Physiology tutorial outline
Cardiovascular Physiology
Renal physiology
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ACEM Physiology level of knowledge 1 - 3
PHYSIOLOGY PRINCIPLES OF CELLULAR FUNCTION
The General and Cellular Basis of Medical Physiology General principles 1
Cellular physiology 1
PHYSIOLOGY OF NERVE AND MUSCLE CELLS
Nerve General morphology and anatomy 3
Nerve function including excitation and conduction, fibre types, neurotransmitters, synapses and neuromuscular transmission 1
Muscle General morphology and anatomy 2
Skeletal Muscle Function, electrical and mechanical and properties 1
Metabolism 1
Cardiac Muscle Function, electrical (including pacemaker tissue) and mechanical, and properties 1
Metabolism 1
Smooth Muscle 2
NERVOUS SYSTEM
Neurotransmitters 1
Reflexes 2
Cutaneous, Deep, and Visceral Sensation 1
Vision Anatomy, pathways and image forming mechanisms 2
Eye movements 2
Hearing and Equilibrium Anatomy, mechanisms of hearing and vestibular functions 2
Hair cells 3
Alert Behaviour, Sleep/Wake, and the Electrical Activity of the Brain 3
Control of Posture and Movement 1 General principles, corticospinal and corticobulbar system, cerebellum 1
Midbrain and basal ganglia 3
The Autonomic Nervous System Pharmacology Central Regulation of Visceral Function Hypothalamic function including vasopressin, temperature regulation 1
Anatomic, cyclic and autonomic considerations 3
Thirst 2
Control of anterior pituitary secretion 2
Oxytocin 3
Language 3
ENDOCRINOLOGY
Thyroid Gland
Thyroid hormones 2
Endocrine Functions of the Pancreas -
Islet cell structure 3
Insulin 1
Regulation of insulin secretion 1
Glucagon 1
Other islet cell hormones 3
The Adrenal Medulla and Adrenal Cortex
Adrenal morphology 2
Adrenal medulla and medullary hormones 1
Adrenal cortex and cortical hormone synthesis/metabolism 3
Glucocorticoids 1
Regulation of glucocorticoid secretion 2
Mineralocorticoids 1
Calcium and Renal
Calcium and phosphorus metabolism 1
Bone physiology 2
Vitamin D and the hydroxycholecalciferols 3
The parathyroid glands 2 Calcitonin 3
he renin-angiotensin system 1 Other renal hormones 2
Pituitary Gland Introduction 1
Morphology 2
Intermediate-lobe hormones 3
Growth hormone 2
Physiology of growth 3
Pituitary insufficiency 1
Pituitary hyperfunction 2
Reproductive Physiology
Sex differentiation and development 3
Pituitary gonadotropins and prolactin 3
The male reproductive system 2
The female reproductive system 2
Pregnancy 1
Lactation 2
GASTROINTESTINAL SYSTEM AND METABOLISM
Gastrointestinal Physiology
General considerations 1
Mouth and oesophagus 2
Stomach 1
Exocrine portion of the pancreas 2
Liver and biliary system 1
Small intestine 2
Colon 2
Gastrointestinal hormones 2
Digestion and Absorption
Carbohydrates 3
Proteins and nucleic acids 3
Lipids 2
Absorption of water and electrolytes 1
Absorption of vitamins and minerals 2
Metabolism and Nutrition
Nutrition and energy metabolism 2
Carbohydrate, protein, fat and intermediary metabolism 2
CIRCULATING BODY FLUIDS 4.13 - H
Bone marrow 1 Blood cell types 1 Haemoglobin 1 Platelets 1 Blood types 1 Plasma 1 Haemostasis 1 Lymph 3
THE HEART
Electrical Activity of the Heart 4.1 -
Ex Cardiac excitation 1
The electrocardiogram 1
Cardiac arrhythmias 1
Electrocardiographic findings in other diseases 1
