NEET MDS Lessons
Physiology
The Lymphatic System
Functions of the lymphatic system:
1) to maintain the pressure and volume of the extracellular fluid by returning excess water and dissolved substances from the interstitial fluid to the circulation.
2) lymph nodes and other lymphoid tissues are the site of clonal production of immunocompetent lymphocytes and macrophages in the specific immune response.
Filtration forces water and dissolved substances from the capillaries into the interstitial fluid. Not all of this water is returned to the blood by osmosis, and excess fluid is picked up by lymph capillaries to become lymph. From lymph capillaries fluid flows into lymph veins (lymphatic vessels) which virtually parallel the circulatory veins and are structurally very similar to them, including the presence of semilunar valves.
The lymphatic veins flow into one of two lymph ducts. The right lymph duct drains the right arm, shoulder area, and the right side of the head and neck. The left lymph duct, or thoracic duct, drains everything else, including the legs, GI tract and other abdominal organs, thoracic organs, and the left side of the head and neck and left arm and shoulder.
These ducts then drain into the subclavian veins on each side where they join the internal jugular veins to form the brachiocephalic veins.
Lymph nodes lie along the lymph veins successively filtering lymph. Afferent lymph veins enter each node, efferent veins lead to the next node becoming afferent veins upon reaching it.
Lymphokinetic motion (flow of the lymph) due to:
1) Lymph flows down the pressure gradient.
2) Muscular and respiratory pumps push lymph forward due to function of the semilunar valves.
Other lymphoid tissue:
1. Lymph nodes: Lymph nodes are small encapsulated organs located along the pathway of lymphatic vessels. They vary from about 1 mm to 1 to 2 cm in diameter and are widely distributed throughout the body, with large concentrations occurring in the areas of convergence of lymph vessels. They serve as filters through which lymph percolates on its way to the blood. Antigen-activated lymphocytes differentiate and proliferate by cloning in the lymph nodes.
2. Diffuse Lymphatic Tissue and Lymphatic nodules: The alimentary canal, respiratory passages, and genitourinary tract are guarded by accumulations of lymphatic tissue that are not enclosed by a capsule (i.e. they are diffuse) and are found in connective tissue beneath the epithelial mucosa. These cells intercept foreign antigens and then travel to lymph nodes to undergo differentiation and proliferation. Local concentrations of lymphocytes in these systems and other areas are called lymphatic nodules. In general these are single and random but are more concentrated in the GI tract in the ileum, appendix, cecum, and tonsils. These are collectively called the Gut Associated Lymphatic Tissue (GALT). MALT (Mucosa Associated Lymphatic Tissue) includes these plus the diffuse lymph tissue in the respiratory tract.
3. The thymus: The thymus is where immature lymphocytes differentiate into T-lymphocytes. The thymus is fully formed and functional at birth. Characteristic features of thymic structure persist until about puberty, when lymphocyte processing and proliferation are dramatically reduced and eventually eliminated and the thymic tissue is largely replaced by adipose tissue. The lymphocytes released by the thymus are carried to lymph nodes, spleen, and other lymphatic tissue where they form colonies. These colonies form the basis of T-lymphocyte proliferation in the specific immune response. T-lymphocytes survive for long periods and recirculate through lymphatic tissues.
The transformation of primitive or immature lymphocytes into T-lymphocytes and their proliferation in the lymph nodes is promoted by a thymic hormone called thymosin. Ocassionally the thymus persists and may become cancerous after puberty and and the continued secretion of thymosin and the production of abnormal T-cells may contribute to some autoimmune disorders. Conversely, lack of thymosin may also allow inadequate immunologic surveillance and thymosin has been used experimentally to stimulate T-lymphocyte proliferation to fight lymphoma and other cancers.
4. The spleen: The spleen filters the blood and reacts immunologically to blood-borne antigens. This is both a morphologic (physical) and physiologic process. In addition to large numbers of lymphocytes the spleen contains specialized vascular spaces, a meshwork of reticular cells and fibers, and a rich supply of macrophages which monitor the blood. Connective tissue forms a capsule and trabeculae which contain myofibroblasts, which are contractile. The human spleen holds relatively little blood compared to other mammals, but it has the capacity for contraction to release this blood into the circulation during anoxic stress. White pulp in the spleen contains lymphocytes and is equivalent to other lymph tissue, while red pulp contains large numbers of red blood cells that it filters and degrades.
