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Anatomy & Physiology

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What you will study

Anatomy and physiology topics for nursing students

This free module moves from core anatomy language and cell physiology into the major body systems nursing students use throughout health assessment, pathophysiology, pharmacology, and clinical reasoning.

Anatomy foundations

Learn anatomical position, directional terms, levels of organization, tissue types, and structure-function relationships.

Includes: anatomical position, directional terms, levels of organization, tissue types.

Cells, membranes, and homeostasis

Review cell membrane structure, passive and active transport, electrochemical gradients, cell signaling, and feedback mechanisms.

Includes: cell membrane, membrane transport, homeostasis, cell signaling.

Cardiovascular system

Study heart anatomy, chambers and valves, blood-flow sequence, the cardiac cycle, blood vessels, and cardiac output.

Includes: heart anatomy, blood flow, cardiac cycle, cardiac output.

Respiratory system

Follow the airway from the nasal cavity to the alveoli and connect ventilation mechanics with oxygen transport and gas exchange.

Includes: airway anatomy, ventilation, alveolar gas exchange, oxygen transport.

Nervous system

Learn neuron structure, action potentials, synaptic transmission, major nervous-system divisions, and autonomic regulation.

Includes: neurons, action potentials, synapses, autonomic nervous system.

Endocrine system

Connect hormone signaling, negative feedback, pituitary function, glucose regulation, stress hormones, and endocrine homeostasis.

Includes: hormone signaling, negative feedback, pituitary gland, insulin and glucose.

Renal and urinary system

Review kidney structure, nephron physiology, filtration, reabsorption, secretion, urine formation, and broader kidney functions.

Includes: kidney anatomy, nephron, filtration, urine formation.

Digestive system

Trace GI tract organs in sequence and compare mechanical digestion, chemical digestion, absorption, and digestive physiology.

Includes: GI tract, mechanical digestion, chemical digestion, absorption.

Musculoskeletal system

Study bone structure and types, joints, skeletal organization, muscle tissue, the neuromuscular junction, and sliding-filament contraction.

Includes: bones, joints, muscle tissue, sliding filament theory.

Integumentary system

Learn skin structure and protective functions, skin integrity, tissue repair, wound-healing phases, and fluid-assessment connections.

Includes: skin anatomy, skin integrity, wound healing, skin turgor.

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Anatomy & Physiology

Master the structure and function of the human body, from cells and tissues to organ systems, building the foundation for clinical nursing practice.

Visual learning

Anatomy visual catalog

Use body organization, planes, cavities, tissues, and organ systems as the starting map for every later clinical topic.

Cell

Basic living unit

Tissue

Specialized group

Organ

Integrated structure

System

Coordinated function

Body

Whole-person care

Concept
Visual cue
Clinical use
Sagittal
Left/right
Useful for midline and side-to-side location
Frontal
Front/back
Useful for anterior and posterior structures
Transverse
Top/bottom
Common CT or axial image orientation
  1. 1

    Cells form tissues

    Cell groups specialize into epithelial, connective, muscle, and nervous tissue.

  2. 2

    Tissues form organs

    Organs combine tissue types so structure and function work together.

  3. 3

    Organs form systems

    Systems coordinate functions such as oxygenation, movement, digestion, and regulation.

  4. 4

    Planes locate findings

    Sagittal, frontal, and transverse planes make imaging and documentation more precise.

  5. 5

    Cavities protect organs

    Thoracic, abdominal, pelvic, cranial, and spinal cavities organize clinical assessment.

Clinical connection

Anatomy lets learners describe where a finding is located, what structure is affected, and why a symptom appears.

Structural Organization

The human body is organized in a hierarchy of increasing complexity. Each level of organization builds upon the previous, with emergent properties at each stage that cannot be predicted from the level below alone.

Chemical

Atoms & molecules

→

Cellular

Basic unit of life

→

Tissue

Groups of cells

→

Organ

Multiple tissues

→

System

Organs working together

→

Organism

Complete human

Disease can originate at any level and cascade upward. A molecular mutation (chemical level) can impair cell function (cellular), damage tissue, compromise an organ, and ultimately affect the whole organism. Understanding this hierarchy helps you trace symptoms back to root causes.

All anatomical descriptions reference the anatomical position. Using standardized directional terms ensures clear communication among healthcare providers.

Paired Directional Terms

Superior/Inferior (above/below) • Anterior/Posterior (front/back) • Medial/Lateral (toward/away from midline) • Proximal/Distal (closer/farther from trunk) • Superficial/Deep (surface/internal)

Body Planes & Sections

Sagittal (left/right) • Frontal/Coronal (anterior/posterior) • Transverse/Horizontal (superior/inferior). CT scans typically show transverse sections; MRI can show any plane.

Precise anatomical language prevents medical errors. 'The wound is on the medial aspect of the right lower leg, 3 cm distal to the knee' is far more useful than 'the wound is on the inside of the leg near the knee.' Always use directional terms in documentation.

Homeostasis is the central organizing principle of physiology. Nearly every disease can be understood as a failure of homeostatic mechanisms.

Negative Feedback (Most Common)

Opposes the initial change, returning the variable toward the set point. Examples: thermoregulation, blood glucose regulation, blood pressure control via baroreceptors.

Positive Feedback (Rare)

Amplifies the initial change until a culminating event occurs. Examples: oxytocin during labor (contractions intensify until delivery), blood clotting cascade, fever in some contexts.

Every feedback loop has three components: (1) Receptor, detects the change (sensor), (2) Control Center, processes information and determines response (often the brain), (3) Effector, carries out the corrective action (muscle, gland). Failure at any component disrupts homeostasis.

The principle of complementarity of structure and function is fundamental, you can predict a structure's function by examining its anatomy, and vice versa.

Integumentary & SkeletalProtection, support, movement framework

Integumentary: skin, hair, nails, protection, thermoregulation, vitamin D synthesis. Skeletal: 206 bones, support, protection of organs, mineral storage, blood cell production (hematopoiesis).

Muscular & NervousMovement and control/communication

Muscular: skeletal, smooth, cardiac, movement, posture, heat production. Nervous: brain, spinal cord, nerves, rapid electrochemical communication, sensation, integration, motor control.