Pump Function 4.1 - Ex Mechanical events of the cardiac cycle 1
Cardiac output 1
Cardiac function in health and disease 1
THE CIRCULATION
Blood and Lymph Flow 4.1 - Ex Biophysics 1
Blood circulation- vessels 1
Lymphatic circulation 1 Interstitial fluid 1
Cardiovascular Regulatory Mechanisms
Local regulation 1 Hormonal regulation 1
Regulation by the nervous system 1 Circulation through Special Regions
Cerebral circulation 1 Coronary circulation 1 Pulmonary circulation 1 Renal circulation 1 Splanchnic circulation 2 Cutaneous circulation 2 Placental and foetal circulation 2
*RESPIRATORY PHYSIOLOGY
Anatomy, Structure and Functional interface 1
Ventilation 1
Anatomy 1
Regulation and control 1
Mechanics of breathing Pulmonary Blood Flow 1
Water and fluid balance in the lung 1 Pulmonary metabolic function 1
Ventilation – Perfusion Relationships 1
Gas Diffusion 1
Gas Transport by the Blood and to tissues 1
Respiratory aspects of acid base balance 1 Respiratory System under Stress 2
Tests of Pulmonary Function 3 Forced expiration 2
RENAL PHYSIOLOGY
Renal Function and Micturition 4.8 – H, 2.5 - Ex
Anatomy 1
Renal circulation 1
Glomerular filtration 1
Tubular function and regulation 1
Renal function disorder and diuretics 1
The bladder 2
Regulation of Extracellular Fluid Composition, Volume and Acid-Base balance
Tonicity 1
Volume 1
Specific ionic composition 1
The Renin-Angiotensin System 1
Natriuretic factors 2 H+ and bicarbonate regulation 1
Acidosis and alkali 1
The General and Cellular Basis of Medical Physiology General principles 1
Cellular physiology 1
PHYSIOLOGY OF NERVE AND MUSCLE CELLS
Nerve General morphology and anatomy 3
Nerve function including excitation and conduction, fibre types, neurotransmitters, synapses and neuromuscular transmission 1
Muscle General morphology and anatomy 2
Skeletal Muscle Function, electrical and mechanical and properties 1
Metabolism 1
Cardiac Muscle Function, electrical (including pacemaker tissue) and mechanical, and properties 1
Metabolism 1
Smooth Muscle 2
NERVOUS SYSTEM
Neurotransmitters 1
Reflexes 2
Cutaneous, Deep, and Visceral Sensation 1
Vision Anatomy, pathways and image forming mechanisms 2
Eye movements 2
Hearing and Equilibrium Anatomy, mechanisms of hearing and vestibular functions 2
Hair cells 3
Alert Behaviour, Sleep/Wake, and the Electrical Activity of the Brain 3
Control of Posture and Movement 1 General principles, corticospinal and corticobulbar system, cerebellum 1
Midbrain and basal ganglia 3
The Autonomic Nervous System Pharmacology Central Regulation of Visceral Function Hypothalamic function including vasopressin, temperature regulation 1
Anatomic, cyclic and autonomic considerations 3
Thirst 2
Control of anterior pituitary secretion 2
Oxytocin 3
Language 3
ENDOCRINOLOGY
Thyroid Gland
Thyroid hormones 2
Endocrine Functions of the Pancreas -
Islet cell structure 3
Insulin 1
Regulation of insulin secretion 1
Glucagon 1
Other islet cell hormones 3
The Adrenal Medulla and Adrenal Cortex
Adrenal morphology 2
Adrenal medulla and medullary hormones 1
Adrenal cortex and cortical hormone synthesis/metabolism 3
Glucocorticoids 1
Regulation of glucocorticoid secretion 2
Mineralocorticoids 1
Calcium and Renal
Calcium and phosphorus metabolism 1
Bone physiology 2
