Human anatomy and physiology. Gaivoronsky I.V. and etc.

6th ed., revised. and additional - M.: 2011. - 496 p.

Modern information about the structure and functions of all systems of the human body is presented. The presented material is a fundamental basis for the subsequent study of clinical disciplines. The textbook pays special attention to the most important issues of the morphology of organs and organ systems for the professional activities of paramedical personnel, and contains the necessary reference material. The textbook can be used in the study of the general professional discipline OP.O3 “Human Anatomy and Physiology” in accordance with the Federal State Educational Standard for Secondary Professional Education for all specialties of the enlarged group 060000 “Healthcare”. For students of secondary medical vocational education institutions.

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TABLE OF CONTENTS
Introduction 3
Chapter 1. Brief historical sketch 5
1.1. History of Anatomy 5
1.2. History of Physiology 12
Chapter 2. Object and methods of research 16
2.1. Object and methods of anatomical research 16
2.2. Planes, axes and main landmarks in anatomy 17
2.3. Object and methods of research in physiology 19
Chapter 3. The human body as a whole. Basics of cytology and histology 21
3.1. Structural and functional organization of the human body 21
3.2. Cell 21
3.3. Fabrics 25
3.4. Organs 36
3.5. Organ systems 36
3.6. The human body as a whole 37
Chapter 4. Skeletal system 40
4.1. General provisions 40
4.2. Torso skeleton 48
4.3. Head skeleton 54
4.4. Upper limb skeleton 79
4.5. Skeleton of the lower limb 85
Chapter 5. Bone connections 94
5.1. General arthrosyndesmology 94
5.2. Connections of the trunk bones 100
5.3. Connections of skull bones 105
5.4. Connections of bones of the upper limb 107
5.5. Connections of the bones of the lower limb 113
Chapter 6. Muscular system 122
6.1. General myology 122
6.2. Muscles, fascia and topography of the back 131
6.3. Muscles, fascia and chest topography 135
6.4. Muscles, fascia and topography of the abdomen 139
6.5. Aperture 144
6.6. Muscles, fascia and topography of the neck 145
6.7. Muscles, fascia and topography of the head 152
6.8. Muscles of the upper limb 156
6.9. Muscles, fascia and topography of the lower limb 166
Chapter 7. Anatomy and physiology of the digestive system 180
7.1. Basic concepts 180
7.2. General plan of the structure of the organs of the digestive system 182
7.3. Oral cavity 185
7.4. Throat 194
7.5. Esophagus 196
7.6. Stomach 199
7.7. Small intestine 204
7.8. Liver 207
7.9. Pancreas 211
7.10. Large intestine 213
7.11. Morphofunctional features of the peritoneum 216
7.12. Physiological aspects of hunger and thirst. Appetite 220
7.13. The role of microflora of the digestive tract. Dysbacteriosis 221
Chapter 8. Anatomy and physiology of the respiratory system 225
8.1. General provisions 225
8.2. Upper respiratory tract 226
8.3. Lower respiratory tract 229
8.4. Lungs 234
8.5. Mediastinum 240
8.6. Physiology of Respiration 241
Chapter 9. Anatomy and physiology of the excretory system 249
9.1. Basic concepts 249
9.2. Kidneys 252
9.3. Urine formation 256
9.4. Urinary tract 260
9.5. Excretory functions of other organs 264
Chapter 10. Metabolism and energy 267
10.1. Basic concepts 267
10.2. Types of metabolism 268
10.3. Vitamins 274
10.4. Decay and oxidation of organic substances in cells 277
10.5. Energy exchange 280
10.6. Regulation of metabolism 283
Chapter 11. Anatomy of the reproductive system. Reproductive function and human development 285
11.1. Male reproductive system 285
11.2. Female reproductive system 292
11.3. Crotch 301
11.4. Human Development 303
Chapter 12. Cardiovascular system 311
12.1. General provisions 311
12.2. Heart 313
12.3. Arterial system 323
12.4. Venous system 334
12.5. Hemomicrocirculatory bed 341
12.6. Vessels of the pulmonary circulation 342
12.7. Movement of blood through vessels 342
12.8. Bleeding 344
12.9. Features of blood circulation in the fetus 345
12.10. Lymphatic system 347
Chapter 13. Internal environments of the body. Blood 353
13.1. Basic concepts 353
13.2. Functions and composition of blood 354
13.3. Blood groups 362
13.4. Blood transfusion. Donation 364
13.5. Immunity 365
Chapter 14. Central nervous system 371
14.1. General questions of anatomy of the nervous system 371
14.2. Spinal cord 379
14.3. Brain 384
14.4. Meninges of the brain and spinal cord 398
14.5. Conducting pathways of the central nervous system 399
Chapter 15. Functional anatomy of the peripheral nervous system 406
15.1. Concepts about the peripheral nervous system 406
15.2. Cranial nerves 409
15.3. Spinal nerves 415
15.4. Autonomic nervous system 423
Chapter 16. Higher nervous activity 431
16.1. Fundamentals 431
16.2. The concept of the first and second signal systems 435
16.3. Electroencephalography 436
16.4. Types of higher nervous activity 437
16.5. Spheres of higher nervous activity 439
16.6. Dream 443
16.7. Physiology of labor 445
Chapter 17. Sense organs. Analyzers 448
17.1. General concepts 448
17.2. Organ of vision 449
17.3. Organ of hearing and balance 456
17.4. Olfactory organ 461
17.5. Taste organ 462
17.6. Somatosensory organs. Leather 463
Chapter 18. Endocrine system 467
18.1. Concept of the endocrine system. General characteristics of hormones 467
18.2. Thyroid gland 469
18.3. Parathyroid glands 470
18.4. Thymus 470
18.5. Pancreas 471
18.6. Adrenal glands 472
18.7. Gonads 473
18.8. Pineal gland 474
18.9. Hypothalamus and pituitary gland 474
Applications 478
References 492