Endocrine & CardiovascularHormonal regulation and transport

Endocrine: glands secreting hormones, slow but prolonged chemical regulation. Cardiovascular: heart and blood vessels, transport oxygen, nutrients, wastes, hormones, and immune cells throughout the body.

Lymphatic, Respiratory & DigestiveImmunity, gas exchange, and nutrient processing

Lymphatic: lymph nodes, vessels, spleen, immunity and fluid recovery. Respiratory: lungs and airways, O2/CO2 exchange, pH regulation. Digestive: GI tract and accessory organs, nutrient breakdown, absorption, elimination.

Urinary & ReproductiveWaste removal and species continuation

Urinary: kidneys, ureters, bladder, fluid/electrolyte balance, waste excretion, blood pressure regulation. Reproductive: gonads and associated structures, gamete production, hormone secretion, fetal development.

Cells communicate via direct contact (gap junctions), chemical signals (hormones, neurotransmitters, paracrines), and electrical signals (neurons). Autocrine signals act on the same cell; paracrine signals act on nearby cells; endocrine signals travel via blood to distant targets. Understanding communication modes explains how drugs, diseases, and therapies work at the cellular level.

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Which level of structural organization involves groups of cells working together to perform a specific function?

Cell & Tissue Biology

The cell membrane (plasma membrane) is the gatekeeper of every cell, controlling substance movement and enabling cellular communication.

Phospholipid Bilayer

Hydrophilic heads face outward (toward water); hydrophobic tails face inward. This arrangement creates a selectively permeable barrier. Small nonpolar molecules (O2, CO2) pass freely; charged ions and large molecules cannot.

Membrane Proteins

Channel proteins (allow specific ions through), carrier proteins (transport molecules via conformational change), receptor proteins (receive chemical signals), and enzymes. These proteins make the membrane functional.

Cholesterol & Glycocalyx

Cholesterol stabilizes membrane fluidity across temperature changes. The glycocalyx (sugar coat) enables cell recognition, immune function, and protection. Blood type antigens are part of the glycocalyx on red blood cells.

Understanding membrane transport is critical for understanding IV fluid therapy, medication absorption, renal function, and electrolyte balance.

Simple DiffusionMovement of small nonpolar molecules down the concentration gradient

No energy or membrane proteins required. O2 and CO2 cross the membrane this way. The rate depends on concentration gradient, temperature, and molecular size. Gases exchange in the lungs and tissues via simple diffusion.

OsmosisWater movement through a semipermeable membrane

Water moves from areas of LOW solute concentration to HIGH solute concentration. This is why hypertonic IV solutions pull water out of cells (crenation) and hypotonic solutions push water into cells (potential lysis). Isotonic solutions (0.9% NaCl) cause no net water movement.

Facilitated DiffusionProtein-assisted passive transport

Large or charged molecules (glucose, ions) need channel or carrier proteins to cross. Still passive (no ATP), still follows the gradient. GLUT transporters move glucose into cells this way. Aquaporins are channel proteins for water.

Active Transport & Na+/K+ PumpATP-powered movement against the gradient

The Na+/K+ ATPase pumps 3 Na+ out and 2 K+ in per ATP. This maintains the electrochemical gradient essential for nerve impulses (-70mV resting potential), muscle contraction, and secondary active transport. Digoxin works by inhibiting this pump.

Vesicular TransportBulk transport via membrane-bound vesicles

Endocytosis brings material INTO the cell (phagocytosis = 'cell eating'; pinocytosis = 'cell drinking'). Exocytosis releases material OUT (neurotransmitter release, hormone secretion). Both require energy and membrane remodeling.

The electrochemical gradient combines the concentration gradient (chemical) with the electrical gradient (charge difference across the membrane). The Na+/K+ pump creates both: more Na+ outside (chemical) and net negative charge inside (electrical). This stored energy drives nerve impulses, muscle contraction, and secondary active transport (e.g., glucose co-transport in the intestine).

Cell signaling underlies pharmacology, drugs work by mimicking or blocking natural signaling molecules.

Receptor Types

Membrane receptors: G-protein coupled, ion channels, enzyme-linked. Intracellular receptors: for lipid-soluble hormones (steroids, thyroid hormone) that cross the membrane and bind DNA directly.

Signal Transduction

Ligand binds receptor → intracellular cascade → cellular response. Second messengers (cAMP, Ca2+) amplify the signal. One hormone molecule can trigger thousands of cellular reactions through signal amplification.

Agonists mimic the natural ligand and activate the receptor (e.g., albuterol mimics epinephrine at beta-2 receptors → bronchodilation). Antagonists block the receptor without activating it (e.g., propranolol blocks beta receptors → decreased heart rate). Understanding receptor pharmacology is the foundation of safe medication administration.

Epithelial TissueCovers surfaces, lines cavities, forms glands

Classified by layers (simple = one layer, stratified = multiple) and cell shape (squamous = flat, cuboidal = cube, columnar = column). Simple squamous lines alveoli and blood vessels (thin for diffusion). Stratified squamous covers skin (thick for protection). Pseudostratified ciliated columnar lines airways.

Connective TissueSupports, binds, and protects structures

Most abundant tissue type. Includes: loose CT (areolar, fills spaces), dense CT (tendons, ligaments), cartilage (hyaline, fibro, elastic), bone, blood, and adipose. All have cells embedded in an extracellular matrix. Connective tissue proper has fibroblasts producing collagen and elastin.

Muscle TissueGenerates force through contraction

Skeletal: voluntary, striated, multinucleated, moves the skeleton. Cardiac: involuntary, striated, branched with intercalated discs, pumps blood. Smooth: involuntary, non-striated, spindle-shaped, found in organ walls (blood vessels, GI tract, airways).

Nervous TissueGenerates and transmits electrical signals

Neurons: excitable cells that transmit electrical impulses via action potentials. Neuroglia (glial cells): support cells, astrocytes (blood-brain barrier), oligodendrocytes (CNS myelin), Schwann cells (PNS myelin), microglia (immune defense). Neurons are generally amitotic (don't divide), damage is often permanent.

Cells respond to stress through adaptive changes: Atrophy (decreased size, muscle wasting from disuse), Hypertrophy (increased size, cardiac enlargement from hypertension), Hyperplasia (increased number, endometrial thickening), Metaplasia (change in type, smoker's bronchial cells). If stress exceeds adaptive capacity, irreversible injury leads to necrosis (pathological death) or apoptosis (programmed death).

