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CLINICAL systems of

Homeostasis Part 1: and

Authors Brendan Doherty, MSc, PGCE, RN, is Artery Plasma Extracellular nurse patient access manager, Prince of Wales fluid Hospital, Sydney, Australia; Colette Foudy, RN, GradDip, is clinical care coordinator, , St George Private Hospital, Sydney, Australia.

This article, the first in a series of four, looks at the anatomy and physiology of . Homeostasis comprises the dynamic processes that enable optimum conditions to be maintained for cells, in spite of continual changes taking place internally and externally (Clancy and McVicar, 1995). All the systems of the are involved, with particular contributions by the endocrine, Venule Capillary nervous, respiratory and renal systems. Whenever an imbalance occurs, regulatory systems become active Capillary to restore optimum conditions, usually by a process Fig 1. extracellular known as negative in which a deviation fluid and vessels from the normal level is detected and initiates Vein changes that bring the level back to where it should be (Clancy and McVicar, 1995). These systems have to Ear Pineal endure for survival and adapt to modifications of the environment so must therefore evolve. Eyes

Anatomy and physiology and smell Pituitary Many factors affect the suitability of body fluids to sensors sustain life. These will be explored later in this series. Thymus They include: l (O2) and (CO2) Andrenals ; l The pH of the ; l Concentrations of and waste products; l of salt and other (); l Volume and pressure of ; Ovaries l Body ; l Blood level. As these properties affect the chemical reactions that sustain life, there are built-in physiological mechanisms to maintain them at desirable levels. The body needs Testes homeostasis to maintain stability and survive by sensors ensuring that the internal environment remains relatively constant (Tortora and Anagnostakos, 2003). To enable cells to survive, the composition of the Nerves intracellular and extracellular fluids must be accurately maintained at all times. Intracellular fluid accounts for two-thirds of total water content (Tortora and Anagnostakos, 2003). Extracellular fluid includes gases, nutrients, plasma (in blood vessels) and , endocrine system all of which are necessary for maintaining life (Tortora and Anagnostakos, 2003) (Fig 1). Fig 2. The endocrine and central nervous systems

Extracellular fluid circulates constantly within Zygo Johnny

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the blood and lymphatic system and is known as References ‘the body’s internal environment’ (Tortora and Homeostasis is constantly disturbed by external Anagnostakos, 2003). factors, which can be described as a form of Bodyguide (2005) Endocrine The body is said to be in homeostasis when its on the internal environment (Tortora and System. www.besthealth.com/ internal environment contains: Anagnostakos, 2003). These stresses can be: besthealth/bodyguide/reftext/html/ l Optimum levels of gases, ions, water and nutrients; l Internal: occurring within the body, for example in endo_sys_fin.html#homeostatic. l Is at optimal temperature; pain, or as a result of high or low ; l Has optimal pressure for the of cells. l External: occurring outside the body, for example as Clancy, J., McVicar, A. (1995) A disturbance in these optimum conditions causes a result of heat, cold or loud noises. Physiology and Anatomy: failure of the organs and may lead to (Tortora Since these stresses affect the chemical reactions A Homeostatic Approach. and Anagnostakos, 2003). sustaining life, there are built-in physiological London: Edward Arnold Publishers. mechanisms to maintain or return them to Docherty, B. (2005) The Homeostatic control desirable levels. arteriovenous system: part one, the The endocrine and central nervous systems are Each or has its own intrinsic way anatomy. Nursing Times; 101: 34, the major control systems for regulating homeostasis of keeping the internal environment within normal 28–29. (Tortora and Anagnostakos, 2003) (Fig 2). The limits. When homeostasis is altered there are two endocrine system consists of a series of possible responses: Docherty, B. (2002) that secrete chemical regulators (). The l In negative feedback the system responds Cardiorespiratory physical nervous system can detect deviation from the to reverse the direction of change. As this tends assessment for the acutely ill: part body’s normal equilibrium (state of homeostasis) to keep things constant, it allows the maintenance one. British Journal of Nursing; and sends messages to the affected organ to of homeostasis. For example, if there is a fall 11: 11, 750–758. counteract this disturbance. Over a relatively in in the blood, the parathyroid glands short time it restores the required balance. Both the decrease and secrete more parathyroid Sherwood, L. (1997) Human systems act mostly automatically but there is some , thereby increasing calcium release from Physiology: From Cells to Systems. voluntary control over the nervous system the ; Pacific Grove, CA: West Publishing. (Sherwood, 1997). l Positive feedback increases the variable in the Tortora, G.J., Anagnostakos, N.P. The control and maintenance of blood sugar levels same direction, a destabilising effect that does (2003) Principles of Anatomy and is an example of homeostatic regulation by the not result in homeostasis. Positive feedback is used Physiology. New York, NY: John endocrine system. Blood sugar is maintained by two when rapid change is needed. For example in Wiley and Sons. hormones secreted by the pancreas: and childbirth the hormone oxytocin is produced to . Blood sugar rises after digestion of food. In stimulate and enhance labour contractions response, pancreas cells are stimulated to secrete (Bodyguide, 2005). insulin, which enables sugar uptake by cells and the storage of sugar in the and muscles. In effect, Components of homeostasis insulin decreases blood sugar levels to normal A system requires three components for homeostasis: (Tortora and Anagnostakos, 2003). l A ; The provides an example l A control centre; of homeostatic regulation by the nervous system. l An . In normal there is a state of homeostasis. These components do specific jobs that allow During exercise the respiratory system must work regulation of the internal environment. faster to keep the O2 in the extracellular fluid and A receptor detects external changes that could in the cells within normal limits, preventing excessive influence the internal environment. For example, build-up of CO2 and disturbance to the blood pH the following are involved in the regulation of through the accumulation of acid (Tortora and blood pressure: Anagnostakos, 2003). Because muscles require l Receptors are in the system; l more O2 during exercise, more CO2 is released and The control centre is the ; therefore also needs to be excreted (Tortora and l The effector is the cardiovascular system. Anagnostakos, 2003). When there is an increase in heart rate more blood These chemical changes are detected in certain is pumped into the arteries resulting in an increase in nerve cells, which send this message to the cardio- blood pressure (Docherty, 2005). This is detected by respiratory centre in the medulla oblongata in the , which are located in the walls of the base of the brain (Docherty, 2002). The brain certain arteries. sends a message to the heart to increase its pumping These receptors send impulses to the control This article has been double-blind action (heart rate) to take on more O2 and enable centre (the medulla oblongata), which interprets peer-reviewed. the blood to give up excess CO2. Respiratory muscles the message and sends impulses to the effectors also receive instructions from the brain to contract (the cardiovascular system). These slow the For related articles on this subject faster, enabling a rise in both O2 delivery and pulse, decreasing blood pressure (Tortora and and links to relevant websites see n www.nursingtimes.net CO2 exhalation. Anagnostakos, 2003).

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