NEET MDS Lessons
Physiology
Hemostasis - the stopping of the blood. Triggered by a ruptured vessel wall it occurs in several steps:
1) vascular spasm - most vessels will constrict strongly when their walls are damaged. This accounts for individuals not bleeding to death even when limbs are crushed. It also can help to enhance blood clotting in less severe injuries.
2) platelet plug - platelets become sticky when they contact collagen, a protein in the basement membrane of the endothelium exposed when the vessel wall is ruptured. As they stick together they can form a plug which will stem the flow of blood in minor vessels.
3) Formation of the Blood Clot:
A) release of platelet factors - as platelets stick together and to the vascular wall some are ruptured releasing chemicals such as thromboxane, PF3, ADP and other substances. These become prothrombin activators. Thromboxane also makes the platelets even stickier, and increases the vascular constriction. These reactions are self perpetuating and become a cascade which represents a positive feedback mechanism.
B) prothrombin activators : prothrombin (already in the blood) is split into smaller products including thrombin, an active protease.
C) thrombin splits soluble fibrinogen, already present in the plasma, into monomers which then polymerize to produce insoluble fibrin threads. The fibrin threads weave the platelets and other cells together to form the actual clot. This occurs within four to six minutes when the injury is severe and up to 15 minutes when it is not. After 15 minutes the clot begins to retract as the fibrin threads contract, pulling the broken edges of the injury together and smoothing the surface of the clot causing the chemical processes to cease. Eventually the clot will dissolve due to enzymes such as plasmin also present in the blood.
The extrinsic pathway: when tissues are damaged the damaged cells release substances called tissue thromboplastin which also acts as a prothrombin activator. This enhances and speeds coagulation when tissue damage is involved.
Anti-thrombin III - this factor helps to prevent clotting when no trigger is present by removing any thrombin present. Its function is magnified many times when heparin is present. Therefore heparin is used clinically as a short-term anticoagulant.
Vitamin K - stimulates the production of clotting factors including prothrombin and fibrinogen in the liver. This vitamin is normally produced by bacteria in the colon. Coumarin (or coumadin) competes with Vitamin K in the liver and is used clinically for long-term suppression of clotting.
Several factors important to clotting are known to be absent in forms of hemophilia. These factors are produced by specific genes which are mutated in the deficient forms. The factors are VIII, IX, and XI.
Calcium is necessary for blood clotting and its removal from the blood by complexing with citrate will prevent the blood from clotting during storage
- Sensory:
- Somatic (skin & muscle) Senses:
Postcentral gyrus (parietal lobe). This area senses touch, pressure, pain, hot, cold, & muscle position. The arrangement is upside-down (head below, feet above) and is switched from left to right (sensations from the right side of the body are received on the left side of the cortex). Some areas (face, hands) have many more sensory and motor nerves than others. A drawing of the body parts represented in the postcentral gyrus, scaled to show area, is called a homunculus . - Vision:
Occipital lobe, mostly medial, in calcarine sulcus. Sensations from the left visual field go to the right cortex and vice versa. Like other sensations they are upside down. The visual cortex is very complicated because the eye must take into account shape, color and intensity. - Taste:
Postcentral gyrus, close to lateral sulcus. The taste area is near the area for tongue somatic senses. - Smell:
The olfactory cortex is not as well known as some of the other areas. Nerves for smell go to the olfactory bulb of the frontal cortex, then to other frontal cortex centers- some nerve fibers go directly to these centers, but others come from the thalamus like most other sensory nerves - Hearing:
Temporal lobe, near junction of the central and lateral sulci. Mostly within the lateral sulcus. There is the usual crossover and different tones go to different parts of the cortex. For complex patterns of sounds like speech and music other areas of the cortex become involved.
- Somatic (skin & muscle) Senses:
- Motor:
- Primary Motor ( Muscle Control):
Precentral gyrus (frontal lobe). Arranged like a piano keyboard: stimulation in this area will cause individual muscles to contract. Like the sensory cortex, the arrangement is in the form of an upside-down homunculus. The fibers are crossed- stimulation of the right cortex will cause contraction of a muscle on the left side of the body. - Premotor (Patterns of Muscle Contraction):
Frontal lobe in front of precentral gyrus. This area helps set up learned patterns of muscle contraction (think of walking or running which involve many muscles contracting in just the right order). - Speech-Muscle Control:
Broca's area, frontal lobe, usually in left hemisphere only. This area helps control the patterns of muscle contraction necessary for speech. Disorders in speaking are called aphasias.
- Primary Motor ( Muscle Control):
- Perception:
- Speech- Comprehension:
Wernicke's area, posterior end of temporal lobe, usually left hemisphere only. Thinking about words also involves areas in the frontal lobe. - Speech- Sound/Vision Association:
Angular gyrus, , makes connections between sounds and shapes of words
- Speech- Comprehension:
Proteins:
- about 50 - 60% of the dry mass of a typical cell
- subunit is the amino acid & amino acids are linked by peptide bonds
- 2 functional categories = structural (proteins part of the structure of a cell like those in the cell membrane) & enzymes
Enzymes are catalysts. Enzymes bind temporarily to one or more of the reactants of the reaction they catalyze. In doing so, they lower the amount of activation energy needed and thus speed up the reaction
Functions of the nervous system:
1) Integration of body processes
2) Control of voluntary effectors (skeletal muscles), and mediation of voluntary reflexes.
