The brain is arguably the most important organ in the human body. It controls and coordinates actions and reactions, allows us to think and feel, and enables us to have memories and feelings—all the things that make us human.

While the brain only weighs about three pounds, it is a highly complex organ made up of many parts. Years of scientific study have made it possible for scientists to identify the various areas of the brain and determine their specific functions. The following information provides a brief description of some of the major parts of the human brain.

The Cell Structure of the Brain

The brain is made up of two types of cells: neurons and glial cells, also known as neuroglia or glia. The neuron is responsible for sending and receiving nerve impulses or signals. Glial cells are non-neuronal cells that provide support and nutrition, maintain homeostasis, form myelin and facilitate signal transmission in the nervous system. In the human brain, glial cells outnumber neurons by about 50 to one. Glial cells are the most common cells found in primary brain tumors.

When a person is diagnosed with a brain tumor, a biopsy may be done, in which tissue is removed from the tumor for identification purposes by a pathologist. Pathologists identify the type of cells that are present in this brain tissue, and brain tumors are named based on this association. The type of brain tumor and cells involved impact patient prognosis and treatment.

The Meninges

The brain is housed inside the bony covering called the cranium. The cranium protects the brain from injury. Together, the cranium and bones that protect the face are called the skull. Between the skull and brain is the meninges, which consist of three layers of tissue that cover and protect the brain and spinal cord. From the outermost layer inward they are: the dura mater, arachnoid and pia mater.

Dura Mater: In the brain, the dura mater is made up of two layers of whitish, nonelastic film or membrane. The outer layer is called the periosteum. An inner layer, the dura, lines the inside of the entire skull and creates little folds or compartments in which parts of the brain are protected and secured. The two special folds of the dura in the brain are called the falx and the tentorium. The falx separates the right and left half of the brain and the tentorium separates the upper and lower parts of the brain.

Arachnoid: The second layer of the meninges is the arachnoid. This membrane is thin and delicate and covers the entire brain. There is a space between the dura and the arachnoid membranes that is called the subdural space. The arachnoid is made up of delicate, elastic tissue and blood vessels of varying sizes.

Pia Mater: The layer of meninges closest to the surface of the brain is called the pia mater. The pia mater has many blood vessels that reach deep into the surface of the brain. The pia, which covers the entire surface of the brain, follows the folds of the brain. The major arteries supplying the brain provide the pia with its blood vessels. The space that separates the arachnoid and the pia is called the subarachnoid space. It is within this area that cerebrospinal fluid flows.

Cerebrospinal Fluid

Cerebrospinal fluid (CSF) is found within the brain and surrounds the brain and the spinal cord. It is a clear, watery substance that helps to cushion the brain and spinal cord from injury. This fluid circulates through channels around the spinal cord and brain, constantly being absorbed and replenished. It is within hollow channels in the brain, called ventricles, that the fluid is produced. A specialized structure within each ventricle, called the choroid plexus, is responsible for the majority of CSF production. The brain normally maintains a balance between the amount of CSF that is absorbed and the amount that is produced. However, disruptions in this system may occur.

The Ventricular System

The ventricular system is divided into four cavities called ventricles, which are connected by a series of holes, called foramen, and tubes.

Two ventricles enclosed in the cerebral hemispheres are called the lateral ventricles (first and second). They each communicate with the third ventricle through a separate opening called the Foramen of Munro. The third ventricle is in the center of the brain, and its walls are made up of the thalamus and hypothalamus.

The third ventricle connects with the fourth ventricle through a long tube called the Aqueduct of Sylvius.

CSF flowing through the fourth ventricle flows around the brain and spinal cord by passing through another series of openings.

Brain Components and Functions

Brainstem

The brainstem is the lower extension of the brain, located in front of the cerebellum and connected to the spinal cord. It consists of three structures: the midbrain, pons and medulla oblongata. It serves as a relay station, passing messages back and forth between various parts of the body and the cerebral cortex. Many simple or primitive functions that are essential for survival are located here.

The midbrain is an important center for ocular motion while the pons is involved with coordinating eye and facial movements, facial sensation, hearing and balance.

The medulla oblongata controls breathing, blood pressure, heart rhythms and swallowing. Messages from the cortex to the spinal cord and nerves that branch from the spinal cord are sent through the pons and the brainstem. Destruction of these regions of the brain will cause “brain death.” Without these key functions, humans cannot survive.

The reticular activating system is found in the midbrain, pons, medulla and part of the thalamus. It controls levels of wakefulness, enables people to pay attention to their environments and is involved in sleep patterns.

Originating in the brainstem are 10 of the 12 cranial nerves that control hearing, eye movement, facial sensations, taste, swallowing and movements of the face, neck, shoulder and tongue muscles. The cranial nerves for smell and vision originate in the cerebrum. Four pairs of cranial nerves originate from the pons: nerves five through eight.

Cerebellum

The cerebellum is located at the back of the brain beneath the occipital lobes. It is separated from the cerebrum by the tentorium (fold of dura). The cerebellum fine tunes motor activity or movement, e.g. the fine movements of fingers as they perform surgery or paint a picture. It helps one maintain posture, sense of balance or equilibrium, by controlling the tone of muscles and the position of limbs. The cerebellum is important in one’s ability to perform rapid and repetitive actions such as playing a video game. In the cerebellum, right-sided abnormalities produce symptoms on the same side of the body.

Cerebrum

The cerebrum, which forms the major portion of the brain, is divided into two major parts: the right and left cerebral hemispheres. The cerebrum is a term often used to describe the entire brain. A fissure or groove that separates the two hemispheres is called the great longitudinal fissure. The two sides of the brain are joined at the bottom by the corpus callosum. The corpus callosum connects the two halves of the brain and delivers messages from one half of the brain to the other. The surface of the cerebrum contains billions of neurons and glia that together form the cerebral cortex.

The cerebral cortex appears grayish brown in color and is called the “gray matter.” The surface of the brain appears wrinkled. The cerebral cortex has sulci (small grooves), fissures (larger grooves) and bulges between the grooves called gyri. Scientists have specific names for the bulges and grooves on the surface of the brain. Decades of scientific research have revealed the specific functions of the various regions of the brain. Beneath the cerebral cortex or surface of the brain, connecting fibers between neurons form a white-colored area called the “white matter.”

The cerebral hemispheres have several distinct fissures. By locating these landmarks on the surface of the brain, it can effectively be divided into pairs of “lobes.” Lobes are simply broad regions of the brain. The cerebrum or brain can be divided into pairs of frontal, temporal, parietal and occipital lobes. Each hemisphere has a frontal, temporal, parietal and occipital lobe. Each lobe may be divided, once again, into areas that serve very specific functions. The lobes of the brain do not function alone: they function through very complex relationships with one another.

Messages within the brain are delivered in many ways. The signals are transported along routes called pathways. Any destruction of brain tissue by a tumor can disrupt the communication between different parts of the brain. The result will be a loss of function such as speech, the ability to read or the ability to follow simple spoken commands. Messages can travel from one bulge on the brain to another (gyri to gyri), from one lobe to another, from one side of the brain to the other, from one lobe of the brain to structures that are found deep in the brain, e.g. thalamus, or from the deep structures of the brain to another region in the central nervous system.

Research has determined that touching one side of the brain sends electrical signals to the other side of the body. Touching the motor region on the right side of the brain would cause the opposite side or the left side of the body to move. Stimulating the left primary motor cortex would cause the right side of the body to move. The messages for movement and sensation cross to the other side of the brain and cause the opposite limb to move or feel a sensation. The right side of the brain controls the left side of the body and vice versa. So if a brain tumor occurs on the right side of the brain that controls the movement of the arm, the left arm may be weak or paralyzed.

