Anatomy & Physiology Diploma Module 4

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

Contents
Contents ....................................................................................................... 2 Course Outline ............................................................................................. 3 Aims & Objectives of the course: ............................................................... 3 Course literature .......................................................................................... 3 Structure of the Course:.............................................................................. 4 Section 1 - The Lymphatic System ............................................................. 6 a. The structure and function of the lymphatic system ............................ 6 b. Lymph nodes and lymph flow ................................................................ 7 c. The role of the Lymphatic system in the body .................................... 11 d. Common Disorders of the Lymphatic System .................................... 13 Section 2 - The Immune System ............................................................... 14 a. The Immune system .............................................................................. 15 b. Non-specific defence mechanisms ...................................................... 15 c. Immunity and immune responses ........................................................ 19 d. Allergic responses ................................................................................ 23 e. Common Disorders of the Immune System ......................................... 24 Section 3 - The Respiratory System ......................................................... 25 a. The structure and function of the respiratory system ................... 26

b. Respiration and breathing .................................................................... 27 c. Common Disorders of the Respiratory System ................................... 30 Further Reading ......................................................................................... 32

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

Course Outline
The Human Body is an amazing and very complex machine which we all take for granted! To be a successful therapist it is crucial that you understand how the body functions normally and what happens when it becomes out of balance and diseased. Throughout this course you will be introduced to each body function, given information on how it works, what happens when it doesnt work and common problems and diseases that can affect it. To ensure you are assimilating the knowledge there will be regular tests. These can take the format of multiple choice questions, short answer questions, longer questions and diagrams to label. Aims & Objectives of the course: By the end of the course you will be able: To provide an introduction to the workings of the human body To provide an understanding of the anatomical terms associated with describing the human body To develop an awareness of the chemistry underlying the functioning of the human body To develop an understanding of the organisation of the human body from cells to systems To provide a thorough understanding of the normal physiology of the human body To develop an awareness of what constitutes a deviation from normal functioning To describe symptoms and signs of these deviations To develop an awareness of how the human body responds to stress To provide an understanding of the mechanisms by which repair may be affected

Course literature
In order to complete the course you will need a copy of: Ross and Wilson Anatomy & Physiology in Health and Illness (11th Edition) by Anne Waugh & Alison Grant ISBN: 978-0-7020-3227-1 We will use this for reference purposes during the modules and you may wish to use it to read more about topics that interest you. I will refer to the book at the end of each section if there is any further reading required. There is a list of books that you may want to use for further reading at the end of each module.

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

Structure of the Course:

The course is presented in five modules: Module 1 Aims & Objectives of the course Introduction to the Human Body The Chemistry of Life Cells Tissues Module 2 The Integumentary System The Skeletal System The Muscular System Module 3 The Nervous System The Endocrine System The Cardiovascular System Module 4 The Lymphatic System The Immune System The Respiratory System Module 5 The Digestive System The Urinary System The Reproductive System The Effects of Stress on the System

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

Throughout the course notes you will find the following images: Image This gives details of a diagram, image or chart in the Ross & Wilson book that you need to look at. Additional Work This gives details of extra reading you need to undertake in order to complete the tests and assignments Media This gives information about films, slideshows or images you may find useful

Additional Work This gives ideas of work to supplement your studies

Have some fun! This gives details of things you may find fun but will help with your learning.

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

Module 4 -

The Lymphatic System The Immune System The Respiratory System

Section 1 - The Lymphatic System

By the end of this section you will be able to: 1. Describe the functions of the lymphatic system 2. Identify the main structures of the lymphatic system (tonsils, spleen, thymus, lymph nodes and vessels) 3. Describe the structure of a lymph capillary and its relation to the blood capillaries 4. Explain the composition, circulation and functions of lymph 5. Locate the major groups of lymph nodes and lymphatic tissue throughout the body and describe their structure 6. Describe the formation of lymph and the mechanisms responsible for lymph flow 7. Describe the structure of a lymph node 8. Describe the role of the lymphatic system in the inflammatory process 9. Explain the role of the lymphatic system in fighting infection 10. Name & describe briefly common disorders/diseases of the lymphatic system including: Oedema Enlarged Lymph Nodes Hodgkins disease Non-Hodgkins lymphatic disease Lymphoedema Tonsillitis

a. The structure and function of the lymphatic system

The lymphatic system is a subsystem of the circulatory system. Its three principal functions are: To collect and return interstitial fluid, including plasma protein to the blood, and thus help maintain fluid balance, To defend the body against disease by producing lymphocytes, To absorb lipids from the intestine and transport them to the blood Image A diagram showing the major parts of the lymphatic system can be found in Ross & Wilson page 128, Figure 6.1 Media This video gives an overview of the lymph system
http://www.youtube.com/watch?v=lGRceUoQRVw&feature=related
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

Lymph is a transparent, straw coloured fluid with the consistency of honey. It is derived from plasma (the liquid part of the blood) and therefore its composition is similar but not identical. Lymph contains fewer nutrients, more waste products, no red cells and relatively more white cells. The Lymphatic system has to have a high intra-vascular pressure if the blood is to be adequately transported. This results in fluid seepage from the capillaries and it is thought that the lymphatic system originally evolved to combat this problem. Lymphatic tissue is a type of connective tissue characterised by large numbers of lymphocytes. The stroma (framework) of lymphatic tissue is a network of reticular fibres. Connective tissue cells including fibroblasts and macrophages are present. Lymphatic tissue is organised in 3 different ways: Diffuse lymphatic tissue Lymph nodules Lymph nodes Small amounts of diffuse lymphatic tissue are found in virtually every organ of the body.

b. Lymph nodes and lymph flow

The lymphatic system has neither a heart nor arteries. Its microscopic deadend capillaries extend into most tissues, paralleling the blood capillaries. The lymphatic circulation is a drainage system. Its job in maintaining fluid balance is to: Collect excess interstitial fluid and return it to the blood (approximately 3 litres daily). Return plasma proteins to the blood Once interstitial fluid enters a lymph capillary, it is referred to as lymph. The three main types of lymphatic vessels are lymph capillaries, lymphatics, and lymph ducts. Lymph capillaries are microscopic tubes located between cells. Lymph capillaries resemble blood capillaries somewhat, but differ in important ways. Whereas a blood capillary has an arterial and a venous end, lymph capillary has no arterial end. Instead, each lymph capillary originates as a closed tube. Lymph capillaries also have a larger and more irregular lumen (inner space) than blood capillaries and are more permeable. The wall of a lymph capillary is constructed of endothelial cells that overlap one another.