Match each transport type to its key characteristic

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A nurse hangs a 0.45% NaCl (hypotonic) IV solution. What will happen to the patient's red blood cells?

Integumentary System

The skin is the body's largest organ, comprising about 16% of body weight. It has three primary layers: epidermis, dermis, and the hypodermis.

Protection

Physical barrier against pathogens, chemicals, UV radiation. Acid mantle (pH 4-6) inhibits bacterial growth.

Thermoregulation

Dermal blood vessel dilation/constriction and sweat gland activation regulate body temperature under hypothalamic control.

Sensation & Synthesis

Rich nerve endings detect touch, pressure, temperature, pain. Vitamin D synthesis occurs when UV light hits the epidermis.

Skin integrity is a critical nursing assessment. Factors that compromise the skin barrier include age (thinner epidermis, less collagen), nutrition (protein/vitamin C deficiency impairs healing), moisture (incontinence-associated dermatitis), pressure (decubitus ulcers), and disease (diabetes impairs microcirculation).

Hemostasis (Immediate)Blood vessel spasm and clot formation

Vascular spasm reduces blood flow. Platelets aggregate and form a temporary plug. The coagulation cascade produces fibrin mesh that stabilizes the clot. This stops bleeding and provides a framework for repair.

Inflammatory Phase (Days 1-4)Immune response clears debris and fights infection

Neutrophils arrive first (within hours) to phagocytize bacteria and debris. Macrophages follow (24-48 hours), cleaning the wound and releasing growth factors. Cardinal signs: redness, heat, swelling, pain, these are NORMAL and necessary.

Proliferative Phase (Days 4-21)New tissue formation and wound closure

Fibroblasts produce collagen (granulation tissue, beefy red appearance). Angiogenesis creates new blood vessels. Epithelial cells migrate across the wound surface (epithelialization). The wound contracts as myofibroblasts pull edges together.

Maturation/Remodeling (21 days-2 years)Scar strengthening and reorganization

Collagen is reorganized and cross-linked for strength. The scar gradually strengthens but only reaches about 80% of original tissue strength. Excessive collagen → hypertrophic scar or keloid. This phase can last up to 2 years.

Skin turgor assesses hydration status. When skin is gently pinched and released, well-hydrated tissue returns immediately to its normal position. Tenting (skin remains raised) indicates dehydration, decreased interstitial fluid reduces skin elasticity. Assess on the sternum or inner forearm; elderly patients' decreased collagen makes extremity turgor unreliable. Insensible water loss through the skin is approximately 300-400 mL/day and increases dramatically with burns, fever, and low humidity.

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A nurse assesses a patient and finds decreased skin turgor. This finding most likely indicates:

Skeletal System

Bones are dynamic living tissue, not static structures. They are continuously remodeled throughout life, responding to mechanical stress, hormonal signals, and nutritional status.

Bone Cells

Osteoblasts BUILD bone (think 'B' for build). Osteoclasts BREAK DOWN bone (think 'C' for consume). Osteocytes are mature bone cells embedded in the matrix that sense mechanical stress and regulate remodeling.

Compact vs Spongy Bone

Compact (cortical) bone: dense outer layer, organized in osteons (Haversian systems). Spongy (cancellous) bone: inner lattice structure (trabeculae), lighter, contains red bone marrow for hematopoiesis in flat bones and epiphyses.

Bone Functions

Support and shape • Protection (skull protects brain, ribs protect heart/lungs) • Movement (muscle attachment) • Mineral storage (calcium, phosphorus) • Blood cell production (hematopoiesis) • Energy storage (yellow marrow = fat).

Calcium homeostasis involves a delicate balance between PTH and calcitonin, with bones serving as the body's calcium reservoir.

PTH (Raises Calcium)

Low Ca2+ → parathyroid glands release PTH → stimulates osteoclasts (bone resorption), increases renal Ca2+ reabsorption, activates vitamin D → calcium rises. Remember: PTH = 'Pulls calcium To High.'

Calcitonin (Lowers Calcium)

High Ca2+ → thyroid C-cells release calcitonin → inhibits osteoclasts, promotes calcium deposition in bone → calcium drops. Calcitonin 'tones down' calcium. Less clinically significant than PTH.

Long bones (femur, humerus), levers for movement. Short bones (carpals, tarsals), gliding movements. Flat bones (skull, sternum, pelvis), protection and hematopoiesis. Irregular bones (vertebrae, facial bones), complex shapes for specific functions. Sesamoid bones (patella), develop within tendons to reduce friction.

Joint Classification

Fibrous joints (synarthroses): immovable (skull sutures). Cartilaginous joints (amphiarthroses): slightly movable (intervertebral discs, pubic symphysis). Synovial joints (diarthroses): freely movable (knee, shoulder, hip), most clinically significant.

Synovial Joint Features

Joint cavity with synovial fluid (lubrication, nutrition). Articular cartilage (smooth, shock-absorbing). Joint capsule with ligaments (stability). Menisci and bursae provide additional support. Movements: flexion, extension, abduction, adduction, rotation, circumduction.

The axial skeleton (80 bones) forms the central axis: skull (22), hyoid (1), vertebral column (26), thoracic cage (25). It protects the brain, spinal cord, and thoracic organs. The appendicular skeleton (126 bones) includes the pectoral girdle, upper limbs, pelvic girdle, and lower limbs, designed for movement and manipulation. Total: 206 bones in the adult skeleton.

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Which cells are responsible for bone resorption (breaking down bone)?

Muscular System

All muscle tissue shares four key properties: excitability, contractility, extensibility, and elasticity. However, the three muscle types differ significantly in structure, control, and location.

Skeletal Muscle

Voluntary, striated, multinucleated. Attached to bones via tendons. Under conscious (somatic nervous system) control. Fast contraction but fatigues. Makes up ~40% of body weight.

Cardiac Muscle

Involuntary, striated, branched. Found ONLY in the heart. Intercalated discs allow synchronized contraction. Autorhythmic, generates its own electrical impulses. Highly resistant to fatigue.