ANATOMY AND PHYSIOLOGY OF HUMAN ANATOMY AND PHYSIOLOGY N. I. Fedyukovich, I. K. Gainutdinov The difference between the Russian Federation and the Russian Federation all the world's most important countries Logo of the Republic Seventeenth edition, supplemented and revised Rostov-on-Don “Phoenix” 2010 UDC 611+612(075:32) BBK 28.70ya723 KTK 18 F32 Fedyukovich N. I. F32 Human anatomy and physiology: textbook / N. I. Fedyukovich, I.K. Gainutdinov. - Ed. 16e, add. and re-slave - Rostov n/d: Phoenix, 2010. - 510 p. : ill. - (Secondary vocational education). ISBN 978-5-222-16959-9 This edition is a new, revised and expanded edition of the basic anatomy textbook. In accordance with this, modern ideas about the structure and functional significance of the normal organs and systems of the human body are presented. Significant corrections have been made to the text, a new classification of a number of muscle groups, heart vessels, and organs of the lymphatic system has been introduced, and the doctrine of the endocrine glands and sensory organs is presented from a modern perspective. The understanding of the structural and functional characteristics of the immune defense organs has been expanded. The textbook was prepared in accordance with the State educational standard of secondary vocational education and is intended for students of medical schools. ISBN 978-5-222-16959-9 UDC 611+612(075:32) BBK 28.70я723 © Fåäþêâè÷ N. E., Gaganov E. К., 2010 © Publication: UNO “Fomen”, 2010 PREFACE Providing medical care is impossible without highly qualified, competent mid-level medical workers. The entire learning process should be a logically connected, justified and carefully worked system, the purpose of which is to prepare a highly professional specialist who has fundamental knowledge, skills and abilities in the specialty and is able to work independently. The formation of a future medical worker begins with disciplines that are studied from the very beginning of training. One of them is human anatomy and physiology. The material of the textbook is presented in 11 chapters, which first provide information on anatomy, and then reveal the physiological functions of a particular organ or system. New definitions and concepts have been introduced into the text of the textbook, and significant corrections have been made to the classification of a number of muscle groups, heart vessels, and some parts of the genitourinary and lymphatic systems. In addition, the main stages in the development of anatomy and physiology are briefly reviewed. At the end of each section there are questions for self-control. For the names of organs and their parts, generally accepted Latin anatomical terms are used, given in the International Anatomical Nomenclature, approved at the London Anatomical Congress in 1985. Quantitative physiological indicators are presented according to the International System of Units (SI). The manual contains drawings and diagrams. Some of the drawings were borrowed from various publications, such as “Human Anatomy” in 2 volumes, ed. M. R. Sapina (M., 1993), “Human Physiology”, ed. R. Schmidt and G. Tevs (M., 1985–1986), “General course of physiology of humans and animals” in 2 volumes, ed. A. D. Nozdracheva (M., 1991), X. Fenish “Pocket Atlas of Human Anatomy based on the International Nomenclature” (Minsk, 1996) and other textbooks. Changes and additions have been made to some drawings. 3 CHAPTER 1 VALUES OF THE SUBJECT, ITS OBJECTIVES AND IMPORTANCE FOR THEORY AND PRACTICE AN human atomy is a science that studies the form and structure of the human body in connection with its functions, development and influence of the environment. The science got its name from the research method - dissection or dissection (from the Greek anateme - I cut). Physiology - studies the functions of the human body and its constituent organs, cells and tissues, their relationships when various conditions and the state of the body change. Human anatomy and physiology are closely related to all medical specialties. Their achievements constantly influence practical medicine. It is impossible to carry out qualified treatment without a good knowledge of human anatomy and physiology. Therefore, before studying clinical disciplines, they study anatomy and physiology. These subjects form the foundation of medical education and medical science in general. At this stage of development of anatomy, they distinguish: systematic, topographic, plastic, age, comparative and functional anatomy. The structure of the human body according to systems is studied by systematic (normal) anatomy (bone, muscle, cardiovascular, etc.). The structure of the human body by region, taking into account the position of the organs and their spatial relationship with each other and with the skeleton, is studied by topographic anatomy. Plastic anatomy examines the external forms and proportions of the human body, as well as the topography of organs in connection with the need to explain the characteristics of the physique; examines the spatial relationships of structures in individual areas of the body, which is why it is also called surgical anatomy. Plastic anatomy explains the external shapes and proportions of the body. Comparative anatomy studies the structural transformations of similar organs in different animals. Functional anatomy, based on the dialectical principle of the unity of form and function, studies the structures of individual parts of the body, taking into account the functions they perform, which significantly expands and deepens anatomical knowledge. Age-related anatomy studies changes in the structure of the body and its parts in the process of individual development of the organism depending on age. Anatomy is also interested in the peculiarities of the development of human organs and systems in the process of evolution of the animal world, that is, in phylogeny (phylon - genus). Of great importance are the data of comparative anatomy, which studies the structural transformations of similar organs in different animals. Currently, in connection with the development and success of experimental physiology and pathology, a direction has appeared in anatomy - experimental morphology, which studies the structural basis of adaptation (adaptatia - adaptation) of the human body to changing environmental conditions (temperature fluctuations, physical inactivity, vibration, weightlessness, changes in composition atmosphere, etc.). Anatomy, like other morphological sciences, belongs to the fundamental sciences that study the laws of the structure of a living organism at various levels of its organization. It equips students with knowledge about the structure of the human body, opens up the opportunity for them to judge the nature of the organic connection of man with other living beings, and gives them the knowledge to understand the origin of man. Revealing the uniqueness of the structures of the human body, anatomy explains the meaning of specific adaptability to social work, which characterizes a person and, therefore, contributes to the formation of a correct natural-scientific worldview. Pathological anatomy studies organs and tissues damaged by a particular disease. 5 The body of physiological knowledge is divided into a number of separate but interrelated areas - general, special (or particular) and applied physiology. General physiology includes information that concerns the nature of basic life processes, general manifestations of life activity, such as the metabolism of organs and tissues, general patterns of the body’s response (irritation, excitation, inhibition) and its structures to environmental influences. Special (private) physiology studies the characteristics of individual tissues (muscle, nervous, etc.), organs (liver, kidneys, heart, etc.). ), patterns of combining them into systems (respiratory, digestive, circulatory systems). Applied physiology studies the patterns of manifestations of human activity in connection with special tasks and conditions (physiology of work, nutrition, sports). Physiology is conventionally divided into normal and pathological. The first studies the patterns of vital activity of a healthy organism, the mechanisms of adaptation of functions to the influence of various factors and the stability of the organism. Pathological physiology examines changes in the functions of a sick organism, clarifies the general patterns of the appearance and development of pathological processes in the body, as well as the mechanisms of recovery and rehabilitation. Knowledge of the normal structure and functions of organs and systems is necessary to understand the changes occurring in the body of a sick person. BRIEF HISTORY OF THE DEVELOPMENT OF ANATOMY AND PHYSIOLOGY The development and formation of ideas about anatomy and physiology begins in ancient times. The first medical works of scientists contained incomplete and primitive anatomical information. Among the first anatomists known to history, one should name Alkemon from Cratona, who lived in the 5th century. BC e. He was the first to dissect (dissect) the corpses of animals in order to study the structure of their bodies, and suggested that the sense organs communicate directly with the brain and that the perception of feelings depends on the brain. 6 Doctors and natural scientists of Ancient Greece enriched the information about the structure and functions of the body. Hippocrates (c. 460 - c. 370 BC) and his students in the 4th century. BC wrote a number of works devoted to anatomy: “On Anatomy”, “On the Heart”, etc. Hippocrates attached paramount importance to the study of anatomy, embryology and physiology, considering them the basis of all medicine. He collected and systematized observations about the structure of the human body, described the bones of the skull roof and the joints of bones with sutures, the structure of the vertebrae, ribs, internal organs, the organ of vision, muscles, and large vessels. The outstanding natural scientists of their time were Plato (427-347 BC) and Aristotle (384-322 BC). Studying anatomy and embryology, Plato discovered that the brain of vertebrates develops in the anterior sections of the spinal cord. Aristotle, opening the corpses of animals, described their internal organs, tendons, nerves, bones and cartilage. In his opinion, the main organ in the body is the heart. He named the largest blood vessel the aorta. The Alexandrian School of Physicians, which was founded in the 3rd century, had a great influence on the development of medical science and anatomy. BC e. Doctors of this school were allowed to dissect human corpses for scientific purposes. During this period, the names of two outstanding anatomists became known: Herophilus (b. c. 300 BC) and Erasistratus (c. 300 - c. 240 BC). Herophilus described the meninges and venous sinuses, the cerebral ventricles and choroid plexuses, the optic nerve and eyeball, the duodenum and mesenteric vessels, and the prostate. Erasistratus described the liver, bile ducts, heart and its valves quite fully for his time; knew that blood from the lung enters the left atrium, then into the left ventricle of the heart, and from there through the arteries to the organs. The Alexandrian school of medicine also belongs to the discovery of a method for ligating blood vessels during bleeding. The most outstanding scientist in various fields of medicine after Hippocrates was the Roman anatomist and physiologist Claudius Galen (c. 130 - c. 201). He first began teaching a course on human anatomy, accompanying it with dissections of animal corpses, mainly monkeys. Dissection of human corpses was prohibited at that time, as a result of which Galen, without proper reservations, transferred the structure of the body of an animal to humans. Possessing encyclopedic knowledge, he described 7 pairs (out of 12) of cranial nerves, connective tissue, muscle nerves, blood vessels of the liver, kidneys and other internal organs, periosteum, and ligaments. Important information was obtained by Galen about the structure of the brain. Galen considered it the center of sensitivity of the body and the cause of voluntary movements. In the book “On the Purpose of Parts of the Human Body,” he expressed his anatomical views and considered anatomical structures in inextricable connection with function. Galen's authority was very high. Medicine was studied from his books for almost 13 centuries. Galen's erroneous ideas about the movement of blood were refuted only in the 17th century by the English scientist William Harvey in his work “Anatomical Studies on the Movement of the Heart and Blood in Animals.” The Persian physician and philosopher Abu Ali ibn Sina, or Avicenna (c. 980–1037), made a great contribution to the development of medical science. He wrote the “Canon of Medical Science,” in which information on anatomy and physiology borrowed from the books of Aristotle and Galen was systematized and supplemented. Avicenna's books were translated into Latin and reprinted more than 30 times. In the XVI–XVIII centuries. Universities were opened in many countries, medical faculties were established, and the foundation of scientific anatomy and physiology was laid. An especially great contribution to the development of anatomy was made by the Italian scientist and artist of the Renaissance, Leonardo da Vinci (1452–1519). He anatomized 30 corpses, made many drawings of bones, muscles, and internal organs, providing them with written explanations. Leonardo da Vinci laid the foundation for plastic anatomy. The founder of scientific anatomy is considered to be the professor of the University of Padua Andras Vesalius (1514–1564), who, based on his own observations made during autopsies of corpses, wrote a classic work in 7 books “On the structure of the human body” (Basel, 1543). In them he systematized the skeleton, ligaments, muscles, blood vessels, nerves, internal organs, brain and sensory organs. Vesalius's research and the publication of his books contributed to the development of anatomy. Subsequently, his students and followers in the 16th–17th centuries. made many discoveries, 8 described in detail many human organs. The names of some organs of the human body are associated with the names of these scientists in anatomy: G. Fallopius (1523–1562) - fallopian tubes; B. Eustachy (1510–1574) - Eustachian tube; M. Malpighi (1628–1694) - Malpighian corpuscles in the spleen and kidneys. Discoveries in anatomy served as the basis for more in-depth research in the field of physiology. The Spanish physician Miguel Servetus (1511–1553), a student of Vesalius R. Colombo (1516–1559), suggested that blood passes from the right half of the heart to the left through the pulmonary vessels. After numerous studies, the English scientist William Harvey (1578–1657) published a book (1628), where he provided evidence of the movement of blood through the vessels of the systemic circulation, and also noted the presence of small vessels (capillaries) between arteries and veins. These vessels were discovered later, in 1661, by the founder of microscopic anatomy, M. Malpighi. In addition, W. Harvey introduced vivisection into the practice of scientific research, which made it possible to observe the functioning of animal organs using tissue sections. The discovery of the doctrine of blood circulation is generally considered to be the founding date of animal physiology. Simultaneously with the discovery of W. Harvey, the work of Cas paro Azelli (1591–1626) was published, in which he made an anatomical description of the lymphatic vessels of the mesentery of the small intestine. During the XVII–XVIII centuries. not only new discoveries in the field of anatomy appear, but a number of new disciplines begin to emerge: histology, embryology, and somewhat later - comparative and topographic anatomy, anthropology. For the development of evolutionary morphology, the teaching of Charles Darwin (1809–1882) on the influence of external factors on the development of the forms and structures of organisms, as well as on the heredity of their offspring, played a major role. Cell theory T. Schwann (1810–1882), the evolutionary theory of Charles Darwin set a number of new tasks for anatomical science: not only to describe, but also to explain the structure of the human body, its features, to reveal the phylogenetic past in anatomical structures, to explain how things developed in the process of history human development and its individual characteristics. 9 To the most significant achievements of the 17th–18th centuries. refers to the concept of “reflected activity of the organism” formulated by the French philosopher and physiologist René Descartes (1596–1650). He introduced into physiology the concept of reflex on a materialistic basis. Later, ideas about the nervous reflex, reflex arc, and the importance of the nervous system in the relationship between the external environment and the body were developed in the works of the famous Czech anatomist and physiologist G. Prohaska (1748–1820). Advances in physics and chemistry have made it possible to use more accurate research methods in anatomy and physiology. In the XVIII–XIX centuries. Particularly significant contributions to the field of anatomy and physiology were made by a number of Russian scientists. M.V. Lomonosov (1711–1765) discovered the law of conservation of matter and energy, expressed the idea of ​​the formation of heat in the body itself, formulated a three-component theory of color vision, and gave the first classification of taste sensations. A student of M.V. Lomonosov, A.P. Protasov (1724–1796), is the author of many works on the study of the human physique, the structure and functions of the stomach. One of the founders of the Russian anatomical school was M. I. Shein (1712–1762), who compiled the first Russian anatomical atlas and published the translated “Abbreviated Anatomy” of Geister in 1757. Moscow University professor S.G. Zabelin (1735–1802) lectured on anatomy and published the book “A Tale on the Structure of the Human Body and How to Protect It from Diseases,” where he expressed the idea of ​​the common origin of animals and humans. In 1783, N. M. Ambodik Maksimovich (1744–1812) published the “Anatomical and Physiological Dictionary” in Russian, Latin and French, and in 1788, A. M. Shumlyansky (1748–1795) described the capsule of the renal glomerulus and urinary tubules. A significant place in the development of anatomy belongs to E. O. Mukhin (1766–1850), who taught anatomy for many years and wrote the textbook “Anatomy Course.” In 1798, the Medical-Surgical Academy was created in St. Petersburg. The first head of the department was P. A. Zagorsky (1764–1846), the author of the first Russian original textbook on anatomy, “A Guide to Understanding the Human Body.” 10 A student of P. A. Zagorsky and his successor in the department since 1833 was the anatomist and surgeon I. V. Buyalsky. He was responsible for the publication in 1828 of the first atlas on operative surgery, the work “Brief General Human Anatomy”. The founder of topographic anatomy is N.I. Pirogov (1810–1881). He developed an original method for studying the human body using cuts from frozen corpses. Author of such famous books as “A Complete Course in Applied Anatomy of the Human Body” and “Topographic Anatomy Illustrated by Sections Drawn through the Frozen Human Body in Three Directions.” N.I. Pirogov especially carefully studied and described the fascia, their relationship with blood vessels, giving them great practical importance. He summarized his research in the book “Surgical anatomy of arterial trunks and fascia.” Functional anatomy was founded by the anatomist J. F. Lesgaft (1837–1909), one of the first to use the radiography method for anatomical studies, the experimental method on animals and methods of mathematical analysis. His provisions on the possibility of changing the structure of the human body through the influence of physical exercises on the functions of the body form the basis of the theory and practice of physical education. I.M. Sechenov (1829–1905) went down in the history of science as the first experimental researcher of a phenomenon that was complex in nature - consciousness. In addition, he was the first who managed to study gases dissolved in the blood, establish the relative effectiveness of the influence of various ions on physicochemical processes in a living organism, and clarify the