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

When fluid outside the capillary pushes against the overlapping cells, they swing slightly inward, like a swinging door that moves in only one direction. Fluid inside the capillary cannot flow out through these openings.

This diagram showing a section through a lymph capillary shows how the interstitial fluid surrounding the capillary enters through the overlapping cells. The arrows represent the direction of flow of the lymph. Note the internal valve, which allows the lymph to flow in one direction only. Media This video gives an overview of the formation of lymph
http://www.youtube.com/watch?v=1rVsonBiBHk

Lymph capillaries branch and interconnect freely and extend into almost all tissues of the body except the CNS (Central Nervous System) and the avascular tissues such as the epidermis and the cartilage. Lymph capillaries join to form larger vessels called lymphatics or lymph veins. These resemble blood-conducting veins but have thinner walls and relatively larger lumen, and they have more valves. In the skin, lymphatics are located in subcutaneous tissue and follow the same paths as veins. In the viscera, lymphatics generally follow arteries and form plexuses (networks) around them. At certain locations lymphatics enter lymph nodes. These are structures that consist of lymphatic tissue. As the lymph flows slowly through the lymph sinuses within the tissue of the lymph node, it is filtered. Macrophages remove bacteria and other foreign matter as well as debris.
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

Lymphocytes are added to the lymph as it flows through the sinuses of a lymph node. Thus the lymph leaving the node is both cleaner of debris and richer in lymphocytes. Lymphatics leaving lymph nodes are called efferent lymph vessels and conduct lymph toward the shoulder region. Large lymphatics that drain groups of lymph nodes are often called lymph trunks. Lymphatics from the lower portion of the body converge to form a dilated lymph vessel, the cysterna chyli, in the lumbar region of the abdominal cavity. The cysterna chyli extends for about 6 centimetres just to the right of the abdominal aorta. At the level of the twelfth thoracic vertebra, the cysterna chyli narrows and becomes the thoracic duct. Lymphatic vessels from all over the body, except the upper right quadrant, drain into the thoracic duct. This vessel delivers the lymph into the base of the left subclavian vein at the junction of the left subclavian and internal jugular veins. In this way lymph is continuously emptied into the blood where it mixes with the plasma. At the junction of the thoracic duct and the venous system, a valve prevents blood from flowing backward into the duct. Image A diagram showing the major parts of the lymphatic system can be found in Ross & Wilson page 128, Figure 6.1 Only about 1 centimetre in length, the right lymphatic duct receives lymph from the lymphatic vessels in the upper right quadrant of the body. The right lymphatic duct empties lymph into the base of the right subclavian vein (at the point where it unites with the internal jugular vein to form the brachiocephalic) An example of the pattern of lymph circulation is: Lymph capillaries cysterna chyli lymphatic thoracic duct lymph node lymphatic

Lymphatic vessels and lymph nodes can be visualised by the process of lymphangiography. A radiopaque (not transparent to x-rays) contrast material is injected into the lymphatic vessel. This will show up the vessel and its connections to other lymph vessels. The fluid is left in the system for 24 hours and X-rays can then observe the lymph nodes. This technique is quite important in the treatment of neoplasms and other disorders of the lymphatic system. The technique is also used to locate lymph nodes for radiation therapy or for surgical removal. Lymph Nodes All the small and medium-sized lymph vessels open into lymph nodes, which are situated in strategic positions throughout the body. The lymph drains
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

through a number of nodes, usually 8 to 10, before returning to the blood. These nodes vary considerably in size: some are as small as a pinhead and the largest are about the size of an almond. Image A diagram showing the structure of a lymph node can be found in Ross & Wilson page 130, Figure 6.4 Lymph nodes have a surrounding capsule of fibrous tissue, which dips down into the node substance forming partitions, or trabeculae. The main substance of the node consists of reticular and lymphatic tissue containing many lymphocytes and macrophages. As many as four or five afferent lymph vessels may enter a lymph node while only one efferent vessel carries lymph away from the node. Each node has a concave surface called the hylum where an artery enters the vein and the efferent lymph vessel leaves. There are large numbers of lymph nodes situated in strategic positions throughout the body in deep and superficial groups. Lymph from the head and neck passes through deep and superficial cervical nodes. Lymph from the upper limbs pass through nodes situated in the elbow region then through the deep and superficial axillary nodes. Lymph from organs and tissues in the thoracic cavity drains through groups of nodes, including: parasternal, intercostal, brachiocephalic, mediastinalis, tracheobronchial, bronchopulmonary and oesophageal nodes. Most of the lymph from the breast passes through the axillary nodes. Lymph from the pelvic and abdominal cavities passes through many lymph nodes before entering the cysterna chyli. The abdominal and pelvic nodes are situated mainly in association with the blood vessels supplying the organs and close to the main arteries, i.e. the aorta and the external and internal iliac arteries. The lymph from the lower limbs drains through deep and superficial nodes including popliteal nodes and inguinal nodes. Functions of lymph nodes Filtering and phagocytosis Lymph is filtered by the reticular and lymphoid tissue as it passes through lymph nodes. Particulate matter may include microbes, dead and live phagocytes containing ingested microbes, cells from malignant tumours, worn out and damaged tissue cells, and inhaled particles. Organic material is destroyed in the lymph nodes by macrophages and antibodies. Some inorganic inhaled particles cannot be destroyed by phagocytosis. These remain inside the macrophage either causing no damage or destroying it. Material not filtered off and dealt with in one lymph node passes on to the next and so on. Thus by the time the lymph reaches the blood it has usually been cleaned of all impurities such as cell debris and foreign bodies. In some
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

