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HUMAN BODY

The study of the human body involves anatomy, physiology, histology and embryology.

The human body is composed of elements including hydrogen, carbon, oxygen and phosphorous.

The main electrolytes in body water outside cells are sodium and chloride, whereas within cells it
is potassium and other phosphates

The body is also host to about the same number of non-human cells[5] as well as multicellular
organisms which reside in the gastrointestinal tract(is an organsystem within humans and
other animals which takes in food, digests it to extract and absorb energy and nutrients, and expels
the remaining waste as feces. The mouth, esophagus, stomach and intestines are part of the
gastrointestinal tract) and on the skin.

Cells sit in an extracellular matrix(is a three-dimensional network of extracellular macromolecules,


such as collagen, enzymes, and glycoproteins, that provide structural and biochemical support of
surrounding cella) that consists of proteins such as collagen, surrounded by extracellular fluids.

Cells in the body function because of DNA. DNA sits within the nucleus of a cell. Here, parts of DNA
are copied and sent to the body of the cell via RNA. The RNA is then used to create proteins which
form the basis for cells, their activity, and their products. Proteins dictate cell function and gene
expression, a cell is able to self-regulate by the amount of proteins produced. However, not all cells
have DNA – some cells such as mature red blood cells lose their nucleus as they mature.

The body consists of four main types of tissues – lining cells (epithelia), connective tissue, nervous
tissue and muscle tissue.

Cells that lie on surfaces exposed to the outside world or gastrointestinal tract (epithelia) or internal
cavities (endothelium) come in numerous shapes and forms – from single layers of flat cells, to cells
with small beating hair-like cilia in the lungs, to column-like cells that line the stomach. Endothelial
cells are cells that line internal cavities including blood vessels and glands. Lining cells regulate what
can and can't pass through them, protect internal structures, and function as sensory surfaces.

Ribonucleic acid (RNA) is a polymeric molecule essential in various biological roles


in coding, decoding, regulation and expression of genes. RNA and DNA are nucleic acids, and,
along with lipids, proteins and carbohydrates, constitute the four major macromolecules essential for
all known forms of life.

Many viruses encode their genetic information using an RNA genome.

protein synthesis, a universal function in which RNA molecules direct the assembly of proteins
on ribosomes. This process uses transfer RNA (tRNA) molecules to deliver amino acids to the
ribosome, where ribosomal RNA (rRNA) then links amino acids together to form proteins.

The human musculoskeletal system (also known as the locomotor system,)is an organ
system that gives humans the ability to move using their muscular and skeletal systems.

It is made up of the bones of the skeleton, muscles, cartilage,[2] tendons, ligaments, joints, and
other connective tissuethat supports and binds tissues and organs together.
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The skeletal portion of the system serves as the main storage system
for calcium and phosphorus and contains critical components of the hematopoietic system( is the
formation of bloodcellular components. All cellular blood components are derived
from haematopoietic stem cells.)

The human skeleton is the internal framework of the body. It is composed of around 270 bones at
birth – this total decreases to around 206 bones by adulthood after some bones get fused together.

The human skeleton can be divided into the axial skeleton and the appendicular skeleton. The axial
skeleton is formed by the vertebral column, the rib cage, the skull and other associated bones. The
appendicular skeleton, which is attached to the axial skeleton, is formed by the shoulder girdle,
the pelvic girdle and the bones of the upper and lower limbs.

The human skeleton performs six major functions; support, movement, protection, production
of blood cells, storage of minerals, and endocrine regulation.

The human female pelvis is also different from that of males in order to facilitate childbirth.[2] Unlike
most primates, human males do not have penile bones

The axial skeleton (80 bones) is formed by the vertebral column (32–34 bones; the number of the
vertebrae differs from human to human as the lower 2 parts, sacral and coccygeal bone may vary in
length), a part of the rib cage (12 pairs of ribs and the sternum), and the skull (22 bones and 7
associated bones).

The upright posture of humans is maintained by the axial skeleton, which transmits the weight from
the head, the trunk, and the upper extremities down to the lower extremities at the hip joints. The
bones of the spine are supported by many ligaments. The erector spinae muscles are also
supporting and are useful for balance.

The appendicular skeleton (126 bones) is formed by the pectoral girdles, the upper limbs, the pelvic
girdle or pelvis, and the lower limbs. Their functions are to make locomotion possible and to protect
the major organs of digestion, excretion and reproduction.

The skeleton helps to protect our many vital internal organs from being damaged.

 The skull protects the brain


 The vertebrae protect the spinal cord.
 The rib cage, spine, and sternum protect the lungs, heart and major blood vessels.

The skeleton is the site of haematopoiesis, the development of blood cells that takes place in
the bone marrow. In children, haematopoiesis occurs primarily in the marrow of the long bones such
as the femur and tibia. In adults, it occurs mainly in the pelvis, cranium, vertebrae, and sternum.

The bone matrix can store calcium and is involved in calcium metabolism, and bone marrow can
store iron in ferritin and is involved in iron metabolism. However, bones are not entirely made of
calcium, but a mixture of chondroitin sulfate and hydroxyapatite, the latter making up 70% of a bone.

Bone cells release a hormone called osteocalcin, which contributes to the regulation of blood
sugar (glucose) and fat deposition. Osteocalcin increases both the insulinsecretion and sensitivity, in
addition to boosting the number of insulin-producing cells and reducing stores of fat
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scoliosis, a side-to-side curve in the back or spine, often creating a pronounced "C" or "S" shape
when viewed on an x-ray of the spine.

Arthritis is a disorder of the joints.

Osteoporosis is a disease of bone where there is reduced bone mineral density, increasing the
likelihood of fractures.

Paleoanthropology-----the study of early humans.

Muscle cells contain protein filaments of actin and myosin that slide past one another, producing
a contraction that changes both the length and the shape of the cell.

Muscle tissues are derived from the mesodermal layer of embryonic germ cells in a process known
as myogenesis.

There are three types of muscle, skeletal or striated, cardiac, and smooth.

Muscles are predominantly powered by the oxidation of fats and carbohydrates,


but anaerobic chemical reactions are also used, particularly by fast twitch fibers. These chemical
reactions produce adenosine triphosphate (ATP) molecules that are used to power the movement of
the myosin heads.

Skeletal muscle or "voluntary muscle" is anchored by tendons to bone and is used to


effect skeletal movement such as locomotion and in maintaining posture.

Smooth muscle or "involuntary muscle" is found within the walls of organs and structures such as
the esophagus, stomach, intestines, bronchi, uterus, urethra, bladder, blood vessels, and
the arrector pili in the skin (in which it controls erection of body hair). Unlike skeletal muscle, smooth
muscle is not under conscious control.

Cardiac muscle (myocardium), is also an "involuntary muscle" but is more akin in structure to
skeletal muscle, and is found only in the heart.

Skeletal (voluntary) muscle is further divided into two broad types: slow twitch and fast twitch:

 Type I, slow twitch, or "red" muscle, is dense with capillaries and is rich
in mitochondria and myoglobin, giving the muscle tissue its characteristic red color. It can carry
more oxygen and sustain aerobic activity using fats or carbohydrates as fuel.[6]Slow twitch fibers
contract for long periods of time but with little force.
 Type II, fast twitch muscle, has three major subtypes (IIa, IIx, and IIb) that vary in both
contractile speed[7] and force generated.[6] Fast twitch fibers contract quickly and powerfully but
fatigue very rapidly, sustaining only short, anaerobic bursts of activity before muscle contraction
becomes painful. They contribute most to muscle strength and have greater potential for
increase in mass. Type IIb is anaerobic, glycolytic, "white" muscle that is least dense in
mitochondria and myoglobin. In small animals (e.g., rodents) this is the major fast muscle type,
explaining the pale color of their flesh..

Skeletal muscles are sheathed by a tough layer of connective tissue called the epimysium.

A tendon is a tough, flexible band of fibrous connective tissue that connects muscles to bones.
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A ligament is a small band of dense, white, fibrous elastic tissue.[7] Ligaments connect the ends of
bones together in order to form a joint.

A bursa is a small fluid-filled sac made of white fibrous tissue and lined with synovial membrane.
Bursa may also be formed by a synovial membrane that extends outside of the joint capsule.

Examples of MSDs include carpal tunnel syndrome, epicondylitis, tendinitis, back pain, tension neck
syndrome, and hand-arm vibration syndrome.

The human digestive system consists of the gastrointestinal tract plus the accessory organs of
digestion (the tongue, salivary glands, pancreas, liver, and gallbladder). Digestion involves the
breakdown of food into smaller and smaller components, until they can be absorbed and assimilated
into the body. The process of digestion has many stages. The first stage is the cephalic phase of
digestion which begins with gastric secretions in response to the sight and smell of food. The next
stage starts in the mouth.

Chewing, in which food is mixed with saliva, begins the mechanical process of digestion. This
produces a bolus which can be swallowed down the esophagus to enter the stomach. Here it is
mixed with gastric acid until it passes into the duodenum where it is mixed with a number
of enzymes produced by the pancreas. Saliva also contains a catalytic enzyme
called amylase which starts to act on food in the mouth. Another digestive enzyme called lingual
lipase is secreted by some of the lingual papillae on the tongue and also from serous glands in the
main salivary glands. Digestion is helped by the chewing of food carried out by the muscles of
mastication, by the teeth, and also by the contractions of peristalsis, and segmentation. Gastric acid,
and the production of mucus in the stomach, are essential for the continuation of digestion.

Peristalsis is the rhythmic contraction of muscles that begins in the esophagus and continues along
the wall of the stomach and the rest of the gastrointestinal tract. This initially results in the production
of chyme which when fully broken down in the small intestine is absorbed as chyle into the lymphatic
system. Most of the digestion of food takes place in the small intestine. Water and
some minerals are reabsorbed back into the blood in the colon of the large intestine. The waste
products of digestion (feces) are defecated from the anus via the rectum.

There are several organs and other components involved in the digestion of food. The organs
known as the accessory digestive glands are the liver, gall bladder and pancreas. Other
components include the mouth, salivary glands, tongue, teethand epiglottis.

The largest structure of the digestive system is the gastrointestinal tract (GI tract). This starts at the
mouth and ends at the anus, covering a distance of about nine (9) metres.

The largest part of the GI tract is the colon or large intestine. Water is absorbed here and the
remaining waste matter is stored prior to defecation.

Most of the digestion of food takes place in the small intestine.

A major digestive organ is the stomach. Within its mucosa are millions of embedded gastric glands.
Their secretions are vital to the functioning of the organ.

There are many specialised cells of the GI tract. These include the various cells of the gastric
glands, taste cells, pancreatic duct cells, enterocytes and microfold cells.
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Some parts of the digestive system are also part of the excretory system, including the large
intestine.

The mouth is the first part of the upper gastrointestinal tract and is equipped with several structures
that begin the first processes of digestion.[3] These include salivary glands, teeth and the tongue. The
mouth consists of two regions; the vestibule and the oral cavity proper. The vestibule is the area
between the teeth, lips and cheeks,[4]and the rest is the oral cavity proper. Most of the oral cavity is
lined with oral mucosa, a mucous membrane that produces a lubricating mucus, of which only a
small amount is needed. Mucous membranes vary in structure in the different regions of the body
but they all produce a lubricating mucus, which is either secreted by surface cells or more usually by
underlying glands. The mucous membrane in the mouth continues as the thin mucosa which lines
the bases of the teeth. The main component of mucus is a glycoprotein called mucin and the type
secreted varies according to the region involved. Mucin is viscous, clear, and clinging. Underlying
the mucous membrane in the mouth is a thin layer of smooth muscle tissue and the loose
connection to the membrane gives it its great elasticity.[5] It covers the cheeks, inner surfaces of
the lips, and floor of the mouth.

The roof of the mouth is termed the palate and it separates the oral cavity from the nasal cavity. The
palate is hard at the front of the mouth since the overlying mucosa is covering a plate of bone; it is
softer and more pliable at the back being made of muscle and connective tissue, and it can move to
swallow food and liquids. The soft palate ends at the uvula.[7] The surface of the hard palate allows
for the pressure needed in eating food, to leave the nasal passage clear.[8] The lips are the mouth's
front boundary and the fauces (the passageway between the tonsils, also called the throat), mark its
posterior boundary.

At either side of the soft palate are the palatoglossus muscles which also reach into regions of the
tongue. These muscles raise the back of the tongue and also close both sides of the fauces to
enable food to be swallowed.[6]:1208 Mucus helps in the mastication of food in its ability to soften and
collect the food in the formation of the bolus..

The main glands are all exocrine glands, secreting via ducts. All of these glands terminate in the
mouth. The largest of these are the parotid glands—their secretion is mainly serous. The next pair
are underneath the jaw, the submandibular glands, these produce both serous fluid and mucus. The
serous fluid is produced by serous glands in these salivary glands which also produce lingual lipase

The third pair are the sublingual glandslocated underneath the tongue and their secretion is mainly
mucous with a small percentage of saliva.

Within the oral mucosa, and also on the tongue, palates, and floor of the mouth, are the minor
salivary glands; their secretions are mainly mucous and they are innervated by the facial
nerve (CN7).[10] The glands also secrete amylase a first stage in the breakdown of food acting on the
carbohydrate in the food to transform the starch content into maltose. There are other glands on the
surface of the tongue that encircle taste buds on the back part of the tongue and these also produce
lingual lipase. Lipase is a digestive enzyme that catalyses the hydrolysis of lipids (fats). These
glands are termed Von Ebner's glands which have also been shown to have another function in the
secretion of histatins which offer an early defense (outside of the immune system) against microbes
in food, when it makes contact with these glands on the tongue tissue.[9][11] Sensory information can
stimulate the secretion of saliva providing the necessary fluid for the tongue to work with and also to
ease swallowing of the food.

Saliva moistens and softens food, and along with the chewing action of the teeth, transforms the
food into a smooth bolus. The bolus is further helped by the lubrication provided by the saliva in its
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passage from the mouth into the esophagus. Also of importance is the presence in saliva of the
digestive enzymes amylase and lipase. Amylase starts to work on the starch in carbohydrates,
breaking it down into the simple sugars of maltose and dextrose that can be further broken down in
the small intestine. Saliva in the mouth can account for 30% of this initial starch digestion. Lipase
starts to work on breaking down fats. Lipase is further produced in the pancreaswhere it is released
to continue this digestion of fats. The presence of salivary lipase is of prime importance in young
babies whose pancreatic lipase has yet to be developed
As well as its role in supplying digestive enzymes, saliva has a cleansing action for the teeth and
mouth.[13] It also has an immunological role in supplying antibodies to the system, such
as immunoglobulin A.[14] This is seen to be key in preventing infections of the salivary glands,
importantly that of parotitis.

