NEET MDS Lessons
Physiology
The hepatic portal system
The capillary beds of most tissues drain into veins that lead directly back to the heart. But blood draining the intestines is an exception. The veins draining the intestine lead to a second set of capillary beds in the liver. Here the liver removes many of the materials that were absorbed by the intestine:
- Glucose is removed and converted into glycogen.
- Other monosaccharides are removed and converted into glucose.
- Excess amino acids are removed and deaminated.
- The amino group is converted into urea.
- The residue can then enter the pathways of cellular respiration and be oxidized for energy.
- Many nonnutritive molecules, such as ingested drugs, are removed by the liver and, often, detoxified.
The liver serves as a gatekeeper between the intestines and the general circulation. It screens blood reaching it in the hepatic portal system so that its composition when it leaves will be close to normal for the body.
Furthermore, this homeostatic mechanism works both ways. When, for example, the concentration of glucose in the blood drops between meals, the liver releases more to the blood by
- converting its glycogen stores to glucose (glycogenolysis)
- converting certain amino acids into glucose (gluconeogenesis).
Events in Muscle Contraction - the sequence of events in crossbridge formation:
1) In response to Ca2+ release into the sarcoplasm, the troponin-tropomyosin complex removes its block from actin, and the myosin heads immediately bind to active sites.
2) The myosin heads then swivel, the Working Stroke, pulling the Z-lines closer together and shortening the sarcomeres. As this occurs the products of ATP hydrolysis, ADP and Pi, are released.
3) ATP is taken up by the myosin heads as the crossbridges detach. If ATP is unavailable at this point the crossbridges cannot detach and release. Such a condition occurs in rigor mortis, the tensing seen in muscles after death, and in extreme forms of contracture in which muscle metabolism can no longer provide ATP.
4) ATP is hydrolyzed and the energy transferred to the myosin heads as they cock and reset for the next stimulus.
Excitation-Contraction Coupling: the Neuromuscular Junction
Each muscle cell is stimulated by a motor neuron axon. The point where the axon terminus contacts the sarcolemma is at a synapse called the neuromuscular junction. The terminus of the axon at the sarcolemma is called the motor end plate. The sarcolemma is polarized, in part due to the unequal distribution of ions due to the Sodium/Potassium Pump.
1) Impulse arrives at the motor end plate (axon terminus) causing Ca2+ to enter the axon.
2) Ca2+ binds to ACh vesicles causing them to release the ACh (acetylcholine) into the synapse by exocytosis.
3) ACH diffuses across the synapse to bind to receptors on the sarcolemma. Binding of ACH to the receptors opens chemically-gated ion channels causing Na+ to enter the cell producing depolarization.
4) When threshold depolarization occurs, a new impulse (action potential) is produced that will move along the sarcolemma. (This occurs because voltage-gated ion channels open as a result of the depolarization -
5) The sarcolemma repolarizes:
a) K+ leaves cell (potassium channels open as sodium channels close) returning positive ions to the outside of the sarcolemma. (More K+ actually leaves than necessary and the membrane is hyperpolarized briefly. This causes the relative refractory period) (b) Na+/K+ pump eventually restores resting ion distribution. The Na+/K+ pump is very slow compared to the movement of ions through the ion gates. But a muscle can be stimulated thousands of times before the ion distribution is substantially affected.
6) ACH broken down by ACH-E (a.k.a. ACHase, cholinesterase). This permits the receptors to respond to another stimulus.
Excitation-Contraction Coupling:
1) The impulse (action potential) travels along the sarcolemma. At each point the voltaged-gated Na+ channels open to cause depolarization, and then the K+ channels open to produce repolarization.
2) The impulse enters the cell through the T-tublules, located at each Z-disk, and reach the sarcoplasmic reticulum (SR), stimulating it.
3) The SR releases Ca2+ into the sarcoplasm, triggering the muscle contraction as previously discussed.
4) Ca2+ is pumped out of the sarcoplasm by the SR and another stimulus will be required to continue the muscle contraction.
1) Storage - the stomach allows a meal to be consumed and the materials released incrementally into the duodenum for digestion. It may take up to four hours for food from a complete meal to clear the stomach.
2) Chemical digestion - pepsin begins the process of protein digestion cleaving large polypeptides into shorter chains .
3) Mechanical digestion - the churning action of the muscularis causes liquefaction and mixing of the contents to produce acid chyme.
