Chapter III

Anatomy and Physiology

Cardiovascular system
The Heart
The Heart lies in the mediastinum, behind the body of the sternum. The shape of the
heart tends to resemble the chest. the heart has chambers divided into four cavities with the
right and left chambers(atria and the ventricles) separated by the septum.
The Blood Vessels
There are 3 types of blood vessels: the arteries, the veins and the capillaries. An artery
is a vessel that carries blood away from the heart. it carries oxygenated blood. Small arteries
are called arterioles. Veins, on the other hand are vessels that carries blood toward the heart. It
contains the deoxygenated blood. Small veins are called venules. Often, very large venous
spaces are called sinuses. Lastly, capillaries are microscopic vessels that carry blood from
small arteries to small veins(arterioles to venules) and back to the heart .
The walls of the blood vessels, the arteries and vein have three main layers: tunica
adventitia, tunica media and tunica intima. Tunica adventitia which is a fibrous type of vessel is
a connective tissue that helps hold vessels open and prevents tearing of the vessel wall during
body movement. tunica media is a smooth muscle, sandwiched together with a layer of elastic
connective tissue. It permits changes of the blood vessel diameter. it allows the constriction and
dilation of the vessels. Tunica intima is made up of endothelium that is continuous with the
endothelium that lines the heart. in arteries, it provides a smooth lining. however in veins it
maintains the one way flow of the blood . the endothelium, which makes up the thin coat of the
capillary, is important because the thinness of the capillary wall allows the exchange of
materials between the blood plasma and the interstitial fluid of the surrounding tissues.
There are two circulatory routes of blood as it flows through the blood vessels: the
systemic and the pulmonary circulation. in systemic circulation, blood flows from the left
ventricle of the heart through blood vessels to all parts of the body(except gas exchange tissues
of lungs) and back to the atrium. in pulmonary circulation on the other hand, venous blood
moves from the right atrium to right ventricle to pulmonary artery to lung arterioles and
capillaries where gases exchanged; oxygenated blood returns to the left atrium via pulmonary
veins; from left atrium, blood enters the left ventricle.



Vasomotor Control Mechanism
Blood distribution patterns, as well as BP can be influence by factors that control
changes in the diameter of arterioles. Such factor might be said to constitute the vasomotor
control mechanism. Like most physiological control mechanism, it consists of many parts. an
area in the medulla called vasomotor center/vasoconstrictor center will, when stimulated initiate
an impulse outflow via sympathetic fibers that ends in smooth muscle surrounding resistance
vessels, arterioles and veins of the blood reservior'' causing their constriction thus the
vasomotor control mechanism plays an important role both in the maintenance of the general
BP and in the distribution of blood to areas of special need.
Venous return of the blood
Venous return refers to the amount of blood that is returned to the heart by the way of
veins. various factors influence venous return, including the operation of venous pumps that
maintains the pressure gradients necessary to keep blood moving into the central veins and
from there the atria of the heart. Changes in the total volume of blood vessels can also alter the
venous return.
The return of venous blood to the heart can be influenced by the factors that change the
total volume of blood in the circulatory pathway. Stated simple, the more the total volume of
blood, the greater the volume of blood returned to the heart. The mechanism that change the
total blood volume most quickly, making them most useful in maintaining constancy of blood
flow, are those that cause water to quickly move into the plasma or out of the plasma. Most of
the mechanisms that accomplish such changes in plasma volume operate by altering the body's
retention of the water.
The primary mechanism for altering the water retention in the body-they are the
endocrine reflexes in the body. One is the ADH mechanism is released in the neurohypophysis
and acts on the kidneys in a way that reduces the amount if water lost by the body. ADH does
this by increasing the amount of water that kidney reabsorb from urine before the urine is
excreted from the body. The more ADH is secreted, the more water will be reabsorb into the
blood, and the greater the blood plasma volume will become.
Another mechanism that changes the blood plasma volume is the rennin angiotensin
mechanism of aldosterone secretion. Renin is an enzyme that is released when the blood
pressure in the kidney is low. renin triggers a series of events that leads to the secretion of
aldosteron. Aldosterone promotes sodium retention by the kidney, which in tum stimulates the
osmotic flow of water to the kidney tubules back into the blood plasma-but only when ADH is
present to permit the movement of water. Thus, low blood pressure increases the secretion of
aldosterone, which in tim stimulates the retention of water and thus an increase in blood
volume. Another effect of reninangiotensinis the vasoconstriction of blood vessels caused by an
intermediate compound called angiotensin II. This complements the volume-increasing effects
of the mechanism and thus also promotes an increase in overall blood flow. precision of blood
volume control contributes to the precision on controlling venous return, which in return yields to
the precise overall control of blood circulation.
Exocrine System
The exocrine system's main function is to regulate the volume and composition of body
fluids and excrete unwanted materials, but it is not the only system in the body that is able to
excrete unnecessary substances.