10

instances where phagocytation is incomplete the node may swell. Swelling of lymph nodes is often an indication of an infection. You may well have experienced swollen cervical lymph nodes. These often accompany a sore throat due to streptococcal infection. Infections in almost any part of the body may result in swelling and tenderness of the lymph nodes associated with that part of the body.

c. The role of the Lymphatic system in the body

The role of the lymphatic system in the inflammatory process Within us all there is a silent system working to keep us healthy- the lymph system. Without it our bodies would swell up like balloons, swamping our cells with stagnant fluid. The lymph system's impact is so far reaching that many don't even realize that minor aches and pains, low energy or susceptibility to colds and flu may be due to a sluggish lymph system and a compromised immune system. Lymph vessels make an intimate meshwork that covers every inch of your skin, and surrounds each organ in great detail. The lymph vessels start very small in what are called the initial lymphatic. Over 70% of the initial lymphatics are in and just under the skin. The initial lymphatic is a very delicate structure, one cell thick. These cells are supported within the connective tissue by collagen and elastin fibres that help to anchor them in place. When the pressure within the interstitial space increases due to a build up of fluid (known as lymph obligatory load LOL), or when the skin is slightly stretched, the filaments deform the wall of the initial lymphatic, opening it up. Then the interstitial fluid flows in and starts to move along the channel. At this point we start calling it lymph. Although only 2-3 litres of lymph are filtered through the lymph system per day, it is vital because it helps to remove proteins that are too large to get back through the capillary wall. The spaces that open in the initial lymphatic are 4 to 6 times bigger than the spaces in the capillaries. Removal of protein is essential because they draw water to themselves, so excess protein in the interstitial spaces causes swelling or oedema. The lymph vessels also collect dead cells, waste products, bacteria, viruses, inorganic substances, water and fats. Each cell is nourished by the nutrients, oxygen and proteins that flow across the walls of capillaries into the interstitial fluid. There is a dynamic balance between the forces that help those nutrients to first exit the capillaries, and then get reabsorbed back into the blood stream. Proteins play a big part in this transfer because they have a tendency to draw water to themselves. This means that the proper amounts of protein on both sides of the capillary wall are vital to keep the tissues balanced. If there are too many proteins within the interstitial spaces, fluid will start to accumulate, causing oedema. The lymph systems role of removing proteins is vital to keeping oedema down. If the lymph system becomes sluggish, or is damaged by surgical removal of
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

11

lymph nodes, oedema can develop. This type of oedema is called lymphostatic oedema- or a high protein oedema. Other causes of oedema can be a chemical imbalance in the body caused by liver disease, diabetes, or a variety of other ailments. This type of oedema is called lymphodynamic oedema, and requires other forms of therapy due to the fact that it is a chemical imbalance. Additional Work Research the role of the lymphatic system in the inflammatory process using books and the internet The role of the lymphatic system in immunity Lymph nodules are small masses of lymph tissue (up to a millimetre or so in diameter) in which lymphocytes are produced. Lymph nodules are scattered throughout loose connective tissue, especially beneath moist epithelial membranes such as those that line the upper respiratory tract, intestine, and urinary tract. Lymph nodules appear to be strategically distributed to defend the body against disease organisms that penetrate the lining of passageways that communicate with the outside of the body. A lymph nodule consists mainly of large numbers of lymphocytes enmeshed within reticular fibres. Lymph nodules do not have vessels bringing lymph to them. The periphery of the nodule is not sharply defined. Some lymph nodules develop germinal centres, central areas filled with immature lymphocytes. Here new lymphocytes proliferate from stem cells that originate in the bone marrow. The lighter-staining germinal centre is surrounded by a darker-staining region called the cortex. Most lymphatic nodules are small and solitary. However, some are found in large clusters. For example large aggregates of lymph nodules occur in the wall of the lower portion (ileum) of the small intestine. These large masses of lymph nodules are known as Peyer's patches. Tonsils are also aggregates of lymph nodules. They are located strategically to defend against invading bacteria. The tonsils produce lymphocytes. They are located under the epithelial lining of the oral cavity and pharynx. The lingual tonsils are located at the base of the tongue. The single pharyngeal tonsil is located in the posterior wall of the nasal portion of the pharynx above the soft palate and is often referred to as the adenoids. So to summarise lymph nodules comprise: Palatine and lingual tonsils--between the mouth and the oral part of the pharynx. Pharyngeal tonsil--on the wall of the nasal part of the pharynx Solitary lymphatic follicles
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

12

Aggregated lymphatic follicles (Peyer's patches)--in the wall of the small intestine Vermiform appendix--an outgrowth from the caecum (first part of the large intestine). Collectively this tissue is referred to as mucosa associated lymph tissue (MALT) and along with the spleen and thymus it is involved in the development of immunity. However, unlike lymph nodes, MALT has no afferent lymph vessels and therefore does not filter lymph. MALT is strategically positioned to protect the respiratory and gastrointestinal tracts from microbes and other foreign material which has entered. Additional Work Research the role of the lymphatic system in fighting infection using books and the internet

d. Common Disorders of the Lymphatic System

Disorders of the lymphatic system can vary from fairly mild with few symptoms to major conditions that can impair function and affect everyday life The list below gives many of the well known disorders: Oedema Enlarged Lymph Nodes Hodgkins disease Non-Hodgkins lymphatic disease Lymphoedema Tonsillitis Auditory disturbances i.e.: deafness, tinnitus, vertigo, and otitis media Additional Work Further information on the disorders of the lymphatic system can be found in Ross & Wilson pages 134 136

Additional Work Research the disorders of the lymphatic system using textbooks and the internet

