MARIAN DIAMOND: All right.
Let's continue now with
our lymphatic system
and try to get you to
appreciate what it does for you
every second that you exist.
And you don't have
to think about it.
So we're continuing with
lymphatic and the thymus.
Your thymus gland was largest
when you were very young--
largest when young--
and then becomes
greatly reduced in
size as an adult,
yet it's still
producing T-cells.
We've said many times,
but since we repeat,
the thymus is located on your
great vessels of the heart.
So now you know that that would
be then your pulmonary trunk
and ascending aorta.
We learned that the thymus
receives T-cells and gives them
an antigen marker, give us
lymphocytes, antigen marker,
which will be our T-cell.
The thymus consists
of two lobes.
It's bilobed.
And I think that is enough for
an introduction to the thymus.
Then we have the tonsils.
How many have had
your tonsils removed?
She really did-- all of them--
but just a few.
And they all sit over on
this side of the room.
Who knows why?
But when we were little,
everyone had tonsils.
As soon as they got
inflamed, you had them out.
They do that much about them.
They thought it was bad to have
them reacting to pathogens.
So we've learned a lot.
Tonsils-- then there are
masses of lymphocytes.
And they are rammed
closely to the beginning
of your respiratory
and digestive systems.
So they form a--
we'll just put a
rim at-- beginning
of respiratory and
digestive system.
So you can appreciate that--
why they get inflamed
when you're little,
getting unwanted
quantities coming in
through these open
passages to the outside.
We need to fight them.
So the tonsils do
not filter lymph
like the other lymphatic
tissue we've talked about--
not filter lymph.
They just produce lymphocytes.
And since they're right beneath
the surface of the mouth,
they will have some stratified
squamous epithelium covering
them, but only some, not
the whole mass of tissue.
So you can always
identify them in your lab
when you're asked what kind
of lymphatic tissue is it.
If you see stratified
squamous, you
know immediately your
tissue is a tonsil.
Now, there are tonsils,
three groups of tonsils.
So we'll have palatine tonsils.
There'll be two of them.
And they are in the
posterior oral cavity.
There are lingual
tonsils, two of them.
Where are they going to be?
What's lingual?
Tongue.
So they're at the
base of the tongue
because tongue curves around--
base of tongue.
And then we have one
pharyngeal tonsil--
pharyngeal.
What did we used to
call pharyngeal tonsils?
Ever heard the term adenoids?
Never.
No.
We had tonsils and adenoids out.
But since we won't
introduce it since they
don't call it that anymore--
pharyngeal, one.
And this will be up
in your nasal pharynx.
[INAUDIBLE] you
can appreciate when
they have to take that one out.
That's not quite as
easy as these two.
So that gives you an
idea of your tonsils
and why you have them,
where you have them.
And then we have
Peyer's patches,
which we mentioned previously.
And Peyer's patches--
again, you can try
to figure out why we have them.
We've mentioned that.
We showed a slide last time.
So you've seen how
abundant they are.
There are masses of
lymphocytes in the ileum.
Now, how does this ileum
differ from the ileum
of your pelvic cavity?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: Pardon?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND:
How does-- spelled?
With your pelvic
cavity, there's an i.
That's our pelvis.
This is part-- it's the last
part of your small intestine.
Right.
That's what he said.
But I couldn't hear him.
That's OK.
I hear it now.
All right.
So this is just before you
go into the large intestine,
the ileum.
Now, why do you want all
those lymphocytes there?
Something for you
to think about.
Yes?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: I think
that's a very good reason,
to control the bacteria.
There's lots of
bacteria, and more of it
in the large intestine.
And not allowing it to come
up into the small intestine
makes good sense.
All right.
Then let's see.
Will that finish us with
our lymphatic system?
No.
We want to just say a few
words about lymph vessels
again to make it clearer how
they differ from blood vessels.
We know that blood vessels
are coming from the heart,
going back to the heart.
So if these were blood vessels,
we're going from the heart out
to arteries out to arterioles--
just reviewing--
out to capillaries,
and from capillaries, then
back to venules, back to veins,
and back to the heart.
Now, with lymph vessels, we
start with lymph capillaries.
And we go to lymph veins.
And we go to lymph ducts.
And the lymph ducts then
go into the blood vessels--
specifically, the internal
jugular and subclavian--
so quite different.
We have no heart.
We have no arteries,
no arterioles.
But we start with
blind capillaries.
And frequently, I think the
hand makes a good picture.
These are blind capillaries.
They don't have the
circulatory coming into them.