Saliva also contains a glycoprotein called haptocorrin which is a binding protein to vitamin B12.[15] It
binds with the vitamin in order to carry it safely through the acidic content of the stomach. When it
reaches the duodenum, pancreatic enzymes break down the glycoprotein and free the vitamin which
then binds with intrinsic factor.

Food enters the mouth where the first stage in the digestive process takes place, with the action of
the tongue and the secretion of saliva. The tongue is a fleshy and muscular sensory organ, and the
very first sensory information is received via the taste buds in the papillae on its surface. If the taste
is agreeable, the tongue will go into action, manipulating the food in the mouth which stimulates the
secretion of saliva from the salivary glands. The liquid quality of the saliva will help in the softening
of the food and its enzyme content will start to break down the food whilst it is still in the mouth. The
first part of the food to be broken down is the starch of carbohydrates (by the enzyme amylase in the
saliva).

The tongue is attached to the floor of the mouth by a ligamentous band called the frenum[5] and this
gives it great mobility for the manipulation of food (and speech); the range of manipulation is
optimally controlled by the action of several muscles and limited in its external range by the stretch
of the frenum. The tongue's two sets of muscles, are four intrinsic muscles that originate in the
tongue and are involved with its shaping, and four extrinsic muscles originating in bone that are
involved with its movement.

Taste is a form of chemoreception that takes place in the specialised taste receptors, contained in
structures called taste budsin the mouth. Taste buds are mainly on the upper surface (dorsum) of
the tongue. The function of taste perception is vital to help prevent harmful or rotten foods from
being consumed. There are also taste buds on the epiglottis and upper part of the esophagus. The
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taste buds are innervated by a branch of the facial nerve the chorda tympani, and
the glossopharyngeal nerve. Taste messages are sent via these cranial nerves to the brain. The
brain can distinguish between the chemical qualities of the food. The five basic tastes are referred to
as those of saltiness, sourness, bitterness, sweetness, and umami. The detection of saltiness and
sourness enables the control of salt and acid balance. The detection of bitterness warns of
poisons—many of a plant's defences are of poisonous compounds that are bitter. Sweetness guides
to those foods that will supply energy; the initial breakdown of the energy-giving carbohydrates by
salivary amylase creates the taste of sweetness since simple sugars are the first result. The taste of
umami is thought to signal protein-rich food. Sour tastes are acidic which is often found in bad food.
The brain has to decide very quickly whether the food should be eaten or not. It was the findings in
1991, describing the first olfactory receptors that helped to prompt the research into taste. The
olfactory receptors are located on cell surfaces in the nose which bind to chemicals enabling the
detection of smells. It is assumed that signals from taste receptors work together with those from the
nose, to form an idea of complex food flavours.

Teeth are complex structures made of materials specific to them. They are made of a bone-like
material called dentin, which is covered by the hardest tissue in the body—enamel.[8] Teeth have
different shapes to deal with different aspects of mastication employed in tearing and chewing
pieces of food into smaller and smaller pieces. This results in a much larger surface area for the
action of digestive enzymes. The teeth are named after their particular roles in the process of
mastication—incisors are used for cutting or biting off pieces of food; canines, are used for
tearing, premolars and molars are used for chewing and grinding. Mastication of the food with the
help of saliva and mucus results in the formation of a soft bolus which can then be swallowed to
make its way down the upper gastrointestinal tract to the stomach.[17] The digestive enzymes in
saliva also help in keeping the teeth clean by breaking down any lodged food particles

The epiglottis is a flap of elastic cartilage attached to the entrance of the larynx. It is covered with a
mucous membrane and there are taste buds on its lingual surface which faces into the mouth.[19] Its
laryngeal surface faces into the larynx. The epiglottis functions to guard the entrance of the glottis,
the opening between the vocal folds. It is normally pointed upward during breathing with its
underside functioning as part of the pharynx, but during swallowing, the epiglottis folds down to a
more horizontal position, with its upper side functioning as part of the pharynx. In this manner it
prevents food from going into the trachea and instead directs it to the esophagus, which is behind.
During swallowing, the backward motion of the tongue forces the epiglottis over the glottis' opening
to prevent any food that is being swallowed from entering the larynx which leads to the lungs; the
larynx is also pulled upwards to assist this process. Stimulation of the larynx by ingested matter
produces a strong cough reflex in order to protect the lungs.

The pharynx is a part of the conducting zone of the respiratory system and also a part of the
digestive system. It is the part of the throat immediately behind the nasal cavity at the back of the
mouth and above the esophagus and larynx. The pharynx is made up of three parts. The lower two
parts—the oropharynx and the laryngopharynx are involved in the digestive system. The
laryngopharynx connects to the esophagus and it serves as a passageway for both air and food. Air
enters the larynx anteriorly but anything swallowed has priority and the passage of air is temporarily
blocked. The pharynx is innervated by the pharyngeal plexus of the vagus nerve.[6]:1465 Muscles in the
pharynx push the food into the esophagus. The pharynx joins the esophagus at the oesophageal
inlet which is located behind the cricoid cartilage.

The esophagus, commonly known as the foodpipe or gullet, consists of a muscular tube through
which food passes from the pharynx to the stomach. The esophagus is continuous with the
laryngopharynx. It passes through the posterior mediastinum in the thorax and enters
the stomach through a hole in the thoracic diaphragm—the esophageal hiatus, at the level of the
tenth thoracic vertebra (T10). Its length averages 25 cm, varying with height. It is divided into
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cervical, thoracic and abdominalparts. The pharynx joins the esophagus at the esophageal inlet
which is behind the cricoid cartilage.

The esophagus, commonly known as the foodpipe or gullet, consists of a muscular tube through
which food passes from the pharynx to the stomach. The esophagus is continuous with the
laryngopharynx. It passes through the posterior mediastinum in the thorax and enters
the stomach through a hole in the thoracic diaphragm—the esophageal hiatus, at the level of the
tenth thoracic vertebra (T10). Its length averages 25 cm, varying with height. It is divided into
cervical, thoracic and abdominalparts. The pharynx joins the esophagus at the esophageal inlet
which is behind the cricoid cartilage.

Once in the esophagus, the bolus travels down to the stomach via rhythmic contraction and
relaxation of muscles known as peristalsis. The lower esophageal sphincter is a muscular sphincter
surrounding the lower part of the esophagus. The junction between the esophagus and the stomach
(the gastroesophageal junction) is controlled by the lower esophageal sphincter, which remains
constricted at all times other than during swallowing and vomiting to prevent the contents of the
stomach from entering the esophagus. As the esophagus does not have the same protection from
acid as the stomach, any failure of this sphincter can lead to heartburn. The esophagus has a
mucous membrane of epithelium which has a protective function as well as providing a smooth
surface for the passage of food. Due to the high volume of food that is passed over time, this
membrane is continuously renewed

The diaphragm is an important part of the body's digestive system. The muscular diaphragm
separates the thoracic cavity from the abdominal cavity where most of the digestive organs are
located. The suspensory muscle attaches the ascending duodenum to the diaphragm. This muscle
is thought to be of help in the digestive system in that its attachment offers a wider angle to
the duodenojejunal flexure for the easier passage of digesting material. The diaphragm also
attaches to, and anchors the liver at its bare area. The esophagus enters the abdomen through
a hole in the diaphragm at the level of T10.
The stomach is a major organ of the gastrointestinal tract and digestive system. It is a consistently J-
shaped organ joined to the esophagus at its upper end and to the duodenum at its lower
end. Gastric acid (informally gastric juice), produced in the stomach plays a vital role in the digestive
process, and mainly contains hydrochloric acid and sodium chloride. A peptide hormone, gastrin,
produced by G cells in the gastric glands, stimulates the production of gastric juice which activates
the digestive enzymes. Pepsinogen is a precursor enzyme (zymogen) produced by the gastric chief
cells, and gastric acid activates this to the enzyme pepsin which begins the digestion of proteins. As
these two chemicals would damage the stomach wall, mucus is secreted by innumerable gastric
glands in the stomach, to provide a slimy protective layer against the damaging effects of the
chemicals on the inner layers of the stomach.
At the same time that protein is being digested, mechanical churning occurs through the action
of peristalsis, waves of muscular contractions that move along the stomach wall. This allows the
mass of food to further mix with the digestive enzymes. Gastric lipase secreted by the chief cells in
the fundic glands in the gastric mucosa of the stomach, is an acidic lipase, in contrast with the
alkaline pancreatic lipase. This breaks down fats to some degree though is not as efficient as the
pancreatic lipase.
The pylorus, the lowest section of the stomach which attaches to the duodenum via the pyloric
canal, contains countless glands which secrete digestive enzymes including gastrin. After an hour or
two, a thick semi-liquid called chyme is produced. When the pyloric sphincter, or valve opens, chyme
enters the duodenum where it mixes further with digestive enzymes from the pancreas, and then
passes through the small intestine, where digestion continues. When the chyme is fully digested, it is
absorbed into the blood. 95% of absorption of nutrients occurs in the small intestine. Water and
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minerals are reabsorbed back into the blood in the colon of the large intestine, where the
environment is slightly acidic. Some vitamins, such as biotinand vitamin K produced by bacteria in
the gut flora of the colon are also absorbed.
The parietal cells in the fundus of the stomach, produce a glycoprotein called intrinsic factor which is
essential for the absorption of vitamin B12. Vitamin B12 (cobalamin), is carried to, and through the
stomach, bound to a glycoprotein secreted by the salivary glands - transcobalamin I also
called haptocorrin, which protects the acid-sensitive vitamin from the acidic stomach contents. Once
in the more neutral duodenum, pancreatic enzymes break down the protective glycoprotein. The
freed vitamin B12 then binds to intrinsic factor which is then absorbed by the enterocytes in the
ileum.
The stomach is a distensible organ and can normally expand to hold about one litre of food.[20] This
expansion is enabled by a series of gastric folds in the inner walls of the stomach. The stomach of a
newborn baby will only be able to expand to retain about 30 ml

The spleen breaks down both red and white blood cells that are spent. This is why it is sometimes
known as the 'graveyard of red blood cells'. A product of this digestionis the pigment bilirubin, which
is sent to the liver and secreted in the bile. Another product is iron, which is used in the formation of
new blood cells in the bone marrow.[5]Medicine treats the spleen solely as belonging to the lymphatic
system, though it is acknowledged that the full range of its important functions is not yet understood.

The liver is the second largest organ (after the skin) and is an accessory digestive gland which plays
a role in the body's metabolism. The liver has many functions some of which are important to
digestion. The liver can detoxify various metabolites; synthesise proteins and
produce biochemicals needed for digestion. It regulates the storage of glycogen which it can form
from glucose (glycogenesis). The liver can also synthesise glucose from certain amino acids. Its
digestive functions are largely involved with the breaking down of carbohydrates. It also maintains
protein metabolism in its synthesis and degradation. In lipidmetabolism it
synthesises cholesterol. Fats are also produced in the process of lipogenesis. The liver synthesises
the bulk of lipoproteins. The liver is located in the upper right quadrant of the abdomen and below
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the diaphragm to which it is attached at one part, This is to the right of the stomach and it overlies
the gall bladder. The liver produces bile, an important alkaline compound which aids digestion.

Bile produced by the liver is made up of water (97%), bile salts, mucus and pigments, 1% fats and
inorganic salts.[21] Bilirubin is its major pigment. Bile acts partly as a surfactant which lowers the
surface tension between either two liquids or a solid and a liquid and helps to emulsify the fats in
the chyme. Food fat is dispersed by the action of bile into smaller units called micelles. The breaking
down into micelles creates a much larger surface area for the pancreatic enzyme, lipase to work on.
Lipase digests the triglycerides which are broken down into two fatty acids and a monoglyceride.
These are then absorbed by villi on the intestinal wall. If fats are not absorbed in this way in the
small intestine problems can arise later in the large intestine which is not equipped to absorb fats.
Bile also helps in the absorption of vitamin K from the diet. Bile is collected and delivered through
the common hepatic duct. This duct joins with the cystic duct to connect in a common bile duct with
the gallbladder. Bile is stored in the gallbladder for release when food is discharged into the
duodenum and also after a few hours.

The gallbladder is a hollow part of the biliary tract that sits just beneath the liver, with the gallbladder
body resting in a small depression.[23] It is a small organ where the bile produced by the liver is
stored, before being released into the small intestine. Bile flows from the liver through the bile
ducts and into the gall bladder for storage. The bile is released in response to cholecystokinin (CCK)
a peptide hormone released from the duodenum. The production of CCK (by endocrine cells of the
duodenum) is stimulated by the presence of fat in the duodenum.