Smooth Muscle

Involuntary, non-striated, spindle-shaped. Found in walls of hollow organs (blood vessels, GI tract, bladder, airways). Slow, sustained contractions. Controlled by ANS, hormones, and local factors.

Muscle contraction follows the sliding filament theory, which begins with a signal at the neuromuscular junction.

Neuromuscular Junction (NMJ)

Motor neuron releases ACh → ACh binds nicotinic receptors on muscle fiber → depolarization → action potential propagates along sarcolemma and into T-tubules → Ca2+ released from sarcoplasmic reticulum → contraction begins.

Contraction Cycle

Ca2+ binds troponin → tropomyosin shifts → actin binding sites exposed → myosin cross-bridge forms → power stroke (pulls actin) → ATP binds myosin (detachment) → cycle repeats. Ca2+ removal → relaxation.

Isotonic contractions: muscle length changes (concentric = shortening, eccentric = lengthening under tension). Isometric contractions: muscle generates force without length change (holding a heavy object). Muscle fatigue occurs from ATP depletion, lactic acid accumulation, electrolyte imbalances (K+, Ca2+, Na+), and CNS fatigue. Creatine phosphate provides immediate ATP for the first 10-15 seconds of intense activity, then aerobic and anaerobic pathways take over.

1/3

The sliding filament theory describes muscle contraction as:

Nervous System

Neurons are the functional units of the nervous system, specialized for rapid electrochemical communication.

Neuron Anatomy

Cell body (soma): contains nucleus and organelles. Dendrites: receive incoming signals (input). Axon: conducts action potentials away from soma (output). Myelin sheath: insulating lipid layer that speeds conduction (saltatory conduction between nodes of Ranvier).

Resting Membrane Potential (-70mV)

At rest, the neuron interior is negative relative to outside. Maintained by: Na+/K+ pump (3 Na+ out, 2 K+ in), K+ leak channels (K+ diffuses out), and large intracellular anions. This 'charged' state is the potential energy for signaling.

1. Resting StateNeuron at -70mV, Na+ channels closed

The membrane is polarized at -70mV. Voltage-gated Na+ and K+ channels are closed. The Na+/K+ pump maintains ion gradients. The neuron is ready to fire but needs sufficient stimulation to reach threshold.

2. DepolarizationNa+ rushes in, membrane reaches +30mV

When a stimulus reaches threshold (-55mV), voltage-gated Na+ channels open rapidly. Na+ floods into the cell, driving the membrane potential from -70mV to about +30mV. This is an 'all-or-nothing' event, once threshold is reached, the full action potential fires.

3. RepolarizationK+ rushes out, membrane returns toward negative

Na+ channels inactivate. Voltage-gated K+ channels open (they're slower). K+ flows OUT of the cell, restoring the negative interior. The membrane potential drops back toward -70mV.

4. Hyperpolarization & RecoveryBrief overshoot below -70mV, then restoration

K+ channels close slowly, so the membrane briefly overshoots to about -80mV (hyperpolarization). The Na+/K+ pump then restores normal ion distribution. The absolute refractory period (during repolarization) prevents backward impulse propagation.

When an action potential reaches the axon terminal: (1) voltage-gated Ca2+ channels open, (2) Ca2+ influx triggers vesicle fusion with the membrane, (3) neurotransmitters are released into the synaptic cleft (exocytosis), (4) neurotransmitters bind postsynaptic receptors, (5) excitatory or inhibitory response generated. The signal is terminated by reuptake, enzymatic breakdown, or diffusion. Most psychiatric and neurological drugs target these synaptic mechanisms.

CNS (Brain & Spinal Cord)

Integration and command center. Protected by meninges, CSF, and bone. Processes sensory input, initiates motor output, and manages higher functions (thought, memory, emotion). Damage is often permanent due to limited regeneration.

PNS (Nerves & Ganglia)

Communication lines between CNS and body. Sensory (afferent) division: carries signals TO the CNS. Motor (efferent) division: carries signals FROM the CNS. Includes somatic (voluntary) and autonomic (involuntary) subdivisions.

Sympathetic NS ('Fight or Flight')

Thoracolumbar origin. Releases norepinephrine. Effects: ↑HR, ↑BP, bronchodilation, pupil dilation, ↑blood glucose, blood shunted to muscles, ↓GI motility. Prepares body for emergency action.

Parasympathetic NS ('Rest & Digest')

Craniosacral origin. Releases acetylcholine. Effects: ↓HR, ↓BP, bronchoconstriction, pupil constriction, ↑GI motility/secretion, promotes digestion. Dominates during rest and recovery.

Acetylcholine (ACh): muscle contraction, parasympathetic effects, memory. Norepinephrine: sympathetic 'fight or flight,' alertness. Dopamine: reward, movement (Parkinson's = dopamine deficiency). Serotonin: mood, sleep, appetite (many antidepressants target serotonin). GABA: main inhibitory NT (benzodiazepines enhance GABA). Glutamate: main excitatory NT. Endorphins: natural pain relief. Understanding these helps you predict drug effects and side effects.

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During an action potential, the rapid depolarization phase is caused by:

Endocrine System

The endocrine system uses hormones for slower but longer-lasting communication compared to the nervous system.

Water-Soluble Hormones

Peptides and proteins (insulin, ADH, oxytocin). Cannot cross cell membranes. Bind surface receptors → second messenger cascade (cAMP). Fast onset, short duration. Cannot be taken orally (digested).

Lipid-Soluble Hormones

Steroids (cortisol, estrogen, testosterone) and thyroid hormones. Cross membranes freely. Bind intracellular/nuclear receptors → alter gene expression. Slow onset, long duration. Many can be taken orally.

Rising hormone levels inhibit further release. Example: Thyroid axis, Hypothalamus releases TRH → Anterior pituitary releases TSH → Thyroid releases T3/T4 → Rising T3/T4 levels inhibit TRH and TSH release (negative feedback). In hypothyroidism, low T3/T4 means TSH is HIGH (no feedback inhibition). In hyperthyroidism, high T3/T4 means TSH is LOW (strong feedback inhibition). This logic applies to most endocrine axes.

The pituitary gland is controlled by the hypothalamus and regulates thyroid, adrenals, gonads, growth, and more.

