Created by CK-12 Foundation/Adapted by Christine Miller

Figure 16.3.1 The surprising uses of pee.

What do gun powder, leather, fabric dyes and laundry service have in common?  This may be surprising, but they all historically involved urine.  One of the main components in gun powder, potassium nitrate, was difficult to come by pre-1900s, so ingenious gun-owners would evaporate urine to concentrate the nitrates it contains.  The ammonium in urine was excellent in breaking down tissues, making it a prime candidate for softening leathers and removing stains in laundry.  Ammonia in urine also helps dyes penetrate fabrics, so it was used to make colours stay brighter for longer.

The actual human urinary system, also known as the renal system, is shown in Figure 16.3.2. The system consists of the kidneys, ureters, bladder, and urethra. The main function of the urinary system is to eliminate the waste products of metabolism from the body by forming and excreting urine. Typically, between one and two litres of urine are produced every day in a healthy individual.

The urinary system is all about urine. It includes organs that form urine, and also those that transport, store, or excrete urine.

Kidneys

Urine is formed by the kidneys, which filter many substances out of the blood, allow the blood to reabsorb needed materials, and use the remaining materials to form urine. The human body normally has two paired kidneys, although it is possible to get by quite well with just one. As you can see in Figure 16.3.3, each kidney is well supplied with blood vessels by a major artery and vein. Blood to be filtered enters the kidney through the renal artery, and the filtered blood leaves the kidney through the renal vein. The kidney itself is wrapped in a fibrous capsule, and consists of a thin outer layer called the cortex, and a thicker inner layer called the medulla.

Blood is filtered and urine is formed by tiny filtering units called nephrons. Each kidney contains at least a million nephrons, and each nephron spans the cortex and medulla layers of the kidney. After urine forms in the nephrons, it flows through a system of converging collecting ducts. The collecting ducts join together to form minor calyces (or chambers) that join together to form major calyces (see Figure 16.3.3 above). Ultimately, the major calyces join the renal pelvis, which is the funnel-like end of the ureter where it enters the kidney.

Ureters, Bladder, Urethra

After urine forms in the kidneys, it is transported through the ureters (one per kidney) via peristalsis to the sac-like urinary bladder, which stores the urine until urination. During urination, the urine is released from the bladder and transported by the urethra to be excreted outside the body through the external urethral opening.

Waste products removed from the body with the formation and elimination of urine include many water-soluble metabolic products. The main waste products are urea — a by-product of protein catabolism — and uric acid, a by-product of nucleic acid catabolism. Excess water and mineral ions are also eliminated in urine.

Besides the elimination of waste products such as these, the urinary system has several other vital functions. These include:

• Maintaining homeostasis of mineral ions in extracellular fluid: These ions are either excreted in urine or returned to the blood as needed to maintain the proper balance.
• Maintaining homeostasis of blood pH: When pH is too low (blood is too acidic), for example, the kidneys excrete less bicarbonate (which is basic) in urine. When pH is too high (blood is too basic), the opposite occurs, and more bicarbonate is excreted in urine.
• Maintaining homeostasis of extracellular fluids, including the blood volume, which helps maintain blood pressure: The kidneys control fluid volume and blood pressure by excreting more or less salt and water in urine.

The formation of urine must be closely regulated to maintain body-wide homeostasis. Several endocrine hormones help control this function of the urinary system, including antidiuretic hormone, parathyroid hormone, and aldosterone.

• Antidiuretic hormone (ADH), also called vasopressin, is secreted by the posterior pituitary gland. One of its main roles is conserving body water. It is released when the body is dehydrated, and it causes the kidneys to excrete less water in urine.
• Parathyroid hormone is secreted by the parathyroid glands. It works to regulate the balance of mineral ions in the body via its effects on several organs, including the kidneys. Parathyroid hormone stimulates the kidneys to excrete less calcium and more phosphorus in urine.
• Aldosterone is secreted by the cortex of the adrenal glands, which rest atop the kidneys, as shown in Figure 16.3.4. Through its effect on the kidneys, it plays a central role in regulating blood pressure. It causes the kidneys to excrete less sodium and water in urine.

Once urine forms, it is excreted from the body in the process of urination, also sometimes referred to as micturition. This process is controlled by both the autonomic and the somatic nervous systems. As the bladder fills with urine, it causes the autonomic nervous system to signal smooth muscle in the bladder wall to contract (as shown in Figure 16.3.5), and the sphincter between the bladder and urethra to relax and open. This forces urine out of the bladder and through the urethra. Another sphincter at the distal end of the urethra is under voluntary control. When it relaxes under the influence of the somatic nervous system, it allows urine to leave the body through the external urethral opening.

Figure 16.3.1

• File:Pyrodex powder ffg.jpg by Hustvedt on Wikimedia Commons is used under a CC BY SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/deed.en).
• Brown leather satchel bag by Álvaro Serrano on Unsplash is used under the Unsplash Licence (https://unsplash.com/license).
• Laundry basket by Andy Fitzsimon on Unsplash is used under the Unsplash Licence (https://unsplash.com/license).
• Tags: Wool Skeins Natural Dyed Colorful Himalayan Weavers by  on Pixabay is used under the Pixabay License (https://pixabay.com/service/license/).

Figure 16.3.2

Urinary_System_(Male) by BruceBlaus on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 16.3.3

2610_The_Kidney by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 16.3.4

Adrenal glands on Kidney  by Alan Hoofring (Illustrator)/ NCI Visuals Online is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 16.3.5

Urinary_Sphincter by BruceBlaus on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

References

Alexandria Doody. (2016, March 29). Maple syrup urine disease. YouTube. https://www.youtube.com/watch?v=pyMcTUQYMQw&feature=youtu.be

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 25.8 Left kidney [digital image].  In Anatomy and Physiology (Section 25.3). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/25-3-gross-anatomy-of-the-kidney

FuseSchool. (2017, June 19). The urinary system - An introduction | Physiology | Biology | FuseSchool. YouTube. https://www.youtube.com/watch?v=dxecGD0m0Xc&feature=youtu.be

Gross Science. (2015, September 15). Three ways pee could change the world. YouTube. https://www.youtube.com/watch?v=xt1Tj5eeS0k&feature=youtu.be

Seeker. (2016, January 16). How accurate are drug tests? YouTube. https://www.youtube.com/watch?v=3z-xjfdJWAI&feature=youtu.be

 

One of two main divisions of the nervous system that includes the brain and spinal cord.

Created by CK-12 Foundation/Adapted by Christine Miller

Why do dogs pee on fire hydrants? Besides “having to go,” they are marking their territory with chemicals in their urine called pheromones. It’s a form of communication, in which they are “saying” with odors that the yard is theirs and other dogs should stay away. In addition to fire hydrants, dogs may urinate on fence posts, trees, car tires, and many other objects. Urination in dogs, as in people, is usually a voluntary process controlled by the brain. The process of forming urine — which occurs in the kidneys — occurs constantly, and is not under voluntary control. What happens to all the urine that forms in the kidneys? It passes from the kidneys through the other organs of the urinary system, starting with the ureters.

As shown in Figure 16.5.2, ureters are tube-like structures that connect the kidneys with the urinary bladder. They are paired structures, with one ureter for each kidney. In adults, ureters are between 25 and 30 cm (about 10–12 in) long and about 3 to 4 mm in diameter.

Each ureter arises in the pelvis of a kidney (the renal pelvis in Figure 16.5.3). It then passes down the side of the kidney, and finally enters the back of the bladder. At the entrance to the bladder, the ureters have sphincters that prevent the backflow of urine.

The walls of the ureters are composed of multiple layers of different types of tissues.  The innermost layer is a special type of epithelium, called transitional epithelium. Unlike the epithelium lining most organs, transitional epithelium is capable of stretching and does not produce mucus. It lines much of the urinary system, including the renal pelvis, bladder, and much of the urethra, in addition to the ureters. Transitional epithelium allows these organs to stretch and expand as they fill with urine or allow urine to pass through. The next layer of the ureter walls is made up of loose connective tissue containing elastic fibres, nerves, and blood and lymphatic vessels. After this layer are two layers of smooth muscles, an inner circular layer, and an outer longitudinal layer. The smooth muscle layers can contract in waves of peristalsis to propel urine down the ureters from the kidneys to the urinary bladder. The outermost layer of the ureter walls consists of fibrous tissue.

The urinary bladder is a hollow, muscular, and stretchy organ that rests on the pelvic floor. It collects and stores urine from the kidneys before the urine is eliminated through urination. As shown in Figure 16.5.4, urine enters the urinary bladder from the ureters through two ureteral openings on either side of the back wall of the bladder. Urine leaves the bladder through a sphincter called the internal urethral sphincter. When the sphincter relaxes and opens, it allows urine to flow out of the bladder and into the urethra.

Like the ureters, the bladder is lined with transitional epithelium, which can flatten out and stretch as needed as the bladder fills with urine. The next layer (lamina propria) is a layer of loose connective tissue, nerves, and blood and lymphatic vessels. This is followed by a submucosa layer, which connects the lining of the bladder with the detrusor muscle in the walls of the bladder. The outer covering of the bladder is peritoneum, which is a smooth layer of epithelial cells that lines the abdominal cavity and covers most abdominal organs.

The detrusor muscle in the wall of the bladder is made of smooth muscle fibres controlled by both the autonomic and somatic nervous systems. As the bladder fills, the detrusor muscle automatically relaxes to allow it to hold more urine. When the bladder is about half full, the stretching of the walls triggers the sensation of needing to urinate. When the individual is ready to void, conscious nervous signals cause the detrusor muscle to contract, and the internal urethral sphincter to relax and open. As a result, urine is forcefully expelled out of the bladder and into the urethra.

The urethra is a tube that connects the urinary bladder to the external urethral orifice, which is the opening of the urethra on the surface of the body. As shown in Figure 16.5.5, the urethra in males travels through the penis, so it is much longer than the urethra in females. In males, the urethra averages about 20 cm (about 7.8 in) long, whereas in females, it averages only about 4.8 cm (about 1.9 in) long. In males, the urethra carries semen (as well as urine), but in females, it carries only urine.  In addition, in males, the urethra passes through the prostate gland (part of the reproductive system) which is absent in women.

Like the ureters and bladder, the proximal (closer to the bladder) two-thirds of the urethra are lined with transitional epithelium. The distal (farther from the bladder) third of the urethra is lined with mucus-secreting epithelium. The mucus helps protect the epithelium from urine, which is corrosive. Below the epithelium is loose connective tissue, and below that are layers of smooth muscle that are continuous with the muscle layers of the urinary bladder. When the bladder contracts to forcefully expel urine, the smooth muscle of the urethra relaxes to allow the urine to pass through.

In order for urine to leave the body through the external urethral orifice, the external urethral sphincter must relax and open. This sphincter is a striated muscle that is controlled by the somatic nervous system, so it is under conscious, voluntary control in most people (exceptions are infants, some elderly people, and patients with certain injuries or disorders). The muscle can be held in a contracted state and hold in the urine until the person is ready to urinate. Following urination, the smooth muscle lining the urethra automatically contracts to re-establish muscle tone, and the individual consciously contracts the external urethral sphincter to close the external urethral opening.