Cranial Nerves

There are 12 pairs of nerves that originate from the brain itself. These nerves are responsible for very specific activities and are named and numbered as follows:

1. Olfactory: Smell
2. Optic: Visual fields and ability to see
3. Oculomotor: Eye movements; eyelid opening
4. Trochlear: Eye movements
5. Trigeminal: Facial sensation
6. Abducens: Eye movements
7. Facial: Eyelid closing; facial expression; taste sensation
8. Auditory/vestibular: Hearing; sense of balance
9. Glossopharyngeal: Taste sensation; swallowing
10. Vagus: Swallowing; taste sensation
11. Accessory: Control of neck and shoulder muscles
12. Hypoglossal: Tongue movement

Hypothalamus

The hypothalamus is a small structure that contains nerve connections that send messages to the pituitary gland. The hypothalamus handles information that comes from the autonomic nervous system. It plays a role in controlling functions such as eating, sexual behavior and sleeping; and regulates body temperature, emotions, secretion of hormones and movement. The pituitary gland develops from an extension of the hypothalamus downwards and from a second component extending upward from the roof of the mouth.

The Lobes

Frontal Lobes

The frontal lobes are the largest of the four lobes responsible for many different functions. These include motor skills such as voluntary movement, speech, intellectual and behavioral functions. The areas that produce movement in parts of the body are found in the primary motor cortex or precentral gyrus. The prefrontal cortex plays an important part in memory, intelligence, concentration, temper and personality.

The premotor cortex is a region found beside the primary motor cortex. It guides eye and head movements and a person’s sense of orientation. Broca’s area, important in language production, is found in the frontal lobe, usually on the left side.

Occipital Lobes

These lobes are located at the back of the brain and enable humans to receive and process visual information. They influence how humans process colors and shapes. The occipital lobe on the right interprets visual signals from the left visual space, while the left occipital lobe performs the same function for the right visual space.

Parietal Lobes

These lobes interpret simultaneously, signals received from other areas of the brain such as vision, hearing, motor, sensory and memory. A person’s memory, and the new sensory information received, give meaning to objects.

Temporal Lobes

These lobes are located on each side of the brain at about ear level, and can be divided into two parts. One part is on the bottom (ventral) of each hemisphere, and the other part is on the side (lateral) of each hemisphere. An area on the right side is involved in visual memory and helps humans recognize objects and peoples’ faces. An area on the left side is involved in verbal memory and helps humans remember and understand language. The rear of the temporal lobe enables humans to interpret other people’s emotions and reactions.

Limbic System

This system is involved in emotions. Included in this system are the hypothalamus, part of the thalamus, amygdala (active in producing aggressive behavior) and hippocampus (plays a role in the ability to remember new information).

Pineal Gland

This gland is an outgrowth from the posterior or back portion of the third ventricle. In some mammals, it controls the response to darkness and light. In humans, it has some role in sexual maturation, although the exact function of the pineal gland in humans is unclear.

Pituitary Gland

The pituitary is a small gland attached to the base of the brain (behind the nose) in an area called the pituitary fossa or sella turcica. The pituitary is often called the “master gland” because it controls the secretion of hormones. The pituitary is responsible for controlling and coordinating the following:

• Growth and development
• The function of various body organs (i.e. kidneys, breasts and uterus)
• The function of other glands (i.e. thyroid, gonads, and adrenal glands)

Posterior Fossa

This is a cavity in the back part of the skull which contains the cerebellum, brainstem and cranial nerves 5-12.

Thalamus

The thalamus serves as a relay station for almost all information that comes and goes to the cortex. It plays a role in pain sensation, attention and alertness. It consists of four parts: the hypothalamus, the epythalamus, the ventral thalamus and the dorsal thalamus. The basal ganglia are clusters of nerve cells surrounding the thalamus.

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In humans, the spinal cord begins at the occipital bone, passing through the foramen magnum and entering the spinal canal at the beginning of the cervical vertebrae. The spinal cord extends down to between the first and second lumbar vertebrae, where it ends. The enclosing bony vertebral column protects the relatively shorter spinal cord. It is around 45 cm (18 in) in men and around 43 cm (17 in) long in women. The diameter of the spinal cord ranges from 13 mm (1⁄2 in) in the cervical and lumbar regions to 6.4 mm (1⁄4 in) in the thoracic area.

The spinal cord functions primarily in the transmission of nerve signals from the motor cortex to the body, and from the afferent fibers of the sensory neurons to the sensory cortex. It is also a center for coordinating many reflexes and contains reflex arcs that can independently control reflexes.

It is also the location of groups of spinal interneurons that make up the neural circuits known as central pattern generators. These circuits are responsible for controlling motor instructions for rhythmic movements such as walking.

Anatomical Position and Structure

The spinal cord is a cylindrical structure, greyish-white in colour. It has a relatively simple anatomical course:

• The spinal cord arises cranially as a continuation of the medulla oblongata (part of the brainstem).
• It then travels inferiorly within the vertebral canal, surrounded by the spinal meninges containing cerebrospinal fluid.
• At the L2 vertebral level the spinal cord tapers off, forming the conus medullaris.

As a result of the termination of the spinal cord at L2, it occupies around two thirds of the vertebral canal. The spinal nerves that arise from the end of the spinal cord are bundled together, forming a structure known as the cauda equina.

During the course of the spinal cord, there are two points of enlargement. The cervical enlargement is located proximally, at the C4-T1 level. It represents the origin of the brachial plexus. Between T11 and L1 is the lumbar enlargement, representing the origin of the lumbar and sacral plexi.

The spinal cord is marked by two depressions on its surface. The anterior median fissure is a deep groove extending the length of the anterior surface of the spinal cord. On the posterior aspect there is a slightly shallower depression – the posterior median sulcus.

Spinal Meninges

The spinal meninges are three membranes that surround the spinal cord – the dura mater, arachnoid mater, and pia mater. They contain cerebrospinal fluid, acting to support and protect the spinal cord. They are analogous with the cranial meninges.

Distally, the meninges form a strand of fibrous tissue, the filum terminale, which attaches to the vertebral bodies of the coccyx. It acts as an anchor for the spinal cord and meninges.

Dura Mater

The spinal dura mater is the most external of the meninges. It extends from the foramen magnum to the filum terminale, separated from the walls of the vertebral canal by the epidural space. This space contains some loose connective tissue, and the internal vertebral venous plexus.

As the spinal nerves exit the vertebral canal, they pierce the dura mater, temporarily passing in the epidural space. In doing so, the dura mater surrounds the nerve root, and fuses with the outer connective tissue covering of the nerve, the epineurium.

The spinal arachnoid mater is a delicate membrane, located between the dura mater and the pia mater. It is separated from the latter by the subarachnoid space, which contains cerebrospinal fluid.

Distal to the conus medullaris, the subarachnoid space expands, forming the lumbar cistern. This space accessed during a lumbar puncture (to obtain CSF fluid) and spinal anaesthesia.

Pia Mater

The spinal pia mater is the innermost of the meninges. It is a thin membrane that covers the spinal cord, nerve roots and their blood vessels. Inferiorly, the spinal pia mater fuses with the filum terminale.

Between the nerve roots, the pia mater thickens to form the denticulate ligaments. These ligaments attach to the dura mater – suspending the spinal cord in the vertebral canal.

Formation of the Spinal Nerves

The spinal nerves are mixed nerves that originate from the spinal cord, forming the peripheral nervous system.

Each spinal nerve begins as an anterior (motor) and a posterior (sensory) nerve root. These roots arise from the spinal cord, and unite at the intervertebral foramina, forming a single spinal nerve.

The spinal nerve then leaves the vertebral canal via the intervertebral foramina, and then divides into two:

• Posterior rami – supplies nerve fibres to the synovial joints of the vertebral column, deep muscles of the back, and the overlying skin.
• Anterior rami – supplies nerve fibres to much of the remaining area of the body, both motor and sensory.

The nerve roots L2-S5 arise from the distal end of the spinal cord, forming a bundle of nerves known as the cauda equina.

Vasculature

The arterial supply to the spinal cord is via three longitudinal arteries – the anterior spinal artery and the paired posterior spinal arteries.

• Anterior spinal artery – formed from branches of the vertebral arteries. They travel in the anterior median fissure.
• Posterior spinal arteries – originate from the vertebral artery or the posteroinferior cerebellar artery. They anastamose with one another in the pia mater.