Anterior Pituitary Hormones

GH (growth), TSH (thyroid), ACTH (adrenals/cortisol), FSH & LH (gonads), Prolactin (milk production). Mnemonic: FLAT PiG, FSH, LH, ACTH, TSH, Prolactin, GH.

Posterior Pituitary Hormones

ADH (antidiuretic hormone): promotes water reabsorption in kidneys, low ADH → diabetes insipidus (dilute urine). Oxytocin: stimulates uterine contractions and milk let-down. Both made in hypothalamus, stored in posterior pituitary.

Insulin & Glucagon

Insulin (beta cells): released when glucose HIGH → moves glucose INTO cells, lowers blood sugar. Glucagon (alpha cells): released when glucose LOW → stimulates glycogenolysis and gluconeogenesis, raises blood sugar. They work as antagonistic partners to maintain glucose 70-100 mg/dL.

Stress Response Hormones

Acute stress: Adrenal medulla releases epinephrine/norepinephrine (catecholamines) → rapid fight-or-flight response. Chronic stress: HPA axis activates → hypothalamus (CRH) → anterior pituitary (ACTH) → adrenal cortex (cortisol) → elevated glucose, suppressed immunity, protein breakdown.

Chronic cortisol elevation (Cushing syndrome): hyperglycemia, immunosuppression, muscle wasting, central obesity, moon face, thin skin, osteoporosis, poor wound healing. Cortisol deficiency (Addison disease): hypoglycemia, hypotension, hyperkalemia, hyponatremia, hyperpigmentation, fatigue. Exogenous corticosteroids (prednisone) mimic cortisol, never stop abruptly (adrenal suppression → adrenal crisis).

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The primary mechanism for controlling most hormone levels in the body is:

Cardiovascular System

The heart is a muscular pump approximately the size of a fist, located in the mediastinum of the thoracic cavity. It has four chambers that work in coordinated pairs to maintain two distinct circulatory loops.

Right Side (Pulmonary Circuit)

Right atrium receives deoxygenated blood from the body via the superior and inferior venae cavae. Blood flows through the tricuspid valve into the right ventricle, then is pumped through the pulmonary semilunar valve into the pulmonary trunk and arteries to the lungs for gas exchange.

Left Side (Systemic Circuit)

The left atrium receives oxygenated blood from the lungs via four pulmonary veins. Blood flows through the bicuspid (mitral) valve into the left ventricle, the most muscular chamber, then is ejected through the aortic semilunar valve into the aorta to supply the entire body.

Step 1: Venous ReturnVenae cavae → Right atrium → Tricuspid valve → Right ventricle

Deoxygenated blood from the systemic circuit returns to the right atrium via the superior vena cava (upper body) and inferior vena cava (lower body), then passes through the tricuspid (right atrioventricular) valve into the right ventricle.

Step 2: Pulmonary CircuitRight ventricle → Pulmonary valve → Pulmonary arteries → Lungs

The right ventricle contracts, closing the tricuspid valve and opening the pulmonary semilunar valve. Blood is pumped into the pulmonary trunk, which splits into left and right pulmonary arteries carrying deoxygenated blood to the lungs for gas exchange.

Step 3: Pulmonary ReturnPulmonary veins → Left atrium → Mitral valve → Left ventricle

Oxygenated blood returns from the lungs via four pulmonary veins into the left atrium, then flows through the bicuspid (mitral) valve into the left ventricle, the thickest, most muscular chamber.

Step 4: Systemic CircuitLeft ventricle → Aortic valve → Aorta → Body → Venae cavae

The left ventricle contracts powerfully, ejecting oxygenated blood through the aortic semilunar valve into the aorta for distribution to all body tissues. After gas exchange at tissue capillaries, deoxygenated blood returns via venules and veins to the venae cavae, completing the circuit.

The left ventricle wall is approximately 3x thicker than the right because it must generate enough pressure to pump blood through the entire systemic circuit. The coronary arteries (right and left) branch from the base of the aorta and supply the myocardium itself with oxygenated blood. The septum separates left and right sides, preventing mixing of oxygenated and deoxygenated blood.

The cardiac cycle includes all events from one heartbeat to the next. The heart's intrinsic conduction system coordinates the rhythmic contractions without requiring external neural input.

Systole (Contraction)

Atrial systole: atria contract, pushing remaining blood into ventricles. Ventricular systole: ventricles contract, AV valves close (S1 “lub”), semilunar valves open, blood ejected into pulmonary trunk and aorta.

Diastole (Relaxation)

Ventricles relax, semilunar valves close (S2 “dub”), AV valves open. Passive ventricular filling occurs (~70% of filling). The heart spends more time in diastole than systole. Coronary perfusion occurs primarily during diastole.

Conduction System

SA node (pacemaker, 60-100 bpm) → AV node (delay) → Bundle of His → right and left bundle branches → Purkinje fibers → ventricular contraction. This intrinsic system allows the heart to beat independently.

Arteries

Carry blood AWAY from the heart. Thick, muscular, elastic walls withstand high pressure. Arteries branch into smaller arterioles, which regulate blood flow to capillary beds via vasoconstriction/vasodilation.

Capillaries

Microscopic vessels with walls only one endothelial cell thick. This is where exchange occurs: O₂ and nutrients diffuse to tissues; CO₂ and wastes diffuse into blood. Connect arterioles to venules.

Veins

Carry blood TOWARD the heart. Thinner walls, lower pressure, larger lumens than arteries. Many contain one-way valves to prevent backflow. Venous return aided by skeletal muscle pump and respiratory pump.

Cardiac output (CO) = Heart Rate (HR) × Stroke Volume (SV). Normal resting CO is approximately 5 L/min. Stroke volume is the amount of blood ejected per beat (~70 mL). CO can increase 4-5x during vigorous exercise through increased HR and SV. Blood pressure = CO × peripheral resistance.

Respiratory System

The respiratory system is divided into the upper respiratory tract and the lower respiratory tract.

TracheaC-shaped cartilage rings maintain patency

The trachea is lined with pseudostratified ciliated columnar epithelium (mucociliary escalator) that traps and propels inhaled particles upward. C-shaped hyaline cartilage rings keep the airway open while the posterior trachealis muscle allows esophageal expansion during swallowing.

