ANATOMY & ANATOMY & PHYSIOLOGY IIPHYSIOLOGY II

HS 130HS 130Dawn Duran, PT, MHS, CSCSDawn Duran, PT, MHS, CSCS

Adjunct ProfessorAdjunct Professor

Kaplan UniversityKaplan University

First SeminarFirst Seminar Welcome! I’m Dawn. Welcome! I’m Dawn. I’m your instructor for I’m your instructor for

A&P II.A&P II. I am a physical therapist I am a physical therapist

who is also a Certified who is also a Certified Strength & Conditioning Strength & Conditioning Specialist and Stott Specialist and Stott Pilates Instructor.Pilates Instructor.

I currently live in El I currently live in El Paso, TX where my husband Paso, TX where my husband is a soldier stationed at is a soldier stationed at Fort Bliss. Fort Bliss.

I have been married for I have been married for more than 10 years. more than 10 years. We have a son, Gabriel, We have a son, Gabriel,

who is nearly 4 years oldwho is nearly 4 years old And a baby boy, Lucas, And a baby boy, Lucas,

who is nearly 11 months who is nearly 11 months oldold

First SeminarFirst Seminar

Don’t be nervous!Don’t be nervous! I am here to help and will do I am here to help and will do my best to answer any questions my best to answer any questions that you may have.that you may have.

COMMUNICATIONCOMMUNICATION Communication is very important!!!Communication is very important!!! My email is DDuran@kaplan.eduMy email is DDuran@kaplan.edu Email anytime! I truly want to help you to Email anytime! I truly want to help you to succeed in this course, and I try to check my succeed in this course, and I try to check my email several times daily to respond to your email several times daily to respond to your questions and concerns. I am usually very questions and concerns. I am usually very focused on responding to you QUICKLY while focused on responding to you QUICKLY while attending to my kiddos though and as a result attending to my kiddos though and as a result my tone comes across as abrupt at times. my tone comes across as abrupt at times. PLEASE communicate with me if you find my PLEASE communicate with me if you find my response to be rude as this is NEVER my response to be rude as this is NEVER my intention. I am merely attempting to respond intention. I am merely attempting to respond as quickly as possible and I keep my writing as quickly as possible and I keep my writing style in emails “to the point.”style in emails “to the point.”

Course DesignCourse Design I designed the course in a format that highlights the I designed the course in a format that highlights the

critical information to succeed on your exams. critical information to succeed on your exams. It is not my style to trick or mislead you in anyway. It is not my style to trick or mislead you in anyway.

While many people might critique the format of my class While many people might critique the format of my class as too easy, I designed it in a format that I desired as too easy, I designed it in a format that I desired when I was a student. I believe that it is my when I was a student. I believe that it is my responsibility to cover ANYTHING that you will see on a responsibility to cover ANYTHING that you will see on a test, hence my power points emphasize that information. test, hence my power points emphasize that information. However, I still want to challenge you to your best, However, I still want to challenge you to your best, so a balance must be found. so a balance must be found.

While all of the information in this course is While all of the information in this course is important, I find that it can be overwhelming when we important, I find that it can be overwhelming when we cover so much in such a short time frame. cover so much in such a short time frame.

This is why you will note info in my presentation that This is why you will note info in my presentation that is is bold andbold and italicizeditalicized. . When you see information in When you see information in this format you should pay close attention as you WILL this format you should pay close attention as you WILL see it again somewhere:)see it again somewhere:)

A Little Business…A Little Business… Tips for SuccessTips for Success Syllabus ReviewSyllabus Review DB Guidelines and examplesDB Guidelines and examples Proper document labels and their Proper document labels and their importanceimportance Acceptable:Acceptable:

DuranD-Unit2option2.docDuranD-Unit2option2.doc Dduran-Unit2seminar.docDduran-Unit2seminar.doc Duran-Unit2.docDuran-Unit2.doc

Unacceptable:Unacceptable: Unit2option2.docUnit2option2.doc My Assignment.docMy Assignment.doc Fantastic Voyage.docFantastic Voyage.doc

SUMMARYSUMMARY

I can’t WAIT to get to know I can’t WAIT to get to know each of you!each of you!

Where can you reach me?Where can you reach me? Email: DDuranEmail: DDuran@kaplan@kaplan..eduedu

Let’s get started on this Let’s get started on this adventure!adventure!

