• The outer adrenal cortex secretes steroid hor- mones. These include the glucocorticoids, which influence glucose metabolism; the miner- alocorticoids, which control electrolyte balance;
and androgens, or male sex hormones.
The principal glucocorticoids are cortisol, corti- sone, and corticosterone, which decrease glucose consumption and promote fat usage. They also reduce inflammation, accounting for their use on skin rashes and other irritations. Aldosterone is the principal mineralocorticoid, helping regulate sodium and water balance in the kidneys.
Gonads
The gonads are the ovaries and testes. The testes produce testosterone, the principal male sex hor- mone. Testosterone promotes sperm maturation, increases protein synthesis in skeletal muscle, and causes the development of male secondary sex characteristics, including facial hair and a deep voice. The ovaries produce estrogens and proges- terone, whose functions include regulation of the menstrual cycle, development of the uterus, and development of the mammary glands and other female secondary sex characteristics.
Disorders of the Endocrine System Disorders affecting the endocrine system most often involve either hypersecretion or hyposecre- tion (Box 6-8). Hypersecretion is most often caused by a tumor of the glandular tissue or excess admin- istration (as with insulin); hyposecretion may result from genetic disease, autoimmunity, or nutritional
deficiency. Diseases of the endocrine system are treated by an endocrinologist. Common laboratory tests ordered for these disorders are listed in Table 6-8.
Urinary bladder Penile urethra
Vas deferens Penis
Glans penis Prepuce (foreskin)
External urethral orifice
Testis Scrotum Epididymis
Bulbourethral (Cowper's) gland
Anus
Prostate gland Rectum
FIGURE 6-20 The male reproductive system.
Ovary Uterus
Urethra Urinary bladder
Clitoris
Fallopian tube
Cervix
Rectum Vagina Anus
Labium minus Labium majus
FIGURE 6-21 The female reproductive system.
whose spongy muscular tissue swells with blood during erection. Ejaculation occurs when strong peristaltic contractions of urethral smooth muscle propel the semen out of the urethra.
Female Reproductive System
The ovaries produce eggs during early develop- ment. Beginning at puberty, one or more eggs ma- ture each month, under the influence of the pituitary hormones FSH and LH. At the same time, estrogens
and progesterone produced by the ovaries induce changes in the uterine lining in preparation for im- plantation of a fertilized egg, including tissue buildup and increased blood flow. Ovulation, or release of the egg, is triggered by a sharp spike in LH levels. The egg enters the fallopian tube (Figure 6-21), where it is conveyed toward the uterus by cilia on the surface of the cells lining the tube. Fertilization occurs within the fallopian tube.
Fertilization can occur only when a sperm swims up
combine to create organ systems and, ultimately, the functioning body. Anatomic terminology is used to describe the relationships of body parts.
Each of the body systems—skeletal, muscular, in- tegumentary, nervous, digestive, urinary, respira- tory, endocrine, and reproductive—has its own set of organs and interactions that contribute to its function, as well as its own set of disorders. A sum- mary table of common laboratory tests, arranged by body system, is presented in Table 6-10.
BOX 6-9 Disorders of the Reproductive System Male Reproductive System
• Benign prostatic hyperplasia
• Prostate cancer
• Sexually transmitted infections (STIs)
• Gonorrhea
• Genital herpes
• Syphilis
• Human immunodeficiency virus (HIV)
• Sperm malformation Female Reproductive System
• Cancer
• Vaginal
• Cervical
• Uterine
• Fibroids: Benign uterine tumors
• Ovarian endometriosis: Endometrial tissue migrates to areas outside the uterus
• Pelvic inflammatory disease (PID): Infections in the pelvic region that cause infertility; can be caused by Chlamydia or other microorganisms
• Premenstrual syndrome (PMS)
• STIs
• Gonorrhea
• Genital herpes
• Syphilis
• HIV
• Chlamydia infection
• Trichomoniasis
• Toxic shock syndrome (TSS): Staphylococcus infection associated with use of superabsorbent tampons
Test Disorder or Purpose
Culture and sensitivity (C&S) Microbial infection Estradiol Assess ovarian or placental
function
Estrogen Assess ovarian function
Fluorescent treponemal antibody absorption test (FTA-ABS)
Syphilis
Human chorionic
gonadotropin (hCG) Assess for pregnancy or ectopic pregnancy
Pap smear Cervical or vaginal
carcinoma Prostate-specific antigen
(PSA) Prostate cancer
Rapid plasma reagin (RPR) Syphilis
Semen analysis Infertility; assess effectiveness of vasectomy
Testosterone Evaluation of testicular function
TABLE 6-9 Common Laboratory Tests for Reproductive Disorders the vagina, through the cervix, through the uterus,
and into the fallopian tube containing the egg and then unites with the egg, all within the 2 to 4 days after ovulation in which the egg remains viable.