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

13

Section 2 - The Immune System

By the end of this section you will be able to: 1. Distinguish between specific immunity and non-specific defence mechanisms 2. Identify non-specific defence mechanisms such as skin, stomach acid, respiratory passageways and explain how they protect against infection. 3. Relate the physiological changes and clinical symptoms associated with inflammation to its role in the defence of the body. 4. Describe the process of phagocytosis 5. Compare the types of T and B lymphocytes with respect to life cycle and function and identify other cells such as macrophages that function in immune responses. 6. Define the terms antigen and antibody and describe how antigens stimulate the immune response 7. Describe the mechanisms of antibody mediated immunity 8. Describe the mechanisms of cell-mediated immunity, including the development of memory cells 9. Define active and passive immunity/ define inborn immunity and compare it with naturally and artificially acquired immunity 10. Describe the allergic response both local and general 11. Differentiate between the allergic response and sensitivity 12. Name & briefly describe common disorders/diseases of the immune system, including: Allergies Auto immune diseases e.g. ankylosing spondylitis, colitis, psoriasis SLE, RA, Graves Immunodeficiency diseases e.g. AIDS Immuno-suppression e.g. after organ transplant Chronic fatigue syndrome

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

14

a. The Immune system

Our bodies are under constant threat from the environment in which we live. It begins as we are forming from a foetus in our mothers womb and only ceases upon our death. The immune system protects us from bacteria, viruses, cancer cells, parasites and foreign cells to name but a few! The immune system can be divided into two distinct categories: Specific Defence mechanisms These are generally grouped under the term immunity. The resistance developed is to only one specific type of invader. Immunological memory develops as part of the immune process giving long term protection against the invader i.e. mumps. Alongside this antigens stimulate immune responses in the body. Non-specific defence mechanisms These protect against a myriad of possible threats to the immune system. Media This video gives an overview of the immune system
http://www.youtube.com/watch?v=Cv_zt9eOB-A&feature=related

b. Non-specific defence mechanisms

They act as the first line of defence, preventing entry into the system or reducing the amount of microbes or foreign materials that pass into the system. There are 5 main non-specific defence mechanisms: Defence at the body surfaces Phagocytosis Naturally occurring antimicrobial substances Inflammatory processes Immunological monitoring Defence at the Body surfaces These take the form of: 1. Skin and mucous membranes providing these are intact and healthy they provide a barrier against invading microbes. The outer layer of skin is only able to be penetrated by a few microbes. Antibacterial and antifungal substances are contained in both the sebum and sweat secreted by the skin. Mucous membranes secrete mucous which helps trap foreign matter and microbes on its sticky surface. 2. Hairs in the nose acts as the first filtration device with the cilia and mucous membranes in the respiratory tract carrying on the process. Any matter needing to be expelled is either coughed up or swallowed. 3. Stomach acid helps to eradicate any bacteria or foreign matter entering the digestive system.
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

15

4. The one-way flow from the kidneys to the bladder also helps reduce the risk of microbes being transported by the urethras to the bladder. The inflammatory process This is the bodys response to tissue damage. Inflammation has a set of characteristics which occur locally to the damage. It usually takes place when microbes have passed through the non-specific defence mechanism. The purpose of inflammation is protective. It achieves this by: Isolating and inactivating the area Removing the cause and any damaged tissue These processes allow healing to take place in the area. The causes of inflammation are many and varied. Generally it is caused by: Microbes bacteria, funguses, protozoa and viruses Physical agents heat, cold, injury and ultraviolet Chemical agents these can be organic (microbial toxins or organic poisons) or inorganic (acids and alkalis) Episodes of inflammation usually are short in duration lasting from a few hours to a few weeks. They can range in severity from minor to very severe. Indicators of inflammation include: Heat Pain Redness Swelling Loss of function Most of the processes involved in the inflammatory process are beneficial to the body for the fact that they remove the harmful agent and set in place the process required for healing to occur. The following steps are a normal part of the inflammatory process: Increased Blood Flow When injury occurs both the arterioles and capillaries supplying blood to the site dilate causing an increased blood flow. This occurs as a result of chemical mediators being released locally from the damaged cells i.e. serotonin and histamine. Oxygen and nutrients are supplied in increased quantities to the area to provide for the increased cellular activity which occurs as part of the inflammatory process. This increase in blood flow causes increased reddening and temperature in the area, also contributing to oedema and swelling.

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

16

Increase tissue fluid formation One of the main signs of inflammation is the swelling of the tissues involved. This is a result of fluid leaving the localised blood vessels and seeping into the interstitial spaces. This is partly as a result of histamine, prostaglandins and serotonin increasing the permeability of the capillaries and also due to increased pressure inside the vessels as a result of the elevated blood flow within the area. The excess fluid drains into the lymphatic system taking with it the damaged tissue and toxins. Plasma proteins which are normally only present in the bloodstream escape through the capillary walls, increasing osmotic pressure and thus drawing out more fluid from the blood. The proteins include antibodies, which help combat infection and fibrinogens which acts as a clotting agent. Fibrinogen in the tissues is converted by thromboplastin to fibrin. This forms an insoluble mesh in the interstitial spaces, closing off the affected area and helping prevent the spread of infection in the body. Some pathogens (usually present in throat and skin infections) contain substances that can break down this network and release infection into the surrounding areas. When swelling occurs in the mouth or respiratory passages it can be fatal so medical assistance should be sought immediately. Most swelling results in pain. Swelling can however cushion joints and restrain movement of the area thus allowing healing to take place faster. Leukocyte migration As a result of fluid being lost from the blood it becomes thicker, slowing the flow and allowing white blood cells (normally fast-flowing) to adhere to the vessel walls. In the most acute phase a leukocyte known as neutrophil enters the tissues to carry out is function in the Phagocytosis of antigens. Raised temperatures that are associated with inflammation (both localised and systemic) promote phagocyte activity. After 24 hours, the most predominant cell type at the site of the inflammation is macrophages. They continue to be present in the tissues if the problem has not been resolved resulting in chronic inflammation. Chemotaxis this is the process of chemical attraction as a result of inflammation that brings leukocytes including neutrophils and macrophages to the area. Increased core temperature A rise in body temperature (pyrexia) may be part of the inflammatory process if there is a significant infection present. Pyrexia causes an increase in the metabolic rate of the cells in the affected area thus, requiring an increase supply of oxygen and nutrients. Increased temperature in the inflamed and
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