It is divided into three sections, a fundus, body and neck. The neck tapers and connects to the biliary
tract via the cystic duct, which then joins the common hepatic ductto form the common bile duct. At
this junction is a mucosal fold called Hartmann's pouch, where gallstones commonly get stuck.
The muscular layer of the body is of smooth muscle tissue that helps the gallbladder contract, so
that it can discharge its bile into the bile duct. The gallbladder needs to store bile in a natural, semi-
liquid form at all times. Hydrogen ions secreted from the inner lining of the gallbladder keep the bile
acidic enough to prevent hardening. To dilute the bile, water and electrolytes from the digestion
system are added. Also, salts attach themselves to cholesterol molecules in the bile to keep them
from crystallising. If there is too much cholesterol or bilirubin in the bile, or if the gallbladder doesn't
empty properly the systems can fail. This is how gallstones form when a small piece of calcium gets
coated with either cholesterol or bilirubin and the bile crystallises and forms a gallstone. The main
purpose of the gallbladder is to store and release bile, or gall. Bile is released into the small intestine
in order to help in the digestion of fats by breaking down larger molecules into smaller ones. After
the fat is absorbed, the bile is also absorbed and transported back to the liver for reuse

The pancreas is a major organ functioning as an accessory digestive gland in the digestive system.
It is both an endocrine gland and an exocrine gland.[25] The endocrine part secretes insulin when
the blood sugar becomes high; insulin moves glucose from the blood into the muscles and other
tissues for use as energy. The endocrine part releases glucagon when the blood sugar is low;
glucagon allows stored sugar to be broken down into glucose by the liver in order to re-balance the
sugar levels. The pancreas produces and releases important digestive enzymes in the pancreatic
juice that it delivers to the duodenum. The pancreas lies below and at the back of the stomach. It
connects to the duodenum via the pancreatic duct which it joins near to the bile duct's connection
where both the bile and pancreatic juice can act on the chyme that is released from the stomach into
the duodenum. Aqueous pancreatic secretions from pancreatic duct cells contain bicarbonate ions
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which are alkaline and help with the bile to neutralise the acidic chyme that is churned out by the
stomach.
The pancreas is also the main source of enzymes for the digestion of fats and proteins. Some of
these are released in response to the production of CKK in the duodenum. (The enzymes that digest
polysaccharides, by contrast, are primarily produced by the walls of the intestines.) The cells are
filled with secretory granules containing the precursor digestive enzymes. The major proteases, the
pancreatic enzymes which work on proteins, are trypsinogen and chymotrypsinogen. Elastase is
also produced. Smaller amounts of lipase and amylase are secreted. The pancreas also
secretes phospholipase A2, lysophospholipase, and cholesterol esterase. The precursor zymogens,
are inactive variants of the enzymes; which avoids the onset of pancreatitis caused by
autodegradation. Once released in the intestine, the enzyme enteropeptidase present in the
intestinal mucosa activates trypsinogen by cleaving it to form trypsin; further cleavage results in
chymotripsin.
The lower gastrointestinal tract (GI), includes the small intestine and all of the large intestine.[26] The
intestine is also called the bowel or the gut. The lower GI starts at the pyloric sphincter of the
stomach and finishes at the anus. The small intestine is subdivided into the duodenum,
the jejunum and the ileum. The cecum marks the division between the small and large intestine. The
large intestine includes the rectum and anal canal.

Partially digested food starts to arrive in the small intestine as semi-liquid chyme, one hour after it is
eaten. After two hours the stomach has emptied.
In the small intestine, the pH becomes crucial; it needs to be finely balanced in order to activate
digestive enzymes. The chyme is very acidic, with a low pH, having been released from the stomach
and needs to be made much more alkaline. This is achieved in the duodenum by the addition of bile
from the gall bladder combined with the bicarbonate secretions from the pancreatic duct and also
from secretions of bicarbonate-rich mucus from duodenal glands known as Brunner's glands. The
chyme arrives in the intestines having been released from the stomach through the opening of
the pyloric sphincter. The resulting alkaline fluid mix neutralises the gastric acid which would
damage the lining of the intestine. The mucus component lubricates the walls of the intestine.
When the digested food particles are reduced enough in size and composition, they can be
absorbed by the intestinal wall and carried to the bloodstream. The first receptacle for this chyme is
the duodenal bulb. From here it passes into the first of the three sections of the small intestine, the
duodenum. (The next section is the jejunum and the third is the ileum). The duodenum is the first
and shortest section of the small intestine. It is a hollow, jointed C-shaped tube connecting the
stomach to the jejunum. It starts at the duodenal bulb and ends at the suspensory muscle of
duodenum. The attachment of the suspensory muscle to the diaphragm is thought to help the
passage of food by making a wider angle at its attachment.
Most food digestion takes place in the small intestine. Segmentation contractions act to mix and
move the chyme more slowly in the small intestine allowing more time for absorption (and these
continue in the large intestine). In the duodenum, pancreatic lipase is secreted together with a co-
enzyme, colipase to further digest the fat content of the chyme. From this breakdown, smaller
particles of emulsified fats called chylomicrons are produced. There are also digestive cells
called enterocytes lining the intestines (the majority being in the small intestine). They are unusual
cells in that they have villi on their surface which in turn have innumerable microvilli on their surface.
All these villi make for a greater surface area, not only for the absorption of chyme but also for its
further digestion by large numbers of digestive enzymes present on the microvilli.
The chylomicrons are small enough to pass through the enterocyte villi and into
their lymph capillaries called lacteals. A milky fluid called chyle, consisting mainly of the emulsified
fats of the chylomicrons, results from the absorbed mix with the lymph in the lacteals.[clarification
needed]
Chyle is then transported through the lymphatic system to the rest of the body.
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The suspensory muscle marks the end of the duodenum and the division between the upper
gastrointestinal tract and the lower GI tract. The digestive tract continues as the jejunum which
continues as the ileum. The jejunum, the midsection of the small intestine contains circular folds,
flaps of doubled mucosal membrane which partially encircle and sometimes completely encircle
the lumen of the intestine. These folds together with villi serve to increase the surface area of the
jejunum enabling an increased absorption of digested sugars, amino acids and fatty acids into the
bloodstream. The circular folds also slow the passage of food giving more time for nutrients to be
absorbed.
The last part of the small intestine is the ileum. This also contains villi and vitamin B12; bile acids
and any residue nutrients are absorbed here. When the chyme is exhausted of its nutrients the
remaining waste material changes into the semi-solids called feces, which pass to the large
intestine, where bacteria in the gut flora further break down residual proteins and starches.
The cecum is a pouch marking the division between the small intestine and the large intestine.[28] The
cecum receives chyme from the last part of the small intestine, the ileum, and connects to
the ascending colon of the large intestine. At this junction there is a sphincter or valve, the ileocecal
valve which slows the passage of chyme from the ileum, allowing further digestion. It is also the site
of the appendix attachment

In the large intestine,[2] the passage of the digesting food in the colon is a lot slower, taking from 12
to 50 hours until it is removed by defecation. The colon mainly serves as a site for the fermentation
of digestible matter by the gut flora. The time taken varies considerably between individuals. The
remaining semi-solid waste is termed feces and is removed by the coordinated contractions of the
intestinal walls, termed peristalsis, which propels the excreta forward to reach the rectumand exit via
defecation from the anus. The wall has an outer layer of longitudinal muscles, the taeniae coli, and
an inner layer of circular muscles. The circular muscle keeps the material moving forward and also
prevents any back flow of waste. Also of help in the action of peristalsis is the basal electrical
rhythm that determines the frequency of contractions.[29] The taeniae coli can be seen and are
responsible for the bulges (haustra) present in the colon. Most parts of the GI tract are covered
with serous membranes and have a mesentery. Other more muscular parts are lined with adventitia.

The digestive system is supplied by the celiac artery. The celiac artery is the first major branch from
the abdominal aorta, and is the only major artery that nourishes the digestive organs.
There are three main divisions – the left gastric artery, the common hepatic artery and the splenic
artery.
The celiac artery supplies the liver, stomach, spleen and the upper 1/3 of the duodenum (to
the sphincter of Oddi) and the pancreas with oxygenated blood. Most of the blood is returned to the
liver via the portal venous system for further processing and detoxification before returning to
the systemic circulation via the hepatic veins.
The next branch from the abdominal aorta is the superior mesenteric artery, which supplies the
regions of the digestive tract derived from the midgut, which includes the distal 2/3 of the duodenum,
jejunum, ileum, cecum, appendix, ascending colon, and the proximal 2/3 of the transverse colon.
The final branch which is important for the digestive system is the inferior mesenteric artery, which
supplies the regions of the digestive tract derived from the hindgut, which includes the distal 1/3 of
the transverse colon, descending colon, sigmoid colon, rectum, and the anus above the pectinate
line.
The enteric nervous system consists of some one hundred million neurons[31] that are embedded in
the peritoneum, the lining of the gastrointestinal tract extending from the esophagus to the
anus.[32] These neurons are collected into two plexuses - the myenteric (or Auerbach's) plexus that
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lies between the longitudinal and the smooth muscle layers, and the submucosal (or Meissner's)
plexus that lies between the circular smooth muscle layer and the mucosa.[33][34][35]
Parasympathetic innervation to the ascending colon is supplied by the vagus nerve. Sympathetic
innervation is supplied by the splanchnic nerves that join the celiac ganglia. Most of the digestive
tract is innervated by the two large celiac ganglia, with the upper part of each ganglion joined by
the greater splanchnic nerve and the lower parts joined by the lesser splanchnic nerve. It is from
these ganglia that many of the gastric plexuses arise.
A common gum disease in the mouth is gingivitis which is caused by bacteria in plaque.
The most common viral infection of the mouth is gingivostomatitis caused by herpes simplex
A common fungal infection is candidiasis commonly known as thrush which affects the mucous
membranes of the mouth.
Schatzki rings that can restrict the passageway, causing difficulties in swallowing. They can also
completely block the esophagus
Stomach diseases are often chronic conditions and include gastroparesis, gastritis, and peptic
ulcers.
Coeliac disease is an autoimmune disorder of the small intestine.
enzyme deficiencies such as exocrine pancreatic insufficiency.
The small intestine can also be obstructed by a volvulus, a loop of intestine that becomes twisted
enclosing its attached mesentery. This can cause mesenteric ischemia if severe enough.
A common disorder of the bowel is diverticulitis
Crohn's disease is a common chronic inflammatory bowel disease (IBD), which can affect any part of
the GI tract,[39] but it mostly starts in the terminal ileum.
Ulcerative colitis an ulcerative form of colitis, is the other major inflammatory bowel disease which is
restricted to the colon and rectum
Irritable bowel syndrome (IBS) is the most common of the functional gastrointestinal disorders.
Giardiasis is a disease of the small intestine caused by a protist parasite Giardia lamblia
mostly involving the ingestion of barium sulphate to investigate disorders of the GI tract.
In humans and other mammals, the anatomy of a typical respiratory system is the respiratory tract.
The tract is divided into an upperand a lower respiratory tract. The upper tract includes
the nose, nasal cavities, sinuses, pharynx and the part of the larynx above the vocal folds. The lower
tract (Fig. 2.) includes the lower part of the larynx, the trachea, bronchi, bronchioles and the alveoli.
In humans and other mammals, the anatomy of a typical respiratory system is the respiratory tract.
The tract is divided into an upperand a lower respiratory tract. The upper tract includes
the nose, nasal cavities, sinuses, pharynx and the part of the larynx above the vocal folds. The lower
tract (Fig. 2.) includes the lower part of the larynx, the trachea, bronchi, bronchioles and the alveoli.
The branching airways of the lower tract are often described as the respiratory tree or
tracheobronchial tree (Fig. 2).[4] The intervals between successive branch points along the various
branches of "tree" are often referred to as branching "generations", of which there are, in the adult
human about 23. The earlier generations (approximately generations 0–16), consisting of the
trachea and the bronchi, as well as the larger bronchioles which simply act as air conduits, bringing
air to the respiratory bronchioles, alveolar ducts and alveoli (approximately generations 17–23),
where gas exchange takes place.[5][6] Bronchioles are defined as the small airways lacking any
cartilagenous support.[4]
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The first bronchi to branch from the trachea are the right and left main bronchi. Second only in
diameter to the trachea (1.8 cm), these bronchi (1 -1.4 cm in diameter)[5] enter the lungs at
each hilum, where they branch into narrower secondary bronchi known as lobar bronchi, and these
branch into narrower tertiary bronchi known as segmental bronchi. Further divisions of the
segmental bronchi (1 to 6 mm in diameter)[7] are known as 4th order, 5th order, and 6th order
segmental bronchi, or grouped together as subsegmental bronchi.[8][9]
Compared to the, on average, 23 number of branchings of the respiratory tree in the adult human,
the mouse has only about 13 such branchings.
The alveoli are the dead end terminals of the "tree", meaning that any air that enters them has to exit
via the same route. A system such as this creates dead space, a volume of air (about 150 ml in the
adult human) that fills the airways after exhalation and is breathed back into the alveoli before
environmental air reaches them.[10][11] At the end of inhalation the airways are filled with environmental
air, which is exhaled without coming in contact with the gas exchanger.
The urinary system, also known as the renal system or urinary tract, consists of
the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate
waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and
metabolites, and regulate blood pH. The urinary tract is the body's drainage system for the eventual
removal of urine.[1] The kidneys have an extensive blood supply via the renal arteries which leave the
kidneys via the renal vein. Each kidney consists of functional units called nephrons. Following
filtration of blood and further processing, wastes (in the form of urine) exit the kidney via the ureters,
tubes made of smooth muscle fibres that propel urine towards the urinary bladder, where it is stored
and subsequently expelled from the body by urination (voiding). The female and male urinary system
are very similar, differing only in the length of the urethra
Urine is formed in the kidneys through a filtration of blood. The urine is then passed through the
ureters to the bladder, where it is stored. During urination, the urine is passed from the bladder
through the urethra to the outside of the body.
The main functions of the urinary system and its components are to

