Bahan Prof Rahmatina.

SIKLUS JANTUNG
Rahmatina B. Herman

The Cardiac Cycle
Definition:
The cardiac events that occur from the beginning
of one heartbeat to the beginning of the next

The cardiac cycle consists of:
- Diastole
which the

:

period of relaxation, during
heart fills with blood

- Systole
which

:

period of contraction, during
the heart ejects blood from its
chambers

Conductive System of Heart
SA Node (sinoatrial node)/ sinus node :
- located in the superior lateral wall of right atrium,
immediately below and slightly lateral to the opening
of the superior vena cava

Internodal pathways:
- conductive system from SA node to AV node

AV node (atrioventricular node):
- located in the posterior septal wall of right atrium,
immediately behind tricuspid valve and adjacent to the
opening of coronary sinus

AV bundle/ His bundle

Purkinje System

…..Co ductive Syste

of Heart

…..Co ductive Syste

of Heart

Organization of AV node

Transmission of Cardiac Impulse

Events of Cardiac Cycle
Generating and transmission of cardiac impulses:
1. Generating rhythmical impulses in SA node

2. Conducting the impulses rapidly throughout atria 
atria contract

3. Conducting impulses to AV node (delay 0,13 sec)
4. Conducting impulses through AV/ His bundle

5. Finally transmission impulses rapidly throughout
ventricles through Purkinye system  ventricle
contract

…..Eve ts of Cardiac Cycle
Because of impulses generate in SA node and
delay i tra s issio to ve tricles → atria
contract (atrial systole) prior to ventricles

Ventricles still in relaxation period (ventricular
diastole), called diastole


AV valves open and allow blood to flow into
ventricles  filling of ventricles

…..Eve ts of Cardiac Cycle

Filling of the ventricles during diastole
Rapid filling:
- Large amount of blood that accumulate in atria
because of closed of AV nodes, immediately push AV
valves open and allow blood to flow rapidly into
ventricles; lasts for ± the first third of diastole
Diastasis:
- During the middle third of diastole, only a small
amount of blood that continues to empty into atria
from veins and passes directly into ventricles
Atrial systole:
- During the last third of diastole, atria contract and
give additional thrust to inflow of blood into ventricles

…..Eve ts of Cardiac Cycle
Emptying of the ventricles during systole
Period of isovolemic (isometric) contraction:
- When ventricular contraction begins, the intraventricular pressures build up and causing AV valves to
close, but not sufficient to push semilunar valves open
- There is no emptying of blood from ventricles

Period of ejection:
- Immediately after semilunar valves opened, blood
begins to pour out of ventricles
Period of isovolemic (isometric) relaxation:
- When ventricular relaxation begins, the intraventricular pressures fall rapidly, allowing semilunar
valves to close, but not sufficient to cause AV valves open
- There is no blood flow into ventricles

…..Eve ts of Cardiac Cycle
During ventricular contraction:
- Period of ejection
- Ventricular pressure rise cause blood to pour from
ventricles into arterial system (aorta and pulmonary
cardiac output (volume / minute)
trunks) 
stroke volume (volume/ contraction)
-

During atrial relaxation:
- Atrial pressure fall and allowing blood flow from

veins into atria  venous return (volume/ minute)

…..Eve ts of Cardiac Cycle
The greater venous return, the greater the heart
muscle is stretched, the greater will be the force
of contraction and the greater stroke volume
Within physiological limits, the heart pumps all
the blood that comes to it without allowing
excessive damming of blood in the veins
(Hukum Frank-Starling)

…..Eve ts of Cardiac Cycle

Ventricular Volume
End diastolic volume (EDV): 110 – 120 cc,
- Can be increased to 150 – 180 cc
Stroke volume (SV): 70 cc
- SV = EDV – ESV (110 cc – 40 cc)
Ejection fraction: 60 %
- SV/EDV x 100%

End systolic volume (ESV): 40 – 50 cc,
- Can be decreased to 10 – 20 cc
- SV can be increased to 140 - 160 cc

Volume – Pressure Diagram

Concepts of Preload and Afterload
Preload:
In assessing the contractile properties of
muscle, it is important to specify the degree of
tension on muscle when it begins to contract

After load:
To specify the load against which the muscle
exerts its contractile force

…..Co cepts of Preload a d Afterload
The importance of the concepts of preload and
afterload:

Many abnormal function states of the heart or
circulation, the pressure during filling of
ventricle (the preload), the arterial pressure
against which the ventricle must contract (the
afterload), or both are severely altered from
the normal

FUNGSI
SEKRESI, ABSORBSI,
EKSKRESI
SISTEM PENCERNAAN
Rahmatina B. Herman
Bagian Fisiologi
Fakultas Kedokteran Universitas Andalas

Introduction
The primary function of the digestive system is to
transfer nutrients, water and electrolytes from the
food e eat i to the ody’s i ter al e viro e t.
Ingested food is essential as:

- an energy source from which the cells can
generate ATP to carry out their particular energydependent activities
- a source of building supplies for the renewal
and addition of body tissues

