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Textbook of Physiology
R Chandramouli
1:
Cell Physiology and Biophysics
CELL MEMBRANE
Fluid mosaic model
Functions of cell membrane proteins
CELL ORGANELLES
Nucleus
Endoplasmic reticulum
Golgi apparatus
Mitochondria
Lysosomes
Peroxisomes
Cytoskeleton
Microtubules
Microfilaments
Cilia
Cell adhesion molecules
INTERCELLULAR CONNECTIONS
Gap Junction
Tight junction
Desmosome
TRANSPORT MECHANISMS
Endocytosis
Exocytosis
Transcytosis
Passive transport
Diffusion of solute
Diffusion of solvent
Osmosis
Solvent drag
Carrier mediated transport
Cotransport
Active transport
Secondary active transport
Counter transport (Antiport)
Antiport
Gibbs Donnan's equilibrium
Membrane potential
CHEMICAL MESSENGERS
How are second messengers formed?
Cyclic GMP
IP3 and DAG
Ca++ as second messenger
Ligands mediating their effects through Cytoplasmic and nuclear receptors
Receptors and its Regulation
ION CHANNELS IN THE CELL MEMBRANE
Study of channels
Sodium channel
Potassium channels
Calcium channels
ANSWER KEYS
2:
Nerve
NERVE BIOPHYSICS
Bioelectric potentials
Excitability
Resting membrane potential
I. Selective permeability of the membrane as the cause of membrane potential
Potassium diffusion potential
Diffusion potential of Na+
Diffusion potential of chloride
II. Electrogenic pump as the cause of membrane potential
III. Presence of anions as the cause of membrane potential
Equilibrium potentials and conductance of the membrane
Changes in ion concentration and Its effect on the membrane potential
Action potential
Depolarization
Repolarization
Channel activity during action potential
Time dependence
Methods to study Ionic current during action potential
Voltage Clamp Technique
Properties of Action Potential
All or None Law
Accommodation
Relationship between excitability and action potential
Strength-duration relationship
Electrotonic potentials (Local response)
Space constant
Space constant depends on
Time constant
Effect of cathodal current
Effect of anodal current
NERVE CONDUCTION
Conduction in an unmyelinated nerve fiber
Conduction in a myelinated nerve fiber
NERVE FIBER TYPES
Energy metabolism in nerve
STRUCTURE OF NEURON
Glial cells
Structure of neuron
Axoplasmic transport
Myelin formation
DEGENERATION AND REGENERATION IN PERIPHERAL NERVE FIBERS
Wallerian degeneration
Regeneration
ANSWER KEYS
3:
Muscle
SKELETAL MUSCLE
Sarcomere
Contractile proteins
Myosin
Actin
Tropomyosin
Sarcotubular system
Triad
MOLECULAR EVENTS DURING MUSCULAR CONTRACTION
Role of Ca++ in the activation of contraction
Cross-bridge mechanism
Sliding filament mechanism
Steps in skeletal muscle contraction
Relaxation
Steps in skeletal muscle relaxation
Rigor mortis
MECHANICS OF MUSCLE CONTRACTION
Isotonic contraction
Isometric contraction
Length-tension relationship
Force-velocity relationship
Summation of contractions and tetanus
Fatigue
ENERGY MECHANISM DURING MUSCLE CONTRACTION
Oxygen debt
Heat production in muscle
MOTOR UNIT
Motor units are of two types
EMG
Uses of EMG
Fibrillation potentials
Fasciculations
NEUROMUSCULAR TRANSMISSION
Release of acetylcholine
Action on end plate
Acetylcholine inactivation
Blocking of neuromuscular transmission
Acetylcholine esterase inhibitors
Diseases affecting neuromuscular transmission
Myasthenia gravis
CARDIAC MUSCLE
Contraction in cardiac muscle
Length-tension relationship in cardiac muscle
SMOOTH MUSCLE
Role of Ca++
Length-tension relationship
ANSWER KEYS
4:
Central Nervous System
SYNAPTIC TRANSMISSION
Structure of synapse
Mechanism of synaptic transmission
Properties of synapse
Oneway conduction
Synaptic delay
Fatigue
Summation
Convergence and divergence
Subliminal fringe
Occlusion
Electrical properties
EPSP
IPSP
Types of inhibition in CNS
Direct inhibition
Indirect inhibition
Presynaptic inhibition
Renshaw cell inhibition
