PAROTID - swollen in the mumps

SUBLINGUAL

SUBMANDIBULAR

Saliva is mucus and water with bicarbonate and salivary amylase for carb breakdown; also has LYSOZYME that kills antibodies

NASOPHARYNS

OROPHARYNX

LARYNGOPHARYNX

1. Mucosa - deepest mucus membrane; goblet cells secrete mucus and digestive enzymes
2. Submucosa - loose CT, has blood, lymph vessels and nerves; has PEYER PATCHES in small intestinal section
3. Muscularis - smooth muscle layer, 2 layers: inner is circular and outer in longitudinal; in the stomach there is a third layer called the oblique muscularis
4. Serosa - serous membrane (peritoneum), very thin epithelium and CT - serous fluid for decreased friction
5. ONLY THE ESOPHAGUS HAS A 5TH LAYER CALLED THE ADVENTITIA OF LOOSE CT.

• Peristalsis begins here
• Lump in throat is when peristalisis occurs here without food
• ONLY FUNCTION IS TRANSPORT
• Ends at "Esophageal sphincter" which isn't a true sphincter; were acid reflux can occur

• Is behind the liver
• length always the same, but diameter varies because of RUGAE (deep folds of wall)
• Can hold about 1 gallon
• Fnxs: stores food, churns and liquifies food mixing with juices; moves food through
• Has 4 regions
• Wall has the regular layers, but muscularis includes another oblique layer
• Epithelium has millions of gastric pits with gastric glands with 4 types of secretory cells that altogether produce gastric juice
• Alcohol is absorbed here, but food is not
• Empties 2-6 hours as acidic CHYME through squirts via pyloric sphincter.

1. Cardiac - near the heart and surround the esophageal 'sphincter'; where the esophagus joins the stomach
2. Fundic - temporary food holding, is superior to the cardiac region
3. Body - main part
4. Pyloric - narrows to the pyloric canal leading to the PYLORIC SPHINCTER

• From 4 types of secretory cells of stomach (gastric glands)
• watery
• contains :

1. PEPSINOGEN made by CHEIF CELLS, become PEPSIN when exposed to HCL
2. HCL by PARIETAL CELLS, keeps stomach at ~pH2 that kills most bacteria and breaks down CT of meat.  DOES NOT DIGEST.
3. INTRINSIC FACTOR by PARIETAL CELLS - protein that binds B12 preventing its destruction by acid, B12 is needed for RBC creation
4. MUCUS

• covers and connects the organs of the abdomen
• a serous membrane (visceral and parietal)
• b/t organs the visceral component becomes the double layered MESENTARY

• is the visceral component of the peritoneum between organs
• double layered
• supports organs, vessels and nerves
• some parts have pecific names:

1. LESSER OMENTUM - mesentary b/t stomach and liver, hold intestinal loops in place
2.  GREATER OMENTUM - large doubled layer apron like hangs over abdominal cavity; fat for cushion and insulation; also has macrophages and can wall off infected areas

• ends at the ileocecal valve
• all foods are digested into absorbable components (unless indigestable)
• Receives pancreatic and liver secretions
• Produced intestinal juices
• Has 3 regions

1. DUODENUM - the first 10 inches - receives pancreatic secretions and liver bile through a common duct; is not folded like the rest of the SI
2. JEJUNEM - the next 8 feet with many folds and villi for absorption
3. ILEUM - last 11 feet with less folds and villi than jejunum; PEYER PATCHES are here (which layer of wall?)