The spleen functions in both immune and hematopoietic systems. Immune functions include: proliferation of lymphocytes, production of antibodies, removal of antigens from the blood. Hematopoietic functions include: formation of blood cells during fetal life, removal and destruction of aged, damaged and abnormal red cells and platelets, retrieval of iron from hemoglobin degradation, storage of red blood cells.
SPECIAL VISCERAL AFFERENT (SVA) PATHWAYS
Taste
Special visceral afferent (SVA) fibers of cranial nerves VII, IX, and X conduct signals into the solitary tract of the brainstem, ultimately terminating in the nucleus of the solitary tract on the ipsilateral side.
Second-order neurons cross over and ascend through the brainstem in the medial lemniscus to the VPM of the thalamus.
Thalamic projections to area 43 (the primary taste area) of the postcentral gyrus complete the relay.
SVA VII fibers conduct from the chemoreceptors of taste buds on the anterior twothirds of the tongue, while SVA IX fibers conduct taste information from buds on the posterior one-third of the tongue.
SVA X fibers conduct taste signals from those taste cells located throughout the fauces.
Smell
The smell-sensitive cells (olfactory cells) of the olfactory epithelium project their central processes through the cribiform plate of the ethmoid bone, where they synapse with mitral cells. The central processes of the mitral cells pass from the olfactory bulb through the olfactory tract, which divides into a medial and lateral portion The lateral olfactory tract terminates in the prepyriform cortex and parts of the amygdala of the temporal lobe.
These areas represent the primary olfactory cortex. Fibers then project from here to area 28, the secondary olfactory area, for sensory evaluation. The medial olfactory tract projects to the anterior perforated substance, the septum pellucidum, the subcallosal area, and even the contralateral olfactory tract.
Both the medial and lateral olfactory tracts contribute to the visceral reflex pathways, causing the viscerosomatic and viscerovisceral responses.
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The Autonomic Nervous System (ANS) Controls the Body's Internal Environment in a Coordinated Manner
- The ANS helps control the heart rate, blood pressure, digestion, respiration, blood pH and other bodily functions through a series of complex reflex actions
- These controls are done automatically, below the conscious level
- To exert this control the activities of many different organs must be coordinated so they work to accomplish the same goal
- In the ANS there are 2 nerves between the central nervous system (CNS) and the organ. The nerve cell bodies for the second nerve are organized into ganglia:
- CNS -> Preganglionic nerve -> Ganglion -> Postganglionic nerve -> Organ
- At each junction neurotransmitters are released and carry the signal to the next nerve or organ.
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The ANS has 2 Divisions, Sympathetic and Parasympathetic
- Comparison of the 2 systems:
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Anatomical
LocationPreganglionic
FibersPostganglionic
FibersTransmitter
(Ganglia)Transmitter
(Organs)Sympathetic
Thoracic/
LumbarShort
Long
ACh
NE
Parasympathetic
Cranial/
SacralLong
Short
ACh
ACh
The Sympathetic is the "Fight or Flight" Branch of the ANS
- Emergency situations, where the body needs a sudden burst of energy, are handled by the sympathetic system
- The sympathetic system increases cardiac output and pulmonary ventilation, routes blood to the muscles, raises blood glucose and slows down digestion, kidney filtration and other functions not needed during emergencies
- Whole sympathetic system tends to "go off" together
- In a controlled environment the sympathetic system is not required for life, but it is essential for any stressful situation
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The Parasympathetic is the Rest and Digest Branch of the ANS
- The parasympathetic system promotes normal maintenance of the body- acquiring building blocks and energy from food and getting rid of the wastes
- It promotes secretions and mobility of different parts of the digestive tract.
- Also involved in urination, defecation.
