NEET MDS Lessons
Physiology
Oxygen Uptake in the Lungs is Increased About 70X by Hemoglobin in the Red Cells
- In the lungs oxygen must enter the blood
- A small amount of oxygen dissolves directly in the serum, but 98.5% of the oxygen is carried by hemoglobin
- All of the hemoglobin is found within the red blood cells (RBCs or erythrocytes)
- The hemoglobin content of the blood is about 15 gm/deciliter (deciliter = 100 mL)
- Red cell count is about 5 million per microliter
Each Hemoglobin Can Bind Four O2 Molecules (100% Saturation)
- Hemoglobin is a protein molecule with 4 protein sub-units (2 alphas and 2 betas)
- Each of the 4 sub-units contains a heme group which gives the protein a red color
- Each heme has an iron atom in the center which can bind an oxygen molecule (O2)
- The 4 hemes in a hemoglobin can carry a maximum of 4 oxygen molecules
- When hemoglobin is saturated with oxygen it has a bright red color; as it loses oxygen it becomes bluish (cyanosis)
The Normal Blood Hematocrit is Just Below 50%
- Blood consists of cells suspended in serum
- More than 99% of the cells in the blood are red blood cells designed to carry oxygen
- 25% of all the cells in the body are RBCs
- The volume percentage of cells in the blood is called the hematocrit
- Normal hematocrits are about 40% for women and 45% for men
At Sea Level the Partial Pressure of O2 is High Enough to Give Nearly 100% Saturation of Hemoglobin
- As the partial pressure of oxygen in the alveoli increases the hemoglobin in the red cells passing through the lungs rises until the hemoglobin is 100% saturated with oxygen
- At 100% saturation each hemoglobin carries 4 O2 molecules
- This is equal to 1.33 mL O2 per gram of hemoglobin
- A person with 15 gm Hb/deciliter can carry:
- Max O2 carriage = 1.33 mL O2/gm X 15 gm/deciliter = 20 mL O2/deciliter
- A plot of % saturation vs pO2 gives an S-shaped "hemoglobin dissociation curve"
- At 100% saturation each hemoglobin binds 4 oxygen molecules
At High Altitudes Hemoglobin Saturation May be Well Below 100%
- At the alveolar pO2 of 105 mm Hg at sea level the hemoglobin will be about 97% saturated, but the saturation will fall at high altitudes
- At 12,000 feet altitude alveolar pO2 will be about 60 mm Hg and the hemoglobin will be 90% saturated
- At 29,000 feet (Mt. Everest) alveolar pO2 is about 24 mm Hg and the hemoglobin will be only 42% saturated
- At very high altitudes most climbers must breath pure oxygen from tanks
- During acclimatization to high altitude the hematocrit can rise to about 60%- this increases the amount of oxygen that can be carried
- Hematocrits above 60% are not useful because the blood viscosity will increase to the point where it impairs circulation
Function of Blood
- transport through the body of
- oxygen and carbon dioxide
- food molecules (glucose, lipids, amino acids)
- ions (e.g., Na+, Ca2+, HCO3−)
- wastes (e.g., urea)
- hormones
- heat
- defense of the body against infections and other foreign materials. All the WBCs participate in these defenses
Contractility : Means ability of cardiac muscle to convert electrical energy of action potential into mechanical energy ( work).
The excitation- contraction coupling of cardiac muscle is similar to that of skeletal muscle , except the lack of motor nerve stimulation.
Cardiac muscle is a self-excited muscle , but the principles of contraction are the same . There are many rules that control the contractility of the cardiac muscles, which are:
1. All or none rule: due to the syncytial nature of the cardiac muscle.There are atrial syncytium and ventricular syncytium . This rule makes the heart an efficient pump.
2. Staircase phenomenon : means gradual increase in muscle contraction following rapidly repeated stimulation..
3. Starling`s law of the heart: The greater the initial length of cardiac muscle fiber , the greater the force of contraction. The initial length is determined by the degree of diastolic filling .The pericardium prevents overstretching of heart , and allows optimal increase in diastolic volume.
Thankful to this law , the heart is able to pump any amount of blood that it receives. But overstretching of cardiac muscle fibers may cause heart failure.
Factors affecting contractility ( inotropism)
I. Positive inotropic factors:
1. sympathetic stimulation: by increasing the permeability of sarcolemma to calcium.
2. moderate increase in temperature . This due to increase metabolism to increase ATP , decrease viscosity of myocardial structures, and increasing calcium influx.
3. Catecholamines , thyroid hormone, and glucagon hormones.
4. mild alkalosis
5. digitalis
6. Xanthines ( caffeine and theophylline )
II. Negative inotropic factors:
1. Parasympathetic stimulation : ( limited to atrial contraction)
2. Acidosis
3. Severe alkalosis
4. excessive warming and cooling .
5. Drugs ;like : Quinidine , Procainamide , and barbiturates .
6. Diphtheria and typhoid toxins.
Graded Contractions and Muscle Metabolism
The muscle twitch is a single response to a single stimulus. Muscle twitches vary in length according to the type of muscle cells involved. .
