Review for Exam 4(Look over notes and PPTs as well.)Know blood flow through the heartDeoxygenated blood enters the heart through the coronary sinus, inferior vena cava, and superior vena cava  right atrium  through tricuspid valve  right ventricle  pulmonary semilunar valve  pulmonary arteries  lungs  oxygenrich blood then goes into the left atrium  mitral (bicuspid) valve  left ventricle  aortic semilunar valve  aorta  rest of the bodyKnow the internal structures of the heartRight atrium, tricuspid valve, right ventricle, left atrium, bicuspid valve, and left ventricle, pectinate muscle, auricles, trabeculae carnae, chordae tendinae, papillary mmKnow (in brief) what causes atrial and ventricular contractions (SA and AV nodes + Purkinge fibers)Electrical impulse that causes rhythmic contraction of heart muscles arises in the SA node (pacemaker of heart)  atrial muscles = atrial contraction, impulse also conducted to the AV node  ventricular muscles by purkinje fibers = ventricular contractionsKnow coronary circulationRight coronary artery  marginal branch (feeds right ventricle) – small cardiac vein runs with this & posterior interventricular artery (feeds left ventricle) – middlecardiac vein runs with this. Left coronary artery  anterior interventricular artery (apex & both ventricles) – great cardiac vein runs with this & circumflex branch (left side, both atrium & ventricle) – coronary sinus runs with thisKnow the structures of the bronchiole tree from trachea to alveolar sacsTrachea  1st main bronchi  2nd lobar bronchi  3rd segmental bronchi  bronchioles  alveoliKnow where gas exchange occursGas exchange occurs in the alveoli or alveolar sacs!***Know what is meant by segmentation of the lungs and why this is clinically importantUnderstand the mechanical aspects of breathing Inhalation – diaphragm down, ribs elevated, pressure decreases, and air rushes inExhalation – diaphragm up, ribs depressed, pressure increases, and air is forced outKnow what muscles are involvedDiaphragm – flattens & moves downward to increase volume of thoracic cage when inhaling, external intercostals – promote inhalation by moving rib cage upward & outward, internal intercostals – support forced exhalation, abdominal muscles – support forced exhalation by increasing pressure put on the diaphragmKnow the organs of the GI tract from mouth to AnusMouth  esophagus  stomach  small intestine  large intestine  rectum  anusYou should understand the features of the GI track as they relate to ingestion, digestion, and excretion/elimination.- Mouth: mastication of food – depends on salivary glands and the amylase within the saliva- Esophagus: carries the food to the stomach by way of peristalsis - Stomach: food storage, mechanical and chemical digestion- Small Intestine: chemical digestion and nutrient absorption- Large Intestine: water reabsorption, compaction, and defacation- Rectum/Anus: where waste exits the bodyKnow the circulatory pathways for the thorax/abdomen (including azygos system, intercostal blood supply from anterior and posterior directions, mesenteric arteries and veins, etc.)Celiac Trunk: left gastric, splenic, & common hepatic- left gastric: esophageal & branches of the lesser curvature of the stomach- splenic: pancreatic branches, left gastroepiploic, & splenic branches- common hepatic: gastrodeuodenal (right gastroepiploic) & proper hepatic (left & right hepatic – right leads to cystic)Azygos System- Azygos Vein: comes off of inferior vena cava and branches into accessory hemiazygos vein & hemiazygos veinIntercostal Blood Supply- Anterior intercostal arteries: T1-T6- Posterior intercostal arteries: T1-T11- Intercostal arteries arise from internal thoracic & musculophrenic arteriesSuperior Mesenteric Artery- small intestine, ascending colon, and transverse colon- Branches: middle colic, right colic, ileocolic, ileal branches, & jejunal branchesInferior Mesenteric Artery- transverse colon, left colic flexure, descending colon, sigmoid colon, rectum and the upper half of the anal canal.- Branches: left colic, sigmoid branches, and superior rectal artery Know the accessory organs to the GI tract (liver, pancreas)(liver, gallbladder, & pancreas included)- Livero Produces & secretes bile for digestiono Stabilizes blood sugar levelso Filtration & detoxificationo 4 lobes: right, left, caudate (superior middle), & quadrate (inferior middle)- Gallbladdero Bile storage & concentrationo Gallstones: A small, hard crystalline mass formed abnormally in thegallbladder, often causing severe pain and blockage of the bile duct.- Pancreaso Endocrine Gland: insulin & glucagon production (hormones)o Exocrine Gland: Digestive enzymesKnow the hepatic portal system- Blood is carried from the intestines, to the liver, to the heart, and then to the rest of the body- The veins draining the intestine lead to a second set of capillary beds in the liver. Here the liver removes many of the materials that were absorbedby the intestineKnow how the liver and the duodenum are connected and what the significance of the gall bladder is in this- Connected by the common hepatic bile duct- Gallbladder produces bile salts – which aid in digestionKnow the spleen and its functions (basic)- Lymph organ (intraperitoneal)- Filters blood: removes aged RBCs and blood borne antigensUrinary Tract- Removal of water, salts, and metabolic wastes / production of urine / endocrine (suprarenal glands)- Kidneys: renal fascia, renal capsule, and perirenal fat- Suprarenal glands: fight or flight hormones (epinephrine and norepinephrine), ion balance (sodium/potassium), controls production of glucose from fat/protein, and androgens and estrogens (male & female sexual development)- Nephron: filtration, reabsorption, secretion, and elimination- Female: ureters, ureteric orifice, internal urethral sphincter, urethra, external urethral sphincter, and external urethral orifice- Male: prostatic urethra, membranous urethra, and spongy urethraKnow the organs of reproduction and their functions (all glands included)General Reproductive System- Primary Organs: produce gametes- Secondary organs: required for reproduction- Secondary sexual characteristics: distinguish sexesMale Reproductive System- Spermatogenesis (meiosis)- Testes: spermatogenesis, testosterone production/secretion, epididymis – sperm maturation, storage, and reabsorption, scrotum –