Attributions

Figure 16.5.1

Cliche by Jackie on Wikimedia Common s is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

Figure 16.5.2

Urinary System Male by BruceBlaus on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 16.5.3

Adrenal glands on Kidney by NCI Public Domain by Alan Hoofring (Illustrator) /National Cancer Institute (photo ID 4355) on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 16.5.4

2605_The_Bladder by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license. (Micrograph originally provided by the Regents of the University of Michigan Medical School © 2012.)

Figure 16.5.5

512px-Male_and_female_urethral_openings.svg by andrybak (derivative work) on Wikimedia Commons is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) license. (Original: Male anatomy blank.svg: alt.sex FAQ, derivative work: Tsaitgaist Female anatomy with g-spot.svg: Tsaitgaist.)

References

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 25.4 Bladder (a) Anterior cross section of the bladder. (b) The detrusor muscle of the bladder (source: monkey tissue) LM × 448 [digital image].  In Anatomy and Physiology (Section 7.3). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/25-2-gross-anatomy-of-urine-transport 

SciShow. (2016, January 22). What happens when you hold your pee? YouTube. https://www.youtube.com/watch?v=dg4_deyHLvQ&feature=youtu.be

TED. (2016, September 2). The taboo secret to better health | Molly Winter. YouTube. https://www.youtube.com/watch?v=2Brajdazp1o&feature=youtu.be

A structure containing neuronal cell bodies in the peripheral nervous system.

Structures containing neuronal cell bodies in the peripheral nervous system.

image shows the signs for mens and women's washroom.

As per caption.

division of the peripheral nervous system that controls involuntary activities

Created by CK-12 Foundation/Adapted by Christine Miller

Does the organism in Figure 17.2.1 look like a space alien? A scary creature from a nightmare? In fact, it’s a 1-cm long worm in the genus Schistosoma. It may invade and take up residence in the human body, causing a very serious illness known as schistosomiasis. The worm gains access to the human body while it is in a microscopic life stage. It enters through a hair follicle when the skin comes into contact with contaminated water. The worm then grows and matures inside the human organism, causing disease.

The Schistosoma worm has a parasitic relationship with humans. In this type of relationship, one organism, called the parasite, lives on or in another organism, called the host. The parasite always benefits from the relationship, and the host is always harmed. The human host of the Schistosoma worm is clearly harmed by the parasite when it invades the host’s tissues. The urinary tract or intestines may be infected, and signs and symptoms may include abdominal pain, diarrhea, bloody stool, or blood in the urine. Those who have been infected for a long time may experience liver damage, kidney failure, infertility, or bladder cancer. In children, Schistosoma infection may cause poor growth and difficulty learning.

Like the Schistosoma worm, many other organisms can make us sick if they manage to enter our body. Any such agent that can cause disease is called a pathogen. Most pathogens are microorganisms, although some — such as the Schistosoma worm — are much larger. In addition to worms, common types of pathogens of human hosts include bacteria, viruses, fungi, and single-celled organisms called protists. You can see examples of each of these types of pathogens in Table 17.1.1. Fortunately for us, our immune system is able to keep most potential pathogens out of the body, or quickly destroy them if they do manage to get in. When you read this chapter, you’ll learn how your immune system usually keeps you safe from harm — including from scary creatures like the Schistosoma worm!

Table 17.1.1: Types of Disease-Causing Pathogens

Type of Pathogen		Description	Disease Caused
Bacteria: Example shown: Escherichia coli		Single celled organisms without a nucleus	Strep throat, staph infections, tuberculosis, food poisoning, tetanus, pneumonia, syphillis
Viruses: Example shown: Herpes simplex		Non-living particles that reproduce by taking over living cells	Common cold, flu, genital herpes, cold sores, measles, AIDS, genital warts, chicken pox, small pox
Fungi: Example shown: Death cap mushroom		Simple organisms, including mushrooms and yeast, that grow as single cells or thread-like filaments	Ringworm, athletes foot, tineas, candidias, histoplasmomis, mushroom poisoning
Protozoa: Example shown: Giardia lamblia		Single celled organisms with a nucleus	Malaria, "traveller's diarrhea", giardiasis, typano somiasis ("sleeping sickness")

What is the Immune System?

The immune systemno post is a host defense system. It comprises many biological structures —ranging from individual leukocytes to entire organs — as well as many complex biological processes. The function of the immune system is to protect the host from pathogens and other causes of disease, such as tumor (cancer) cells. To function properly, the immune system must be able to detect a wide variety of pathogens. It also must be able to distinguish the cells of pathogens from the host’s own cells, and also to distinguish cancerous or damaged host cells from healthy cells. In humans and most other vertebrates, the immune system consists of layered defenses that have increasing specificity for particular pathogens or tumor cells. The layered defenses of the human immune system are usually classified into two subsystems, called the innate immune system and the adaptive immune system.

Innate Immune System

The innate immune system (sometimes referred to as "non-specific defense") provides very quick, but non-specific responses to pathogens. It responds the same way regardless of the type of pathogen that is attacking the host. It includes barriers — such as the skin and mucous membranes — that normally keep pathogens out of the body. It also includes general responses to pathogens that manage to breach these barriers, including chemicals and cells that attack the pathogens inside the human host. Certain leukocytes (white blood cells), for example, engulf and destroy pathogens they encounter in the process called phagocytosis, which is illustrated in Figure 17.2.2. Exposure to pathogens leads to an immediate maximal response from the innate immune system.

Adaptive Immune System

The adaptive immune system is activated if pathogens successfully enter the body and manage to evade the general defenses of the innate immune system. An adaptive response is specific to the particular type of pathogen that has invaded the body, or to cancerous cells. It takes longer to launch a specific attack, but once it is underway, its specificity makes it very effective. An adaptive response also usually leads to immunity. This is a state of resistance to a specific pathogen, due to the adaptive immune system's ability to “remember” the pathogen and immediately mount a strong attack tailored to that particular pathogen if it invades again in the future.

Both innate and adaptive immune responses depend on the immune system's ability to distinguish between self- and non-self molecules. Self molecules are those components of an organism’s body that can be distinguished from foreign substances by the immune system. Virtually all body cells have surface proteins that are part of a complex called major histocompatibility complex (MHC). These proteins are one way the immune system recognizes body cells as self. Non-self proteins, in contrast, are recognized as foreign, because they are different from self proteins.

Antigens and Antibodies

Many non-self molecules comprise a class of compounds called antigens. Antigens, which are usually proteins, bind to specific receptors on immune system cells and elicit an adaptive immune response. Some adaptive immune system cells (B cells) respond to foreign antigens by producing antibodies. An antibody is a molecule that precisely matches and binds to a specific antigen. This may target the antigen (and the pathogen displaying it) for destruction by other immune cells.

Antigens on the surface of pathogens are how the adaptive immune system recognizes specific pathogens. Antigen specificity allows for the generation of responses tailored to the specific pathogen. It is also how the adaptive immune system ”remembers” the same pathogen in the future.

Immune Surveillance

Another important role of the immune system is to identify and eliminate tumor cells. This is called immune surveillance. The transformed cells of tumors express antigens that are not found on normal body cells. The main response of the immune system to tumor cells is to destroy them. This is carried out primarily by aptly-named killer T cells of the adaptive immune system.

The lymphatic system is a human organ system that is a vital part of the adaptive immune system. It is also part of the cardiovascular system and plays a major role in the digestive system (see section 17.3 Lymphatic System). The major structures of the lymphatic system are shown in Figure 17.2.3 .

The lymphatic system consists of several lymphatic organs and a body-wide network of lymphatic vessels that transport the fluid called lymph. Lymph is essentially blood plasma that has leaked from capillaries into tissue spaces. It includes many leukocytes, especially lymphocytes, which are the major cells of the lymphatic system. Like other leukocytes, lymphocytes defend the body. There are several different types of lymphocytes that fight pathogens or cancer cells as part of the adaptive immune system.

Major lymphatic organs include the thymus and bone marrow. Their function is to form and/or mature lymphocytes. Other lymphatic organs include the spleen, tonsils, and lymph nodes, which are small clumps of lymphoid tissue clustered along lymphatic vessels. These other lymphatic organs harbor mature lymphocytes and filter lymph. They are sites where pathogens collect, and adaptive immune responses generally begin.

The brain and spinal cord are normally protected from pathogens in the blood by the selectively permeable blood-brain and blood-spinal cord barriers. These barriers are part of the neuroimmune system. The neuroimmune system has traditionally been considered distinct from the rest of the immune system, which is called the peripheral immune system — although that view may be changing. Unlike the peripheral system, in which leukocytes are the main cells, the main cells of the neuroimmune system are thought to be nervous system cells called neuroglia. These cells can recognize and respond to pathogens, debris, and other potential dangers. Types of neuroglia involved in neuroimmune responses include microglial cells and astrocytes.

• Microglial cells are among the most prominent types of neuroglia in the brain. One of their main functions is to phagocytize cellular debris that remains when neurons die. Microglial cells also “prune” obsolete synapses between neurons.
• Astrocytes are neuroglia that have a different immune function. They allow certain immune cells from the peripheral immune system to cross into the brain via the blood-brain barrier to target both pathogens and damaged nervous tissue.

“They’ll have to rewrite the textbooks!”

That sort of response to a scientific discovery is sure to attract media attention, and it did. It’s what Kevin Lee, a neuroscientist at the University of Virginia, said in 2016 when his colleagues told him they had discovered human anatomical structures that had never before been detected. The structures were tiny lymphatic vessels in the meningeal layers surrounding the brain.

How these lymphatic vessels could have gone unnoticed when all human body systems have been studied so completely is amazing in its own right. The suggested implications of the discovery are equally amazing:

• The presence of these lymphatic vessels means that the brain is directly connected to the peripheral immune system, presumably allowing a close association between the human brain and human pathogens. This suggests an entirely new avenue by which humans and their pathogens may have influenced each other’s evolution. The researchers speculate that our pathogens even may have influenced the evolution of our social behaviors.
• The researchers think there will also be many medical applications of their discovery. For example, the newly discovered lymphatic vessels may play a major role in neurological diseases that have an immune component, such as multiple sclerosis. The discovery might also affect how conditions such as autism spectrum disorders and schizophrenia are treated.

Attributions

Figure 17.1.1

Schistosome Parasite by Bruce Wetzel and Harry Schaefer (Photographers) from the National Cancer Institute, Visuals online is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 17.1.2

Phagocytosis by Rlawson at en.wikibooks on Wikimedia Commons is used under a CC BY ­SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/deed.en) license. (Transferred from en.wikibooks to Commons by User:Adrignola.)