 Regulate blood volume and composition (e.g. sodium, potassium and calcium)
 Regulate blood pressure.
 Regulate pH homeostasis of the blood.
 Contributes to the production of red blood cells by the kidney.
 Helps synthesize calcitrol the (active form of Vitamin D).
 Stores waste product (mainly urea and uric acid) before it and other products are removed from
the body.
 In the first part of the nephron, Bowman's capsule filters blood from the circulatory
system into the tubules. Hydrostatic and osmotic pressure gradients facilitate filtration across
a semipermeable membrane. The filtrate includes water, small molecules, and ions that
easily pass through the filtration membrane. However larger molecules such
as proteins and blood cells are prevented from passing through the filtration membrane. The
amount of filtrate produced every minute is called the glomerular filtration rate or GFR and
amounts to 180 litres per day. About 99% of this filtrate is reabsorbed as it passes through
the nephron and the remaining 1% becomes urine.
 The urinary system is regulated by the endocrine system by hormones such as antidiuretic
hormone, aldosterone, and parathyroid hormone
urinary tract obstruction is a urologic disease that can cause urinary retention.
Diabetes also can have a direct effect in urination due to peripheral neuropathies, which occur in
some individuals with poorly controlled blood sugar levels.
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Urinary incontinence can result from a weakening of the pelvic floor muscles caused by factors such
as pregnancy, childbirth, aging, and being overweight. Pelvic floor exercises known as Kegel
exercises can help in this condition by strengthening the pelvic floor. There can also be underlying
medical reasons for urinary incontinence which are often treatable. In children, the condition is
called enuresis.
The endocrine system is a chemical messenger system consisting of hormones, the group
of glands of an organism that secrete those hormones directly into the circulatory system to regulate
the function of distant target organs, and the feedback loops which modulate hormone release so
that homeostasis is maintained. In humans, the major endocrine glands are the thyroid gland and
the adrenal glands. In vertebrates, the hypothalamus is the neural control center for all endocrine
systems. The study of the endocrine system and its disorders is known as endocrinology.
Endocrinology is a branch of internal medicine
Special features of endocrine glands are, in general, their ductless nature, their vascularity, and
commonly the presence of intracellular vacuoles or granules that store their hormones. In
contrast, exocrine glands, such as salivary glands, sweat glands, and glands within
the gastrointestinal tract, tend to be much less vascular and have ducts or a hollow lumen. A number
of glands that signal each other in sequence are usually referred to as an axis, for example,
the hypothalamic-pituitary-adrenal axis.
In addition to the specialized endocrine organs mentioned above, many other organs that are part of
other body systems, such as bone, kidney, liver, heart and gonads, have secondary endocrine
functions. For example, the kidney secretes endocrine hormones such as erythropoietin and renin.
Hormones can consist of either amino acid complexes, steroids, eicosanoids, leukotrienes,
or prostaglandins.[1]
The endocrine system is in contrast to the exocrine system, which secretes its hormones to the
outside of the body using ducts. As opposed to endocrine factors that travel considerably longer
distances via the circulatory system, other signaling molecules, such as paracrine factors involved
in paracrine signalling diffuse over a relatively short distance.
Endocrine glands are glands of the endocrine system that secrete their products, hormones, directly
into interstitial spaces and then absorbed into blood rather than through a duct. The major glands of
the endocrine system include the pineal gland, pituitary gland, pancreas, ovaries, testes, thyroid
gland, parathyroid gland, hypothalamus and adrenal glands. The hypothalamus and pituitary gland
are neuroendocrine organs.
A hormone is any of a class of signaling molecules produced by glands in multicellular
organisms that are transported by the circulatory system to target distant organs to
regulate physiology and behaviour. Hormones have diverse chemical structures, mainly of 3
classes: eicosanoids, steroids, and amino acid/protein derivatives (amines, peptides, and proteins).
The glands that secrete hormones comprise the endocrine system. The term hormone is sometimes
extended to include chemicals produced by cells that affect the same cell (autocrine or intracrine
signalling) or nearby cells (paracrine signalling).
Hormones are used to communicate between organs and tissues for physiological regulation
and behavioral activities, such as digestion, metabolism, respiration, tissue function, sensory
perception, sleep, excretion, lactation, stress, growth and development, movement, reproduction,
and mood.[3][4]
Hormones affect distant cells by binding to specific receptor proteins in the target cell resulting in a
change in cell function. This may lead to cell type-specific responses that include rapid changes to
the activity of existing proteins, or slower changes in the expression of target genes. Amino acid–
based hormones (amines and peptide or protein hormones) are water-soluble and act on the surface
of target cells via signal transductionpathways; steroid hormones, being lipid-soluble, move through
the plasma membranes of target cells to act within their nuclei.
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The typical mode of cell signalling in the endocrine system is endocrine signaling, that is, using the
circulatory system to reach distant target organs. However, there are also other modes, i.e.,
paracrine, autocrine, and neuroendocrine signaling. Purely neurocrine signaling between neurons,
on the other hand, belongs completely to the nervous system.
Autocrine signaling is a form of signaling in which a cell secretes a hormone or chemical messenger
(called the autocrine agent) that binds to autocrine receptors on the same cell, leading to changes in
the cells.
Some endocrinologists and clinicians include the paracrine system as part of the endocrine system,
but there is not consensus. Paracrines are slower acting, targeting cells in the same tissue or organ.
An example of this is somatostatin which is released by some pancreatic cells and targets other
pancreatic cells.
uxtacrine signaling is a type of intercellular communication that is transmitted via oligosaccharide,
lipid, or protein components of a cell membrane, and may affect either the emitting cell or the
immediately adjacent cells.[5]
It occurs between adjacent cells that possess broad patches of closely opposed plasma membrane
linked by transmembrane channels known as connexons. The gap between the cells can usually be
between only 2 and 4 nm.
Diseases of the endocrine system are common,[8] including conditions such as diabetes
mellitus, thyroid disease, and obesity. Endocrine disease is characterized by misregulated hormone
release (a productive pituitary adenoma), inappropriate response to signaling (hypothyroidism), lack
of a gland (diabetes mellitus type 1, diminished erythropoiesis in chronic renal failure), or structural
enlargement in a critical site such as the thyroid (toxic multinodular goitre). Hypofunction of
endocrine glands can occur as a result of loss of reserve, hyposecretion, agenesis, atrophy, or
active destruction. Hyperfunction can occur as a result of hypersecretion, loss of
suppression, hyperplastic or neoplastic change, or hyperstimulation.
Other common diseases that result from endocrine dysfunction include Addison's disease, Cushing's
disease and Graves' disease. Cushing's disease and Addison's disease are pathologies involving
the dysfunction of the adrenal gland. Dysfunction in the adrenal gland could be due to primary or
secondary factors and can result in hypercortisolism or hypocortisolism . Cushing's disease is
characterized by the hypersecretion of the adrenocorticotropic hormone (ACTH) due to a pituitary
adenoma that ultimately causes endogenous hypercortisolism by stimulating the adrenal
glands.[10] Some clinical signs of Cushing's disease include obesity, moon face, and
hirsutism.[11] Addison's disease is an endocrine disease that results from hypocortisolism caused by
adrenal gland insufficiency. Adrenal insufficiency is significant because it is correlated with
decreased ability to maintain blood pressure and blood sugar, a defect that can prove to be fatal
Graves' disease involves the hyperactivity of the thyroid gland which produces the T3 and T4
hormones.[11] Graves' disease effects range from excess sweating, fatigue, heat intolerance and high
blood pressure to swelling of the eyes that causes redness, puffiness and in rare cases reduced or
double vision
The circulatory system, also called the cardiovascular system or the vascular system, is
an organ system that permits blood to circulate and transport nutrients (such as amino
acids and electrolytes), oxygen, carbon dioxide, hormones, and blood cells to and from the cells in
the body to provide nourishment and help in fighting diseases,stabilize temperature and pH, and
maintain homeostasis.
The circulatory system includes the lymphatic system, which circulates lymph.[1] The passage of
lymph for example takes much longer than that of blood.[2] Blood is a fluid consisting of plasma, red
blood cells, white blood cells, and platelets that is circulated by the heart through the vertebrate
vascular system, carrying oxygen and nutrients to and waste materials away from all body tissues.
Lymph is essentially recycled excess blood plasma after it has been filtered from the interstitial
HUMAN BODY

fluid (between cells) and returned to the lymphatic system. The cardiovascular (from Latin words
meaning "heart" and "vessel") system comprises the blood, heart, and blood vessels.[3] The
lymph, lymph nodes, and lymph vessels form the lymphatic system, which returns filtered blood
plasma from the interstitial fluid (between cells) as lymph.
The circulatory system of the blood is seen as having two components, a systemic circulation and a
pulmonary circulation.[4]
While humans, as well as other vertebrates, have a closed cardiovascular system (meaning that the
blood never leaves the network of arteries, veins and capillaries), some invertebrate groups have an
open cardiovascular system. The lymphatic system, on the other hand, is an open system providing
an accessory route for excess interstitial fluid to be returned to the blood.[5] The more
primitive, diploblastic animal phyla lack circulatory systems.
Many diseases affect the circulatory system. This includes cardiovascular disease, affecting the
cardiovascular system, and lymphatic disease affecting the lymphatic system.Cardiologists are
medical professionals which specialise in the heart, and cardiothoracic surgeons specialise in
operating on the heart and its surrounding areas. Vascular surgeons focus on other parts of the
circulatory system.
The essential components of the human cardiovascular system are the heart, blood and blood
vessels.[6] It includes the pulmonary circulation, a "loop" through the lungs where blood is
oxygenated; and the systemic circulation, a "loop" through the rest of the body to
provide oxygenated blood. The systemic circulation can also be seen to function in two parts –
a macrocirculation and a microcirculation. An average adult contains five to six quarts (roughly 4.7 to
5.7 liters) of blood, accounting for approximately 7% of their total body weight.[7] Blood consists
of plasma, red blood cells, white blood cells, and platelets. Also, the digestive system works with the
circulatory system to provide the nutrients the system needs to keep the heart pumping.[8]
The cardiovascular systems of humans are closed, meaning that the blood never leaves the network
of blood vessels. In contrast, oxygen and nutrients diffuse across the blood vessel layers and
enter interstitial fluid, which carries oxygen and nutrients to the target cells, and carbon dioxide and
wastes in the opposite direction. The other component of the circulatory system, the lymphatic
system, is open.
Oxygenated blood enters the systemic circulation when leaving the left ventricle, through the aortic
semilunar valve. The first part of the systemic circulation is the aorta, a massive and thick-walled
artery. The aorta arches and gives branches supplying the upper part of the body after passing
through the aortic opening of the diaphragm at the level of thoracic ten vertebra, it enters the
abdomen. Later it descends down and supplies branches to abdomen, pelvis, perineum and the
lower limbs. The walls of aorta are elastic. This elasticity helps to maintain the blood
pressure throughout the body. When the aorta receives almost five litres of blood from the heart, it
recoils and is responsible for pulsating blood pressure. Moreover, as aorta branches into smaller
arteries, their elasticity goes on decreasing and their compliance goes on increasing.
Arteries branch into small passages called arterioles and then into the capillaries.[9] The capillaries
merge to bring blood into the venous system.
Capillaries merge into venules, which merge into veins. The venous system feeds into the two major
veins: the superior vena cava – which mainly drains tissues above the heart – and the inferior vena
cava – which mainly drains tissues below the heart. These two large veins empty into the right
atrium of the heart.
The general rule is that arteries from the heart branch out into capillaries, which collect into veins
leading back to the heart. Portal veins are a slight exception to this. In humans the only significant
example is the hepatic portal vein which combines from capillaries around the gastrointestinal
tract where the blood absorbs the various products of digestion; rather than leading directly back to
the heart, the hepatic portal vein branches into a second capillary system in the liver.
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The heart pumps oxygenated blood to the body and deoxygenated blood to the lungs. In the
human heart there is one atrium and one ventricle for each circulation, and with both a systemic and
a pulmonary circulation there are four chambers in total: left atrium, left ventricle, right
atrium and right ventricle. The right atrium is the upper chamber of the right side of the heart. The
blood that is returned to the right atrium is deoxygenated (poor in oxygen) and passed into the right
ventricle to be pumped through the pulmonary artery to the lungs for re-oxygenation and removal of
carbon dioxide. The left atrium receives newly oxygenated blood from the lungs as well as the
pulmonary vein which is passed into the strong left ventricle to be pumped through the aorta to the
different organs of the body.
The heart itself is supplied with oxygen and nutrients through a small "loop" of the systemic
circulation and derives very little from the blood contained within the four chambers. The coronary
circulation system provides a blood supply to the heart muscle itself. The coronary circulation begins
near the origin of the aorta by two coronary arteries: the right coronary artery and the left coronary
artery. After nourishing the heart muscle, blood returns through the coronary veins into the coronary
sinus and from this one into the right atrium. Back flow of blood through its opening during atrial
systole is prevented by the Thebesian valve. The smallest cardiac veins drain directly into the heart
chambers
The circulatory system of the lungs is the portion of the cardiovascular system in which oxygen-
depleted blood is pumped away from the heart, via the pulmonary artery, to the lungs and returned,
oxygenated, to the heart via the pulmonary vein.
Oxygen deprived blood from the superior and inferior vena cava enters the right atrium of the heart
and flows through the tricuspid valve (right atrioventricular valve) into the right ventricle, from which it
is then pumped through the pulmonary semilunar valve into the pulmonary artery to the lungs. Gas
exchange occurs in the lungs, whereby CO
2 is released from the blood, and oxygen is absorbed. The pulmonary vein returns the now oxygen-
rich blood to the left atrium.[8]
A separate system known as the bronchial circulation supplies blood to the tissue of the larger
airways of the lung.
Systemic circulation is the portion of the cardiovascular system which transports oxygenated blood
away from the heart through the aorta from the left ventricle where the blood has been previously
deposited from pulmonary circulation, to the rest of the body, and returns oxygen-depleted blood
back to the heart.
The brain has a dual blood supply that comes from arteries at its front and back. These are called
the "anterior" and "posterior" circulation respectively. The anterior circulation arises from the internal
carotid arteries and supplies the front of the brain. The posterior circulation arises from the vertebral
arteries, and supplies the back of the brain and brainstem. The circulation from the front and the
back join together (anastomise) at the Circle of Willis.
The renal circulation receives around 20% of the cardiac output. It branches from the abdominal
aorta and returns blood to the ascending vena cava. It is the blood supply to the kidneys, and
contains many specialized blood vessels.
About 98.5% of the oxygen in a sample of arterial blood in a healthy human, breathing air at sea-
level pressure, is chemically combined with hemoglobin molecules. About 1.5% is physically
dissolved in the other blood liquids and not connected to hemoglobin. The hemoglobin molecule is
the primary transporter of oxygen in mammals and many other species.
Another major cardiovascular disease involves the creation of a clot, called a "thrombus". These can
originate in veins or arteries. Deep venous thrombosis, which mostly occurs in the legs, is one cause
of clots in the veins of the legs, particularly when a person has been stationary for a long time.
These clots may embolise, meaning travel to another location in the body. The results of this may
include pulmonary embolus, transient ischaemic attacks, or stroke.
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Atherosclerosisis the precursor to many of these diseases. It is where small atheromatous


plaques build up in the walls of medium and large arteries. This may eventually grow or rupture to
occlude the arteries. It is also a risk factor for acute coronary syndromes, which are diseases which
are characterised by a sudden deficit of oxygenated blood to the heart tissue. Atherosclerosis is also
associated with problems such as aneurysm formation or splitting ("dissection") of arteries.

Open circulatory system


In arthropods, the open circulatory system is a system in which a fluid in a cavity called the
hemocoel bathes the organs directly with oxygen and nutrients and there is no distinction
between blood and interstitial fluid; this combined fluid is called hemolymph or
haemolymph.[15] Muscular movements by the animal during locomotion can facilitate hemolymph
movement, but diverting flow from one area to another is limited. When the heart relaxes, blood is
drawn back toward the heart through open-ended pores (ostia).
Hemolymph fills all of the interior hemocoel of the body and surrounds all cells. Hemolymph is
composed of water, inorganic salts (mostly sodium, chloride, potassium, magnesium, and calcium),
and organic compounds (mostly carbohydrates, proteins, and lipids). The primary oxygen transporter
molecule is hemocyanin.
There are free-floating cells, the hemocytes, within the hemolymph. They play a role in the
arthropod immune system.