……I trodu tio
The digestive system performs 4 basic digestive
processes:
1. Motility along gastrointestinal tract
2. Secretion of digestive juices
3. Digestion of food
4. Absorption the small absorbable units
Excretion of the waste materials
Regulation of digestive function through neural
reflexes and hormonal pathways

Protection against any damages

Pathways Controlling Digestive System
Local changes in

Digestive Tract (DT)

External influences

Receptors in DT

Extrinsic (ANS)

Intrinsic (ENS)

GI Hormones

Smooth Muscle (self excitable)
Exocrine gland cells (digestive juices)
Endocrine gland cells (GI & Pancreatic Hormones

FUNGSI SEKRESI
SALURAN PENCERNAAN

Daily Secretion of Digestive Juices

Daily Volume (ml)

pH

Saliva

1000

6.0 – 7.0

Gastric secretion

1500

1.0 – 3.5

Pancreatic secretion

1000

8.0 – 8.3

Bile

1000

7.8

Small intestine secretion

1800

7.5 – 8.0

Brunner’s gland secretion

200

8.0 – 8.9

Large intestine secretion

200

7.5 – 8.0

Total

6700

General Principles of Digestive Secretion
Type of digestive glands:
- Type of secretions:
◊ digestive enzymes
◊ digestive fluids
◊ mucus

- Anatomical type of glands:
◊
◊
◊
◊

single cell mucous gland/ mucous cells (goblet cells)
crypts of Lieberkuhn: small intestine
tubular glands: in stomach, upper duodenum
complex glands: salivary, pancreas, liver

Basic Mechanism of Stimulation
Epithelial stimulation:
- tactile stimulation
- chemical irritation
- distention of gut wall

Nervous stimulation
- Enteric nervous system - ENS (intrinsic)
- Autonomic nervous system – ANS (extrinsic):
- parasympathetic stimulation
- sympathetic stimulation

Hormonal stimulation: gastrointestinal hormones GIH

Secretion in The Mouth
Saliva:
> Saliva glands:
-

parotid gland: serous – ptyalin (-amylase)
submandibullar/ submaxillar gland: mix
sublingual: mix
buccal: mucus

> Function:
- digestive process
- oral hygiene:
◊ stream: flush away fine particles
◊ thiocyanate ion, lysozime, antibody,
bicarbonate buffers

Lingual lipase

Esophageal Secretion
Mucoid (entirely):
◊ Function:
- lubrication
- protection
◊ Glands:
- simple mucous glands: lubrication
- compound mucous glands: protection
- in the initial portion of esophagus
- near the esophago-gastric junction

Gastric Secretion
Oxyntic glands (gastric glands):
at corpus and fundus
- mucous neck cells: mucus & pepsinogen
- peptic cells (chief cells): pepsinogen
- oxyntic cells (parietal cells): HCl & intrinsic factor

Pyloric glands: at antrum
- mucus, hormone gastrin, pepsinogen

Mucus-secreting cells:
spread over the surface of the gastric mucosa
-

mucus

Enzymes: lipase, amylase, gelatinase

Postulated Mechanism for Secretion of HCl
Extracellular
Fluid

Lumen of
Canaliculus

Oxyntic (Parietal) Cell

CO2

CO2

HCO3-

HCO3-

H2O
CO2 + OH- + H+

H+ (155 mEq/L
P

K+
Na+

ClH2O

P

K+

K+

K+ (15 mEq/L)

Na+

Na+

Na+ (3mEq/L)

Cl-

Cl(Osmosis)

P

P

Cl- (173 mEq/L)
H2O

Regulation of Gastric Secretion
Acetylcholine:
excites secretion by all the secretory types in the gastric
glands

Gastrin and histamine :
stimulate strongly the secretion of HCL

A few other substances such as circulating amino
acids, caffeine, and alcohol
also stimulate the gastric secretory cells but the
stimulatory effects of these are slightly in comparison
with acetylcholine, gastrin, and histamine

Phases of Gastric Secretion
1. Cephalic phase

: via vagus

2. Gastric phase :
- vagal reflexes
- local enteric reflexes
- gastrin stimulation

3. Intestinal phase

:

- gastrin that also secreted by duodenal mucosa
- nervous and hormonal mechanisms: inhibition

Pancreatic Secretions
Digestive enzymes:
-

carbohydrate: ◊ pancreatic amylase
fat:
◊ pancreatic lipase

◊ cholesterol esterase
◊ phospholipase

-

protein :
◊
◊
◊
◊

trypsinogen
chymotrypsinogen
pro-carboxylpolypeptidase
elastases & nucleases

Trypsin inhibitor
Bicarbonate ions
Entering duodenum via sphincter Oddi

Activated by
Interkinase secreted
by duodenal mucosa

Regulation of Pancreatic Secretion
- Acetylcholine
- Gastrin
- Cholecystokinin

pancreatic digestive enzymes

- Secretin
Na Bicarbonate solution
◊ Gastric acid
: Na B solution > enzymes
◊ Fat (soap)
: Na B solution = enzymes
◊ Peptones
: Na B solution < enzymes
Phases of pancreatic secretion:
- Cephalic phase
- Gastric phase
- Intestinal phase

Secretion of Bile
Function:
-

in fat digestion: emulsifying/ detergent function
in fat absorption: micelles
excretion of bilirubin and excesses cholesterol