Additional arterial supply is via the anterior and posterior segmental medullary arteries – small vessels which enter via the nerve roots. The largest anterior segmental medullary artery is the artery of Adamkiewicz. It arises from the inferior intercostal or upper lumbar arteries, and supplies the inferior 2/3 of the spinal cord.

Venous drainage is via three anterior and three posterior spinal veins. These veins are valveless, and form an anastamosing network along the surface of the spinal cord. They also receive venous blood from the radicular veins. The spinal veins drain into the internal and external vertebral plexuses, which in turn empty into the systemic segmental veins. The internal vertebral plexus also empties into the dural venous sinuses superiorly.

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The peripheral nervous system refers to parts of the nervous system outside the brain and spinal cord. It includes the cranial nerves, spinal nerves and their roots and branches, peripheral nerves, and neuromuscular junctions.

Structure

Each nerve is covered on the outside by a dense sheath of connective tissue, the epineurium. Beneath this is a layer of fat cells, the perineurium, which forms a complete sleeve around a bundle of axons. Perineurial septae extend into the nerve and subdivide it into several bundles of fibres. Surrounding each such fibre is the endoneurium. This forms an unbroken tube from the surface of the spinal cord to the level where the axon synapses with its muscle fibres, or ends in sensory receptors. The endoneurium consists of an inner sleeve of material called the glycocalyx and an outer, delicate, meshwork of collagen fibres. Nerves are bundled and often travel along with blood vessels, since the neurons of a nerve have fairly high energy requirements.

Within the endoneurium, the individual nerve fibres are surrounded by a low-protein liquid called endoneurial fluid. This acts in a similar way to the cerebrospinal fluid in the central nervous system and constitutes a blood-nerve barrier similar to the blood-brain barrier. Molecules are thereby prevented from crossing the blood into the endoneurial fluid. During the development of nerve edema from nerve irritation (or injury), the amount of endoneurial fluid may increase at the site of irritation. This increase in fluid can be visualized using magnetic resonance neurography, and thus MR neurography can identify nerve irritation and/or injury.

Afferent, Efferent, and Mixed Nerves

Some of the nerves in the body are specialized for carrying information in only one direction, similar to a one-way street. Nerves that carry information from sensory receptors to the central nervous system only are called afferent nerves. Other neurons, known as efferent nerves, carry signals only from the central nervous system to effectors such as muscles and glands. Finally, some nerves are mixed nerves that contain both afferent and efferent axons. Mixed nerves function like 2-way streets where afferent axons act as lanes heading toward the central nervous system and efferent axons act as lanes heading away from the central nervous system.

Cranial Nerves

Extending from the inferior side of the brain are 12 pairs of cranial nerves. Each cranial nerve pair is identified by a Roman numeral 1 to 12 based upon its location along the anterior-posterior axis of the brain. Each nerve also has a descriptive name (e.g. olfactory, optic, etc.) that identifies its function or location. The cranial nerves provide a direct connection to the brain for the special sense organs, muscles of the head, neck, and shoulders, the heart, and the GI tract.

Spinal Nerves

Extending from the left and right sides of the spinal cord are 31 pairs of spinal nerves. The spinal nerves are mixed nerves that carry both sensory and motor signals between the spinal cord and specific regions of the body. The 31 spinal nerves are split into 5 groups named for the 5 regions of the vertebral column. Thus, there are 8 pairs of cervical nerves, 12 pairs of thoracic nerves, 5 pairs of lumbar nerves, 5 pairs of sacral nerves, and 1 pair of coccygeal nerves. Each spinal nerve exits from the spinal cord through the intervertebral foramen between a pair of vertebrae or between the C1 vertebra and the occipital bone of the skull.

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Similar to the eyes of other mammals, the human eye’s non-image-forming photosensitive ganglion cells in the retina receive light signals which affect adjustment of the size of the pupil, regulation and suppression of the hormone melatonin and entrainment of the body clock.

External (Extraocular) Anatomy

Extraocular Muscles

There are six muscles that are present in the orbit (eye socket) that attach to the eye to move it. These muscles work to move the eye up, down, side to side, and rotate the eye.

The superior rectus is an extraocular muscle that attaches to the top of the eye. It moves the eye upward. The inferior rectus is an extraocular muscle that attaches to the bottom of the eye. It moves the eye downward. The medial rectus is an extraocular muscle that attaches to the side of the eye near the nose. It moves the eye inward toward the nose. The lateral rectus is an extraocular muscle that attaches to the side of the eye near the temple. It moves the eye outward.

The superior oblique is an extraocular muscle that comes from the back of the orbit. It travels through a small pulley (the trochlea) in the orbit near the nose and then attaches to the top of the eye. The superior oblique rotates the eye inward around the long axis of the eye (front to back). The superior oblique also moves the eye downward.

The inferior oblique is an extraocular muscle that arises in the front of the orbit near the nose. It then travels outward and backward in the orbit before attaching to the bottom part of the eyeball. It rotates the eye outward along the long axis of the eye (front to back). The inferior oblique also moves the eye upward.

Conjunctiva

The conjunctiva is a transparent mucous membrane that covers the inner surface of the eyelids and the surface of the eye. When it is inflamed or infected it becomes red or pink. This is called conjunctivitis or “pink eye”.

Lacrimal gland

The lacrimal gland produces tears that lubricate the eye. It is located under the lateral edge of the eyebrow in the orbit.

Tenon’s Cpsule

Tenon’s capsule is a layer of tissue that lies between the conjunctiva and the surface of the eye.

Sclera

The sclera is the white outer wall of the eye. It covers nearly the entire surface of the eyeball. It is a strong layer made of collagen fibers. The tendons of the six extraocular muscles attach to the sclera.

Cornea

The cornea occupies the front center part of the outer wall of the eye. It is made of collagen fibers in a very special arrangement so that the cornea is clear. One looks through the cornea to see the iris and pupil. The cornea bends light coming into the eye so that it is focused on the retina. The cornea is the part of the eye on which contact lenses are placed.

Internal (Intraocular)Anatomy

Anterior Chamber

The anterior chamber is a fluid (aqueous humor) filled space inside the eye. The cornea lies in front of the anterior chamber, and the iris and the pupil are behind it.

Iris/Pupil

The iris is the colored part of the eye. It is disc shaped with a hole in the middle (the pupil). Muscles in the iris cause the pupil to constrict in bright light and to dilate in dim light. The change in pupil size regulates the amount of light that reaches the posterior (back) part of the eye.

Lens

The lens of the eye is located directly behind the pupil. The lens bends light coming into the eye to help focus it on the retina. It changes shape to help the eye focus to see objects clearly at near. The lens is suspended from the wall of the eye by many small fibers (zonules) that attach to its capsule.

Ciliary Body

The ciliary body is attached to the outer edge of the iris near the wall of the eye. The ciliary body produces the fluid (aqueous humor) that fills the eye and nourishes its structures. It also helps to change the shape of the lens when focusing occurs.

Vitreous Cavity

The vitreous cavity lies between the lens and the retina and fills 4/5 of the space inside the back part of the eye. A gelatinous substance known as the vitreous humor fills the cavity. This plays an important role in nourishing the inner structures of the eye. Light comes into the eye through the pupil and passes through the vitreous to be projected on the retina.

Retina

The retina is a thin, transparent structure that covers the inner wall of the eye. The eye works like a camera, and the retina is similar to the film in the camera. It is where images are first projected before they are transmitted through the optic nerve to the brain. It is a very complex structure with 10 layers of specialized cells including the photoreceptor cells (rods and cones).

Photoreceptors

Photoreceptors are highly specialized cells of the retina that receive light impulses and change them into chemical energy that can be transmitted by nerve cells to the brain. The two types of photoreceptors are rods and cones. Rods perceive black and white and serve night vision primarily. Cones are responsible for color perception and central vision.

Macula

The macula is a small, specialized area of the retina that has very high sensitivity and is responsible for central vision.