Unit 1 Unit 1 (Chapter 11)(Chapter 11) BLOODBLOOD

Presented by Dawn Duran, Presented by Dawn Duran, PT, MHS, CSCSPT, MHS, CSCS

BloodBlood

The liquid portion of blood is called The liquid portion of blood is called plasmaplasma

The best approximation for blood in a The best approximation for blood in a typical adult is 5 Ltypical adult is 5 L Plasma makes up 2.6 LPlasma makes up 2.6 L

Blood is alkaline (pH is 7.5 to 7.45)Blood is alkaline (pH is 7.5 to 7.45) Americans donate 14 million units Americans donate 14 million units annuallyannually Donated blood can only be stored for 6 Donated blood can only be stored for 6 weeksweeks

Blood TypesBlood Types Blood types are identified by self-Blood types are identified by self-antigens located on the surface of the antigens located on the surface of the RBCRBC

These antigens are substances that the These antigens are substances that the body recognizes as foreignbody recognizes as foreign

An antigen is a substance that can An antigen is a substance that can activate the immune system to make activate the immune system to make certain responses (including the certain responses (including the production of antibodies)production of antibodies)

Antibodies are molecules in the plasma Antibodies are molecules in the plasma that destroy harmful toxinsthat destroy harmful toxins

We classify blood using the ABO systemWe classify blood using the ABO system

Blood TypesBlood Types ABO SystemABO System

Type A blood – have type A antigens in Type A blood – have type A antigens in RBCs; anti-B type antibodies in plasmaRBCs; anti-B type antibodies in plasma

Type B blood – have type B antigens in Type B blood – have type B antigens in RBCs; anti-A type antibodies in plasmaRBCs; anti-A type antibodies in plasma

Type AB blood – have type A and type B Type AB blood – have type A and type B antigens in RBCs; no anti-A or anti-B antigens in RBCs; no anti-A or anti-B antibodies in plasma antibodies in plasma

called universal recipient bloodcalled universal recipient blood Type O blood – no type A or type B Type O blood – no type A or type B antigens in RBCs; both anti-A and anti-antigens in RBCs; both anti-A and anti-B antibodies in plasmaB antibodies in plasma

Called universal donor bloodCalled universal donor blood

Blood TypesBlood Types In an emergency, the one blood type that In an emergency, the one blood type that could be used without danger of antibodies could be used without danger of antibodies clumping its red blood cells is O negative clumping its red blood cells is O negative blood (O). In other words, a person with blood (O). In other words, a person with Type A blood can receive a blood donation Type A blood can receive a blood donation from an individual with Type O blood. from an individual with Type O blood.

A person with Type A blood can receive a A person with Type A blood can receive a blood donation from an individual with blood donation from an individual with Type O blood. Type O blood.

O contains no A, B or Rh antigens so it O contains no A, B or Rh antigens so it cannot be agglutinated by anti-A, anti-B cannot be agglutinated by anti-A, anti-B or anti-Rh antibodies. or anti-Rh antibodies.

Named for Rhesus Monkey in which the Named for Rhesus Monkey in which the antigen was first foundantigen was first found

Based on presence of or absence Based on presence of or absence of Rh Factor in the bloodof Rh Factor in the blood

Surface of RBC’s contains Surface of RBC’s contains markers that the immune system markers that the immune system can recognizecan recognize

Using + or – systemUsing + or – system 85% of the world population has 85% of the world population has Rh+bloodRh+blood

Rh SystemRh System

Rh SystemRh System If a person has B negative (B–) blood, If a person has B negative (B–) blood, for example, that person is Rh-for example, that person is Rh-negative. A person with B positive negative. A person with B positive blood (B+) is Rh-positive.blood (B+) is Rh-positive.

People with Rh-positive blood can People with Rh-positive blood can receive Rh-negative blood; people with receive Rh-negative blood; people with Rh-negative blood will have a Rh-negative blood will have a transfusion reaction if they receive transfusion reaction if they receive Rh-positive blood. Rh-positive blood.

Transfusion reactions caused by Transfusion reactions caused by mismatched Rh blood types can be mismatched Rh blood types can be serious.serious.