Formation: in liver
-

secreted by hepatocytes
along the bile ducts: secretion of Na+ & HCO3-

Storage: in gallbladder
- re-absorption of water & electrolytes except
K+

Entero-hepatic circulation

Ca2+&

Composition of Bile
Liver Bile

Gallbladder Bile

Water

97.5 gm/dl

92 gm/dl

Bile salts

1.1 gm/dl

6 gm/dl

Bilirubin

0.04 gm/dl

0.3 gm/dl

Cholesterol

0.1 gm/dl

0.3 – 0.9 gm/dl

Fatty acids

0.12 gm/dl

0.3 – 1.2 gm/dl

Lecithin

0.04 gm/dl

0.3 gm/dl

Na+

145 mEq/L

130 mEq/L

K+

5 mEq/L

12 mEq/L

Ca++

5 mEq/L

23 mEq/L

Cl-

100 mEq/L

25 mEq/L

HCO3-

28 mEq/L

10 mEq/L

Secretions of Small Intestine
Mucus:
-

by Brunner glands especially at proximal

Digestive juices:
-

extracellular fluids
secreted by crypts of Lieberkuhn
function: watery vehicles for absorption of
substances from the chymes

Intestinal enzymes
-

at brush border
peptidases
sucrase, maltase, iso-maltase, lactase
intestinal lipase

Regulation of Small Intestinal Secretion
Local enteric reflex mechanisms

-

in response to the presence of chyme in the
intestine

-

dominant role

Hormonal regulation
Some of same hormones that promote secretion in GIT
especially secretin and cholecystokinin

Secretions of Large Intestine
Mucus:
- function:

- control:

◊ protection (together with NaHCO3)
◊ lubrication
◊ adherent medium for holding fecal
material together
◊ local
◊ parasympathetic
emotional disturbance: mucus stool

Water and electrolyte:

- in response to irritation  diarrhea
- none at normal condition

FUNGSI ABSORPSI
SALURAN PENCERNAAN

Basic Principles of Gastrointestinal Absorption
Basic mechanism: Transport across membrane
- active transport:
◊ primary
◊ secondary:
> co - transport
> counter - transport

- passive transport (diffusion):
◊ simple diffusion
◊ facilitated diffusion

- osmosis

…Basi Pri iples of Gastroi testi al
Absorption

Cell membrane consists of:
- lipid bilayer

- integral protein molecules:
◊ channel

◊ carrier

Absorption in The Stomach
Tight ju tio
Only a few:

● fat-soluble material: alcohol
● drug: aspirin

Absorption in The Small Intestines
Almost all of nutrient, water, and electrolytes
Nutrients:

◊ carbohydrate:
◊ protein:
◊ fat: - micelles
- diffusion
- chylomicrons

-Active transport
(Na co-transport)
-Facilitated diffusion

Ions:

◊ positive ions: - active transport
◊ negative ions:
- passive transport

Water:

- osmosis
- through intercellular spaces

………S all I testi es
Absorption facilities
Absorptive surface:
● Valvula of coniventes (Kerckring)
● Villi
● Microvilli (Brush border)

Transportation in villi:

: 3 x lipat
: 10 x lipat
: 20 x lipat

● Vascular system  portal circulation
● Central lacteal lymph  large vein in neck
● Pinositic vesicles

Large Intestines
Absorbing colon
◊ absorption almost all of water & electrolytes
◊ absorption capacity of colon: 5 – 7 L/day
◊ bacterial action:
- digesting small amounts of cellulose
- vit. K, B12, thiamin, riboflavin
- gases: CO2, hydrogen, methan

Storage colon

…..Large I testi es
Composition of normal feces:
◊ three-fourths water and one-forth solid
material
◊ color: stercobilin dan urobilin
◊ odor: by products of bacterial action
- indol, skatol, mercaptan, H2S

- depending on colonic bacterial flora,
and on the type of food eaten

FUNGSI EKSKRESI
SALURAN PENCERNAAN
DEFEKASI

General Principles of
Gastrointestinal Motility
Characteristic of intestinal wall:
- mucosa, muscularis, serosa, peritonium
- smooth muscles:
> tunica muscularis, 2 muscle layers:
- exterior: longitudinal
- interior: circular
> muscularis mucosae in the deeper layer of
the mucosa
- smooth muscles function as syncytium

...General Principles of
Gastrointestinal Motility
Electrical activities in gastrointestinal smooth
muscles:

 Slow waves: basic electrical rhythm
(BER)

- resting membrane potential (-50-60 mV)
- because of activities of Na-K pump

 Spike potentials:

- a tio pote tial → us le o tra tio
- on the top of slow waves (> - 40 mVolt)
- Ca-Na channels

...General Principles of
Gastrointestinal Motility
Functional types of movements in the GIT:
 Propulsive movements: peristalsis
- function of the myenteric plexus
- peristaltic reflex/ myenteric reflex
- law of gut: receptive relaxation

 Mixing movements:

- quite different in difference parts of GIT
- local constrictive contractions every few
centimeters in the gut wall
- also by peristaltic & sphincter activities
(pyloric pump)