Figure 17.1.3

2201_Anatomy_of_the_Lymphatic_System by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

 

Table 17.1.1 

• EscherichiaColi NIAID [photo] by Rocky Mountain Laboratories,  NIH National Institute of Allergy and Infectious Diseases (NIAID) on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).
• Herpes simplex virus TEM B82-0474 lores by Dr. Erskine Palmer/ CDC Public Health Image Library (PHIL) on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).
• Red death cap mushroom by Rosendahl on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain). (Transferred from Pixnio by Fæ.)
• Scanning electron micrograph (SEM) of Giardia lamblia by Janice Haney Carr/ CDC, Public Health Image Library (PHIL) Photo ID# 8698 is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

References

Barney, J. (2016, March 21). They’ll have to rewrite the textbooks [online article]. Illimitable - Discovery. UVA Today/ University of Virginia. https://news.virginia.edu/illimitable/discovery/theyll-have-rewrite-textbooks

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 21.2 Anatomy of the lymphatic system [digital image].  In Anatomy and Physiology (Section 21.1). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/21-1-anatomy-of-the-lymphatic-and-immune-systems

Handwritten Tutorials. (2011, October 25). Overview of the immune system. YouTube. https://www.youtube.com/watch?v=Nw27_jMWw10&feature=youtu.be

ImmiflexImmuneSystem. (2013). Neutrophil phagocytosis - White blood cell eats staphylococcus aureus bacteria. YouTube. https://www.youtube.com/watch?v=Z_mXDvZQ6dU

Kurzgesagt – In a Nutshell. (2016, March 16). The antibiotic apocalypse explained. YouTube. https://www.youtube.com/watch?v=xZbcwi7SfZE&feature=youtu.be

Louveau, A., Smirnov, I., Keyes, T. J., Eccles, J. D., Rouhani, S. J., Peske, J. D., Derecki, N. C., Castle, D., Mandell, J. W., Lee, K. S., Harris, T. H., & Kipnis, J. (2015). Structural and functional features of central nervous system lymphatic vessels. Nature, 523(7560), 337–341. https://doi.org/10.1038/nature14432

Mayo Clinic Staff. (n.d.). Autism spectrum disorder [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928

Mayo Clinic Staff. (n.d.). Multiple sclerosis [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269

Mayo Clinic Staff. (n.d.). Schizophrenia [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443

TED-Ed. (2016, April 19). The surprising reason you feel awful when you're sick - Marco A. Sotomayor. YouTube. https://www.youtube.com/watch?v=gVdY9KXF_Sg&feature=youtu.be

 

Created by CK-12 Foundation/Adapted by Christine Miller

Her name was Marie Stopes, and she was a British author and paleobotanist who lived from 1880 to 1958. She is pictured in Figure 18.11.1 in her lab next to her microscope. Stopes made significant contributions to science and was the first woman on the faculty of the University of Manchester in England. Her primary claim to fame was her work as a family planning pioneer.

Along with her husband, Stopes founded the first birth control clinic in Britain. She also edited a newsletter called Birth Control News, which gave explicit practical advice on how to avoid unwanted pregnancies. In 1918, she published a sex manual titled Married Love. The book was controversial and influential, bringing the subject of contraception into wide public discourse for the first time.

About a century after Married Love, more than half of all fertile married couples worldwide use some form of contraception. Contraception, also known as birth control, is any method or device used to prevent pregnancy. Birth control methods have been used for centuries, but safe and effective methods only became available in the 20th century, in part because of the work of people like Marie Stopes.

Many different birth control methods are currently available, but they differ considerably in their effectiveness at preventing pregnancy. The effectiveness of contraception is generally expressed as the failure rate, which is the percentage of women who become pregnant using a given method during the first year of use. Virtually no one uses any method of birth control perfectly, so the failure rate with typical use is almost always higher — and often much higher — than the failure rate with perfect use. For example, with perfect use, a birth control method might have a failure rate of just 1%, whereas with typical use, the failure rate might be 25%. For comparison, there is an average one-year pregnancy rate of 85% if no contraception is used.

All methods of birth control have potential adverse effects, but their health risks are less than the health risks associated with pregnancy. Using contraception to space the children in a family is also good for the children’s health and development, as well as for the health of the mother.

Types of birth control methods include barrier methods, hormonal methods, intrauterine devices, behavioural methods, and sterilization. With the exception of sterilization, all of these methods are reversible. Examples of each type of birth control method and their failure rates with typical use are described below. Much of the information is also summarized in Figure 18.11.2.

Barrier Methods

Barrier methods are devices that are used to physically block sperm from entering the uterus. They include condoms and diaphragms.

 

Condoms

Condoms are the most commonly used method of birth control globally. There are condoms for females and males, but male condoms are more widely used, less expensive, and more readily available. Both types of condoms are pictured in Figures 18.11.3 and 18.11.4. A male condom is placed on a man’s erect penis, and a female condom is placed inside a woman’s vagina. Whichever type of condom is used, it must be put in place before sexual intercourse occurs. Condoms work by physically blocking ejaculated sperm from entering the vagina of the sexual partner. With typical use, male condoms have an 18% failure rate, and female condoms have a 21% failure rate. Unlike virtually all other birth control methods, condoms also help prevent the spread of sexually transmitted infections (STIs), in addition to helping to prevent pregnancy.

Diaphragms

Diaphragms, like the one pictured in Figure 18.11.5, ideally prevent sperm from passing through the cervical canal and into the uterus. A diaphragm is inserted vaginally before sexual intercourse occurs and must be placed over the cervix to be effective. It is usually recommended that a diaphragm be covered with spermicide before insertion for extra protection. It is also recommended that the diaphragm be left in place for at least six hours after intercourse. The failure rate of diaphragms with typical use is about 12%, which is about half that of condoms. However, diaphragms do not help prevent the spread of STIs, and their use is also associated with an increased frequency of urinary tract infections in females.

 

Hormonal Methods

Hormonal contraception is the administration of hormones to prevent ovulation. Hormones can be taken orally in birth control pills, implanted under the skin, injected into a muscle, or received transdermally from a skin patch. Hormonal methods are currently available only for women, although hormonal contraceptives for men are being tested in clinical trials.

Birth control pills are the most common form of hormonal contraception. There are two types of pills: the combined pill (which contains both estrogen and progesterone) and the progesterone-only pill. Both types of pills inhibit ovulation and thicken cervical mucus. The failure rate of birth control pills is only about 1% or less, if used perfectly. However, the failure rate rises to about 10% with typical use, because women do not always remember to take the pill at the same time every day. The combined pill is associated with a slightly increased risk of blood clots, but a reduced risk of ovarian and endometrial cancers. The progesterone-only pill does not increase the risk of blood clots, but it may cause irregular menstrual periods. It may take a few weeks or even months for fertility to return to normal after long-term use of birth control pills.

Intrauterine Devices

An intrauterine device (IUD) is a T-shaped or coiled plastic structure that is inserted into the uterus via the vagina and cervix that contains either copper or a hormone. You can see an IUD in the uterus in the drawing of the female reproductive system in Figure 18.11.6. An IUD is inserted by a physician and may be left in place for months or even years. A physician also must remove an IUD, using the strings attached to the device. The copper in copper IUDs prevents pregnancy by interfering with the movement of sperm so they cannot reach and fertilize an egg. The copper may also prevent implantation in the unlikely circumstance of a sperm managing to reach and fertilize an ovum, in which case the blastocyst/zygote would be shed during menstruation. The hormones in hormonal IUDs prevent pregnancy by thickening cervical mucus and trapping sperm. The hormones may also interfere with ovulation, so there is no egg to fertilize.

For both types of IUDs, the failure rates are <1%, and failure rates with typical use are virtually the same as failure rates with perfect use. Their effectiveness is one reason that IUDs are among the most widely used forms of reversible contraception. Once removed, even after long-term use, fertility returns to normal immediately. On the other hand, IUDs do have a risk of complications, including increased menstrual bleeding and more painful menstrual cramps. IUDs are also occasionally expelled from the uterus, and there is a slight risk of perforation of the uterus by the IUD.

Behavioural Methods

The least effective methods of contraception are behavioural methods. They involve regulating the timing or method of intercourse to prevent introduction of sperm into the female reproductive tract, either altogether or when an egg may be present. Behavioural methods include fertility awareness methods and withdrawal. Abstinence from sexual activity, or at least from vaginal intercourse, is sometimes considered a behavioural method, as well — but it is unlikely to be practiced consistently enough by most people to prevent pregnancy. Even teens who receive abstinence-only sex education do not have reduced rates of pregnancy. Abstinence is also ineffective in cases of non-consensual sex.

Fertility Awareness Methods

Fertility awareness methods involve estimating the most fertile days of the menstrual cycle and then avoiding unprotected vaginal intercourse on those days. The most fertile days are generally a few days before ovulation occurs, the day of ovulation, and another day or two after that. Unless unprotected sex occurs on those days, pregnancy is unlikely. Techniques for estimating the most fertile days include monitoring and detecting minor changes in basal body temperature or cervical secretions. This requires daily motivation and diligence, so it is not surprising that typical-use failure rates of these methods are at least 20–25%, and for some individuals may be as high as using no contraception at all (85%).

Basal body temperature is the lowest body temperature when the body is at rest (usually during sleep). It is most often estimated by a temperature measurement taken immediately upon awakening in the morning and before any physical activity has occurred. Basal body temperature normally rises after ovulation occurs, as shown in the graph below (Figure 18.11.7). The increase in temperature is small but consistent and may be used to determine when ovulation occurs, around which time unprotected intercourse should be avoided to prevent pregnancy. However, basal body temperature only shows when ovulation has already occurred, and it cannot predict in advance when ovulation will occur. Sperm can live for up to a week in the female reproductive tract, so determining the occurrence of ovulation only after ovulation has already happened is a major drawback of this method.

Monitoring cervical mucus has the potential for being more effective than monitoring basal body temperature, because it can predict ovulation ahead of time. As ovulation approaches, cervical secretions usually increase in amount and become thinner (which helps sperm swim through the cervical canal). By recognizing the changing characteristics of cervical mucus, a woman may be able to predict when she will ovulate. From this information, she can determine when she should avoid unprotected sex to prevent pregnancy.

Withdrawal

Withdrawal (also called coitus interruptus) is the practice of withdrawing the penis from the vagina before ejaculation ensues. The main risk of the withdrawal method is that the man may not perform the maneuver correctly or in a timely manner. Fluid typically released from the penis before ejaculation occurs may also contain some sperm. In addition, if sperm are ejaculated just outside of the vagina, there is a chance they will be able to enter the vagina and travel through the female reproductive tract to fertilize an egg. For all these reasons, the withdrawal method has a relatively high failure rate of about 22% with typical use.

Sterilization

The most effective contraceptive method is sterilization. In both sexes, sterilization generally involves surgical procedures that are considered irreversible. Additional surgery may be able to reverse a sterilization procedure, but there are no guarantees. Male sterilization is generally less invasive and less risky than female sterilization.

Male Sterilization

Male sterilization is usually achieved with a vasectomy. In this surgery, the vas deferens from each testis is clamped, cut, or otherwise sealed (see Figure 18.11.8). This prevents sperm from traveling from the epididymis to the ejaculatory ducts and being ejaculated from the penis. The same amount of semen will still be ejaculated, but it will not contain any sperm, making fertilization impossible. After a vasectomy, the testes continue to produce sperm, but the sperm are reabsorbed. It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. In the meantime, another method of birth control should be used.

