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Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for

Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for reproduction or display. Tonsils Right lymphatic duct Cervical lymph node Thoracic duct Thymus Axillary lymph node Mammary plexus Subclavian veins Thoracic duct Spleen Lymphatic vessel (transports lymph) Bone marrow (a) Lacteals in intestinal wall Inguinal lymph node

Fig. 16. 14 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 16. 14 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Villi Blood capillary network Lacteal Epithelium Circular folds Epithelium Intestinal gland Submucosa Circular muscle Longitudinal muscle (a) Serosa (b) Duodenal gland Top of circular fold Microvilli of epithelial cell surface Villus Epithelial cell Capillary (blood) Lacteal (lymph) (d) (c)

Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for

Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for reproduction or display. Tonsils Right lymphatic duct Cervical lymph node Thoracic duct Thymus Axillary lymph node Mammary plexus Subclavian veins Thoracic duct Spleen Lymphatic vessel (transports lymph) Bone marrow (a) Lacteals in intestinal wall Inguinal lymph node

Fig. 14. 2 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 2 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Arteriole (from heart) Blood capillary Venule (to heart) Valve closed (backflow of lymph is prevented) Lymph Fluid entering lymphatic capillary Valve open (lymph flows forward) Direction of lymph flow in capillary Fluid entering lymphatic capillary (a) (b) To venous system Lymphatic capillary Tissue cells Overlapping epithelial cells

Fig. 14. 1 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 1 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Tonsils Right lymphatic duct Cervical lymph node Area drained by right lymphatic Thoracic duct Thymus Axillary lymph node Mammary plexus Subclavian veins Thoracic duct Spleen Lymphatic vessel (transports lymph) Bone marrow (a) Lacteals in intestinal wall Inguinal lymph node (b) Area drained by thoracic duct

Fig. 14. 2 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 2 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Arteriole (from heart) Blood capillary Venule (to heart) Valve closed (backflow of lymph is prevented) Lymph Fluid entering lymphatic capillary Valve open (lymph flows forward) Direction of lymph flow in capillary Fluid entering lymphatic capillary (a) (b) To venous system Lymphatic capillary Tissue cells Overlapping epithelial cells

Fig. 14. 4 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 4 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Capsule Trabecula Lymphatic tissue Cortex Lymphatic sinuses Lymphatic nodule Germinal center Afferent lymphatic vessel carrying lymph to the lymph node Efferent lymphatic vessel carrying lymph away from the lymph node Artery Vein

Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for

Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for reproduction or display. Tonsils Right lymphatic duct Cervical lymph node Thoracic duct Thymus Axillary lymph node Mammary plexus Subclavian veins Thoracic duct Spleen Lymphatic vessel (transports lymph) Bone marrow (a) Lacteals in intestinal wall Inguinal lymph node

Fig. 14. 3 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 3 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Pharyngeal tonsil Palatine tonsil Lingual tonsil

Fig. 16. 2 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 16. 2 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Blood vessels Enteric plexus Myenteric plexus Lymphatic vessel Submucosal plexus Nerve Gland in submucosa Mesentery Ducts from glands Lymphatic nodule Intestinal gland Mucosa (mucous membrane) Epithelium Lamina propria Muscularis mucosae Submucosa Muscularis Circular muscle layer Longitudinal muscle layer Serosa (serous membrane; visceral peritoneum) Connective tissue layer Simple squamous epithelium

Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for

Fig. 14. 1 -1 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for reproduction or display. Tonsils Right lymphatic duct Cervical lymph node Thoracic duct Thymus Axillary lymph node Mammary plexus Subclavian veins Thoracic duct Spleen Lymphatic vessel (transports lymph) Bone marrow (a) Lacteals in intestinal wall Inguinal lymph node

Fig. 14. 4 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 4 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Capsule Trabecula Lymphatic tissue Cortex Lymphatic sinuses Lymphatic nodule Germinal center Afferent lymphatic vessel carrying lymph to the lymph node Efferent lymphatic vessel carrying lymph away from the lymph node Artery Vein

