NEET MDS Lessons
Physiology
4. Emphysema
1. Permanent enlargement of airways with distension of alveolar walls
Thickened Bronchial Submucosa, Edema & Cellular Infiltration (loss of elasticity), Dilation of Air spaces, due to destruction of alveolar walls (Air trapped by obstruction)
2. Lower Respiratory tree destruction
Respiratory Bronchioles, Alveolar ducts, & Alveolar sacs
Types of Emphysema:
1. Centrilobular (Centriacinar) = Respiratory Bronchioles
Rarely seen in non Smokers, More in Men than Women, Found in Smokers with Bronchitis
2. Panlobular (Panacinar)
Hereditary, Single autosomal recessive gene. Deficient in 1-globulin (1-antitrypsin), Protects respiratory tract from neutrophil elastase (Enzyme that distroys lung connective tissue) , Aged persons, Results from Bronchi or Bronchiolar constriction
NOTE: Smoking = Leading cause of Bronchitis, Emphysema
Sensory pathways include only those routes which conduct information to the conscious cortex of the brain. However, we will use the term in its more loosely and commonly applied context to include input from all receptors, whether their signals reach the conscious level or not.
Remember the following principles before proceeding :
- Reabsorption occurs for most of substances that have been previously filterd .
- The direction of reabsorption is from the tubules to the peritubular capillaries
- All of transport mechanism are used here.
- Different morphology of the cells of different parts of the tubules contribute to reabsorption of different substances .
- There are two routes of reabsorption: Paracellular and transcellular : Paracellular reabsorption depends on the tightness of the tight junction which varies from regeon to region in the nephrons .Transcellular depends on presence of transporters ( carriers and channels for example).
1. Reabsorption of glucose , amino acids , and proteins :
Transport of glucose occurs in the proximal tubule . Cells of proximal tubules are similar to those of the intestinal mucosa as the apical membrane has brush border form to increase the surface area for reabsorption , the cells have plenty of mitochondria which inform us that high amount of energy is required for active transport , and the basolateral membrane of the cells contain sodium -potassium pumps , while the apical membrane contains a lot of carrier and channels .
The tight junction between the tubular cells of the proximal tubules are not that (tight) which allow paracellular transport.
Reabsorption of glucose starts by active transport of Na by the pumps on the basolateral membrane . This will create Na gradient which will cause Na to pass the apical membrane down its concentration gradient . Glucose also passes the membrane up its concentration gradient using sodium -glucose symporter as a secondary active transport.
The concentration of glucose will be increased in the cell and this will enable the glucose to pass down concentration gradient to the interstitium by glucose uniporter . Glucose will then pass to the peritubular capillaries by simple bulk flow.
Remember: Glucose reabsorption occurs via transcellular route .
Glucose transport has transport maximum . In normal situation there is no glucose in the urine , but in uncontrolled diabetes mellitus patients glucose level exceeds its transport maximum (390 mg/dl) and thus will appear in urine .
2. Reabsorption of Amino acids : Use secondary active transport mechanism like glucose.
3. Reabsorption of proteins :
Plasma proteins are not filtered in Bowman capsule but some proteins and peptides in blood may pass the filtration membrane and then reabsorbed . Some peptides are reabsorbed paracellulary , while the others bind to the apical membrane and then enter the cells by endocytosis , where they will degraded by peptidase enzymes to amino acids .
4. Reabsorption of sodium , water , and chloride:
65 % of sodium is reabsorbed in the proximal tubules , while 25% are reabsorbed in the thick ascending limb of loob of Henle , 9% in the distal and collecting tubules and collecting ducts .
90% of sodium reabsorption occurs independently from its plasma level (unregulated) , This is true for sodium reabsorbed in proximal tubule and loop of Henle , while the 9% that is reabsorbed in distal ,collecting tubules and collecting ducts is regulated by Aldosterone.