Closed circulatory system


The circulatory systems of all vertebrates, as well as of annelids (for example, earthworms)
and cephalopods (squids, octopuses and relatives) are closed, just as in humans. Still, the systems
of fish, amphibians, reptiles, and birds show various stages of the evolution of the circulatory
system.[16]
In fish, the system has only one circuit, with the blood being pumped through the capillaries of
the gills and on to the capillaries of the body tissues. This is known as single cycle circulation. The
heart of fish is, therefore, only a single pump (consisting of two chambers).
In amphibians and most reptiles, a double circulatory system is used, but the heart is not always
completely separated into two pumps. Amphibians have a three-chambered heart.
In reptiles, the ventricular septum of the heart is incomplete and the pulmonary artery is equipped
with a sphincter muscle. This allows a second possible route of blood flow. Instead of blood flowing
through the pulmonary artery to the lungs, the sphincter may be contracted to divert this blood flow
through the incomplete ventricular septum into the left ventricle and out through the aorta. This
means the blood flows from the capillaries to the heart and back to the capillaries instead of to the
lungs. This process is useful to ectothermic (cold-blooded) animals in the regulation of their body
temperature.
Birds, mammals, and crocodilians show complete separation of the heart into two pumps, for a total
of four heart chambers; it is thought that the four-chambered heart of birds and crocodilians evolved
independently from that of mammals.[17]

No circulatory system
Circulatory systems are absent in some animals, including flatworms. Their body cavity has no lining
or enclosed fluid. Instead a muscular pharynx leads to an extensively branched digestive
system that facilitates direct diffusion of nutrients to all cells. The flatworm's dorso-ventrally flattened
body shape also restricts the distance of any cell from the digestive system or the exterior of the
organism. Oxygen can diffuse from the surrounding water into the cells, and carbon dioxide can
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diffuse out. Consequently, every cell is able to obtain nutrients, water and oxygen without the need
of a transport system.
Some animals, such as jellyfish, have more extensive branching from their gastrovascular
cavity (which functions as both a place of digestion and a form of circulation), this branching allows
for bodily fluids to reach the outer layers, since the digestion begins in the inner layers.
The lymphatic system is part of the vascular system and an important part of the immune system,
comprising a large network of lymphatic vessels that carry a clear fluid called lymph (from
Latin, lympha meaning "water"[1]) directionally towards the heart. The lymphatic system was first
described in the seventeenth century independently by Olaus Rudbeck and Thomas Bartholin.
Unlike the circulatory system, the lymphatic system is not a closed system. The human circulatory
system processes an average of 20 litres of blood per day through capillary filtration, which
removes plasma while leaving the blood cells. Roughly 17 litres of the filtered plasma is reabsorbed
directly into the blood vessels, while the remaining three litres remain in the interstitial fluid. One of
the main functions of the lymph system is to provide an accessory return route to the blood for the
surplus three litres.[2]
The other main function is that of defense in the immune system. Lymph is very similar to blood
plasma: it contains lymphocytes. It also contains waste products and cellular debris together
with bacteria and proteins. Associated organs composed of lymphoid tissue are the sites of
lymphocyte production. Lymphocytes are concentrated in the lymph nodes. The spleen and
the thymus are also lymphoid organs of the immune system. The tonsils are lymphoid organs that
are also associated with the digestive system. Lymphoid tissues contain lymphocytes, and also
contain other types of cells for support.[3] The system also includes all the structures dedicated to the
circulation and production of lymphocytes (the primary cellular component of lymph), which also
includes the bone marrow, and the lymphoid tissue associated with the digestive system.[4]
The blood does not come into direct contact with the parenchymal cells and tissues in the body
(except in case of an injury causing rupture of one or more blood vessels), but constituents of the
blood first exit the microvascular exchange blood vessels to become interstitial fluid, which comes
into contact with the parenchymal cells of the body. Lymph is the fluid that is formed when interstitial
fluid enters the initial lymphatic vessels of the lymphatic system. The lymph is then moved along the
lymphatic vessel network by either intrinsic contractions of the lymphatic passages or by extrinsic
compression of the lymphatic vessels via external tissue forces (e.g., the contractions of skeletal
muscles), or by lymph hearts in some animals. The organization of lymph nodes and drainage
follows the organization of the body into external and internal regions; therefore, the lymphatic
drainage of the head, limbs, and body cavity walls follows an external route, and the lymphatic
drainage of the thorax, abdomen, and pelvic cavities follows an internal route.[5] Eventually, the
lymph vessels empty into the lymphatic ducts, which drain into one of the two subclavian veins, near
their junction with the internal jugular veins.
The lymphatic system consists of lymphatic organs, a conducting network of lymphatic vessels, and
the circulating lymph.
The primary or central lymphoid organs generate lymphocytes from immature progenitor cells.
The thymus and the bone marrow constitute the primary lymphoid organs involved in the production
and early clonal selection of lymphocyte tissues. Bone marrow is responsible for both the creation
of T cells and the production and maturation of B cells. From the bone marrow, B cells immediately
join the circulatory system and travel to secondary lymphoid organs in search of pathogens. T cells,
on the other hand, travel from the bone marrow to the thymus, where they develop further. Mature T
cells join B cells in search of pathogens. The other 95% of T cells begin a process of apoptosis, a
form of programmed cell death.
Secondary or peripheral lymphoid organs, which include lymph nodes and the spleen, maintain
mature naive lymphocytes and initiate an adaptive immune response. The peripheral lymphoid
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organs are the sites of lymphocyte activation by antigens. Activation leads to clonal expansion and
affinity maturation. Mature lymphocytes recirculate between the blood and the peripheral lymphoid
organs until they encounter their specific antigen.
Secondary lymphoid tissue provides the environment for the foreign or altered native molecules
(antigens) to interact with the lymphocytes. It is exemplified by the lymph nodes, and the lymphoid
follicles in tonsils, Peyer's patches, spleen, adenoids, skin, etc. that are associated with the mucosa-
associated lymphoid tissue (MALT).
In the gastrointestinal wall the appendix has mucosa resembling that of the colon, but here it is
heavily infiltrated with lymphocytes.
Tertiary lymphoid organs (TLO) are abnormal lymph node–like structures that form in peripheral
tissues at sites of chronic inflammation, such as chronic infection, transplanted
organsundergoing graft rejection, some cancers, and autoimmune and autoimmune-related
diseases.[6] TLOs are regulated differently from the normal process whereby lymphoid tissues are
formed during ontogeny, being dependent on cytokines and hematopoietic cells, but still
drain interstitial fluid and transport lymphocytes in response to the same chemical messengers and
gradients.[7] TLOs typically contains far fewer lymphocytes, and assumes an immune role only when
challenged with antigens that result in inflammation. It achieves this by importing the lymphocytes
from blood and lymph.
The thymus is a primary lymphoid organ and the site of maturation for T cells, the lymphocytes of
the adaptive immune system. The thymus increases in size from birth in response to postnatal
antigen stimulation, then to puberty and regresses thereafter.[9] The loss or lack of the thymus results
in severe immunodeficiency and subsequent high susceptibility to infection.[9] In most species, the
thymus consists of lobules divided by septa which are made up of epithelium and is therefore an
epithelial organ. T cells mature from thymocytes, proliferate and undergo selection process in the
thymic cortex before entering the medulla to interact with epithelial cells.
The thymus provides an inductive environment for development of T cells from hematopoietic
progenitor cells. In addition, thymic stromal cells allow for the selection of a functional and self-
tolerant T cell repertoire. Therefore, one of the most important roles of the thymus is the induction of
central tolerance.
The thymus is largest and most active during the neonatal and pre-adolescent periods. By the early
teens, the thymus begins to atrophy and thymic stroma is mostly replaced by adipose tissue.
Nevertheless, residual T lymphopoiesis continues throughout adult life.
The main functions of the spleen are:

1. to produce immune cells to fight antigens


2. to remove particulate matter and aged blood cells, mainly red blood cells.
3. to produce blood cells during fetal life
The spleen synthesizes antibodies in its white pulp and removes antibody-coated bacteria and
antibody-coated blood cells by way of blood and lymph node circulation. A study published in 2009
using mice found that the spleen contains, in its reserve, half of the body's monocytes within the red
pulp.[10] These monocytes, upon moving to injured tissue (such as the heart), turn into dendritic
cells and macrophages while promoting tissue healing.[10][11][12] The spleen is a center of activity of
the mononuclear phagocyte system and can be considered analogous to a large lymph node, as its
absence causes a predisposition to certain infections.
Like the thymus, the spleen has only efferent lymphatic vessels. Both the short gastric arteries and
the splenic artery supply it with blood.[13]
The germinal centers are supplied by arterioles called penicilliary radicles.[14]
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Up to the fifth month of prenatal development the spleen creates red blood cells. After birth the bone
marrow is solely responsible for hematopoiesis. As a major lymphoid organ and a central player in
the reticuloendothelial system, the spleen retains the ability to produce lymphocytes. The spleen
stores red blood cells and lymphocytes. It can store enough blood cells to help in an emergency. Up
to 25% of lymphocytes can be stored at any one time
A lymph node is an organized collection of lymphoid tissue, through which the lymph passes on its
way back to the blood. Lymph nodes are located at intervals along the lymphatic system.
Several afferent lymph vessels bring in lymph, which percolates through the substance of the lymph
node, and is then drained out by an efferent lymph vessel. There are between five and six hundred
lymph nodes in the human body, many of which are grouped in clusters in different regions as in the
underarm and abdominal areas. Lymph node clusters are commonly found at the base of limbs
(groin, armpits) and in the neck, where lymph is collected from regions of the body likely to sustain
pathogen contamination from injuries.
The substance of a lymph node consists of lymphoid follicles in an outer portion called the cortex.
The inner portion of the node is called the medulla, which is surrounded by the cortex on all sides
except for a portion known as the hilum. The hilum presents as a depression on the surface of the
lymph node, causing the otherwise spherical lymph node to be bean-shaped or ovoid. The efferent
lymph vessel directly emerges from the lymph node at the hilum. The arteries and veins supplying
the lymph node with blood enter and exit through the hilum.
The region of the lymph node called the paracortex immediately surrounds the medulla. Unlike the
cortex, which has mostly immature T cells, or thymocytes, the paracortex has a mixture of immature
and mature T cells. Lymphocytes enter the lymph nodes through specialised high endothelial
venules found in the paracortex.
A lymph follicle is a dense collection of lymphocytes, the number, size and configuration of which
change in accordance with the functional state of the lymph node. For example, the follicles expand
significantly when encountering a foreign antigen. The selection of B cells, or B lymphocytes, occurs
in the germinal centre of the lymph nodes.
Lymph nodes are particularly numerous in the mediastinum in the chest, neck, pelvis, axilla, inguinal
region, and in association with the blood vessels of the intestines.
Lymphoid tissue associated with the lymphatic system is concerned with immune functions in
defending the body against infections and the spread of tumours. It consists of connective
tissue formed of reticular fibers, with various types of leukocytes, (white blood cells),
mostly lymphocytes enmeshed in it, through which the lymph passes.[16]Regions of the lymphoid
tissue that are densely packed with lymphocytes are known as lymphoid follicles. Lymphoid tissue
can either be structurally well organized as lymph nodes or may consist of loosely organized
lymphoid follicles known as the mucosa-associated lymphoid tissue.
The central nervous system also has lymphatic vessels, as discovered by the University of Virginia
Researchers. The search for T-cell gateways into and out of the meningesuncovered
functional meningeal lymphatic vessels lining the dural sinuses, anatomically integrated into the
membrane surrounding the brain.
The lymphatic vessels, also called lymph vessels, conduct lymph between different parts of the
body. They include the tubular vessels of the lymph capillaries, and the larger collecting vessels–
the right lymphatic duct and the thoracic duct (the left lymphatic duct). The lymph capillaries are
mainly responsible for the absorption of interstitial fluid from the tissues, while lymph vessels propel
the absorbed fluid forward into the larger collecting ducts, where it ultimately returns to the
bloodstream via one of the subclavian veins. These vessels are also called the lymphatic channels
or simply lymphatics.[18]
The lymphatics are responsible for maintaining the balance of the body fluids. Its network of
capillaries and collecting lymphatic vessels work to efficiently drain and transport extravasated fluid,
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along with proteins and antigens, back to the circulatory system. Numerous intraluminal valves in the
vessels ensure a unidirectional flow of lymph without reflux.[19] Two valve systems are used to
achieve this one directional flow—a primary and a secondary valve system.[20] The capillaries are
blind-ended, and the valves at the ends of capillaries use specialised junctions together with
anchoring filaments to allow a unidirectional flow to the primary vessels. The collecting lymphatics,
however, act to propel the lymph by the combined actions of the intraluminal valves and lymphatic
muscle cells.
Lymphatic tissues begin to develop by the end of the fifth week of embryonic
development.[22] Lymphatic vessels develop from lymph sacs that arise from developing veins, which
are derived from mesoderm.
The first lymph sacs to appear are the paired jugular lymph sacs at the junction of the internal jugular
and subclavian veins.[22] From the jugular lymph sacs, lymphatic capillary plexuses spread to the
thorax, upper limbs, neck and head.[22] Some of the plexuses enlarge and form lymphatic vessels in
their respective regions. Each jugular lymph sac retains at least one connection with its jugular vein,
the left one developing into the superior portion of the thoracic duct.
The next lymph sac to appear is the unpaired retroperitoneal lymph sac at the root of the mesentery
of the intestine. It develops from the primitive vena cava and mesonephric veins. Capillary plexuses
and lymphatic vessels spread from the retroperitoneal lymph sac to the abdominal viscera and
diaphragm. The sac establishes connections with the cisterna chyli but loses its connections with
neighbouring veins.
The last of the lymph sacs, the paired posterior lymph sacs, develop from the iliac veins. The
posterior lymph sacs produce capillary plexuses and lymphatic vessels of the abdominal wall, pelvic
region, and lower limbs. The posterior lymph sacs join the cisterna chyli and lose their connections
with adjacent veins.
With the exception of the anterior part of the sac from which the cisterna chyli develops, all lymph
sacs become invaded by mesenchymal cells and are converted into groups of lymph nodes.
The spleen develops from mesenchymal cells between layers of the dorsal mesentery of the
stomach.[22] The thymus arises as an outgrowth of the third pharyngeal pouch.
The lymphatic system has multiple interrelated functions:[23]

 It is responsible for the removal of interstitial fluid from tissues


 It absorbs and transports fatty acids and fats as chyle from the digestive system
 It transports white blood cells to and from the lymph nodes into the bones
 The lymph transports antigen-presenting cells, such as dendritic cells, to the lymph nodes where
an immune response is stimulated.
Fat absorption[edit]
Lymph vessels called lacteals are at the beginning of the gastrointestinal tract, predominantly in the
small intestine. While most other nutrients absorbed by the small intestine are passed on to
the portal venous system to drain via the portal vein into the liver for processing, fats (lipids) are
passed on to the lymphatic system to be transported to the blood circulation via the thoracic duct.
(There are exceptions, for example medium-chain triglycerides are fatty acid esters of glycerol that
passively diffuse from the GI tract to the portal system.) The enriched lymph originating in the
lymphatics of the small intestine is called chyle. The nutrients that are released into the circulatory
system are processed by the liver, having passed through the systemic circulation.

