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Physiology tutorial outline

Cardiovascular Physiology

Respiratory Physiology
session outline
session resources

Renal physiology

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



Link to short answer questions
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

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  • home page
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  • Paediatrics
    • Paed Education Timetable
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    • Resources >
      • Paediatric fracture management
      • Procedural sedation
  • EMERGENCY MEDICINE CAREER