17

damaged tissues has the effect of inhibiting the growth and division of microbes, whilst encouraging the activity of phagocytes. Pain Pain associated with inflammation is caused by the swelling compressing the sensory nerve endings. Chemical mediators that are part of the inflammatory process may cause the pain to be more acute which increase sensitivity of the sensory nerve ending to pain stimuli. Pain can help promote healing as it encourages reduced movement and thus protection of the affected area. Pus formation (suppuration) Pus contains dead phagocytes, cells and debris, fibrin, exudates from the inflammatory process along with living and dead cells. These are contained in a membrane of new blood capillaries, fibroblasts and phagocytes. Small amounts of pus result in boils whereas larges amounts result in abscesses being formed. Pus formation can result in: Rupturing and discharge of pus followed by healing Partial rupture followed by the formation of a chronic abscess Rupture and discharge into adjacent organs Removal of pus by the phagocytes Enclosure of the pus by fibrous tissue, creating a source for further infection Formation of fibrous adhesions Inflammation is normally resolved resulting in the area healing with new healthy tissues with or without the formation of a scar. Occasionally the inflammation is not resolved and a chronic inflammation results. This can lead to deep seated abscesses, wound and possibly bone infections. Media This video gives an overview of the inflammatory process

http://www.youtube.com/watch?v=7r94q8Z3CH0&feature=related

Additional Work Further information on the inflammatory process can be found in Ross & Wilson pages 367 - 369 Phagocytosis This is the process when phagocytic defence cells (macrophages and neutrophils) travel to areas of infection or inflammation. They are attracted by the chemoattractants released by neutrophils and invading microbes. They
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

18

then trap particles by either engulfing them with their body mass or extending long pseudopodia towards them and reeling them in. They have the ability to bind, engulf and digest all foreign particles and cells. Macrophages form an important link between the non-specific and specific defence mechanisms. After they have ingested an antigen they take on the role of antigen-presenting cells. They display their antigen on their cell surface, stimulating T-lymphocytes and activating the immune response. Media This video gives an overview of phagocytosis
http://www.youtube.com/watch?v=7VQU28itVVw

c. Immunity and immune responses

The cell which controls the immunity in our bodies is the lymphocyte. It is a white blood cell manufactured in the bone marrow. Once it is present in the blood stream further processing occurs which results in two distinct types of lymphocytes being formed: T-lymphocytes These are processed by the thymus gland. Thymosin, a hormone released by this gland causes the lymphocytes to be processed resulting in mature, specialised, functioning T-lymphocytes. These are only able to recognise one type of antigen. It reacts to no other form of antigen it may meet during its passage through the body. T-lymphocytes provide the body with cellmediated immunity. B-lymphocytes These are produced and processed in the bone marrow. Their role is in the production of antibodies (immunoglobulins), these are proteins designed to bind and destroy antigens. As with T-lymphocytes they react to only one specific type of antigen. B-lymphocytes provide antibody-mediated immunity. As you may gather from the above descriptions the body contains millions of different types of T and B-lymphocytes which need to be produced and present in the body during its lifetime Antigens & Antibodies Antibodies These are also known as immunoglobins. They are types of protein manufactured by the body in the response to foreign substances (antigens) which can enter the body. The antibodies inactivate the antigen by binding or attaching themselves to it.
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

19

A healthy adults body contains thousands of different types of antibodies. They have a characteristic Y shape with a binding site on each arm of the Y. These sites each have a specific shape relating to the antigen they are designed to inactivate. Antigens These are substances that stimulate the immune system to produce antibodies. They can take many forms including viruses, fungi and bacteria. They can also be allergens which cause an allergic reaction to take place in the body. Allergens include food, dust, pollen and stings. Blood transfusions can also result in antibodies being produced if the antigens in the transfused blood are incompatible with the bodys own blood. When foreign substances enter the body for the first time the body immune system needs time to produce antibodies to fight. This results in symptoms being present. However, when subsequent attacks take place the body is prepared and there may be no symptoms. This shows that the body has developed immunity to the antigen. Media This video shows antibodies and antigens

http://www.youtube.com/watch?v=KpNFAEbLcvk&feature=related

Cell-mediated immunity T-lymphocytes which have been formed by the thymus are free to circulate within the body. When they encounter an antigen for the first time they become sensitised to it. If the cell is of a foreign origin it needs to be presented to the T-lymphocyte. This is done on the surface of the antigenpresenting cell. Macrophages are one of the main types of antigen-presenting cells. They are apart of the non-specific defences as they engulf, and digest antigens of any type, as well as taking part in immune responses. In order to complete this task they first ingest the antigen transporting the most antigenic fragment in its own cell membrane, displaying it on the surface until it meets the T-lymphocyte specifically manufactured to deal with the antigen. If the antigen is classified as an abnormal cell (cancer cell) it also displays foreign material on its surface which will also stimulate T-lymphocyte activity. When the antigen is finally present to the T-lymphocyte it stimulates clonal expansion (division and proliferation). Four main types of T-lymphocyte are produced against the original antigen: 1. Memory T-cells These are long living cells which remain in the body long after the initial episode has ended. They provide cell-mediated immunity which can respond rapidly to further encounter with the same antigen.
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

20

2. Cytotoxic T-cells These inactivate any cells carrying antigens by attaching themselves to the target cell and releasing powerful toxins. Their main role is to destroy abnormal body cells. 3. Helper T-cells These are essential for the correct functioning of both cell-mediated and antibody-mediated immunity. When this type of cells number are diminished the whole immune system enters a compromised state. Their main functions include: The production of cytokines which support and promote cytotoxic Tlymphocytes and macrophages Producing antibodies in cooperation with B-lymphocytes. 4. Suppressor T-cells These cells cause a cessation in the production of T- and B- lymphocyte cells. These prevent potential harm to the immune system. Media This video explains cell-mediated immunity
http://www.youtube.com/watch?v=1tBOmG0QMbA