...General Principles of
Gastrointestinal Motility
Basic mechanisms of stimulation
- distention (stretch) of the gut wall
- neural control
◊ enteric nervous system
- myenteric plexus (Auerbach)
- submucosal plexus (Meissner)
◊ autonomic nervous system
- parasympathetic innervation
- sympathetic innervation

- hormonal control

Gastrointestinal Reflexes
Reflexes that occur entirely within the enteric nervous
system
Reflexes from the gut to the prevertebral sympathetic
ganglia and then back to the GIT
Reflexes from the gut to the spinal cord/ brain stem and
then back to the GIT:
- Reflexes from stomach and duodenum to the
brain
stem and back to the GIT: gastrocolic, duodenocolic,
gastroileal, enterogastric
- pain reflexes that cause general inhibition of GIT
- defecation reflexes that travel to the spinal cord
and back
again to produce the powerful colonic,
rectal, and

abdominal contractions required for defecation (extrinsic)

Defecation
Ordinarily, defecation is initiated by defecation
reflexes
Defecation reflexes:
- intrinsic reflex: relatively weak
mediated by the local enteric nervous
system
- extrinsic reflex: parasympathetic
defecation
reflex
mediated by parasympathetic nervous
system
(sacral division)
- initiated by distention of the rectal wall

…Defe atio
Whe fe es e ter the re tu → diste tio of the
re tal all → i itiated peristalti aves
As the peristaltic waves approach the anus:
- internal anal sphincter is relaxed (receptive
relaxation by myenteric plexus
- if the external anal sphincter is consciously,
voluntarily relaxed at the same time, defecation
will occur

To be effective in causing defecation, usually must
be fortified by parasympathetic defecation reflex

FISIOLOGI
REPRODUKSI
Rahmatina B. Herman
Bagian Fisiologi
Fakultas Kedokteran Universitas Andalas

Reproduction
Reproduction is process to maintain
continuation of species by which
- new individuals of a species are produced
- genetic material is passed from generation
to generation
Cell division in a multicellular organism is
necessary for growth and it involves passing of
genetic material from parent cells to daughter
cells

Performed by reproductive system

The Reproductive System
This system does not contribute to homeostasis

Is not essential for survival of an individual
But still plays a i porta t i a perso ’s life,
e.g. the manner:
- in which people relate as sexual beings
contributes in significant ways to
psychosocial behavior
- how people view themselves
- how people interact with others

…..The Reprodu tive Syste
Reproductive function also has a profound
effect on society:
- universal organization of societies into family
units provide a stable environment that is
conducive for perpetuating our species
- on other hand, population explosion and its
resultant drain on dwindling resources
have led to worldwide concern with means
by which reproduction can be limited

…..The Reprodu tive Syste
Reproductive capability depends on intricate
relationship among hypothalamus, anterior
pituitary, reproductive organs, and target cells
of sex hormones
These relationship employ many of regulatory
mechanisms used by other body systems for
maintaining homeostasis, such as negativefeedback control

…..The Reprodu tive Syste
The organ of male and female may be grouped by
function
Testes and ovaries (called gonads), function in
production of gametes: sperm cells and ova
Gonads also secrete hormones
The ducts of reproductive systems transport, receive,
and store gametes
Accessory sex glands produce materials that support
gametes
In females, the breasts are also considered accessory
reproductive organs
The externally visible portions of reproductive system
are known as external genitalia

Secondary Sexual Characteristic
Secondary sexual characteristic (SSC) are many
external characteristics not directly involved in
reproduction
That distinguish male and female

Development and maintenance governed by
testosterone in males and estrogen in females
Progesterone has no influence on SSC
Axillary and pubic hair growth is not SSC

…..Se o dary Se ual Chara teristi
In some species, secondary sexual
characteristic are great importance in courting
a d ati g ehavior (e.g. to attra t fe ale’s
attention)
In humans, attraction the opposite sex not
only influenced by secondary sexual
characteristic but also strongly affected by the
complexities of human society and cultural
behavior

Sex Determination and Differentiation
Reproductive cells each contain a half set of
chromosomes
Gametogenesis is accomplished by meiosis
The sex of and individual is determined by
combination of sex chromosomes
Sexual differentiation along male or female
lines depends on the presence/ absence of
masculinizing determinant

Parents with diploid (46 chr) somatic cells

Mother

Father

Meiotic division
of germ cells

Meiotic division
of germ cells
Haploid Sperm

Haploid Ovum
Fertilization

Diploid fertilized Ovum
Mitosis

Offspring of diploid somatic cells

Ovum with X sex chromosome
Sperm with Y sc
Embryo with XY sc

Fertilized by

Genetic sex

Embryo with XX sc
No Y chr, so no SRY
and no H-Y antigen

Sex-determining region
of Y chr (SRY) stimulates
Production of H-Y antigen
In plasma membrane of
undifferentiated gonad
H-Y antigen directs
differentiation
of gonads into testes

Sperm with X sc

Gonadal
sex

With no H-Y antigen,
undifferentiated gonads
develop into ovaries

Testes secrete hormone and factor
Testosterone

Mullerian-inhibiting factor

Converted to
Degeneration of
Mullerian ducts

Dihydrotestosterone

Promotes development of
undifferentiated external
genitalia along male lines
(e.g. penis, scrotum)