4) Some absorption - water, electrolytes, monosaccharides, and fat soluble molecules including alcohol are all absorbed in the stomach to some degree.
The Cardiac Cycle: the sequence of events in one heartbeat.
systole - the contraction phase; unless otherwise specified refers to left ventricle, but each chamber has its own systole.
diastole - the relaxation phase; unless otherwise specified refers to left ventricle, but each chamber has its own diastole.
1) quiescent period - period when all chambers are at rest and filling. 70% of ventricular filling occurs during this period. The AV valves are open, the semilunar valves are closed.
2) atrial systole - pushes the last 30% of blood into the ventricle.
3) atrial diastole - atria begin filling.
4) ventricular systole - First the AV valves close causing the first heart sound, then after the isovolumetric contraction phase the semilunar valves open permitting ventricular ejection of blood into the arteries.
5) ventricular diastole - As the ventricles relax the semilunar valves close first producing the second heart sound, then after the isovolumetric relaxation phase the AV valves open allowing ventricular filling.
Vital Capacity: The vital capacity (VC) is the maximum volume which can be ventilated in a single breath. VC= IRV+TV+ERV. VC varies with gender, age, and body build. Measuring VC gives a device for diagnosis of respiratory disorder, and a benchmark for judging the effectiveness of treatment. (4600 ml)
Vital Capacity is reduced in restrictive disorders, but not in disorders which are purely obstructive.
The FEV1 is the % of the vital capacity which is expelled in the first second. It should be at least 75%. The FEV1 is reduced in obstructive disorders.
Both VC and the FEV1 are reduced in disorders which are both restrictive and obstructive
Oxygen is present at nearly 21% of ambient air. Multiplying .21 times 760 mmHg (standard pressure at sea level) yields a pO2 of about 160. Carbon dioxide is .04% of air and its partial pressure, pCO2, is .3.
With alveolar air having a pO2 of 104 and a pCO2 of 40. So oxygen diffuses into the alveoli from inspired air and carbon dioxide diffuses from the alveoli into air which will be expired. This causes the levels of oxygen and carbon dioxide to be intermediate in expired air when compared to inspired air and alveolar air. Some oxygen has been lost to the alveolus, lowering its level to 120, carbon dioxide has been gained from the alveolus raising its level to 27.
Likewise a concentration gradient causes oxygen to diffuse into the blood from the alveoli and carbon dioxide to leave the blood. This produces the levels seen in oxygenated blood in the body. When this blood reaches the systemic tissues the reverse process occurs restoring levels seen in deoxygenated blood.
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Partial Pressures of O2 and CO2 in the body (normal, resting conditions):
- Alveoli
- PO2 = 100 mm Hg
- PCO2 = 40 mm Hg
- Alveolar capillaries
- Entering the alveolar capillaries
- PO2 = 40 mm Hg (relatively low because this blood has just returned from the systemic circulation & has lost much of its oxygen)
- PCO2 = 45 mm Hg (relatively high because the blood returning from the systemic circulation has picked up carbon dioxide)
- Entering the alveolar capillaries
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While in the alveolar capillaries, the diffusion of gasses occurs: oxygen diffuses from the alveoli into the blood & carbon dioxide from the blood into the alveoli.
- Leaving the alveolar capillaries
- PO2 = 100 mm Hg
- PCO2 = 40 mm Hg
- Blood leaving the alveolar capillaries returns to the left atrium & is pumped by the left ventricle into the systemic circulation. This blood travels through arteries & arterioles and into the systemic, or body, capillaries. As blood travels through arteries & arterioles, no gas exchange occurs.
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- Entering the systemic capillaries
- PO2 = 100 mm Hg
- PCO2 = 40 mm Hg
- Body cells (resting conditions)
- PO2 = 40 mm Hg
- PCO2 = 45 mm Hg
- Entering the systemic capillaries
- Because of the differences in partial pressures of oxygen & carbon dioxide in the systemic capillaries & the body cells, oxygen diffuses from the blood & into the cells, while carbon dioxide diffuses from the cells into the blood.
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- Leaving the systemic capillaries
- PO2 = 40 mm Hg
- PCO2 = 45 mm Hg
- Leaving the systemic capillaries
- Blood leaving the systemic capillaries returns to the heart (right atrium) via venules & veins (and no gas exchange occurs while blood is in venules & veins). This blood is then pumped to the lungs (and the alveolar capillaries) by the right ventricle.
