Conducting and Respiratory Airways

• trachea
• bronchi
• terminal bronchioles
• respiratory bronchioles
• alveolar ducts
• alveolar sacs

Vestibule

• in nose 
• transition from skin to non-keratinized epithelium to respiratory epithelium
• contains vibrissae(short thick hairs)
• sabaceous glands

APUD Cells

• granule in basal part of cytoplasm
• synthesize polypeptide hormones and serotonine
• paracrine and endocrine 
• cant see in Light Microscopy 
• in respiratory epithelium 

Brush Cell

• columnar Cell  with blunt microvili
• small mucous granules
• chemosensory receptor associated w/ sneeze reflex

Airway Mucus

• 97% water, 3% solids
• mucins (MUC5AC, MUC5B)
• bind fluid 
• low viscosity, elastic mucous
• antimicrobial, lysozymes, immunoglobulins

Mucus Production

• goblet cells (MUC5AC and MUC5B)
• clara cells of terminal bronchioles (MUC5AC, MUC5B)
• serous cells of submucosal glands (MUC5B)
• pericillary layer and mucous gel layer

Olfactory Nerve

• CN I and sense of smell
• cribiform plate of ethmoid bone
• nonmyelinated and attaches to olfactory bulb
• about 20 branches cross plate
• olfactory hair 

Bowman's Glands

• secrete a seromucous fluid
• odoriferous substances are disolved
• contains/secretes oderant binding protein(OBP)
• OBP takes odor to olfactory cell receptors 
• also secrete lysozymes, IgA
• this prevents pathogens from intracranial entry

Larynx

• hyaline and elastic cartilage
• eppiglottis closes over when eating
• stratified squamos on lingual surface of epiglottis and true vocal chords
• protection of epithelium

Terminal Bronchioles

• ciliated cuboidal epithelium with clara cells
• no cartilage and absent glands
• continuous (no breaks for alveolars)
• no gas exchange 

Clara Cells

• dome shaped 
• surfactant
• mucins
• antimicrobial peptides
• stem cells 
• repair and maintain bronchioles
• act as progenitores in injury for all

Asthma

• chronic inflamatory
• recurrent wheezing, breathlessness, chest tightness, cough
• inflamation(neutrophil, macrophages,-> tcell eosinophils)
• obstruction by mucus(increase in goblet cells)
• vasodialation
• bronchodialators and corticosteroids
• eosinophil MBP responsible for airway damage

Type I Pneumocyte

• squamous epithelial cell
• long cytoplasmic extensions
• 40% of epithelial population
• 90% of alveolar surface
• huge surface area

Type II Pneumocytes

• cuboidal w/ microvili
• bulge in alveolus
• lamellar bodies(contain surfactants)
• stem cells that proliferate into type I when Type Is are damaged 

Pulmonary Surfactant 

• lowers surface tension at blood-air barrier
• reduces tendancy of alveolus to colapse
• phospholipid(DDPC), cholesteral, surfactant Protein(SP-A, B, C)

Surfactant Protein 

• SP-A, B transform DPPC into mature surfactant
• SP-B,C stabalize surfactant

Alveolar Interstitium

• space between pneumocytes
• capillaries
• elastic, collagen fibers
• produced by fibroblasts
• capilaries w/ no connective tissue
• angiotensin converting enzyme (ACE)
• converts angiotensin I -->II

Dust Cell (alveolar Macrophages)

• monitor inhaled dust/bacteria
• remove degraded surfactant
• induce leukocyte migration
• moves up mucous escalator 

Emphysema

• destruction of elastic tissue alveolar wall
• destroyed by elastase (neutrophils)
• anitrypsin usually counteracts
• more neutrophils in this
• no tissue recoil, confluent large air sacs

Derivitives of Lateral Plate

(splanchnic) Mesoderm

• pericardial sac - fibrous connective tissue 
• cardiac muscle tissue 
• fibrous skeleton-fibrous conn tissue
• blood vessels for heart and blood cells

Process of Cardiac Muscle Protein

Stimulation

• mesenchimal cell
• BMP2 and 4 proteins trigger crescent proteins that inhibit wnt
• these activate NKX 2.5 
• this actifates GATA4 leads to ANF 
• This stimulates MEF2 that gives rise to cardiac muscle cells

Vasculogenesis and Angiogenesis

• Vasculogenesis is formation of new blood vessel
• Angiogenesis is formation of new blood vessels from existing blood vessels
• both require VEGF and some FGF
• receptors for vasculogenesis are FLK -1 and FLT -1

Hemopoiesis

• creation of blood cells
• first in yolk sac (till 3rd wk)
• then mostly liver and some spleen(till wk 6 or 7)
• from week 7 on done in bone marrow