Female Sterilization

The procedure undertaken for female sterilization is usually tubal ligation. The oviducts may be tied or cut in a surgical procedure, which permanently blocks the tubes. Alternatively, tiny metal implants may be inserted into the oviducts in a nonsurgical procedure. Over time, scar tissue grows around the implants and permanently blocks the tubes. Either method stops eggs from traveling from the ovaries through the oviducts, where fertilization usually takes place.

Emergency Contraception

Emergency contraception is any form of contraception that is used after unprotected vaginal intercourse. One method is the so-called “morning-after” pill. This is essentially a high-dose birth control pill that helps prevent pregnancy by temporarily preventing ovulation. It works only if ovulation has not already occurred, and when taken within five days after unprotected sex. The sooner the pill is taken, the more likely it is to work. Another method of emergency contraception is the IUD. An IUD that is inserted up to five days after unprotected sex can prevent nearly 100% of pregnancies. It keeps sperm from reaching and fertilizing an egg, or inhibits implantation if an ovum has already been fertilized. The IUD can then be left in place to prevent future pregnancies.

Attributions

Figure 18.11.1

512px-Marie_Stopes [cropped] by AdamBMorgan on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/public_domain). (Original by Unknown author: File:Marie Stopes in her laboratory, 1904.jpg).

Figure 18.11.2
Effectivenessofcontraceptives by Center for Disease Control and Prevention on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/public_domain).

Figure 18.11.3

Condom by  Reproductive Health Supplies Coalition on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 18.11.4

Female condom by Ceridwen on Wikimedia Commons is used under a CC BY-SA 2.0 FR (https://creativecommons.org/licenses/by-sa/2.0/fr/deed.en) license.

Figure 18.11.5

Contraceptive_diaphragm by Axefan2 on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/public_domain).

Figure 18.11.6

1024px-Blausen_0585_IUD by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 18.11.7

Basal_Body_Temperature by BruceBlaus on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 18.11.8

1024px-Open_Vasectomy_ by Timdwilliamson on Wikimedia Commons is used under a CC BY SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

References

Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

SciShow. (2012, August 16). Finally, a male pill? YouTube. https://www.youtube.com/watch?v=vIaL5QiKbWI&feature=youtu.be

Stopes, M. (1918). Married love. Wikisource. https://en.wikisource.org/w/index.php?title=Married_Love&oldid=6230157 (Originally published with Preface and Notes by William J. Robinson, by The Critic and Guide Company. This book was banned in the United States until 1933.)

TED-Ed. (2016, September). How do contraceptives work? - NWHunter. YouTube. https://www.youtube.com/watch?v=Zx8zbTMTncs&feature=youtu.be

Time. (2015, January 30). The history of birth control | TIME. YouTube. https://www.youtube.com/watch?v=jdr1yDO7MoY&feature=youtu.be

Wikipedia contributors. (2020, August 9). Marie Stopes. In Wikipedia. https://en.wikipedia.org/w/index.php?title=Marie_Stopes&oldid=972063381

Created by CK-12 Foundation/Adapted by Christine Miller

The white patches on either side of the throat in Figure 17.3.1 are signs of tonsillitis. The tonsils are small structures in the throat that are very common sites of infection. The white spots on the tonsils pictured here are evidence of infection. The patches consist of large amounts of dead bacteria, cellular debris, and white blood cells — in a word: pus. Children with recurrent tonsillitis may have their tonsils removed surgically to eliminate this type of infection. The tonsils are organs of the lymphatic system.

The lymphatic system is a collection of organs involved in the production, maturation, and harboring of white blood cells called lymphocytes. It also includes a network of vessels that transport or filter the fluid known as lymph in which lymphocytes circulate. Figure 17.3.2 shows major lymphatic vessels and other structures that make up the lymphatic system. Besides the tonsils, organs of the lymphatic system include the thymus, the spleen, and hundreds of lymph nodes distributed along the lymphatic vessels.

The lymphatic vessels form a transportation network similar in many respects to the blood vessels of the cardiovascular system. However, unlike the cardiovascular system, the lymphatic system is not a closed system. Instead, lymphatic vessels carry lymph in a single direction — always toward the upper chest, where the lymph empties from lymphatic vessels into blood vessels.

The return of lymph to the bloodstream is one of the major functions of the lymphatic system. When blood travels through capillaries of the cardiovascular system, it is under pressure, which forces some of the components of blood (such as water, oxygen, and nutrients) through the walls of the capillaries and into the tissue spaces between cells, forming tissue fluid, also called interstitial fluid (see Figure 17.3.3). Interstitial fluid bathes and nourishes cells, and also absorbs their waste products. Much of the water from interstitial fluid is reabsorbed into the capillary blood by osmosis. Most of the remaining fluid is absorbed by tiny lymphatic vessels called lymph capillaries. Once interstitial fluid enters the lymphatic vessels, it is called lymph. Lymph is very similar in composition to blood plasma. Besides water, lymph may contain proteins, waste products, cellular debris, and pathogens. It also contains numerous white blood cells, especially the subset of white blood cells known as lymphocytes. In fact, lymphocytes are the main cellular components of lymph.

The lymph that enters lymph capillaries in tissues is transported through the lymphatic vessel network to two large lymphatic ducts in the upper chest. From there, the lymph flows into two major veins (called subclavian veins) of the cardiovascular system. Unlike blood, lymph is not pumped through its network of vessels. Instead, lymph moves through lymphatic vessels via a combination of contractions of the vessels themselves and the forces applied to the vessels externally by skeletal muscles, similarly to how blood moves through veins. Lymphatic vessels also contain numerous valves that keep lymph flowing in just one direction, thereby preventing backflow.

Lymphatic vessels called lacteals (see Figure 17.3.4) are present in the lining of the gastrointestinal tract, mainly in the small intestine. Each tiny villus in the lining of the small intestine has an internal bed of capillaries and lacteals. The capillaries absorb most nutrients from the digestion of food into the blood. The lacteals absorb mainly fatty acids from lipid digestion into the lymph, forming a fatty-acid-enriched fluid called chyle. Vessels of the lymphatic network then transport chyle from the small intestine to the main lymphatic ducts in the chest, from which it drains into the blood circulation. The nutrients in chyle then circulate in the blood to the liver, where they are processed along with the other nutrients that reach the liver directly via the bloodstream.

The primary immune function of the lymphatic system is to protect the body against pathogens and cancerous cells. This function of the lymphatic system is centred on the production, maturation, and circulation of lymphocytes. Lymphocytes are leukocytes that are involved in the adaptive immune system. They are responsible for the recognition of — and tailored defense against — specific pathogens or tumor cells. Lymphocytes may also create a lasting memory of pathogens, so they can be attacked quickly and strongly if they ever invade the body again. In this way, lymphocytes bring about long-lasting immunity to specific pathogens.

There are two major types of lymphocytes, called B cells and T cells. Both B cells and T cells are involved in the adaptive immune response, but they play different roles.

Production and Maturation of Lymphocytes

Like all other types of blood cells (including erythrocytes), both B cells and T cells are produced from stem cells in the red marrow inside bones. After lymphocytes first form, they must go through a complicated maturation process before they are ready to search for pathogens. In this maturation process, they “learn” to distinguish self from non-self. Only those lymphocytes that successfully complete this maturation process go on to actually fight infections by pathogens.

B cells mature in the bone marrow, which is why they are called B cells. After they mature and leave the bone marrow, they travel first to the circulatory system and then enter the lymphatic system to search for pathogens. T cells, on the other hand, mature in the thymus, which is why they are called T cells. The thymus is illustrated in Figure 17.3.5. It is a small lymphatic organ in the chest that consists of an outer cortex and inner medulla, all surrounded by a fibrous capsule. After maturing in the thymus, T cells enter the rest of the lymphatic system to join B cells in the hunt for pathogens. The bone marrow and thymus are called primary lymphoid organs because of their role in the production and/or maturation of lymphocytes.

Lymphocytes in Secondary Lymphoid Organs

The tonsils, spleen, and lymph nodes are referred to as secondary lymphoid organs. These organs do not produce or mature lymphocytes. Instead, they filter lymph and store lymphocytes. It is in these secondary lymphoid organs that pathogens (or their antigens) activate lymphocytes and initiate adaptive immune responses. Activation leads to cloning of pathogen-specific lymphocytes, which then circulate between the lymphatic system and the blood, searching for and destroying their specific pathogens by producing antibodies against them.

Tonsils

There are four pairs of human tonsils. Three of the four are shown in Figure 17.3.6. The fourth pair, called tubal tonsils, is located at the back of the nasopharynx. The palatine tonsils are the tonsils that are visible on either side of the throat. All four pairs of tonsils encircle a part of the anatomy where the respiratory and gastrointestinal tracts intersect, and where pathogens have ready access to the body. This ring of tonsils is called Waldeyer's ring.

Spleen

The spleen (Figure 17.3.7) is the largest of the secondary lymphoid organs, and is centrally located in the body. Besides harboring lymphocytes and filtering lymph, the spleen also filters blood. Most dead or aged erythrocytes are removed from the blood in the red pulp of the spleen. Lymph is filtered in the white pulp of the spleen. In the fetus, the spleen has the additional function of producing red blood cells. This function is taken over by bone marrow after birth.

Lymph Nodes

Each lymph node is a small, but organized collection of lymphoid tissue (see Figure 17.3.8) that contains many lymphocytes. Lymph nodes are located at intervals along the lymphatic vessels, and lymph passes through them on its way back to the blood.

There are at least 500 lymph nodes in the human body. Many of them are clustered at the base of the limbs and in the neck. Figure 17.3.9 shows the major lymph node concentrations, and includes the spleen and the region named Waldeyer’s ring, which consists of the tonsils.

When lymph nodes become enlarged and tender to the touch, they are obvious signs of immune system activity. Because it is easy to see and feel swollen lymph nodes, they are one way an individual can monitor his or her own health. To be useful in this way, it is important to know the myths and realities about swollen lymph nodes.

 

Myth	Reality
"You should see a doctor immediately whenever you have swollen lymph nodes."	Lymph nodes are constantly filtering lymph, so it is expected that they will change in size with varying amounts of debris or pathogens that may be present. A minor, unnoticed infection may cause swollen lymph nodes that may last for a few weeks. Generally, lymph nodes that return to their normal size within two or three weeks are not a cause for concern.
"Swollen lymph nodes mean you have a bacterial infection."	Although an infection is the most common cause of swollen lymph nodes, not all infections are caused by bacteria. Mononucleosis, for example, commonly causes swollen lymph nodes, and it is caused by viruses. There are also other causes of swollen lymph nodes besides infections, such as cancer and certain medications.
"A swollen lymph node means you have cancer."	Cancer is far less likely to be the cause of a swollen lymph node than is an infection. However, if a lymph node remains swollen longer than a few weeks — especially in the absence of an apparent infection — you should have your doctor check it.
"Cancer in a lymph node always originates somewhere else. There is no cancer of the lymph nodes."	Cancers do commonly spread from their site of origin to nearby lymph nodes and then to other organs, but cancer may also originate in the lymph nodes. This type of cancer is called lymphoma.