phenomenon of summation in the central nervous system (CNS). I.M. Sechenov gained the greatest fame after the discovery of the process of inhibition in the central nervous system. After the publication of I.M. Sechenov’s work “Reflexes of the Brain” in 1863, the concept of mental activity was introduced into the physiological foundations. The development of physiology was greatly influenced by the works of I. P. Pavlov (1849–1936). He created the doctrine of the higher nervous activity of humans and animals. Studying the regulation and self-regulation of blood circulation, he established the presence of special nerves, some of which strengthen, others delay, and others change the strength of heart contractions without changing their frequency. At the same time, I.P. Pavlov studied the physiology of digestion. Having developed and put into practice a number of special surgical techniques, he created a new physiology of digestion. Studying the dynamics of digestion, he showed its ability to adapt to excitatory secretion when consuming various foods. His book “Lectures on the work of the main digestive glands” became a guide for physiologists around the world. For his work in the field of digestive physiology in 1904, I. P. Pavlov was awarded the Nobel Prize. His discovery of the conditioned reflex allowed him to continue the study of mental processes that underlie the behavior of animals and humans. The results of many years of research by I.P. Pavlov were the basis for the creation of the doctrine of higher nervous activity, according to which it is carried out by the higher parts of the nervous system and regulates the relationship of the organism with the environment. From 1813 to 1835, Professor E. O. Mukhin (1766–1850) headed the department of anatomy at Moscow University. He published the textbook “Anatomy Course for Students Studying Medical and Surgical Science.” In the XIX-XX centuries. functional and experimental directions in anatomy were successfully developed by such scientific researchers as Lesgaft P. F. (1837–1909), Gruber V. L. (1814–1890), Iosifov G. M. (1870–1953), Iosifov G. M. (1870–1933), Vorobyov V. P. (1876–1937), Shevkunenko V. N. (1872–1952), Tonkov V. N. (1872–1952), Zhdanov D. A. (1908–1971) , Ognev B.V. (1901–1978), Sinelnikov E.D. (1896–1983), Privesa M.G. (1904–2000), Kupriyanov V.V. (1912), Sapin M.R. (1925 ) and a huge number of representatives of various anatomical schools who have made and are making a significant contribution to the development of anatomical science. A significant mark in the history of Russian anatomy was left by N.K. Lysenkov (1865–1941), the author (together with V.I. Bushkovich) of a popular textbook on anatomy. The anatomy of the lymphatic system is studied by Academician Yu. I. Borodin and his students (Novosibirsk), the heart and blood vessels - Professor V. I. Kozlov (Moscow), Professor V. V. Kolesnikov (Moscow), Academician M. R. Sapin and his employees (V. S. Revazov, Selin, V. Ya. Bocharov, G. S. Satyukova, N. O. Bartosh, etc.), N. A. Javakhishvili (Tbilisi), N. V. Krylova (Moscow), etc. 12 Anatomical science in our country considers the organism as a morphological and functional whole, associated with environmental conditions. Along with classical anatomical methods, modern scientists widely use new methods for studying structures - x-ray, histochemical, ultrasound location, stereomorphometric, electron microscopic, experimental, which allows a deeper understanding of the relationships between cells, tissues and organs in the process of formation of the human body. Modern science examines the human body in dynamics, in continuous development, and strives not only to reveal the structural features of a particular organ of the human body, but also to study the external and internal causes affecting the body. The analysis of observed phenomena in modern anatomy is based on the natural scientific principle of development, which gives scientists the opportunity to understand the objective laws of nature. The human body is considered as a single, very complex living organism that lives and develops according to general biological laws. The formation of physiology as an independent science in the 20th century. significantly contributed to advances in the field of physics and chemistry, which, thanks to precise methodological techniques, made it possible to characterize the physical and chemical essence of physiological processes. Physiology of the 20th century. is characterized by significant achievements in the field of revealing the activities of organs, systems, and the organism as a whole. A feature of modern physiology is a deep analytical approach to the study of membrane and cellular processes, and the description of the biophysical aspects of excitation and inhibition. Knowledge about the quantitative relationships between various processes makes it possible to carry out their mathematical modeling and find out certain disorders in a living organism. RESEARCH METHODS When studying the structure of the human body and its functions, various research methods are used. Modern methods for studying humans are quite numerous and complex. To study the morphological characteristics of humans, two groups of methods are distinguished. The first group is used to study the structure of the human body on cadaveric material, and the second - on a living person. The first group includes: 1) the dissection method using simple tools (scalpel, tweezers, saw, etc.) - allows you to study the structure and topography of organs; 2) the method of soaking corpses in water or a special liquid for a long time to isolate the skeleton and individual bones to study their structure; 3) the method of sawing up frozen corpses - developed by N. I. Pirogov, allows one to study the relationships of organs in a single part of the body; 4) the method of corrosion, or corrosion - is used to study blood vessels and other tubular formations in internal organs by filling their cavities with hardening substances (liquid metal, plastics), and then destroying organ tissue using strong acids and alkalis, after which an impression of the infused formations remains; 5) injection method, infusion - consists of introducing dyes into organs that have cavities, followed by clarification of the organ parenchyma with glycerin, methyl alcohol, etc. Widely used for studying the circulatory and lymphatic systems, bronchi, lungs, etc.; 6) macro, microscopic method - study of the structural features of organs using instruments that provide a magnified image. It is used when studying objects that are on the border between macro and microscopic vision. The second group includes: 1) the x-ray method and its modifications (x-ray, x-ray, angiography, lymphography, x-ray kymography, etc.) - allows you to study the structure of organs, their topography on a living person at different periods of his life. In recent years, a technique of color fluoroscopy in combination with tomography has been developed, which makes it possible to study anatomical formations in a living organism in a color image; 14 2) somatoscopic (visual examination) method of studying the human body and its parts - used to determine the shape of the chest, the degree of development of individual muscle groups, curvature of the spine, body constitution, etc. Along with visual examination, the clinic uses the palpation method (palpation), percussion (percussion), listening (auscultation) of individual areas of the body; 3) anthropometric, or somatometric method - studies the human body and its parts by measuring, determining the proportion of the body, the ratio of muscle, bone and fat tissue, the degree of mobility of the joints, etc.; 4) the method of endoscopy of internal organs - makes it possible to examine on a living person, using light guide technology, the inner surface of the digestive and respiratory systems, the cavities of the heart and blood vessels, the genitourinary apparatus and study the processes occurring in them. Modern anatomy uses new research methods, such as computed tomography, ultrasonic echolocation, stereophotogrammetry, nuclear magnetic resonance, etc. In turn, histology, the study of tissues, and cytology, the science of the structure and function of cells, have emerged from anatomy. Experimental methods were usually used to study physiological processes. In the early stages of the development of physiology, the method of extirpation (removal) of an organ or part of it was used, followed by observation and recording of the obtained indicators. The fistula method is based on inserting a metal or plastic mass tube into a hollow organ (stomach, gall bladder, intestines) and securing it to the skin. Using this method, the secretory function of organs is determined. The catheterization method is used to study and record processes that occur in the ducts of the exocrine glands, in blood vessels, and the heart. Various medications are administered using thin synthetic tubes - catheters. The denervation method is based on cutting the nerve fibers innervating the organ in order to establish the dependence of the organ’s function on the influence of the nervous system. To stimulate organ activity, electrical or chemical stimulation is used. In recent decades, instrumental methods have found widespread use in physiological research (electrocardiography, electroencephalography, recording the activity of the nervous system by implanting macro and microelements, etc.). Depending on the form of conduct, a physiological experiment is divided into acute, chronic and in conditions of an isolated organ. An acute experiment is intended for artificial isolation of organs and tissues, stimulation of various nerves, recording electrical potentials, administration of drugs, etc. A chronic experiment is used in the form of targeted surgical operations (fistulas, neurovascular anastomoses, transplantation of various organs, implantation electrodes, etc.). The function of an organ can be studied not only in the whole organism, but also in isolation from it. In this case, all the necessary conditions for its life are created for the organ, including the supply of nutrient solutions to the vessels of the isolated organ (perfusion method). The use of computer technology in conducting physiological experiments has significantly changed its technique, methods of recording processes, and processing the results obtained. Questions for self-control 1. Define the terms “anatomy” and “physiology”. 2. Describe the main periods of development of anatomy and physiology. 3. What research methods are used: a) in anatomy; b) in physiology? 4. What modern methods does anatomy have? 16 Chapter 2 SUMMARY OF CELLS AND TISSUE Cells The human body is complex, integral, self-regulating and self-renewing an evolving system with a specific organization of its structures. The basis of the structure and development of a person is the cell - an elementary structural, functional and genetic unit of living organisms, capable of division and exchange with the environment. It transmits genetic information through self-reproduction. Cells are very diverse in structure, function, shape, and size (Fig. 1). The latter range from 5 to 200 microns. The largest cells in the human body are the egg and nerve cells, and the smallest are blood lymphocytes. The shape of the cells is spherical, spindle-shaped, flat, cubic, prismatic, etc. Some cells, together with their processes, reach a length of up to 1.5 m or more (for example, neurons). Each cell has a complex structure and is a system of biopolymers, containing a nucleus, cytoplasm and organelles located in it (Fig. 2). The cell is delimited from the external environment by a cell membrane - plasmalemma (thickness 9–10 mm), which transports necessary substances into the cell and, conversely, interacts with neighboring cells and intercellular substance. Inside the cell there is a nucleus in which protein synthesis occurs; it stores genetic information in the form of DNA (deoxyribonucleic acid). 17 The nucleus (nucleus, caryon) is the most important structural part of the cell. Usually a cell has one nucleus, but there are also multinucleated cells, as well as anucleate cells - erythrocytes and platelets. The shape of the nucleus can be round or ovoid, but in flat cells it is somewhat flattened, and in leukocytes it is rod-shaped or bean-shaped. The nucleus is covered with a nuclear envelope, the nucleolemma, and has nuclear juice, the nucleoplasm, which is a gel-like substance and contains chromatin and a nucleolus. The nucleus is surrounded by cytoplasm, which includes hyaloplasm, cytoplasmic organelles and inclusions. 1 2 5 3 6 4 7 Fig. 1. Cell shapes: 1 - nervous; 2 - epithelial; 3 - connective tissue; 4 - smooth muscle; 5 - erythrocyte; 6 - sperm; 7 - egg Hyaloplasm, or cytoplasmic matrix, is the main substance of the cytoplasm, has a semi-liquid consistency and a fine-grained structure. Hyaloplasm is involved in the metabolic processes of the cell, contains proteins, fats, polysaccharides, water, nucleic acid, enzymes, etc. Proteins perform a plastic function - cellular structures are built from them. Carbohydrates and fats are a source of energy. Nucleic acids participate in the processes of protein biosynthesis, which are based on the mechanisms of organism development, growth, transmission and reproduction of hereditary characteristics. 18 15 14 1 2 3 4 13 12 5 a b6 7 8 9 11 10 Fig. 2. Diagram of the ultramicroscopic structure of a cell (according to M.R. Sapin, G.L. Bilich, 1989): 1 - cytolemma (plasma membrane); 2 - pinocytotic vesicles; 3 - centrosome (cellular center, cyto center); 4 - hyaloplasm; 5 - endoplasmic reticulum (a - endoplasmic reticulum membranes, b - ribosomes); 6 - core; 7- connection of the perinuclear space with the cavities of the endoplasmic reticulum; 8 - nuclear pores; 9 - nucleolus; 10 - intracellular mesh apparatus (Golgi complex); 11 - secretory vacuoles; 12 - mitochondria; 13 - lysosomes; 14 - three successive stages of phagocytosis; 15 - connection of the cell membrane (cytolemma) with the membranes of the endoplasmic reticulum. Hyaloplasm is a semi-liquid medium that unites all cellular structures and ensures their chemical interaction with each other. The permanent parts of the cell that have a specific structure and perform biochemical functions are called cytoplasmic organelles. These include: cell center, mitochondria, Golgi complex, endoplasmic (cytoplasmic) reticulum, ribosomes, lysosomes. The cell center is usually located near the nucleus or Golgi complex, consists of two dense formations - cent 19 ryoles, which are part of the spindle of a moving cell, their function is the formation of basal bodies located at the base of the cilia and flagella of cells. Mitochondria have the shape of grains, threads, rods, and are formed from two membranes - internal and external. The length of the mitochondrion ranges from 1 to 15 µm, the diameter - from 0.2 to 1.0 µm. The inner membrane forms folds (cristae) in which enzymes are located. In mitochondria, the breakdown of glucose and amino acids, the oxidation of fatty acids, and the formation of ATP (adenosine triphosphoric acid) - the main energy material - occur. The Golgi complex (intracellular mesh apparatus) has the appearance of a branched mesh structure and consists of a system of flat and flattened cisterns, vesicles, plates, and tubes located around the nucleus. Its function is to transport substances, process them chemically and remove waste products from the cell outside the cell. The endoplasmic (cytoplasmic) reticulum is formed from the agranular (smooth) and granular (granular) reticulum. The agranular endoplasmic reticulum is formed mainly by small cisternae and tubules with a diameter of 50–100 nm, which are involved in the metabolism of lipids and polysaccharides. The granular endoplasmic reticulum consists of plates, tubes, cisterns, the walls of which are adjacent to small formations - ribosomes that synthesize proteins. Ribosomes are complexly organized, the smallest cell organelles, located on the membranes of the endoplasmic reticulum or freely in the cytoplasm. They contain proteins and high molecular weight RNA in approximately equal proportions. The function of ribosomes is to synthesize body proteins. Lysosomes are round bodies 0.2–0.4 µm in size, the walls of which are formed by the cytoplasmic membrane. The lysosome matrix contains a large set of hydrolytic enzymes involved in the process of intracellular digestion of nutrients entering the cell. Special purpose organelles include: myofibrils, located in the cells of smooth muscle tissue and striated muscle fibers and ensuring muscle contraction; tonofibrils that perform a supporting function in epithelial cells; neurofibrils, flagella, cilia, villi, which determine the specific function of the cell. Neurofibrils in the cells of the nervous system conduct nerve impulses, flagella and cilia are designed to move specialized cells (sperm) or ensure the movement of fluid around the cells. Cytoplasmic inclusions are unstable structures of the cytoplasm that are products of cellular metabolism. They accumulate in the form of vacuoles, granules, droplets, and crystals. These include protein, fat, lysaccharide, pigment and secretory inclusions. Basic functions of a cell A living cell is a complex functional system in which metabolism, constant self-renewal and self-reproduction occur throughout its life. In addition to metabolism, the main vital manifestations of a cell are growth, movement, irritability, development and the ability to reproduce. Metabolism, or metabolism, is a set of chemical reactions that form the basis of the life of a cell. It includes assimilation, or anabolism - the absorption by the cell of substances entering it, and dissimilation - the decomposition of substances, which is accompanied by the release of energy necessary for the life of the cell. Irritability is the ability of cells to respond to changes in environmental factors: light, temperature, humidity, chemicals, osmotic pressure, etc. The cell’s response to irritation can manifest itself in increased metabolism, movement of cellular structures, secretion, muscle contraction, and others forms of excitation. Cell growth is the process of increasing the size of cellular structures, due to which the volume of the cell increases, and development is the acquisition of specific functions by the cell. Reproduction, or the ability of cells to reproduce themselves, is the basis for the preservation and development of cells, and with them the whole organism, the replacement of aging and dead cells, the regeneration (restoration) of tissues and the growth of the organism. 