Parietal and Visceral(epicardium)

Pericardium

• parietal is made up of a dense fibrous layer, areolar tissue, and mesothelium(simple squamous epithelium)
• epicardium only areolar and mesothelium

Resting Heart Rate

• 80 BPM
• 60 BPM with absolutely zero sympathetic inervation

Cushion Cells 

• fibroblasts in heart cells that produce fibromembranous skeleton 
• lateral, anterior and posterior endocardial cushios
• anterior and posterior synthesize to fuse the two to form the atrioventricular canals

AV Valve Leaflet Layers

• Atrial Side 
• Spongiosa
• Fibrosa
• Ventricularis 
• Ventrical side
• increases in fibers as layers go towards ventricle side
• increase in strength at ventricular surface
• simple squamous epithelium coats both sides

Calcification of Valves

• reduces blood flow as much as 70-80%
• valve stenosis
• starts around age 70-80
• 50%-80% of patients w. out surgical intervention will die from Myocardial infraction or Congestive heart failure
• aortice semilunar valve most affected

Pruning and Remodeling 

of Blood Vessels

• uses Platelet Derived Growth Factor (PDGF)
• and Transforming Growth Factor (TGFβ)

angiopoietin

• produced by endothelium cells
• recruits smooth muscle cells to the endothelium to form the middle layer

Collateral Vs. Recurrent Blood Vessels

• collateral branch fromm major blood vessel taking different path around joint or structures
• recurrent is reverse of blood flow direction

Portal System

• two capilary networks instead of one 
• used to move objecs picked up in frist capilary to location of second
• one in kidneys and one in interior pituitary gland
• an arterial has oxygenated blood in between (hadnt dont gas exchange) and a venous doesnt (did gas exchange in first capilary bed)

Tunics/Layers of Blood Vessels

• tunica intima/endothelium -SSE w. thin aereolar layer below serface lining
• Tunica media- middle most layer of smooth muscle
• tunica externa/aduentitia- outermost layer of fibrous connective tissue- usually vascularized in larger blood vessels

Elastic Artery 

• aorta, immediate branchs off aorta 
• thickest muscular wall of arteries (around 50 layers)
• elastic fibers

Muscular Arteries

• also refered to as distribution arteries
• despite there name, only 5-10 layers of muscle

Vasa Vasorum

• blood supply to larger blood vessels

Nervi Vascularis

• nerve supply to tunica media of blood vessels

Vasa Nervorum

• blood supply for large nerves

Aortic Dissection

• tear in tunica intima that allowed blood in between the tunica intema and tunica media 
• forms clot 
• can rupture with time

Aneursym

• balloon like buldge in the wall of a blood vessel due to weakness w. in wall which may be congenital
• involves all 3 tunics

Glomus/ carotid Bodies

• embedded in wall at bifercation of common carotid Artery
• tunica media
• chemoreceptors
• senses changes in O2, Co2, and blood ph(H+)
• relaease NT to sensory afferents of CN IX which transfers signal to medulla oblongata 

Hirudotherapy 

• use of leaches to get rid of clotted blood and dead tissue in veracous veins

Central Cells

• hematopoietic stem cells
• eventually populate liver, spleen, Thymus (begining of wk 8)
• aprox 7th month will begin to poplate RBM at primary ossification centers 

4 Layers of Alimentary Tract

• mucosa, submucosa, muscularis (inner circular and outer longitudinal), and adventitia/serosa

Mucosa

• innermost layer of alimentary tract
• epithelium lines lumen and can be modified for protection, secretion or absorption
• lamina propria is layer of loose connective tissue that has glands, blood vessels, immune cells
• muscularis mucosa is smooth muscle involved in the contraction of the mucosa
• runs peripindicular to vili

Submucosa 

• layer of alimentary tract made of dense irr CT
• blood and lymphatic vessels and nerve plexis
• esophageal submucosal glands and brunners glands in duodenum
• meissners plexus controls sectrion in the mucosa and submucosa(sends to aurbachs plexus)
• this is a chemoreceptor and mechanoreceptor

Muscularis Externa

• smooth muscle (mostly)
• inner reduces size of lumen and outer contraction shortens length of tube
• some skeletal muscle (variation)
• auerbach's plexus 

Auerbach's (Mynteric) Plexus

• controls churning(inner circular layer) and peristalsis of outer longitudinal ring
• part of enteric Nervous System
• chemoreceptors and mechanoreceptors
• recieves signals from meissners plexus
• responsible of muscularis externa contraction

Adventitia and Seorsa

• serosa is thin layer of Loose CT covered in mesothelium
• continuous w/ mesenteries in abdominal cavity that allows for organs to slide past each other
• adventitia is thick layer that lacks mesothelium
• adheres GI tract to body wall

Stomach Rugae

• longitudinal fold of gastric mucosa and submucosa
• cover by pits and glands
• allow for stomach to shrink and expand

Gastric Mucous Cell

• produce gastric mucosal barrier
• protects the mucosal surface from low ph of gastric juices
• surface mucous cells line pits
• mucous neck cells where gland meets pit(smaller)
• both produce mucin and glycoproteins
• 95% water, 5% mucins, protective barrier, traps bicarbonate. 