 

Attributions

Figure 17.3.1

512px-Tonsillitis by Michaelbladon at English Wikipedia on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).  (Transferred from en.wikipedia to Commons by Kauczuk)

Figure 17.3.2

Blausen_0623_LymphaticSystem_Female by BruceBlaus  on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 17.3.3

2201_Anatomy_of_the_Lymphatic_System (cropped) by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 17.3.4

1000px-Intestinal_villus_simplified.svg by Snow93 on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 17.3.5

2206_The_Location_Structure_and_Histology_of_the_Thymus by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 17.3.6

Blausen_0861_Tonsils&Throat_Anatomy2 by BruceBlaus  on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 17.3.7

Figure_42_02_14 by CNX OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 17.3.8

Illu_lymph_node_structure by NCI/ SEER Training on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain). (Archives: https://web.archive.org/web/20070311015818/http://training.seer.cancer.gov/module_anatomy/unit8_2_lymph_compo1_nodes.html)

Figure 17.3.9

1000px-Lymph_node_regions.svg by Fred the Oyster (derivative work) on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain). (Original by NCI/ SEER Training)

References

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 21.2 Anatomy of the lymphatic system [digital image].  In Anatomy and Physiology (Section 21.1). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/21-1-anatomy-of-the-lymphatic-and-immune-systems

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 21.7 Location, structure, and histology of the thymus [digital image].  In Anatomy and Physiology (Section 21.1). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/21-1-anatomy-of-the-lymphatic-and-immune-systems

Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

Compton Care. (2016, March 7). What is lymphoedema or lymphedema? YouTube. https://www.youtube.com/watch?v=RMLPwOiYnII&feature=youtu.be

OpenStax. (2016, May 27) Figure 14. The spleen is similar to a lymph node but is much larger and filters blood instead of lymph [digital image]. In Open Stax, Biology (Section 42.2). OpenStax CNX.  https://cnx.org/contents/GFy_h8cu@10.8:etZobsU-@6/Adaptive-Immune-Response

Simple Nursing. (2015, June 28). Spleen physiology What does the spleen do in 2 minutes. YouTube. https://www.youtube.com/watch?v=ah74jT00jBA&feature=youtu.be

University Hospitals Bristol and Weston NHS FT. (2020, May 13). How to check your lymph nodes. YouTube. https://www.youtube.com/watch?v=L4KexZZAdyA&feature=youtu.be

 

Created by CK-12 Foundation/Adapted by Christine Miller

It’s just a paper cut, but the break in your skin could provide an easy way for pathogens to enter your body. If bacteria were to enter through the cut and infect the wound, your innate immune system would quickly respond with a dizzying array of general defenses.

The innate immune system is a subset of the human immune system that produces rapid, but non-specific responses to pathogens. Innate responses are generic, rather than tailored to a particular pathogen. The innate system responds in the same general way to every pathogen it encounters. Although the innate immune system provides immediate and rapid defenses against pathogens, it does not confer long-lasting immunity to them. In most organisms, the innate immune system is the dominant system of host defense. Other than most vertebrates (including humans), the innate immune system is the only system of host defense.

In humans, the innate immune system includes surface barriers, inflammation, the complement system, and a variety of cellular responses. Surface barriers of various types generally keep most pathogens out of the body. If these barriers fail, then other innate defenses are triggered. The triggering event is usually the identification of pathogens by pattern-recognition receptors on cells of the innate immune system. These receptors recognize molecules that are broadly shared by pathogens, but distinguishable from host molecules. Alternatively, the other innate defenses may be triggered when damaged, injured, or stressed cells send out alarm signals, many of which are recognized by the same receptors as those that recognize pathogens.

The body’s first line of defense consists of three different types of barriers that keep most pathogens out of body tissues. The types of barriers are mechanical, chemical, and biological barriers.

Mechanical Barriers

Mechanical barriers are the first line of defense against pathogens, and they physically block pathogens from entering the body. The skin is the most important mechanical barrier. In fact, it is the single most important defense the body has. The outer layer of skin — the epidermis — is tough, and very difficult for pathogens to penetrate. It consists of dead cells that are constantly shed from the body surface, a process that helps remove bacteria and other infectious agents that have adhered to the skin. The epidermis also lacks blood vessels and is usually lacking moisture, so it does not provide a suitable environment for most pathogens. Hair — which is an accessory organ of the skin — also helps keep out pathogens. Hairs inside the nose may trap larger pathogens and other particles in the air before they can enter the airways of the respiratory system (see Figure 17.4.2).

Mucous membranes provide a mechanical barrier to pathogens and other particles at body openings. These membranes also line the respiratory, gastrointestinal, urinary, and reproductive tracts. Mucous membranes secrete mucus, which is a slimy and somewhat sticky substance that traps pathogens. Many mucous membranes also have hair-like cilia that sweep mucus and trapped pathogens toward body openings, where they can be removed from the body. When you sneeze or cough, mucus and pathogens are mechanically ejected from the nose and throat, as you can see in Figure 17.4.3.  A sneeze can travel as fast as 160 Km/hr (about 99 mi/hour) and expel as many as 100,000 droplets into the air around you (a good reason to cover your sneezes!). Other mechanical defenses include tears, which wash pathogens from the eyes, and urine, which flushes pathogens out of the urinary tract.

Chemical Barriers

Chemical barriers also protect against infection by pathogens. They destroy pathogens on the outer body surface, at body openings, and on inner body linings. Sweat, mucus, tears, saliva, and breastmilk all contain antimicrobial substances (such as the enzyme lysozyme) that kill pathogens, especially bacteria. Sebaceous glands in the dermis of the skin secrete acids that form a very fine, slightly acidic film on the surface of the skin. This film acts as a barrier to bacteria, viruses, and other potential contaminants that might penetrate the skin. Urine and vaginal secretions are also too acidic for many pathogens to endure. Semen contains zinc — which most pathogens cannot tolerate — as well as defensins, which are antimicrobial proteins that act mainly by disrupting bacterial cell membranes. In the stomach, stomach acid and digestive enzymes called proteases (which break down proteins) kill most of the pathogens that enter the gastrointestinal tract in food or water.

Biological Barriers

Biological barriers are living organisms that help protect the body from pathogens. Trillions of harmless bacteria normally live on the human skin and in the urinary, reproductive, and gastrointestinal tracts. These bacteria use up food and surface space that help prevent pathogenic bacteria from colonizing the body. Some of these harmless bacteria also secrete substances that change the conditions of their environment, making it less hospitable to potentially harmful bacteria. They may release toxins or change the pH, for example. All of these effects of harmless bacteria reduce the chances that pathogenic microorganisms will be able to reach sufficient numbers and cause illness.

If pathogens manage to breach the barriers protecting the body, one of the first active responses of the innate immune system kicks in. This response is inflammation. The main function of inflammation is to establish a physical barrier against the spread of infection. It also eliminates the initial cause of cell injury, clears out dead cells and tissues damaged from the original insult and the inflammatory process, and initiates tissue repair. Inflammation is often a response to infection by pathogens, but there are other possible causes, including burns, frostbite, and exposure to toxins.

The signs and symptoms of inflammation include redness, swelling, warmth, pain, and frequently some loss of function. These symptoms are caused by increased blood flow into infected tissue, and a number of other processes, illustrated in Figure 17.4.4.

Inflammation is triggered by chemicals such as cytokines and histamines,which are released by injured or infected cells, or by immune system cells such as macrophages (described below) that are already present in tissues. These chemicals cause capillaries to dilate and become leaky, increasing blood flow to the infected area and allowing blood to enter the tissues. Pathogen-destroying leukocytes and tissue-repairing proteins migrate into tissue spaces from the bloodstream to attack pathogens and repair their damage. Cytokines also promote chemotaxis, which is migration to the site of infection by pathogen-destroying leukocytes. Some cytokines have anti-viral effects. They may shut down protein synthesis in host cells, which viruses need in order to survive and replicate.

See the video "The inflammatory response" by Neural Academy to learn about inflammatory response in more detail:

https://youtu.be/Fbzb75HA9M8

The inflammatory response, Neural Academy, 2019.

The complement system is a complex biochemical mechanism named for its ability to “complement” the killing of pathogens by antibodies, which are produced as part of an adaptive immune response. The complement system consists of more than two dozen proteins normally found in the blood and synthesized in the liver. The proteins usually circulate as non-functional precursor molecules until activated.

As shown in Figure 17.4.5, when the first protein in the complement series is activated —typically by the binding of an antibody to an antigen on a pathogen — it sets in motion a domino effect. Each component takes its turn in a precise chain of steps known as the complement cascade. The end product is a cylinder that punctures a hole in the pathogen’s cell membrane. This allows fluids and molecules to flow in and out of the cell, which swells and bursts.

Cellular responses of the innate immune system involve a variety of different types of leukocytes. Many of these leukocytes circulate in the blood and act like independent, single-celled organisms, searching out and destroying pathogens in the human host. These and other immune cells of the innate system identify pathogens or debris, and then help to eliminate them in some way. One way is by phagocytosis.

Phagocytosis

Phagocytosis is an important feature of innate immunity that is performed by cells classified as phagocytes. In the process of phagocytosis, phagocytes engulf and digest pathogens or other harmful particles. Phagocytes generally patrol the body searching for pathogens, but they can also be called to specific locations by the release of cytokines when inflammation occurs. Some phagocytes reside permanently in certain tissues.

As shown in Figure 17.4.6, when a pathogen such as a bacterium is encountered by a phagocyte, the phagocyte extends a portion of its plasma membrane, wrapping the membrane around the pathogen until it is enveloped. Once inside the phagocyte, the pathogen becomes enclosed within an intracellular vesicle called a phagosome. The phagosome then fuses with another vesicle called a lysosome, forming a phagolysosome. Digestive enzymes and acids from the lysosome kill and digest the pathogen in the phagolysosome. The final step of phagocytosis is excretion of soluble debris from the destroyed pathogen through exocytosis.

Types of leukocytes that kill pathogens by phagocytosis include neutrophils, macrophages, and dendritic cells. You can see illustrations of these and other leukocytes involved in innate immune responses in Figure 17.4.7.

Neutrophils

Neutrophils are leukocytes that travel throughout the body in the blood. They are usually the first immune cells to arrive at the site of an infection. They are the most numerous types of phagocytes, and they normally make up at least half of the total circulating leukocytes. The bone marrow of a normal healthy adult produces more than 100 billion neutrophils per day. During acute inflammation, more than ten times that many neutrophils may be produced each day. Many neutrophils are needed to fight infections, because after a neutrophil phagocytizes just a few pathogens, it generally dies.

