LEC FINAL CUM.txt
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(SG1.3) ★ Characteristics and functions of the Ventricles:
- All heart valves except the bicuspid, have three flaps.
- Left and right ventricles are major (left) systemic and (right) pulmonary pumping chambers
- Walls of the left ventricle being significantly thicker than the right because of the distance the left has to pump through.
- The left ventricle receives blood through the mitral or bicuspid valve and outputs it to the aorta via the aortic semilunar valve.
- Right ventricle receives blood through the tricuspid valve and outputs it to the pulmonary trunk via the pulmonary semilunar valve.
- BP at Aorta: 100-120 mm Hg, and at Right Atrium: 0 mm Hg.
(SG2.1) ★ Morphology of RBC?
- About 7.5 µm in diameter
- Biconcave - very large surface area to volume
- No nucleus, ribosomes or mitochondria
- Males: 4.5-6.3 million RBC / mm³, Females: 4.2-5.5 million RBC / mm³
- One-third of the cell volume is the red protein pigment: hemoglobin which is a protein.
- Hemoglobin has a higher attraction to CO versus O2.
- Hematocrit is the % of whole blood that is RBC: Males about 45%, Females about 42%.
- Hematocrit would be high with diarrhea or vomiting, and low if you drank a lot of water.
- Can fit through capillaries often smaller in diameter than 7.5 µm
- Flexibility through stretchable fibers of protein spectrin
- Circulating life: 105-120 days
- Each RBC has 200-300 million molecules of hemoglobin and 95% of the dry weight of each cell
(SG2.3) ★ Relate anemia to hemoglobin content
Normal men have 14-16 g of hemoglobin per 100 ml of blood (this is because of the stimulating effect on erythropoiesis by testosterone, the primary adrogen: male sex characteristic), while women have 12-14 g. Anyone with less than 10g/100ml is diagnosed as having anemia.
(SG3.1) ★ Erythropoiesis?
- All formed blood elements, including RBCs, which is what erythropoiesis is about, are generated from adult blood-forming stem cells known as hematopoietic stem cells, which are called hemocytoblasts.
- Maturation from these nucleated cells begins in the red bone marrow.
- The differentiated daughter cell created via mitosis for erythrocytes is the proerythroblast.
- Development states progress until the cell no longer has a nucleus and is called a reticulocyte.
- The complete process takes about 4 days.
- RBC are created at a rate of 200 billion per day to replace worn out/damaged RBCs.
- from kidneys stimulates erythropoiesis when there is a low partial pressure, i.e. you are acclimating to the mountains.
(SG4.1) ★ Characteristics of the outermost layer of the heart.
- Be carefull! The outermost layer of the heart is the epicarium, a layer of simple squamous epithelial cells underlain by loose connestive tissue.
- Fibrous Pericardium and parietal layer of the serous pericerdium are considered by Titi to be "coverings of the heart"
- The parietal layer is attached to the diaphragm and to the major blood vessels exiting the top of the heart.
(SG4.2) ★ Layers of the Heart from outside to inside...
- Fibrous Pericardium
- Parietal layer of the serous pericardium
- Pericardial space filled with 10-15 ml of pericardial or serous fluid
- Epicardium or visceral layer of the serous pericardium
- Fatty connective tissue with coronary vessels
- Endocardium covering beamlike protrusions of the myocardium called trabeculae carneae
(SG6.1) ★ Normal pattern of impulse conduction through the heart:
- Sinoatrial (SA) node - alone or with influence from sympathetic/parasympathetic
- Three internodal bundles, including an interatrial bundle to the left atrium
- Atrioventricular (AV) node - impulse SLOWS here to allow complete contraction of both atria
- AV bundle (bundle of His)
- Left and right AV bundle branches (septum)
- Subendocardial branches (Purkinje fibers) to lateral walls. Note: these start at the apex of the heart.
(SG6.2) ★ Four structures make up the core of the electrical conduction system of the heart:
Less than 1% of all myocardial tissue is made up of the above four conductive tissues, which means that 99% of the myocardium is contractile tissue.