Blood TransfusionsBlood Transfusions

All blood intended for All blood intended for transfusion is type and cross-transfusion is type and cross-matched. matched. Matched carefully to the blood of Matched carefully to the blood of the recipient for ABO and Rh the recipient for ABO and Rh compatabilitycompatability

Further cross-matched for minor Further cross-matched for minor antigens that may also cause antigens that may also cause reactionsreactions

RhoGAMRhoGAM A disease caused by Rh incompatibility is A disease caused by Rh incompatibility is erythroblastosis fetalis. erythroblastosis fetalis.

A baby born to an Rh- mother and Rh+ father A baby born to an Rh- mother and Rh+ father runs the risk of erythoblastosis fetalis.runs the risk of erythoblastosis fetalis. When a mother is Rh-, the father is Rh+ and When a mother is Rh-, the father is Rh+ and the infant is Rh+ an agglutination of the the infant is Rh+ an agglutination of the infant’s red blood cells is possible if the infant’s red blood cells is possible if the baby inherits the Rh+ trait from the father baby inherits the Rh+ trait from the father which would stimulate the mother’s blood to which would stimulate the mother’s blood to form anti-Rh antibodies. form anti-Rh antibodies.

The mother in this scenario should receive The mother in this scenario should receive an injection of the medication RhoGAM to an injection of the medication RhoGAM to avoid compatibility problems. avoid compatibility problems.

Blood PlasmaBlood Plasma Liquid fraction of whole blood Liquid fraction of whole blood minus any formed elementsminus any formed elements

It contains water as well as It contains water as well as dissolved substancesdissolved substances Food, saltsFood, salts About 3% of total oxygen About 3% of total oxygen transported in bloodtransported in blood

About 5% of total carbon dioxideAbout 5% of total carbon dioxide Plasma proteinsPlasma proteins

Plasma ProteinsPlasma Proteins

Plasma proteinsPlasma proteins are the most are the most abundant type of solute in the abundant type of solute in the plasmaplasma This group includes the This group includes the

albuminsalbumins (help thicken and maintain (help thicken and maintain blood volume), blood volume),

immunoglobulinsimmunoglobulins ( (include antibodiesinclude antibodies that help protect us from that help protect us from infection)infection)

fibrinogenfibrinogen ( (necessary for blood necessary for blood clottingclotting))

Clot FormationClot Formation Thrombocytes are also called Thrombocytes are also called platelets and they are necessary for platelets and they are necessary for blood clotting. blood clotting.

Vitamin K stimulates liver cells to Vitamin K stimulates liver cells to increase the synthesis of increase the synthesis of prothrombin, which is necessary for prothrombin, which is necessary for successful clot formation. successful clot formation.

In clot formation, prothrombin is In clot formation, prothrombin is converted to thrombin, which combines converted to thrombin, which combines with fibrinogen to form fibrin. with fibrinogen to form fibrin. Fibrin traps blood cells and forms a Fibrin traps blood cells and forms a clot.clot.

ClotsClots A stationary blood clot is called a THROMBUSA stationary blood clot is called a THROMBUS A dislodged, moving clot is called an A dislodged, moving clot is called an EMBOLUSEMBOLUS

If a clot dislodges and begins circulating If a clot dislodges and begins circulating in the blood it is more dangerous to the in the blood it is more dangerous to the person.person. It can become lodged in any blood It can become lodged in any blood vessel, including those in the heart, lung, vessel, including those in the heart, lung, or brain and become critical or deadly.or brain and become critical or deadly.

Therefore, an embolus or thrombus can result Therefore, an embolus or thrombus can result in heart attack (myocardial infarction) or in heart attack (myocardial infarction) or stroke (CVA)stroke (CVA)

CoumadinCoumadin

Coumadin inhibits the synthesis Coumadin inhibits the synthesis of prothrombin and other of prothrombin and other Vitamin K -dependent clotting Vitamin K -dependent clotting factors and is, therefore, an factors and is, therefore, an anticoagulant. anticoagulant.