1. Cheif cells - produce PEPSINOGEN (turns into PEPSIN by HCL)
2. Parietal cells - produce HCL and INTRINSIC FACTOR
3. Enteroendocrine cells - produce GASTRIC, a hormone that enters gastric blood and circulates through stomach and regulates muscular contractions and secretions by stomach
4. Mucous cells - secrete thick later of mucus to prevent acid breakdown of wall (ulcer, usually H. Pylori)

• said to be as much surface area as a tennis court becuase of vill and microvilli
• CIRCULAR FOLDS are permanant folds of mucosa and submucosa
• Each VILLUS has many MICROVILLI, making epithelial lining look blury under microscope, "brush border"
• This brush border is what makes so-called brush border enzymes (are the small intestinal enzymes)

1. completes all digestion - by enzymes of SI, from common suct entering duodenum receiving enzymes from liver (gall bladder) and pancreas; BILE by liver, stored in gallbladder, emulsifies (separates and suspends in water) fats; pancreatic juices neutralize CHYME by sodium bicarbonate, etc.
2. Absorbs nutrients - at each villus, lots of capillaries and small lymph LACTEALS (glycerol and fatty acid absorption)
3. Movement of undigestables to LI and mixing by SEGEMENTATION (locatl contractions/constrictions mixing chyme with juices) and PERISTALSIS (moves to LI)

1. 1st phase - CEPHALIC PHASE - (head) when look at, small, taste food causing hypothalamus to stimulate hunger, triggering parasympathetic nerves to stimulate gut secretion/contraction
2. 2nd phase - GASTRIC PHRASE - stretch of stomach stimulates enteric nerves network and release of GASTRIC into local blood causing smooth mucle contraction and gastic gland secretion
3. 3rd phase - INTESTINAL PHASE - duodenum stretch stimulates intestinal secretion and contraction; stimulates duodenal wall to secrete 3 hormones (secretin, GIP and CCK); liver/gallbladder also respond to secretin and CCK

*these 3 phases initially occur sequentially, but later may occur all at the same time while eating.

1. SECRETIN - stimulated by acids, esp. acidin chyme; stimulates secretion of bicarbonate solution by pancreas; stimulates liver to increase bile production
2. GASTRIC INHIBITORY PEPTIDE (GIP) - opposes gastic; inhibits gastric gland secretion and slows stomach contractions; prevents stomach emptying too quickly
3. CHOLECYTOKININ (CCK) - stimulates pancreatic enzyme secretion; stimulates gallbladder to reliease stored bile

• Leptin is produced by fat cells; acts on hypothalamus; stimulates feeling of fullness
• Ghrelin produced by stomach, acts on hypothalamus and triggers hunger and food seeking behavior

• absorbs water, salts and some vitamins
• stores indigestable food

• 4 parts:

1. Cecum - the blind end underneath entrance from SI; has VERIFORM (wormlike) APPENDIX
2. Colon - adscending (water removed), transverse (fecal matter begins formations), descening and sigmoid; has HAUSTRA (pouches along lendth that expnad to store food) and TAENIA COLI (band of muscle that cuases peristalsis mass movements) in addition to regular muscularis later
3. Rectum - stretch stimulates defectation reflex
4. Anal canal

• 75% water
• 25% solids - bacteria, dead cells, cullulose fiber, etc.
• Breakdown of bilirubin and oxidized account for color

• eat cellulose and produce fatty acids, B-vitamins and most vitimin K needed
• release H+ gas and sulfer compounds
• usually harmless, but can get out of LI and cause disease

• can begin from polyps (though not all polyps are cancerous)
• if caught early and is only local, completely curable from surgical removal
• Fat may increase risk of colon cancer because of increases bile with bacteria convert into carcinogens
• Decreased fiber associated
• Fiber may dilute bile by pulling in water and promoting movement through so toxins don't linger

• most cells are exocrine (pancreatic acinar cells) that produce pancreatic juice into pancreatic duct into duodenum
• Pancreatic juice included sodium bicarbonate (neutralizes chyme and increases pH so enzymes work best) and digestive enzymes for ALL foods
• Also secretes PANCREATIC AMYLASE to digest startch and LIPASE for fats
• Produces 3 protein enzymes: TRYPSIN, CHYMOTRYPSIN and CARBOXYPEPTIDASE; secreted into duodenum in inactive form so don't digest pancreas itself; Trypsin is activated by ENTEROKINASE from the SI, then trypsin activates the other two.
• Produces 2 NUCLEASES which break down nucleic acids into nucleotides, AA and phosphate group