21 The reproduction of any organism is associated with the processes of cell reproduction. All these processes are associated with cell division. There are two main forms of cell division: mitosis, or indirect cell division, and meiosis, or reduction division of germ cells. Mitosis is the most common form of cell division, as a result of which two exactly the same cells are formed from one cell, since an even distribution of hereditary material is ensured between the newly emerging daughter cells. During mitotic division, a cell sequentially goes through 4 stages: prophase, metaphase, anaphase, telophase. The period between two divisions is called interphase. Meiosis is a form of nuclear division in which the number of chromosomes in a fertilized cell is halved and a restructuring of the cell’s gene apparatus is observed. The period from one cell division to another is called its life cycle. Simple (or direct) cell division - amitosis - occurs rarely, in cases where the cell is divided into equal or unequal parts. Tissues The cell is part of the tissue that makes up the body of humans and animals. Tissue is a system of cells and extracellular structures, united by the same origin, identical structure and function. Each organ consists of different tissues that are closely interconnected. For example, the stomach, intestines, and other organs consist of epithelial, connective, smooth muscle and nervous tissues. Thus, the various tissues that make up a particular organ ensure the performance of the main function of this organ. In addition to cells, the human body contains extracellular structures. The intercellular substance is a complex system consisting of a basic structureless substance; it can have a liquid, solid or jelly-like consistency, in which fibers with various functional purposes are located. Intercellular substance fills the space between cells and has a characteristic feature for all living things - metabolism. As a result of the interaction of the organism with the external environment, which developed during the process of evolution, four types of tissues with certain functional characteristics appeared: epithelial, connective, muscle and nervous. Epithelial tissue (textus epithelialis, epithelium) covers the entire outer surface of the body of humans and animals, lines the mucous membranes of hollow internal organs (stomach, intestines, urinary tract, pleura, pericardium, peritoneum) and is part of the endocrine glands. There are integumentary (surface) and secretory (glandular) epithelium. Epithelial tissue participates in the metabolism between the body and the external environment, performs a protective function (skin epithelium), functions of secretion, absorption (intestinal epithelium), excretion (kidney epithelium), gas exchange (lung epithelium), and has a great regenerative capacity. Nutrition of epithelial tissue cells is carried out diffusely through the basement membrane, which separates the epithelial tissue from the underlying loose connective tissue and serves as a support for the epithelium. Depending on the number of cell layers and the shape of individual cells, multilayered epithelium is distinguished - keratinized and non-keratinized, transitional and single-layered - simple columnar, simple cubic (flat), simple squamous (mesothelium) (Fig. 3). Based on the shape of the cells, epithelium is divided into: flat, cubic and prismatic. Single-layer squamous epithelium lines the alveoli of the lungs, the walls of capillaries, blood vessels, and the cavities of the heart, where, due to its thinness, it diffuses various substances and reduces the friction of flowing fluids. Single-layer cubic epithelium lines the ducts of many glands, and also forms kidney tubules and performs a secretory function. Single-layer prismatic epithelium lines the mucous membrane of the stomach and intestinal tract. A type of multirow prismatic epithelium is ciliated epithelium, on the surface of which there are outgrowths of the cytoplasm (cilia). 23 A B C D E F Fig. 3. Different types of epithelium: A - single-layer squamous; B - single-layer cubic; B - cylindrical; G - single-layer ciliated; D - multi-row; E - stratified keratinizing Ciliated epithelial cells usually have the shape of a cylinder with many cilia on free surfaces; lines the fallopian tubes, ventricles of the brain, spinal canal and respiratory tract, where it ensures the transport of various substances. Multirow epithelium lines the urinary tract, trachea, respiratory tract and is part of the mucous membrane of the olfactory cavities. Multilayer epithelium consists of several layers of cells and, based on the keratinization of the upper cells, is divided into keratinizing (skin epithelium) and non-keratinizing (corneal epithelium). It lines the outer surface of the skin, the mucous membrane of the esophagus, the inner surface of the cheeks, and the vagina. A special form of multilayer epithelium, the transitional epithelium, is found in those organs that are subject to strong stretching (bladder, ureter, renal pelvis). The thickness of the transitional epithelium prevents urine from entering the surrounding tissues. The glandular epithelium makes up the bulk of the glands and has the ability to synthesize and secrete substances necessary for the functioning of the body. This function is called secretory, and the substances released are called secretions. 24 Glands (glandulae) are divided into two types of secretory cells - exocrine, which secrete secretions onto the free surface of the epithelium and through ducts into the cavity (stomach, intestines, respiratory tract, etc.), and endocrine, which do not have ducts and secrete secretions ( hormone) directly into the blood or lymph (pituitary gland, thyroid and parathyroid glands, adrenal glands). Exocrine glands are salivary, sweat and mammary glands, which have a tubular, alveolar, tubular alveolar structure. Connective tissue (textus connectivus) in its structure unites a significant group of tissues: connective tissue itself (loose fibrous, dense fibrous - unformed and formed); tissues that have special properties (adipose, reticular); skeletal solid (bone and cartilage) and liquid (blood, lymph). Its general morphological feature is that this tissue consists of cells and a large amount of intercellular substance, which includes the ground substance and fibrous structures (collagen, elastic, reticular). Connective tissue performs supporting, protective, shape-forming, plastic and trophic functions (formation of the stroma of the soft skeleton of organs, nutrition of cells and tissues, transport of oxygen and carbon dioxide, various substances). It protects against the introduction of microorganisms and viruses, protects organs from damage and unites different types of tissues with each other. Based on their appearance and physicochemical properties, fibers are divided into collagen, reticular and elastic. Collagen fibers are formed by the protein collagen, have great strength and are usually grouped into bundles. Reticular fibers are similar to collagen fibers and form the connective tissue basis of some organs: lymph nodes, bone marrow. Elastic fibers do not consist of elastin protein and have less strength, but are easily stretched and more elastic. Connective tissue forms the supporting systems of the body: skeletal bones, cartilage, ligaments, fascia and tendons. Connective tissue can be divided into two large groups: connective tissue itself and special 25 connective tissue - with supporting (cartilaginous and bone) and hematopoietic properties (myeloid and lymphoid tissues). Connective tissue itself consists of fibrous and connective tissue with special properties. Fibrous connective tissue includes: 1) loose fibrous connective tissue; 2) dense fibrous shaped connective tissue; 3) dense fibrous unformed connective tissue. Loose fibrous connective tissue is widely distributed in the body of humans and animals. It contains cellular elements (fibroblasts, macrophages, plasma and mast cells, etc.). Depending on the structure and function of the organ, the fibers are differently oriented in the main substance. This tissue is found in blood vessels, ducts, nerves, is part of all organs and forms stroma in many of them. Connective tissue consists of cells - fibroblasts, plasma cells, histiocytes, adipose, mast, reticular, pigment - and intercellular substance formed by the main (amorphous) substance and loosely located collagen, elastic and reticular fibers running in different directions. Dense fibrous connective tissue can be formed or unformed. In formed dense connective tissue, the fibers are arranged parallel and collected in a bundle; they participate in the formation of ligaments, tendons, membranes and fascia. Unformed dense connective tissue is characterized by interlacing of fibers and a small number of cellular elements. Connective tissue with special properties is represented by reticular, adipose, mucous, pigment and embryonic tissues. Cartilaginous tissue (textus cartilagineus) consists of chondrocytes, which are arranged in groups of two to three cells, and the main (intercellular) substance, which is in a gel state. Cartilage cells are oval or round, located singly or in groups in special cavities. The cartilage matrix is ​​formed by collagen and elastic fibers and ground substance. On the outside, cartilage is covered with perichondrium, 26 or perichondrium - a connective tissue membrane consisting of two layers: external fibrous and internal chondrogenic, forming cartilage cells. The perichondrium performs trophic and regenerative functions. Cartilaginous tissue makes up the bulk of cartilage. Afterwards, they have a supporting function, so they are part of various parts of the skeleton. There are hyaline, fibrous and elastic cartilages. Hyaline cartilage is the most common cartilage in the human body. It covers the articular surfaces of bones, forms the anterior ends of the ribs, enters the thyroid and cricoid cartilages of the larynx, large bronchi, and part of the nasal septum. With age, hyaline cartilage can become calcified. Fibrous (collagen) cartilage in its structure occupies an intermediate position between dense fibrous connective tissue and hyaline cartilage. The presence of collagen fibers gives it particular strength. It enters the intervertebral and intraarticular discs, the menisci, covers the articular surfaces of the temporomandibular and sternoclavicular joints, as well as at the attachment points of some tendons and ligaments. Elastic cartilage in the ground substance contains a large number of elastic fibers, which give the cartilage elasticity. It never calcifies. The auricle, epiglottis, external auditory canal, auditory tubes, and corniculate and wedge-shaped cartilages of the larynx are made of elastic cartilage. Bone tissue (textus osseus) consists of cells - osteocytes, osteoblasts and osteoclasts - and intercellular substance containing thin collagen fibers and a ground substance in which mineral salts (mainly calcium) are deposited. Bone tissue forms the human skeleton, creates the shape of his body, protects organs located in the skull, thoracic and pelvic cavities, and takes part in mineral and fat metabolism. Red bone marrow, contained in the bones, is the central organ of hematopoiesis and performs the function of biological protection, since macrophages and lymphocytes develop in it. The strength of bone tissue is ensured by a complex chemical composition, crystals of calcium salts and the nature of the arrangement of fibers. 27 The structural and functional unit of bone tissue is the osteon. The osteon consists of bone cells and concentrically located, inserted into each other bone plates that have a cylindrical shape. In the center of the spine, it passes through the central canal, in which blood vessels pass. Depending on the location of the fibers in the intercellular substance, coarse fibrous and lamellar bone tissue is distinguished. Coarse fibrous tissue forms all bones in the embryonic period of development. In this tissue, collagen (ossein) fibers, collected in thick, coarse bundles, are randomly located in the amorphous intercellular substance, and osteocytes are scattered between the fibers. In the adult body, this type of tissue is found only at the sites of tendon attachment. In the process of growth and development of the body, coarse fibrous bone tissue is gradually transformed into lamellar bone tissue. In lamellar bone tissue, the intercellular substance forms bone plates, in which ossein fibers are arranged in parallel bundles. Osteocytes are found in cavities located between or inside the plates. The structure and functions of lamellar bone tissue are more perfect, and it is much stronger than coarse-fibered bone tissue. Plastic bone tissue is the basis of the bones of an adult and forms spongy and compact bones. Spongy bone consists of bony plates, forming bone beams and crossbars that run in different directions. This type of bone is characteristic of the epiphyses (articular ends) of tubular bones. Compact bone consists of bony plates that fit closely together; it is found in the diaphysis, or middle parts of the long bones. The surface layer of the bone is formed by the periosteum, due to which the bone is nourished and grows during development and regenerates when damaged. Adipose tissue is formed under the skin, especially under the peritoneum and omentum, and does not have its own basic substance. In each cell, a fat drop is located in the center, and the nucleus and cytoplasm are located at the periphery. Adipose tissue serves as an energy depot, protects internal organs from shock, and retains heat in the body. 28 Muscle tissue (textus muscularis) is a type of tissue whose main property is the ability to contract. Contraction of muscle tissue ensures motor processes in the human body (for example, the movement of blood through blood vessels, the movement of food during digestion, etc.) with the help of special contractile structures - myofibrils. There are three types of muscle tissue: smooth (unstriated), skeletal striated (striated), and cardiac striated (striated) (Figure 4). I II A B C Fig. 4. Types of muscle tissue: I - longitudinal section; II - cross section; A - smooth (unstriated); B - striated skeletal; B - striated cardiac muscle tissue has such functional features as excitability, conductivity and contractility. Smooth muscle tissue consists of spindle-shaped cells - myocytes - 15–500 µm long and about 8 µm in diameter, located parallel to each other, forming muscle layers. Smooth muscle cells have a contractile apparatus in the form of threads - myofilaments. Smooth muscle is found in the walls of many formations, such as the intestine, bladder, blood vessels, ureters, uterus, vas deferens, etc. For example, in the intestinal wall there are outer longitudinal and inner annular layers, the contraction of which causes elongation of the intestine and its narrowing. This coordinated work of muscles is called peristalsis and promotes the movement of the contents of the intestine or its substances inside the hollow organs. This type of contractile activity is called tonic. Smooth muscle tissue contracts gradually and is able to remain in a state of contraction for a long time, consuming a relatively small amount of energy, without getting tired, and has the ability to regenerate. Striated muscle tissue moves the bones of the skeleton, and is also part of some internal organs (tongue, pharynx, upper esophagus, external rectal sphincter). Striated skeletal muscle tissue consists of multinuclear cylindrical fibers, located parallel to one another, in which dark and light areas (discs, stripes) alternate and which have different light refractive properties. Identical sections of neighboring myofibrils are located in the fiber at the same level, which determines the transverse striation of the entire fiber. Dark disks are birefringent and are called anisotropic disks, while light disks are called isotropic disks. In the middle of each disk there are partitions that cross it in the transverse direction. The length of such fibers ranges from 1000 to 40,000 microns, the diameter is about 100 microns. The contraction of skeletal muscles is voluntary; they are innervated by the spinal and cranial nerves. The contractile proteins of striated muscle fiber (myosin, actin, etc.) are contained in myofibrils in the form of protein filaments (myofilaments) of two types: thin - actin, and thick - myosin. The sliding of actin myofilaments relative to myosin ones in the longitudinal direction during nervous excitation of the muscle fiber leads to contraction of striated muscle fibers. The sarcoplasm of muscle fibers contains the respiratory pigment myoglobin, or muscle hemoglobin, which determines their red color. Depending on the myoglobin content in muscle tissue, red, white and intermediate muscle fibers are distinguished. Red muscle fibers are capable of long-term contraction, white fibers provide rapid motor function. The composition of almost all striated muscles in humans is mixed: they contain both white and red fibers. Cardiac striated muscle tissue is found only in the heart and resembles smooth muscle tissue in function and striated skeletal muscle tissue in structure. It has a very good blood supply and is significantly less susceptible to fatigue than ordinary striated tissue. The functional unit of muscle tissue is the cardiomyocyte. Cardiac muscle tissue is characterized by cell connections using special intercalary discs, which play a significant role in transmitting excitation from one cell to another. With the help of intercalary discs, cardiomyocytes form the conduction system of the heart. The contraction of the heart muscle does not depend on the will of a person. Nervous tissue (textus nervosus) is the main component of the nervous system, ensures the transmission of signals (impulses) to the brain, regulates and coordinates all processes in the human body, ensuring its integrity and interrelating with the environment. In the process of evolution, it has developed the ability to perceive irritation, analyze it, form a nerve impulse and transmit it to the working organs. It is the most specialized tissue in the human body. The structural and functional unit of nervous tissue is a nerve cell - a neuron (neurocyte), located in neuroglia (gliocytes), which performs trophic, supporting, protective and other functions. Nervous tissue forms the central nervous system (brain and spinal cord) and the peripheral nervous system (plexuses, ganglia). There are many neurons in the nervous system. They are characterized by the functions of excitation and conduction of nerve impulses from peripheral receptors to executive organs (Fig. 5). Each nerve cell consists of cytoplasm, nuclear part and processes. The part of the neuron where the nucleus and the bulk of the organelles are located is called the body of the neuron. In the cytoplasm of a nerve cell there is a chromatophilic substance, represented by groups of cisterns of the granular endoplasmic reticulum, actively synthesizing protein. Nerve cells differ in shape, size and branching of their processes. 