Phenotype
sex

Transforms Wolfian ducts
into male reproductive tract
(e.g. epididymis, ductus
deferens, ejaculatory duct,
seminal vesicle)

Ovaries does not secrete hormone and factor
Absence of testosterone

Absence of Mullerianinhibiting factor

Degeneration of
Wolfian ducts
Undifferentiated external
genitalia along female lines
(e.g. clitoris. labia)
Phenotype
sex

Mullerian ducts develop
Into female reproductive
tract (e.g. oviducts, uterus)

FISIOLOGI
REPRODUKSI PRIA

Reproductive Functions of Male
The essential reproductive functions of male are:
1. Production of sperm (spermatogenesis) by
testes (in skin-covered sac: scrotum)
2. Delivery of sperm to female – semen by
- male reproductive tract: epididymis, vas
deferens, ejaculatory duct
- urethra (in penis)
3. Male accessory sex glands: providing bulk of
semen: seminal vesicle, prostate,
bulbourethral gland

Testes
Primary male reproductive organs
Perform dual function:
- producing sperm (spermatogenesis)
- secreting male sex hormone: testosterone

Scrotal location provides a cooler environment
essential for spermatogenesis
Position of scrotum in relation to abdominal
cavity can be varied by spinal reflex mechanism
that plays important role in regulating
temperature

Development of Testes
In male embryo, testes develop from the genital ridge
located at the rear of abdominal cavity
In last months of fetal life, testes begin a slow descent,
passing out of abdominal cavity through inguinal canal
into scrotum which is induced by testosterone
After testes descend into scrotum, the opening of
abdominal wall through which inguinal canal passes
closes snugly around sperm-carrying duct
Incomplete closure or rupture of this opening permits
abdominal viscera to slip through resulting inguinal
hernia

Functioning of Testis
During fetal life:
- stimulated by chorionic gonadotropin (hCG)

A few weeks after birth until puberty
(prepubertal period / childhood):
- dormant

Productive period:
- stimulated by gonadotropic hormone (GnH)
- Spermatogenesis usually continues until death

Male climacteric:
- Decrease testosterone secretion
- Decreasing sexual function

Ductal System
Ductus epididymis
- Loosely attached to the rear surface of each testes
- Sperm from seminiferous tubules are swept into
epididymis as a result of pressure created by continual
secretion tubular fluid by Sertoli cells

Ductus (vas) deferens
- Formed from converged of epididymal ducts
- Thick-walled, muscular duct
- Ductus deferens from each testes passes up out of scrotal
sac and runs back through inguinal canal into abdominal
cavity, where it eventually empties into urethra at neck
of bladder

Accessory Sex Glands
Seminal vesicles:
-

Empty secretions into the last portion of ductus deferens
Supply fructose to nourish the ejaculated sperm
Secrete prostaglandin for sperm motility to help transport
Provide precursors for clotting of semen (fibrinogen)

Prostate gland:
- Completely surrounds urethra at bladder neck
- Secretes alkaline fluid
- Provides clotting enzymes and fibrinolysin

Bulbourethral glands:
- Empty secretions into urethra just before urethra enters
penis

Spermatogenesis
Tubuli seminiferi

During active sexual life
As the result of stimulation by anterior
pituitary gonadotropic hormones
Beginning at age of ± 13 ys
Continuing throughout the remainder of life

…..Sper atoge esis
Steps of Spermatogenesis

1. Mitosis: spermatogonia A  spermatogonia B
2. Enlargement:  primary spermatocyte

3. Meiosis:
I. Primary spermatocyte  secondary spermatocyte
II. Secondary spermatocyte  early spermatid
4. Physically reshaping: spermiogenesis
Early spermatid  late spermatid  spermatozoon  23
pairs of chromosomes

…..Sper atoge esis

Hormonal Control of Testes Function

Sperms
(Normal and Mature)
Motile
Fertile
Movement: 1 – 4 mm/min.
Travel in a straight line
Activity: enhanced in neutral and slightly alkaline,
depressed in mildly acidic media
Rapid death in strong acidic media
Temperature   activity   metabolism rate  
shortened life
Live: - many weeks in genital ducts of testes
- 1 - 2 days in female genital tract

Semen
Fluid: - vas deferens (10 %)
- vesicula seminalis (60 %)
- prostat (30 %)
- mucous glands (bulbourethral)
pH: ± 7.5
Mucoid and milky
Weak coagulum  dissolve in 15 – 30 minutes
May be stored for years in - 100°C

FISIOLOGI
REPRODUKSI WANITA

Reproductive Functions of Female
Fe ale’s role i reprodu tio is

ore o pli ated:

1. Production of ova (oogenesis) by ovaries
2. Reception of sperm: vagina-cervix
3. Reception of sperm and ovum to a common site for
union (fertilization or conception): Fallopian tube
4. Maintenance of the developing fetus until it can
survive in outside world (gestation or pregnancy),
including formation of placenta: uterus
5. Giving birth to the baby (parturition)
6. Nourishing the infant after birth by milk production
(lactation): mammae