Antibody mediated immunity T lymphocytes vary from B-lymphocytes as they circulate freely around the body with the ability to recognise and bind antigen cells without needing the assistance of an antigen-presenting cell. B-lymphocytes are fixed in lymphoid tissue. When they are presented with an antigen they begin to enlarge and divide (clonal expansion). As a result of this process the following cells are formed: 1. Plasma cells These secrete immunoglobins (antibodies) into the blood. These are then carried throughout the tissues of the body. They live no longer than 24 hours producing just one type of antibody targeting only the antigen same as the one originally bound to the b-lymphocyte. These cells: Bind to the antigens, making them visible so other defence cells (macrophages and cytotoxic T-lymphocytes) Binding and neutralising bacterial toxins Activates complement reactions 2. Memory B-cells These act in a similar way to memory T-cells. They remain in the body long term and after the initial episode they are quick to react to another encounter with the same antigen by producing antibody secreting plasma cells.
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

21

There is a fine balance in the bodies immune system which does not normally allow the body to develop immune reactions to its own cells. When this occurs autoimmune diseases result. Media This video explains antibody-mediated immunity
http://www.youtube.com/watch?v=hQmaPwP0KRI

Acquired Immunity After an antigen has been detected for the first time a primary response follows. This normally lasts for around 2 weeks. During this time a low level of antibodies can be detected in the blood. Normally this is sufficient to deal with the antigen and after this time the levels of antibodies in the blood will fall unless the antigen is encountered again in the system. A secondary response occurs when the antigen is encountered again. This elicits a rapid response by the memory B-cells and a marked increase in the production of antibodies. Further increases are generally as a result of further encounters until a maximum is reached. This is the principle used when active immunisation is used against infectious diseases. Immunity can be acquired either naturally or artificially with both forms having an active and passive mechanism. Active immunity results when the body has been exposed and has reacted to an antigen by producing its own antibodies resulting in the formation of a long lasting resistance. In passive immunity the antibodies are provided by a third party. This type of immunity does not normally result in long tem protection. Active naturally acquired immunity The body may be stimulated to form its own antibodies in the following ways: Being exposed to the disease infection during the time of infection the body develops B-lymphocytes to overcome the infection Having a sub-clinical infection this is when the body is exposed to the antigen but it does not develop into full blown symptoms. This may however result in the body developing immunity to the antigens Active artificially acquired immunity This type of immunity is developed when the body is exposed to either dead, artificially weakened microbes or deactivated toxins. These can take the form of vaccines or toxoids which are able to stimulate the development of immunity in the system but are not able to develop into the full blown disease. Many infectious diseases can be prevented by artificial immunisation

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

22

Passive naturally acquired immunity This type of immunity is acquired before birth by the passage of antibodies from the mother across the placenta to the foetus and also through the breast milk. This type is very dependant on the strength of the mothers immune system and is only short lived. Passive artificially acquired immunity This is a result of ready-made antibodies in the form of serum being injected into the recipient. They can be administered either before the disease develops to provide immunity or when disease is present to help accelerate the immune function of the body. Additional Work Further information on immunity can be found in Ross & Wilson pages 369 373

d. Allergic responses
An allergy is the term used to describe a powerful immune response which occurs in the body due to an antigen. The allergen is usually harmless in nature i.e. dust, pollen or dander. It is the body which causes the damage to itself and not the allergen. When initial exposure occurs the body becomes sensitised. When further exposure to the antigen occurs the body creates a response which is out of proportion to the danger posed by exposure to the antigen. These reactions can range from runny eyes, swelling and itching through to anaphylactic shock which can in extreme cases result in death. Hypersensitivity is classified into 4 categories: 1. Type I anaphylactic hypersensitivity This generally occurs in individuals who have inherited elevated levels of immunoglobins E. When exposure to antigens occurs the body reacts by releasing large levels of mast cells and basophils. Histamine is also released causing constricture in some smooth tissue. This can lead to bronchoconstriction and shock. This type of reaction can result in death if not treated quickly. 2. Type II cytotoxic hypersensitivity When an antibody and antigen (i.e. bacteria) react together on the surface of a cell the result is normally that the cell is marked for destruction. This occurs by one of several processes. However, if the anti-bodies are directed at the self antigens it results in the destruction of body tissues (auto-immune disorders). This type of reaction can occur when transfusion or organ transplants are performed.
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

23

3. Type III immune-complex-mediated hypersensitivity Phagocytosis normally occurs within the body to clear antibody-antigen complexes, however if this process fails or excessive amounts of the immune responses are manufactured they can be deposited in the tissues (kidneys, skin, joints and eyes) where they set up an inflammatory reaction. When this occurs in the kidneys it can impair kidney function but in other areas of the body it can create rashes, joint pains and occasionally haematuria. **Sensitivity to penicillin is classified as a type III reaction** 4. Type IV delayed type hypersensitivity This type of hypersensitivity is due to an over reaction of T-lymphocytes to an antigen. When memory T-lymphocytes detect an antigen they create clonal expansion resulting in cytotoxic T-lymphocytes being released to eliminate the antigen. If this response is not in proportion it can result in damage to the body tissues. An example of this is contact dermatitis. Additional Work Further information on allergic responses can be found in Ross & Wilson pages 374 375

Media This video briefly summarises allergic reactions

http://www.youtube.com/watch?v=nudFAzJsTog&feature=related

e. Common Disorders of the Immune System Disorders of the immune system can vary from fairly mild with few symptoms (sneezing, running eyes, itching) to major reactions that can result in death The list below gives many of the well known disorders: Allergies Auto immune diseases e.g. ankylosing spondylitis, colitis, psoriasis SLE, RA, Graves Immunodeficiency diseases e.g. AIDS Immuno-suppression e.g. after organ transplant Chronic fatigue syndrome Additional Work Further information on the disorders of the immune system can be found in Ross & Wilson pages 374 - 377

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

24

Additional Work Research the disorders of the immune system using textbooks and the internet. You could also talk to people who suffer various immune reactions and disorders.