Implantation of the fertilized egg in the wall of the uterus induces changes that lead to the develop- ment of the placenta. Among other hormones, the placenta releases human chorionic gonadotropin (hCG), which can be detected by early pregnancy tests. Without hCG, the uterine lining begins to de- teriorate shortly after ovulation, culminating in menstruation. An unfertilized egg passes out of the uterus at that time.
Disorders of the Reproductive Systems
Disorders of the male reproductive system are treated by a urologist or an endocrinologist.
Disorders of the female reproductive system are treated by an obstetrician/gynecologist or an endo- crinologist (Box 6-9). Infertility may be treated by a specialist. Common laboratory tests ordered for these disorders are listed in Table 6-9.
REVIEW FOR CERTIFICATION
Cells are the smallest unit of structure and function in the body and are made up of numerous subcel- lular structures, including the nucleus, the mito- chondria, and the plasma membrane. Cells of similar function combine to make tissue. The four tissue types—epithelial, connective, muscle, and nerve—combine to create organs, which in turn
TABLE 6-10 Summary of Common Laboratory Tests by Body System
Test Disorder or Purpose
Bone and Joints
Alkaline phosphatase (ALP) Bone metabolism marker
Anticitrullinated protein (rheumatoid factor [RF]) Rheumatoid arthritis (RA)
Calcium Mineral calcium imbalance
Erythrocyte sedimentation rate (ESR) General inflammation test
Fluorescent antinuclear antibody (ANA) Systemic lupus erythematosus (SLE)
Magnesium Mineral magnesium imbalance
Synovial fluid analysis Arthritis
Uric acid Gout
Digestive System
Amylase, lipase Pancreatitis
Carotene Steatorrhea (malabsorption syndrome causing fatty stools)
Complete blood count (CBC) Appendicitis
Gastrin Gastric malignancy
Liver tests
• ALP
• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• g-Glutamyltransferase (GCT)
• Bilirubin
• Hepatitis B surface antigen (HBsAG)
• Hepatitis C antibody
• Hepatitis C virus by polymerase chain reaction
• Ammonia
Liver disease
Occult blood Gastrointestinal bleeding
Ova and parasites (O&P) Parasitic infection
Stool culture Stool pathogens
Endocrine System
Calcium Parathyroid function
Catecholamines (epinephrine, norepinephrine) Adrenal function
Cortisol Adrenal cortex function and Addison disease
Fasting glucose or fasting blood sugar (FBS) Diabetes mellitus
Follicle-stimulating hormone (FSH) Infertility
Growth hormone (GH) Pituitary function
Luteinizing hormone (LH) Infertility
Parathyroid hormone (PTH) Parathyroid function
Phosphorus Parathyroid function
Testosterone Infertility
Triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH)
Graves disease and Hashimoto thyroiditis
Thyroid function studies Thyroid disorder
Vitamin D Parathyroid function
Integumentary System
Culture and sensitivity (C&S) Bacterial or fungal infection
Potassium hydroxide (KOH) prep Fungal infection
Skin biopsy Malignancy
Muscle
Aldolase Muscle disease
Aspartate aminotransferase (AST) Muscle disease
Creatine kinase (CK-MM) Muscle damage
CK isoenzymes (CK-MM, CK-MB) Cardiac muscle damage
Continued
TABLE 6-10 Summary of Common Laboratory Tests by Body System—cont’d
Test Disorder or Purpose
Lactate dehydrogenase Cardiac muscle damage
Myoglobin Muscle damage
Troponin Cardiac muscle damage
Nervous System
Cell count and differential Infection
Cerebrospinal fluid (CSF) analysis Meningitis, other neurologic disorders
CK isoenzymes (CK-BB) Brain damage (causes elevations)
Culture and Gram stain Infection
Protein and glucose Disorders of the nervous system
Reproductive System
Culture and sensitivity (C&S) Microbial infection
Estradiol Assess ovarian or placental function