31 1 2 3 4 5 6 7 8 I 9 9 2 3 II 6 1 III 2 5 3 1 4 4 5 Fig. 5. Structure of a neuron (diagram): I - sensory neuron: 1 - neuron endings; 2 - axon; 3 - core; 4 - cell body; 5 - dendrite; 6 - myelin sheath; 7 -receptor; 8 - organ; 9 - neurilemma; II - motor neuron: 1 - dendrites; 2 - axon; 3 - terminal plaque; 4 - interception of Ranvier; 5 - Schwann cell nucleus; 6 - Schwann cell; III - interneuron: 1 - axon; 2 - dendrites; 3 - core; 4 - cell body; 5 - dendron Near the nucleus, thin threads of neurofibrils intertwine, and in the processes they run parallel. Based on their function, they usually distinguish between motor, intermediate, or reticular, and sensory neurons. Depending on the number of processes extending from the nerve cell, neurons with one process are called unipolar, with two - bipolar, with three or more - multipolar (Fig. 6). Multipolar neurons are most common. The unipolar neuron is further divided into peripheral and central processes. There are two types of processes: dendrites and axons. Dendrites conduct excitation to the body of the nerve cell. Each cell usually has several dendrites. They are short and break up into thin branches. Along an axon, or neurite, a nerve impulse moves from the body of a nerve cell to a working organ (gland, muscle) or to another nerve cell. A group of processes of nerve cells, covered with 32 sheaths, forms nerve fibers; the process itself lies in the center of the fiber and is called the axial cylinder. Neuroglia cells line the brain cavity, the spinal canal, form the supporting apparatus of the central nervous system, and surround the bodies of neurons and their processes. Axons are thinner than dendrites, their length can reach 1.5 m. C The distal section of the axon B falls into many branches A with sacs at the ends and is connected using contacts Fig. 6. Types of neurons: (synapses) with other neurons A - unipolar; or organs. At synapses, excitation B is bipolar; transmission from one cell to another B - multipolar or to an organ is transmitted with the help of neurotransmitters (acetylcholine, norepinephrine, serotonin, dopamine, etc.). Nerve fibers can be myelinated (meaty) or unmyelinated (non-myelinated). In the first case, the nerve fiber is covered with a myelin sheath in the form of a muff and a myelin sheath, or Schwann. The myelin sheath is interrupted at regular intervals, forming nodes of Ranvier. On the outside, the myelin sheath is surrounded by a non-elastic membrane - the neurilemma. Unmyelinated nerve fibers do not have a myelin sheath and are found mainly in the internal organs of humans. Bundles of nerve fibers form nerve trunks, or nerves, covered with a connective membrane - epineurium. Outgrowths of the epineurium directed inward are called perineurium, which divides the nerve fibers into small bundles and surrounds them. Inside the nerve bundle is the endoneurium. Nerve fibers end in terminal devices called nerve endings. Depending on the function they perform, they are divided into sensory receptors and motor effectors. Sensitive nerve endings perceive irritations from the external and internal environment, transform them into nerve impulses and transmit them to other cells and organs. Receptors that perceive stimuli from the external environment are called exteroceptors, and those from the internal environment are called interoreceptors. Proprioreceptors perceive irritations in body tissues embedded in muscles, ligaments, tendons, bones, etc. Depending on the nature of irritation, there are thermoreceptors (perceive temperature changes), mechanoreceptors (contact the skin, compress it), nociceptors (perceive pain irritation). Motor nerve endings transmit nerve impulses (excitation) from nerve cells to the working organ. Effectors that transmit impulses to the smooth muscles of internal organs, blood vessels and glands are constructed as follows: the terminal branches of motor neurons approach the cells and contact them with a slight thickening. Using special microphotography, it was established that the nerve process in contact with the nerve cell contracts. Nervous excitation is transmitted along a reflex arc, i.e. the path followed by the reflex. The reflex arc is understood as a set of formations involved in the implementation of the reflex. The motor nerve endings of skeletal muscles have a complex structure and are called motor plaques. The nerves that transmit impulses to the central nervous system are called afferent (sensory), and those from the center are called efferent (motor). Afferent and efferent neurons communicate using interneurons. Not ditches with mixed function transmit impulses in both directions. The transmission of a nerve impulse from one neuron to another is carried out using contacts called interneuron synapses. Each neuron can have several thousand synapses, which are divided into axodendritic, axosomatic and axoaxonal. Internal environment of the body The term “internal environment of the body” is applied to the intercellular substance and the cells located in it. The main physiological characteristic of the internal environment of the body is maintaining the constancy of its parameters, carried out by various regulatory mechanisms, the most important among which is the principle of negative feedback. The constancy of the internal environment is a necessary condition for the normal functioning of the body and is called homeostasis. Feedback - the basic principle of control systems - is reinforced by multiple processes, which provides opportunities for the body to adapt to constantly changing conditions of existence. The internal environment of the body is represented by blood, lymph and tissue fluid. It provides communication between the cells of the body, has a constant composition and physicochemical properties. Blood (sanguis) consists of a liquid part - blood plasma (55–60% of the total blood volume) and formed elements - cells (hematocrit 40–45%). The adult body contains about 5 liters of blood, or 6–8% of body weight. Blood cells include: erythrocytes (red blood cells), leukocytes (white blood cells), platelets (blood platelets). Blood plasma is a yellowish liquid. It contains 90% water, 7–8% proteins (albumin, globulins, fibrinogen), 0.1% glucose, 1.1% mineral salts. Blood plasma has a slightly alkaline reaction (pH 7.36–7.42), its osmotic pressure is 7.6–8.1 atm. The constancy of the osmotic pressure of the plasma ensures a constant water content in the cells, which is a necessary condition for the correct course of physiological processes. The viscosity of blood is 5.0, and plasma is 1.7–2.2 (relative to the viscosity of water, which is 1). Specific density of blood - 1.050–1.060, plasma - 1.025–1.034, erythrocytes - 1.090. The composition and properties of blood plasma are constant and change little. After the separation of formed elements, plasma contains salts, proteins, carbohydrates, biologically active compounds, as well as carbon dioxide and oxygen dissolved in water. Plasma ensures the constant volume of intravascular fluid and acid-base balance (ABC), and also participates in the transfer of active substances and metabolic products. Plasma proteins are divided into two main groups: albumins and globulins. The first group includes about 60% of plasma proteins. 35 Globulins are represented by fractions: alpha1, alpha2, beta2 and gammaglobulins. The globulin fraction also includes fibrinogen. Plasma proteins are involved in processes such as the formation of tissue fluid, lymph, urine and water absorption. The nutritional function of plasma is associated with the presence of lipids in it, the content of which depends on the characteristics of nutrition. Blood plasma without fibrinogen is called serum. The importance of blood in the body is enormous. It performs the following functions: 1) respiratory, nutritional - delivers oxygen and nutrients to tissue cells; 2) excretory - removes metabolic products from tissue cells; 3) humoral regulation of the body - with the help of hormones; 4) protective - the production of antibodies and the ability to clot; 5) thermoregulation; 6) homeostatic, regulatory. Thanks to the respiratory function, blood carries oxygen from the lungs to organs and tissues, removes metabolic products and carbon dioxide, produces antibodies, and carries hormones that regulate the activity of various body systems. Blood circulates in blood vessels and is separated from other tissues by the vascular wall, but formed elements, as well as blood plasma, can pass into the connective tissue surrounding the blood vessels. Thanks to this, blood ensures the constancy of the composition of the internal environment of the body. The homeostatic function is the uniform distribution of blood between organs and tissues, maintaining a constant osmotic pressure and pH with the help of blood plasma proteins, etc. The regulatory function is the transfer of hormones produced by the endocrine glands to certain target organs to transmit information within the body. The protective function is to neutralize microorganisms and their toxins by blood cells, form antibodies, remove tissue breakdown products, and stop bleeding as a result of blood clot formation. The thermoregulatory function is carried out by transferring heat outward from deep-lying organs to the vessels of the skin, as well as by uniform distribution of heat in the body as a result of the high thermal capacity and thermal conductivity of the blood. In humans, blood mass makes up 6–8% of body weight and is normally approximately 4.5–5.0 liters. At rest, only 40–50% of all blood circulates, the rest is in the depot (liver, spleen, skin). The pulmonary circulation contains 20–25% of the blood volume, and the systemic circulation contains 75–85% of the blood. 15–20% of blood circulates in the arterial system, 70–75% in the venous system, and 5–7% in the capillaries. Blood is a colloidal polymer solution, the solvent in which is water, and the soluble substances are salts, low molecular weight organic compounds, proteins and their complexes. Osmotic pressure of blood is the force of movement of a solvent through a semi-permeable membrane from a less concentrated solution to a more concentrated one. The osmotic pressure of the blood is at a relatively constant level for metabolism. The concentration of salts in the blood is 0.9%, and the osmotic pressure of the blood mainly depends on their content. With the help of osmotic pressure, water is distributed evenly between cells and tissues. Regulation of osmotic pressure is carried out through the neurohumoral pathway. A constant pH reaction is maintained in the blood. The reaction of the environment is determined by the concentration of hydrogen ions, expressed by the pH value, which is of great importance, since the vast majority of biochemical reactions can normally occur only at certain pH values. Formed elements of blood The formed elements of blood include erythrocytes, leukocytes and platelets. Erythrocytes - red blood cells, have the shape of biconcave discs measuring 7–8 nm. Mature red blood cells do not have nuclei. The main function of red blood cells is the transport of oxygen and carbon dioxide. Red blood cells are formed in the red bone marrow (up to 10 million every second), and destroyed in the spleen and liver. Their lifespan is 80–120 days. 37 The number of red blood cells in the blood can change: residents living in flat areas have fewer of them than those living in highlands, children have more of them than adults. Red blood cells are highly specialized cells; therefore, they have lost their nucleus, cell center, mitochondria, and endoplasmic reticulum. They are highly elastic and easily pass through capillaries, which have half the diameter of the cell itself. The total surface area of ​​all red blood cells in an adult is about 3800 m2, i.e. 1500 times the surface of the body. The blood of men contains about 5 × 1012/l of red blood cells, the blood of women contains 4.0–4.5 × 1012/l. With intense physical activity, the number of red blood cells in the blood can increase to 6 × 1012/l. This is due to the entry of deposited blood into the circulation. Red blood cells contain hemoglobin, which consists of the globin protein and the prosthetic group heme, which are attached to the four polypeptide chains of globin and give the blood its red color. Hemoglobin carries oxygen and carbon dioxide. The normal level of hemoglobin is 140 g/l: in women - 120–140 g/l, in men - 130–155 g/l. Hemoglobin easily reacts with oxygen, forming an unstable compound - oxyhemoglobin. Hemoglobin that has given up oxygen is called reduced, or reduced, and has the color of venous blood. Having given up oxygen, the blood gradually absorbs the final product of metabolism - CO2 (carbon dioxide). The reaction of hemoglobin joining to CO2 is more complicated than binding with oxygen. This is explained by the role of CO2 in the formation of acid-base balance in the body. Hemoglobin that binds carbon dioxide is called carbohemoglobin. Under the influence of the enzyme carbonic anhydrase found in red blood cells, carbonic acid is broken down into CO2 and H2O. Carbon dioxide is released by the lungs, and there is no change in the blood reaction. Hemoglobin attaches especially easily to carbon monoxide (CO) due to its high chemical affinity (300 times higher than for O2) to hemoglobin. Hemoglobin blocked by carbon monoxide can no longer serve as a carrier of oxygen and is called carboxyhemoglobin. As a result, oxygen starvation occurs in the body, accompanied by vomiting, headache, and loss of consciousness. 38 A decrease in the amount of hemoglobin in red blood cells is called anemia. It is observed during bleeding, intoxication, deficiency of vitamin B12, folic acid, etc. When blood is in a vertical test tube, downward sedimentation of erythrocytes is observed. This happens because the specific density of erythrocytes is higher than the density of plasma (1.096 and 1.027). The erythrocyte sedimentation rate (ESR) is expressed in millimeters of the height of the plasma column above the red blood cells per unit of time (usually 1 hour). This reaction characterizes some physicochemical properties of blood. ESR in men is normally 5–7 mm/h, in women – 8–12 mm/h. The mechanism of erythrocyte sedimentation depends on many factors, for example, on the number of erythrocytes, their morphological features, charge size, ability to agglomerate, protein composition of plasma, etc. Increased ESR is typical for pregnant women - up to 30 mm/h, patients with infectious and inflammatory processes, as well as with malignant formations - up to 50 mm/h or more. Leukocytes are spherical white blood cells ranging in size from 6 to 23 nm and having a nucleus. The lifespan of leukocytes is 8–12 days. The number of leukocytes in human blood is normally 4–9 × 109/l and fluctuates throughout the day. There are fewer of them in the morning on an empty stomach. Leukocytes of all types have mobility and, in the presence of appropriate chemical stimuli, pass through the wall of blood capillaries (diapedesis) into the surrounding connective and epithelial tissue and participate in the body’s protective reactions - the digestion of foreign bodies, microorganisms, the formation of bactericidal substances and immunocompetent proteins. An increase in the number of leukocytes in the blood is called leukocytosis, and a decrease is called leukopenia. There are physiological and reactive leukocytosis. The first is more often observed after meals, during pregnancy, during muscle strain, pain, emotional stress, etc. The second type is characteristic of inflammatory processes and infectious diseases. Leukopenia is observed in some infectious diseases, exposure to ionizing radiation, taking medications, etc. Based on the presence of granularity in the cytoplasm, leukocytes are divided into granular (granulocytes) and non-granular (agranulocytes). 39 Cells whose granules are stained with acidic dyes (eosin, etc.) are called eosinophils; basic dyes (methylene blue, etc.) - basophils; neutral paints - neutrophils. Granulocytes make up 72% of the total number of leukocytes, of which 70% are neutrophils, 1.5% eosinophils and 0.5% basophils. In granulocytes, the nuclei are usually segmented and have the appearance of rods, horseshoes or lumps. Eosinophils are leukocytes capable of neutralizing foreign proteins; basophils - cells that take part in the processes of blood clotting and regulation of vascular permeability for blood cells, produce heparin and histamine; In this way, trophils are able to penetrate into the intercellular spaces of infected areas of the body, absorb and digest pathogenic bacteria. Together with the remains of destroyed cells and tissues, neutrophils form pus. Agranulocytes are leukocytes with an oval-shaped nucleus and non-granular cytoplasm. These include monocytes and lymphocytes. Monocytes are large blood cells, have a bean-shaped nucleus, their diameter is up to 20 microns. They are capable of active phagocytosis and perform a protective function. According to modern concepts, monocytes can give rise to the development of connective tissue histiocytes, macrophages of the liver, spleen, bone marrow, lungs, lymph nodes, osteoclasts and microglial cells of nervous tissue. They actively penetrate into areas of inflammation and absorb (phagocytose) bacteria. Lymphocytes are formed in the thymus gland (thymus) and are called thymus-dependent leukocytes, or Tlymphocytes. There are T and B lymphocytes. Tlymphocytes produce antibodies and take part in cellular immune reactions, destroy foreign cells, with the help of enzymes they independently destroy microorganisms, viruses, cells of transplanted tissue and are called killers - cell killers. Vlymphocytes do not develop in the thymus, but in lymphoid accumulations of the small intestine, lymph nodes, and tonsils. They protect the body from infections with the help of specific proteins - antibodies, preparing bacteria and viruses for phagocytosis, and are responsible for the immune system. The lifespan of lymphocytes ranges on average from 3 days to 6 months. Some cells live up to 5 years. 40 Lymphocytes are the main link of the immune system; they participate in the processes of cell growth, tissue regeneration, and control of the genetic apparatus of other cells. Platelets (blood platelets) are colorless polymorphic anucleate bodies with a diameter of 2–5 µm. They are formed in large bone marrow cells - megakaryocytes. The lifespan of platelets is from 5 to 11 days. They play an important role in blood clotting. A significant part of them is stored in the spleen, liver, lungs and, as needed, enters the blood. During muscle work, eating, and pregnancy, the number of platelets in the blood increases. The normal platelet count is 250 × 109/L. In the body, the formed elements of blood are found in certain quantitative ratios, which are usually expressed by the blood formula (hemogram). The ratio of different types of leukocytes in the blood is called the leukocyte formula (Table 1). The number of certain types of leukocytes increases in a number of diseases. For example, with whooping cough and typhoid fever, the number of lymphocytes increases; in malaria - monocytes, and in other infectious diseases - neutrophils. The number of eosinophils increases in allergic diseases (bronchial asthma, scarlet fever, etc. ). Characteristic changes in the leukocyte formula make it possible to make an accurate diagnosis. Tab. 1 Lymphocytes Neutrophils, % Leuko Eosi Baso Lympho Mono seg rodocytes, nophyphiles, cytes, mentocytes, young conuclears, % % % % 109 /l nuclei nal 4.0–9.0 1–4 0– 0.5 0–1 2–5 55–68 25–30 6–8 Lymph (lymphoplasm), like blood, consists of plasma and formed elements - lymphocytes, eosinophils, monocytes. Lymphoplasm, unlike blood, contains more metabolic products coming from tissues. 41 Blood groups are immunogenetic and individual characteristics of blood that unite people by the similarity of certain antigens - agglutinogens - in erythrocytes and antibodies - agglutinins found in the blood plasma. Based on the presence or absence of specific mucopolysaccharides, agglutinogens A and B, in the membranes of donor red blood cells and agglutinins α and β in the recipient’s blood plasma, the blood group is determined (Table 2). Chapter 2 agglutinogens in erythrocytes Agglutinins in serum 0 (1) - α, β A (II) A β B (III) B α AB (IV) A, B - In this regard, four blood groups are distinguished: O (I), A (II), B (III) and AB (IV). When similar erythrocyte agglutinogens are combined with plasma agglutinins, an agglutination (gluing) reaction of erythrocytes occurs, which underlies group incompatibility of blood. This provision must be followed when transfusing blood. The study of blood groups has become significantly more complex due to the discovery of new agglutinogens. For example, group A has a number of subgroups, in addition, new agglutinogens have been found - M, N, S, P, etc. These factors sometimes cause complications during repeated blood transfusions. People with the first blood group are considered universal donors. However, it turned out that this universality is not absolute. This is due to the fact that in people with the first blood group, immune anti-A and anti-Vagglutinins are largely detected. Transfusion of such blood can lead to serious complications and possibly death. These data served as the basis for transfusion of only one group of blood (Fig. 7). 