The kidneys resemble the lima beans in shape. the average-sized kidney measures
around 11cm by 7cm by 3cm. the left kidney is often larger than the right. The kidneys are
highly vascular organs. Approximately, one-fifth if the blood pumped from the heart goes to the
kidneys. The kidneys process blood plasma and form urine from waste to be excreted and
removed from the body. These functions are vital because they maintain the homeostatic
balance of the body. The kidneys maintain the fluid-electrolyte and acid-base balance. In
addition, they also influence the rate of secretion of the hormones ADH and aldosterone.
Microscopic functional units called nephrons make up the buld of the kidney. The
nephron is uniquely suited to its function of blood plasma processing and urine function. A
nephron contains certain structures in which fluids flows through them and they are as follows:
renal corpuscle, bowman's capsule, proximal convulted tubule, loop of henle, distal convoluted
tubule and the collecting tube. The bowman's capsule is a cup-shaped mouth of a nephron. it is
usually formed by two layers of epithelial cells. fluids, electrolytes and waste products that pass
through the porous glomerular capillaries and enter the space that constitute the glomerular
filtrate, which will be processed in the nephron to form urine.
The glomerulus is the body's well-known capillary network and is surely one of the most
important ones for survival. Glomerulus and bowman's capsule together are called renal
corpuscle. The permeability of the glomerular endothelium increases sufficiently to allow plasma
proteins to filter out into the capsule.
Endocrine System
The endocrine system performs their regulatory functions by means of chemical
messenger sent to specific cells. The endocrine system, secreting cells send hormones by way
of the bloodstream to signal specific target cells throughout the body. Hormones diffuse into the
blood to be carried to nearly every point in the body. The endocrine glands secrete their
products, hormones, directly into the blood. There are two classifications of hormones: steroid
hormones and non-steriod hormones. The steroid hormones which are manufactured by the
endocrine cells fro, cholesterol, is an important lipid in the human body. Non-steroid hormones
are synthesized primarily from amino acids rather from the cholesterol. Non-steroids hormones
are further subdivided in two: protein hormones and glycoprotein hormones.

Pathophysiology
Whereas all hypertensive disorders in pregnancy (pre-eclampsia, essential
hypertension, 'secondary' hypertension) share high blood pressure as a common theme (
probably mediated by inappropriate vasoconstriction), pre-eclampsia is the only disorder with
multisystem abnormalities.
The triad of physiological derangements in pre-eclampsia is:
1. Intense vasospasm
2. Local or disseminated intravascular coagulation
3. Plasma volume contraction
Although the cause of pre-ec is unknown the placenta appears to be the culprit-delivery
if the placenta is the only known cure and the disorder is more frequent with large placental
mass. Example: Twins or abnormal placenta. Current hypotheses propose release of a toxic
factor from the placenta which alters maternal endothelial cell function, though this is unproven.
Vasospasm follows due to excess production or sensitivity to vasoconstrictors
(angiotensin II, serotonin and endothelin are the most popular candidates) and decreased
production or sensitivity to vasodilators (prostacyclin and nitric oxide are the current
candidates).
Intravascular coagulation is associated with platelet activation, thrombocytopenia and often
reduced production of anti-thrombin III.
Plasma volume contraction follows vasospasm, capillary leakage and in more severe
cases, reduction in plasma osmotic pressures. There is redistribution of fluid from the
intravascular to interstitial fluid spaces so that total extra cellular fluid volume remains unaltered.
These are important considerations as intravascular volume correction may result in pulmonary
edema when capillary permeability is high and plasma osmotic pressure low.
The result if this triad of abnormal physiology is organ hypoperfusion.
System most commonly affected are the kidney ( manifested by reduced GFR,
proteinuria, hyperuricaemia and occasionally oliguria) the liver ( manifested by elevated
aspartate transaminase with or without epigastric and right upper quadrant pain), the
brain(manifested most commonly by transient visual scotomata due to occipital lobe ischemia,
severe headaches and rarely convulsions, ex. eclampsia) and the placenta(manifested by
intrauterine fetal growth retardation and less commonly placental abruption or fetal death in
utero). peripheral edema is common but is not a useful clinical sign; pulmonary edema is rare
and when it occurs usually teratogenic.