Vitamin D and the hydroxycholecalciferols 3
The parathyroid glands 2 Calcitonin 3
he renin-angiotensin system 1 Other renal hormones 2
Pituitary Gland Introduction 1
Morphology 2
Intermediate-lobe hormones 3
Growth hormone 2
Physiology of growth 3
Pituitary insufficiency 1
Pituitary hyperfunction 2
Reproductive Physiology
Sex differentiation and development 3
Pituitary gonadotropins and prolactin 3
The male reproductive system 2
The female reproductive system 2
Pregnancy 1
Lactation 2
GASTROINTESTINAL SYSTEM AND METABOLISM
Gastrointestinal Physiology
General considerations 1
Mouth and oesophagus 2
Stomach 1
Exocrine portion of the pancreas 2
Liver and biliary system 1
Small intestine 2
Colon 2
Gastrointestinal hormones 2
Digestion and Absorption
Carbohydrates 3
Proteins and nucleic acids 3
Lipids 2
Absorption of water and electrolytes 1
Absorption of vitamins and minerals 2
Metabolism and Nutrition
Nutrition and energy metabolism 2
Carbohydrate, protein, fat and intermediary metabolism 2
CIRCULATING BODY FLUIDS 4.13 - H
Bone marrow 1 Blood cell types 1 Haemoglobin 1 Platelets 1 Blood types 1 Plasma 1 Haemostasis 1 Lymph 3
THE HEART
Electrical Activity of the Heart 4.1 -
Ex Cardiac excitation 1
The electrocardiogram 1
Cardiac arrhythmias 1
Electrocardiographic findings in other diseases 1
Pump Function 4.1 - Ex Mechanical events of the cardiac cycle 1
Cardiac output 1
Cardiac function in health and disease 1
THE CIRCULATION
Blood and Lymph Flow 4.1 - Ex Biophysics 1
Blood circulation- vessels 1
Lymphatic circulation 1 Interstitial fluid 1
Cardiovascular Regulatory Mechanisms
Local regulation 1 Hormonal regulation 1
Regulation by the nervous system 1 Circulation through Special Regions
Cerebral circulation 1 Coronary circulation 1 Pulmonary circulation 1 Renal circulation 1 Splanchnic circulation 2 Cutaneous circulation 2 Placental and foetal circulation 2
*RESPIRATORY PHYSIOLOGY
Anatomy, Structure and Functional interface 1
Ventilation 1
Anatomy 1
Regulation and control 1
Mechanics of breathing Pulmonary Blood Flow 1
Water and fluid balance in the lung 1 Pulmonary metabolic function 1
Ventilation – Perfusion Relationships 1
Gas Diffusion 1
Gas Transport by the Blood and to tissues 1
Respiratory aspects of acid base balance 1 Respiratory System under Stress 2
Tests of Pulmonary Function 3 Forced expiration 2
RENAL PHYSIOLOGY
Renal Function and Micturition 4.8 – H, 2.5 - Ex
Anatomy 1
Renal circulation 1
Glomerular filtration 1
Tubular function and regulation 1
Renal function disorder and diuretics 1
The bladder 2
Regulation of Extracellular Fluid Composition, Volume and Acid-Base balance
Tonicity 1
Volume 1
Specific ionic composition 1
The Renin-Angiotensin System 1
Natriuretic factors 2 H+ and bicarbonate regulation 1
Acidosis and alkali 1
Physiology fast facts
Nerves etc
RMP -90mV nerve, - 80mV cardiac muscle, - 60mV pacemaker cell
Na+ – k+ pump 3 Na out 2 K in
CVS
CO = HR x SV
MAP = CO x TPR
Work = MAP x SV
MAP = diastolic + 1/3 pulse pressure RAP – 2
CO = 5 l /min RVP – 25/12
SV = 70 ml LAP – 5
EDV = 130 ml LVP – 120/0
ESV = 50 ml Pulmonary pressures 8----12
EF = 70% Preload = approx CVP
SV = EDV – ESV CVP 8
Afterload = systolic BP, approx TRP + aortic stenosis
Regulation of blood pressure
Sensor
Mediator
End Organ