Retinal Pigment Epithelium (RPE)

The retinal pigment epithelium is a layer of cells deep in the retina. This single layer of cells helps maintain the function of the photoreceptor cells in the retina by processing vitamin A products, turning over used photoreceptor segments, absorbing light, and transporting nutrients in and out of the photoreceptor cells.

Choroid

The choroid is a tissue layer that lies between the retina and the sclera. The choroid has a rich supply of blood vessels that nourish the retina.

Uveal tract

The uveal tract is a pigmented component of the eye that is comprised of 1) the iris, 2) the ciliary body, and 3) the choroid.

Optic nerve

The optic nerve connects each eye to the brain. It is a structure that sends the picture seen by the eye to the brain so that they can be processed. The optic nerves end in a structure called the optic chiasm. In an adult, the optic nerve is about the diameter of a pencil. There are over 1 million individual nerve cells in the optic nerve.

Optic Chiasm

The optic chiasm is the place in the brain where the two optic nerves meet. The individual nerve fibers from each nerve are sorted in the chiasm. The sorting occurs in such a way that the right side of the brain controls the view of objects in left visual space and the left side of the brain controls the view of objects in right visual space [See figure 3].

Visual Cortex

This is an area of the brain in the posterior occipital lobe to which the neurons in the retina ultimately give visual information. The visual cortex helps to process information regarding the image such as its color, composition, and relation in space to other objects. This information is then sent to other parts of the brain that serve higher visual functions.

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The mastoid bone surrounds the middle ear. The external ear collects sound waves. The ear canal carries sound waves to the eardrum. The eardrum vibrates from sound waves, setting the middle ear bones in motion. The middle ear bones (ossicles) vibrate, transmitting sound waves to the inner ear. When the ear is healthy, air pressure remains balanced in the middle ear. The eustachian tube helps control air pressure in the middle ear. The semicircular canals help maintain balance. The vestibular nerve carries balance signals to the brain. The auditory nerve carries sound signals to the brain. The cochlea picks up sound waves and makes nerve signals. 

Structure

Parts of the External Ear

The external ear can be divided functionally and structurally into two parts; the auricle (or pinna), and the external acoustic meatus – which ends at the tympanic membrane.

Auricle

The auricle is a paired structure found on either side of the head. It functions to capture and direct sound waves towards the external acoustic meatus.

It is a mostly cartilaginous structure, with the lobule being the only part not supported by cartilage. The cartilaginous part of the auricle forms an outer curvature, known as the helix. A second innermost curvature runs in parallel with the helix – the antihelix. The antihelix divides into two cura; the inferoanterior crus, and the superoposterior crus.

In the middle of the auricle is a hollow depression, called the concha. It continues into the skull as the external acoustic meatus. The concha acts to direct sound into the external acoustic meatus. Immediately anterior to the beginning of the external acoustic meatus is an elevation of cartilaginous tissue – the tragus. Opposite the tragus is the antitragus.

External Acoustic Meatus

The external acoustic meatus is a sigmoid shaped tube that extends from the deep part of the concha to the tympanic membrane. The walls of the external 1/3 are formed by cartilage, whereas the inner 2/3 are formed by the temporal bone.

The external acoustic meatus does not have a straight path, and instead travels in an S-shaped curve as follows:

• Initially it travels in a superoanterior direction.
• In then turns slightly to move superoposteriorly.
• It ends by running in an inferoanterior direction.

Tympanic Membrane

The tympanic membrane lies at the distal end of the external acoustic meatus. It is a connective tissue structure, covered with skin on the outside and a mucous membrane on the inside. The membrane is connected to the surrounding temporal bone by a fibrocartilaginous ring.

The translucency of the tympanic membrane allows the structures within the middle ear to be observed during otoscopy. On the inner surface of the membrane, the handle of malleus attaches to the tympanic membrane, at a point called the umbo of tympanic membrane.

The handle of malleus continues superiorly, and at its highest point, a small projection called the lateral process of the malleus can be seen. The parts of the tympanic membrane moving away from the lateral process are called the anterior and posterior malleolar folds.

Vasculature

The external ear is supplied by branches of the external carotid artery:

• Posterior auricular artery
• Superficial temporal artery
• Occipital artery
• Maxillary artery (deep auricular branch) – supplies the deep aspect of the external acoustic meatus and tympanic membrane only.

Venous drainage is via veins following the arteries listed above.

Innervation

The sensory innervation to the skin of the auricle comes from numerous nerves:

• Greater auricular nerve (branch of the cervical plexus) – innervates the skin of the auricle
• Lesser occipital nerve (branch of the cervical plexus) – innervates the skin of the auricle
• Auriculotemporal nerve (branch of the mandibular nerve) – innervates the skin of the auricle and external auditory meatus.
• Branches of the facial and vagus nerves – innervates the deeper aspect of the auricle and external auditory meatus

Some individuals can complain of an involuntary cough when cleaning their ears – this is due to stimulation of the auricular branch of the vagus nerve (the vagus nerve is also responsible for the cough reflex).

Parts of the Middle Ear

The middle ear can be divided into two parts:

• Tympanic cavity – located medially to the tympanic membrane. It contains three small bones known as the auditory ossicles: the malleus, incus and stapes. They transmit sound vibrations through the middle ear.
• Epitympanic recess – a space superior to the tympanic cavity, which lies next to the mastoid air cells. The malleus and incus partially extend upwards into the epitympanic recess.

Borders

The middle ear can be visualised as a rectangular box, with a roof and floor, medial and lateral walls and anterior and posterior walls.

• Roof – formed by a thin bone from the petrous part of the temporal bone. It separates the middle ear from the middle cranial fossa.
• Floor – known as the jugular wall, it consists of a thin layer of bone, which separates the middle ear from the internal jugular vein
• Lateral wall – made up of the tympanic membrane and the lateral wall of the epitympanic recess.
• Medial wall – formed by the lateral wall of the internal ear. It contains a prominent bulge, produced by the facial nerve as it travels nearby.
• Anterior wall – a thin bony plate with two openings; for the auditory tube and the tensor tympani muscle. It separates the middle ear from the internal carotid artery.
• Posterior wall (mastoid wall) – it consists of a bony partition between the tympanic cavity and the mastoid air cells.
  • Superiorly, there is a hole in this partition, allowing the two areas to communicate. This hole is known as the aditus to the mastoid antrum.

Bones

The bones of the middle ear are the auditory ossicles – the malleus, incus and stapes. They are connected in a chain-like manner, linking the tympanic membrane to the oval window of the internal ear.

Sound vibrations cause a movement in the tympanic membrane which then creates movement, or oscillation, in the auditory ossicles. This movement helps to transmit the sound waves from the tympanic membrane of external ear to the oval window of the internal ear.

The malleus is the largest and most lateral of the ear bones, attaching to the tympanic membrane, via the handle of malleus. The head of the malleus lies in the epitympanic recess, where it articulates with the next auditory ossicle, the incus.

The next bone – the incus – consists of a body and two limbs. The body articulates with the malleus, the short limb attaches to the posterior wall of the middle, and the long limb joins the last of the ossicles; the stapes.

The stapes is the smallest bone in the human body. It joins the incus to the oval window of the inner ear. It is stirrup-shaped, with a head, two limbs, and a base. The head articulates with the incus, and the base joins the oval window.

Mastoid Air Cells

The mastoid air cells are located posterior to epitympanic recess. They are a collection of air-filled spaces in the mastoid process of the temporal bone. The air cells are contained within a cavity called the mastoid antrum. The mastoid antrum communicates with the middle ear via the aditus to mastoid antrum.

The mastoid air cells act as a ‘buffer system‘ of air –  releasing air into the tympanic cavity when the pressure is too low.

Muscles

There are two muscles which serve a protective function in the middle ear; the tensor tympani and stapedius. They contract in response to loud noise, inhibiting the vibrations of the malleus, incus and stapes, and reducing the transmission of sound to the inner ear. This action is known as the acoustic reflex.