- Sinoatrial (SA) node
- Atrioventricular (AV) node
- AV bundle (bundle of His)
- Subendocardial branches (Purkinje fibers)
(SG7.1) ★ Blood Flow beginning with return of deoxygenated blood?
- Returns to Right Atrium via the superior and inferior Vena Cava, as well as the Coronary Sinus.
- The thin wall between the laft and righrt atrium is the fossa ovalis - open during fetal development.
- SVC: Arms, head and Upper Torso
- IVC: Legs, Abdomin and Pelvis
- Through AV Tricuspid Valve to Right Ventricle.
- Out the Pulmonary Semilunar Valve to the Pulmonary Trunk.
- To Lungs or Pulmonary Circuit.
- Returns to Left Atrium via the Left and Right Pulmonary veins.
- Through AV Mitral or Bicuspid Valve to Left Ventricle.
- Out the Aortic Semilunar Valve to the Ascending Aorta.
- To Body or Systemic Circuit.
(SG9.1) ★ Know the valves of the heart and their pathologies.
The right pulmonary semilunar and tricuspid valves can suffer from the problems below, but it is probably a greater issue for the left heart valves.
Mitral Valve Prolapse
- Valves that are narrower than normal, slowing blood flow through the heart. This can be caused by calcific nodules as on the cusps of the mitral valve. It can also be caused by rheumatic fever which can cause stenosis or other deformities of the valves, chordae tendineae, and myocardia.
- It has a genetic basis, but can result from rheumatic fever. The prolapse condition (generally less serious than a valve stenosis.) results in the flap extending back into the left atrium causing incompetence (leaking). Though 1 in 20 have the condition, in most cases, it is asymptomatic.
- The leaking of ejected blood back into the left ventricle causes a volume overload on the left ventricle with subsequent hypertrophy and dilation. The left ventricle tries to overcome the increased load by increasing its contractions (Starling's Law), but this can lead to stress that ultimately results in a myocardial ischemia, i.e. decreased blood supply to the heart.
(SG10.1) Nervous System Division Review:
- Somatic - under your control
Autonomic - NOT under your control
- Somatic Sensory - afferent
- Somatic Motor = efferent
- Visceral Sensory - afferent
- Sympathetic - efferent - "Fight or Flight"
- Parasympathetic - efferent - "Rest and Repair"
(SG10.2) ★ Neurological factors that affect heart rate
Ratio of sympathetic and parasympathetic nerve impulses (autonomic) conducted to the SA node.
- sympathetic (fight/flight)
: distal end of cardiac nerve
- Action: stimulatory
- Mode: release of norepinephrine
- Parasympathetic (rest/repair)
: chiefly by vagus nerve
- Action: inhibitory
- Mode: release of acetylcholine
(SG21.1) ★ Show basic understanding of Murmur:
- Murmurs are abnormal heart sounds that are produced as a result of turbulent blood flow that is sufficient to produce audible noise.
- Murmurs may also be the result of various problems, such as narrowing or leaking of valves, or the presence of abnormal passages through which blood flows in or near the heart.
(SG21.5) ★ Show basic understanding of Stenosis:
- An abnormal narrowing in a blood vessel or other tubular organ or structure.
- Stenosis of the vascular type are often associated with unusual blood sounds resulting from turbulent flow over the narrowed blood vessel.
(SG21.14) ★ Show basic understanding of Fibrillation:
: atrial fibrillation and ventricular fibrillation.
- There are two major classes of cardiac fibrillation
- Atrial fibrillation occurs commonly in mitral stenosis, rheumatic heart disease, and infarction of the atrial myocardium. It can be treated with digoxin or by cardioversion - the application of carefully timed electrical shocks to restore normal rhythm.
- Ventricular fibrillation is rapidly fatal if not reversed by defibrillation. No electrical impulse is given off in this form of dysrhythmia.
- Fibrillation may sometimes be used after heart surgery to stop the heart from beating while any minor leaks are stitched up.
(SG21.16) ★ Show basic understanding of Ectopic focus:
- Pacemaker cells in the SA Node posses an intrinsic rhythm, that is they themselves initiate impulses at regular rhythms without stimulation of nerve impulses from the brain.
- An ectopic pacemaker or ectopic focus is an excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the human heart.