Stomach Fundus/Body Cell Types

• mucous cells(protective mucous blanket)
• chief cells(release pepsinogen)
• parietal cells (release HCl)
• APUD cells (regulate digestion and absorbtion, many cells)
• stem cells (repopulate epithelium)

Chief Cells

• predominatly in fundus/body of stomach
• lots of RER (basophilic cytoplasm)
• granules contain pepsinogen
• acetylocholine stimulates secretion

Pepsinogen

• proenzyme requiring activation
• stored in zymogen granules of chief cells
• low pH activates (gastric juices)
• pepsinogen activated to pepsin in lumen of stomach
• pepsin in proteosomething enzyme that digests protiens

Parietal Cell

• fundus/body of stomach
• secretes HCl and intrinsic factor
• regulated by gastrin (main endocrine), histamine (perocrine) and ach (neural)
• has a resting state and active state
• intracellular caniliculus

Parietal Cell Resting/Active State

• filled w/ tubulovesicular system rich w/ H/K ATPase proton pump
• in resting cell pump only active for short periods because mech for k transport isnt present/active
• stimulate causes Tubulovesicualar to fuse w/ canaliculus
• microvili in coniculi and abbundant mitochondria
• H/K exchange occurs and HCl produced

Steps of Parietal Cell Activation

• stimulation and C02 diffuses into cell to form H2C03
• this dissociates to form H and HCO3 and H stays in cell
• H is exchanged for K by ATPase proton pump
• Cl brought in by active transport (NaCl)
• HCl made then in lumen by H and Cl

Intrinsic Factor

• glycoprotein secreted by parietal cells
• forms complex w/ vitamin B12 in stomach and duodenum
• binding of intrinsic factor necessary for absorption of vitamin in illeum

Pernicious Anemia

• caused by to few RBC's, low intrinsic factor, B12 deficiency, autoimune rx against parietal cells
• tingling/burning skin, red/shiny tounge, numbness, tired, spasm in limbs, trouple breathing, bad night balance and incontinence
• treated with large doses of B12(inj, pills, spray
• also folic acid

APUD Cells

• visible only in EM(stomach fundus body)
• produces peptide hormones
• GI "largest endocrine" organ in body
• amino acids enter, polypeptide hormones released to lamina propria, then blood capillaries
• amines are part of polypeptide(inhibit or stimulate
• gastrin, secretin, cholecystokinin(CCK) released

Gastrin

• secreted by APUD in pyloric stomach in response to meal or high gastric pH
• stim production of HCl by parietal cells
• stim CCK to stimulate (constrict) gall bladder and pancreas to secrete insulin
• also stim gastric motility and growth of stomach mucosal cells
• regulated by gastrin releasing peptide and somatostatin(inhib)

Secretin

• APUD cells in duodenum
• stimulates release of bicarbonate(pancreatic and brunners glands)
• stim fluid release to regulate pH of duodenum
• coordinates w/ CCK to stim growth of exocrine pancreas
• inhibits gastrin release
• works w/ ach to stimulate chief cells

Cholecystokinin (CCK)

• APUD cells of duodenum
• key regulator of digestion
• gallbladder contraction 
• relaxation of spincter of oddi 
• pancreatic enzyme and bicarobonate ion secretion
• pancreatic growth 
• gastric emptying inhibits this

Brunners Glands

• in submucosa of duodenum
• secrete alkaline mucus to neutralize the acid chyme from stomach

Pancreas Endocrine Gland (organ)

• cells: islets of langerhans (pink)
• output: insulin, glucagon, somatostatinm, pancreatic polypeptides
• target:empty into blood vessels. alter metabolism
• structure: ductless

Pancreas Exocrine Gland

• cells: serous cells (arranged in acini) granules
• output: numerous digestive enzyme precursors. collectively, these are zymogen (or inactive form)
• target: empty from acini into pancreatic duct system. main pancreatic duct empties into duodenum
• structure: acinar cells and duct system

Pancreatic Duct System

• acini transmits to intercalated ducts(flattened cuboidal epithelium)
• intercalated ducts to intralobar ducts(cuboidal ep)
• intralobar ducts to inerlobar ducts (cuboidal to columnar)
• main pancreatic duct recieves secretions from interlobar ducts