The tensor tympani originates from the auditory tube and attaches to the handle of malleus, pulling it medially when contracting. It is innervated by the tensor tympani nerve, a branch of the mandibular nerve. The stapedius muscle attaches to the stapes, and is innervated by the facial nerve.

Auditory Tube

The auditory tube (eustachian tube) is a cartilaginous and bony tube that connects the middle ear to the nasopharynx. It acts to equalise the pressure of the middle ear to that of the external auditory meatus.

It extends from the anterior wall of the middle ear, in an anterior, medioinferior direction, opening onto the lateral wall of the nasopharynx. In joining the two structures, it is a pathway by which an upper respiratory infection can spread into the middle ear.

The tube is shorter and straighter in children, therefore middle ear infections tend to be more common in children than adults.

Structure of the Inner Ear

The inner ear is located within the petrous part of the temporal bone. It lies between the middle ear and the internal acoustic meatus, which lie laterally and medially respectively. The inner ear has two main components – the bony labyrinth and membranous labyrinth.

• Bony labyrinth – consists of a series of bony cavities within the petrous part of the temporal bone. It is composed of the cochlea, vestibule and three semi-circular canals. All these structures are lined internally with periosteum and contain a fluid called perilymph.
• Membranous labyrinth – lies within the bony labyrinth. It consists of the cochlear duct, semi-circular ducts, utricle and the saccule. The membranous labyrinth is filled with fluid called endolymph.

The inner ear has two openings into the middle ear, both covered by membranes. The oval window lies between the middle ear and the vestibule, whilst the round window separates the middle ear from the scala tympani (part of the cochlear duct).

Bony Labyrinth

The bony labyrinth is a series of bony cavities within the petrous part of the temporal bone. It consists of three parts – the cochlea, vestibule and the three semi-circular canals.

Vestibule

The vestibule is the central part of the bony labyrinth. It is separated from the middle ear by the oval window, and communicates anteriorly with the cochlea and posterioly with the semi-circular canals. Two parts of the membranous labyrinth; the saccule and utricle, are located within the vestibule.

Cochlea

The cochlea houses the cochlea duct of the membranous labyrinth – the auditory part of the inner ear. It twists upon itself around a central portion of bone called the modiolus, producing a cone shape which points in an anterolateral direction. Branches from the cochlear portion of the vestibulocochlear (VIII) nerve are found at the base of the modiolus.

Extending outwards from the modiolus is a ledge of bone known as spiral lamina, which attaches to the cochlear duct, holding it in position. The presence of the cochlear duct creates two perilymph-filled chambers above and below:

• Scala vestibuli: Located superiorly to the cochlear duct. As its name suggests, it is continuous with the vestibule.
• Scala tympani: Located inferiorly to the cochlear duct. It terminates at the round window.

Semi-circular Canals

There are three semi-circular canals; anterior, lateral and posterior. They contain the semi-circular ducts, which are responsible for balance (along with the utricle and saccule).

The canals are situated superoposterior to the vestibule, at right angles to each other. They have a swelling at one end, known as the ampulla.

Membranous Labyrinth

The membranous labyrinth is a continuous system of ducts filled with endolymph. It lies within the bony labyrinth, surrounded by perilymph. It is composed of the cochlear duct, three semi-circular ducts, saccule and the utricle.

The cochlear duct is situated within the cochlea and is the organ of hearing. The semi-circular ducts, saccule and utricle are the organs of balance (also known as the vestibular apparatus).

Cochlear Duct

The cochlear duct is located within the bony scaffolding of the cochlea. It is held in place by the spiral lamina. The presence of the duct creates two canals above and below it –  the scala vestibuli and scala tympani respectively. The cochlear duct can be described as having a triangular shape:

• Lateral wall – Formed by thickened periosteum, known as the spiral ligament.
• Roof – Formed by a membrane which separates the cochlear duct from the scala vestibuli, known as the Reissner’s membrane.
• Floor – Formed by a membrane which separates the cochlear duct from the scala tympani, known as the basilar membrane.

The basilar membrane houses the epithelial cells of hearing – the Organ of Corti. A more detailed description of the Organ of Corti is beyond the scope of this article.

Saccule and Utricle

The saccule and utricle are two membranous sacs located in the vestibule. They are organs of balance which detect movement or acceleration of the head in the vertical and horizontal planes, respectively.

The utricle is the larger of the two, receiving the three semi-circular ducts. The saccule is globular in shape and receives the cochlear duct.

Endolymph drains from the saccule and utricle into the endolymphatic duct. The duct travels through the vestibular aqueduct to the posterior aspect of the petrous part of the temporal bone. Here, the duct expands to a sac where endolymph can be secreted and absorbed.

Semi-circular Ducts

The semi-circular ducts are located within the semi-circular canals, and share their orientation. Upon movement of the head, the flow of endolymph within the ducts changes speed and/or direction. Sensory receptors in the ampullae of the semi-circular canals detect this change, and send signals to the brain, allowing for the processing of balance.

Vasculature

The bony labyrinth and membranous labyrinth have different arterial supplies. The bony labyrinth receives its blood supply from three arteries, which also supply the surrounding temporal bone:

• Anterior tympanic branch (from maxillary artery).
• Petrosal branch (from middle meningeal artery).
• Stylomastoid branch (from posterior auricular artery).

The membranous labyrinth is supplied by the labyrinthine artery, a branch of the inferior cerebellar artery (or, occasionally, the basilar artery). It divides into three branches:

• Cochlear branch – supplies the cochlear duct.
• Vestibular branches (x2) – supply the vestibular apparatus.

Venous drainage of the inner ear is through the labyrinthine vein, which empties into the sigmoid sinus or inferior petrosal sinus.

Innervation

The inner ear is innervated by the vestibulocochlear nerve (CN VIII). It enters the inner ear via the internal acoustic meatus, where it divides into the vestibular nerve (responsible for balance) and the cochlear nerve (responsible for hearing):

• Vestibular nerve – enlarges to form the vestibular ganglion, which then splits into superior and inferior parts to supply the utricle, saccule and three semi-circular ducts.
• Cochlear nerve – enters at the base of the modiolus and its branches pass through the lamina to supply the receptors of the Organ of Corti.

The facial nerve, CN VII, also passes through the inner ear, but does not innervate any of the structures present.

The post The Ears appeared first on Medika Life.

The skin is a vital organ that covers the entire outside of the body, forming a protective barrier against pathogens and injuries from the environment. The skin is the body’s largest organ; covering the entire outside of the body, it is about 2 mm thick and weighs approximately six pounds. It shields the body against heat, light, injury, and infection. The skin also helps regulate body temperature, gathers sensory information from the environment, stores water, fat, and vitamin D, and plays a role in the immune system protecting us from disease.

The color, thickness and texture of skin vary over the body. There are two general types of skin; thin and hairy, which is more prevalent on the body, and thick and hairless, which is found on parts of the body that are used heavily and endure a large amount of friction, like the palms of the hands or the soles of the feet.