Blood PlasmaBlood Plasma

Plasma minus clotting factors Plasma minus clotting factors called serumcalled serum Serum is liquid remaining after Serum is liquid remaining after whole blood clotswhole blood clots

Serum contains antibodiesSerum contains antibodies Which are helpful to destroy toxinsWhich are helpful to destroy toxins They are specific to an antigenThey are specific to an antigen

Reminder: antigen is a foreign substance Reminder: antigen is a foreign substance in the body capable of causing diseasein the body capable of causing disease

Formed Elements in Formed Elements in BLOOD includeBLOOD include::

Thrombocytes (platelets)Thrombocytes (platelets) Erythroyctes (Red Blood Cells/RBC)Erythroyctes (Red Blood Cells/RBC) Leukocytes (White Blood Cells/WBC)Leukocytes (White Blood Cells/WBC)

There are different categories of There are different categories of leukocytes, noted below:leukocytes, noted below:

NeutrophilsNeutrophils EosiniphilsEosiniphils BasophilsBasophils Lymphocytes (Lymphocytes are a type of Lymphocytes (Lymphocytes are a type of leukocyte) leukocyte)

MonocytesMonocytes

Red Blood CellsRed Blood Cells

The most numerous cells in a given volume of blood The most numerous cells in a given volume of blood are erythrocytesare erythrocytes

The formation of red blood cells is known as The formation of red blood cells is known as hematopoiesishematopoiesis

Formed in red bone marrow from myeloid and Formed in red bone marrow from myeloid and lymphatic tissuelymphatic tissue Myeloid tissue is the same as red bone marrowMyeloid tissue is the same as red bone marrow

Are a biconcave disc shapeAre a biconcave disc shape (thin center (thin center and thick edges)and thick edges)

Lack a nucleus Lack a nucleus

Red Blood CellsRed Blood Cells

Erythrocytes transport oxygen and Erythrocytes transport oxygen and carbon dioxide throughout the bodycarbon dioxide throughout the body

Red Blood Cells contain Red Blood Cells contain hemoglobin, hemoglobin, which is the oxygen carrying protein of which is the oxygen carrying protein of blood. It is a red-pigmented cell. blood. It is a red-pigmented cell.

A critical component of hemoglobin is A critical component of hemoglobin is IRONIRON

Iron allows the hemoglobin to bind with Iron allows the hemoglobin to bind with O2 and transport it through the bodyO2 and transport it through the body

RBC FunctionsRBC Functions

Transport of respiratory gases Transport of respiratory gases (oxygen(oxygen and carbon dioxide) and carbon dioxide)

Plays an important role in Plays an important role in homeostasis of acid-base homeostasis of acid-base balancebalance

A CBC (complete blood count) is A CBC (complete blood count) is a laboratory test used to a laboratory test used to measure the amount or levels of measure the amount or levels of many blood constituentsmany blood constituents

Diseases involving Diseases involving ErythrocytesErythrocytes

Polycythemia refers to an Polycythemia refers to an excessive production of excessive production of erythrocyteserythrocytes

-emia is the suffix that refers -emia is the suffix that refers to a blood conditionto a blood condition

Anemia is the inability of Anemia is the inability of blood to carry sufficient blood to carry sufficient oxygen to the tissuesoxygen to the tissues

AnemiaAnemia Low oxygen carrying capacity of bloodLow oxygen carrying capacity of blood Major symptom: fatigueMajor symptom: fatigue Hemorrhagic anemiaHemorrhagic anemia

Accidents / bleeding ulcersAccidents / bleeding ulcers Aplastic anemia refers to the Aplastic anemia refers to the destruction of blood forming elements destruction of blood forming elements in the bone marrowin the bone marrow. . Toxic chemicals, excessive xrays, Toxic chemicals, excessive xrays, chemotherapychemotherapy

Pernicious anemia is caused by a lack Pernicious anemia is caused by a lack of intrinsic factor and decreased of intrinsic factor and decreased absorption of vitamin B12absorption of vitamin B12

Pernicious AnemiaPernicious Anemia

This can be due to a This can be due to a deficiency deficiency or due to stomach lining fails or due to stomach lining fails to produce intrinsic factorto produce intrinsic factor, , which is the substance that which is the substance that allows B12 to be absorbed. allows B12 to be absorbed.

Sickle Cell AnemiaSickle Cell Anemia

This is a form of anemia caused This is a form of anemia caused by a defective gene resulting by a defective gene resulting in abnormal hemoglobinin abnormal hemoglobin

Sickle Cell AnemiaSickle Cell Anemia Severe and sometimes fatal hereditary diseaseSevere and sometimes fatal hereditary disease Sickle cell disease changes normal, round red Sickle cell disease changes normal, round red blood cells into cells that are shaped like blood cells into cells that are shaped like crescent moons. The name "sickle cell" comes crescent moons. The name "sickle cell" comes from the crescent shape of the cellsfrom the crescent shape of the cells

Sickle cell disease is inherited, which means Sickle cell disease is inherited, which means it is passed from parent to child. To get it is passed from parent to child. To get sickle cell disease, a child has to inherit sickle cell disease, a child has to inherit two sickle cell genes-one from each parent.two sickle cell genes-one from each parent.