Liver: Basic Anatomy

• right, left, quadrate, caudate lobes
• porta hepatis: hapatic portal vein,  hepatic artery proper and common hepatic duct
• liver encased in thin CT called glisson's capsule
• contain hepatocytes

Development of Liver

• liver develops as endodermal outpocketing of forgut
• hepatic cells endoderm
• gall bladder develops from ventral outgrowth of bile duct
• connect tissue and kupffer cells devvelop from mesoderm

Plicae Circulares

• folds on inner surface of intestine
• composed of mucosa and some submucosa
• dont completely flatten and covered in villi

Small Inestine Villi

• finer like projects of mucosa (evaginations)
• shape/length differ in each part of small intestine
• core of loose CT(lamina propria; attached to plicae)
• covered in enterocytes

Crypts of Lieberkuhn

• opening btw base of villi
• invaginations of mucosa
• location of paneth cells

Small Intestine Microvilli

• apical surface of enterocytes
• evaginations on cell surface w/ core actin microfilaments
• covered w/ glycocalyx
• enzymes for digestion and absorbtion
• this is the last modification and all togething increase SA by 600 times

Histological Difference of Small

intestine regions

• Brunners gland in duodenum, large plicae in jejunum, and peyers patches in ileum

Enterocyte

• columnar cell
• microvilli w/ glycocalyx
• terminal digestion of carbs and proteins(enterokinase)
• absorbs lipids, carbs, proteins and vitamins

Goblet Cell

• mucus secreting(80% carbs, 20% protein)
• apical domain (goblet shaped) large mucus granules
• basal domain has RER where mucus is produced 
• 2 mucus layers

Mucus Layers of Small Intestine

• outer layer for trapping microorganisms
• inner layer resistent to microorganism penetration, antimicrobial protection 
• paneth cells, enterocytes and gobelt cells

Paneth Cells

• base of crypts 
• eosinophillic (red)
• stores/secretes lysozyme and other anibacterial
• provides innate immunity (no antigen)

M Cells

• modified epithelial cells
• cover peyers patches of ileum and lymph nodules
• apical microfolds(yellow)
• deep recesses of cell house lymphocytes (green)
• pinocytose proteins from lumen to monitor for antigens
• transfer antigens to dendritic cells and lmyphocytes

Major Duodenal Papilla

• allows for passage of bile and pancreatic zymogens(inactive proenzyme)
• Oddi?

Pancreatic Enzyme Activation

• chyme arrives in duodenum, activated mucosal cells to activate enterokinase
• this converts trypsinogen to trypsin
• trypsin activates more trypsin and other pancreatic enzymes
• active proteases that hydroyze protein peptide bond

Peyers Patches

• extensive aggregates of nodules
• follicle associate epithelium w. M Cells and enterocytes
• domes with b Cells, macrophages, plasma cells, 
• germinal centers with plasma cells and "B cells

Cells of Colon

• enterocytes, goblet cells, stem cells, and extensive GALT

Appendix

• more lymphocytes then colon
• covered by serous cell around except at adventitic mesothelium
• absorptive and goblet cells
• no villi or teniae coli
• lymphoid nodules obscure boundary btw lamina propria and submucosa
• free surface surrounded by serousa-meso appendix connection via adventitia
• resevoir for good gut bacteria

Recto-anal Junction

• rectum histology identical to colon 
• abrupt transition to stratified non-squamous at junction (pectinate line)
• transition to skeletal muscle
• no glands helps tell diff from esophageal cardiac junction

Hemroids

• internal above pectinate line 
• external below pectinate line
• veins dialated and bluge the mucosa
• bleed may occur during defacation

Jaundice

• yellowing of skin, sclera, and mucous membrane due to bile pigments in blood
• caused by high level of bilirubin
• prehepatic(to much bilirubin in blood)
• hepatic( liver defect/disease preventing conversion
• post hepatic (obstruction of biliary drainage system

Three types of liver lobules

• classic hepatic lobule drains blood from the portal vein and the hepatic artery to hepatic or central vein
• protal lobule drains bile from hepatocytes to the bile duct
• portal acinus supplies oxygenated blood to hepatocytes

Pancreas

• head, neck, body, tail, and ucinate process
• endocrine gland secretes insulin and glucagon
• exocrine gland secretes pancreatic juic into duodenum
• accessory duct and main duct

Islets of Langerhans

• clusters of endocrine cells
• takes sympathetic and parasympathetic innervation
• seperated from exocrine cell by reticular fibers
• highly vascularized, circular, less granular

Type I Diabetes (Mellitus)

• body does not produce insulin because beta cells are destroyed by an autoimmune disorder, toxin, and trauma
• individuals w/ type I diabetes must take daily insulin injections to survive
• type I diabetes usually manifest itself in children or young adults (10 % of diabetes)