Section 3 - The Respiratory System

By the end of this section you will be able to: 1. Identify the major structures of the respiratory system and their relative positions: Nose, nasal cavity, pharynx, epiglottis, larynx, bronchi, bronchioles, alveoli, pleura, sinuses 2. Describe the structure and function of the lungs 3. Define and differentiate between pulmonary ventilation, external respiration and internal respiration 4. Describe the mechanism and regulation of breathing including internal and external respiration, inspiration, expiration and exchange of gases 5. Recognise the ways in which oxygen and carbon dioxide are transported in the blood 6. Name & briefly describe common disorders/disease of the Respiratory system, including: Acute Tuberculosis Pleurisy Bronchitis Pneumonia Seasonal rhinitis (hayfever) Sinusitis Coryza (common cold) Influenza Laryngitis
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

25

Chronic Chronic obstructive pulmonary disease (COPD) Asthma Lung cancer Emphysema Rhinitis

a. The structure and function of the respiratory system

The structures involved in the process of respiration are divided into two main parts, they are firstly the air passages and secondly the lungs. The air passages filter, moisten and warm the air as it enters the body and the lungs provide the location for the exchange of gases into and from the body. The first structure in the respiratory system is the nose. There are right and left nasal cavities which are divided by a structure called a septum. These cavities are lined with mucous membrane, which secretes a sticky fluid called mucus. Mucus helps to moisten the air on its way to the lungs. On the surface of the membrane are cilia, which help to move inhaled dust and bacteria away from the lungs. The sinuses communicate with the nasal cavities, explaining why the sinuses are so susceptible to infection. The roof of the nasal cavity is formed by the ethmoid bone, which holds the olfactory bulb giving access to the olfactory lobe in the brain. Behind the nose is the nasopharynx, which is connected to the middle ear via the eustachian tube. Just below the nasopharynx lies the pharynx. It provides a passage for both air on its way to the lungs and for food on its way to the stomach, but cannot be used for both at the same time. When swallowing, food is prevented from going up to the nasal cavity by the uvula (soft palate) and from entering the lower respiratory tract, by the epiglottis, which closes the entrance to the trachea. This prevents us choking or suffocating because of food. The next part of the upper respiratory tract is the larynx (voice box). The larynx is supported by hyaline cartilage to the front, which prevents the airway from collapsing. The vocal cords are also situated in the larynx. The trachea is a continuation of the larynx. It is approximately 10 centimetres long and at its lower end divides into the two bronchi. The trachea is kept permanently open by means of rings of cartilage joined together by muscle tissue at the back. This arrangement allows the trachea to be flexible but at the same time the cartilage prevents it from collapsing, so allowing it to remain permanently open. The trachea is lined with mucous membrane to moisten and filter the air on its way to the lungs. The bronchi start where the trachea divides into two. Each bronchus passes to either the left or right lung. These two short tubes are built on a similar
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

26

structure to the trachea so that there is no obstruction to the airway. From each main bronchus, numerous smaller bronchi branch off and these divide even further into very fine bronchioles. The bronchioles are formed from muscular tissue and there are no hoops of cartilage, meaning that they may collapse. Each bronchiole ends in an irregularly shaped sac called an alveolus. These minute circular chambers grouped together are known as alveoli; they are lined with very thin flattened epithelial tissue and are surrounded by numerous blood capillaries. The exchange of gases takes place through the thin walls of both these structures. The lungs are the organs of respiration and they lie in the thoracic cavity. The right and left lungs are separated in the middle by the heart and the great vessels, the aorta and vena cava. The lungs occupy the whole of the thoracic cavity, except for the structures in the mediastinum, the heart & its vessels. The lungs are composed of bronchi, bronchioles and alveoli. A thin double layer of serous membrane called the pleura covers each lung. The outer (visceral) layer lines the thoracic cavity. The inner (parietal) layer lines the lung surface. These layers are lubricated by serous fluid, which prevents friction when breathing. Between these two layers is a space called the pleural cavity where the pressure is slightly below atmospheric pressure, which helps to draw the air into the lungs. Image A diagram showing the structure of the respiratory can be found in Ross & Wilson page 234, Figure 10.1 Additional Work Further information on the respiratory system can be found in Ross & Wilson pages 234 246 Media This video briefly shows the respiratory system during respiration
http://www.youtube.com/watch?v=HiT621PrrO0

b. Respiration and breathing

The mechanism of breathing The structures involved in the physical process of respiration are the muscles of respiration, the thoracic cage and the pleura. When we breathe there is a series of events taking place known as the respiratory cycle. There are three phases to this cycle inspiration (breathing in), expiration (breathing out), followed by a pause. The cycle occurs approximately 16 times a minute. During inspiration the rib cage expands by swinging upwards and outwards and the volume of the thorax is increased so taking in air. In expiration the
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

27

ribs swing down and reduce the volume of the thorax and air is expelled. Before the cycle begins again there is a slight pause. During this phase, the air begins to pour into the lungs, which is due to the atmospheric pressure being greater than the pressure within the lungs. Pressure within the pleural cavity is lower than atmospheric pressure so the air will flow from higher to lower pressure, filling the lungs. The muscles used in respiration are the diaphragm and the intercostals. The diaphragm, the main muscle of inspiration, is domed-shaped and it separates the thoracic cavity from the abdominal cavity. During inspiration the diaphragm descends and flattens. In expiration the diaphragm relaxes to return to its dome shape. The intercostal muscles lie within the spaces between each rib. There are two layers of these muscles called the external and internal intercostals and their muscle fibres run at right angles to each other. They are antagonistic, so when the external intercostals are contracted, the internal intercostals are relaxed and vice versa. The external layer of muscles contracts with the diaphragm during inspiration. The internal layer contracts during expiration. As one or other of the layers is always contracted, the rib cage is prevented from collapsing. The muscles mentioned above are the ones used during quiet, normal breathing. There are several other muscles, know as accessory muscles that are used in forced respiration, for example when you are out of breath. These include the pectorals, sternocleidomastoid, platysma and the abdominal muscles. Pulmonary Ventilation Pulmonary ventilation or breathing is the exchange of gases that occurs between the lungs and the external environment. This mechanical process is dependant on the difference of atmospheric air pressure and pressure in the alveoli. On inhalation increased internal volume occurs along with a reduction in internal pressure. The diaphragm and intercostals are the muscles responsible for this process. During this action the diaphragm contracts and moves downwards, flattening its dome shape and increasing the size of the chest cavity and reducing the pressure on the lungs. The intercostals also contract causing the ribs to move upwards and outwards. This action also lowers the pressure on the lungs whilst increasing the size of the chest cavity. When the diaphragm and intercostals muscles contract internal pressure is reduced relative to the atmospheric pressure, thereby causing air to rush into the lungs. When the diaphragm relaxes, its domed shape returns along with the intercostals relaxing to bring the ribs down and inwards. This action results in the size of the chest cavity being reduced causing increased pressure in the lungs, thus forcing out the air. Diffusion of gasses When there is a difference in pressure across a semi-permeable membrane an exchange of gases will occur. Gases move by a process of diffusion from
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