42 Erythrocyte group Plasma groups 0 (I) A (II) B (III) AB (IV) I α +β II β III α IV Fig. 7. Blood group compatibility: trait - compatible; square - incompatible Transfusion of incompatible blood leads to the development of hemotransfusion shock (thrombosis, and then hemolysis of red blood cells, kidney damage, etc. ). In addition to the main agglutinogens A and B, there may be others in erythrocytes, in particular the so-called Rh factor, which was first found in the blood of the Macacaresus monkey. Based on the presence or absence of the Rh factor, Rh-positive (about 85% of people) and Rh-negative (about 15% of people) organisms are distinguished. In medical practice, the Rh factor is of great importance. Thus, in Rh negative people, blood transfusions or repeated pregnancies cause the formation of Rh antibodies. When Rh positive blood is transfused to people with Rh antibodies, severe hemolytic reactions occur, accompanied by the destruction of transfused red blood cells. The development of Rh-conflict pregnancy is based on the entry of Rh-positive fetal erythrocytes into the body through the placenta of a Rh-negative woman and the formation of specific antibodies (Fig. 8). In such cases, the first child who inherits Rh positive is born normal. And during the second pregnancy, the mother’s antibodies, which penetrate into the blood of the fetus, cause the destruction of red blood cells, the accumulation of 43 bilirubin in the blood of the newborn and the appearance of hemolytic jaundice with damage to the internal organs of the child. Fetal blood Mother's blood + immunocyte Destruction of fetal erythrocytes Placenta I Anti-Rhesus agglutinins Introduction of rhesus drugs II immunocyte does not recognize fetal erythrocytes and antibodies are not formed Fig. 8. Development of rhesus conflict and its prevention: I - rhesus conflict; II - prevention of rhesus conflict Blood clotting is a protective reaction that prevents blood loss and the entry of disease-free microbes into the body. This constitutes a multi-stage process. It involves 12 factors that are found in the blood plasma, as well as substances released from damaged tissues and platelets. There are three stages in blood coagulation. In the first stage, the blood flowing from the wound mixes with substances from damaged tissues, destroyed platelets and comes into contact with air. Then the released thromboplastin precursor, under the influence of plasma factors and calcium ions (Ca2+), is converted into active thromboplastin. In the second stage, with the participation of thromboplastin, plasma factors, and calcium ions, the inactive plasma protein prothrombin is converted into thrombin. In the third stage, thrombin (a proteolytic enzyme) breaks down the fibrinogen plasma protein molecule into small pieces and creates a network of fibrin strands (an insoluble protein), which precipitates. Fibrin networks retain blood cells and form a clot, which prevents blood loss and the penetration of microorganisms into the wound. After removing fibrin from the plasma, we are left with a liquid - serum. Blood is a healing agent. In practical medicine, transfusion of blood and its preparations is widely used. To provide blood, donation is widespread. People who donate blood for medicinal purposes are called donors. For active donors, a single blood donation dose is 250–450 ml. As a rule, this results in a decrease in the amount of hemoglobin and red blood cells in proportion to the amount of blood taken. The rate at which donor blood returns to normal depends on many reasons, including the dose of blood taken, age, gender, nutrition, etc. BASIC ANATOMICAL CONCEPTS Organs and organ systems. The body as a whole By connecting with each other, different tissues form organs. An organ is a part of the body that has a certain shape and structure, occupies a corresponding place in the body and performs a specific function. Various tissues take part in the formation of any organ, but only one of them is the main one, the rest perform an auxiliary function. For bones it is bone tissue, for muscles it is cervical tissue, for the brain it is nervous tissue, for glands it is epithelial tissue, etc. Other tissues included in the organ perform auxiliary functions: connective tissue forms the stroma (framework) of the organ, muscle tissue participates in the formation of hollow organs, epithelial tissue lines the mucous membranes of the respiratory and digestive systems. Organs that have a common origin and perform the same function constitute an organ system. The following organ systems are distinguished in the human body: 1) digestive - unites the organs with the help of which food is digested in the body and assimilated; 2) respiratory - includes the respiratory organs in which gas exchange occurs between the blood and its environment; 45 3) cardiovascular - unites the heart and blood vessels that provide blood circulation; 4) urinary - carries out the release of metabolic products from the body (salts, urea, creatinine, etc.); 5) nervous - connects all organs and systems into a single whole, regulates their activity; 6) sensory system - perceives irritations from the external and internal environment; 7) endocrine - regulates all processes in the body with the help of special substances (hormones). Organs that perform the same function, but have different structures and origins, form the apparatus of the organ; new: musculoskeletal, endocrine, etc. The totality of organ systems and apparatuses forms an integral human organism, in which its component parts are interconnected with each other. The main role in uniting the body into a single whole belongs to the nervous and endocrine systems. Thanks to its integrity, the organism has basic vital properties: metabolism and energy with the environment, movement, growth and development, reproduction, heredity, variability, adaptability to living conditions. The integrity of the body as a biological system, the connection into a single whole of cells, tissues, organs and its functions is ensured by the regulation of the neurohumoral system. The human body is constantly influenced by the environment through the senses and nervous system. The unity of the organism and the environment is the basis of evolution. In the process of evolution and under changing environmental conditions, the organism adapts. The living conditions of humans and animals constitute the biological environment. For a person, in addition to the biological environment, the social environment, which consists of working and living conditions, is of great importance. A person’s professional activity entails the development of those parts of the body whose function the given specialty is associated with. In the process of evolution, humans developed speech, creativity, intelligence, and consciousness. However, as a living being, man belongs to the animal world. Humans belong to the phylum Chordata; subphylum - vertebrates (Vertebrata); class - mammals (Mamma 46 lia), genus - humans (Homo), species - homo sapiens (Homo sapiens). Self-regulation of physiological functions is the main mechanism for maintaining the vital functions of the body at a relatively constant level. The relative constancy of the internal environment in humans is maintained by neurohumoral physiological mechanisms that regulate the activity of the cardiovascular and respiratory systems, digestive organs, kidneys and sweat glands, which ensure the removal of metabolic products from the body. Parts of the body, planes and axis of rotation. To denote the position of a body in space and its various parts relative to each other, the concepts of body parts, planes and axes are used. The natural anatomical position of the body, proposed by Kölliker and Krause, is the vertical position of the human body, arms down along the body, palms facing forward and thumbs outward. The human body has the following parts: head, neck, torso, upper and lower limbs. The head is divided into two sections - the facial and the brain. Each upper limb consists of a girdle, upper limb, shoulder, forearm and hand, and each lower limb consists of a pelvic girdle, thigh, lower leg and foot. The body is divided into the chest, back, abdomen, and pelvis. Inside the body there are cavities: thoracic, abdominal and pelvic. The human body is built on the principle of bilateral symmetry and is divided into two halves - right and left. When describing parts of the body and the position of individual organs, three mutually perpendicular planes are used: sagittal, frontal and horizontal. To orient organs and parts of the body relative to the position of the body, axes of rotation are identified - lines formed when the planes intersect: frontal or transverse; sagittal, or anteroposterior, and vertical. The frontal axis is formed at the intersection of the frontal and horizontal planes; flexion (flexio) and extension (extensio) occur around it. When the sagittal and horizontal planes intersect, a sagittal axis is formed, around which abduction (abductio) and adduction (adductio) are carried out. The vertical axis is formed at the intersection of the frontal and sagittal planes, and rotation (rotatio) occurs around it. To determine the projection of the boundaries of organs (heart, lungs, liver, etc.) on the surface of the body, approximate vertical lines are conventionally drawn along the human body. The anterior midline runs along the anterior surface of the body, on the border between the right and left halves, the posterior midline runs along the spinal column, along the tops of the spinous processes of the vertebrae, the paravertebral line - along the spinal column through the costotransverse joints. The sternal line runs in the middle of the chest, the midclavicular line runs through the middle of the clavicle; the parasternal line runs along the edge of the sternum; the anterior, middle and posterior axillary lines pass from the anterior fold, the middle part of the posterior fold of the axillary fossa; The scapular line passes through the lower angle of the scapula. To indicate the position of organs and parts of the body, the following anatomical terms are used: medial (medialis), if the organ lies closer to the median plane; lateral (lateralis), if the organ is located further from the median plane; internal (internus), lying inside, and external (externus) - outward. Organs located inside the cavity (part of the body): deep (profundus) - lying deeper, or outside it - superficial (superficialis) - lying on the surface. The surface facing the head is called cranialis, and the surface facing the pelvis is called caudalis. To assess the condition of the upper and lower extremities, the following terms are used: proximal (proximalis) - lying closer to the body, and distal (distalis) - distant from it. Questions for self-control 1. Tell us about the structure of a cell and define the term “tissue”. 2. Name the types of fabrics. 3. Which tissues are epithelial, explain the features of their structure and function. 4. Tell us about the structure and role of connective tissue in the body. 5. Name the types of connective tissue and describe them. 48 6. Composition and role of blood in the body. 7. List the main functions of blood. 8. Explain about osmotic pressure and blood pH. 9. Describe the structure of red blood cells. 10. Classification of leukocytes and their functional role. 11. Explain the structure of granular leukocytes. 12. Tell us about the structure of non-granular leukocytes, their composition and significance. 13. What is the leukocyte formula? Its practical application. 14. What are the structural features of platelets? Their role in the body. 15. What are blood groups? 16. What do you know about the Rh factor? 17. Tell us about the erythrocyte sedimentation rate and its clinical significance. 18. Classification of muscle tissue. 19. Explain the structure of smooth muscle tissue. 20. Structure and function of striated tissue. 21. Name the structural and functional features of the muscle tissue of the heart. 22. Tell us about the structure and significance of nervous tissue. 23. Features of the structure of a neuron. 24. Types of nerve fibers and their structure. 25. Define the concepts “organ”, “system” and “apparatus of organs”. 49 CHAPTER 3 CONSIDERATIONS One of the main functions of a person is his movement in space. Movement is the main adaptive reaction of the body to its environment. This function in mammals (and humans) is performed by the musculoskeletal system. The musculoskeletal system consists of two parts: passive and active. Passive includes bones that are connected to each other, while active includes muscles, the contraction of which changes the position of the body in space. The skeleton performs many functions. The main ones are the supporting function, the protection of organs, and the receptacle for the red and yellow bone marrow. Skeletal bones, ligaments that are attached to bones, fascia - all of them together perform the function of moving the human body in space. The bones of the skeleton form cavities in which the brain and spinal cord, sensory organs, respiratory, digestive, genitourinary, endocrine, circulatory and immune systems are located, and protect these organs from the mechanical influences of the external environment. The biological significance of the skeletal system is also associated with its participation in mineral metabolism (depot of phosphorus, calcium, iron, etc. ). CLASSIFICATION OF BONES There are more than 200 bones in the human skeleton, which can be divided into paired and unpaired. Human bones also vary in shape and size. There are the following types of bones: tubular, spongy (short), flat (wide), mixed and pneumatic. Tubular bones perform the function of levers and form the skeleton of the free part of the limbs; they are divided into long (humerus, femurs, bones of the forearm and lower leg) and short (metacarpal and metatarsal bones, phalanges of the fingers). 50 Long tubular bones have a cylindrical body, or middle part - diaphysis, widened ends of various shapes - epiphyses. The area between the epiphysis and diaphysis is called the metaphysis. The epiphyses of bones are completely or partially covered with hyaline cartilage and participate in the formation of joints. In the body of the tubular bones, consisting of a compact substance, there is a bone marrow cavity filled with yellow bone marrow. The compact substance, located outside, becomes thinner in the area of ​​the epiphyses. Inwardly from it there is a spongy substance, consisting of intersecting bone crossbars, forming voids in the form of cells. The latter contains red bone marrow. Spongy (short) bones are located in those parts of the skeleton where the strength of the bones is combined with the mobility of the carpal bones, tarsus, vertebral bodies, and sesamoid bones. Spongy bones are covered on the outside with a layer of compact substance, and on the inside they consist of spongy substance. Due to the structure of the spongy substance, such bones can withstand heavy loads. Flat (wide) bones are involved in the formation of the roof of the skull, thoracic and pelvic cavities. These also include the bones of the shoulder and pelvic girdles. Between the two plates of the compact substance there is a layer of spongy substance. Flat bones perform a protective function and have a large surface area for muscle attachment. Mixed bones have a complex structure and different shapes. Some of them can be classified as spongy bones, others - as flat ones. This group of bones includes vertebrae, the bodies of which are spongy, and the processes and arches are flat. Air bones contain a cavity in the body with air, lined with mucous membrane. These include the maxilla, frontal, sphenoid and ethmoid bones of the skull. GENERAL DATA ABOUT THE STRUCTURE OF BONES AND THEIR CONNECTIONS The human bone (os) is a complex organ, actively functioning and continuously changing. The vessels and nerves penetrating into the bone contribute to its interaction with the body, participation in the general metabolism of 51 substances, the performance of functions and the necessary restructuring during growth, development and changing living conditions. In a living organism, bone contains about 50% water, 28% organic substances, including 16% fats and 22% inorganic substances. In addition, bones also contain sodium, magnesium, potassium, chlorine, fluorine, carbonates and nitrates in varying quantities. Fat-free and dried bone consists of 1/3 of organic matter and 2/3 of inorganic matter. The predominance of organic substances in the composition of bones gives the skeleton greater flexibility, but less hardness, and an increase in the content of inorganic substances in the bone leads to fragility, which can be observed in older people. The organic matter of bone is mainly ossein, which forms collagen fibers. Inorganic matter consists of various salts of calcium, magnesium, phosphorus, etc. Bone is formed by bone tissue, which belongs to the connective tissue. There are two types of cells in bone tissue - osteoblasts and osteoclasts. Osteoblasts are young bone cells of a polygonal shape, rich in elements of the granular cytoplasmic reticulum, ribosomes and a well-developed Golgi complex. They contain a large amount of ribonucleic acid and alkaline phosphatase. Osteoblasts gradually differentiate into osteocytes, and the number of organelles in them decreases. The intercellular substance formed by osteoblasts surrounds osteocytes on all sides and is impregnated with calcium salts. Osteocytes are mature multi-processed cells that lie in bone lacunae, produce intercellular substance and are usually immured in it. The number of cellular organelles in osteocytes is reduced, and they often store glycogen. If there is a need for structural changes in bones, osteoblasts are activated, quickly differentiate and turn into osteocytes. The system of bone tubules ensures the exchange of substances between osteocytes and tissue fluid. In addition to the above-mentioned cells, bone tissue also contains osteoclasts - large multinucleated cells poor in chromatin. The cytoplasm of such cells has many protrusions covered with a plasma membrane. Cells contain mitochondria, lysosomes, vacuoles, hydrolytic enzymes and pronounced Golgi complexes. The plasma membrane in this area forms many folds and is called a corrugated bank. 1 Osteoclasts are capable of resorbing calcified cartilage and intercellular substance of bone tissue during the development and reconstruction of bone. According to modern information, osteoclasts are of monocyte origin and belong to the macrophage system. On the outside, the bone is covered with a layer of dense connective tissue - periosteum. This is a thin, dense connecting plate, rich in Fig. 9. A segment of long blood and lymphatics from the tubular bone: vessels and nerves. The periosteum has 1 - os; 2 - periosteum; outer and inner layers (Figure 9). 3 - сavitas medullaris The outer layer of the periosteum is fibrous, the inner layer is germinal (bone-forming). The inner layer attaches directly to the bone tissue and forms young cells (osteoblasts) that are located on the surface of the bone. Thus, as a result of the bone-forming properties of the periosteum, the bone grows in thickness. The periosteum fuses tightly with the bone with the help of penetrating fibers that go deep into the bone. The outer layer of bone is represented by a plate of compact substance, which is thicker in the diaphyses of long bones than in the epiphyses. In the compact substance, bone plates are arranged in a certain order and form complex systems - osteons - structural units of bone. Ostheon consists of 5–20 cylindrical plates inserted one into the other. The central (Haversian) canal runs through the center of each osteon. Through it, in turn, pass one artery and one vein, which branch into capillaries and through channels approach the lacunae of the Haversian system. They ensure the influx and outflow of nutrients and metabolic products, CO2 and O2, from cells. Each Haversian canal also contains a lymphatic vessel and nerve fibers. On the outer and inner surfaces of the bone, the bone plates do not form concentric cylinders, but are located around them. These areas are pierced by Volkmann's canals, through which blood vessels pass, connecting with the vessels of the Haversian canals. The ground substance of compact bone consists of bone collagen, produced by osteoblasts, and hydroxyapatite; in addition, it includes magnesium, sodium, carbonates and nitrates. Under the compact substance is the spongy substance, which is a network of thin anastomosed bone elements - trabeculae. Trabeculae are oriented in those directions in which the bones increase their resistance to stress and compression with minimal mass. Spongy bone is also found in the epiphyses of tubular long and short bones (vertebrae, carpal and tarsal bones). It is also characteristic of embryos and growing organisms. Inside the bone, in the medullary cavity and cells of the spongy substance, there is bone marrow. In the prenatal period and in newborns, all bones contain red bone marrow, which primarily performs a hematopoietic function. In an adult, red bone marrow is contained only in the cells of the spongy substance of flat bones (sternum, skull bones, ilium), in spongy (short bones), and epiphyses of long bones. In the bone marrow cavity of the diaphyses of long bones there is yellow bone marrow. It consists of fatty inclusions and degenerated reticular stroma. BONE CONNECTIONS The bones of the human skeleton are combined into a common functional system (the passive part of the musculoskeletal system) using various types of joints. All bone joints are divided into three types: continuous, synovial joints - joints, and symphyses, or semi-joints. Depending on the type of tissue that connects the 54 bones, the following types of continuous connections are distinguished: fibrous, bone and cartilaginous synchondrosis connections (Fig. 10). 1 2 3 1 10 2 7 B 5 8 6 1 2 4 9 D A C Fig. 10. Types of bone connections (diagram): A - joint; B - fibrous compound; B - synchondrosis (cartilaginous junction); G - symphysis (hemiarthrosis); 1 - periosteum; 2 - bone; 3 - fibrous connective tissue; 4 - cartilage; 5 - synovial membrane; 6 - fibrous membrane; 7 - articular cartilage; 8 - articular cavity; 9 - gap in the interpubic disc; 10 - interpubic disc Fibrous joints