Type II Diabetes

• body develops insulin resistance coupled w/ a deficiency in insulin production
• type II diabetes usually occurs in individuals over 40, over weight w/ family history of diabetes 
• 90% of diabetes

Serous Acini and Intercalated Ducts

• pancreas exocrine secratory
• round nucleus and basophilic in basal region
• zymogen granules in apex
• intercalated duct recieves secretion for acini
• intercalated ducts secrete bicarobonate to flush enzymes and neutralizes acidic chyme coming from stomach
• acini have centroacinar cells in pancreas

Pancreatitis

• inflamation of pancreas
• occurs when pancreatic enzymes become active in the pancreas instead of small intestines
• may be acute or chronic

Hepatic Lobule

• organized as interconnected plates to form liver lobules
• surrounded by portal spaces (3-6 per lobule)
• lobules contain central veins that drain to hepatic veins
• discontinuous capilaries called inusoids run btw plates of hepatocytes
• bile duct in portal triad has round nuclei

Space of Disse

• subendothelial space seperating endothelial cells of hepatocytes and sinusoids
• fenestra in endothelium allow exchange of molecules to this space
• has both endocytotic and pinocytic activity

Kupffer Cells

• macrophages in luminal surface of sinusoids
• metabolize aged erythrocytes
• digest hemoglobin 
• destroy bacteria that enter liver via portal circulation
• 15% of liver cells
• most found near portal triads

Hepatic Stellate (Ito) Cells

• fat storing cells containing vitamin A rich lipids
• roles in retinoid uptake and storage, synthesis and secretion of ECM and proteoglycans, secreting growth factors and sinusoid lumen diameter
• major cell type in liver fibrosis (cirrhosis)

Pit (natural Killer) Cells

• liver-specific lymphocytes that kill tumor cells 
• activated by interlukin-2
• prob wont see in histo slides

Cirrhosis of Liver

• chronically diseased liver, ito cells proliferate and take on features of myofibroblasts
• play role in fibrosis of liver
• if irreversible can lead to cirrhosis
• CT turquoise 

Hepatocyte 

• polyhedral cells w/ 1-2 round nuclei
• protrude into dissse
• have microvili and large # of SER, RER and mitoch.
• basophilic bodies from RER
• SER perform in activation/detoxification
• communicate w/ sinusoids and have gap junctions btw other hepatocytes
• differ based on location in lobule

Bile

• mix of water, cholesterol, bile acids, bilirubins and ions
• 90% of bile acids are reabsorbed from intestinal epithelium thru enterohepatic recirculation
• wase products like bilirubin eliminated from body by secretion
• cholesterol eliminated through bile
• chyme in small intestine stimulate bile release

Bilirubin 

• eliminated in bile 
• useless, toxic breakdown product of hemoglobin
• heme converted to free bilirubin and absorbed by hepatocytes
• SER converts to conjugated bilirubin which is excreted in bile

Hepatic Fat Metabolism

• oxidize triglycerides to produce energy
• synthesize and exports ketone bodies into blood converts excess carbs and proteins to fatty acid
• liver sn large quantity of cholesterol and phospholipids

Hepatic Protein Metabolism

• Deamination and transmiamination of amino acids followed by conversion of non-nitrogenous part of those molecules to glucose or lipids
• removal of amonia through conversion to urea
• if faulty can cause CNS disease 
• hepatocytes synthesize of most plasma membranes
• albumin the major plasma membrane protein
• liver synthesizes many clotting factor

Portal Lobule

• triangular shape w/ central veins at each vertex centered on portal triad
• represents flow of bile out of liver

Portal Acinus 

• eliptical and divided into zones I, II, and III(peri, middle, and centrolobular)
• pe=ortal triads at either side of a central dividing line
• central veins at either end of acini
• organization of acini, relates to levels of oxygenated blood flow
• blood oxygenation zone I> II> III

Gall Bladder

• stores 5X concentrated bile from liver
• cystic duct fuses w/ comman hepatic duct to form the common bile duct
• mucosa, lamina propria, smooth muscle, perimuscular(CT) and serous membrane
• Rokitansky Aschoff(R-A) crypts
• Na/K ATPases
• CCK contracts smooth muscle and relaxes oddi spinchter

Gallstones

• composed predominantly of cholesterol
• results that allow cholesterol to precipitate from bile
• can block bile flow
• causes cholecystitis(inflamation of gallbladder)
• or block bile ducts causing jaundice

Corrtical Nephron

• outer region of cortex
• short loop of henle
• efferent Glomerular arteriole branches to surround the convuluted segments of corticol nephrons