Macrophages

Macrophages are large phagocytic leukocytes that develop from monocytes. Macrophages spend much of their time within the interstitial fluid in body tissues. They are the most efficient phagocytes, and they can phagocytize substantial numbers of pathogens or other cells. Macrophages are also versatile cells that produce a wide array of chemicals — including enzymes, complement proteins, and cytokines — in addition to their phagocytic action. As phagocytes, macrophages act as scavengers that rid tissues of worn-out cells and other debris, as well as pathogens. In addition, macrophages act as antigen-presenting cells that activate the adaptive immune system.

Dendritic Cells

Like macrophages, dendritic cells develop from monocytes. They reside in tissues that have contact with the external environment, so they are located mainly in the skin, nose, lungs, stomach, and intestines. Besides engulfing and digesting pathogens, dendritic cells also act as antigen-presenting cells that trigger adaptive immune responses.

Eosinophils

Eosinophils are non-phagocytic leukocytes that are related to neutrophil. They specialize in defending against parasites. They are very effective in killing large parasites (such as worms) by secreting a range of highly-toxic substances when activated. Eosinophils may become overactive and cause allergies or asthma.

Basophils

Basophils are non-phagocytic leukocytes that are also related to neutrophils. They are the least numerous of all white blood cells. Basophils secrete two types of chemicals that aid in body defenses: histamines and heparin. Histamines are responsible for dilating blood vessels and increasing their permeability in inflammation. Heparin inhibits blood clotting, and also promotes the movement of leukocytes into an area of infection.

Mast Cells

Mast cells are non-phagocytic leukocytes that help initiate inflammation by secreting histamines. In some people, histamines trigger allergic reactions, as well as inflammation. Mast cells may also secrete chemicals that help defend against parasites.

Natural Killer Cells

Natural killer cells are in the subset of leukocytes called lymphocytes, which are produced by the lymphatic system. Natural killer cells destroy cancerous or virus-infected host cells, although they do not directly attack invading pathogens. Natural killer cells recognize these host cells by a condition they exhibit called “missing self.” Cells with missing self have abnormally low levels of cell-surface proteins of the major histocompatibility complex (MHC), which normally identify body cells as self.

Many pathogens have evolved mechanisms that allow them to evade human hosts' innate immune systems. Some of these mechanisms include:

• Invading host cells to replicate so they are “hidden” from the immune system. The bacterium that causes tuberculosis uses this mechanism.
• Forming a protective capsule around themselves to avoid being destroyed by immune system cells. This defense occurs in bacteria, such as Salmonella species.
• Mimicking host cells so the immune system does not recognize them as foreign. Some species of Staphylococcus bacteria use this mechanism.
• Directly killing phagocytes. This ability evolved in several species of bacteria, including the species that causes anthrax.
• Producing molecules that prevent the formation of interferons, which are immune chemicals that fight viruses. Some influenza viruses have this capability.
• Forming complex biofilms that provide protection from the cells and proteins of the immune system. This characterizes some species of bacteria and fungi. You can see an example of a bacterial biofilm on teeth in Figure 17.4.8.

Attributions

Figure 17.4.1

Oww_Papercut_14365 by Laurence Facun on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

Figure 17.4.2

hairy-nose by Piotr Siedlecki  on publicdomainpictures.net is used under a CC0 1.0 Universal Public Domain Dedication (http://creativecommons.org/publicdomain/zero/1.0/) license.

Figure 17.4.3

1024px-Sneeze by James Gathany/ CDC Public Health Image library (PHIL) ID# 11162 on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/public_domain).

Figure 17.4.4

OSC_Microbio_17_06_Erythema by CNX OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 17.4.5

2212_Complement_Cascade_and_Function by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 17.4.6

512px-Phagocytosis2 by Graham Colm at English Wikipedia on Wikimedia Commons is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) license.

Figure 17.4.7

Innate_Immune_cells.svg by Fred the Oyster on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 17.4.8

1024px-Gingivitis-before-and-after-3 by Onetimeuseaccount on Wikimedia Commons is used under a CC0 1.0 Universal Public Domain Dedication (http://creativecommons.org/publicdomain/zero/1.0/) license.

References

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 21.13 Complement cascade and function [digital image].  In Anatomy and Physiology (Section 21.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/21-2-barrier-defenses-and-the-innate-immune-response

Discovery. (2011, October 27). Cough grosser than sneeze? | Curiosity - World's dirtiest man. YouTube. https://www.youtube.com/watch?v=dy1D3d1FBcw&feature=youtu.be

Gross Science. (2017, January 31). Everything you didn't want to know about snot. YouTube. https://www.youtube.com/watch?v=shEPwQPQG4I&feature=youtu.be

Janux. (2015, January 10). Human physiology - Innate immune system. YouTube. https://www.youtube.com/watch?v=sYjtMP67vyk&feature=youtu.be

Mayo Clinic Staff. (n.d.). Anthrax [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/anthrax/symptoms-causes/syc-20356203

Mayo Clinic Staff. (n.d.). Influenza (flu) [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719

Mayo Clinic Staff. (n.d.). Salmonella infection [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/salmonella/symptoms-causes/syc-20355329

Mayo Clinic Staff. (n.d.). Staph infection [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/staph-infections/multimedia/staph-infection/img-20008600

Mayo Clinic Staff. (n.d.). Tuberculosis [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250

OpenStax. (2016, November 11). Figure 17.23 A typical case of acute inflammation at the site of a skin wound - Erythema [digital image]. In OpenStax, Microbiology (Section 17.5). https://openstax.org/details/books/microbiology?Bookdetails

TED. (2014, October 14). Myriam Sidibe: The simple power of handwashing. YouTube. https://www.youtube.com/watch?v=c64M1tZyWPM&feature=youtu.be

TED-Ed. (2015, November 5). How mucus keeps us healthy - Katharina Ribbeck. YouTube. https://www.youtube.com/watch?v=WW4skW6gucU&feature=youtu.be

A division of the autonomic nervous system that controls digestive functions.

A rigid organ that constitutes part of the vertebrate skeleton in animals.

Created by: CK-12/Adapted by Christine Miller

All in the Family

This family photo (Figure 5.12.1) clearly illustrates an important point: children in a family resemble their parents and each other, but the children never look exactly the same, unless they are identical twins. Each of the daughters in the photo have inherited a unique combination of traits from the parents. In this concept, you will learn how this happens. It all begins with sex — sexual reproduction, that is.

Reproduction is the process by which organisms give rise to offspring. It is one of the defining characteristics of living things. Like many other organisms, human beings reproduce sexually. Sexual reproduction involves two parents. As you can see from Figure 5.12.2, in sexual reproduction, parents produce reproductive (sex) cells — called gametes — that unite to form an offspring. Gametes are haploid (or 1N) cells. This means they contain one copy of each chromosome in the nucleus. Gametes are produced by a type of cell division called meiosis, which is described in detail below. The process in which two gametes unite is called fertilization. The fertilized cell that results is referred to as a zygote. A zygote is a diploid (or 2N) cell, which means it contains two copies of each chromosome. Thus, it has twice the number of chromosomes as a gamete.

The process that produces haploid gametes is called meiosis. Meiosis is a type of cell division in which the number of chromosomes is reduced by half. It occurs only in certain special cells of an organism. During meiosis, homologous (paired) chromosomes separate, and four haploid cells form that have only one chromosome from each pair. The diagram (Figure 5.12.3) gives an overview of meiosis.

As you can see in the meiosis diagram, two cell divisions occur during the overall process, producing a total of four haploid cells from one parent cell. The two cell divisions are called meiosis I and meiosis II. Meiosis I begins after DNA replicates during interphaseno post. Meiosis II follows meiosis I without DNA replicating again. Both meiosis I and meiosis II occur in four phases, called prophase, metaphase, anaphase, and telophase. You may recognize these four phases from mitosis, the division of the nucleus that takes place during routine cell division of eukaryotic cells.

Meiosis I- Increasing genetic variation

The phases of Meiosis I are:

1. Prophase I: The nuclear envelope begins to break down, and the chromosomes condense. Centrioles start moving to opposite poles of the cell, and a spindle begins to form. Importantly, homologous chromosomes pair up, which is unique to prophase I. In prophase of mitosis and meiosis II, homologous chromosomes do not form pairs in this way. During prophase I, crossing-over occurs. The significance of crossing-over is discussed below.
2. Metaphase I: Spindle fibres attach to the paired homologous chromosomes. The paired chromosomes line up along the equator of the cell, randomly aligning in a process called independent alignment.  The significance of independent alignment is discussed below. This occurs only in metaphase I. In metaphase of mitosis and meiosis II, it is sister chromatids that line up along the equator of the cell.
3. Anaphase I: Spindle fibres shorten, and the chromosomes of each homologous pair start to separate from each other. One chromosome of each pair moves toward one pole of the cell, and the other chromosome moves toward the opposite pole.
4. Telophase I and Cytokinesis: The spindle breaks down, and new nuclear membranes form. The cytoplasm of the cell divides, and two haploid daughter cells result. The daughter cells each have a random assortment of chromosomes, with one from each homologous pair. Both daughter cells go on to meiosis II.

Meiosis II- Halfing the DNA

The phases of Meiosis II are:

1. Prophase II: The nuclear envelope breaks down, and the spindle begins to form in each haploid daughter cell from meiosis I. The centrioles also start to separate.
2. Metaphase II: Spindle fibres line up the sister chromatids of each chromosome along the equator of the cell.
3. Anaphase II: Sister chromatids separate and move to opposite poles.
4. Telophase II and Cytokinesis: The spindle breaks down, and new nuclear membranes form. The cytoplasm of each cell divides, and four haploid cells result. Each cell has a unique combination of chromosomes.

At the end of meiosis, four haploid cells have been produced, but the cells are not yet gametes. The cells need to develop before they become mature gametes capable of fertilization. The development of haploid cells into gametes is called gametogenesis. It differs between males and females.

• A gamete produced by a male is called a sperm, and the process that produces a mature sperm is called spermatogenesis. During this process, a sperm cell grows a tail and gains the ability to “swim,” like the human sperm cell shown in Figure 5.12.8.
• A gamete produced by a female is called anegg or ovum, and the process that produces a mature egg is called oogenesis, during which just one functional egg is produced. The other three haploid cells that result from meiosis are called polar bodies, and they disintegrate. The single egg is a very large cell, as you can see from the human egg also shown in Figure 5.12.8.

Figure 5.12.1

Family portrait by loly galina on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 5.12.2

Human Life Cycle by Christine Miller is used under a CC BY-NC-SA 4.0 (https://creativecommons.org/licenses/by-nc-sa/4.0/) license.

Figure 5.12.3

MajorEventsInMeiosis_variant_int by PatríciaR (internationalization) on Wikimedia Commons is used and adapted by Christine Miller. This image in the public domain. (Original image from NCBI; original vector version by Jakov.)

Figure 5.12.4

Meiosis 1/ Meiosis Stages by Ali Zifan on Wikimedia Commons is used and adapted by Christine Miller under a  CC BY-SA 4.0  (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 5.12.5

Meiosis 2/ Meiosis Stages by Ali Zifan on Wikimedia Commons is used and adapted by Christine Miller under a  CC BY-SA 4.0  (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 5.12.6

Crossover/ Figure 17 02 01 by CNX OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 5.12.7

Independent_assortment by Mtian20 on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 5.12.8

sperm fertilizing egg by AndreaLaurel on Flickr is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/) license.