Fig. 14. 5 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 5 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Branch of splenic artery Branch of splenic vein White pulp Splenic artery Splenic vein Red pulp Trabecula (a) (b) Capsule

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Fig. 14. 6 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Trabecula Trachea Lymph nodes Thymus Lobule Cortex Medulla Adipose tissue Heart (a) (b) b: ©Trent Stephens LM 10 x

Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Fig. 14. 7

Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Fig. 14. 7 Arterial circulation Venous circulation Heart 1 Lymphatic capillaries remove fluid from tissues. The fluid becomes lymph (see figure 14. 2 a). 2 Lymph flows through lymphatic vessels, which have valves that prevent the backflow of lymph (see figure 14. 2 b). Lymphatic capillary Lymphatic vessels 1 Valves 2 Lymph 5 Fluid 3 Lymph nodes filter lymph (see figure 14. 4) and are sites where lymphocytes respond to infections. 4 Lymph enters the thoracic duct or the right lymphatic duct. Lymph node (filters lymph) 3 5 Lymph enters the blood. Thoracic duct or right lymphatic duct 4 Chyle 7 Lacteals in the small intestine (absorb lipids) 6 Lacteals in the small intestine (see figure 16. 14) absorb lipids, which enter the thoracic duct. Thoracic duct 6 7 Chyle, which is lymph containing lipids, enters the blood. 8 The spleen (see figure 14. 5) filters blood and is a site where lymphocytes respond to infections. Spleen (filters blood) 8 9 Lymphocytes (pre-B and pre-T cells) originate from stem cells in the red bone marrow (see figure 14. 9). The pre-B cells become mature B cells in the red bone marrow and are released into the blood. The pre. T cells enter the blood and migrate to the thymus. B cells Pre-T cells Red bone marrow Bone 9 10 The thymus (see figure 14. 6) is where pre-T cells derived from red bone marrow increase in number and become mature T cells that are released into the blood (see figure 14. 9). 11 B cells and T cells from the blood enter and populate all lymphatic tissues. These lymphocytes can remain in tissues or pass through them and return to the blood. B cells and T cells can also respond to infections by dividing and increasing in number. Some of the newly formed cells enter the blood and circulate to other tissues. Pre-T cells Thymus 10 B and T cells All lymphatic tissues 11 Blood capillaries B and T cells

Table 14. 1

Table 14. 1

Table 11. 2 -6 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for

Table 11. 2 -6 Copyright © The Mc. Graw-Hill Companies, Inc. Permission required for reproduction or display. TABLE 11. 2 Cell Type Formed Elements of the Blood Illustration Description Function Red Blood Cell Biconcave disk; no nucleus; contains hemoglobin, which colors the cell red; 6. 5– 8. 5 µm in diameter Transports oxygen and carbon dioxide White Blood Cells Spherical cells with a nucleus Five types of white blood cells, each with specific functions Neutrophil Nucleus with two to four lobes connected by thin filaments; cytoplasmic granules stain a light pink or reddish purple; 10– 12 μm in diameter Phagocytizes microorganisms and other substances Basophil Nucleus with two indistinct lobes; cytoplasmic granules stain blue-purple; 10– 12 μm in diameter Releases histamine, which promotes inflammation, and heparin, which prevents clot formation Eosinophil Nucleus often bilobed; cytoplasmic granules stain orange-red or bright red; 11– 14 μm in diameter Participates in inflammatory response of allergic reactions and asthma; attacks certain worm parasites Lymphocyte Round nucleus; cytoplasm forms a thin ring around the nucleus; 6– 14 μm in diameter Produces antibodies and other chemicals responsible for destroying microorganisms; contributes to allergic reactions, graft rejection, tumor control, and regulation of immune system Monocyte Nucleus round, kidney-shaped, or horseshoe-shaped; contains more cytoplasm than does lymphocyte; 12– 20 μm in diameter Phagocytic cell in the blood; leaves the blood and becomes a macrophage, which phagocytizes bacteria, dead cells, cell fragments, and other debris within tissues Granulocytes Agranulocytes