Ovaries
Primary female reproductive organs
Perform dual function:
- producing ova (oogenesis)
- secreting female sex hormones:
estrogen and progesterone which act together to:
> promote fertilization of ovum
> prepare female reproductive system for pregnancy

Homologous to testes (in structure, position,
and origin)

Descend to brim of pelvis during third month of
development

Development of Ovaries
During fetal life, the outer surface of ovary is
covered by germinal epithelium
Cells that give rise to ova arise from endoderm
of yolk sac and migrate to ovaries during
embryonic development at 5-6 weeks of
gestation
Primordial (primitive) germ cells migrate from
endoderm of the yolk sac to ovaries during
early fetal development

Functioning of Ovaries
During fetal life:
- stimulated by chorionic gonadotropin (hCG)

A few weeks after birth until puberty
(prepubertal period / childhood):
- dormant

Productive period:
- stimulated by gonadotropic hormone (GnH)
and ovarian hormone

Menopause

Components of Female Reproductive Tract
Oviducts (Fallopian tubes)
- in close association with ovaries,
- pick up ova on ovulation and serve as fertilization site
Uterus
thick-walled hollow: responsible for
- maintaining fetus during development
- expelling it at the end of pregnancy
Cervix
- lowest portion of uterus
- projects into vagina

Cervical canal
pathway for sperm and passageway for baby delivery

…..Co po e ts of Fe ale Reprodu tive Tra t
Vagina
expandable tube, connects uterus to external environment

Vaginal opening
located in perineal region between urethral and anal
opening

Hymen
thin mucus membrane partially covering vaginal opening

Labia minora and labia majora
skin folds surrounding vaginal and urethral openings
Clitoris

Female external genitalia collectively: vulva

Oogenesis
In the 3rd month of prenatal development: oogonia
divided mitotically into primary oocytes (diploid/ 2n)
until 20-24 weeks  7 million (maximum)
7 month after conception, fetal oogonia cease dividing
From this point on no new germ cells are generated

Almost from the start, attrition process occurs:
- by birth only 2 million primary oocytes remain
- by puberty: 300.000 - 400.000
- during active sexual life: 400 expelled ova
- at or soon after menopause: few (if any)

…..Ooge esis
Primary oocytes enter reduction division (meiosis I),
but do not complete the division in the fetus
Cells are said to be in a state meiotic arrest, and this
state continues until puberty
Only primary oocytes destined for ovulation will ever
complete the first meiotic division, for it occurs just
before the egg is ovulated

The second meiotic division occurs in a fallopian tube
after ovulation, but only if the secondary oocyte is
penetrated by a sperm (fertilized )
Daughter cell receive 23 chromosomes (haploid/ n)
Each primary oocyte can produce only one ovum

…..Ooge esis

Hormonal Control of Ovarian Function
Hypothalamus
GnRH

Primarily FSH

Anterior Pituitary
FSH and LH
FSH

Granulosa
Cells

LH
Theca
Cells
Androgen

Estrogen

Inhibin

Estrogen

Ovaries

Female Monthly Rhythm
Cycle: 28 days (20 – 45 days)

Ovarian cycle
1. The follicular phase: - ovarian follicle growth
- ovulation
2. The luteal phase: development of corpus luteum

Endometrial cycle (Uterine cycle)
1. Proliferative phase: 2. Secretory phase:
3. Menstruation

estrogen phase
before ovulation
progestational phase
after ovulation

…..Fe ale Mo thly Rhyth

Ovarian Cycle

Endometrial Cycle

ANATOMI FISIOLOGI SIRKULASI
FETUS, BAYI & DEWASA

Rahmatina B. Herman
Bagian Fisiologi
Fakultas Kedokteran Universitas Andalas

Fetal Circulation
Differs from the postnatal (after birth) circulation,
because
Lungs, kidneys, and gastrointestinal tract are
nonfunctional
O2 and nutrients are derived from maternal
blood
CO2 and wastes are eliminated into maternal
blood

Placenta
Is the fetal lu g
However cellular layers covering the villi are
thicker and less permeable than the alveolar
membranes in the lungs and exchange is much
less efficient

Is also the route by which all nutritive materials
enter the fetus and wastes are discharged to
the maternal blood

Arrangement of Fetal Circulation
55 % of fetal COP goes through placenta
Blood in umbilical vein (UV) ± 80 % saturated
with O2 (in arterial circulation of adult: ± 98 % )
Ductus venosus (DV) diverts some of the blood
directly to Inferior Vena Cava (IVC) and
remainders mixes with portal blood
- IVC blood is ± 67 % saturated with O2
- Portal and systemic venous blood is only ± 26
% saturated with O2

….Arra ge e t of Fetal Cir ulatio
Most of the blood entering heart through IVC is
diverted directly to left atrium (LA) via foramen
ovale  left ventricle (LV)
Most of blood from SVC enters right ventricle
(RV) and is expelled into pulmonary artery (PA)
Resistance of collapsed lungs is very high
Pressure in PA > aorta
Most of the blood from PA passes into aorta via
ductus arteriosus

….Arra ge e t of Fetal Cir ulatio
In this fashion:
Relatively unsaturated blood from RV is
diverted into trunk and lower body
The head of fetus receives the betteroxygenated blood from the LV
From aorta, some of blood is pumped into the
umbilical arteries (UA) and back to placenta
O2 saturation of the blood in lower aorta and
UA is ± 60 % saturated with O2