Juxtaglomerular Nephron

• in cortex near medulla
• long loop of henle that extends deep into medulla
• efferent glomerular arteriole forms vasa recta that surround collecting ducts and limbs of the loop of henle
• conserves the most water

Autosomal Polycystic Kidney Disease

(APDKD)

• mutations in either PDK-1 or PDK2 genes (code for polycystin 1 or 2)
• symptoms are flank pain, blood hypertension, large kidneys, progressive renal failure after 30-40 years of age, and destruction of kidney parenchyma 
• defect in mechanosensing cilia
• cysts caused by dilation of collecting ducts
• treatment is to extend life via renal dialysis or transplantation
• ultimatly fatal

Identifying Macula Densa

• apically located nuclei that appear crowded
• cells are narrower, taller and more closely packed than other DCT cells
• golgi in basal domain

Identifying Juxtaglomerular Cells

(JG cells)

• smooth muscle cells in the afferent arteriole
• also within the vascular pole
• cells contain secretory granules and sphericle nuclei
• release renin when blood pressure falls to increase blood pressure and volume

Aldosterone

• reduces the excretion of NaCl by stimulating vascular reabsorption of NaCL by thick ascending limb of the LOH, DCT and collecting tubule
• this causes water to follow osmotic gradient resulting in increased BP and Blood volume

Anti-Diuretic Hormone (ADH)

• secreted by posterior part of pituitary gland
• regulations concentration of solutes in urine by altering ion shutting in loops of henle and collecting tubules of nephrons and there adjacent vessels (vasa recta)
• binds to principal cells of collecting ducts opening aquaporins that allow for mvt of water from filtrate to medulla
• alcohol inhibits ADH and ADH is absent when vary hydrated
• hypertonic (urine conc) and hypotonic (urine diluted)

Male Urethra

• longitudinally folded mucosa
• epithelial variations for male go from stratified columnar, to pseudostratified to statified squamous at distal end
• males also have prostate (urothelium), mebranous external urethral sphincter (strat. or pseudstr columnar) and penile corpus spongiosum (pseud. strat. columnar with patches of stratified squamous)

Glands of Littre

• urethral glands found along the length
• small mucus secreting
• lubricates urethra

Female Urethra

• lined by urothelium near bladder, pseud columnar w/ patches of strat squamos more distally
• fibroelastic lamina propria assist in firm closure
• plexus of veins in lamina propria that aid in closure
• 2 smooth muscle layers: inner and outer longit.

Transitional Cell Carcinoma

of the Bladder

• most common type of cancer in urinary tract
• symptoms: haematuria (RBC in urine), flank pain and difficulty urination
• cytoscopy or biopsy for tumor staging
• treatments resection, intravesicular therapy(thru catheter) or chemotherapy
• the higher the stage the deeper it penetrates until it gets to the subcutaneous layers

UTI's

• bacterial UTIs in bladder(cystitis) or kidney (pyelonephritis)
• cranberry juic inhibits attachment of ptype fimbriae of E coli (90% of UTIs)

Stages of Prophase I

• leptotene
• zygotene
• pachytene
• diplotene(when female born all eggs locked here)
• diakenesis 

Spermatogonium

• sperm stem cells
• typa a dark: true germinal stem cell, undergo mitosis, self renewing
• type a pale: generated from dark mytosis under certain circumstances, mitosis of these makes cohort, become part of gamate cell in future 
• type B: (undergo S phase and driven into prophase I., known as primary spermatocytes then 

Corpus Luteum vs Albican

• albican has few plasma membrane and few nuclei because of apoptosis
• albican smaller and lighter staining
• luteum still maintains all major structures and stains darker

Fallopian Tubes

• simple columnar ciliated epithelium
• basment mem/lamina propria
• muscularis= circ and long smooth muscle layer
• serosa (mesothelium w/ loose CT) ensheathed by broad ligament(mesentary)
• peg cells(goblet) that secrete viscous fluid, glycogen rich(have microvili) 

Endometrium layers

• consist of basalis layer and functional layer
• functional layer is shed each month
• straight arteries found the basilis layer and move into functional layer through hormonal control as spiral arteries
• uterine glands that project through both layers (stem cells that create all the surrounding tissue)

Three Phases of Endometrium 

• menses phase (day 1-5)
• proliferative phase (ends with ovulation) driven by estrogen (day 6-14)
• secretory phase( release fluids) driven by progesterone (day 15-28)

Cervical canal

• has a squamocolumnar junction
• goes from stratified squamous at begining to simple columnar inside canal
• 95% of cervical squamous cell carcinomas occur in the transformation zone (most often associated with HPV)

Secretory Products of Seminal Vesicle

Prostate Gland Secretion

• 30% of fluid volume
• semen anti-coagulants (fibrinolysis, PSA, PAP)

