An obstetrician may elect to numb the perineum during childbirth and perform an episiotomy, an incision made in the posterior vaginal wall and perineum to prevent tearing and to also facilitate the birth of the fetus’ head. Perineal tears and episiotomies must be sutured shortly after birth to ensure optimal healing.
As this procedure is no longer routinely recommended, I'm not sure we should include it.
Several ligaments
Should we include the round ligament here, particularly as it is such a common source of pain in pregnancy?
chromosomes.
I would add "and is genetically unique" here to emphasize the role of meiosis in the genetic diversity of the population.
The primary spermatocyte undergoes meiosis I to form two haploid secondary spermatocytes. These two cells undergo Meiosis II to form four spermatids, which then develop into mature sperm.
Maybe a reference here that further discussion of Meiosis is coming in the next section.
raphae.
We use raphae in the text and raphe in the diagram. Should we change text to raphe to be consistent?
a UTI or more serious conditions such as kidney stones, glomerulonephritis, or cancer
Should we add trauma to this list?
Aldosterone, a hormone produced by the adrenal cortex, increases the reabsorption of Na+, which then increases the reabsorption of water. Antidiuretic hormone (ADH), a hormone released by the posterior pituitary gland, also increases the reabsorption of water. ADH exerts its effect farther along in the nephron at the distal collecting tubule and collecting duct. It influences how dilute or concentrated the final urine will be
Do we want to have a quick conversation about obligatory vs selective reabsorption here? I worry that this section implies that these hormones impact all reabsorption instead of only selective.
The distal convoluted tubule will recover another 10–15 percent before the filtrate enters the collecting ducts
I agree with calling out the specific percentage here, but I feel that if we are going to do so we should also do it in the PCT and loop discussion.
About 99 percent of the water and most of the solutes filtered by the nephron are reabsorbed
I feel like this sentence should be earlier, because it's inclusion here implies that 99% of reabsorption is happening in the PCT.
See Figure 15.3[2] for an illustration of the location of the kidneys.
Neither diagram nor text reflect that right kidney is slightly inferior to the left due to the presence of the liver.
general, diet, health, and stress
Exercise plays an important influencing role here as well and should probably be mentioned.
The digestion of proteins and carbohydrates begins in the mouth with salivary amylase
This sentence seems to imply that salivary amylase chemically digests proteins, which would not be accurate.
Although one might think that the size of a person’s stomach is related to how much food that individual consumes, body weight does not correlate with stomach size. Rather, when greater quantities of food are eaten—such as at holiday dinner—the stomach stretches more than when less is eaten.
Should we discuss emesis as a protective mechanism either here or in the disorders section?
Salivary amylase, an enzyme in saliva, begins the chemical digestion of starches in the mouth.
I think this would flow better if we discuss salivary amylase before we state that chemical digestion is continued in the stomach.
bolus
I don't believe that we have defined this term yet, which may confuse students.
envelope
Spelling error that slipped through the spellcheck. Envelop, not envelope.
The stomach is equipped for its churning function by the addition of a third layer,
Should we point out that the muscularis of the stomach is composed of smooth muscle before we discuss the third layer?
superficial
Deep
(ingestion), break down the foods you eat (digestion), absorb those nutrients (absorption), and eliminate wastes from the body (defecation)
The sources I have used for this course consistently consider propulsion a separate and distinct function that is added to this list.
virus.
I would like to see us specifically mention that masks trap the droplets that spread the disease, as there is misinformation out there that because masks don't filter particles as small as the virus they cannot be effective.
External respiration (or alveolar gas exchange) is the exchange of gases between the alveoli and the pulmonary capillaries. Internal respiration (or systemic gas exchange) is the exchange of gases between the systemic capillaries and the tissues.
I would like to see us specifically discuss which gases are moving in which direction for each of these.
12 mL.
Looks like a typo here
This lubrication reduces friction between the two layers. See Figure 13.10[11] for an illustration of the pleurae and pleural cavity.
A discussion of the role of the pleura in keeping the lungs inflated seems important, particularly in relation to conditions such as pneumothorax.
The glottis is the opening inside the larynx, which also contains the vocal folds or cords. Air passes through this opening when breathing and making speech.