BronchiProgressive branching with decreasing cartilage

Primary (main) bronchi enter each lung at the hilum. They subdivide into secondary (lobar) bronchi (3 right, 2 left, matching lung lobes), then tertiary (segmental) bronchi. As airways branch, cartilage decreases and smooth muscle increases, allowing autonomic control of airway diameter.

BronchiolesNo cartilage; smooth muscle controls diameter

Bronchioles lack cartilage entirely and rely on smooth muscle for structural support and diameter regulation. Terminal bronchioles are the smallest conducting airways. The conducting zone (nose through terminal bronchioles) warms, humidifies, and filters air but performs no gas exchange, this is anatomical dead space (~150 mL).

Respiratory ZoneRespiratory bronchioles → Alveolar ducts → Alveoli

The respiratory zone begins at respiratory bronchioles, which have scattered alveoli budding from their walls. These lead to alveolar ducts and alveolar sacs. An estimated 300 million alveoli provide ~70 m² of surface area for gas exchange, roughly the size of a tennis court.

Alveolar Structure

Type I pneumocytes: thin squamous cells forming the gas exchange surface. Type II pneumocytes: secrete pulmonary surfactant, which reduces surface tension and prevents alveolar collapse (atelectasis). Alveolar macrophages: phagocytize inhaled particles and pathogens.

Gas Exchange (External Respiration)

O₂ diffuses from alveoli (high PO₂) into pulmonary capillary blood (low PO₂). CO₂ diffuses from blood (high PCO₂) into alveoli (low PCO₂). Diffusion occurs across the respiratory membrane: alveolar epithelium + shared basement membrane + capillary endothelium (~0.5 μm total thickness).

Inspiration is an ACTIVE process: the diaphragm contracts and flattens, external intercostals elevate the ribs, thoracic volume increases, intrapulmonary pressure drops below atmospheric pressure, and air flows IN (Boyle's law). Quiet expiration is PASSIVE: the diaphragm and intercostals relax, elastic recoil of lungs decreases thoracic volume, intrapulmonary pressure rises above atmospheric pressure, and air flows OUT. Forced expiration recruits internal intercostals and abdominal muscles.

~98.5% of O₂ is transported bound to hemoglobin (as oxyhemoglobin, HbO₂) within red blood cells. ~1.5% is dissolved in plasma. Each hemoglobin molecule can carry up to 4 O₂ molecules. CO₂ transport: ~70% as bicarbonate (HCO₃⁻) in plasma, ~23% bound to hemoglobin (carbaminohemoglobin), ~7% dissolved in plasma.

Digestive System

The gastrointestinal (GI) tract is a continuous muscular tube approximately 9 meters long, extending from the mouth to the anus. The wall of the GI tract has four basic layers: mucosa, submucosa, muscularis externa (smooth muscle for peristalsis), and serosa (outermost protective layer).

Mouth (Oral Cavity)Mechanical and initial chemical digestion begins

Mastication (chewing) physically breaks food into smaller pieces. Salivary glands secrete saliva containing salivary amylase (begins starch digestion) and lingual lipase (begins fat digestion). The tongue mixes food with saliva to form a bolus for swallowing.

Pharynx & EsophagusSwallowing propels bolus via peristalsis

The pharynx connects the oral cavity to the esophagus. Swallowing (deglutition) is coordinated by the swallowing center in the medulla. The epiglottis covers the larynx to prevent aspiration. The esophagus uses peristalsis to move the bolus to the stomach. The lower esophageal sphincter (cardiac sphincter) prevents reflux.

StomachChurning and chemical digestion produce chyme

The stomach churns food and mixes it with gastric juice. Parietal cells secrete HCl (denatures proteins, activates pepsinogen, kills bacteria) and intrinsic factor (essential for vitamin B12 absorption in the ileum). Chief cells secrete pepsinogen, activated to pepsin by HCl. The resulting acidic mixture is called chyme.

Small IntestinePrimary site of chemical digestion and nutrient absorption

Duodenum: receives bile (from liver/gallbladder via common bile duct) and pancreatic juice (from pancreas via pancreatic duct). Most chemical digestion is completed here. Jejunum: primary site of nutrient absorption. Ileum: absorbs vitamin B12 and bile salts. Villi and microvilli create an enormous absorptive surface area.

Large IntestineWater absorption, microbiota, feces formation

The large intestine (cecum → ascending colon → transverse colon → descending colon → sigmoid colon → rectum → anal canal) absorbs water and electrolytes from remaining indigestible material. It houses trillions of gut microbiota that synthesize vitamin K and some B vitamins. Feces are formed, stored in the rectum, and eliminated via defecation.

Liver

Largest internal organ. Produces bile (emulsifies fats for digestion). Metabolizes nutrients absorbed from the GI tract (via hepatic portal vein). Detoxifies substances, synthesizes plasma proteins (albumin, clotting factors), stores glycogen, and produces urea from ammonia.

Pancreas

Dual function organ. Exocrine: secretes pancreatic juice into the duodenum containing digestive enzymes (pancreatic amylase, lipase, trypsinogen, chymotrypsinogen) and bicarbonate (neutralizes gastric acid). Endocrine: islets of Langerhans produce insulin (beta cells) and glucagon (alpha cells).

Gallbladder

Stores and concentrates bile produced by the liver. When fat enters the duodenum, cholecystokinin (CCK) is released, stimulating the gallbladder to contract and release bile through the common bile duct into the duodenum for fat emulsification.

Mechanical digestion physically breaks food into smaller pieces without altering chemical composition, includes mastication (chewing), churning in the stomach, and segmentation in the small intestine. Chemical digestion uses enzymes and other chemicals to break covalent bonds in macromolecules: amylase breaks starch into maltose, pepsin/trypsin break proteins into peptides, lipase breaks triglycerides into fatty acids and monoglycerides, and brush border enzymes complete final digestion at the intestinal wall.

Urinary System

The urinary system consists of two kidneys, two ureters, the urinary bladder, and the urethra. The kidneys are retroperitoneal organs located against the posterior abdominal wall. Each kidney has an outer renal cortex and an inner renal medulla.