• largest organ in body
• mostly in upper right quadrant
• has 2 lobes, R is largest, two are separated by ligament
• divides into many heaptic LOBULES, each with a central vein, surrounded by hepatic sinusoids to which are attached KUPFFER CELLS
• B/t each lobule are PORTAL TRIADS

• have many macrophages to remove pathogens and debris from the hepatic protal vein
• In the hepatic sinusoids surrounding each central vein of many lobules of liver

• Provides liver and pancreatic enzymes to duodenum
• Receives pancreatic duct from pancreas
• Receives cystic duct from gall bladder and common hepatic duct from liver (which receives L and R hepatic ducts)

• In the liver, between each lobule
• Each has 3 structures

1. a bile duct - takes bile away from the liver
2. a branch of hepatic artery that brings O2 rich bllod to liver
3. a branch of the hepatic portal vein that brings nutrients from the intestines to be filtered

• from the hepatic portal vein, blood is detoxified by KUPFFER CELLS
• removes and stores nutrients like iron and the fat soluble vitimins (KADE)
• makes plasma proteins from the AAs it receives; like albumins and fibrinogin
  
• regulates cholesterol
• maintains blood glucose by storing as or breaking up GLYCOGEN
• if glycogen is depleated, the liver will breakdown fats and AAs to make glucose via GLUCONEOGENESIS; when this happens (protain catabolism) the end product is UREA, which can be toxic (drink water to filter)
• makes BILE which contains BILIRUBIN from RBC breakdown and BILE SALTS which are derived from cholesterol to emulsify fats in small intestine for better enzymatic breakdown of fats (this is how it helps regulate cholesterol)
• IS THE MOST IMPORTANT METABOLIC ORGAN, therfore receives lots of blood, 3/4 of it's supply from portal vein which drains the small intestine; the other 1/4 is from the abdominal aorta via the hepatic artery

is a viral inflammation of the liver, 3 types:

1. A - usually from sewage is the water
2. a STD and very contageous, can also get from needels, etc.  There is a vaccine.
3. is deadly and trasmitted by blood

• receives/stores excess liver BILE (liver makes about 1L a day)
• bile gets thicker here because water is reabsorbed
• bile exits GB by CYSTIC DUCT, joining the common hepatic duct to form the common bile duct to the duodenum
• If gallbladder problem like gall stones, bile can be stored outside of the body in an artifical sac

• bile salts are the portion of bile that emulsifies fats (other portion is the yellow bilirubin)
• emulsification creates more surface area, and decreases size for absorption
• Is derived from cholesterol and contains cholesterolm which can come out of solution and form gallstones which may block the cystic duct, possibly requiring surgican removal

• all enzymes are all HYDROLYTIC, meaning water breaks up bonds
• Requires specific pHs; all the major enzymes prefer a basic environment, except for pepsin which requires acidity and salivary amylase which likes a neutral pH
• All foods are completely broken down in the small intestine by brush border enzymes and pancreatic/hepatic substances recieved at the duodenum by the common bile duct

• SALIVARY AMYLASE breaks starches into maltose (a disaccharide needing further breakdown)
• PANCREATIC AMYLASE also breaks starch into maltose
• MALTASE, SUCRASE and LACTASE complete sugar breakdown into single sugars like glucose, fructose and galactose

• Enzymes released by the pancreas break proteins into smaller pertides and some AAs, they are TRYPSIN, CHYMOTRYPSIN and CARBOXYPEPTIDASE
• PEPTIDASES made by the small intestine complete peptide breakdown into single amino acids

• NUCLEASE released by pancreas breaks RNA and DNA into nucletides
• NUCLEOTIDASE released by the small intestin breaks nucleotides into bases, sugars and phosphate groups