Synaptic plasticity
NEUROTRANSMITTERS
Types of neurotransmitters
Acetylcholine
Acetylcholine receptors
Nicotinic receptors
Muscarinic receptors
Biogenic amines
Adrenergic receptors
Serotonin (5 hydroxy tryptamine)
Histamine
Amino acid transmitters
Inhibitory transmitters
Glycine
GABA
Peptides
Opioid peptides
Other peptides
Substance P
VIP
NO (Nitric oxide)
Other functions of NO
SENSORY SYSTEM
Sensory receptors
Types of sensory receptors
Cutaneous receptors
Properties of receptors
Specificity
Adequate stimulus
Adaptation (Fig. 4.18)
Sensory coding
Sensory modality
Spatial location
Threshold
Intensity of stimulus
Generator potential (Receptor potential)
Intensity discrimination
Sensory unit
Physiology of cutaneous receptors
Mechanoreceptors
Thermoreceptors
Nociceptors
Proprioceptors
SENSORY PATHWAYS
Organization
I Order neuron
II Order neuron
III Order neuron
Dorsal column
Anterolateral system
Pathway of pain, temperature and crude touch
Touch pathway (Figs 4.22 and 4.23)
Spinocerebellar tracts
PHYSIOLOGY OF PAIN
Pain pathway
Types of pain
Fast and slow pain
Deep pain
Muscle pain
Headache
Visceral pain
Referred pain
Phantom pain
Pain inhibition
Gate control mechanism
Stress analgesia
Synthetic senses
SOMATOTOPIC ORGANIZATION
Effects of sensory cortex lesions
MOTOR ORGANIZATION AND CONTROL
Motor organization at the spinal level
Reflex action
Types of reflexes
Flexor reflex
Properties of reflexes
Local sign
CES and CIS
After discharge
Irradiation and recruitment of motor units
Reciprocal innervation
Crossed extensor reflex
Stretch reflex
Muscle tone
Motor innervation of spindles
Gamma motor neuron discharge
Golgi tendon organ reflex
Inverse stretch reflex
SPINAL CORD
Ventral horn of spinal cord
Tracts in the lateral funiculus
Lateral corticospinal tract rubrospinal tract
Interneurons of spinal cord
MOTOR ORGANIZATION IN THE BRAINSTEM
Extrapyramidal pathways
Rubrospinal tract
Tectospinal tract
Vestibulospinal tract
Reticulospinal tract
Olivospinal tract
MOTOR CONTROL FROM BASAL GANGLIA
Connections of basal ganglia
Functions of basal ganglia (Table 4.1)
Disorders of basal ganglia
Wilson's disease
Huntington chorea
Parkinson's disease
Chorea and athetosis
Ballism
MOTOR CONTROL FROM CEREBELLUM
Functions
Vestibulocerebellum
Spinocerebellum
Cerebrocerebellum (Neocerebellum)
Planning of sequential movements
Timing of complex movements
Motor learning
Effects of lesion of cerebellum
MOTOR CORTEX
Supplementary motor area (Fig. 4.57)
Premotor cortex
Somatosensory cortex and posterior parietal cortex (Fig. 4.59)
Pyramidal tract
Functions of pyramidal tract
Effects of lesion of corticospinal tract
Effects of lesion of lower motor neuron
Overall motor organization and control
SPINAL CORD LESIONS
Spinal shock
Recovery from spinal shock
Hemisection of spinal cord
At the level of lesion
Below the level of lesion
Same side
Opposite side
POSTURAL REFLEXES
Lesion of spinal cord and its effects on posture
Lesion in the brainstem and its effects on postural reflexes
Decerebrate rigidity
Decorticate preparation
Midbrain preparation
Righting reflexes
Statokinetic reflexes
Semicircular canals
Vestibulo ocular reflex
Nystagmus
Central vestibular connections
Effects of excessive stimulation of vestibular apparatus
THALAMUS
Anterior nucleus
Dorsal
Ventral
Thalamo-cortical-thalamic circuit
Anterior nucleus
Dorsomedial
Ventral anterior
Ventrolateral
Ventral posterior lateral (VPL)
Ventral posterior medial
Pulvinar
Lateral geniculate body
Medial geniculate body
Reticular nucleus
Intrinsic nuclei
Functions of thalamus
RETICULAR FORMATION
ARAS (ascending reticular activating system)
Descending reticulospinal pathway
ELECTROENCEPHALOGRAM (EEG)
Alpha wave
Beta wave
Theta wave
Delta wave
Uses of EEG
SLEEP
Slow wave sleep
REM sleep
Genesis of SWS
Genesis of REM sleep
HYPOTHALAMUS
Nuclei of hypothalamus