Name: Human anatomy and physiology.

The textbook covers issues of normal human anatomy and physiology, taking into account modern achievements of biological and medical science. The subject, objectives and significance of the course in human anatomy and physiology are considered, a brief historical outline of their development is given. Issues of anatomy and particular physiology are presented.

CONTENT
PREFACE. 3
INTRODUCTION 4
BRIEF HISTORY OF THE DEVELOPMENT OF ANATOMY 5 AND PHYSIOLOGY. 5
RESEARCH METHODS. eleven
Questions for self-control. 13
CELLS AND TISSUE. 14
CELLS. 14
FABRICS. 16
Epithelial tissue. 17
Connective tissue. 19
Muscle. 28
Nervous tissue. 29
ORGANS AND ORGAN SYSTEMS. 32
THE ORGANISM AS A SINGLE WHOLE WHOLE WHOLE WHOLE WHOLE WHOLE WHOLE WHOLE WHOLE WHOLE UNIT. 32
Questions for self-control. 33
Practical lessons. 34
BONES AND THEIR COMPOUNDS. 35
BONE STRUCTURE. 35
CONNECTION OF BONES. 38
SKELETON OF THE TORSO. 41
SKELETON OF THE HEAD. 50
SKELETON OF LIMB. 65
Bones of the upper limb. 66
Bones of the lower limb. 74
Questions for self-control. 83
Practical lessons. 83
MUSCULAR SYSTEM. 84
MUSCLE STRUCTURE. 85
CLASSIFICATION OF MUSCLES. 85
AUXILIARY APPARATUS AND MUSCLE WORK. 87
MUSCLES AND FASCIA OF THE TORSO. 90
MUSCLES AND FASCIA OF THE HEAD AND NECK. 98
MUSCLES AND FASCIA OF THE UPPER LIMB. 104
MUSCLES AND FASCIA OF THE LOWER LIMB. 112
Questions for self-control. 121
Practical lessons. 121
INTERNAL ORGANS. 122
DIGESTIVE SYSTEM. 123
Oral cavity. 124
Glands of the mouth. 127
Pharynx. 128
Esophagus. 129
Stomach. 130
Small intestine. 132
Colon. 134
Liver. Gallbladder. 136
Pancreas. 138
Abdominal cavity and peritoneum. 139
Physiology of digestion. 140
Regulation of digestion. 145
Questions for self-control. 146
Practical lessons. 146
RESPIRATORY SYSTEM. 146
Nasal cavity. 147
Larynx. 148
Trachea and bronchi. 150
Lungs. 151
Pleura and mediastinum. 154
Physiology of respiration. 155
Questions for self-control. 159
Practical lessons. 159
Genitourinary apparatus. 159
Bud. 160
Ureters. 163
Bladder. 164
Urethra. 165
Physiology of the kidneys. 166
Male genital organs. 167
Female genital organs. 171
Questions for self-control. 177
Practical lessons. 178
METABOLISM AND ENERGY. 179
PROTEIN METABOLISM. 179
CARBOHYDRATE METABOLISM. 180
LIPID METABOLISM. 181
WATER AND MINERAL EXCHANGE. 182
VITAMINS. 183
FORMATION AND ENERGY CONSUMPTION. 184
Questions for self-control. 187
Practical lessons. 187
Tasks. 188
ENDOCRINE GLANDS. 189
PITUITARY AND EPIPHYSIS. 189
THYROID AND PARATHYROID GLANDS. 192
THYMUS. 192
ADRENAL. 194
ENDOCRINE PART OF THE PANCREAS. 196
ENDOCRINE PART OF THE GENITAL GLANDS. 197
REGULATION OF INTERNAL SECRETION GLANES. 197
Questions for self-control. 198
Practical lessons. 199
THE CARDIOVASCULAR SYSTEM. 200
HEART. 203
VESSELS OF THE SMALL CIRCULATION. 209
VESSELS OF THE GREAT CIRCULATION. 210
BRANCHES OF THE AORTIC ARCH. 210
Branches of the thoracic aorta. 214
Branches of the abdominal aorta. 214
VEINS OF THE GREAT CIRCULATION. 219
Venous system of the heart. 219
The superior vena cava system. 219
The inferior vena cava system. 223
Portal vein system. 224
LYMPHATIC SYSTEM. 226
BLOOD-FORMING ORGANS. 230
PHYSIOLOGY OF CARDIOVASCULAR AND LYMPHATIC SYSTEMS. 231
REGULATION OF THE ACTIVITY OF THE CARDIOVASCULAR SYSTEM. 240
EDUCATION, COMPOSITION AND PROPERTIES OF LYMPH. 242
Questions for self-control. 243
Practical lessons. 244
NERVOUS SYSTEM. 245
CENTRAL NERVOUS SYSTEM. 246
Spinal cord. 247
Brain. 253
PERIPHERAL NERVOUS SYSTEM. 273
Cranial nerves. 274
Spinal nerves. 286
VEGETATIVE (AUTONOMOUS) NERVOUS SYSTEM. 295
The sympathetic part of the autonomic (autonomic) nervous system. 299
The parasympathetic part of the autonomic (autonomic) nervous system. 302
PHYSIOLOGY OF THE NEUROMUSCULAR SYSTEM. 304
PHYSIOLOGY OF THE CENTRAL NERVOUS SYSTEM. 309
CONDITIONED AND UNCONDITIONED REFLEXES. 314
TYPES OF HIGHER NERVOUS ACTIVITY. 315
SIGNAL SYSTEMS. 315
SLEEP PHYSIOLOGY. 316
Questions for self-control. 317
Practical lessons. 318
SENSORY ORGANS 320
ORGAN OF VISUAL. 321
ORGAN OF HEARING AND BALANCE. 329
ORGAN OF TASTE. 337
OLFACTORY ORGAN. 338
LEATHER. 339
Questions for self-control. 342
Practical lessons. 342
APPLICATIONS. 343
1. IMPORTANT QUANTITATIVE PHYSIOLOGICAL INDICATORS OF THE ADULT HUMAN BODY (According to the literature). 344
2. TABLE FOR CALCULATING BASIC METABOLISM IN MEN AND WOMEN (1 KCAL = 4.19 KJ). 347
3. NOMOGRAM FOR READ FORMULA. 350
LITERATURE.