• Overall increase is GI disorders
• Peridonitis is more commone causing loss of teeth, can contribute to heart problems
• Esophageal hiatal hernia (esophagus below the diapragm protrudes into thoracic cavity)
• More heartburn, ulcers, diverticulosis, constipation, hemorrhoids, incontinence, gallstones, cancers
• Sometimes the esophageal "sphincter" won't open to receive bolus causing pain
• Peristalsis slows
• Liver shrinks with decreased blood supply

• OBESITY = above 20% of ideal weight; in the US 33% of women and 30% of men are obese
• BULIMIA - alters the blood composition causing arrythmias, kidney damage, esophageal inflammation, teeth erosion, esophageal rupture and even death
• ANOREXIA - can cause low BP, arrythmias, constipation, decreased bone density and more bone fractures, no menstruation, and even death; the whole body shuts down and all functions are impaired.

• 20 baby teeth and 32 adult
• are hardest substance in body
• dentition is even more unique than DNA

• removal of metabolic wastes (substances that were once used by the body)
• Kidneys are the primary excretory organ

1. Excretion of metabolic wastes - esp. nirogenous wates, primarily UREA which is the end products of protein metabolism; also excretion of creatinine, which is from the breakdown of creatinine phosphate during muscle contraction; and excretion of uric acid from the breakdown of nucleotides (can build up in gout); excretion of ammonium (ammonia which is toxic plus H+); excretion of UROCHROME that gives urine yellow color, is a product of bilirubin breakdown in the small intestine
2. Preservation of salt-water balance - by regulating blood volume and pressure via salt reabsorption, etc.  Also maintains other electrolytes balances which affect blood volume.
3. Maintainence of blood pressure - kidneys directly influence cardiac output and peripheral resistance by RENIN, activation ANGIOTENSIN constriction blood vessels
4. Regulation of pH - 7.4 - by excreting H+ from blood and reabsorption of bicarbonate
5. Secretion of hormones - renin by kidneys when it's own blood supply is low, activates angiotensin which activates aldosteron of adrenal cortex (promotes sodium reabsorption by kidneys); secretion of ERYTHROPOIETIN by kidneys (EPO) when the oxygen carrying capacity is too low, stimulates RBC production; also helps to activate vitimin D.

1. KIDNEYS - fist sized, lie against deep muscles of back
2. URETERS - from hilum of kidneys (depression) to inferior/posterior bladder; has 3 layers - inner mucosa, smooth muscle and fibrous CT; has peristalsis; urine enters bladder in spurts about 1-5 times per minute
3. URINARY BLADDER - muscle layers together are the DETRUSOR MUSCLE; has transitional (expandable) epithelium and rugae (folds); are 2 sphincters - inner and voluntary external (skeletal muscle)
4. URETHRA - in males carries both urine and sperm

1. Cortex - most of nephron structure here (glomerulus and convoluted tubules)
2. Medulla - Loops of Henle (part of a nephron) dip down here; also collecting ducts travel through here giving appearance of RENAL PYRAMIDS
3. Pelvis - the central cavity that is continuous with the ureters; where the collecting ducts from the nephron regionds converge

• is the functional unit of the kidneys that filter blood and allow reabsorption of filtrate, collecting waste and water and excreting
• are millions
• are 2 structures in each nephron:

1. RENAL CORPUSCLE - is the glomerulus and glomerular capsule
2. RENAL TUBULE - proximal, Henle's loops, distal, and collection duct

= BOWMAN'S CAPSULE

• contains the GLOMERULUS, a vascular structure that receives an AFFERENT ARTERIOLE and filters blood the first time; filtrate from glomerulus is deposted into the glomerular capsule, continuous with the convoluted tubules, for further fultraion and reabsoption.

• are the capillary beds surrounding the nephrotic convoluted tubules
• conduct the second filtration of blood, and allows for reabsorption of nutrients, water, etc.
• A specialized portion is the VASA RECTA which surround the Loop of Henle, helping to maintain solute concentration....