All right.
If you want to illustrate--
capillaries, lymph
veins, lymph ducts,
back into the blood vessels.
So that gives you-- what
lymph ducts did we mention?
A big one coming up from
the abdominal cavity
up into the thorax,
emptying into the jugular,
internal jugular, at the base of
the neck-- what did we call it?
What cavity is this?
Thoracic.
What do we call the duct?
Thoracic duct.
Yes.
You have the thoracic
duct as one of these.
[? Now, ?] as a
graduate student,
we had to learn a lot
about that thoracic duct.
They were studying fat uptake.
So you inject radioactive
fat into the stomach
and let it go down
into the intestine.
And then it gets absorbed
into the thoracic duct.
And then you pick it
up here at the neck.
You collect the
lymph to see the rate
of flow of fat absorption--
[INAUDIBLE] very
neat experiments.
So we had thoracic
ducts for lymph ducts.
And we have the right
lymphatic duct--
so two ways in which we get
back into the blood vessels
from these two ducts.
So now let's go to
a brand new system.
Let's go to our
respiratory system.
The respiratory system
comes under the term--
we can speak of the science
of otorhinolaryngology--
so quite a mouthful, right?
With our other
systems, cardiology--
here we've got
otorhinolaryngology.
So how do we separate this?
Oto is what?
Ear.
Rhino is what?
STUDENT: Nose.
MARIAN DIAMOND: Nose.
Good.
And laryngology-- throat.
Ear, nose, and throat--
so it goes under this category.
The respiratory system
is very closely related
to the cardiovascular system.
Respiratory and
cardiovascular systems--
they're related structurally
and functionally.
So in what ways?
Well, we've already
seen them as we
studied the heart and its
vessels going to the lungs
and back again.
The people in the
field have divided this
into external respiration
and internal respiration,
showing the integration
of the respiratory system
with the cardiovascular.
So let's put, for example,
external respiration.
This will be at the
level of what are called
the alveoli of the lungs--
alveoli of lungs-- with--
this is where the air is
coming into the alveoli.
And it has to go into the
blood vascular system--
namely, capillaries.
So the exchange of gases for
external respiration of your O2
and CO2 is in the alveoli of
lungs with the capillaries.
This was air.
This was blood--
close correlation.
Then we have
internal respiration,
which takes place between
the blood capillaries
and the tissue cells.
Internal respiration-- this
will be blood capillaries now
with tissue cells, whether it
be liver, kidney, whatever.
So they do break
up the difference
between external and
internal at these two levels.
So now what we'd like to do
is follow the constituents
of our respiratory system.
You wonder why you
just can't have
a plexus close to
the skin and the air
get right into your blood.
Look at all the
adaptations we have
to make to get blood
in through the nose
and down into the
alveoli of the lungs.
Let's begin then with the nose.
We go from the nose
to the nasal cavity,
from the nasal cavity
to the nasal pharynx,
from the nasal pharynx
to the oral pharynx,
from the oral pharynx
to the larynx,
from the larynx to the
trachea, from the trachea
to the bronchi, from the
bronchi to the bronchioles.
And here we'll have
terminal bronchioles.
Terminal bronchioles will go
to respiratory bronchioles.
And where do respiratory
bronchioles go?
To the alveoli.
Correct.
So there must be
reasons for air to have
to travel through all
of these various units
before we get exchange of gases.
So then let's go back and look
at the function of the nose
and start with it.
Three things we
can say right off--
one, that it has
to clean the air.
Two, it has to moisten the air.
And three is what?
Warm the air.
Right.
So in order to do
all of this, we
have to have a very
special type of epithelium.
You've had simple
squamous epithelium,
stratified squamous.
This is pseudostratified
columnar ciliated epithelium
with goblet cells--
quite a complex epithelium.
So the epithelium, which is
designed to help us do this,
is pseudostratified,
columnar ciliated epithelium
with goblet cells, the
most complex epithelium
you're going to encounter.
What does pseudo mean?
False.
You've learned that before--
a pseudo unipolar cell.
So what's pseudostratified mean?
If I have a basement
membrane here,
I'll have stratified
epithelium in you skin.
Stratified-- many layers.
That's stratified.
Only one layer touches
the basement membrane.
Pseudostratified-- they look
stratified, but they're not.
With pseudostratified, they all
touch the basement membrane.
I don't know if we have
our basement membrane.
And we said it's
going to be columnar.
So we'll have a
columnar cell here.
That's perfectly fine.
But here, I may
have another cell
that comes around like this,
making it look stratified.