Fig. 14. 8 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 8 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Bacteria enter tissue. Tissue damage occurs. Chemical mediators are released. Chemotaxis, increased vascular permeability, increased blood flow Increased numbers of white blood cells and chemical mediators at site of tissue damage Bacteria are contained, destroyed, and phagocytized. Bacteria gone Tissue repair Bacteria remain Additional chemical mediators activated

Fig. 14. 9 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 9 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Stem cell Red bone marrow Pre-B cell Pre-T cell B cell Circulation B cell Pre-T cell Circulation Thymus Lymph node

Fig. 14. 12 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 12 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Antigen-binding site Variable regions of light and heavy chains Heavy chain Light chain Complement-binding site Site of binding to macrophages, basophils, and mast cells Constant regions of light and heavy chains

Table 14. 2

Table 14. 2

Fig. 14. 13 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 13 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Antigen (a) Inactivate the antigen. An antibody binds to an antigen and inactivates it. Antibody (b) Bind antigens together. Antibodies bind several antigens together. (c) Activate the complement cascade. An antigen binds to an antibody. As a result, the antibody can activate complement proteins, which can produce inflammation, chemotaxis, and lysis. Inflammation, chemotaxis, lysis Complement cascade activated (d) Initiate the release of inflammatory chemicals. An antibody binds to a mast cell or a basophil. When an antigen binds to the antibody, it triggers the release of chemicals that cause inflammation. Chemicals Inflammation Mast cell or basophil (e) Facilitate phagocytosis. An antibody binds to an antigen and then to a macrophage, which phagocytizes the antibody and antigen. Macrophage

Fig. 14 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. More

Fig. 14 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. More memory B cells Memory B cells B cell 1 Fewer plasma cells Memory B cells 2 More plasma cells More antibodies Magnitude of response Fewer antibodies Secondary response First exposure Primary response Longer response time (3– 14 days) 1 Primary response. The primary response occurs when a B cell is first activated by an antigen. The B cell proliferates to form plasma cells and memory cells. The plasma cells produce antibodies. Second exposure Shorter response time (hours to a few days) 2 Secondary response. The secondary response occurs when another exposure to the same antigen causes the memory cells to rapidly form plasma cells and additional memory cells. The secondary response is faster and produces more antibodies than the primary response.

Fig. 14. 9 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 9 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Stem cell Red bone marrow Pre-B cell Pre-T cell B cell Circulation B cell Pre-T cell Circulation Thymus Lymph node

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Fig. 14. 16 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Cytotoxic T cells Release cytokines Produce inflammation, initiate phagocytosis, and activate T cells Kill cells on contact Activation of a cytotoxic T cell by antigen on the surface of a cell (see figure 14. 15) Cytotoxic T cell Target cell T cell Memory T cells Target cell lyses.

Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Fig. 14. 18

Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Fig. 14. 18 Antigen INNATE IMMUNITY Physical barriers General response that does not improve with subsequent exposure Neutrophils, macrophages, basophils, and eosinophils Chemical mediators Interferons prevent viral infections. Inflammation and phagocytosis cause destruction of the antigen. ADAPTIVE IMMUNITY Specific response that improves with subsequent exposure; begins with a macrophage presenting an antigen to a helper T cell Macrophage presents processed antigen to helper T cell (see figure 14. 10). Helper T cell Cytokines and antibodies enhance inflammation and phagocytosis. Helper T cell proliferates and secretes cytokines. Helper T cell can activate a cytotoxic T cell (see figure 14. 15). Helper T cell can activate a B cell (see figure 14. 11). Cytotoxic T cell B cell proliferates and differentiates. Plasma cell Cytotoxic T cell proliferates and differentiates. Memory B cell Antibodies Direct effects against antigen Memory T cell Responsible for adaptive immunity secondary response Cytotoxic T cell Lysis of cells expressing antigen Cytokines Antibody-mediated immunity Cell-mediated immunity Antibodies act against antigens in solution or on the surfaces of extracellular microorganisms. Cytotoxic T cells act against antigens bound to MHC molecules on the surface of cells; they are effective against intracellular microorganisms, tumors, and transplanted cells.