1. Glomerular capsule is continuous with tubule.  Are large pores for easier passage of small molecules.
2. Proximal convoluted tubule - has many microvilli for reabsorption by simple diffusion
3. Loop of Henle - the u-turn that dips into the medulla, surrounded by the vasa recta
4. Distal convoluted tubule - has many mitochondria bu NO microvilli; b/c conducts active transport of molecules back into the blood (=tubular secretion); several distal tubules enter into a single collecting duct; many collecting ducts travel to the renal plevis

1. GLOMERULAR FILTRATION - while blood enters afferent arterioles into glomerulus; BP pushes out small molecules (nitrogenous wastes, salts, ions, creatinine, urochrome, small nutrients) and water into the glomerular capsule = GLOMERULAR FILTRATE; the stuff that doesn't get filtered out leaves via the efferent arteriole; ABOUT 180 L a day!!
2. TUBULAR REABSORPTION - at the proximal tubule; moleules/ions are reabsorbed into blood via the peritubular capillary network; Uses ACTIVE and PASSIVE TRANSPORT; Passively, the osmotic pressure of blood (from nonfilterables like the blood cells and plasma proteins) pulls in water, also the more sodium pulled in actively, the more osmotic pressure and Cl- follows; Actively, sodium is pumped in and specific carrier proteins transport their specific molecules like glucose (there are limited spots though, so if excess will cause excess in urine like glycosuria and also increase osmostic pressure of urine, pulling out more water causing frequent urination).  The molecules that are normally reabsorbed are most water, most salt, and nutrients.  The nonreabsorbable molecules are some water, most nitrogenous wastes, escess salts, creatinine, urochrome and molecules not recognized by the carrier proteins like drugs.  Onto the loop of Henle and then...
3. TUBULAR SECRETION - by ACTIVE transport at the distal convuluted tubules; more stuff is actively secreted out of the blood like H+ ions, potassium, etc.; the final product is urine containing glomerular filtrate not reabsorpbed and stuff actively secreted our of the blood at distal tubule.

1. FLUID AND ELECTROLYTE BALANCE - by water and salt reabsorption, mostly at the proximal tubule by osmosis; also by excretion into urine; is influenced by hypothalamis hormones like ADH, aldosterone of adrenal cortex, renin of kidneys and ANP of heart.
2. ACID/BASE BALANCE - affected by diet and metabolism; assists the blood buffer and respiratory systems (these methods are quicker but less effective than the kidneys); KIDNEYS HAVE ULTIMATE CONTROL OF PH.  When the blood is too acidis, the kidneys will reaborb more bicarbonate and excrete more H+ ions; when the blood is too basic, H+ will not be excreted and bicarbonate will not be reabsorbed;  Also, ammonis (toxic) from AA breakdown combine with H+ to form ammonium and is excreted via the kidneys, assisting is H+ ion removal.

• Water input 60% liquids, 30% foods and 10% metabolism
• about equals
• Water output 52% urine, 26% sweat, 18% exhalation and 4% feces
• Both are about 2.5 L a day
• Men are about 60% water and women 50% (more fat)
• 2/3 of water is in the cells, other 1/3 in tissue, plasma, lymph, etc)

• by the hypothalamus, released by the posterior pituitary, when blodd solute is too high, in order to retain more water.
• affects water reabsorption at the distal convoluted tubules and colelction cucts
• ADH is transported via blood to the distal tubule causing specialized cell mnembrane cahnnels called AQUAPORINS to open, allowing water to diffuse from the collectin duct into the kidney interstitial space to be reabsorbed by blood.

• Electrolyes influence the osmolarity of tissues
• are compounds that ionize in water and therfore carry an electrical current
• Regulated largely by the kidneys by excretion and reabsorption
• Most common electolytes in plasma are sodium (influences nerve APs and muscle contraction), chloride, and bicarbonate (carries CO2 to maintain pH)
• Most common in the intracellular fluid are potassium (influences nerve APs and muscle contraction esp. cardiac) and phosphate.
• More than 99% of sodium feltered at glomerulus is reabsorbed into blood, mostly at the proximal tubule.