But it's not.
It's pseudostratified--
another one here.
So it looks like you've
got these layers.
But each one of them will
come down somehow and touch
the basement membrane.
I don't know why.
It's just the way it is.
But it explains it to you.
Then they'll have cilia on them.
These are pseudostratified
columnar cells.
And what do we need to add?
We need to add goblet
cells to give us our mucus.
So we'll find that goblet
cells are sort of interspersed
in here.
A goblet cell--
it's a mucous cell.
And it secretes mucus.
Why do I spell this
out so carefully?
Because the spelling
of the name of mucous
when it's an adjective here is
different from the mucus that's
secreted.
You see this is M-U-C-O-U-S.
This is just M-U-C-U-S.
So now let's see
how these function.
Let's take our cilia first.
As we saw, all the
cells have cilia.
And the cilia is
beating posteriorly
towards the nasopharynx.
So all the chalk dust that
I'm getting in my nasal cavity
now is being picked
up by the cilia
and going back to my nasal.
It's not coming this way, right?
So the cilia will convey--
we'll just put dust or
dirt, whatever you like,
toward nasopharynx.
So they're cleaning the air.
Now, to moisten the air,
we need our goblet cells.
They're secreting mucus.
How much nasal mucus do the
goblet cells produce each day?
[? Isn't that ?] amazing?
500 ccs.
One lecture when I gave
this, I didn't know somebody
from the Rolling Stones
magazine was in the audience.
And the next issue said
that the Cal students
are taught how much nasal
mucus they form each day.
So they thought that
was rather unusual.
So secreting mucus--
500 ccs per 24 hours.
That's a lot.
So aren't you glad that it goes
out through your nasal pharynx
rather than out through
the other direction?
We're so self-conscious
if we get
one little drip of nasal
mucus coming out the nose.
Aren't we?
And you tell the
other person, hey,
you got something
coming out your nose.
Oh, gosh.
You're really pouring out
500 ccs the other way.
So this mucus will go
into your nasopharynx.
And it will go down.
We'll see if all the solutions
and everything-- where they're
finally going to be reabsorbed
because you're not going to get
rid of all of this.
Then we need to warm the air.
So we need a venous sinus.
And the venous sinuses
are beneath the epithelium
that line the nasal cavity--
beneath epithelium,
which lines nasal cavity.
And their function then since--
is to warm the air--
so all these adaptations
to help prepare
the air for continuing on down.
These are within our
functions of the nose.
So other functions of the nose
give resonance to our voice.
All you have to do is turn to
the person sitting next to you,
hold your nose, and talk.
And you sound entirely
different, right?
So resonance to the voice
is another function of nose
as we continue.
And then it gives you
your hereditary signature.
You often wonder-- this
little bump out here.
You look at the parents.
You say you have a hereditary
signature like your parents.
These are functions of nose.
And it provides a living for
our plastic surgeons, right?
[LAUGHTER]
Rhinoplasty.
We'll put survival.
They do more than survive.
[LAUGHTER]
But it is interesting.
The psychology of noses--
it's a whole field
in itself, right?
Everybody identifies
with his nose--
either likes it or
doesn't like it.
It's just like hair.
We can have whole
classes on hair
and how people look at hair.
The psychology of noses--
another function.
I've not seen a class on it.
But we know that it
would be available
if we stop to think about it.
All right.
Let's see if we've got
all your functions here.
No.
One more very
important function--
it houses the olfactory
nerves up at the roof--
olfactory nerves.
Now let's look at its structure.
How is it built
to do all of this?
You ever thought so
much about your nose
before, right there in
front of you all day long?
No?
Structure-- well, first,
we have to bring in air.
So we have what are
called external nares.
What's another term for nares?
Yes, nostrils.
And our internal nares will
be back here, much broader.
And we'll have our
nasopharynx back here.
And now we can begin to
look at the boundaries.
So the roof will be what bone--
is going to be the most
anterior part of the roof?
The cribriform is the
structure within what bone?
STUDENT: The ethmoid.
MARIAN DIAMOND: The ethmoid.
Good for you.
So two will be the ethmoid
in the rear in the roof.
And three will be the what?
What's just behind the ethmoid?
No.
We're going to run into
palatine down here in the floor.
We're up in the roof.
STUDENT: Sphenoid.
MARIAN DIAMOND: Pardon?
Sphenoid.
Good for you.
So then in the floor, what
will we have anterior?
No.
That's posterior.
You're getting close.
We want anterior.
Pardon?
No.