Glomerular FiltrationBlood pressure forces plasma components into Bowman's capsule

Hydrostatic pressure in the glomerular capillaries forces water, electrolytes, glucose, amino acids, and waste products through the filtration membrane (fenestrated endothelium, basement membrane, podocyte filtration slits) into Bowman's capsule. ~180 L of filtrate is produced daily; only ~1-2 L becomes urine. Normal GFR ≈ 125 mL/min. Blood cells and most proteins are too large to be filtered.

Tubular ReabsorptionEssential substances reclaimed from filtrate back into blood

The proximal convoluted tubule (PCT) reclaims ~65% of filtered water, nearly all glucose and amino acids, and most Na+, Cl⁻, K+, and HCO₃⁻ via active transport, cotransport, and osmosis. The descending limb of the loop of Henle is permeable to water (water reabsorbed). The ascending limb actively pumps out Na+/Cl⁻ (creating the medullary concentration gradient). The DCT and collecting duct perform hormonally regulated fine-tuning (ADH, aldosterone).

Tubular SecretionUnwanted substances moved from blood into tubular fluid

Substances are actively transported FROM peritubular capillary blood INTO the tubular fluid for elimination. Key substances secreted include H+ ions (critical for acid-base balance), K+ (regulated by aldosterone), NH₄+, certain drugs (penicillin, aspirin metabolites), and creatinine. Secretion is essentially the reverse of reabsorption and provides an additional mechanism for removing wastes and regulating blood composition.

Nephron Components

Glomerulus (capillary tuft enclosed by Bowman's capsule) → Proximal convoluted tubule (PCT) → Descending limb of loop of Henle (permeable to water) → Ascending limb (impermeable to water, actively transports Na+/Cl−) → Distal convoluted tubule (DCT) → Collecting duct → Renal pelvis.

Hormonal Regulation

ADH (from posterior pituitary): increases water reabsorption in collecting ducts, concentrating urine. Aldosterone (from adrenal cortex): increases Na+ reabsorption and K+ secretion in DCT/collecting duct. ANP (from heart atria): promotes Na+ and water excretion, lowering blood volume. Renin-angiotensin-aldosterone system (RAAS): activated by low blood pressure to retain Na+ and water.

The kidneys do far more than produce urine. They regulate blood volume and pressure (RAAS, ADH), maintain electrolyte balance (Na+, K+, Ca²+, phosphate), regulate acid-base balance (H+ secretion, HCO₃⁻ reabsorption), produce erythropoietin (EPO, stimulates red blood cell production), activate vitamin D (calcitriol, for calcium absorption), and perform gluconeogenesis during prolonged fasting.

Body Systems Review

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Blood returning from the body enters the heart through the:

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Reproductive System

Female Reproductive Anatomy and Physiology

External and internal anatomy, menstrual cycle, oogenesis, and clinical relevance

The female reproductive system produces oocytes, facilitates fertilization, and supports fetal development. It is also a major endocrine system, with estrogen and progesterone governing the menstrual cycle and supporting pregnancy.

External Anatomy

Vulva includes: mons pubis, labia majora (outer folds, adipose and sebaceous glands), labia minora (inner folds, highly vascular), clitoris (erectile tissue, rich nerve supply), vestibule (space enclosed by labia minora containing vaginal orifice and urethral meatus), and Bartholin glands (lubrication during arousal).

Internal Anatomy \u2014 Vagina and Cervix

Vagina: fibromuscular canal (pH 3.5\u20134.5, maintained by Lactobacillus producing lactic acid \u2014 prevents infection). Cervix: lower uterine segment with internal and external os. transformation zone (squamocolumnar junction) is sampled during Pap smears.

Uterus and Fallopian Tubes

Uterus: fundus (top), body, isthmus, cervix. Three layers: endometrium (shed in menstruation), myometrium (smooth muscle \u2014 oxytocin target), perimetrium (outer serous layer). Normal position: anteflexed. Fallopian tubes: isthmus \u2192 ampulla \u2192 infundibulum \u2192 fimbriae. Fertilization normally occurs in the ampulla.

Ovaries

Paired gonads: cortex contains follicles at various stages (primordial \u2192 primary \u2192 secondary \u2192 Graafian). Medulla contains blood vessels. Oogenesis: primary oocytes formed before birth, arrested in prophase I of meiosis. At puberty, one follicle per cycle completes meiosis I. Meiosis II completed only at fertilization.

Menstrual Cycle Phases (28-Day Average)

Follicular / Proliferative Phase (Days 1–14)FSH rises → follicle development → estrogen rises → LH surge

FSH from the anterior pituitary stimulates several follicles to develop in the ovarian cortex. The dominant follicle produces rising estrogen, which proliferates the endometrium (rebuilding after menstruation). High estrogen triggers the LH surge around Day 14. Simultaneously, the endometrium thickens from ~1 mm to ~10 mm. Day 1 of the cycle = first day of menstrual bleeding.

Ovulation (Day 14)LH surge → dominant follicle ruptures → oocyte released

The LH surge (~36 hours before ovulation) triggers final maturation of the dominant follicle and its rupture, releasing the secondary oocyte (arrested in metaphase II). Fimbriae sweep the oocyte into the fallopian tube. Mittelschmerz (mid-cycle pelvic pain) may occur from follicular rupture and peritoneal irritation. Ovulation = the most fertile point of the cycle.

Luteal / Secretory Phase (Days 15–28)Corpus luteum → progesterone dominant → endometrium prepares for implantation

The ruptured follicle transforms into the corpus luteum, which secretes progesterone (dominant) and estrogen. Progesterone converts the endometrium to a secretory state — rich in glycogen, highly vascular — ready for implantation. If fertilization occurs, hCG from the trophoblast maintains the corpus luteum. If not, the corpus luteum degenerates (~Day 24), progesterone and estrogen fall, and menstruation begins.

Menstruation (Days 1–5)Progesterone withdrawal → spiral artery spasm → endometrial shedding

Falling progesterone causes spiral arteries in the functional layer to spasm, cutting off blood supply. The ischemic endometrium sheds, producing menstrual flow (blood + endometrial tissue + mucus). Normal duration: 3–7 days; volume: 30–80 mL. PGF2α (prostaglandin) drives uterine contractions — responsible for dysmenorrhea. NSAIDs are first-line treatment (inhibit prostaglandin synthesis).