Basically, the skin is comprised of two layers that cover a third fatty layer. These three layers differ in function, thickness, and strength. The outer layer is called the epidermis; it is a tough protective layer that contains the melanin-producing melanocytes. The second layer (located under the epidermis) is called the dermis; it contains nerve endings, sweat glands, oil glands, and hair follicles. Under these two skin layers is a fatty layer of subcutaneous tissue, known as the subcutis or hypodermis. The skin contains many specialized cells and structures:

• Basket Cells
  Basket cells surround the base of hair follicles and can sense pressure. They are evaluated when assessing overall nerve health and condition.
• Blood Vessels
  Blood vessels carry nutrients and oxygen-rich blood to the cells that make up the layers of skin and carry away waste products.
• Hair Erector Muscle (Arrector Pili Muscle)
  The arrector pili muscle is a tiny muscle connected to each hair follicle and the skin. When it contracts it causes the hair to stand erect, and a “goosebump” forms on the skin.
• Hair Follicle
  The hair follicle is a tube-shaped sheath that surrounds the part of the hair that is under the skin and nourishes the hair. It is located in the epidermis and the dermis.
• Hair Shaft
  The hair shaft is the part of the hair that is above the skin.
• Langerhans Cells
  These cells attach themselves to antigens that invade damaged skin and alert the immune system to their presence.
• Melanocyte
  A melanocyte is a cell that produces melanin, and is located in the basal layer of the epidermis.
• Merkel Cells
  Merkel cells are tactile cells of neuroectodermal origin located in the basal layer of the epidermis.
• Pacinian Corpuscle
  A pacinian corpuscle is a nerve receptor located in the subcutaneous fatty tissue that responds to pressure and vibration.
• Sebaceous Gland
  Sebaceous glands are small, sack-shaped glands which release an oily substance onto the hair follicle that coats and protects the hair shaft from becoming brittle. These glands are located in the dermis.
• Sensory Nerves
  The epidermis is innervated with sensory nerves. These nerves sense and transmit heat, pain, and other noxious sensations. When they are not functioning properly sensations such as numbness, pins-and-needles, pain, tingling, or burning may be felt. When evaluating a skin biopsy, total number, contiguity, diameter, branching, swelling, and overall health of the sensory nerves are assessed.
• Stratum Corneum
  The stratum corneum is outermost layer of the epidermis, and is comprised of dead skin cells. It protects the living cells beneath it by providing a tough barrier between the environment and the lower layers of the skin. The stratum corneum is useful for diagnosis because in some conditions it will become thinner than normal.
• Sweat Gland (Sudoriferous Gland)
  These glands are located in the epidermis and produce moisture (sweat) that is secreted through tiny ducts onto the surface of the skin (stratum corneum). When sweat evaporates, skin temperature is lowered.

Layers of the Skin

The Epidermis

The epidermis is the outermost layer of the skin, and protects the body from the environment. The thickness of the epidermis varies in different types of skin; it is only .05 mm thick on the eyelids, and is 1.5 mm thick on the palms and the soles of the feet. The epidermis contains the melanocytes (the cells in which melanoma develops), the Langerhans’ cells (involved in the immune system in the skin), Merkel cells and sensory nerves. The epidermis layer itself is made up of five sublayers that work together to continually rebuild the surface of the skin:

The Basal Cell Layer

The basal layer is the innermost layer of the epidermis, and contains small round cells called basal cells. The basal cells continually divide, and new cells constantly push older ones up toward the surface of the skin, where they are eventually shed. The basal cell layer is also known as the stratum germinativum due to the fact that it is constantly germinating (producing) new cells.

The basal cell layer contains cells called melanocytes. Melanocytes produce the skin coloring or pigment known as melanin, which gives skin its tan or brown color and helps protect the deeper layers of the skin from the harmful effects of the sun. Sun exposure causes melanocytes to increase production of melanin in order to protect the skin from damaging ultraviolet rays, producing a suntan. Patches of melanin in the skin cause birthmarks, freckles and age spots. Melanoma develops when melanocytes undergo malignant transformation.

Merkel cells, which are tactile cells of neuroectodermal origin, are also located in the basal layer of the epidermis.

The Squamous Cell Layer

The squamous cell layer is located above the basal layer, and is also known as the stratum spinosum or “spiny layer” due to the fact that the cells are held together with spiny projections. Within this layer are the basal cells that have been pushed upward, however these maturing cells are now called squamous cells, or keratinocytes. Keratinocytes produce keratin, a tough, protective protein that makes up the majority of the structure of the skin, hair, and nails.

The squamous cell layer is the thickest layer of the epidermis, and is involved in the transfer of certain substances in and out of the body. The squamous cell layer also contains cells called Langerhans cells. These cells attach themselves to antigens that invade damaged skin and alert the immune system to their presence.

The Stratum Granulosum & the Stratum Lucidum

The keratinocytes from the squamous layer are then pushed up through two thin epidermal layers called the stratum granulosum and the stratum lucidum. As these cells move further towards the surface of the skin, they get bigger and flatter and adhere together, and then eventually become dehydrated and die. This process results in the cells fusing together into layers of tough, durable material, which continue to migrate up to the surface of the skin.

The Stratum Corneum

The stratum corneum is the outermost layer of the epidermis, and is made up of 10 to 30 thin layers of continually shedding, dead keratinocytes. The stratum corneum is also known as the “horny layer,” because its cells are toughened like an animal’s horn. As the outermost cells age and wear down, they are replaced by new layers of strong, long-wearing cells. The stratum corneum is sloughed off continually as new cells take its place, but this shedding process slows down with age. Complete cell turnover occurs every 28 to 30 days in young adults, while the same process takes 45 to 50 days in elderly adults.

The Dermis

The dermis is located beneath the epidermis and is the thickest of the three layers of the skin (1.5 to 4 mm thick), making up approximately 90 percent of the thickness of the skin. The main functions of the dermis are to regulate temperature and to supply the epidermis with nutrient-saturated blood. Much of the body’s water supply is stored within the dermis. This layer contains most of the skins’ specialized cells and structures, including:

• Blood Vessels
  The blood vessels supply nutrients and oxygen to the skin and take away cell waste and cell products. The blood vessels also transport the vitamin D produced in the skin back to the rest of the body.
• Lymph Vessels
  The lymph vessels bathe the tissues of the skin with lymph, a milky substance that contains the infection-fighting cells of the immune system. These cells work to destroy any infection or invading organisms as the lymph circulates to the lymph nodes.
• Hair Follicles
  The hair follicle is a tube-shaped sheath that surrounds the part of the hair that is under the skin and nourishes the hair.
• Sweat Glands
  The average person has about 3 million sweat glands. Sweat glands are classified according to two types:
  1. Apocrine glands are specialized sweat glands that can be found only in the armpits and pubic region. These glands secrete a milky sweat that encourages the growth of the bacteria responsible for body odor.
  2. Eccrine glands are the true sweat glands. Found over the entire body, these glands regulate body temperature by bringing water via the pores to the surface of the skin, where it evaporates and reduces skin temperature. These glands can produce up to two liters of sweat an hour, however, they secrete mostly water, which doesn’t encourage the growth of odor-producing bacteria.
• Sebaceous glands
  Sebaceous, or oil, glands, are attached to hair follicles and can be found everywhere on the body except for the palms of the hands and the soles of the feet. These glands secrete oil that helps keep the skin smooth and supple. The oil also helps keep skin waterproof and protects against an overgrowth of bacteria and fungi on the skin.
• Nerve Endings
  The dermis layer also contains pain and touch receptors that transmit sensations of pain, itch, pressure and information regarding temperature to the brain for interpretation. If necessary, shivering (involuntary contraction and relaxation of muscles) is triggered, generating body heat.
• Collagen and Elastin
  The dermis is held together by a protein called collagen, made by fibroblasts. Fibroblasts are skin cells that give the skin its strength and resilience. Collagen is a tough, insoluble protein found throughout the body in the connective tissues that hold muscles and organs in place. In the skin, collagen supports the epidermis, lending it its durability. Elastin, a similar protein, is the substance that allows the skin to spring back into place when stretched and keeps the skin flexible.

The dermis layer is made up of two sublayers:

The Papillary Layer

The upper, papillary layer, contains a thin arrangement of collagen fibers. The papillary layer supplies nutrients to select layers of the epidermis and regulates temperature. Both of these functions are accomplished with a thin, extensive vascular system that operates similarly to other vascular systems in the body. Constriction and expansion control the amount of blood that flows through the skin and dictate whether body heat is dispelled when the skin is hot or conserved when it is cold.

The Reticular Layer

The lower, reticular layer, is thicker and made of thick collagen fibers that are arranged in parallel to the surface of the skin. The reticular layer is denser than the papillary dermis, and it strengthens the skin, providing structure and elasticity. It also supports other components of the skin, such as hair follicles, sweat glands, and sebaceous glands.