Bulbourethral Glands

• empty into penile urethra
• mucosa-dense in mucous acini
• pre-ejaculate-lubrication to facilitate penetration
• secretion contains galactose

Male Vs Female Urethra

• penile urethra if surrounded by porus, fibrous CT, that may be filled with RBC (c. spongiosum)
• female urethra do not have tunica alberginia
• penile urethra have glands of littre

Kidney Endocrine Cell

• syn and secrete glycoprotein hormone Erythropoietin (EPO) -regulates RBC formation
• syn and secretion of renin (enzyme)-reg BP and blood volume
• activates vitamin D into calcitrol vitamin D3

Nephron

• consists of renal corpuscle and tubular system
• renal corpuscle consists of bowmans capsule and glomerulus
• tubular system consists of proximal convuluted tube, loop of henle (thick, thin, thick), distal convuluted tube
• macula dense btw thick henle and DCT
• afferent arteriole brings blood to glomerulus and efferent away

Renal Corpuscle

• contains mesangium
• bowmans capsule made up of squamous cells
• filters waters, solutes and nutrients from blood
• urinary space accepts filltrate before PCT
• msangium is an extracellular matrix that is secreted by mesangial cells(supports capillary surface that is not covered by pedicels)
• vascular and urinary pole
• PCT is first site of reabsorbtion/recycling

Glomerulus Filtration

• glomerular capilaries with basement membrane
• podocytes that extend foot proccess called pedicels around capilaries
• stops big particles
• contains filtration slits

Nephrin

• proteins
• ajacent overlap in center forming a barier
• pores on either side of overlaping nephrins
• anchored to actin filaments with pedicels
• filtrate includes water/glucose, AA, ions, urea,hormones, vitamin B, ketones and some protein

Mesangial Cell Types

• intraglomerular are enclosed by basement membrane
• Extraglomerular are btw arterioles and DCT in the vascular pole
• forms part of juxtaglomerular aparatus(regulates renal blood flow)

Mesangial Cell Functions

• contraction in response to BP changes
• phagocytic(remove trapped particles in the GBM)
• capable of proliferation
• syn and secrete mesangial matrix, collagen, construction of afferent and efferent arterioles
• also offer structural support

Proximal Convoluted Tubule

• simple cuboidal epithelium w/ brush border(microvili and glycocalyx)
• reabsorbs organic nutrients, proteins and most water and electrolytes
• secreates H+ and NH4+

Loop of Henle

• reabsorbs 15-25% of filtered NaCl
• contributes to generation of hypertonic medullary interstitium
• descending thin limb permeable to water, not salts
• ascending limbs active reabsorbtion of electrolytes(impermeable to H2O
• thick lined by cuboidal, thin by squamous

Distal Convoluted Tubule

(DCT)

• short cuboidal w/ no brush border(lumen white)
• specialized region called macula densa
• little or no water permiability 
• reabsorbs 5-7% of altered NaCl stim by aldosterone from adrenal glands
• maintians acid-base balance in blood by secreting H+ and NH4+

Collecting Ducts

• not part of nephron 
• ADH acts to regulate the reabsorbtion of water
• intercaled cell with microvili secrete H+ and HCO3- to regulate acid-base
• principal cells w/ primary cillium that are mechanoreceptors
• also contain lots of water channels (aquaporins), polycstin-1 (adhesion) and polycystin-2 (ca2+channel)

Juxtaglomerular Apparatus

• macula densa and juxtaglomerular cells(specialized region of glomerular afferent arteriole)
• macula dense senses low sodium and signals JGC to release renin
• causes are low intake, low renal blood pressure or low sodium in volume of circulating blood

Renin-angiotensin-Aldosterone System

• renin cleaves angiotensingogen in circ blood into angiotensin I
• Angiotensin I converted to angiotensin II in lungs by angiotensin converting enzyme (ACE)
• Ang. II causes aldosterone secretion from adenal cortex of kidney
• leads to vasoconstriction(inc in BP), ADH secretion and thirst, reabsorption of NaCL by peritubular cap.)
• when normal BP Juxtaglomerular cells stop secreting renin

Ureters

• longitudinal folded mucosa lined urothelium
• thick muscularis(inner long, outer circ) and extra 1/3 has extra longitudinal layer
• muscularis much thicker then mucosa
• adventitia is also present

Bladder

• urothelium, lamina propria and submucosa made of dense irregular CT and is lightly vascularized
• inner long., middle circ, outer longitudinal smooth muscle layers
• superior surface has serosa and inferior adventitia

Breakdown of Testis 

• about 200-250 lobules dived by septum in each testi
• there are 1-4 semineferous tubules/ lobule
• mediastinum is on posterior side of scrotal sac