- Acute occurrence is usually non-life threatening, but chronic occurrence can progress into tachycardia, bradycardia or ventricular fibrillation.
- In a normal heart beat rhythm, the SA node usually suppresses the ectopic pacemaker activity due to the higher impulse rate of the SA node. However, in the instance of either a malfunctioning SA node or an ectopic foci bearing an intrinsic rate superior to SA node rate, ectopic pacemaker activity may rule over the heart rhythm.
★ What do abnormal heart sounds mean, e.g. a murmur?
Any deviation from the normal is an indication of an improperly functioning valve. A "swishing" sound may mean an incomplete closing of the value (valvular insufficiency) or a stenosis (constriction or narrowing).
★ Name the four tissue types and what type is blood
Epithelial, connective, muscle and nervous.
Blood is CONNECTIVE
★ Compare viscosity of blood to water.
Blood is 5X ticker than water because of the inclusion of formed elements.
★ Components of blood formed elements?
(counts are per cubic millimeter
- ~45% (37-54%) is living cells (55% plasma)
- 99.9% RBC, 4.2-6.2 million erythrocytes
- <0.1%, 5000-9000 leukocytes 700X less than RBC
- <0.1%, 140-340k platelets 70X less than WBC
★ Components of WBC?
NEVER LET MONKEYS EAT BANANAS
- Multi-lobed, Pink-Purple Granulocyte
- Cellular defense; phagocytosis of small pathogens
- Smallest WBC; Scant cytoplasm
- Humoral (fluid) defense; Immune System response & regulation; Antibodies; T- attack infected or cancerous cells; B- produce antibodies.
- Largest WBC; Horseshoe Nucleus
- Migrating Macophage: Bacteria, cellular Debris; Cancerous cells
- Two-lobed; Orange-Red Granulocyte
- Vellular defense; Eats Protozoa & Parasitic Worms; Antiinflammatory for Allergic reactions
- Two-lobed; Purple Granulocytes
- Anticoagulant: Heperin; Inflammatory response: Histamine
(Q9) ★ Know the major categories of nonspecific defenses
- These are “born with” and they are not species specific. – skin & mucus
- Phagocytes – Neutrophils and Monocytes
- Immunological Surveillance
- Interferon - produced only be infected cells, which are not “saved”, in an effort to save nearby cells.
- Inflammatory response
(Q21.1) ★ Anatomical structures of the upper respiratory conducting zones.
(Q21.2) ★ Anatomical structures of the lower respiratory conducting zones.
- Bronchi (Bronchus - singular)
- Bronchioles - down to lumen < 1 mm - sometimes called terminal bronchioles, or the last bronchioles that serve solely to conduct air.
(Q21.3) ★ Function of the respiratory conducting zones.
- Transport of air
- Filtering of
- Humidifying of
- Warming of
(Q22.1) ★ Anatomical structures of the respiratory zones.
- All "respiratory" zones contain alveoli.
- Respiratory bronchioles have thin gas-exchanging walls, which
- transition into alveolar ducts, which
- end in one or more alveolar sacs, the walls of which consist of
- numerous alveoli grouped together
(Q23.1) ★ Functions of the respiratory epithelium
- Lined with ciliated pseudostratified epithelium with a dense uderlying vasculature of blood vessels to warm air and goblet (mucus producing) cells.
- Filter & trap inspired particulate matter
- Helps humidify air
- Sweep mucus to pharynx where it is swallowed
(Q35) ★ Know the important pressures involved in mechanisms of breathing.
- : Patm) is atmospheric pressure, or 760 mm Hg at sea level.
- PA is alveolar pressure. (Titi: Pa) Pv “intrapulmonary pressure”)
- PIP is intrapleural pressure.
(Q39) ★Know the centers and areas that generate the basic rhythm of the respiratory circle.
- The pneumotaxic center is a network of neurons in the pons. It antagonizes the apneustic center, cyclically inhibiting inspiration. It limits the burst of action potentials in the phrenic nerve, effectively decreasing the tidal volume and regulating the respiratory rate. It's absence will increase in depth of respiration and a decrease in respiratory rate.
- Medulla Oblongata sets the basic rhythm via the Medullary Rhythmicity Area.