Fig. 14. 17 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display.

Fig. 14. 17 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Acquired adaptive immunity Active immunity Immunity is provided by the individual’s own immune system. Natural Antigens are introduced through natural exposure. Artificial Antigens are deliberately introduced in a vaccine. Passive immunity Immunity is transferred from another person or an animal. Natural Antibodies from the mother are transferred to her child across the placenta or in milk. Artificial Antibodies produced by another person or an animal are injected.

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Page 407 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. SKELETAL

Page 407 Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. SKELETAL Arthritis, tendinitis, and death of bone tissue can develop. INTEGUMENTARY MUSCULAR Skin lesions frequently occur and are made worse by exposure to the sun. Hair loss results in diffuse thinning of the hair. URINARY Renal lesions and glomerulonephritis can result in progressive failure of kidney functions. Excess proteins are lost in the urine, resulting in lower than normal blood proteins, which can produce edema. DIGESTIVE Ulcers develop in the oral cavity and pharynx. Abdominal pain and vomiting are common, but no cause can be found. inflammation of the pancreas and occasionally enlargement of the liver and minor abnormalities in liver function tests occur. Destruction of muscle tissue and muscular weakness occur. Systemic Lupus Erythematosus NERVOUS Memory loss, intellectual deterioration, disorientation, psychosis, reactive depression, headache, seizures, nausea, and loss of appetite can occur. Stroke is a major cause of dysfunction and death. Cranial nerve involvement results in facial muscle weakness, drooping of the eyelid, and double vision. Central nervous system lesions can cause paralysis. Symptoms (Highly variable) Skin lesions, particularly on face Fever Fatigue Arthritis Anemia Treatment Anti-inflammatory drugs Antimalarial drugs RESPIRATORY Chest pain may be caused by inflammation of the pleural membranes; fever, shortness of breath, and hypoxemia may occur due to inflammation of the lungs; alveolar hemorrhage can develop. ENDOCRINE Sex hormones may play a role in SLE because 90% of the cases occur in females, and females with SLE have reduced levels of androgens. C ARDIOVASCULAR Inflammation of the pericardium (pericarditis) with chest pain can develop. Damage to heart valves, inflammation of cardiac tissue, tachycardia, arrhythmias, angina, and myocardial infarction also occur. Hemolytic anemia and leukopenia can be present (see chapter 11). Antiphospholipid antibody syndrome, through an unknown mechanism, increases coagulation and thrombus formation, which increases the risk of stroke and heart attack.

Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Fig. 14. 18

Copyright © Mc. Graw-Hill Education. Permission required for reproduction or display. Fig. 14. 18 Antigen INNATE IMMUNITY Physical barriers General response that does not improve with subsequent exposure Neutrophils, macrophages, basophils, and eosinophils Chemical mediators Interferons prevent viral infections. Inflammation and phagocytosis cause destruction of the antigen. ADAPTIVE IMMUNITY Specific response that improves with subsequent exposure; begins with a macrophage presenting an antigen to a helper T cell Macrophage presents processed antigen to helper T cell (see figure 14. 10). Helper T cell Cytokines and antibodies enhance inflammation and phagocytosis. Helper T cell proliferates and secretes cytokines. Helper T cell can activate a cytotoxic T cell (see figure 14. 15). Helper T cell can activate a B cell (see figure 14. 11). Cytotoxic T cell B cell proliferates and differentiates. Plasma cell Cytotoxic T cell proliferates and differentiates. Memory B cell Antibodies Direct effects against antigen Memory T cell Responsible for adaptive immunity secondary response Cytotoxic T cell Lysis of cells expressing antigen Cytokines Antibody-mediated immunity Cell-mediated immunity Antibodies act against antigens in solution or on the surfaces of extracellular microorganisms. Cytotoxic T cells act against antigens bound to MHC molecules on the surface of cells; they are effective against intracellular microorganisms, tumors, and transplanted cells.