Smineferous tubules

• stratified epithelium
• where spermatogenosus, spermiogenesis, and spermiation take place
• tubular fluid
• firbroblast like cells outside basement membrane can contract to cause peristalsis (extratubular matrix)(peritublar)
• leydig cells(interstitual cells) are aggregates of cells that produce testosterone
• sertoli cells 

Sertoli Cells

• span the entire wall of the semineferous tubules
• also known as nurse cells or suspensular cells
• nuclei large and at midpoint; prominant nucleolus
• site of spermatogenesis

Hypothalmo-Hypophyseal-Testes Axis

• hypothalmus release GNRH that stimulates the pituitary to release FSH and LH
• FSH drives meosis and stimulates spermatogenesis in sertoli cells? (testosterone also helps)
• LH positive influence on interstitial(leydig) cells that leads to testosterone

Spermatogenisis

• type B undergoes interphase and then prohase I(leads to primary spermatocyte)
• After meiosis I it is secondary spermatocyte
• spermatids at end of meoisis II(23 chrom. n)
• with spermiogenesis happening in tandem it takes up to 74 days to get a spermatazoa(non motile)
• matures in epididimis for till day 90ish

Spermiogenesis

• golgi phase where polarities are formed and the golgi produce enzymes that will develop acrosome
• cap phase where golgi aparatus surrounds the condensed nucleus forming the acrosomal cap
• acrosomal/tail phase where a centriole elongates to form tail that orients towards lumen(machette assists)
• the excess cytoplasm known as residual bodies are phagocytosed by sertoli cells

Function of Sertoli Cells

• forms the blood-testi barrier(basal tight junction btw sertoli cells that stops possible immune response)
• seperate spermatogonia cells from spermatocytes (basal compared to adluminal compartment)
• nutritive support for developing spermatocyte
• production of ABP(bind testosterone), activin and inhibin(reglate testosterone), tubular fluid
• phagocytosis of residual bodies

Leydig Cells

• produce testosterone and Dihydrotestosterone from cholesterol
• prostate can convert testosterone to DHT
• this stimulates epithelium making benign hypoplastic prostate
• usually down in mitochondria but can also be done in SER
• prolactin drives synthesis of LH receptors on leydig cells

Steroidogenic Acute Regulatory Protein

(STAR)

• first cholesterol enters cell and must be esterfied so that it is to large to leave
• this then binds esterfied cholesterol and transports to mitochondria
• once in mitochondria it is transformed to testosterone

Choriocarcinoma

• testicular cancer(20-30's)
• small, hardened, painless nodules through scrotal sac wall
• multiple nuclei, cytoplasmic mass, 
• blood vessels can hemorage
• leukocytes then infiltrate
• high rate of metastisis/invassive
• 100% of time elevated hCG(embryonic hormone)

Excurrent/Sperm Transport System

• spermatozoa then move to straight tubles with simple cuboidal and sertoli cells(apical tight jnx now)
• then move to Rete Testi's(simple cuboidal)
• at this point no cilia on spermatozoa
• next efferent ductules(10-12) that have principal cells w/ microvili and ciliated cells
• then dump into epididimis with pricipal cells w/ elongated stereocilia and basal cells-this reabsorbs tubular fluid and secretes nourishing fluids

Types of Follicles

• starts as primordial folicle and goes to unilaminar follicle
• multilaminar is next and moves to antral follicle
• antral follicle begins to form fluild filled antrum
• the final folicle is a mture preovulatory(grafian)
• FSH stimulates 6-10 antral folicles a month
• after oocyte is ejected goes to corpus luteum(yel) and if doesnt implant albican(white)

Graffian (mature preovulatroy)

Follicle

• has outer layer of theca externa (smooth muscle) and inner layer of theca interna
• the externa forces oocyte out of cell
• interna turns cholesterol to estrogen intermediate(androsteindione)
• Granulosa SER converts this to Estrogen

Z protiens

• produced by oocyte and granulosa
• Zp-1, Zp-2 and Zp-3
• Zp-3 most important because spermatazoa have receptors for it
• Zona pellicada is a thick jello layer?

oocyte position in folicle

• corona radiata is a shell of cells around the oocyte itself
• cumulus oophorus the connects it to the inner wall of folicle

Stigma

• rupturing of ovarian wall to release the oocyte
• causes scar tissue to form over the wound
• afterwards granulosa lutein enlarges and theca shrinks and progesterone produced
• infertility in older women can be caused by accumulation of scar tisue

Epitope 

• most immune stimulation portion of a pathogens proteins
• most variable from human
• forein protein is an antigen

TH1 and TH2

• TH2 activates B Lymphocytes
• TH1 activates killer or cytotoxic cells