- This can be over-ridden by the PONS, which in turn can over-ridden by the Cerebral Cortex, where for example, we may consciously “hyperventilate” or breath to sing.
- There are 3 sets of receptors that influence the autonomic process:
- Chemoreceptors, e.g. excess H+ ions, or acidosis, will trigger hyperventilation for pH balance. These are in the aortic arch and carotid sinuses, and they send their data to the PONS.
- Baroreceptors, e.g. the partial pressure of O2 or CO2, are collocated with the chemoreceptors, and they also influence via the PONS.
- Stretch receptors in the lungs and thorax signal directly to the medulla oblongata.
★ Gastric glands contain how many major secretory cells, and they are called…
Chief, parietal and endocrine
★ What is intrinsic factor?
A secretion of the parietal cells of the stomach (along with HCl), that binds to vitamin B12, protecting it from the digestive environment of the stomach until it can be absorbed via the small intestine.
(F17) ★ Components of Gastric Juice and the cells that create them?
- Gastric juice contains:
- Water, mucus, pepsin (chief cells)
- Acidic Mucus (mucosal neck cells)
- Pepsinogen, i.e. enzymes of gastric juice (chief cells)
- Hydrochloric acid & Intrinsic Factor (parietal cells)
- Gastrin, and ghrelin (GHRL) – a hormone that stimulates the hypothalamus to secrete growth hormone and increase appetite (endocrine cells)
★ The ejection of bile from the gallbladder is controlled by which hormones?
CCK and secretin
1. ★ Know the location of the organs of gastrointestinal tract (intra or retroperitoneal)
- Transverse Colon
- Small intestine
- Rectum (Titi: colon)
- Kidneys (urinary, not gastrointestinal)
3. ★ What gallbladder hormone stimulates bile release?
- CCK (cholecystokinin) and Secretin
9. ★ Know the histology of alimentary canal and be able to list the layers.
- Mucosa Mucus, enzymes & ectopic hormones
- Sub Mucosa Blood & Lymphatic vessels, with nerves in Connective tissue
- Thick layer of Muscularis consisting of 2 layers
- Inner Circular, which becomes a sphincter in some locations, and serves both Peristalsis and Segmentation
- Outer Longitudinal
10. ★ Know the phases of gastric (stomach) secretion.
- Cephalic triggered by sight, smell, taste or thought. Vagal nerve impulses also stimulate endocrine G cells in gastric mucosa to secrete gastrin, which stimulates gastric secretion.
- Gastric stretch reflexes in stomach release 2/3 of the gastric juice. Products of protein digestion that have reached the pyloric portion of the stomach stimulate its mucosa to secrete gastrin where after circulating to the gastric glands greatly accelerates the secretion of gastric juice, high in pepsinogen and HCl.
- Intestinal has both a brief excitatory phase, and an inhibitory phase for gastric secretions. Chyme with fats, carbohydrates and acid in the duodenum inhibit gastric secretions via GIP, secretin, and CCK. Also, the enterogastric reflex, which reduces gastric peristalsis, may also inhibit gastric secretions.
★ Cholecystokinin (CCK): Source & Action:
Formed by intestinal mucosa in presence of fats, partially digested proteins, and acids.
Stimulates ejection of bile from gallbladder and secretion of pancreatic juice high in enzymes; opposes the action of gastrin, raising the pH of gastric juice.
12. ★ Know the anatomical parts of the stomach.
- Cardius – near heart and esophagus at the LES or Lower Esophageal Sphincter.
- Fundus – dome shape to the left of esophageal opening
- Body – middle with three layers of musculature: oblique, circular and longitudinal.
- Pylorus – near the opening to the duodenum, lined with “Rugae” and aligned toward the pyloric sphincter.
23. ★ Know the functions of the urinary system.
- Primary – regulation of
- Blood Volume, i.e. BP
- Chemical makeup of blood
- Metabolism of Vitamin D
- Production of Renin, which is released by JG (Juxtaglomerular cells) by detection of the increased reabsorption of Na+ & Cl-, resulting from decreased arterial BP. Renin sets in motion the release of a vasoconstrictor to raise BP.