- Does not "go off" together; activities initiated when appropriate
- The vagus nerve (cranial number 10) is the chief parasympathetic nerve
- Other cranial parasympathetic nerves are: III (oculomotor), VII (facial) and IX (glossopharyngeal)
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The Hypothalamus Has Central Control of the ANS
- The hypothalamus is involved in the coordination of ANS responses,
- One section of the hypothalamus seems to control many of the "fight or flight" responses; another section favors "rest and digest" activities
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The Adrenal Medulla is an Extension of the Sympathetic Nervous System
- The adrenal medulla behaves like a combined autonomic ganglion and postsynaptic sympathetic nerve (see diagram above)
- Releases both norepinephrine and epinephrine in emergency situations
- Releases a mixture of epinephrine (E = 80%) and norepinephrine (NE = 20%)
- Epinephrine = adrenaline
- This action is under control of the hypothalamus
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Sympathetic & Parasympathetic Systems
- Usually (but not always) both sympathetic and parasympathetic nerves go to an organ and have opposite effects
- You can predict about 90% of the sympathetic and parasympathetic responses using the 2 phrases: "Fight or Flight" and "Rest and Digest".
- Special cases:
- Occasionally the 2 systems work together: in sexual intercourse the parasympathetic promotes erection and the sympathetic produces ejaculation
- Eye: the sympathetic response is dilation and relaxation of the ciliary muscle for far vision (parasympathetic does the opposite)
- Urination: the parasympathetic system relaxes the sphincter muscle and promotes contraction of muscles of the bladder wall -> urination (sympathetic blocks urination)
- Defecation: the parasympathetic system causes relaxation of the anal sphincter and stimulates colon and rectum to contract -> defecation (sympathetic blocks defecation)
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Organ
Parasympathetic Response
"Rest and Digest"Sympathetic Response
"Fight or Flight"Heart
(baroreceptor reflex)Decreased heart rate
Cardiac output decreasesIncreased rate and strength of contraction
Cardiac output increasesLung Bronchioles
Constriction
Dilation
Liver Glycogen
No effect
Glycogen breakdown
Blood glucose increasesFat Tissue
No effect
Breakdown of fat
Blood fatty acids increaseBasal Metabolism
No effect
Increases ~ 2X
Stomach
Increased secretion of HCl & digestive enzymes
Increased motilityDecreased secretion
Decreased motilityIntestine
Increased secretion of HCl & digestive enzymes
Increased motilityDecreased secretion
Decreased motilityUrinary bladder
Relaxes sphincter
Detrusor muscle contracts
Urination promotedConstricts sphincter
Relaxes detrusor
Urination inhibitedRectum
Relaxes sphincter
Contracts wall muscles
Defecation promotedConstricts sphincter
Relaxes wall muscles
Defecation inhibitedEye
Iris constricts
Adjusts for near visionIris dilates
Adjusts for far visionMale Sex Organs
Promotes erection
Promotes ejaculation
Glomerular filtration
Kidneys receive about 20% of cardiac output , this is called Renal Blood Flow (RBF) which is approximatley 1.1 L of blood. Plasma in this flow is about 625 ml . It is called Renal Plasma Flow (RPF) .
About 20 % of Plasma entering the glomerular capillaries is filtered into the Bowman`s capsule .
Glomerular filtration rate is about 125 ml/min ( which means 7.5 L/hr and thus 180 L/day) This means that the kidney filters about 180 liters of plasma every day.
The urine flow is about 1ml/min ( about 1.5 liter /day) This means that kidney reabsorbs about 178.5 liters every day .
Filtration occurs through the filtration unit , which includes :
1- endothelial cells of glomerular capillaries , which are fenestrated . Fenestrae are quite small so they prevent filtration of blood cells and most of plasma proteins .
2- Glomerular basement membrane : contains proteoglycan that is negatively charged and repels the negatively charged plasma proteins that may pass the fenestrae due to their small molecular weight like albumin . so the membrane plays an important role in impairing filtration of albumin .
3- Epithelial cells of Bowman`s capsule that have podocytes , which interdigitate to form slits .
Many forces drive the glomerular filtration , which are :
1- Hydrostatic pressure of the capillary blood , which favours filtration . It is about 55 mmHg .
2- Oncotic pressure of the plasma proteins in the glomerular capillary ( opposes filtration ) . It is about 30 mm Hg .