Fetal Respiration
Tissues of fetal and newborn mammals have a
remark-able but poorly understood resistance to
hypoxia
O2 saturation of maternal blood in placenta is so
low that the fetus might suffer hypoxic damage if
fetal red cells did not have a greater O2 affinity
than adult
Fetal red cells contain fetal Hb (Hb F) while adult
red cells contain adult Hb (Hb A)

…..Fetal Respiratio
The fetal oxyhemoglobin dissociation curve is
shifted to the left → at e ual pressure of O2,
fetal blood carries significantly more O2 than
does maternal
In early fetal life, the high cardiac glycogen levels
that prevail may protect the heart from acute
periods of hypoxia
The glycogen levels decrease in the late fetal life
and reach adult levels by term

Umbilical Vessels
Umbilical vessels have thick muscular walls with a
muscular sphincter
Hemorrhage of the newborn is prevented by
constriction of the umbilical vessels, because they are
very reactive to trauma, sympathomimetic amines,
bradykinin, angiotensin, and changes in PO2
Closure of the umbilical vessels increases the total
peripheral resistance and the blood pressure
When blood flow ceases through the umbilical
vessels, the ductus venosus closes (the event that
closes of DV is still unknown)

Changes in
Fetal Circulation & Respiration at Birth
At birth, placental circulation is cut off and
peripheral resistance suddenly rises
Pressure in aorta rises until > in PA
Because of placental circulation has been cut off,
the infant becomes increasingly asphyxial and
ooli g of the ody → a tivates respiratory e ter
Finally, infant gasps several times and the lungs
e pa d → vas ular resista e de rease to ± 1/10
Markedly negative intrapleural pressure (-30 to -50
mmHg) during the gasps contributes to the
expansion of the lungs

…..Cha ges i
Fetal Circulation & Respiration at Birth
The sucking action of the first breath plus
constriction umbilical veins (UV) squeezes 100 ml of
lood fro pla e ta (the pla e tal tra sfusio
Once the lungs are expanded, the pulmonary
vascular resistance falls to < 20% of utero value and
pulmonary blood flow increases markedly
Blood returning from the lungs raises the pressure
in the LA, closing foramen ovale by pushing the
valve that guards it against the interatrial septum

…..Cha ges i
Fetal Circulation & Respiration at Birth
The LA pressure is raised > IVC and RA by:
1. The de rease i pul o ary resista e → large
flow of blood through the lungs to the LA
2. The redu tio of flo to the RA ← o lusio of
the UV
3. The i reased resista e to LV output ←
occlusion of the UA
↓
Abruptly closes the valve over the foramen ovale
The septal leaflets fuse over several days

…..Cha ges i
Fetal Circulation & Respiration at Birth
The de rease i pul o ary vas ular resista e →
the pressure in the PA fall to ± ½ (to ± 35 mmHg)
The slight i rease i aorti pressure → reverses
the blood flow through the ductus arteriosus (DA)
↓
The large ductus arteriosus begin to constrict
↓
Manifested as a murmur in the newborn, because of
turbulent flow

…..Cha ges i
Fetal Circulation & Respiration at Birth
DA constricts within a few hours after birth, producing
functional closure, and permanent anatomic closure
follows in the next 24-48 hours due to extensive intimal
thickening
Mechanism producing the initial constriction is not
completely understood, but the increase in arterial O2
tension plays an important role as follows:
1. The high O2 tension of the arterial blood that passes
through the DA
2. The pulmonary ventilation with O2 that closes the DA.
Ventilation with air low in O2 opens this shunt vessel

Whether O2 acts directly on the DA, or through the
release of a vasoconstrictor substance is not known

…..Cha ges i
Fetal Circulation & Respiration at Birth
Relatively high concentrations of vasodilators
(especially prostaglandin) are present in the DA

Synthesis of the prostaglandin is facilitated by
cyclooxygenase at birth
In many premature infants the ductus fails to
close spontaneously, but closure can be
produced by infusion of drugs that inhibit
cyclooxygenase

The Walls of Cardiovascular System
At birth:
- The walls of the two ventricles are approximately
of the same thickness, with a possibly slight
preponderance of the RV
- The muscle layer of the PA is thick, which is partly
responsible for the high pulmonary vascular
resistance of the fetus

After birth:
- The thickness of the RV and PA walls diminishes
- The LV walls become thicker
These changes are progressive over a period of weeks
after birth

FISIOLOGI
HIDUNG DAN
SINUS PARANASAL
Rahmatina B. Herman
Bagian Fisiologi
FK-UNAND

Physiology of Nose
The interior of nose are specialized for 3
functions:
1. Incoming air is warmed, moistened, and
filtered
2. Olfactory stimuli are received
3. Large, hollow resonating chambers modify
speech sounds

…………..Ph siolog of Nose
When air enters the nostrils, it passes:
Through vestibule which is lined by skin containing
coarse hairs that filter out large dust particles
Then passes into upper nasal cavity :

- 3 conchae: superior, middle, inferior
- 3 meatuses: superior, middle, inferior
All lined by mucous membrane