Estrogen Assess ovarian function
Fluorescent treponemal antibody absorption test (FTA-ABS) Syphilis
Human chorionic gonadotropin (hCG) Assess for pregnancy or ectopic pregnancy
Pap smear Cervical or vaginal carcinoma
Prostate-specific antigen (PSA) Prostate cancer
Rapid plasma reagin (RPR) Syphilis
Semen analysis Infertility; assess effectiveness of vasectomy
Testosterone Evaluation of testicular function
Respiratory System
Arterial blood gases (ABGs): pH (acidity), Po2 (oxygen), Pco2 (carbon dioxide)
Most respiratory disorders; assess lung function Cold agglutinins (test for antibodies that react with red
blood cells at cold temperatures)
Atypical pneumonia
Electrolytes Impaired gas exchange
Microbiologic tests
• Cultures
• Throat swabs
• Bronchial washings
Microbial infection—pneumonia or pharyngitis
Purified protein derivative (PPD) Skin test for tuberculosis
Respiratory syncytial virus (RSV) Viral pneumonia
Urologic System
Blood urea nitrogen (BUN) Kidney disease
Creatinine Kidney disease
Creatinine clearance Glomerular filtration
Culture and sensitivity (C&S) Urinary tract infection (UTI)
Electrolytes Fluid balance
Osmolality Fluid balance
Protein/microalbumin Kidney disorders
Renin/angiotensin-converting enzyme (ACE) Hypertension
Routine urinalysis Screening for renal or metabolic disorders
BI BLIOG R AP HY
Hall JE: Guyton and Hall textbook of medical physiology, ed. 12,
Philadelphia, 2011, Saunders. Patton KT, Thibodeau GA: Anatomy & physiology, ed. 8, St. Louis, 2013, Mosby.
STUDY QUESTIONS
See answers in Appendix F.
1. What is homeostasis?
2. Name the four basic types of tissues that compose the human body, and give an example of each.
Match each term to its description:
3. Nucleus a. regulates the flow of materials in and out of the cell
b. “power plants” of the cell c. contains DNA
d. cellular material 4. Plasma membrane
5. Mitochondria 6. Cytoplasm
7. Describe the anatomic position.
8. What are body cavities?
Match each position to its description:
9. Ventral a. lying on the abdomen facing down b. toward the side
c. toward the middle d. straightening the joint e. front surface of the body f. below
g. back surface of the body h. lying on the back 10. Posterior
11. Lateral 12. Medial 13. Prone 14. Supine 15. Extension 16. Inferior
17. Name and describe the three body planes.
18. What is hematopoiesis?
19. Name three laboratory tests, and the disorders they test for, that are used to assess for bone and joint disorders.
20. ____________ is a bone infection that can be caused by improper phlebotomy technique.
21. Name four laboratory tests that are used to assess for muscle disorders.
22. What are the divisions of the CNS?
23. Name five laboratory tests that are used to assess for digestive disorders.
24. Describe the difference between external and internal respiration.
25. What does the endocrine system do?
26. Name the three types of joints, and give an example of each.
CERTIFICATION EXAMINATION PREPARATION
See answers in Appendix F.
1. The term to define the overall well-being of the body is
a. hemolysis.
b. hemostasis.
c. homeostasis.
d. hematopoiesis.
2. The functional unit of the nervous systems is a. nephron.
b. neuron.
c. neoplasm.
d. nucleus.
12. Pancreatitis can be screened for by performing which laboratory test?
a. Amylase b. CSF c. Myoglobin d. Occult blood
13. The functional unit of the kidney is known as the a. neuron.
b. medulla.
c. thalamus.
d. nephron.
14. Microbiology may perform the following laboratory test for urologic disorders:
a. BUN.
b. PPD.
c. C&S.
d. FBS.
15. ABGs typically test for a. digestive disorders.
b. urinary disorders.
c. respiratory disorders.
d. muscular disorders.