• released by adrenal cortex
• promotes renal excretion of potassium and reabsorption of sodium into the blood
• Therfore promotes water retention
• Secretion by adrenal cortex is stimulated by structure of the kidneys called the JUXTAGLOMERULAR APPARATUS that secretes RENIN when afferent blood pressure is too low for glomerular filtration

• secreted by the JUXTAGLOMERULAR APPARATUS of the kidneys when blood pressure is too low for glomerular filtration
• stimulates ALDOSTERONE release from the adrenal cortex
• Is an enzyme that changes ANGIOTENSINOGEN (large protein by liver) into ANGIOTENSIN I which is changed to ANGIOTENSIN II, a potent vasoconstrictore to increase blood pressure

• hormone secreted by the heart when atria are stretched too much by high blood volume
• inhibits renin and aldosteron secretion
• promotes sodium and water excretion by kidneys = NATIURESIS to decrease blood volume and pressure

• URETHRITIS - inflammation of urethra, more common is females (shorter urethra)
• CYSTITIS - of the bladder
• PYELONEPHRITIS - of the kidneys, very painful, can cause damage

• from infection, hypertension, diabetes, inadequate blood supply, etc.
• Damage to glomerulus can cause excess permeability and blood proteins and cells escape into the urine
• Excessive damage may result is toxins not being excreted like urea = UREMIA
• Worst result is water and sodium retention causing edema and heart failure
• May require hemodialysis or kidney transplant

• can use an artificial kidney machine with an artificial or natural semi-permeable membrane OR CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)
• Dialysis = diffusion of small molecules through a semipermeable membrane tube
• Patients blood is passed through the membrane tube that us surrounded by DIALYSATE
• Simple diffusion will move high blood concentrations into the diasylate and higher disylate concentration will move into the blood
• Toxins are removed from blood, mostly urea and certain substances like bicoarbonate are added to the blood (if blood is too acidic)
• Takes 3-6 hours, about 2 X week
• With CAPD, the dialysis membrane is the peritoneal lining.  Diasylate is pured directly into the abdominal cavity via a surgically implanted tube and drained somehow.

• overall increase in infections

• urinary disorders are common causes of death in elderly
• total renal function is only 50% of young adult
• kidney size decreases, along with less nephrons
• vascular problems of age are most significant cause of decreased kidney function; causes glomerulus degeneration
• Increased kidney stones from diet and too little water
• prostate enlargement can lead to urine retention and kidney disease
• increased cancers of protate, cancer, etc
• increased incontinence
• decreased bladder capacity; more urgency and frequency
• more residual urine

• Over ~50 prostate grows from walnut size to lime; is BENIGN PROSTATIC HYPERPLASIA
• Due to a prostate enzyme 5-alpha-reductase that converts testosterone into a substance that promotes prostate growth
• can cause urine retention in bladder, then ureters, and even into kideny
• Treatments are to shrink prostate with drugs, destroy with mnicrowaves; Saw palmetto and finasteride act on 5-alpha-reductase but decrease libido, etc.; Are other drugs that decrease LH/testosterone levels or relaxes prostate muscles, though not changing size
• BPH not necessarily cancerous b/c occurs in inner zone, whereas cancer is usually on the outer zone of prostate
• Prostate cancer is the 2nd most common male cancer but not very deadly; it is slow growing and survivor rate is 98% if caught early.

• Collect fats via the villi of the small intestine
• Goes to the thoracic duct (lymphatic) and is therfore not first filtered by the liver (all other nutrients go into blood and drained into hepatic portal vein)

Too little urine

The decreased output of urine may be a sign of dehydration, renal failure, hypovolemic shock, multiple organ dysfunction syndrome, or urinary obstruction/urinary retention.