…………..Ph siolog of Nose
Olfactory receptors lie in the membrane lining
superior concha and adjacent septum, called olfactory
epithelium
Below olfactory epithelium, mucous membrane
contains capillaries; air which is whirls around
conchae and meatus warmed by blood in capillaries
Mucous membrane also contains epithelial cells with
many goblet cells; mucus secreted by goblet cells
moistens the air and traps dust particles

…………..Ph siolog of Nose
Drainage from the nasolacrimal ducts and
perhaps secretions from paranasal sinuses also
help moistens the air
The cilia move the mucus-dust packages to the
pharynx so they can be eliminated from
respiratory tract by swallowing or
expectoration (spitting)

Physiology of Paranasal Sinuses
Paired cavities in certain cranial and facial bones near
nasal cavity:
frontal, sphenoid, ethmoid, maxillae

Lined with mucous membranes that are continuous
with the lining of the nasal cavity
Producing mucus
Lighten the skull bones
Serve as resonating chambers for sound as we speak or
sing

OLFACTORY SENSATION
(SMELL)

Introduction
Smell and taste are generally classified as visceral
sense because of their close association with
gastrointestinal function
Physiologically they are related to each other
Flavors of various foods are in large part a combination
of their taste and smell
Food a taste differe t if o e has a old that
depresses sense of smell

…………………..I trodu tio
Both smell and taste receptors are chemo-receptors
that are stimulated by molecules in solution in mucus
in the nose and saliva in the mouth
However, anatomically quite difference:
- Smell receptors are distance receptors (teleceptors),
and its pathways have no relay in thalamus
- Taste pathways pass up brainstem to thalamus and
project to postcentral gyrus

Olfactory Mucous Membrane
Is specialized portion of nasal mucosa
With yellowish pigmented
In which olfactory receptor cells are located
Is constantly covered by mucus which is produced by
Bow a ’s gla ds

In dogs and other animals in which sense of smell is
highly developed (macrosmatic animals)
Contains supporting cells and progenitor cells for
olfactory receptors

Olfactory Receptors
Each olfactory receptor is a neuron

Each neuron has a short thick dendrite with expanded
end called an olfactory rod
From the rods, cilia project to surface of mucus

Each receptor has 10-20 cilia
Axon of the neurons pierce cribriform plate of ethmoid
bone and enter olfactory bulbs
Olfactory neurons are constantly being replaced with a
half-time of a few weeks

Olfactory Bulbs
In olfactory bulbs, axons of receptors contact primary
dendrites of mitral cells and tufted cells to form
complex globular synapses called olfactory glomeruli
Olfactory bulbs also contain periglomerular cells which
are inhibitory neurons connecting one glomerolus to
another
Granule cells have no axons and make reciprocal
synapses with lateral dendrites of mitral and tufted
cells

Olfactory Pathways
1. The very old olfactory system (medial olfactory area):

concerning with basic olfactory reflexes to olfaction,
such as licking the lips, salivation, and other feeding
responses caused by smell of food
2. The less old olfactory system (lateral olfactory area):
provides learned control of food intake (like / dislike
certain foods)
3. The newer olfactory system: other cortical sensory
systems and is used for conscious perception of
olfaction

Olfactory Cortex
Axons of mitral and tufted cells pass posteriorly
through intermediate olfactory stria and lateral
olfactory stria to olfactory cortex
In humans, sniffing activates pyriform cortex
Smells activate lateral and anterior orbitofrontal gyri
of frontal lobe

Orbitofrontal activation is generally greater on right
side than left side

………………Olfa tor Corte

Other fibers project:

- to amygdala, which is probably involved
with emotional responses to olfactory
stimuli,
- to entorhinal cortex which is
with olfactory memories

concerned

Olfactory threshold & Discrimination

Olfactory receptors respond only to substances that
are in contact with olfactory epithelium and are
dissolved in thin layer of mucus that covers it
Olfactory threshold remarkable sensitive to some
substances
Olfactory discrimination is remarkable

Humans can recognize  10,000 different odors

….Olfa tor threshold & Dis ri i atio

Determination of differences in intensity of any given
odor is poor
Concentration of odor-producing substance must be
changed by about 30% before a difference can be
detected

Comparable visual discrimination threshold is a 1%
change in light intensity

Role of Pain Fibers in Nose
Naked endings of many trigeminal pain fibers are
found in olfactory mucous membrane
They are stimulated by irritating substances, and an
irritative
Trigeminally mediated component is part of
hara teristi odor of su h su sta es as
peppermint, menthol, chlorine

These endings also responsible for initiating
sneezing, lacrimation, respiratory inhibition, and
other reflex responses to nasal irritants

Adaptation
When one is continuously exposed to even most
disagreeable odor, perception of odor decreases and
eventually ceases
This phenomenon is due to fairly rapid adaptation, or
desensitization that occurs in olfactory system

Mediated by Calcium ion acting via calmodulin on
cyclic nucleotide-gated (CNG)
When CNG is knocked out, adaptation is slowed

Abnormalities
Anosmia

: absence of sense of smell

Hyposmia

: diminished olfactory
sensitivity

Dysosmia

: distorted sense of smell