3) Control of involuntary effectors ( smooth muscle, cardiac muscle, glands) and mediation of autonomic reflexes (heart rate, blood pressure, glandular secretion, etc.)
4) Response to stimuli
5) Responsible for conscious thought and perception, emotions, personality, the mind.
The Kidneys
The kidneys are the primary functional organ of the renal system.
They are essential in homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and the regulation of blood pressure (by maintaining salt and water balance).
They serve the body as a natural filter of the blood and remove wastes that are excreted through the urine.
They are also responsible for the reabsorption of water, glucose, and amino acids, and will maintain the balance of these molecules in the body.
In addition, the kidneys produce hormones including calcitriol, erythropoietin, and the enzyme renin, which are involved in renal and hemotological physiological processes.
Anatomical Location
The kidneys are a pair of bean-shaped, brown organs about the size of your fist. They are covered by the renal capsule, which is a tough capsule of fibrous connective tissue.
Right kidney being slightly lower than the left, and left kidney being located slightly more medial than the right.
The right kidneys lie just below the diaphragm and posterior to the liver, the left below the diaphragm and posterior to the spleen.
Resting on top of each kidney is an adrenal gland (adrenal meaning on top of renal), which are involved in some renal system processes despite being a primarily endocrine organ.
They are considered retroperitoneal, which means that they lie behind the peritoneum, the membrane lining of the abdominal cavity.
The renal artery branches off from the lower part of the aorta and provides the blood supply to the kidneys.
Renal veins take blood away from the kidneys into the inferior vena cava.
The ureters are structures that come out of the kidneys, bringing urine downward into the bladder.
Internal Anatomy of the Kidneys
There are three major regions of the kidney:
1. Renal cortex
2. Renal medulla
3. Renal pelvis
The renal cortex is a space between the medulla and the outer capsule.
The renal medulla contains the majority of the length of nephrons, the main functional component of the kidney that filters fluid from blood.
The renal pelvis connects the kidney with the circulatory and nervous systems from the rest of the body.
Renal Cortex
The kidneys are surrounded by a renal cortex
The cortex provides a space for arterioles and venules from the renal artery and vein, as well as the glomerular capillaries, to perfuse the nephrons of the kidney. Erythropotein, a hormone necessary for the synthesis of new red blood cells, is also produced in the renal cortex.
Renal Medulla
The medulla is the inner region of the parenchyma of the kidney. The medulla consists of multiple pyramidal tissue masses, called the renal pyramids, which are triangle structures that contain a dense network of nephrons.
At one end of each nephron, in the cortex of the kidney, is a cup-shaped structure called the Bowman's capsule. It surrounds a tuft of capillaries called the glomerulus that carries blood from the renal arteries into the nephron, where plasma is filtered through the capsule.
After entering the capsule, the filtered fluid flows along the proximal convoluted tubule to the loop of Henle and then to the distal convoluted tubule and the collecting ducts, which flow into the ureter. Each of the different components of the nephrons are selectively permeable to different molecules, and enable the complex regulation of water and ion concentrations in the body.
Renal Pelvis
The renal pelvis contains the hilium. The hilum is the concave part of the bean-shape where blood vessels and nerves enter and exit the kidney; it is also the point of exit for the ureters—the urine-bearing tubes that exit the kidney and empty into the urinary bladder. The renal pelvis connects the kidney to the rest of the body.
Supply of Blood and Nerves to the Kidneys
• The renal arteries branch off of the abdominal aorta and supply the kidneys with blood. The arterial supply of the kidneys varies from person to person, and there may be one or more renal arteries to supply each kidney.
• The renal veins are the veins that drain the kidneys and connect them to the inferior vena cava.
• The kidney and the nervous system communicate via the renal plexus. The sympathetic nervous system will trigger vasoconstriction and reduce renal blood flow, while parasympathetic nervous stimulation will trigger vasodilation and increased blood flow.
• Afferent arterioles branch into the glomerular capillaries, while efferent arterioles take blood away from the glomerular capillaries and into the interlobular capillaries that provide oxygen to the kidney.
• renal vein
The veins that drain the kidney and connect the kidney to the inferior vena cava.
• renal artery
These arise off the side of the abdominal aorta, immediately below the superior mesenteric artery, and supply the kidneys with blood.
The Types of muscle cells. There are three types, red, white, and intermediate.
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White Fibers Fast twitch Large diameter, used for speed and strength. Depends on the phosphagen system and on glycolysis-lactic acid. Stores glycogen for conversion to glucose. Fewer blood vessels. Little or no myoglobin. |
Red Fibers Slow twitch Small diameter, used for endurance. Depends on aerobic metabolism. Utilize fats as well as glucose. Little glycogen storage. Many blood vessels and much myoglobin give this muscle its reddish appearance. |
Intermediate Fibers: sometimes called "fast twitch red", these fibers have faster action but rely more on aerobic metabolism and have more endurance. Most muscles are mixtures of the different types. Muscle fiber types and their relative abundance cannot be varied by training, although there is some evidence that prior to maturation of the muscular system the emphasis on certain activities can influence their development
Alveolar Ventilation: is the volume of air of new air , entering the alveoli and adjacent gas exchange areas each minute . It equals to multiplying of respiratory rate by ( tidal volume - dead space).
Va = R rate X (TV- DsV)
= 12 X ( 500-150)
= 4200 ml of air.