The Subcutis

The subcutis is the innermost layer of the skin, and consists of a network of fat and collagen cells. The subcutis is also known as the hypodermis or subcutaneous layer, and functions as both an insulator, conserving the body’s heat, and as a shock-absorber, protecting the inner organs. It also stores fat as an energy reserve for the body. The blood vessels, nerves, lymph vessels, and hair follicles also cross through this layer. The thickness of the subcutis layer varies throughout the body and from person to person.

The post The Skin appeared first on Medika Life.

The trachea begins at the inferior end of the larynx in the base of the neck. It is located along the body’s mid line, anterior to the esophagus and just deep to the skin, so that it is possible to feel the larynx through the skin of the neck. From its origin at the larynx, the trachea extends inferiorly into the thorax posterior to the sternum.

In the thorax, the trachea ends where it splits into the left and right bronchi, which continue onward toward the lungs.

Viewed in cross section, the trachea is about one inch (2.6 cm) in diameter. It has a thin, membranous wall with C-shaped rings of cartilage embedded into it. Between sixteen and twenty cartilage rings are stacked along the length of the trachea, with narrow membranous regions spaced between the cartilage rings. The open ends of the cartilage rings face the posterior of the trachea near the esophagus.

Four layers of tissues make up the walls of the trachea:

• The mucosa is the innermost layer and consists of ciliated pseudostratified columnar epithelium with many goblet cells. Goblet cells produce sticky mucus to coat the inner lining of the trachea and catch any debris present in inhaled air before it reaches the lungs. On the surface of the columnar cells, long, hair-like cilia beat together to push mucous away from the lungs like a microscopic conveyor belt. Mucus from the trachea, along with any trapped contaminants, makes its way to the larynx, where it is either expelled during coughing or swallowed and digested in the stomach.
• Deep to the mucosa is the submucosa layer, which is made of areolar connective tissue containing blood vessels and nervous tissue. Many collagen, elastin and reticular protein fibers give soft support and elasticity to the wall of the trachea, while blood vessels and nerves support the other layers of the tracheal wall. Longitudinal smooth muscle fibers are present in the posterior trachea between the ends of the cartilage rings. This smooth muscle tissue allows the trachea to adjust its diameter as needed.
• Surrounding the submucosa is a layer of hyaline cartilage that forms the supportive rings of the trachea. Hyaline provides a strong, yet flexible structure that maintains an open airway and is resistant to external stresses.
• The outermost layer of the trachea is the adventitia, a layer of areolar connective tissue that loosely anchors the trachea to the surrounding soft tissues.

While the trachea plays a vital role as a passive air passageway, it also performs several other important functions as well. The trachealis muscle in the posterior wall allows the trachea to contract and reduce its diameter, which makes coughs more forceful and productive. During the process of swallowing food, the esophagus expands into the space normally occupied by the trachea. The incomplete cartilage rings of the trachea allow it to narrow and permit the esophagus to expand into its space. Finally, the loose connection of the adventitia allows the trachea to move within the neck and thorax, aiding the lungs in their expansion and contraction during breathing.

The post The Trachea or Windpipe appeared first on Medika Life.

It is encased in a weak outer connective tissue capsule which allows for protection and also the expansion of the organ and is subdivided into many smaller internal sections termed lobules. The spleen has an anterior and posterior segment and rests on the upper pole of the left kidney and tail of the pancreas. The spleen has 3 distinct borders: superior, inferior, and intermediate. The superior border of the spleen has a notch on the anterior end.

The spleen has 2 surfaces, the visceral and diaphragmatic. The latter surface is convex and smooth, whereas the former surface is concave and irregular with several imprints. The most concave imprint on the spleen is a resultant of the fundus of the stomach. The left kidney leaves an imprint on the intermediate and inferior borders. The colic imprint is from the splenic flexure of the colon.

The tail of the pancreas leaves an impression between the hilum and colic impression sites. The splenic hilum is found on the inferomedial aspect of the gastric imprint. The splenic hilum contains nerves, splenic vessels, and also contains attachments for the splenorenal and gastrosplenic ligaments. It is roughly the size of an individual’s fist, measuring about 10 cm to 12 cm (about 3.94 to 4.72 in) and weighing about 150 g to 200 g (about 5.29 oz to 7.05 oz).

Structure and Function

The spleen has several functions, including the filtering of blood, removing microbes and inadequate red blood cells (RBCs), producing white blood cells (WBCs), and antibody synthesis. It is important to note, that while the spleen does have a wide range of functions, it is not a vital organ. Individuals can survive without a spleen as other organs of the body, such as the liver, can adapt in its absence to serve just about the same functions.

The spleen consists of 2 different tissue types, termed white pulp and red pulp, with each tissue type serving unique functions. White pulp is composed of periarteriolar lymphoid sheaths (PALS) and lymphatic nodules. The white pulp tissue is involved with the production and maturity of WBCs, particularly lymphocytes (types B and T) and thereby the production of antibodies. The red pulp is composed of splenic sinusoids (wide blood vessels) and cords/threads of connective tissue. The red pulp tissue is involved more so with the filtering aspect of the blood. The red pulp removes old, damaged, and/or useless red blood cells. Contained within the red pulp are also WBCs, particularly phagocytes (macrophages in particular) which destroy microorganisms such as viruses, bacteria, and fungi.

The red pulp also acts as a storage area for WBCs and platelets, which are typically released to injury sites to aid in healing and inflammation regulation or to assist in blood loss compensation. The white and red pulp regions are separated by a border known as the marginal zone which functions as a filter, filtering pathogens out of the blood and into the white pulp.   

Embryology

Mesenchymal cells are the source from which the spleen is derived from, which are located between the tiers of the dorsal mesogastrium as early as the fifth and sixth weeks of fetal development. The characteristic shape of the spleen is something which occurs early in the fetal period. The rotation of the stomach during embryonic development causes the left mesogastrium surface fusion with the peritoneum above the left kidney and the resultant dorsal attachment of the lienorenal ligament. The yolk sac wall and near dorsal aorta are the sources of the cells needed for the hemopoietic function of the spleen. By the second trimester, the spleen is capable of both RBC and WBC generation.

Blood Supply and Lymphatics

As previously mentioned, the spleen is an organ of high vascularity. The splenic artery primarily supplies the organ arterially, entering the splenic hilum near the middle of the visceral surface. The splenic artery branches off of the celiac trunk and runs within the splenorenal ligament, lateral and across the superior pancreatic aspect. Upon approaching the spleen, the splenic artery divides into 5 branches which supply blood to different regions of the organ.

The result of this is vascular segmentation of the spleen as the 5 sub-branches do not anastomose. The splenic vein allows for the venous drainage of the spleen. It also runs from the hilum and runs posteriorly to the pancreas and later joins with the superior mesenteric vein to constitute the portal vein. The spleen is a major organ of the lymphatic system, and as such contains lymphatic vessels not necessarily in proper splenic tissue, but rather some arisen from the capsule region.

However, the lymphatic vessels of the spleen are solely efferent lymphatic vessels, with the spleen acting analogously to a large lymph node supplying lymph material to neighboring nodes such as the pancreaticosplenic lymph nodes.

The post The Spleen appeared first on Medika Life.

Structure

The ovaries are covered on the outside by a layer of simple cuboidal epithelium called germinal (ovarian) epithelium. This is actually the visceral peritoneum that envelops the ovaries. Underneath this layer is a dense connective tissue capsule, the tunica albuginea. The substance of the ovaries is distinctly divided into an outer cortex and an inner medulla. The cortex appears more dense and granular due to the presence of numerous ovarian follicles in various stages of development. Each of the follicles contains an oocyte, a female germ cell. The medulla is a loose connective tissue with abundant blood vessels, lymphatic vessels, and nerve fibers.

Oogenesis

Female sex cells, or gametes, develop in the ovaries by a form of meiosis called oogenesis. The sequence of events in oogenesis is similar to the sequence in spermatogenesis, but the timing and final result are different. Early in fetal development, primitive germ cells in the ovaries differentiate into oogonia. These divide rapidly to form thousands of cells, still called oogonia, which have a full complement of 46 (23 pairs) chromosomes. Oogonia then enter a growth phase, enlarge, and become primary oocytes. The diploid (46 chromosomes) primary oocytes replicate their DNA and begin the first meiotic division, but the process stops in prophase and the cells remain in this suspended state until puberty.