Immune function[edit]
Further information: Immune system
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The lymphatic system plays a major role in the body's immune system, as the primary site for cells
relating to adaptive immune system including T-cells and B-cells. Cells in the lymphatic system react
to antigens presented or found by the cells directly or by other dendritic cells. When an antigen is
recognized, an immunological cascade begins involving the activation and recruitment of more and
more cells, the production of antibodies and cytokines and the recruitment of other immunological
cells such as macrophages.
The study of lymphatic drainage of various organs is important in the diagnosis, prognosis, and
treatment of cancer. The lymphatic system, because of its closeness to many tissues of the body, is
responsible for carrying cancerous cells between the various parts of the body in a process
called metastasis. The intervening lymph nodes can trap the cancer cells. If they are not successful
in destroying the cancer cells the nodes may become sites of secondary tumours.

Enlarged lymph nodes


Lymphadenopathy refers to one or more enlarged lymph nodes. Small groups or individually
enlarged lymph nodes are generally reactive in response to infection or inflammation. This is
called local lymphadenopathy. When many lymph nodes in different areas of the body are involved,
this is called generalised lymphadenopathy. Generalised lymphadenopathy may be caused
by infections such as infectious mononucleosis, tuberculosis and HIV, connective tissue
diseases such as SLE and rheumatoid arthritis, and cancers, including both cancers of tissue within
lymph nodes, discussed below, and metastasis of cancerous cells from other parts of the body, that
have arrived via the lymphatic system.[24]

Lymphedema
Lymphedema is the swelling caused by the accumulation of lymph, which may occur if the lymphatic
system is damaged or has malformations. It usually affects limbs, though the face, neck and
abdomen may also be affected. In an extreme state, called elephantiasis, the edema progresses to
the extent that the skin becomes thick with an appearance similar to the skin on elephant limbs.[25]
Causes are unknown in most cases, but sometimes there is a previous history of severe infection,
usually caused by a parasitic disease, such as lymphatic filariasis.
Lymphangiomatosis is a disease involving multiple cysts or lesions formed from lymphatic vessels.
Lymphedema can also occur after surgical removal of lymph nodes in the armpit (causing the arm to
swell due to poor lymphatic drainage) or groin (causing swelling of the leg). Conventional treatment
is by manual lymphatic drainage and compression garments. Two drugs for the treatment of
lymphedema are in clinical trials: Lymfactin[26] and Ubenimex/Bestatin.
There is no evidence to suggest that the effects of manual lymphatic drainage are permanent.[27]
Cancer of the lymphatic system can be primary or secondary. Lymphoma refers to cancer that arises
from lymphatic tissue. Lymphoid leukaemias and lymphomas are now considered to be tumours of
the same type of cell lineage. They are called "leukaemia" when in the blood or marrow and
"lymphoma" when in lymphatic tissue. They are grouped together under the name "lymphoid
malignancy".
Lymphoma is generally considered as either Hodgkin lymphoma or non-Hodgkin lymphoma.
Hodgkin lymphoma is characterised by a particular type of cell, called a Reed–Sternberg cell, visible
under microscope. It is associated with past infection with the Epstein-Barr Virus, and generally
causes a painless "rubbery" lymphadenopathy. It is staged, using Ann Arbor
staging. Chemotherapy generally involves the ABVD and may also involve radiotherapy.[24] Non-
Hodgkin lymphoma is a cancer characterised by increased proliferation of B-cells or T-cells,
generally occurs in an older age group than Hodgkin lymphoma. It is treated according to whether it
is high-grade or low-grade, and carries a poorer prognosis than Hodgkin lymphoma.
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Lymphangiosarcoma is a malignant soft tissue tumour, whereas lymphangioma is a benign tumour


occurring frequently in association with Turner syndrome. Lymphangioleiomyomatosis is a benign
tumour of the smooth muscles of the lymphatics that occurs in the lungs.
Lymphoid leukaemia is another form of cancer where the host is devoid of different lymphatic cells.

Other

 Castleman's disease
 Chylothorax
 Kawasaki disease
 Kikuchi disease
 Lipedema
 Lymphangitis
 Lymphatic filariasis
 Lymphocytic choriomeningitis
 Solitary lymphatic nodule