Acute
Baroreceptors
Carotid sinus and aortic arch dec BP; dec fire in glosopharengeal nerve
Autonomic NS
Peripheral – vasoconstriction
Central – inc HR, inc contractility
Medium
Peripheral acidosis
Local mediators
Vasoconstriction – inc preload
Long
Local and central dec in renal perfusion
Thirst
Renin angiotensin
ADH
Agt II
ADH / aldosterone
Vasocontriction
H2O
Renal
Renal blood flow
GFR = 125 ml/min
Osmolarity 280 = 2Na + urea + glucose
C=UV/P = volume of plasma cleared of a solute by the kidneys in 1 min
Hormone
Main role
Released from
Release stimulated by
Actions
ADH
Osmolarity
Brain
Changes in osmolarity Brain receptor
Thirst
H2O retained
Aquaporin channels CD
Angiotensin II
Volume / pressure
Angiotensinogen
AGT I ~(ACE)àAGTII
Renin (renal BP)
Release:
- ADH
- Aldosterone
Na retention (PCT)
Vasoconstriction
Thirst
Aldosterone
Volume (Na retention)
Adrenal
Stress
Renin ( renal blood pressure)
AII
Na retention
K secretion
Acidify urine
Principle cells eNac’s
ANP
pressure/volume
Atrial muscle
stretch
Dec renin, aldosterone, ADH,
opposes ADH,
renal vasodilation
Respiratory
TV = 500 ml
Pulmonary blood flow 5 l / min
TLC = 7 L
VC = 5L
Alveolar ventilation = 5 l/min
PAO2 = PIO2 – PCO2 x1.5
PIO2 = FIO2 x (atmospheric pressure – water vapour pressure)
=21% x(760-47)
therefore ----PAO2 = 147 – CO2 x 1.2 at atmospheric pressure with 21% O2
PAO2 = PaO2 (approx) if lungs are normal
Normal Aa gradient = 0.3 (+.21x age in years )+/-5mmhg
Laws
Ficks law = rate of diffusion thru tissues α area, pressure difference, solubility. 1/thickness 1/ MW
Laplace law = T = pr/w ; tension = transmural pressure x radius / wall thickness
Daltons law = each gas in a mixture exerts its own pressure
Starlings law = hydrostatic pressure vs colloid osmotic pressures
Starlings law (heart) = the energy released during contraction depends on the initial length of the fibers
Henrys law = amount of gas dissolved is proportional to its partial pressure
Poiseulle law = flow depends of 1/ length, 1/viscosity, pressure difference, radius4
Boyles law = volume of a gas is inversely proportional to its pressure
Endocrine
Ca – handled by the kidneys the same as Na – filtered/ resorbed in PCT / regulated in PCT by PTH
Calcium in blood in 3 forms:
1. bound to protein 405
2. bound to citrate etc.
3. free ionic 50% - only free is active
Low serum Ca – increases membrane permeability of Na thus hrate of AP formation (tetany, Inc QT)
High serum Ca – constipation, short QT, polyuria, polydypsia
PTH
Parathyroid gland - chief cells
Negative feedback from high Ca levels
Inc Ca
serum levels
Inc Gut absorption of Ca
(cations not generally absorbed)
Renal inc Ca resorption in DCT and dec PO4 resorption
Bone (late action)
Vit D
Can be manufactured
Diet or skin contain cholecalciferol (D3) converted in liver then kidney to 1,25D3. renal step( in PCT) under PTH control – rate limiting step
Inc Ca
total body
Inc Gut absorption of Ca by inc Ca binding protein in gut wall
If absent bone demineralized
Calcitonin
Thyroid – C cells
Dec Ca
Bone
Kidney
? role
Nerves etc
RMP -90mV nerve, - 80mV cardiac muscle, - 60mV pacemaker cell
Na+ – k+ pump 3 Na out 2 K in
CVS
CO = HR x SV
MAP = CO x TPR
Work = MAP x SV
MAP = diastolic + 1/3 pulse pressure RAP – 2
CO = 5 l /min RVP – 25/12
SV = 70 ml LAP – 5