When a child inherits the gene from just one When a child inherits the gene from just one parent, that child has sickle cell trait. parent, that child has sickle cell trait. Having this trait means that you do not have Having this trait means that you do not have the disease, but you are a carrier and could the disease, but you are a carrier and could pass it on to your children.pass it on to your children.

Sickle Cell AnemiaSickle Cell Anemia

White Blood CellsWhite Blood Cells Called leukocytesCalled leukocytes Categorized with granules or without Categorized with granules or without granulesgranules

Granulocytic WBCs (i.e these CONTAIN Granulocytic WBCs (i.e these CONTAIN granules)granules) NeutrophilsNeutrophils EosinophilsEosinophils BasophilsBasophils

Agranulocytes (i.e. these contain NO Agranulocytes (i.e. these contain NO granules)granules) LymphocytesLymphocytes MonocytesMonocytes

Function of WBCs – protection and Function of WBCs – protection and disease fightingdisease fighting

Functions of Specific Functions of Specific LeukocytesLeukocytes

Neutrophils function in immune Neutrophils function in immune defense and phagocytosisdefense and phagocytosis Phagocytes are cells that are capable of Phagocytes are cells that are capable of

ingesting foreign substances and ingesting foreign substances and organisms for their destructionorganisms for their destruction

Eosiniphils function in defending Eosiniphils function in defending against parasitesagainst parasites

Basophils are involved in allergic Basophils are involved in allergic reactionsreactions

White Blood CellsWhite Blood Cells Basophils secrete heparin, an Basophils secrete heparin, an anticoagulant, which is thought to play a anticoagulant, which is thought to play a role in the prevention of clotting. role in the prevention of clotting.

Lymphocytes play a major role in immunity Lymphocytes play a major role in immunity to infectious diseases and produce to infectious diseases and produce antibodies to destroy themantibodies to destroy them

B lymphocytes are responsible for antibody B lymphocytes are responsible for antibody productionproduction

An antigen is a foreign substance that can An antigen is a foreign substance that can cause the body to produce an antibodycause the body to produce an antibody

Macrophages are specialized phagocytic Macrophages are specialized phagocytic cells found outside of the circulatory cells found outside of the circulatory system and are derived from monocytessystem and are derived from monocytes

WBC CountWBC Count

Amt of WBCs per cubic Amt of WBCs per cubic millimeter of whole bloodmillimeter of whole blood

Ranges from 5000-9000Ranges from 5000-9000 LeukopeniaLeukopenia – low WBC count/ – low WBC count/a a decreased in WBC countdecreased in WBC count

Leukocytosis – high WBC countLeukocytosis – high WBC count

LeukemiaLeukemia

WBC count exceeds 100,000WBC count exceeds 100,000 Acute or Chronic – depends on Acute or Chronic – depends on how quickly symptoms appear how quickly symptoms appear after the disease beginsafter the disease begins

Lymphocytic or Myeloid – Lymphocytic or Myeloid – depends on the cell type depends on the cell type involvedinvolved

Hematocrit (Hct)Hematocrit (Hct) This is a common lab testThis is a common lab test It is a measure of the total blood volume It is a measure of the total blood volume make up by the red blood cellsmake up by the red blood cells

A tube of blood is placed into a A tube of blood is placed into a centrifuge and spun downcentrifuge and spun down

The heavier elements settle to the bottom The heavier elements settle to the bottom of the tube - ie RBCsof the tube - ie RBCs

In a dehydrated individual the hematocrit In a dehydrated individual the hematocrit is more likely to be increasedis more likely to be increased

HematocritHematocrit

The buffy coat layer in a The buffy coat layer in a hematocrit blood tube contains hematocrit blood tube contains white blood cells and white blood cells and platelets.platelets. The “buffy coat” is The “buffy coat” is the layer of WBCs and platelets the layer of WBCs and platelets visible in any centrifuged visible in any centrifuged blood sample.blood sample.

The RBCs are located at the The RBCs are located at the bottom of the tubebottom of the tube

That’s All, Folks!That’s All, Folks!