The cerebrum is the largest part of the human brain. It is divided into two cerebral hemispheres.
The cerebral cortex is an outer layer of grey matter, covering the core of white matter. The cortex is
split into the neocortex and the much smaller allocortex. The neocortex is made up of six neuronal
layers, while the allocortex has three or four. Each hemisphere is conventionally divided into
four lobes – the frontal, temporal, parietal, and occipital lobes. The frontal lobe is associated
with executive functions including self-control, planning, reasoning, and abstract thought, while the
occipital lobe is dedicated to vision. Within each lobe, cortical areas are associated with specific
functions, such as the sensory, motor and association regions. Although the left and right
hemispheres are broadly similar in shape and function, some functions are associated with one side,
such as language in the left and visual-spatial ability in the right. The hemispheres are connected
by commissural nerve tracts, the largest being the corpus callosum.
The cerebrum is connected by the brainstem to the spinal cord. The brainstem consists of
the midbrain, the pons, and the medulla oblongata. The cerebellum is connected to the brainstem
by pairs of tracts. Within the cerebrum is the ventricular system, consisting of four
interconnected ventricles in which cerebrospinal fluid is produced and circulated. Underneath the
cerebral cortex are several important structures, including the thalamus, the epithalamus, the pineal
gland, the hypothalamus, the pituitary gland, and the subthalamus; the limbic structures, including
the amygdala and the hippocampus; the claustrum, the various nuclei of the basal ganglia; the basal
forebrainstructures, and the three circumventricular organs. The cells of the brain
include neurons and supportive glial cells. There are more than 86 billion neurons in the brain, and a
more or less equal number of other cells. Brain activity is made possible by the interconnections of
neurons and their release of neurotransmitters in response to nerve impulses. Neurons connect to
form neural pathways, neural circuits, and elaborate network systems. The whole circuitry is driven
by the process of neurotransmission.
The brain is protected by the skull, suspended in cerebrospinal fluid, and isolated from
the bloodstream by the blood–brain barrier. However, the brain is still susceptible
to damage, disease, and infection. Damage can be caused by trauma, or a loss of blood supply
known as a stroke. The brain is susceptible to degenerative disorders, such as Parkinson's
disease, dementias including Alzheimer's disease, and multiple sclerosis. Psychiatric conditions,
including schizophrenia and clinical depression, are thought to be associated with brain
dysfunctions. The brain can also be the site of tumours, both benign and malignant; these
mostly originate from other sites in the body.
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The study of the anatomy of the brain is neuroanatomy, while the study of its function
is neuroscience. A number of techniques are used to study the brain. Specimens from other animals,
which may be examined microscopically, have traditionally provided much information. Medical
imaging technologies such as functional neuroimaging, and electroencephalography (EEG)
recordings are important in studying the brain. The medical history of people with brain injury has
provided insight into the function of each part of the brain.
The adult human brain weighs on average about 1.2–1.4 kg (2.6–3.1 lb) which is about 2% of the
total body weight,[3][4] with a volume of around 1260 cm3 in men and 1130 cm3 in women, although
there is substantial individual variation.[5] Neurological differences between the sexes have not been
shown to correlate in any simple way with IQ or other measures of cognitive performance.[6]
The cerebrum, consisting of the cerebral hemispheres, forms the largest part of the brain and
overlies the other brain structures.[7] The outer region of the hemispheres, the cerebral cortex, is grey
matter, consisting of cortical layers of neurons. Each hemisphere is divided into four main lobes –
the frontal lobe, parietal lobe, temporal lobe, and occipital lobe.[8] Three other lobes are included by
some sources which are a central lobe, a limbic lobe, and an insular lobe.[9] The central lobe
comprises the precentral gyrus and the postcentral gyrus and is included since it forms a distinct
functional role.[9][10]
The brainstem, resembling a stalk, attaches to and leaves the cerebrum at the start of
the midbrain area. The brainstem includes the midbrain, the pons, and the medulla oblongata.
Behind the brainstem is the cerebellum (Latin: little brain).[7]
The cerebrum, brainstem, cerebellum, and spinal cord are covered by three membranes
called meninges. The membranes are the tough dura mater; the middle arachnoid mater and the
more delicate inner pia mater. Between the arachnoid mater and the pia mater is the subarachnoid
space and subarachnoid cisterns, which contain the cerebrospinal fluid.[11] The outermost membrane
of the cerebral cortex is the basement membrane of the pia mater called the glia limitans and is an
important part of the blood–brain barrier.[12] The living brain is very soft, having a gel-like consistency
similar to soft tofu.[13] The cortical layers of neurons constitute much of the cerebral grey matter, while
the deeper subcortical regions of myelinated axons, make up the white matter.[14] The white matter of
the brain makes up about half of the total brain volume.
The cerebrum is the largest part of the brain, and is divided into nearly symmetrical left and
right hemispheres by a deep groove, the longitudinal fissure.[16] Asymmetry between the lobes is
noted as a petalia.[17] The hemispheres are connected by five commissures that span the longitudinal
fissure, the largest of these is the corpus callosum.[7] Each hemisphere is conventionally divided into
four main lobes; the frontal lobe, parietal lobe, temporal lobe, and occipital lobe, named according to
the skull bones that overlie them.[8]Each lobe is associated with one or two specialised functions
though there is some functional overlap between them.[18] The surface of the brain is folded into
ridges (gyri) and grooves (sulci), many of which are named, usually according to their position, such
as the frontal gyrus of the frontal lobe or the central sulcus separating the central regions of the
hemispheres. There are many small variations in the secondary and tertiary folds.[19]
The outer part of the cerebrum is the cerebral cortex, made up of grey matter arranged in layers. It is
2 to 4 millimetres (0.079 to 0.157 in) thick, and deeply folded to give a convoluted
appearance.[20] Beneath the cortex is the cerebral white matter. The largest part of the cerebral
cortex is the neocortex, which has six neuronal layers. The rest of the cortex is of allocortex, which
has three or four layers.[21]
The cortex is mapped by divisions into about fifty different functional areas known as Brodmann's
areas. These areas are distinctly different when seen under a microscope.[22]The cortex is divided
into two main functional areas – a motor cortex and a sensory cortex.[23] The primary motor cortex,
which sends axons down to motor neurons in the brainstem and spinal cord, occupies the rear
portion of the frontal lobe, directly in front of the somatosensory area. The primary sensory
areas receive signals from the sensory nerves and tracts by way of relay nuclei in the thalamus.
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Primary sensory areas include the visual cortex of the occipital lobe, the auditory cortex in parts of
the temporal lobe and insular cortex, and the somatosensory cortex in the parietal lobe. The
remaining parts of the cortex, are called the association areas. These areas receive input from the
sensory areas and lower parts of the brain and are involved in the complex cognitive
processes of perception, thought, and decision-making.[24] The main functions of the frontal lobe are
to control attention, abstract thinking, behaviour, problem solving tasks, and physical reactions and
personality.[25][26] The occipital lobe is the smallest lobe; its main functions are visual reception, visual-
spatial processing, movement, and colour recognition.[25][26] There is a smaller occipital lobule in the
lobe known as the cuneus. The temporal lobe controls auditory and visual memories, language, and
some hearing and speech.[25]
The cerebrum contains the ventricles where the cerebrospinal fluid is produced and circulated.
Below the corpus callosum is the septum pellucidum, a membrane that separates the lateral
ventricles. Beneath the lateral ventricles is the thalamus and to the front and below this is
the hypothalamus. The hypothalamus leads on to the pituitary gland. At the back of the thalamus is
the brainstem.[27]
The basal ganglia, also called basal nuclei, are a set of structures deep within the hemispheres
involved in behaviour and movement regulation.[28] The largest component is the striatum, others are
the globus pallidus, the substantia nigra and the subthalamic nucleus.[28] Part of the dorsal striatum,
the putamen, and the globus pallidus, lie separated from the lateral ventricles and thalamus by
the internal capsule, whereas the caudate nucleus stretches around and abuts the lateral ventricles
on their outer sides.[29] At the deepest part of the lateral sulcus between the insular cortex and the
striatum is a thin neuronal sheet called the claustrum.[30]
Below and in front of the striatum are a number of basal forebrain structures. These include
the nucleus accumbens, nucleus basalis, diagonal band of Broca, substantia innominata, and
the medial septal nucleus. These structures are important in producing
the neurotransmitter, acetylcholine, which is then distributed widely throughout the brain. The basal
forebrain, in particular the nucleus basalis, is considered to be the major cholinergic output of the
central nervous system to the striatum and neocortex.
The cerebellum is divided into an anterior lobe, a posterior lobe, and the flocculonodular lobe.[32] The
anterior and posterior lobes are connected in the middle by the vermis.[33] The cerebellum has a
much thinner outer cortex that is narrowly furrowed horizontally.[33] Viewed from underneath between
the two lobes is the third lobe the flocculonodular lobe.[34] The cerebellum rests at the back of
the cranial cavity, lying beneath the occipital lobes, and is separated from these by the cerebellar
tentorium, a sheet of fibre.[35]
It is connected to the midbrain of the brainstem by the superior cerebellar peduncles, to the pons by
the middle cerebellar peduncles, and to the medulla by the inferior cerebellar peduncles.[33] The
cerebellum consists of an inner medulla of white matter and an outer cortex of richly folded grey
matter.[35] The cerebellum's anterior and posterior lobes appear to play a role in the coordination and
smoothing of complex motor movements, and the flocculonodular lobe in the maintenance
of balance[36] although debate exists as to its cognitive, behavioural and motor functions.
The brainstem lies beneath the cerebrum and consists of the midbrain, pons and medulla. It lies in
the back part of the skull, resting on the part of the base known as the clivus, and ends at
the foramen magnum, a large opening in the occipital bone. The brainstem continues below this as
the spinal cord,[38] protected by the vertebral column.
Ten of the twelve pairs of cranial nerves[a] emerge directly from the brainstem.[38] The brainstem also
contains many cranial nerve nuclei and nuclei of peripheral nerves, as well as nuclei involved in the
regulation of many essential processes including breathing, control of eye movements and
balance.[39][38] The reticular formation, a network of nuclei of ill-defined formation, is present within and
along the length of the brainstem.[38] Many nerve tracts, which transmit information to and from the
cerebral cortex to the rest of the body, pass through the brainstem.
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The human brain is primarily composed of neurons, glial cells, neural stem cells, and blood vessels.
Types of neuron include interneurons, pyramidal cells including Betz cells, motor
neurons (upper and lower motor neurons), and cerebellar Purkinje cells. Betz cells are the largest
cells (by size of cell body) in the nervous system.[40] The adult human brain is estimated to contain
86±8 billion neurons, with a roughly equal number (85±10 billion) of non-neuronal cells.[41] Out of
these neurons, 16 billion (19%) are located in the cerebral cortex, and 69 billion (80%) are in the
cerebellum.[4][41]
Types of glial cell are astrocytes (including Bergmann glia), oligodendrocytes, ependymal
cells (including tanycytes), radial glial cells, microglia, and a subtype of oligodendrocyte progenitor
cells. Astrocytes are the largest of the glial cells. They are stellate cells with many processes
radiating from their cell bodies. Some of these processes end as perivascular end-feet
on capillary walls.[42] The glia limitans of the cortex is made up of astrocyte foot processes that serve
in part to contain the cells of the brain.[12]
Mast cells are white blood cells that interact in the neuroimmune system in the brain.[43] Mast cells in
the central nervous system are present in the meninges;[43] they mediate neuroimmune responses in
inflammatory conditions and help to maintain the blood–brain barrier, particularly in brain regions
where the barrier is absent.[43][44] Across systems, mast cells serve as the main effector cell through
which pathogens can affect the gut–brain axis.[45][46]
Some 400 genes are shown to be brain-specific. In all neurons, ELAVL3 is expressed, and in
pyramidal neurons, NRGN and REEP2 are also expressed. GAD1 – essential for the biosynthesis of
the neurotransmitter GABA – is expressed in interneurons. Proteins expressed in glial cells are
astrocyte markers GFAP, and S100B. Myelin basic protein, and the transcription factor, OLIG2 are
expressed in oligodendrocytes.
Cerebrospinal fluid is a clear, colourless transcellular fluid that circulates around the brain in
the subarachnoid space, in the ventricular system, and in the central canal of the spinal cord. It also
fills some gaps in the subarachnoid space, known as subarachnoid cisterns.[48] The four ventricles,
two lateral, a third, and a fourth ventricle, all contain choroid plexus that produces cerebrospinal
fluid.[49] The third ventricle lies in the midline and is connected to the lateral ventricles.[48] A
single duct, the cerebral aqueduct between the pons and the cerebellum, connects the third ventricle
to the fourth ventricle.[50] Three separate openings, the middle and two lateral apertures, drain the
cerebrospinal fluid from the fourth ventricle to the cisterna magna one of the major cisterns. From
here, cerebrospinal fluid circulates around the brain and spinal cord in the subarachnoid space,
between the arachnoid mater and pia mater.[48] At any one time, there is about 150mL of
cerebrospinal fluid – most within the subarachnoid space. It is constantly being regenerated and
absorbed, and replaces about once every 5–6 hours.[48]
A glymphatic system has been described[51][52][53] as the lymphatic drainage system of the brain. The
brain-wide glymphatic pathway includes drainage routes from the cerebrospinal fluid, and from
the meningeal lymphatic vessels that are associated with the dural sinuses, and run alongside the
cerebral blood vessels.The pathway drains interstitial fluid from the tissue of the brain.
The internal carotid arteries supply oxygenated blood to the front of the brain and the vertebral
arteries supply blood to the back of the brain.[56] These two circulations join together in the circle of
Willis, a ring of connected arteries that lies in the interpeduncular cistern between the midbrain and
pons.[57]
The internal carotid arteries are branches of the common carotid arteries. They enter
the cranium through the carotid canal, travel through the cavernous sinus and enter
the subarachnoid space.[58] They then enter the circle of Willis, with two branches, the anterior
cerebral arteries emerging. These branches travel forward and then upward along the longitudinal
fissure, and supply the front and midline parts of the brain.[59] One or more small anterior
communicating arteries join the two anterior cerebral arteries shortly after they emerge as
branches.[59] The internal carotid arteries continue forward as the middle cerebral arteries. They
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travel sideways along the sphenoid bone of the eye socket, then upwards through the insula cortex,
where final branches arise. The middle cerebral arteries send branches along their length.[58]
The vertebral arteries emerge as branches of the left and right subclavian arteries. They travel
upward through transverse foramina – spaces in the cervical vertebrae and then emerge as two
vessels, one on the left and one on the right of the medulla.[58] They give off one of the three
cerebellar branches. The vertebral arteries join in front of the middle part of the medulla to form the
larger basilar artery, which sends multiple branches to supply the medulla and pons, and the two
other anterior and superior cerebellar branches.[60] Finally, the basilar artery divides into two posterior
cerebral arteries. These travel outwards, around the superior cerebellar peduncles, and along the
top of the cerebellar tentorium, where it sends branches to supply the temporal and occipital
lobes.[60] Each posterior cerebral artery sends a small posterior communicating artery to join with the
internal carotid arteries.
Cerebral veins drain deoxygenated blood from the brain. The brain has two main networks of veins:
an exterior or superficial network, on the surface of the cerebrum that has three branches, and
an interior network. These two networks communicate via anastomosing (joining) veins.[61] The veins
of the brain drain into larger cavities the dural venous sinusesusually situated between the dura
mater and the covering of the skull.[62] Blood from the cerebellum and midbrain drains into the great
cerebral vein. Blood from the medulla and pons of the brainstem have a variable pattern of drainage,
either into the spinal veins or into adjacent cerebral veins.[61]
The blood in the deep part of the brain drains, through a venous plexus into the cavernous sinus at
the front, and the superior and inferior petrosal sinuses at the sides, and the inferior sagittal sinus at
the back.[62] Blood drains from the outer brain into the large superior sagittal sinus, which rests in the
midline on top of the brain. Blood from here joins with blood from the straight sinus at the confluence
of sinuses.[62]
Blood from here drains into the left and right transverse sinuses.[62] These then drain into the sigmoid
sinuses, which receive blood from the cavernous sinus and superior and inferior petrosal sinuses.
The sigmoid drains into the large internal jugular veins.
The larger arteries throughout the brain supply blood to smaller capillaries. These smallest of blood
vessels in the brain, are lined with cells joined by tight junctions and so fluids do not seep in or leak
out to the same degree as they do in other capillaries, thereby creating the blood–brain
barrier.[44] Pericytes play a major role in the formation of the tight junctions.[63] The barrier is less
permeable to larger molecules, but is still permeable to water, carbon dioxide, oxygen, and most fat-
soluble substances (including anaesthetics and alcohol).[44] The blood–brain barrier is not present in
the circumventricular organs, structures in the brain that may need to respond to changes in body
fluids, such as the pineal gland, area postrema, and some areas of the hypothalamus.[44] There is a
similar blood–cerebrospinal fluid barrier, which serves the same purpose as the blood–brain barrier,
but facilitates the transport of different substances into the brain due to the distinct structural
characteristics between the two barrier systems.
At the beginning of the third week of development, the embryonic ectoderm forms a thickened strip
called the neural plate.[65] By the fourth week of development the neural plate has widened to give a
broad cephalic end, a less broad middle part and a narrow caudal end. These swellings are known
as the primary brain vesicles and represent the beginnings of
the forebrain, midbrain and hindbrain.[66]
Neural crest cells (derived from the ectoderm) populate the lateral edges of the plate at the neural
folds. In the fourth week in the neurulation stage the neural folds close to form the neural tube,
bringing together the neural crest cells at the neural crest.[67] The neural crest runs the length of the
tube with cranial neural crest cells at the cephalic end and caudal neural crest cells at the tail. Cells
detach from the crest and migrate in a craniocaudal (head to tail) wave inside the tube.[67] Cells at the
cephalic end give rise to the brain, and cells at the caudal end give rise to the spinal cord.[68]
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The tube flexes as it grows, forming the crescent-shaped cerebral hemispheres at the head. The
cerebral hemispheres first appear on day 32.[69] Early in the fourth week the cephalic part bends
sharply forward in a cephalic flexure.[67] This flexed part becomes the forebrain (prosencephalon); the
adjoining curving part becomes the midbrain (mesencephalon) and the part caudal to the flexure
becomes the hindbrain (rhombencephalon). These areas are formed as swellings known as the
three primitive vesicles. In the fifth week of development five brain vesicles have formed.[70] The
forebrain separates into two vesicles – an anterior telencephalon and a posterior diencephalon. The
telencephalon gives rise to the cerebral cortex, basal ganglia, and related structures. The
diencephalon gives rise to the thalamus and hypothalamus. The hindbrain also splits into two areas
– the metencephalon and the myelencephalon. The metencephalon gives rise to the cerebellum and
pons. The myelencephalon gives rise to the medulla oblongata.[71]Also during the fifth week, the brain
divides into repeating segments called neuromeres.[66][72] In the hindbrain these are known
as rhombomeres.[73]
A characteristic of the brain is the cortical folding known as gyrification. During fetal development,
the cortex starts off smooth. By the gestational age of 24 weeks, the wrinkled morphology showing
the fissures that begin to mark out the lobes of the brain is evident.[74] Scientists do not have a clear
answer as to why the cortex wrinkles and folds, but they have linked gyrification with intelligence
and neurological disorders, and have proposed a number of gyrification theories.[74] These theories
include those based on mechanical buckling,[75][18] axonal tension,[76] and differential tangential
expansion.[75]
The first cleft to appear in the fourth month is the lateral cerebral fossa.[69] The expanding caudal end
of the hemisphere has to curve over in a forward direction to fit into the restricted space. This covers
the fossa and turns it into a much deeper ridge known as the lateral sulcus and this marks out the
temporal lobe.[69] By the sixth month other sulci have formed that demarcate the frontal, parietal, and
occipital lobes.[69] A gene present in the human genome (ArhGAP11B) may play a major role in
gyrification and encephalisation.
The motor system of the brain is responsible for the generation and control of
movement.[78] Generated movements pass from the brain through nerves to motor neurons in the
body, which control the action of muscles. The corticospinal tract carries movements from the brain,
through the spinal cord, to the torso and limbs.[79] The cranial nerves carry movements related to the
eyes, mouth and face.
Gross movement – such as locomotion and the movement of arms and legs – is generated in
the motor cortex, divided into three parts: the primary motor cortex, found in the prefrontal gyrus and
has sections dedicated to the movement of different body parts. These movements are supported
and regulated by two other areas, lying anterior to the primary motor cortex: the premotor area and
the supplementary motor area.[80] The hands and mouth have a much larger area dedicated to them
than other body parts, allowing finer movement; this has been visualised in a motor
homunculus.[80] Impulses generated from the motor cortex travel along the corticospinal tract along
the front of the medulla and cross over (decussate) at the medullary pyramids. These then travel
down the spinal cord, with most connecting to interneurons, in turn connecting to lower motor
neuronswithin the grey matter that then transmit the impulse to move to muscles themselves.[79] The
cerebellum and basal ganglia, play a role in fine, complex and coordinated muscle
movements.[81] Connections between the cortex and the basal ganglia control muscle tone, posture
and movement initiation, and are referred to as the extrapyramidal system.
The sensory nervous system is involved with the reception and processing of sensory information.
This information is received through the cranial nerves, through tracts in the spinal cord, and directly
at centres of the brain exposed to the blood.[83] The brain also receives and interprets information
from the special senses of vision, smell, hearing, and taste. Mixed motor and sensory signals are
also integrated.[83]
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From the skin, the brain receives information about fine