Hormonal Regulation Summary

GnRH (hypothalamus) \u2192 FSH + LH (anterior pituitary) \u2192 estrogen + progesterone (ovaries). Negative feedback: rising estrogen and progesterone suppress GnRH/FSH/LH. Exception: just before ovulation, high estrogen switches to positive feedback \u2192 triggers the LH surge. This is the only positive feedback loop in the menstrual cycle.

Clinical Relevance

Endometriosis: ectopic endometrial tissue (ovaries, peritoneum) responds to cyclic hormones \u2192 pain, adhesions, infertility. PID: ascending infection (vagina \u2192 cervix \u2192 uterus \u2192 tubes) \u2192 tubal scarring \u2192 infertility, ectopic risk. Ectopic pregnancy: implantation in fallopian tube \u2192 rupture = life-threatening emergency (hypotension, peritoneal signs). PCOS: elevated androgens, anovulation, insulin resistance, irregular cycles.

Female Reproductive System Check

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Fertilization of the oocyte most commonly occurs in which structure?

Male Reproductive Anatomy and Spermatogenesis

Testicular anatomy, accessory glands, spermatogenesis, and hormonal regulation

The male reproductive system produces spermatozoa and delivers them via a series of ducts and glands. Unlike oogenesis, spermatogenesis is continuous from puberty and produces millions of gametes daily. The process requires a temperature 2\u00b0C below core body temperature, which is why the scrotum keeps testes outside the body cavity.

Testes \u2014 Internal Structure

seminiferous tubules (spermatogenesis site) \u2192 epididymis (sperm maturation, 20-day transit). Interstitial Leydig cells produce testosterone (LH-stimulated). Sertoli cells (FSH-stimulated): nurse cells, blood-testis barrier, inhibin production.

Duct System and Accessory Glands

Epididymis \u2192 vas deferens \u2192 ejaculatory duct \u2192 urethra. seminal vesicles (60% semen \u2014 fructose). prostate gland (30% semen \u2014 zinc, citric acid, PSA). Bulbourethral (Cowper) glands: pre-ejaculatory fluid, neutralizes urethral acidity. Penis: glans, corpus cavernosum \u00d72 (erectile tissue, flanking), corpus spongiosum (urethra runs through).

Spermatogenesis \u2014 Step by Step

Spermatogonia (Diploid Stem Cells)Mitotic divisions maintain stem cell pool and produce committed cells

Type A spermatogonia divide mitotically, maintaining the stem cell population throughout life. Type B spermatogonia commit to differentiation, becoming primary spermatocytes. Unlike females (who have a fixed oocyte supply), males continuously produce new spermatogonia from puberty onward.

Primary Spermatocytes → Meiosis IFirst meiotic division produces secondary spermatocytes

Primary spermatocytes (diploid, 2n) undergo meiosis I (reductive division), producing two secondary spermatocytes (haploid, 1n — each with duplicated DNA). This is the longest phase of spermatogenesis. Crossing over during prophase I creates genetic diversity.

Secondary Spermatocytes → Meiosis IISecond meiotic division produces spermatids

Each secondary spermatocyte undergoes meiosis II, producing two spermatids (haploid, 1n). Four spermatids are produced from each primary spermatocyte. Spermatids are round, immobile — not yet functional sperm. Sertoli cells provide glucose, growth factors, and structural support throughout.

Spermiogenesis — Spermatid MaturationSpermatids differentiate into spermatozoa over ~74 days total

Spermatids undergo extensive morphological transformation: acrosome forms from Golgi (contains digestive enzymes for egg penetration), nucleus condenses, midpiece develops mitochondria (ATP for motility), flagellum forms from centriole. Total time from spermatogonium to spermatozoon: ~74 days. Sperm then transit the epididymis for ~20 days to acquire motility and fertilizing capacity.

Hormonal Regulation

GnRH \u2192 LH (stimulates Leydig cells \u2192 testosterone) + FSH (stimulates Sertoli cells \u2192 spermatogenesis support). Testosterone \u2192 negative feedback \u2192 \u2193GnRH/LH. Inhibin (from Sertoli cells) \u2192 negative feedback \u2192 \u2193FSH specifically. This dual feedback allows fine-tuned control of sperm production. Anabolic steroid abuse mimics testosterone \u2192 suppresses LH \u2192 Leydig cells atrophy \u2192 testicular shrinkage and infertility.

Clinical Relevance

BPH: prostate enlarges with age \u2192 urethral obstruction \u2192 urinary retention, nocturia, weak stream. Tx: \u03b1-blockers (relax smooth muscle), 5\u03b1-reductase inhibitors (\u2193DHT). Prostate cancer: most common cancer in men; PSA screening, DRE exam. Testicular torsion: absent cremasteric reflex, 6-hour surgical window. Varicocele: dilated pampiniform venous plexus \u2192 \u2191scrotal temp \u2192 impaired spermatogenesis \u2192 male factor infertility.

Spermatogenesis \u2014 Key Facts

Spermatogenesis is continuous from puberty throughout life (unlike oogenesis). The sequence: Spermatogonia (diploid stem cells) → Primary spermatocytes (meiosis I) → Secondary spermatocytes (meiosis II) → Spermatids (haploid) → Spermiogenesis (maturation) → Spermatozoa. Takes ~74 days. Temperature-sensitive: cryptorchidism (undescended testes) causes infertility because spermatogenesis requires 2°C below core body temperature. Testosterone from Leydig cells drives the process; FSH targets Sertoli cells (nurse cells) to support sperm development.

Reproductive Hormonal Axis \u2014 Nursing Connections

The hypothalamic-pituitary-gonadal (HPG) axis controls reproduction in both sexes. GnRH (hypothalamus) → FSH + LH (anterior pituitary) → sex hormones (gonads). Contraception works by disrupting this axis: combined OCP (estrogen + progestin) suppress GnRH/LH/FSH, preventing ovulation. Progestin-only pills primarily thicken cervical mucus. IUDs work locally. Understanding the axis explains infertility workups: high FSH with low estrogen = ovarian insufficiency; low FSH + low LH + low estrogen = hypothalamic cause. Endocrine disruptors (BPA, phthalates) mimic or block sex hormones, raising reproductive and developmental health concerns.

Male Reproductive System Check

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Testosterone is produced by which testicular cells?