Inner base of the skull(basis cranii interna) has three cranial fossae: anterior, middle and posterior (Fig. 34). In the anterior cranial fossa there are the lobes of the cerebral hemispheres, in the middle - the temporal lobes of the cerebral hemispheres, and in the posterior - the cerebellum and parts of the brain stem: the cerebral peduncles and the medulla oblongata.

Anterior cranial fossa formed by the orbital part of the frontal bone, the ethmoid bone (lamina cribrosa) and the lesser wings of the sphenoid bone and communicates with the nasal cavity through holes in the cribriform plate. These openings serve as the passage for the olfactory nerves (1st pair).

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Name: Human anatomy and physiology.
Fedyukovich N.I.
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Anatomy

And physiology

Human

Approved by the Ministry of Education of the Russian Federation

as a teaching aid for students

medical schools studying in the specialty0406 Nursing

Second edition

Rostov-on-Don

"Phoenix"

BBK 28.8ya723

Fedyukovich N. I.

F 32 Human Anatomy and Physiology: Textbook. Ed. 2nd. - Rostov n/d: publishing house:

"Phoenix", 2003. - 416 p.

The textbook covers issues of normal human anatomy and physiology, taking into account modern achievements of biological and medical science. The subject, objectives and significance of the course in human anatomy and physiology are considered, a brief historical outline of their development is given. Issues of anatomy and particular physiology are presented.

For students of medical schools majoring in nursing.

ISBN 5-222-03190-Х ББК 28.8я723

© N. I. Fedyukovich, 2003

© Design, publishing house "Phoenix", 2003

Preface

The quality of nursing education depends not only on the skill of teaching the subject, the technical equipment of training sessions, but also on the availability of modern textbooks and teaching aids.

The textbook “Anatomy and Physiology” was developed in accordance with the program approved by the Ministry of Health of the Russian Federation .

The formation of a future nurse begins with disciplines that are studied from the very beginning of training. One of them is human anatomy and physiology.

The material in the textbook is presented in a traditional anatomy and physiology manner. It has 12 sections, which first provide information on anatomy, and then reveal the physiological functions of a particular organ or system. In addition, the main stages of development of anatomy and physiology are briefly reviewed. At the end of each section there are questions for self-control.

For the names of organs and their parts, generally accepted Latin anatomical terms are used, given in the International Anatomical Nomenclature, approved at the London Anatomical Congress in 1985. Quantitative physiological indicators are presented according to the International System of Units (SI).

The manual contains drawings and diagrams. Some of the drawings were borrowed from various publications, such as “Human Anatomy” in 2 volumes, ed. M. R. Sapina (M., 1993), “Human Physiology”, ed. R. Schmidt and G. Tevs (M., 1985-1986), “General course of physiology of humans and animals” in 2 volumes, ed. A. D. Nozdracheva (M., 1991), X. Fenish “Pocket Atlas of Human Anatomy based on the International Nomenclature” (Minsk, 1996) and other textbooks. Changes and additions have been made to some drawings.

The author expresses sincere gratitude to Dr. med. sciences, prof. Department of Human Anatomy MGMI P. G. Pivchenko and the Chairman of the cyclic methodological commission of general professional disciplines of Minsk Medical School No. 2 I. M. Baidak for carefully reading the manuscript, useful comments that concerned not only the sequence, but also the essence of the presentation of the material, contributed better development of teaching aids. The author will be grateful to everyone who can express their comments on the structure and content of the manual.

I. I. Fedyukovich