- Production of EPO (erythropoietin) to stimulate RBC generation.
- Gluconeogenesis from amino acids and possibly fatty acids. Though primarily a liver process, it does occur in the cortex of the kidneys.
31.3 ★ Renal failure:
- Cannot eliminate UREA, a nitrogen–containing waste product from the catabolism of proteins. Diagnosed via high BUN (blood urea nitrogen) Renal failure can be acute or chronic.
- See also AZA…EMIA - nitrogen on the blood.
31.41 ★ Uremia:
- : “Toxins of meat digestion”. Book indicates that it is essentially high UREA in the blood.
- An indication of some failure of the kidneys.
1.1 ★ Be able to tell the common characteristics between the endocrine and nervous system.
Both facilitate Communication, Integration & Control
Both regulate to maintain homeostasis.
Both control by regulatory feedback loops.
1.7 ★ Characteristics of regulatory effect between the endocrine and nervous system.
- Endocrine: Slow to appear, but long lasting.
- Nervous: Appears rapidly, but short-lived.
2.1 ★ Describe the chemical classifications of hormones.
- Cortisol (hydrocortisone)
- Proteins – long strands of amino acids
- Growth Hormone (GH)
- Prolactin (PRL)
- Parathyroid hormone (PTH)
- Calcitonin (CT)
- Adrenocorticotropic hormone (ACTH)
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Thyroid-stimulating hormone (TSH)
- Human chorionic gonadotropin (hCG)
- Peptides – smaller strands of amino acids
- Antidiuretic hormone (ADH)
- Oxytocin (OT)
- Melanocyte-stimulating hormone (MSH)
- Somatostatin (SS)
- Thyrotropin-releasing hormone (TRH)
- Gonadotropin-releasing hormone (GnRH)
- Atrial natriuretic hormone (ANH)
- Amino Acid derivatives – “single” amino acids: Norepinephrine (NE), Epinephrine (Epi), Melatonin
- Iodinated amino acids: Thyroxine (T4), Triiodothyronine (T3)
3.1 ★ Know the messengers of the 2 messenger systems.
→ The 1st
messenger systems apply to most
all nonsteroid hormones.
→ The 1st
messenger is the hormone itself, which binds to a specific receptor (a membrane protein) in the cell plasma membrane.
→ The 2nd
messenger is created within the cell cytoplasm as a result of this 1st
- There are several, but the most important are:
- cAMP (cyclic Adenine Mono-Phosphate created from ATP), which then activates or deactivates enzymes in the cytoplasm.
- Ca++ is another mechanism that can form a 2nd messenger. In this case the cell membrane protein that the 1st messenger binds to will open a Calcium channel with which it is associated. The influx of Ca++ then binds with calmodilin, which forms a “complex” (the 2nd messenger), which then activates/deactivates enzymes.
11.1 ★ Describe characteristics of the mechanism of action of mineralocorticoids.
- Mineralocorticoids, of which aldosterone being the only physiologically important human example, have an important role in how mineral salts (electrolytes) are processed in the body.
- Aldosterone is not under the control of the adenohypophysis or hypothalamus.
- It is under a negative feedback control system that starts with BP as seen at the juxtaglomerular apparatus
- It primarily controls sodium homeostasis, but also has an effect on potassium and pH blood levels.
- Aldosterone secretion is controlled mainly by the renin-angiotensin-aldosterone system (RAAS) and by blood potassium concentration.
14. ★ Know the characteristics of prostaglandins.
→ Prostaglandins are a group of lipid molecules that serve important and widespread integrative functions in the body but do not meet the usual definition of a hormone.
→ Although prostaglandins may be secreted directly into the bloodstream, they are rapidly metabolized, so that circulating levels are extremely low.
→ The term tissue hormone
is appropriate because the secretion is produced in a tissue and diffuses only a short distance to other cells within the same tissue. Whereas typical hormones integrate activities of widely separated organs, prostaglandins tend to integrate activities of neighboring cells.
→ There are at least 16 different prostaglandins
, falling into nine structural classes—prostaglandin A through prostaglandin I.
- Differentiation of endocrine (blood traveling hormones) from “local” or tissue hormones can be further refine by:
- Paracrine hormones – that regulate activity in nearby cells within the same tissue as their source.