touch, pressure, pain, vibration and temperature. From the joints, the brain receives information
about joint position.[84] The sensory cortex is found just near the motor cortex, and, like the motor
cortex, has areas related to sensation from different body parts. Sensation collected by a sensory
receptoron the skin is changed to a nerve signal, that is passed up a series of neurons through tracts
in the spinal cord. The dorsal column–medial lemniscus pathway contains information about fine
touch, vibration and position of joints. Neurons travel up the back part of the spinal cord to the back
part of the medulla, where they connect with second-order neuronsthat immediately swap sides.
These neurons then travel upwards into the ventrobasal complex in the thalamus where they
connect with third-order neurons and travel up to the sensory cortex.[84]The spinothalamic
tract carries information about pain, temperature, and gross touch. Neurons travel up the spinal cord
and connect with second-order neurons in the reticular formation of the brainstem for pain and
temperature, and also at the ventrobasal complex of the medulla for gross touch.[85]
Vision is generated by light that hits the retina of the eye. Photoreceptors in the retina transduce the
sensory stimulus of light into an electrical nerve signal that is sent to the visual cortexin the occipital
lobe. Vision from the left visual field is received on the right side of each retina (and vice versa) and
passes through the optic nerve until some information changes sides, so that all information about
one side of the visual field passes through tracts in the opposite side of the brain. The nerves reach
the brain at the lateral geniculate nucleus, and travel through the optic radiation to reach the visual
cortex.[86]
Hearing and balance are both generated in the inner ear. The movement of liquids within the inner
ear is generated by motion (for balance) and transmitted vibrations generated by the ossicles (for
sound). This creates a nerve signal that passes through the vestibulocochlear nerve. From here, it
passes through to the cochlear nuclei, the superior olivary nucleus, the medial geniculate nucleus,
and finally the auditory radiation to the auditory cortex.[87]
The sense of smell is generated by receptor cells in the epithelium of the olfactory mucosa in
the nasal cavity. This information passes through a relatively permeable part of the skull to
the olfactory nerve. This nerve transmits to the neural circuitry of the olfactory bulb from where
information is passed to the olfactory cortex.[88][89] Taste is generated from receptors on the
tongue and passed along the facial and glossopharyngeal nerves into the solitary tract in the
brainstem. Some taste information is also passed from the pharynx into this area via the vagus
nerve. Information is then passed from here through the thalamus into the gustatory cortex.
Autonomic functions of the brain include the regulation, or rhythmic control of the heart rate and rate
of breathing, and maintaining homeostasis.
Blood pressure and heart rate are influenced by the vasomotor centre of the medulla, which causes
arteries and veins to be somewhat constricted at rest. It does this by influencing
the sympathetic and parasympathetic nervous systems via the vagus nerve.[91] Information about
blood pressure is generated by baroreceptors in aortic bodies in the aortic arch, and passed to the
brain along the afferent fibres of the vagus nerve. Information about the pressure changes in
the carotid sinus comes from carotid bodies located near the carotid artery and this is passed via
a nerve joining with the glossopharyngeal nerve. This information travels up to the solitary nucleus in
the medulla. Signals from here influence the vasomotor centre to adjust vein and artery constriction
accordingly.[92]
The brain controls the rate of breathing, mainly by respiratory centres in the medulla and
pons.[93] The respiratory centres control respiration, by generating motor signals that are passed
down the spinal cord, along the phrenic nerve to the diaphragm and other muscles of respiration.
This is a mixed nerve that carries sensory information back to the centres. There are four respiratory
centres, three with a more clearly defined function, and an apneustic centre with a less clear
function. In the medulla a dorsal respiratory group causes the desire to breathe in and receives
sensory information directly from the body. Also in the medulla, the ventral respiratory group
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influences breathing out during exertion. In the pons the pneumotaxic centre influences the duration
of each breath,[93] and the apneustic centre seems to have an influence on inhalation. The respiratory
centres directly senses blood carbon dioxide and pH. Information about blood oxygen, carbon
dioxide and pH levels are also sensed on the walls of arteries in the peripheral chemoreceptors of
the aortic and carotid bodies. This information is passed via the vagus and glossopharyngeal nerves
to the respiratory centres. High carbon dioxide, an acidic pH, or low oxygen stimulate the respiratory
centres.[93] The desire to breathe in is also affected by pulmonary stretch receptors in the lungs
which, when activated, prevent the lungs from overinflating by transmitting information to the
respiratory centres via the vagus nerve.[93]
The hypothalamus in the diencephalon, is involved in regulating many functions of the body.
Functions include neuroendocrine regulation, regulation of the circadian rhythm, control of
the autonomic nervous system, and the regulation of fluid, and food intake. The circadian rhythm is
controlled by two main cell groups in the hypothalamus. The anterior hypothalamus includes
the suprachiasmatic nucleus and the ventrolateral preoptic nucleus which through gene expression
cycles, generates a roughly 24 hour circadian clock. In the circadian day an ultradian rhythm takes
control of the sleeping pattern. Sleep is an essential requirement for the body and brain and allows
the closing down and resting of the body's systems. There are also findings that suggest that the
daily build-up of toxins in the brain are removed during sleep.[94] Whilst awake the brain consumes a
fifth of the body's total energy needs. Sleep necessarily reduces this use and gives time for the
restoration of energy-giving ATP. The effects of sleep deprivation show the absolute need for
sleep.[95]
The lateral hypothalamus contains orexinergic neurons that control appetite and arousal through
their projections to the ascending reticular activating system.[96][97] The hypothalamus controls
the pituitary gland through the release of peptides such as oxytocin, and vasopressin, as well
as dopamine into the median eminence. Through the autonomic projections, the hypothalamus is
involved in regulating functions such as blood pressure, heart rate, breathing, sweating, and other
homeostatic mechanisms.[98] The hypothalamus also plays a role in thermal regulation, and when
stimulated by the immune system, is capable of generating a fever. The hypothalamus is influenced
by the kidneys – when blood pressure falls, the renin released by the kidneys stimulates a need to
drink. The hypothalamus also regulates food intake through autonomic signals, and hormone
release by the digestive system.
The study on how language is represented, processed, and acquired by the brain is
called neurolinguistics, which is a large multidisciplinary field drawing from cognitive
neuroscience, cognitive linguistics, and psycholinguistics.
The cerebrum has a contralateral organisation with each hemisphere of the brain interacting
primarily with one half of the body: the left side of the brain interacts with the right side of the body,
and vice versa. The developmental cause for this is uncertain.[105] Motor connections from the brain
to the spinal cord, and sensory connections from the spinal cord to the brain, both cross sides in the
brainstem. Visual input follows a more complex rule: the optic nerves from the two eyes come
together at a point called the optic chiasm, and half of the fibres from each nerve split off to join the
other.[106] The result is that connections from the left half of the retina, in both eyes, go to the left side
of the brain, whereas connections from the right half of the retina go to the right side of the
brain.[107] Because each half of the retina receives light coming from the opposite half of the visual
field, the functional consequence is that visual input from the left side of the world goes to the right
side of the brain, and vice versa.[105] Thus, the right side of the brain receives somatosensory input
from the left side of the body, and visual input from the left side of the visual field.[108][109]
The left and right sides of the brain appear symmetrical, but they function asymmetrically.[110] For
example, the counterpart of the left-hemisphere motor area controlling the right hand is the right-
hemisphere area controlling the left hand. There are, however, several important exceptions,
involving language and spatial cognition. The left frontal lobe is dominant for language. If a key
language area in the left hemisphere is damaged, it can leave the victim unable to speak or
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understand,[110] whereas equivalent damage to the right hemisphere would cause only minor
impairment to language skills.
A substantial part of current understanding of the interactions between the two hemispheres has
come from the study of "split-brain patients"—people who underwent surgical transection of the
corpus callosum in an attempt to reduce the severity of epileptic seizures.[111] These patients do not
show unusual behaviour that is immediately obvious, but in some cases can behave almost like two
different people in the same body, with the right hand taking an action and then the left hand
undoing it.[111][112] These patients, when briefly shown a picture on the right side of the point of visual
fixation, are able to describe it verbally, but when the picture is shown on the left, are unable to
describe it, but may be able to give an indication with the left hand of the nature of the object shown.
Emotions are generally defined as two-step multicomponent processes involving elicitation, followed
by psychological feelings, appraisal, expression, autonomic responses, and action
tendencies.[114] Attempts to localize basic emotions to certain brain regions have been controversial,
with some research finding no evidence for specific locations corresponding to emotions, and
instead circuitry involved in general emotional processes. The amygdala, orbitofrontal cortex, mid
and anterior insula cortex and lateral prefrontal cortex, appeared to be involved in generating the
emotions, while weaker evidence was found for the ventral tegmental area, ventral
pallidum and nucleus accumbens in incentive salience.[115] Others, however, have found evidence of
activation of specific regions, such as the basal ganglia in happiness, the subcallosal cingulate
cortex in sadness, and amygdala in fear
The brain is responsible for cognition,[117][118] which functions through
numerous processes and executive functions.[118][119][120] Executive functions include the ability to filter
information and tune out irrelevant stimuli with attentional control and cognitive inhibition, the ability
to process and manipulate information held in working memory, the ability to think about multiple
concepts simultaneously and switch tasks with cognitive flexibility, the ability to
inhibit impulses and prepotent responses with inhibitory control, and the ability to determine the
relevance of information or appropriateness of an action.[119][120] Higher order executive functions
require the simultaneous use of multiple basic executive functions, and include planning and fluid
intelligence (i.e., reasoning and problem solving).[120]
The prefrontal cortex plays a significant role in mediating executive functions.[118][120][121] Planning
involves activation of the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex, angular
prefrontal cortex, right prefrontal cortex, and supramarginal gyrus.[121] Working memory manipulation
involves the DLPFC, inferior frontal gyrus, and areas of the parietal cortex.[118][121] Inhibitory
control involves multiple areas of the prefrontal cortex, as well as the caudate
nucleus and subthalamic nucleus.
Brain activity is made possible by the interconnections of neurons that are linked together to reach
their targets.[123] A neuron consists of a cell body, axon, and dendrites. Dendrites are often extensive
branches that receive information in the form of signals from the axon terminals of other neurons.
The signals received may cause the neuron to initiate an action potential (an electrochemical signal
or nerve impulse) which is sent along its axon to the axon terminal, to connect with the dendrites or
with the cell body of another neuron. An action potential is initiated at the initial segment of an axon,
which contains a complex of proteins.[124] When an action potential, reaches the axon terminal it
triggers the release of a neurotransmitter at a synapse that propagates a signal that acts on the
target cell.[125] These chemical neurotransmitters include dopamine, serotonin, GABA, glutamate,
and acetylcholine.[126] GABA is the major inhibitory neurotransmitter in the brain, and glutamate is the
major excitatory neurotransmitter.[127] Neurons link at synapses to form neural pathways, neural
circuits, and large elaborate network systems such as the salience network and the default mode
network, and the activity between them is driven by the process of neurotransmission.
The brain consumes up to 20% of the energy used by the human body, more than any other
organ.[128] In humans, blood glucose is the primary source of energy for most cells and is critical for
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normal function in a number of tissues, including the brain.[129] The human brain consumes
approximately 60% of blood glucose in fasted, sedentary individuals.[129] Brain metabolism normally
relies upon blood glucose as an energy source, but during times of low glucose (such
as fasting, endurance exercise, or limited carbohydrate intake), the brain uses ketone bodies for fuel
with a smaller need for glucose. The brain can also utilize lactate during exercise.[130] The brain
stores glucose in the form of glycogen, albeit in significantly smaller amounts than that found in
the liver or skeletal muscle.[131] Long-chain fatty acids cannot cross the blood–brain barrier, but the
liver can break these down to produce ketone bodies. However, short-chain fatty acids (e.g., butyric
acid, propionic acid, and acetic acid) and the medium-chain fatty acids, octanoic acid and heptanoic
acid, can cross the blood–brain barrier and be metabolized by brain cells.[132][133][134]
Although the human brain represents only 2% of the body weight, it receives 15% of the cardiac
output, 20% of total body oxygen consumption, and 25% of total body glucoseutilization.[135] The
brain mostly uses glucose for energy, and deprivation of glucose, as can happen in hypoglycemia,
can result in loss of consciousness.[136] The energy consumption of the brain does not vary greatly
over time, but active regions of the cortex consume somewhat more energy than inactive regions:
this fact forms the basis for the functional brain imaging methods PET and fMRI.[137] These functional
imaging techniques provide a three-dimensional image of metabolic activity.[138]
The function of sleep is not fully understood; however, there is evidence that sleep enhances the
clearance of metabolic waste products, some of which are potentially neurotoxic, from the brain and
may also permit repair.[53][139][140] Evidence suggests that the increased clearance of metabolic waste
during sleep occurs via increased functioning of the glymphatic system.[53] Sleep may also have an
effect on cognitive function by weakening unnecessary connections
Injury to the brain can manifest in many ways. Traumatic brain injury, for example received
in contact sport, after a fall, or a traffic or work accident, can be associated with both immediate and
longer-term problems. Immediate problems may include bleeding within the brain, this may
compress the brain tissue or damage its blood supply. Bruising to the brain may occur. Bruising may
cause widespread damage to the nerve tracts that can lead to a condition of diffuse axonal
injury.[167] A fractured skull, injury to a particular area, deafness, and concussion are also possible
immediate developments. In addition to the site of injury, the opposite side of the brain may be
affected, termed a contrecoup injury. Longer-term issues that may develop include posttraumatic
stress disorder, and hydrocephalus. Chronic traumatic encephalopathy can develop following
multiple head injuries.
Neurodegenerative diseases result in progressive damage to different parts of the brain's function,
and worsen with age. Common examples include dementia such as Alzheimer's disease, alcoholic
dementia or vascular dementia; Parkinson's disease; and other rarer infectious, genetic, or metabolic
causes such as Huntington's disease, motor neuron diseases, HIV dementia, syphilis-related
dementia and Wilson's disease. Neurodegenerative diseases can affect different parts of the brain,
and can affect movement, memory, and cognition.[169]
The brain, although protected by the blood–brain barrier, can be affected by infections
including viruses, bacteria and fungi. Infection may be of the meninges (meningitis), the brain matter
(encephalitis), or within the brain matter (such as a cerebral abscess).[170] Rare prion
diseases including Creutzfeldt–Jakob disease and its variant, and kuru may also affect the brain.
Brain tumours can be either benign or cancerous. Most malignant tumours arise from another part of
the body, most commonly from the lung, breast and skin.[171] Cancers of brain tissue can also occur,
and originate from any tissue in and around the brain. Meningioma, cancer of the meninges around
the brain, is more common than cancers of brain tissue.[171] Cancers within the brain may cause
symptoms related to their size or position, with symptoms including headache and nausea, or the
gradual development of focal symptoms such as gradual difficulty seeing, swallowing, talking, or as
a change of mood.[171] Cancers are in general investigated through the use of CT scans and MRI
scans. A variety of other tests including blood tests and lumbar puncture may be used to investigate
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for the cause of the cancer and evaluate the type and stage of the
cancer.[171] The corticosteroid dexamethasone is often given to decrease the swelling of brain tissue
around a tumour. Surgery may be considered, however given the complex nature of many tumours
or based on tumour stage or type, radiotherapy or chemotherapy may be considered more suitable.
A stroke is a decrease in blood supply to an area of the brain causing cell death and brain injury.
This can lead to a wide range of symptoms, including the "FAST" symptoms of facial droop, arm
weakness, and speech difficulties (including with speaking and finding words or forming sentences).
Brain death refers to an irreversible total loss of brain function.[193][194] This is characterised by coma,
loss of reflexes, and apnoea,[193] however, the declaration of brain death varies geographically and is
not always accepted.[194] In some countries there is also a defined syndrome of brainstem
death.[195] Declaration of brain death can have profound implications as the declaration, under the
principle of medical futility, will be associated with the withdrawal of life support,[196] and as those with
brain death often have organs suitable for organ donation.[194][197] The process is often made more
difficult by poor communication with patients' families.[198]
When brain death is suspected, reversible differential diagnoses such as, electrolyte, neurological
and drug-related cognitive suppression need to be excluded.[193][196] Testing for reflexes[b] can be of
help in the decision, as can the absence of response and breathing.[196] Clinical observations,
including a total lack of responsiveness, a known diagnosis, and neural imaging evidence, may all
play a role in the decision to pronounce brain death.

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