3- Hydrostatic pressure of the Bowman`s capsule , which also opposes filtration. It is about 15 mmHg .
The net pressure is as follows :
Hydrostatic pressure of glomerular capillaries - ( Oncotic pressure of glomerular capillaries + Hydrostatic pressure of the Bowman capsule):
55-(35+10)
=55-45
=10 mmHg .
Te glomerular filtration rate does not depend only on the net pressure , but also on an other value , known as filtration coefficient ( Kf) . The later depends on the surface area of the glomerular capillaries and the hydraulic conductivity of the glomerular capillaries.
Events in gastric function:
1) Signals from vagus nerve begin gastric secretion in cephalic phase.
2) Physical contact by food triggers release of pepsinogen and H+ in gastric phase.
3) Muscle contraction churns and liquefies chyme and builds pressure toward pyloric sphincter.
4) Gastrin is released into the blood by cells in the pylorus. Gastrin reinforces the other stimuli and acts as a positive feedback mechanism for secretion and motility.
5) The intestinal phase begins when acid chyme enters the duodenum. First more gastrin secretion causes more acid secretion and motility in the stomach.
6) Low pH inhibits gastrin secretion and causes the release of enterogastrones such as GIP into the blood, and causes the enterogastric reflex. These events stop stomach emptying and allow time for digestion in the duodenum before gastrin release again stimulates the stomach.
Blood is a liquid tissue. Suspended in the watery plasma are seven types of cells and cell fragments.
- red blood cells (RBCs) or erythrocytes
- platelets or thrombocytes
- five kinds of white blood cells (WBCs) or leukocytes
- Three kinds of granulocytes
- neutrophils
- eosinophils
- basophils
- Two kinds of leukocytes without granules in their cytoplasm
- lymphocytes
- monocytes
- Three kinds of granulocytes
Reflexes
A reflex is a direct connection between stimulus and response, which does not require conscious thought. There are voluntary and involuntary reflexes.
The Stretch Reflex:
The stretch reflex in its simplest form involves only 2 neurons, and is therefore sometimes called a 2-neuron reflex. The two neurons are a sensory and a motor neuron. The sensory neuron is stimulated by stretch (extension) of a muscle. Stretch of a muscle normally happens when its antagonist contracts, or artificially when its tendon is stretched, as in the knee jerk reflex. Muscles contain receptors called muscle spindles. These receptors respond to the muscles's stretch. They send stimuli back to the spinal cord through a sensory neuron which connects directly to a motor neuron serving the same muscle. This causes the muscle to contract, reversing the stretch. The stretch reflex is important in helping to coordinate normal movements in which antagonistic muscles are contracted and relaxed in sequence, and in keeping the muscle from overstretching.
Since at the time of the muscle stretch its antagonist was contracting, in order to avoid damage it must be inhibited or tuned off in the reflex. So an additional connection through an interneuron sends an inhibitory pathway to the antagonist of the stretched muscle - this is called reciprocal inhibition.
The Deep Tendon Reflex:
Tendon receptors respond to the contraction of a muscle. Their function, like that of stretch reflexes, is the coordination of muscles and body movements. The deep tendon reflex involves sensory neurons, interneurons, and motor neurons. The response reverses the original stimulus therefore causing relaxation of the muscle stimulated. In order to facilitate that the reflex sends excitatory stimuli to the antagonists causing them to contract - reciprocal activation.
The stretch and tendon reflexes complement one another. When one muscle is stretching and stimulating the stretch reflex, its antagonist is contracting and stimulating the tendon reflex. The two reflexes cause the same responses thus enhancing one another.
The Crossed Extensor Reflex -
The crossed extensor reflex is just a withdrawal reflex on one side with the addition of inhibitory pathways needed to maintain balance and coordination. For example, you step on a nail with your right foot as you are walking along. This will initiate a withdrawal of your right leg. Since your quadriceps muscles, the extensors, were contracting to place your foot forward, they will now be inhibited and the flexors, the hamstrings will now be excited on your right leg. But in order to maintain your balance and not fall down your left leg, which was flexing, will now be extended to plant your left foot (e.g. crossed extensor). So on the left leg the flexor muscles which were contracting will be inhibited, and the extensor muscles will be excited