EDV = 130 ml LVP – 120/0
ESV = 50 ml Pulmonary pressures 8----12
EF = 70% Preload = approx CVP
SV = EDV – ESV CVP 8
Afterload = systolic BP, approx TRP + aortic stenosis
Regulation of blood pressure
Sensor
Mediator
End Organ
Acute
Baroreceptors
Carotid sinus and aortic arch dec BP; dec fire in glosopharengeal nerve
Autonomic NS
Peripheral – vasoconstriction
Central – inc HR, inc contractility
Medium
Peripheral acidosis
Local mediators
Vasoconstriction – inc preload
Long
Local and central dec in renal perfusion
Thirst
Renin angiotensin
ADH
Agt II
ADH / aldosterone
Vasocontriction
H2O
Renal
Renal blood flow
GFR = 125 ml/min
Osmolarity 280 = 2Na + urea + glucose
C=UV/P = volume of plasma cleared of a solute by the kidneys in 1 min
Hormone
Main role
Released from
Release stimulated by
Actions
ADH
Osmolarity
Brain
Changes in osmolarity Brain receptor
Thirst
H2O retained
Aquaporin channels CD
Angiotensin II
Volume / pressure
Angiotensinogen
AGT I ~(ACE)àAGTII
Renin (renal BP)
Release:
- ADH
- Aldosterone
Na retention (PCT)
Vasoconstriction
Thirst
Aldosterone
Volume (Na retention)
Adrenal
Stress
Renin ( renal blood pressure)
AII
Na retention
K secretion
Acidify urine
Principle cells eNac’s
ANP
pressure/volume
Atrial muscle
stretch
Dec renin, aldosterone, ADH,
opposes ADH,
renal vasodilation
Respiratory
TV = 500 ml
Pulmonary blood flow 5 l / min
TLC = 7 L
VC = 5L
Alveolar ventilation = 5 l/min
PAO2 = PIO2 – PCO2 x1.5
PIO2 = FIO2 x (atmospheric pressure – water vapour pressure)
=21% x(760-47)
therefore ----PAO2 = 147 – CO2 x 1.2 at atmospheric pressure with 21% O2
PAO2 = PaO2 (approx) if lungs are normal
Normal Aa gradient = 0.3 (+.21x age in years )+/-5mmhg
Laws
Ficks law = rate of diffusion thru tissues α area, pressure difference, solubility. 1/thickness 1/ MW
Laplace law = T = pr/w ; tension = transmural pressure x radius / wall thickness
Daltons law = each gas in a mixture exerts its own pressure
Starlings law = hydrostatic pressure vs colloid osmotic pressures
Starlings law (heart) = the energy released during contraction depends on the initial length of the fibers
Henrys law = amount of gas dissolved is proportional to its partial pressure
Poiseulle law = flow depends of 1/ length, 1/viscosity, pressure difference, radius4
Boyles law = volume of a gas is inversely proportional to its pressure
Endocrine
Ca – handled by the kidneys the same as Na – filtered/ resorbed in PCT / regulated in PCT by PTH
Calcium in blood in 3 forms:
1. bound to protein 405
2. bound to citrate etc.
3. free ionic 50% - only free is active
Low serum Ca – increases membrane permeability of Na thus hrate of AP formation (tetany, Inc QT)
High serum Ca – constipation, short QT, polyuria, polydypsia
PTH
Parathyroid gland - chief cells
Negative feedback from high Ca levels
Inc Ca
serum levels
Inc Gut absorption of Ca
(cations not generally absorbed)
Renal inc Ca resorption in DCT and dec PO4 resorption
Bone (late action)
Vit D
Can be manufactured
Diet or skin contain cholecalciferol (D3) converted in liver then kidney to 1,25D3. renal step( in PCT) under PTH control – rate limiting step
Inc Ca
total body
Inc Gut absorption of Ca by inc Ca binding protein in gut wall
If absent bone demineralized
Calcitonin
Thyroid – C cells
Dec Ca
Bone
Kidney
? role