References

Amoeba Sisters. (2017, July 11). Meiosis (updated). YouTube. https://www.youtube.com/watch?v=VzDMG7ke69g&feature=youtu.be

Amoeba Sisters. (2018, May 31). Mitosis vs meiosis comparison. YouTube. https://www.youtube.com/watch?v=zrKdz93WlVk&feature=youtu.be

CrashCourse, (2012, April 23). Meiosis: Where the sex starts - Crash Course Biology #13. YouTube. https://www.youtube.com/watch?v=qCLmR9-YY7o&feature=youtu.be

OpenStax CNX. (2016, May 27). Figure 1 Crossover may occur at different locations on the chromosome. In OpenStax, Biology (Section 17.2). http://cnx.org/contents/185cbf87-c72e-48f5-b51e-f14f21b5eabd@10.53.

Clear fluid produced by the brain that forms a thin layer within the meninges and provides protection and cushioning for the brain and spinal cord.

A long extension of the cell body of a neuron that transmits nerve impulses to other cells.

The central part of a neuron that contains the nucleus and other cell organelles.

Created by CK-12 Foundation/Adapted by Christine Miller

Did you ever hear of a person looking at something or someone with a “jaundiced eye”? It means to take a negative view, such as envy, maliciousness, or ill will. The expression may be based on the antiquated idea that liver bile is associated with such negative emotions as these, as well as the fact that excessive liver bile causes jaundice, or yellowing of the eyes and skin. Jaundice is likely a sign of a liver disorder or blockage of the duct that carries bile away from the liver. Bile contains waste products, making the liver an organ of excretion. Bile has an important role in digestion, which makes the liver an accessory organ of digestion, too.

Accessory organs of digestion are organs that secrete substances needed for the chemical digestion of food, but through which food does not actually pass as it is digested. Besides the liver, the major accessory organs of digestion are the gallbladder and pancreas. These organs secrete or store substances that are needed for digestion in the first part of the small intestine — the duodenum — where most chemical digestion takes place. You can see the three organs and their locations in Figure 15.6.2.

Liver

The liver is a vital organ located in the upper right part of the abdomen. It lies just below the diaphragm, to the right of the stomach. The liver plays an important role in digestion by secreting bile, but the liver has a wide range of additional functions unrelated to digestion. In fact, some estimates put the number of functions of the liver at about 500! A few of them are described below.

Structure of the Liver

The liver is a reddish brown, wedge-shaped structure. In adults, the liver normally weighs about 1.5 kg (about 3.3 lb). It is both the heaviest internal organ and the largest gland in the human body. The liver is divided into four lobes of unequal size and shape. Each lobe, in turn, is made up of lobules, which are the functional units of the liver. Each lobule consists of millions of liver cells, called hepatic cells (or hepatocytes). They are the basic metabolic cells that carry out the various functions of the liver.

As shown in Figure 15.6.3, the liver is connected to two large blood vessels: the hepatic artery and the portal vein. The hepatic artery carries oxygen-rich blood from the aorta, whereas the portal vein carries blood that is rich in digested nutrients from the GI tract and wastes filtered from the blood by the spleen. The blood vessels subdivide into smaller arteries and capillaries, which lead into the liver lobules. The nutrients from the GI tract are used to build many vital biochemical compounds, and the wastes from the spleen are degraded and excreted.

Functions of the Liver

The main digestive function of the liver is the production of bile. Bile is a yellowish alkaline liquid that consists of water, electrolytes, bile salts, and cholesterol, among other substances, many of which are waste products. Some of the components of bile are synthesized by hepatocytes. The rest are extracted from the blood.

As shown in Figure 15.6.4, bile is secreted into small ducts that join together to form larger ducts, with just one large duct carrying bile out of the liver. If bile is needed to digest a meal, it goes directly to the duodenum through the common bile duct. In the duodenum, the bile neutralizes acidic chyme from the stomach and emulsifies fat globules into smaller particles (called micelles) that are easier to digest chemically by the enzyme lipase. Bile also aids with the absorption of vitamin K. Bile that is secreted when digestion is not taking place goes to the gallbladder for storage until the next meal. In either case, the bile enters the duodenum through the common bile duct.

Besides its roles in digestion, the liver has many other vital functions:

• The liver synthesizes glycogen from glucose and stores the glycogen as required to help regulate blood sugar levels. It also breaks down the stored glycogen to glucose and releases it back into the blood as needed.
• The liver stores many substances in addition to glycogen, including vitamins A, D, B12, and K. It also stores the minerals iron and copper.
• The liver synthesizes numerous proteins and many of the amino acids needed to make them. These proteins have a wide range of functions. They include fibrinogen, which is needed for blood clotting; insulin-like growth factor (IGF-1), which is important for childhood growth; and albumen, which is the most abundant protein in blood serum and functions to transport fatty acids and steroid hormones in the blood.
• The liver synthesizes many important lipids, including cholesterol, triglycerides, and lipoproteins.
• The liver is responsible for the breakdown of many waste products and toxic substances. The wastes are excreted in bile or travel to the kidneys, which excrete them in urine.

The liver is clearly a vital organ that supports almost every other organ in the body. Because of its strategic location and diversity of functions, the liver is also prone to many diseases, some of which cause loss of liver function. There is currently no way to compensate for the absence of liver function in the long term, although liver dialysis techniques can be used in the short term. An artificial liver has not yet been developed, so liver transplantation may be the only option for people with liver failure.

The gallbladder is a small, hollow, pouch-like organ that lies just under the right side of the liver (see Figure 15.6.5). It is about 8 cm (about 3 in) long and shaped like a tapered sac, with the open end continuous with the cystic duct. The gallbladder stores and concentrates bile from the liver until it is needed in the duodenum to help digest lipids. After the bile leaves the liver, it reaches the gallbladder through the cystic duct. At any given time, the gallbladder may store between 30 to 60 mL (1 to 2 oz) of bile. A hormone stimulated by the presence of fat in the duodenum signals the gallbladder to contract and force its contents back through the cystic duct and into the common bile duct to drain into the duodenum.

Pancreas

The pancreas is a glandular organ that is part of both the digestive system and the endocrine system. As shown in Figure 15.6.6, it is located in the abdomen behind the stomach, with the head of the pancreas surrounded by the duodenum of the small intestine. The pancreas is about 15 cm (almost 6 in) long, and it has two major ducts: the main pancreatic duct and the accessory pancreatic duct. Both of these ducts drain into the duodenum.

As an endocrine gland, the pancreas secretes several hormones, including insulin and glucagon, which circulate in the blood. The endocrine hormones are secreted by clusters of cells called pancreatic islets (or islets of Langerhans). As a digestive organ, the pancreas secretes many digestive enzymes and also bicarbonate, which helps neutralize acidic chyme after it enters the duodenum. The pancreas is stimulated to secrete its digestive substances when food in the stomach and duodenum triggers the release of endocrine hormones into the blood that reach the pancreas via the bloodstream. The pancreatic digestive enzymes are secreted by clusters of cells called acini, and they travel through the pancreatic ducts to the duodenum. In the duodenum, they help to chemically break down carbohydrates, proteins, lipids, and nucleic acids in chyme. The pancreatic digestive enzymes include:

• Amylase, which helps digest starch and other carbohydrates.
• Trypsin and chymotrypsin, which help digest proteins.
• Lipase, which helps digest lipids.
• Deoxyribonucleases and ribonucleases, which help digest nucleic acids.

 

Attributions

Figure 15.6.1

Scleral_Icterus by Sheila J. Toro on Wikimedia Commons is used under a  CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 15.6.2

Blausen_0428_Gallbladder-Liver-Pancreas_Location by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 15.6.3

Diagram_showing_the_two_lobes_of_the_liver_and_its_blood_supply_CRUK_376.svg by Cancer Research UK on Wikimedia Commons is used under a CC BY-SA 4.0  (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 15.6.4

Gallbladder by NIH Image Gallery on Flickr is used CC BY-NC 2.0 (https://creativecommons.org/licenses/by-nc/2.0/) license.

Figure 15.6.5

Gallbladder_(organ) (1) by BruceBlaus on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license. (See a full animation of this medical topic at blausen.com.)

Figure 15.6.6

Blausen_0698_PancreasAnatomy by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

References

Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

nature video. (2018, December 19). Scar wars: Repairing the liver. YouTube. https://www.youtube.com/watch?v=a0d1yvGcfzQ&feature=youtu.be

TED-Ed. (2014, November 25). What does the liver do? - Emma Bryce. YouTube. https://www.youtube.com/watch?v=wbh3SjzydnQ&feature=youtu.be

TED-Ed. (2015, February 19). What does the pancreas do? - Emma Bryce. YouTube. https://www.youtube.com/watch?v=8dgoeYPoE-0&feature=youtu.be

Created by CK-12 Foundation/Adapted by Christine Miller

If you had a skin rash like the one shown in Figure 15.7.1, you probably wouldn’t assume that it was caused by a digestive system disease. However, that’s exactly why the individual in the picture has a rash. He has a gastrointestinal (GI) tract disorder called Crohn’s disease. This disease is one of a group of GI tract disorders that are known collectively as inflammatory bowel disease. Unlike other inflammatory bowel diseases, signs and symptoms of Crohn’s disease may not be confined to the GI tract.

Inflammatory bowel disease (IBD) is a collection of inflammatory conditions primarily affecting the intestines. The two principal inflammatory bowel diseases are Crohn’s disease and ulcerative colitis. Unlike Crohn’s disease — which may affect any part of the GI tract and the joints, as well as the skin — ulcerative colitis mainly affects just the colon and rectum. Both diseases occur when the body’s own immune systemno post attacks the digestive system. Both diseases typically first appear in the late teens or early twenties, and occur equally in males and females.  Approximately 270,000 Canadians are currently living with IBD, 7,000 of which are children.  The annual cost of caring for these Canadians is estimated at $1.28 billion.  The number of cases of IBD has been steadily increasing and it is expected that by 2030 the number of Canadians suffering from IBD will grow to 400,000.

Crohn’s Disease

Crohn’s disease is a type of inflammatory bowel disease that may affect any part of the GI tract from the mouth to the anus, among other body tissues. The most commonly affected region is the ileum, which is the final part of the small intestine. Signs and symptoms of Crohn’s disease typically include abdominal pain, diarrhea (with or without blood), fever, and weight loss. Malnutrition because of faulty absorption of nutrients may also occur. Potential complications of Crohn’s disease include obstructions and abscesses of the bowel. People with Crohn’s disease are also at slightly greater risk than the general population of developing bowel cancer. Although there is a slight reduction in life expectancy in people with Crohn’s disease, if the disease is well-managed, affected people can live full and productive lives.  Approximately 135,000 Canadians are living with Crohn's disease.