28

a place of higher to an area of lower concentration until a state of equilibrium is achieved. The pressure of atmospheric nitrogen which is present during this process remains unchanged at all times. Pulmonary Circulation (External Respiration) Pulmonary circulation is the circulation of blood between the heart and the lungs, where the pulmonary artery carries the deoxygenated blood away from the heart towards the lungs. A branch of the artery passes to each lung where it divides into smaller and smaller branches forming a vast capillary network around all the alveoli. Once this exchange has taken place, the pulmonary veins carry oxygenated blood back to the heart. The function of the lungs is to allow a free exchange of gases to take place between the alveoli and the capillary network around them. This process is known as external respiration. Internal Respiration This term is used to define the process of diffusion between blood in the capillaries and the cells of the body. There is no gaseous exchange in the walls of the arteries carrying blood from the heart to the tissue as their walls are too thick. Blood carried to the tissues of the body has been cleansed of any carbon dioxide and saturated with oxygen during its journey through the lungs. This concentration gradient ensures that gaseous exchange occurs diffusing oxygen from the bloodstream into the tissues via the capillary wall and returning carbon dioxide through the intracellular fluid out into the bloodstream. Image A diagram showing internal and external respiration can be found in Ross & Wilson page 251, Figure 10.24 and 10.25 Transport of gases The transport of both oxygen and carbon dioxide in the blood is essential for internal respiration to occur. Oxygen is carried in the following ways by the blood: In chemical combination with the haemoglobin as oxyhaemoglobin As a solution in plasma water These are in ratio of 98.5% to 1.5% Carbon dioxide is a waste product produced during metabolism which is excreted by the lungs. It is carried in the following ways: As a bicarbonate in the plasma In the erythrocytes in a combination with haemoglobin as carbaminohaemoglobin Dissolved in the plasma
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

29

This ratio is 70% to 23% to 7% Control of respiration The control of respiration is normally involuntary however voluntary control can be exerted. Factors that affect the control of respiration can include: Exercise and strenuous activity Speech Singing Emotional factors crying, laughing or fear Drugs sedatives and alcohol Sleep Additional Work Further information on the control of respiration can be found in Ross & Wilson pages 252 253 c. Common Disorders of the Respiratory System We all encounter disorders of the immune system from a common cold through to some of the chronic respiratory conditions. Chronic breathing conditions can limit our ability to carry out everyday task sometimes resulting in the need for oxygen and breathing aids. The list below gives many of the well known disorders: Acute Tuberculosis Pleurisy Bronchitis Pneumonia Seasonal rhinitis (hayfever) Sinusitis Coryza (common cold) Influenza Laryngitis Chronic Chronic obstructive pulmonary disease (COPD) Asthma Lung cancer Emphysema Rhinitis Additional Work Further information on the disorders of the respiratory system can be found in Ross & Wilson pages 254 264
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

30

Additional Work Research the disorders of the respiratory system using textbooks and the internet. You could also talk to people who suffer various respiratory system disorders.

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

31

Further Reading
Anderson P D. 2004 Human Anatomy and Physiology Colouring Workbook and Study Guide Jones and Bartlett Publishers, Inc; Understanding Disease: A Health Practitioner's Handbook Vermilion Anatomy of Movement Eastland Press The Muscle Book Himalayan Institute Press An Illustrated atlas of the skeletal muscles, Morton publishing, USA The Pocket Atlas of the Moving Body Ebury Press Memmler's the Human Body in Health and Disease Lippincott, Williams & Wilkins Photographic Atlas for Anatomy and Physiology Morton publishing, USA The Concise Book of Muscles Lotus Publishing Anatomy Colouring Book Benjamin Cummings Physiology Colouring Book Benjamin Cummings Concise Medical Dictionary OUP Oxford The Human Body Book: The Ultimate Visual Guide to Anatomy, Systems and Disorders Dorling Kindersely The Human Body in Health and Disease, Mosby
2012 Essentially Holistic
Not for reproduction in any form without prior permission of Essentially Holistic

Ball J. 2005

Blandine C G. 2004 Blakey P. 2008 Bowden B & J. 2002 Cash M 1999 Cohen BJ. 2008

Crawley J L. 2002

Jarmey C. 2008 Kapit W & Elson L. 2001 Kapit W, Macey RI & Meisami E. 1999 Martin E. 2007 Parker S & Medi-mation 2007

Thibodeau GA & Patton KT. 2009

Tortora GJ & Grabowski SR. 2008: Waugh A & Grant A. 2006

Principles of Anatomy and Physiology with Atlas and Registration Card John Wiley Ross and Wilson's Anatomy and Physiology Colouring and Workbook Churchill Livingstone A massage therapists guide to Pathology Lippincott Williams & Wilkins,

Werner R. 2009 DVDs

Anatomy for Beginners Dr Gunther von Hagens This was originally shown on Channel 4 television and shows an autopsy taking place. Interesting but not for the squeamish!! ***The Books & DVDs Highlighted in Red are particularly recommended***

2012 Essentially Holistic

Not for reproduction in any form without prior permission of Essentially Holistic

33