In proximal tubules : 65% of sodium is reabsorbed . The initial step occurs by creating sodium gradient by sodium-potassium pump on the basolateral membrane . then the sodium will pass from the lumen into the cells down concentration gradient by sodium -glucose symporter , sodium -phosphate symporter and by sodium- hydrogen antiporter and others
After reabsorption of sodium , an electrical gradient will be created , then chloride is reabsorbed following the sodium . Thus the major cation and anion leave the lumen to the the interstitium and thus the water follows by osmosis . 65% of water is reabsorbed in the proximal tubule.
Discending limb of loop of Henle is impermeable to electrolytes but avidly permeable to water . 10 % of water is reabsorbed in the discending thin limb of loob of Henle .
The thick ascending limb of loop of Henly is permeable to electrolytes , due to the presence of Na2ClK syporter . 25% of sodium is reabsorbed here .
In the distal and collecting tubules and the collecting ducts 9% of sodium is reabsorbed .this occurs under aldosterone control depending on sodium plasma level. 1% of sodium is excreted .
Water is not reabsorbed from distal tubule but 5-25% of water is reabsorbed in collecting tubules .
Asthma = Reversible Bronchioconstruction 4%-5% of population
Extrinsic / Atopic = Allergic, inherited (familia), chromosome 11
IgE, Chemical Mediators of inflammation
a. Intrinsic = Negative for Allergy, Normal IgE, Negative Allergic Tests
Nucleotide Imbalance cAMP/cGMP: cAMP = Inhibits mediator release, cGMP = Facilitates mediator release
b. Intolerance to Asprin (Triad Asthma)
c. Nasal Polyps & Asthma
d. Treatment cause, Symptoms in Acute Asthma
1. Bronchial dilators
2. steroids edema from Inflamation
3. Bronchiohygene to prevent Secondary Infection, (Remove Excess Mucus)
4. Education
Chemical Controls of Respiration
A. Chemoreceptors (CO2, O2, H+)
1. central chemoreceptors - located in the medulla
2. peripheral chemoreceptors - large vessels of neck
B. Carbon Dioxide Effects
1. a powerful chemical regulator of breathing by increasing H+ (lowering pH)
a. hypercapnia Carbon Dioxide increases ->
Carbonic Acid increases ->
pH of CSF decreases (higher H+)- >
DEPTH & RATE increase (hyperventilation)
b. hypocapnia - abnormally low Carbon Dioxide levels which can be produced by excessive hyperventilation; breathing into paper bag increases blood Carbon Dioxide levels
C. Oxygen Effects
1. aortic and carotid bodies - oxygen chemoreceptors
2. slight Ox decrease - modulate Carb Diox receptors
3. large Ox decrease - stimulate increase ventilation
4. hypoxic drive - chronic elevation of Carb Diox (due to disease) causes Oxygen levels to have greater effect on regulation of breathing
D. pH Effects (H+ ion)
1. acidosis - acid buildup (H+) in blood, leads to increased RATE and DEPTH (lactic acid)
E. Overview of Chemical Effects
Chemical Breathing Effect
increased Carbon Dioxide (more H+) increase
decreased Carbon Dioxide (less H+) decrease
slight decrease in Oxygen effect CO2 system
large decrease in Oxygen increase ventilation
decreased pH (more H+) increase
increased pH (less H+) decrease
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
The hypothalamus is a region of the brain. It secretes a number of hormones.
- Thyrotropin-releasing hormone (TRH)
- Gonadotropin-releasing hormone (GnRH)
- Growth hormone-releasing hormone (GHRH)
- Corticotropin-releasing hormone (CRH)
- Somatostatin
- Dopamine
All of these are released into the blood, travel immediately to the anterior lobe of the pituitary, where they exert their effects.
Two other hypothalamic hormones:
- Antidiuretic hormone (ADH) and
- Oxytocin
travel in neurons to the posterior lobe of the pituitary where they are released into the circulation.