PHYSIOLOGY OF THE BRAIN
- The Cerebrum (Telencephalon) Lobes of the cerebral cortex
- Frontal Lobe
- Precentral gyrus, Primary Motor Cortex, point to point motor neurons, pyramidal cells: control motor neurons of the brain and spinal cord. See Motor homunculus
- Secondary Motor Cortex repetitive patterns
- Broca's Motor Speech area
- Anterior - abstract thought, planning, decision making, Personality
- Parietal Lobe
- Post central gyrus, Sensory cortex, See Sensory homunculus, size proportional to sensory receptor density.
- Sensory Association area, memory of sensations
- Occipital Lobe
- Visual cortex, sight (conscious perception of vision)
- Visual Association area, correlates visual images with previous images, (memory of vision, )
- Temporal Lobe
- Auditory Cortex, sound
- Auditory Association area, memory of sounds
- Common Integratory Center - angular gyrus, Parietal, Temporal & Occipital lobes
- One side becomes dominent, integrats sensory (somesthetic, auditory, visual) information
- The Basal nuclei (ganglia)
- Grey matter (cell bodies) within the White matter of cerebrum, control voluntary movements
- Cauadate nucles - chorea (rapi, uncontrolled movements), Parkinsons: (dopamine neurons of substantia nigra to caudate nucles) jerky movements, spasticity, tremor, blank facial expression
- The limbic system - ring around the brain stem, emotions(w/hypothalamus), processing of olfactory information
- Frontal Lobe
- The Diencephalon
- The Thalamus - Sensory relay center to cortex (primitive brain!)
- The Hypothalamus
- core temperature control"thermostat", shivering and nonshivering thermogenesis
- hunger & satiety centers, wakefulness, sleep, sexual arousal,
- emotions (w/limbic-anger, fear, pain, pleasure), osmoregulation, (ADH secretion),
- Secretion of ADH, Oxytocin, Releasing Hormones for Anterior pitutary
- Linkage of nervous and endocrine systems
- The Mesencephalon or Midbrain -
- red nucleus, motor coordination (cerebellum/Motor cortex),
- substantia nigra
- The Metencephalon
- The Cerebellum -
- Performs automatic adjustments in complex motor activities
- Input from Proprioceptors (joint, tendon, muscles), position of body in Space
- Motor cortex, intended movements (changes in position of body in Space)
- Damping (breaking motor function), Balance, predicting, inhibitory function of Purkinji cells (GABA), speed, force, direction of movement
- The Pons - Respiratory control centers (apneustic, pneumotaxic)
- Nuclei of cranial nerves V, VI, VII, VIII
- The Cerebellum -
- Myelencephalon
- The Medulla
- Visceral motor centers (vasomotor, cardioinhibtory, respiratory)
- Reticular Formation RAS system, alert cortex to incoming signals, maintenance of consciousness, arousal from sleep
- All Afferent & Efferent fibers pass through, crossing over of motor tracts
- Corpus Callosum: Permits communication between cerebralhemispheres
- The Medulla
- Generalized Brain Avtivity
- Brain Activity and the Electroencephalogram(EEG)
- alpha waves: resting adults whose eyes are closed
- beta waves: adults concentrating on a specific task;
- theta waves: adults under stress;
- delta waves: during deep sleep and in clinical disorders
- Brain Seizures
- Grand Mal: generalized seizures, involvs gross motor activity, affects the individual for a matter or hours
- Petit mal: brief incidents, affect consciousness but may have no obvious motor abnormalities
- Chemical Effects on the Brain
- Sedatives: reduce CNS activity
- Analgesics: relieve pain by affecting pain pathways or peripheral sensations
- Psychotropics: alter mood and emotional states
- Anticonvulsants: control seizures
- Stimulants: facilitate CNS activity
- Memory and learning
- Short-term, or primary, memories last a short time, immediately accessible (phone number)
- Secondary memories fade with time (your address at age 5)
- Tertiary memories last a lifetime (your name)
- Memories are stored within specific regions of the cerebral cortex.
- Learning, a more complex process involving the integration of memories and their use to direct or modify behaviors
- Neural basis for memory and learning has yet to be determined.
- Brain Activity and the Electroencephalogram(EEG)
- Fibers in CNS
- Association fibers: link portions of the cerebrum;
- Commissural fibers: link the two hemispheres;
- Projection fibers: link the cerebrum to the brain stem