- Autocrine hormones – that regulate activity in the secreting cell itself.
- In addition to prostaglandins, which have diverse local (paracrine/autocrine) effects such as inflammation and muscle contraction in blood vessels, there are:
- Thromboxane, a blood regulator important in blood clotting.
- Leukotrienes, which are regulators of immunity.
15. ★ Describe the hormones of the gonads (testes and ovaries).
- Adrenal Androgens and Estrogens are secreted from the Zona Reticularis.
- Testes secrete Testosterone (small amounts from Adrenal and Ovary), which stimulates sperm production, male sexual characteristics and muscle growth.
- Ovaries & placenta secrete Estrogen (including estradiol (E2) and estrone) and Progesterone for: growth of uterus; egg maturation and secondary sex characteristics.
- These also cause the epiphysis (long bones) to fill with calcium terminating female growth.
19. ★ Describe the electrolyte, regulation of intake and output.
- IN: Food & drink
- OUT: sweat, feces, urine
- Cations: Na+, Ca+, K+, Aldosterone.
- Note: K+ is secreted when Na+ is reserved.
20. ★ Know the main cations and anions in the extracellular fluid,
- Major: Na+, Cl-, bicarbonate (HCO3-).
- Minor: K+, Mg++, Ca++, Phosphate (HPO4-2), Sulfate (SO4-2).
22. ★ Know the acid base balance. Be able to tell what happens when blood pH is above or below its normal range.
- 7.35 – 7.45 normal pH
- 7.3 – rapid breathing to expel CO2, which reduces the amount available to make carbonic acid or H2CO3
- 7.2 – fatigue
- 7.1 – vasodilation; irregular pulse
- 7.0 – decreased consciousness
- 6.8 – DEATH
- 7.5 – breathing slow to keep CO2, increasing the amount available to make carbonic acid or H2CO3
- 7.6 – muscle cramps
- 7.7 - seizures; tetany
- 7.8 – DEATH
24. ★ Know the mechanisms involved in regulation of H ion concentration.
- → Chemical buffer (Acid base) systems – immediate
- → Respiratory response system, one of the Physiological buffer systems – minutes
→ Renal response system, one of the Physiological buffer systems – hours
26. ★ Describe the role of pulmonary and renal systems as buffers in regulation of acid-base balance.
- The first line of defense after the chemical buffer systems is the pulmonary (respiratory) physiological buffer system, which can regulate the amount of CO2 in the blood.
- The availability of CO2 can increase/decrease the right-side components of the following reaction:
- CO2 + H2O (via carbonic anhydrase) H2CO3 (carbonic acid) → H+ + HCO3- (bicarbonate)
- The Renal buffer systems acts as a backup to the Respiratory Buffer System and can excrete more or less H+ as needed.
- Note: DCT can reabsorb 95% of bicarbonate (HCO3-).
30. ★ Be able to tell the difference between metabolic acidosis and alkalosis compared to respiratory acidosis and alkalosis.
- Normal pH: 7.4 +/- 0.05
- Normal PCO2: 40 +/- 5
- Normal HCO3-: 24 +/- 2
- Respiratory Acidosis
- Very low pH, e.g. 7.2 v 7.4
- Higher than normal PCO2, e.g. 60 v 40
- Normal concentration of HCO3-, e.g. 24
- Respiratory Alkalosis
- Very high pH, e.g. 7.58 v 7.4
- Lower than normal PCO2, e.g. 27 v 40
- Normal concentration of HCO3-, e.g. 24
- Metabolic Acidosis
- Very low pH, e.g. 7.2 v 7.4
- Normal PCO2, e.g. 42 v 40
- Lower than normal concentration of HCO3-, e.g. 12
- Metabolic Alkalosis
- Very high pH, e.g. 7.6 v 7.4
- Normal PCO2, e.g. 40 v 40
- Higher than normal concentration of HCO3-, e.g. 39
21. ★ Know the main cations and anions in the intracellular fluid.
Major: K+, Phosphate (HPO4-2), Mg++
Minor: Na+, Cl-, bicarbonate (HCO3-)
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