target cell
|
|
|
body contains
|
not only millions of different T cells but also millions of different B cells capable of responding to a specific antigen
|
|
|
whereas cytotoxic T cells leave lymphoid tissue to meet a foreign antigen
|
B cells stay put
|
|
|
in presence of foreign antigen
|
specific B cells in lymph nodes, spleen or lymphoid tissue in GI tract b/come activated
|
|
|
B cells differentiate into
|
plasma cells that secrete antibodies, which then circulate in lymph & blood to reach site of invasion
|
|
|
B cells respond to
|
unprocessed antigens, but response is more intense when dendritic cells present antigens to them
|
|
|
provides costimulation for proliferation of B cells
|
inerleukin-2 (IL-2) & other cytokines secreted by helper T cells
|
|
|
an activated B cell develops into
|
a clone of antibody-producing plasma cells; cells produce antibodies at an incredible rate of 2,000 molecules per sec per cell for 5 days until plasma cell dies
|
|
|
functions of antibodies (a)
|
neutralization of antigens by covering them w/ binding antibodies
|
|
|
functions of antibodies (b)
|
immobilization of bacteria via antibodies binding to cilia & flagella
|
|
|
functions of antibodies (c)
|
aggultination & precipitation occurs since antibodies have 2 binding bonding sites that aggregate antigens & this in turn causes them 2 b/come insoluble
|
|
|
functions of antibodies (d)
|
activation of complement thru CI proteins
|
|
|
functions of antibodies (e)
|
enhancement of phagocytosis by making antigens easier to engulf thru aggregation & precipitation
|
|
|
functions of antibodies (f)
|
provision of fetal & newborn immunity via placenta & breast milk
|
|
|
activated B cells that do not differentiate
|
into plasma cells remain as memory B cells & are ready to respond more rapidly & forcefully should same antigen appear again in future
|
|
|
monoclonal antibodies (Mabs) are
|
pure antibodies produced by fusing B cells w/ tumor cell that is capable of proliferating endlessly; called hybridoma
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monoclonal antibodies are important in
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measuring drug levels in blood, diagnosis of pregnancy, allergies, diseases (rabies & STDs); early detection of cancer & extent of metastasis; in preparing vaccines to counteract transplant rejection, autoimmune diseases & perhaps AIDS
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immunology memory is due to
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presense of long-lived antibodies & very long-lived lymphocytes that arise during proliferation & differentiation of antigen-stimulated B & T cells
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immunization against certain microbes is possible
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memory B cells & T cells remain after primary response to antigen
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secondary response (immunological memory)
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provides protection should same microbe enter the body again; rapid proliferation of memory cells, resulting in far greater antibody titer than during primary response
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antibody titer
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amt of antibody in serum
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positive & negative selection
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T cells undergo both to ensure they can recognize self-MHC antigens (self-recognition) & they do not react to other self-proteins (tolerance)
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negative selection
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involves both deletion & anergy
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B cells develop
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tolerance thru deletion & anergy
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when a normal cell transforms into a cancer cell
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it may display cell surface components called tumor antigens
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immunologic surveillance (immune response)
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if immune system can recognize tumor antigens as nonself, it can destroy cancer cells carrying them; carried out by cytotoxic T cells, macrophages & NK cells
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tumor immunotherapy
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inducing immune system to mount attack against cancer; b/coming viable means of treating cancer; forms- adoptive cellular immunology, cytokine & antibody therapy
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acquired immune deficiency syndrome (AIDS)
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lowers bodys immunity by decreasing # of helper T cell; result is progressive collapse of immune system, making one susceptible to opportunistic infections; caused by human immunodeficiency virus (HIV) a retrovirus
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autoimmune diseases (autoimmunity) result
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body does not recognize "self" antigens & produces antibodies against them
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human autoimmune diseases include
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rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), thyroiditis, rheumatic fever, glomerulonephritis, encephalomyelitis, hemolytic/pernicious anemias, addison's/graves' disease, diabetes mellitus (type I), myasthenia gravis & multiple sclerosis
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therapy for autoimmune diseases involves
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drugs to suppress immune response, leaving person prone to opportunistic infections; another treatment oral antigen therapy
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systemic lupus erythematosus (SLE or lupus)
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inflammatory disease of connective tissue in young women
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In SLE
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damage to BV walls results in release of chem that mediate inflammatory response; BV damage occurs in every body system
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symptoms of SLE
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painful joints, slight fever, fatigue, mouth ulcers, weight loss, enlarged lymph nodes & spleen, photosensitivity, rapid loss of large amts of hair & "butterfly rash" (across bridge of nose)
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chronic fatigue syndrome (CFS)
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affects young adults, females; extreme fatigue that impairs normal activities for at least 6 mo & absense of known disease w/ similar symptoms
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symptoms of CFS
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sore throat, headache, muscular aches, fever & chills, fatigue, joint pain, neuropsychological complaints, sleep disturbances & development of the intitial symptoms over few hours/days; cause is unknown
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severe combined immunodeficiency (SCID)
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rare diease in which both B & T cells are missing or are unable to provide immunity
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hypersensitivity (allergy)
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overreactivity to an antigen; localized anaphylactic reactions- hay fever, asthma, eczema & hives; acute anaphylaxis- severe reaction w/ systemic effects
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hypersensitivity
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whenever an allergic reaction occurs there is tissue injury; antigens that induce an allergic reaction are called allergens
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surgical & nonsurgical procedures for CAD
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coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), percutaneous balloon valvuloplasty, laser angioplasty, balloon-laser welding & catheter arthrectomy
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IgA
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secretions (tears, saliva), immunity to newborns
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IgD
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not a big time, a protein of B, helps in the activation of B cells
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IgM
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2nd most abundant, 1st antibody to be produced against disease; 1st responder; anti A & B
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IgG
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most abundant, involved in complement activity (killing & destroying), crosses placenta temporarily to provide immunity to the fetus; secondary responder; anti-Rh (D)
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IgE
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involved in inflammation, allergies, allergic responses
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active immunity
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inject ourselves w/disease, bacteria, virus, etc & we make antibodies against it; vaccine
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passive immunity
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we inject animals w/ disease. bacteria, virus, etc & then we extract antibodies
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antibodies to HIV are
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develop w/in 3 to 20 weeks; are not protective, but indicator of HIV (diagnosis)
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US gov definition of AIDS
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anyone infected w/HIV & having CD4 lymphocyte count under 200/mm of blood; normal is 1200/mm
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