16. The hormone that regulates the amount of calcium and phosphorus in the circulation is
a. insulin.
b. thymosin.
c. oxytocin.
d. parathyroid hormone.
17. Which hormone regulates water reabsorption by the kidney?
a. ACTH b. TSH c. ADH d. MSH
18. The hormone that can be detected by early pregnancy tests is
a. hCG.
b. ADH.
c. GH.
d. MSH.
19. Thyroxine is otherwise known as a. T3.
b. T4. c. TSH.
d. T1.
20. Hormones are produced by which body system?
a. Integumentary b. Endocrine c. Digestive d. Respiratory 3. ATP is found in which part of the cell?
a. Mitochondria b. Cytoplasm c. Nucleus
d. Plasma membrane
4. Which type of muscle tissue is involved in hemostasis?
a. Skeletal b. Smooth c. Epithelial d. Striated
5. Blood is considered which type of tissue?
a. Nerve b. Connective c. Muscle d. Epithelial
6. In which system does hematopoiesis occur?
a. Skeletal b. Nervous c. Muscular d. Digestive
7. Which is not a laboratory test that assesses for muscle disorders?
a. AST b. Troponin c. C&S d. Myoglobin
8. Which is not a laboratory test that assesses for disorders of the integumentary system?
a. C&S b. KOH prep c. BUN d. Skin biopsy 9. Hepatitis involves the
a. heart.
b. liver.
c. brain.
d. ovaries.
10. Which laboratory test is not useful in the assessment of liver problems?
a. AST b. GGT c. ALP
d. All are important
11. _______________ promotes the breakdown of glycogen back to glucose.
a. Insulin b. Glucagon c. Thymosin d. Calcitonin
95 acquired immunodeficiency
syndrome (AIDS) adhesion aggregation albumin allergy antibodies anticoagulant antigens aorta
aortic semilunar valve arteries
arterioles atria autoimmunity B cells basilic vein basophils bicuspid valve CD41 cells
cellular immunity cephalic vein common pathway complement coronary arteries cytokines cytotoxic T cells diastole
disseminated intravascular coagulation (DIC)
KEY TE R M S
electrolytes endocardium eosinophils epicardium erythrocyte extrinsic pathway fibrin
fibrin degradation products (FDPs)
fibrinogen 1. Describe the circulation of blood from the heart to
the lungs and other body tissues.
2. Differentiate arteries, veins, and capillaries.
3. Locate the major arteries and veins of the human body.
4. Define systole, diastole, and sphygmomanometer.
5. List and define at least 10 diseases of the heart and blood vessels.
6. Describe the components of whole blood.
7. Describe the three cellular elements of the blood, including their major functions.
8. Explain the process of hemostasis.
OBJ ECTIVE S
9. For red blood cells (RBCs), white blood cells (WBCs), and hemostasis, list at least three diseases that affect each.
10. Describe laboratory tests that may be used to detect diseases of RBCs, WBCs, and hemostasis.
11. Differentiate lymphatic circulation from that of blood.
12. Explain the functions of the lymphatic system.
13. Differentiate among nonspecific, humoral, and cellular immunity.
14. Describe the functions of T and B cells.
After completing this chapter, you should be able to:
OUTLI N E
Circulatory System Heart
Circulation Through the Heart Contraction of the Heart and
Blood Pressure Blood Vessels
Blood Hemostasis Blood Disorders Lymphatic System
Lymphatic Vessels Lymph Organs
Lymphatic System Disorders Immune System
Nonspecific Immunity Specific Immunity Immune System Disorders Review for Certification
CHAPTER 7
Circulatory, Lymphatic, and Immune Systems
clotting factors that minimize blood leakage in the event of injury. Hemostasis ensures that a rupture in a blood vessel is repaired quickly. A separate but linked circulatory system, the lymphatic system, redistributes intercellular fluid and provides an im- portant route of transport for cells of the immune system. The immune system fights foreign invaders through a combination of cellular and chemical defenses.
T
he circulatory system transports blood contain- ing oxygen and nutrients throughout the body and picks up metabolic waste products for disposal.Beginning at the heart, blood passes from arteries, to capillaries, to veins, and then back to the heart.
The structure of each type of blood vessel is adapted to its function within the system. In addi- tion to its role in nutrient and waste transport, blood transports hormones and enzymes, as well as