Maybe a quick functional discussion stating that the glottis is widened when breathing, but narrowed during phonation to allow the passing air to vibrate the vocal chords?
males due to the effects of testosterone
Maybe remove the gender reference and simply state that it is enlarged with increasing levels of testosterone?
The sinuses produce mucus and lighten the weight of the skull.
Do we want to discuss their impact on vocal resonance and why the voice sounds different when we have a cold?
Lymphatic System Disorders
Should we add myasthenia gravis to this list due to it's relation to thymus? We also have a lot of students that fit into the higher risk category for this disease, so raising awareness may be prudent.
lymphatic system.
Maybe a comment about the removal of lymphatics in mastectomy to reduce risk of metastasis?
When administered to a healthy individual, it causes a weakened primary immune response and the development of immunological memory. With administration of vaccines, one can avoid the damage from disease that results from exposure to a pathogen yet reap the benefits of protection from immunological memory.
We don't discuss primary vs secondary immune responses, so this sentence may not clearly illustrate this concept. Should we give a basic outline of primary vs secondary immune response to further clarify the role of vaccination?
many B cells
Do we want to introduce the term "plasma cells" here?
The septum prevents the impulse from spreading directly to the ventricles without passing through the AV node first.
Do we want to mention why this is important in order to help lead us into the Cardiac Cycle conversation?
Because these openings and valves structurally weaken the atrioventricular septum, the remaining tissue is reinforced with dense connective tissue called the cardiac fibrous skeleton of the heart.
We mention this here and in the Myocardium section. Do we need the redundancy? Maybe just mention it here?
which then contract and push blood into the lower chambers
Maybe "empty blood into the ventricles?" I find that students get confused when we initially tell them that the atria squeeze blood into the ventricle and then later clarify that most of the blood moves passively from the atria into the ventricles.
Complete this supplementary learning activity
I really like this resource for this topic as well and students tend to enjoy it:
https://educationalgames.nobelprize.org/educational/medicine/bloodtypinggame/
In a vascular spasm, the smooth muscle in the walls of the vessel constricts dramatically. T
In our instruction we typically discuss a normal time frame for each stage of hemostasis. Do we want to add that here?
Adult females have an average of 4 to 5 liters of blood, and adult males have an average of 5 to 6 liters of blood.
I like to clarify here that blood volume is dependent on size, not gender.
As discussed in Chapter 8, the nervous system uses two types of communication – electrical signals and chemical messengers called neurotransmitters.
Actually, this was never discussed in Chapter 8. There is no mention of neurotransmitters or the Action Potential in the chapter.
Symptoms of Bell’s palsy include sudden weakness or paralysis on one side of the face, a drooping eyebrow and mouth, and drooling from one side of the mouth and difficulty closing one eyelid, which causes eye dryness.
A conversation about differentiating Bell's Palsy and Stroke seems prudent in this section or in the Stroke section.
Movement is sensed by the semicircular canals, three ring-like extensions adjacent to the vestibule. One is oriented in the horizontal plane, whereas the other two are oriented in the vertical plane
We basically say the same thing above. Do we need both?
Much of what you think is taste when you’re eating is actually really smell.
Maybe a reference to a change in the taste of food when we have a cold and lose some smell sensation to exemplify this point?
lacrimation
Should we define this quickly?
The respiratory, cardiovascular, and musculoskeletal systems are activated together to allow more oxygen to be inhaled and delivered to skeletal muscle
I would again tie this to energy production to emphasize the purpose of oxygen in the body.
leg
"lower extremity?"
leg
"lower extremity?"
arms
Perhaps use "upper extremity" to avoid reinforcing the perception of "arm" as referring to the entire upper extremity.
Because the spinal cord does not extend through the lower lumbar region of the vertebral column,
Should we mention earlier that the cord ends at L1?
Neurons are very sensitive to oxygen deprivation
I would like to see us tie this back to the conversation about the role of oxygen in ATP production to reinforce why we die without oxygen.
Immediately below the brain stem is the cervical region, followed by the thoracic, then the lumbar, and finally the sacral region.