Fast twitch muscles such as those which move the eyeball have twitches which reach maximum contraction in 3 to 5 ms (milliseconds). [superior eye] and [lateral eye] These muscles were mentioned earlier as also having small numbers of cells in their motor units for precise control.
The cells in slow twitch muscles like the postural muscles (e.g. back muscles, soleus) have twitches which reach maximum tension in 40 ms or so.
The muscles which exhibit most of our body movements have intermediate twitch lengths of 10 to 20 ms.
The latent period, the period of a few ms encompassing the chemical and physical events preceding actual contraction.
This is not the same as the absolute refractory period, the even briefer period when the sarcolemma is depolarized and cannot be stimulated. The relative refractory period occurs after this when the sarcolemma is briefly hyperpolarized and requires a greater than normal stimulus
Following the latent period is the contraction phase in which the shortening of the sarcomeres and cells occurs. Then comes the relaxation phase, a longer period because it is passive, the result of recoil due to the series elastic elements of the muscle.
We do not use the muscle twitch as part of our normal muscle responses. Instead we use graded contractions, contractions of whole muscles which can vary in terms of their strength and degree of contraction. In fact, even relaxed muscles are constantly being stimulated to produce muscle tone, the minimal graded contraction possible.
Muscles exhibit graded contractions in two ways:
1) Quantal Summation or Recruitment - this refers to increasing the number of cells contracting. This is done experimentally by increasing the voltage used to stimulate a muscle, thus reaching the thresholds of more and more cells. In the human body quantal summation is accomplished by the nervous system, stimulating increasing numbers of cells or motor units to increase the force of contraction.
2) Wave Summation ( frequency summation) and Tetanization- this results from stimulating a muscle cell before it has relaxed from a previous stimulus. This is possible because the contraction and relaxation phases are much longer than the refractory period. This causes the contractions to build on one another producing a wave pattern or, if the stimuli are high frequency, a sustained contraction called tetany or tetanus. (The term tetanus is also used for an illness caused by a bacterial toxin which causes contracture of the skeletal muscles.) This form of tetanus is perfectly normal and in fact is the way you maintain a sustained contraction.
Treppe is not a way muscles exhibit graded contractions. It is a warmup phenomenon in which when muscle cells are initially stimulated when cold, they will exhibit gradually increasing responses until they have warmed up. The phenomenon is due to the increasing efficiency of the ion gates as they are repeatedly stimulated. Treppe can be differentiated from quantal summation because the strength of stimulus remains the same in treppe, but increases in quantal summation
Length-Tension Relationship: Another way in which the tension of a muscle can vary is due to the length-tension relationship. This relationship expresses the characteristic that within about 10% the resting length of the muscle, the tension the muscle exerts is maximum. At lengths above or below this optimum length the tension decreases.
Neural Substrates of Breathing
A. Medulla Respiratory Centers
Inspiratory Center (Dorsal Resp Group - rhythmic breathing) → phrenic nerve→ intercostal nerves→ diaphragm + external intercostals
Expiratory Center (Ventral Resp Group - forced expiration) → phrenic nerve → intercostal nerves → internal intercostals + abdominals (expiration)
1. eupnea - normal resting breath rate (12/minute)
2. drug overdose - causes suppression of Inspiratory Center
B. Pons Respiratory Centers
1. pneumotaxic center - slightly inhibits medulla, causes shorter, shallower, quicker breaths
2. apneustic center - stimulates the medulla, causes longer, deeper, slower breaths
C. Control of Breathing Rate & Depth
1. breathing rate - stimulation/inhibition of medulla
2. breathing depth - activation of inspiration muscles
3. Hering-Breuer Reflex - stretch of visceral pleura that lungs have expanded (vagal nerve)
D. Hypothalamic Control - emotion + pain to the medulla
E. Cortex Controls (Voluntary Breathing) - can override medulla as during singing and talking
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.
Red Blood Cells (erythrocytes)
- Women average about 4.8 million of these cells per cubic millimeter (mm3; which is the same as a microliter [µl]) of blood.
- Men average about 5.4 x 106 per µl.
- These values can vary over quite a range depending on such factors as health and altitude.
- RBC precursors mature in the bone marrow closely attached to a macrophage.
- They manufacture hemoglobin until it accounts for some 90% of the dry weight of the cell.
- The nucleus is squeezed out of the cell and is ingested by the macrophage.
RBC have characteristic biconcave shape
Thus RBCs are terminally differentiated; that is, they can never divide. They live about 120 days and then are ingested by phagocytic cells in the liver and spleen. Most of the iron in their hemoglobin is reclaimed for reuse. The remainder of the heme portion of the molecule is degraded into bile pigments and excreted by the liver. Some 3 million RBCs die and are scavenged by the liver each second.
Red blood cells are responsible for the transport of oxygen and carbon dioxide.