Crohn’s disease is caused by a combination of genetic and environmental factors that lead to impairment of the generalized immune response (called innate immunity). The chronic inflammation of Crohn’s disease is thought to be the result of the immune system “trying” to compensate for the impairment. Dozens of genes are likely to be involved, only a few of which have been identified. Because of the genetic component, close relatives such as siblings of people with Crohn’s disease are many times more likely to develop the disease than people in the general population. Environmental factors that appear to increase the risk of the disease include smoking tobacco and eating a diet high in animal proteins. Crohn’s disease is typically diagnosed on the basis of a colonoscopy, which provides a direct visual examination of the inside of the colon and the ileum of the small intestine.

People with Crohn’s disease typically experience recurring periods of flare-ups followed by remission. There are no medications or surgical procedures that can cure Crohn’s disease, although medications such as anti-inflammatory or immune-suppressing drugs may alleviate symptoms during flare-ups and help maintain remission. Lifestyle changes, such as dietary modifications and smoking cessation, may also help control symptoms and reduce the likelihood of flare-ups. Surgery may be needed to resolve bowel obstructions, abscesses, or other complications of the disease.

Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers (sores) in the colon and rectum. Unlike Crohn’s disease, other parts of the GI tract are rarely affected in ulcerative colitis. The primary symptoms of the disease are lower abdominal pain and bloody diarrhea. Weight loss, fever, and anemia may also be present. Symptoms typically occur intermittently with periods of no symptoms between flare-ups. People with ulcerative colitis have a considerably increased risk of colon cancer and should be screened for colon cancer more frequently than the general population. Ulcerative colitis, however, seems to primarily reduce the quality of life, and not the lifespan.

The exact cause of ulcerative colitis is not known. Theories about its cause involve immune system dysfunction, genetics, changes in normal gut bacteria, and lifestyle factors, such as a diet high in animal protein and the consumption of alcoholic beverages. Genetic involvement is suspected in part because ulcerative colitis tens to “run” in families. It is likely that multiple genes are involved. Diagnosis is typically made on the basis of colonoscopy and tissue biopsies.

Lifestyle changes, such as reducing the consumption of animal protein and alcohol, may improve symptoms of ulcerative colitis. A number of medications are also available to treat symptoms and help prolong remission. These include anti-inflammatory drugs and drugs that suppress the immune system. In cases of severe disease, removal of the colon and rectum may be required and can cure the disease.

Diverticulitis is a digestive disease in which tiny pouches in the wall of the large intestine become infected and inflamed. Symptoms typically include lower abdominal pain of sudden onset. There may also be fever, nausea, diarrhea or constipation, and blood in the stool. Having large intestine pouches called diverticula (see Figure 15.7.2) that are not inflamed is called diverticulosis. Diverticulosis is thought to be caused by a combination of genetic and environmental factors, and is more common in people who are obese. Infection and inflammation of the pouches (diverticulitis) occurs in about 10–25% of people with diverticulosis, and is more common at older ages. The infection is generally caused by bacteria.

Diverticulitis can usually be diagnosed with a CT scan and can be monitored with a colonoscopy (as seen in Figure 15.7.3). Mild diverticulitis may be treated with oral antibiotics and a short-term liquid diet. For severe cases, intravenous antibiotics, hospitalization, and complete bowel rest (no nourishment via the mouth) may be recommended. Complications such as abscess formation or perforation of the colon require surgery.

A peptic ulcer is a sore in the lining of the stomach or the duodenum (first part of the small intestine). If the ulcer occurs in the stomach, it is called a gastric ulcer. If it occurs in the duodenum, it is called a duodenal ulcer. The most common symptoms of peptic ulcers are upper abdominal pain that often occurs in the night and improves with eating. Other symptoms may include belching, vomiting, weight loss, and poor appetite. Many people with peptic ulcers, particularly older people, have no symptoms. Peptic ulcers are relatively common, with about ten per cent of people developing a peptic ulcer at some point in their life.

The most common cause of peptic ulcers is infection with the bacterium Helicobacter pylori, which may be transmitted by food, contaminated water, or human saliva (for example, by kissing or sharing eating utensils). Surprisingly, the bacterial cause of peptic ulcers was not discovered until the 1980s. The scientists who made the discovery are Australians Robin Warren and Barry J. Marshall. Although the two scientists eventually won a Nobel Prize for their discovery, their hypothesis was poorly received at first. To demonstrate the validity of their discovery, Marshall used himself in an experiment. He drank a culture of bacteria from a peptic ulcer patient and developed symptoms of peptic ulcer in a matter of days. His symptoms resolved on their own within a couple of weeks, but, at his wife's urging, he took antibiotics to kill any remaining bacteria. Marshall’s self-experiment was published in the Australian Medical Journal, and is among the most cited articles ever published in the journal.  Figure 15.7.4 shows how H. pylori cause peptic ulcers.

Another relatively common cause of peptic ulcers is chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen. Additional contributing factors may include tobacco smoking and stress, although these factors have not been demonstrated conclusively to cause peptic ulcers independent of H. pylori infection. Contrary to popular belief, diet does not appear to play a role in either causing or preventing peptic ulcers. Eating spicy foods and drinking coffee and alcohol were once thought to cause peptic ulcers. These lifestyle choices are no longer thought to have much (if any) of an effect on the development of peptic ulcers.

Peptic ulcers are typically diagnosed on the basis of symptoms or the presence of H. pylori in the GI tract. However, endoscopy (shown in Figure 15.7.5), which allows direct visualization of the stomach and duodenum with a camera, may be required for a definitive diagnosis. Peptic ulcers are usually treated with antibiotics to kill H. pylori, along with medications to temporarily decrease stomach acid and aid in healing. Unfortunately, H. pylori has developed resistance to commonly used antibiotics, so treatment is not always effective. If a peptic ulcer has penetrated so deep into the tissues that it causes a perforation of the wall of the stomach or duodenum, then emergency surgery is needed to repair the damage.

 

Gastroenteritis, also known as infectious diarrhea or stomach flu, is an acute and usually self-limiting infection of the GI tract by pathogens. Symptoms typically include some combination of diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may also occur. The illness generally lasts less than two weeks, even without treatment, but in young children it is potentially deadly. Gastroenteritis is very common, especially in poorer nations. Worldwide, up to five billion cases occur each year, resulting in about 1.4 million deaths.

Commonly called “stomach flu,” gastroenteritis is unrelated to the influenza virus, although viruses are the most common cause of the disease (see Figure 15.7.6). In children, rotavirus is most often the cause which is why the British Columbia immunization schedule now includes a rotovirus vaccine. Norovirus is more likely to be the cause of gastroenteritis in adults. Besides viruses, other potential causes of gastroenteritis include fungi, bacteria (most often E. coli or Campylobacter jejuni), and protozoa(including Giardia lamblia, more commonly called Beaver Fever, described below). Transmission of pathogens may occur due to eating improperly prepared foods or foods left to stand at room temperature, drinking contaminated water, or having close contact with an infected individual.

Gastroenteritis is less common in adults than children, partly because adults have acquired immunity after repeated exposure to the most common infectious agents. Adults also tend to have better hygiene than children. If children have frequent repeated incidents of gastroenteritis, they may suffer from malnutrition, stunted growth, and developmental delays. Many cases of gastroenteritis in children can be avoided by giving them a rotavirus vaccine. Frequent and thorough handwashing can cut down on infections caused by other pathogens.

Treatment of gastroenteritis generally involves increasing fluid intake to replace fluids lost in vomiting or diarrhea. Oral rehydration solution, which is a combination of water, salts, and sugar, is often recommended. In severe cases, intravenous fluids may be needed. Antibiotics are not usually prescribed, because they are ineffective against viruses that cause most cases of gastroenteritis.

Giardiasis, popularly known as beaver fever, is a type of gastroenteritis caused by a GI tract parasite, the single-celled protozoan Giardia lamblia (pictured in Figure 15.7.7). In addition to human beings, the parasite inhabits the digestive tract of a wide variety of domestic and wild animals, including cows, rodents, and sheep, as well as beavers (hence its popular name). Giardiasis is one of the most common parasitic infections in people the world over, with hundreds of millions of people infected worldwide each year.

Transmission of G. lamblia is via a fecal-oral route (as in, you got feces in your food). Those at greatest risk include travelers to countries where giardiasis is common, people who work in child-care settings, backpackers and campers who drink untreated water from lakes or rivers, and people who have close contact with infected people or animals in other settings. In Canada, Giardia is the most commonly identified intestinal parasite and approximately 3,000 Canadians will contract the parasite annually.

Symptoms of giardiasis can vary widely. About one-third third of people with the infection have no symptoms, whereas others have severe diarrhea with poor absorption of nutrients. Problems with absorption occur because the parasites inhibit intestinal digestive enzyme production, cause detrimental changes in microvilli lining the small intestine, and kill off small intestinal epithelial cells. The illness can result in weakness, loss of appetite, stomach cramps, vomiting, and excessive gas. Without treatment, symptoms may continue for several weeks. Treatment with anti-parasitic medications may be needed if symptoms persist longer or are particularly severe.

Attributions

Figure 15.7.1

BADAS_Crohn by Dayavathi Ashok and Patrick Kiely/ Journal of medical case reports on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

Figure 15.7.2

512px-Ds00070_an01934_im00887_divert_s_gif.webp by Lfreeman04  on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 15.7.3

Colon_diverticulum by melvil on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 15.7.4

H_pylori_ulcer_diagram by Y_tambe on Wikimedia Commons is used under a CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/) license.

Figure 15.7.5

1024px-Endoscopy_training by Yuya Tamai on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

Figure 15.7.6

Gastroenteritis_viruses by Dr. Graham Beards [en:User:Graham Beards] at en.wikipedia on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 15.7.7

Giardia_lamblia_SEM_8698_lores by Janice Haney Carr from CDC/ Public Health Image Library (PHIL) ID# 8698 on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/public_domain).

References

Ashok, D., & Kiely, P. (2007). Bowel associated dermatosis - arthritis syndrome: a case report. Journal of medical case reports, 1, 81. https://doi.org/10.1186/1752-1947-1-81

Marshall, B. J., Armstrong, J. A., McGechie, D. B., & Glancy, R. J. (1985). Attempt to fulfil Koch's postulates for pyloric Campylobacter. The Medical Journal of Australia, 142(8), 436–439.

Marshall, B. J., McGechie, D. B., Rogers, P. A., & Glancy, R. J. (1985). Pyloric campylobacter infection and gastroduodenal disease. The Medical Journal of Australia, 142(8), 439–444.

TED-Ed. (2017, September 28). The surprising cause of stomach ulcers - Rusha Modi. YouTube. https://www.youtube.com/watch?v=V_U6czbDHLE&feature=youtu.be

TED-Ed. (2018, January 4). Who's at risk for colon cancer? - Amit H. Sachdev and Frank G. Gress. YouTube. https://www.youtube.com/watch?v=H5zin8jKeT0&feature=youtu.be

An involuntary human body response mediated by the nervous and endocrine systems that prepares the body to fight or flee from perceived danger.

A body system including a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine, and anus. The liver, pancreas, and gallbladder are the solid organs of the digestive system.