I'm not sure why we are omitting the coccygeal region here.
which responds primarily to changes in hydrogen, carbon dioxide, and pH levels in the body
Do we want to emphasize the point here that respiration is not primarily controlled by oxygen levels?
Astrocytes support neurons in the central nervous system by maintaining the concentration of chemicals in the extracellular space, removing excess signaling molecules, reacting to tissue damage, and contributing to the blood-brain barrier (BBB)
Maybe we also mention their role in synapse formation?
in the olfactory epithelium (where smell stimuli are sensed) and as part of the retina.
We clarified olfactory epithelium here, but not retina. We might want to clarify both as we have not defined retina yet and some students may be unfamiliar with the term.
made from neuroglia
As we have not yet defined neuroglia, students may misinterpret this as a substance, not a cell type. Maybe "made by cells that support the nervous system called glial cellls, which we will explore in more detail later."
Stretching pulls on the muscle fibers and results in an increased blood flow to the muscles being worked
Do we want to discuss that dynamic stretching prior to exercise provides more benefit than static stretching based on current understanding?
biceps brachii is the prime mover; however, because it is assisted by the brachialis, the brachialis is called a synergist.
Biceps brachii is not the prime mover of elbow flexion, brachialis is. Biceps brachii is the prime mover of supination.
The tension is released from the biceps brachii and the angle of the elbow joint increases.
It may be helpful to contrast this with relaxation, as my students initially struggle with this concept. I use the controlled descent portion of a pushup as an example of an eccentric contraction of triceps brachii or losing an arm-wrestling match as another example.
much like a key unlocking a lock. This allows the myosin heads to attach to actin.
FWIW, the analogy I like to use here is a garage door opener (troponin) pulling open the garage door (tropomyosin), allowing the car (myosin head) to enter the garage (myosin binding site on actin).
some skeletal muscles are also located throughout the body at the openings of internal tracts to control the movement of various substances
Maybe mention muscles attached to the skin used in facial expression?
sports with running, twisting, or throwing actions;
Running as a contributor to osteoarthritis is not clear in the literature and may even have a protective effect. I'm not sure we want to include this in the list.
Arms There are three bones in each arm,
I would also use "upper extremity" here for clarity
Leg
Lower extremity?
Injury, exercise, and other activities lead to remodeling, but even without injury or exercise, about 5 to 10 percent of the skeleton is remodeled annually just by destroying old bone and replacing it with fresh bone.
A discussion of Wolff's Law seems appropriate here, especially as we earlier referenced changes in bone density due to force placed upon them.
endochondral ossification,
A note here breaking down the roots of the word may help students remember that this occurs "within cartilage."
.
Maybe also briefly mention role in blood calcium regulation to plant that seed for later?
Protect tendons from compressive forces
Do we want to mention the mechanical advantage provided by these bones here?
the arms (i.e., humerus, ulna, and radius) and legs (i.e., femur, tibia, fibula), as well as in the fingers
We might want to say upper and lower extremity rather than arms and legs here to avoid later confusion when we discuss muscle action (thigh vs leg, for example).
Eczema
Do we want to add a section on dermatitis here?
fingerprints. Fingerprints
Maybe a reference here to the functional purpose of dermal papillae in improving grip.
is the third layer of the skin directly below the dermis
Do we want to split the hair that hypodermis is technically not part of the skin, but supports the skin and attaches it to the muscle beneath?
Sweating releases heat. Convection (air moving across the sweaty skin) lifts heat off the skin.
Evaporation of sweat is the primary means of removing heat from the body, not sweating itself. After evaporation, convection removes the warm moist air from the skin, aiding in the heat removal.
which makes it very strong and resistant to stretching
Maybe we note that the parallel fibers provide good tensile (straight-line) strength, not very good shear (perpendicular) strength, leading to tears when perpendicular forces are applied as in many knee injuries.
diffuse across during gas exchange
A useful analogy here might be that simple squamous epithelium is similar to a screen door, letting smaller substances through but not larger ones. I then explain that we find this tissue in areas that we need exchange to occur.
The sloughing off of dead cells
Maybe a note that the deepest layer of the tissue is the only one that divides, and as cells get pushed closer to the surface they flatten out and die.
it doesn’t have a blood supply
Maybe add that this contributes to its role as a barrier, preventing infectious material from directly entering the bloodstream from the environment.