STUDENT: Maxilla.
MARIAN DIAMOND: Maxilla.
Sure.
Where is the maxillary bone?
Now, what is posterior
in the floor?
The palatine.
If you say it long
enough, we'll come to it.
Right.
Palatine.
Right.
So now we're at the palatine.
There are actually
two of these--
two maxillaries, two palatines.
And the palatine
and the maxillary
make up what's called
the hard palate.
So posterior to the palatine
will be the soft palate.
So in pink here, we've got
5, which is the soft palate.
And it consists then of
mucous membrane and muscle.
And this little projection
of muscle and mucous membrane
which you see when you
looked in the mirror
when you brush your
teeth at the very
posterior aspect of your
oral cavity is called what?
The uvula.
We'll just put 6 year.
And 6 equals our uvula.
What does uvula mean?
Grape-- looked like a grape
back there to somebody.
And why do you have that
protrusion back there?
What's its function?
Let's say we have
our tongue here.
So when you swallow, this uvula
comes up and blocks substances
from entering the nasopharynx.
So it has a very
important function.
Uvula blocks entrance
to nasopharynx.
Has anybody ever swallowed
and had something go up
into your nasopharynx?
It really hurts.
Doesn't it?
Yes.
No.
When we were kids and we
were helping pick grapes
in the war when all
the fellows were away--
they brought in all the Los
Angeles girls to pick grapes.
But we had to take salt pills.
They gave you a salt pill.
Then you had to bend over
the drinking fountain
and swallow it.
Guess where that pill
would frequently go?
Right up into your nasopharynx.
You had to wait
for it to dissolve.
And it really burned.
So when you take your pills,
always stand up, right?
Good lesson.
All right.
Why'd they give-- because
we were sweating so much.
We were losing so much
salt. It was 125 in the sun.
This was down in Bakersfield.
And we loved it because
we wanted to get tan.
You can see--
[LAUGHTER]
We survived.
But that's life.
But we help the war effort.
And that's what they needed.
We got all the grapes
picked so they got shipped
where they were supposed to go.
That was the purpose.
All right.
Let's get back now to our
bony structure of the nose.
We've done the roof.
We've done the floor.
We want to do the medial septum.
My goodness.
All right.
What forms our medial septum?
It's going to be dividing our
right and left nasal cavity--
divides right and
left nasal cavity.
We'll have a bone
called the vomer.
We'll have the perpendicular
plane of the ethmoid.
And we'll have
hyaline cartilage.
So our septum consists
of, one, the vomer.
What does vomer mean?
Plow.
Have you ever seen a
plow with a sharp blade
that goes through the earth?
This was the shape
of a plow, vomer.
Two, this was perpendicular
plate of ethmoid.
And three will be cartilage.
Now, who can tell me
what kind of cartilage?
Hyaline.
Good for you.
You know it's not elastic.
And you know it's not fibro.
So everything else has
to be hyaline, right?
You're learning.
Great.
This is hyaline cartilage.
Process of elimination
is part of learning.
All right.
Let's just take
the later wall then
because we've had medial wall.
We've had roof and floor.
Lateral wall has
its own personality.
We're going to have concha.
And right now, in
this direction,
we're going to
put them linearly.
But what they really are
are curved like a shell.
These big conch that you
find on the beaches of Hawaii
or out in the
Pacific, they curve.
So we'll have a superior conch,
a middle, and an inferior.
And under the
curve, if we have--
coming from the side, the
conch would look like this.
This is the lateral wall.
This is superior,
middle, and inferior.
And the area underneath the
conch is called a meatus.
The middle meatus,
which would be this one,
receives secretion from the
maxillary and frontal sinus.
The maxillary and
frontal sinuses
drain into the middle meatus.
What drains into
the inferior meatus?
Notice when you cry and
your tears are pouring out,
your nose runs.
It's tears.
Your inferior meatus--
you get tears.
How do they get there?
Here's your eye.
Here's your eye.
On the lateral superior
aspect of your eyes,
you have your tear glands
called lacrimal glands.
This would be a lacrimal gland.
And those tears are
designed to moisten your eye
and clean your eye.
They're going across in
this direction, your tears.
And at the medial aspect of your
orbit here, you have a duct.
This is called the
nasolacrimal duct.
And so the tears then
are going to go down.
And they're going to come out
here in your inferior meatus.
So that's how your nose runs.
They're really tears.
It's not nasal mucus.
It's tear.
I guess we will have to
wait for our slides then.
Thank you.
I'm sorry.
We'll have to do
those next time.