Many of the primary oocytes degenerate before birth, but even with this decline, the two ovaries together contain approximately 700,000 oocytes at birth. This is the lifetime supply, and no more will develop. This is quite different than the male in which spermatogonia and primary spermatocytes continue to be produced throughout the reproductive lifetime. By puberty the number of primary oocytes has further declined to about 400,000.

Beginning at puberty, under the influence of follicle-stimulating hormone, several primary oocytes start to grow again each month. One of the primary oocytes seems to outgrow the others and it resumes meiosis I. The other cells degenerate. The large cell undergoes an unequal division so that nearly all the cytoplasm, organelles, and half the chromosomes go to one cell, which becomes a secondary oocyte. The remaining half of the chromosomes go to a smaller cell called the first polar body. The secondary oocyte begins the second meiotic division, but the process stops in metaphase. At this point ovulation occurs. If fertilization occurs, meiosis II continues. Again this is an unequal division with all of the cytoplasm going to the ovum, which has 23 single-stranded chromosome. The smaller cell from this division is a second polar body.

The first polar body also usually divides in meiosis I to produce two even smaller polar bodies. If fertilization does not occur, the second meiotic division is never completed and the secondary oocyte degenerates. Here again there are obvious differences between the male and female. In spermatogenesis, four functional sperm develop from each primary spermatocyte. In oogenesis, only one functional fertilizable cell develops from a primary oocyte. The other three cells are polar bodies and they degenerate.

Ovarian Follicle Development

An ovarian follicle consists of a developing oocyte surrounded by one or more layers of cells called follicular cells. At the same time that the oocyte is progressing through meiosis, corresponding changes are taking place in the follicular cells. Primordial follicles, which consist of a primary oocyte surrounded by a single layer of flattened cells, develop in the fetus and are the stage that is present in the ovaries at birth and throughout childhood.

Beginning at puberty, follicle-stimulating hormone stimulates changes in the primordial follicles. The follicular cells become cuboidal, the primary oocyte enlarges, and it is now a primary follicle. The follicles continue to grow under the influence of follicle-stimulating hormone, and the follicular cells proliferate to form several layers of granulose cells around the primary oocyte. Most of these primary follicles degenerate along with the primary oocytes within them, but usually one continues to develop each month. The granulosa cells start secreting estrogen and a cavity, or antrum, forms within the follicle. When the antrum starts to develop, the follicle becomes a secondary follicle. The granulose cells also secrete a glycoprotein substance that forms a clear membrane, the zona pellucida, around the oocyte. After about 10 days of growth the follicle is a mature vesicular (graafian) follicle, which forms a “blister” on the surface of the ovary and contains a secondary oocyte ready for ovulation.

Ovulation

Ovulation, prompted by luteinizing hormone from the anterior pituitary, occurs when the mature follicle at the surface of the ovary ruptures and releases the secondary oocyte into the peritoneal cavity. The ovulated secondary oocyte, ready for fertilization is still surrounded by the zona pellucida and a few layers of cells called the corona radiata. If it is not fertilized, the secondary oocyte degenerates in a couple of days. If a sperm passes through the corona radiata and zona pellucida and enters the cytoplasm of the secondary oocyte, the second meiotic division resumes to form a polar body and a mature ovum

After ovulation and in response to luteinizing hormone, the portion of the follicle that remains in the ovary enlarges and is transformed into a corpus luteum. The corpus luteum is a glandular structure that secretes progesterone and some estrogen. Its fate depends on whether fertilization occurs. If fertilization does not take place, the corpus luteum remains functional for about 10 days; then it begins to degenerate into a corpus albicans, which is primarily scar tissue, and its hormone output ceases. If fertilization occurs, the corpus luteum persists and continues its hormone functions until the placenta develops sufficiently to secrete the necessary hormones. Again, the corpus luteum ultimately degenerates into corpus albicans, but it remains functional for a longer period of time.

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The thymus is made up of immature T cells called thymocytes, as well as lining cells called epithelial cells which help the thymocytes develop. T cells that successfully develop react appropriately with MHC immune receptors of the body (called positive selection,) and not against proteins of the body, (called negative selection).

The thymus is largest and most active during the neonatal and pre-adolescent periods. By the early teens, the thymus begins to decrease in size and activity and the tissue of the thymus is gradually replaced by fatty tissue. Nevertheless, some T cell development continues throughout adult life.

Structure

The thymus is an organ that sits beneath the sternum in the upper front part of the chest, stretching upwards towards the neck. In children, the thymus is pinkish-gray, soft, and lobulated on its surfaces. At birth it is about 4–6 cm long, 2.5–5 cm wide, and about 1 cm thick. It increases in size until puberty, where it may have a size of about 40–50 g, following which it decreases in size in a process known as involution.

The thymus is made up of two lobes that meet in the upper midline, and stretch from below the thyroid in the neck to as low as the cartilage of the fourth rib. The lobes are covered by a capsule. The thymus lies beneath the sternum, rests on the pericardium, and is separated from the  aortic arch and great vessels by a layer of fascia. The left brachiocephalic vein may even be embedded within the thymus. In the neck, it lies on the front and sides of the trachea, behind the sternohyoid and sternothyroid muscles

Functions of the Thymus

T cell maturation

The thymus facilitates the maturation of T cells, an important part of the immune system providing cell-mediated immunity. T cells begin as hematopoietic precursors from the bone-marrow, and migrate to the thymus, where they are referred to as thymocytes. In the thymus they undergo a process of maturation, which involves ensuring the cells react against antigens (“positive selection”), but that they do not react against antigens found on body tissue (“negative selection”). Once mature, T cells emigrate from the thymus to provide vital functions in the immune system.

Each T cell has a distinct T cell receptor, suited to a specific substance, called an antigen. Most T cell receptors bind to the major histocompatibility complex on cells of the body. The MHC presents an antigen to the T cell receptor, which becomes active if this matches the specific T cell receptor. In order to be properly functional, a mature T cell needs to be able to bind to the MHC molecule (“positive selection”), and not to react against antigens that are actually from the tissues of body (“negative selection”).

Positive selection occurs in the cortex and negative selection occurs in the medulla of the thymus. After this process T cells that have survived leave the thymus, regulated by sphingosine-1-phosphate. Further maturation occurs in the peripheral circulation. Some of this is because of hormones and cytokines secreted by cells within the thymus, including thymulin, thymopoietin, and thymosins.

Positive selection

T cells have distinct T cell receptors. These distinct receptors are formed by process of V(D)J recombination gene rearrangement stimulated by RAG1 and RAG2 genes. This process is error-prone, and some thymocytes fail to make functional T-cell receptors, whereas other thymocytes make T-cell receptors that are autoreactive. If a functional T cell receptor is formed, the thymocyte will begin to express simultaneously the cell surface proteins CD4 and CD8.

The survival and nature of the T cell then depends on its interaction with surrounding thymic epithelial cells. Here, the T cell receptor interacts with the MHC molecules on the surface of epithelial cells. A T cell with a receptor that doesn’t react, or reacts weakly will die by apoptosis. A T cell that does react will survive and proliferate. A mature T cell expresses only CD4 or CD8, but not both. This depends on the strength of binding between the TCR and MHC class 1 or class 2. A T cell receptor that binds mostly to MHC class I tends to produce a mature “cytotoxic” CD8 positive T cell; a T cell receptor that binds mostly to MHC class II tends to produces a CD4 positive T cell.

Negative selection

T cells that attack the body’s own proteins are eliminated in the thymus, called “negative selection”. Epithelial cells in the medulla and dendritic cells in the thymus express major proteins from elsewhere in the body. The gene that stimulates this is AIRE. Thymocytes that react strongly to self antigens do not survive, and die by apoptosis. Some CD4 positive T cells exposed to self antigens persist as T regulatory cells

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