.
Do we want to mention a very brief overview of meiosis and the reasons we need it here for those students who will not move on the Advanced A&P?
.
I like to point out that Telophase effectively undoes Prophase, so that if we know what happens in Prophase we can predict what happens in Telophase (the opposite).
.
We may also mention here that this is when the spindle fibers attach to the chromosomes.
use of energy
I would suggest altering to say "use of cellular energy"
In other words, water moves from a dilute or watery environment towards a concentrated (“saltier”) environment, commonly referred to as “water follows salt.”
I like to point out here that this still fits the definition of passive transport because the substance that is moving (in this case, water) is moving down ITS concentration gradient.
. T
I would reemphasize here that substances move until they achieve equilibrium. This is going to set us up better for the external respiration conversation and the problems with breathing at altitude, for example.
Passive transport is the movement of substances across the membrane without the use of energy. For example, when riding a bike down a hill, no energy is needed to move the bike. You can coast down the hill without pedaling the bike. This is similar to passive transport of substances across the membrane. No input of energy is required to move the substance across the membrane. Active transport is the movement of substances across the membrane using an energy molecule called adenosine triphosphate (ATP). For example, riding a bike uphill requires energy. You have to pedal the bike to get up the hill. This is similar to active transport of substances across the membrane. Energy is also required to move the substance across the membrane.
I much prefer to define passive transport as using energy from the environment (repulsion of like charges, for example) while active transport requires the cell to provide the energy needed for movement. If we say passive transport does not require energy, students wonder why they are moving at all. If we use environmental energy that more naturally leads to a conversation about equilibrium and how particles with like charges establish a maximum distance from each other. It also sets up the conversation for moving up or down concentration gradients.
form genes
We define what genes are made of, but never discuss their role in the body. Some reference to genes being the instructions for forming proteins is probably warranted.
The unique sequence for every protein is ultimately determined by the gene that encodes the protein.
We haven't introduced genes or their role in the body yet, so this may be a very confusing sentence. Maybe put the nucleic acid conversation before the protein conversation in this chapter in order to help define this concept before it is applied?
using protein for energy causes tissue breakdown and results in body wasting
I'm afraid that students may misinterpret this to mean that using dietary protein for energy causes body wasting. Maybe some reference to starvation, etc. to make this clearer?
hydrophobic and hydrophilic
Have we defined these terms?
y. A
A comparison of the relative energy content of fats vs carbohydrates (kcal/g) may be useful here.
r g
Nitpicky, but maybe say "blood glucose levels" instead of just glucose levels for better tie-in to future blood glucose regulation conversations.
.
A sentence here about how forming compounds changes how these substances interact with the body may be useful here. An example to potentially include could be that elemental sodium explodes when exposed to water, but when combined with chloride it becomes table salt and is critical to the functioning of the nervous system. There is a lot of misinformation out there claiming that some substances are dangerous to the body in all forms when they are demonstrably perfectly safe in compounded forms.
nine regions
We are getting feedback that some GAP students struggle to identify organ location as they move on to future courses. Identifying major organs/structures in each abdominopelvic region may be a wise investment of our time here.
back
Stating that dorsal means toward the spine side may help to differentiate "dorsal" from "posterior."
Toward the side
"Away from the midline" might be clearer here?
with the palms facing forward
I like to point out that palms forward allows radius and ulna to be seen distinctly instead of being partially superimposed as a way to help them remember which direction the palms should be facing.
A temperature of 102.5° F is a disruption of that homeostasis, and the body will work to restore the temperature back to the normal temperature of 98.6° F.
I feel that this statement may cause confusion when discussing fevers. A temperature of 102.5 from exercise or exposure to a warm environment would be a disruption of homeostasis. A fever of 102.5 due to illness does not constitute a disruption of homeostasis, rather a resetting of the set point. In this case, the body will not try to restore a temperature of 98.6F, but will maintain the higher temperature. More info on this discussion here:
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/209609
I would maybe add the phrase "due to external sources" or some other qualifier so that students don't later become confused about the relationship between homeostasis and fever.