Medial group contains
Lateral group includes
Posterior group contains
Connections of hypothalamic nuclei
Afferent connections
Efferent connections
Functions of hypothalamus
Control of autonomic nervous system
Temperature regulation
Regulation of food intake
Regulation of body weight
Water balance
Control of anterior pituitary
Secretion of posterior pituitary hormones
Rage
Sex behavior
Sleep
Motivation
Circadian rhythm
Immunity
LIMBIC SYSTEM
Areas of limbic system included in the cortex
Subcortical areas
Connections
Functions of limbic lobe
Emotion
Regulation of visceral activity
Memory and learning
Kindling effect
Motivation
CEREBRAL CORTEX
Cytoarchitecture and higher functions
Methods of studying cortical function
Evoked potential
Functional areas of cerebral cortex (Figs 4.80 and 4.81)
Parietal lobe
Frontal lobe
Temporal lobe
Association areas
Prefrontal cortex
Connections
Afferent
Efferent connections
Functions of prefrontal lobe
Experimental neurosis
Hemispheric specialization
Handedness and lateralization
Intracortical transfer of information
Effects of damage to categorical hemisphere (left side)
Effect of damage to representational hemisphere (right side)
HIGHER FUNCTIONS OF CORTEX
Speech
Speech disorders
Aphasia
Types
Fluent aphasia
Motor aphasia
Word blindness (visual agnosia)
Word deafness (auditory agnosia)
Global aphasia
Dysarthria
Learning
Nonassociative learning
Habituation
Sensitization
Associative learning
Conditioned reflexes
Memory
Short-term memory
Long-term memory
Neurological basis of memory
Cholinergic pathways in memory
Anterograde amnesia
CEREBROSPINAL FLUID
Functions of CSF
Blood brain barrier
Significance of blood brain barrier
Regions of brain outside blood brain barrier
AUTONOMIC NERVOUS SYSTEM
Divisions of autonomic nervous system
Sympathetic nervous system
Transmission in sympathetic nervous system
Functions of sympathetic nervous system
Parasympathetic nervous system
Transmission in parasympathetic nervous system
Functions of parasympathetic system
Regulation of ANS activity
5:
Special Senses
VISION
Retina
Visual receptors (Fig. 5.3)
Rods
Cones
Electrophysiology of retina
Organization of receptive fields in ganglion cells
Organization of ganglion cell
Organization in lateral geniculate body
Visual cortex (striate cortex)
Columnar organization in visual cortex
Other cortical areas contributing to vision
Visual pathway (Fig. 5.6)
Lesion of optic pathway
Electroretinogram (ERG)
Optics of eye
Cornea
Lens
Reduced eye (Fig. 5.9)
Accommodation
Accommodation pathway
Purkinje sanson images
Dark adaptation
Light adaptation
Light reflex (pupillary reflexes)
COLOR VISION
Color blindness
Types of color blindness
Acuity of vision
Binocular vision and stereopsis
Depth perception (stereopsis)
Refractive errors of eye (Fig. 5.14)
Myopia (short sightedness)
Hypermetropia (long sightedness)
Astigmatism
Aqueous humor
Ocular muscles and eye movements
HEARING
Middle ear
Middle ear muscles (acoustic reflex)
Impedance matching of middle ear
Inner ear
Organ of Corti (Fig. 5.18)
Inner hair cell (Fig. 5.19)
Outer hair cells (Fig. 5.20)
Mechanism of hearing
Place theory of hearing
Tuning of inner hair cells
Traveling wave
Coding of sound intensity
Transduction of receptors
Auditory pathway (Fig. 5.25)
Disorders of hearing
Conduction deafness
Nerve deafness (sensory neural)
Clinical audiometry
CHEMICAL SENSES
Taste (Gustation)
Taste buds (Fig. 5.27)
Taste receptors transduction
Taste coding
Transduction of receptors
Adaptation
Taste pathway (Fig. 5.28)
Smell (olfaction)
Olfactory receptors
Transduction of receptors
Coding of odours
Olfactory pathway (Fig. 5.29)
SELF-STUDY QUESTIONS
Multiple Choice Questions
Choose the single best answer
ANSWER KEYS
6:
Blood
PLASMA
Plasma proteins
Serum
Separation of plasma proteins
Functions of plasma proteins
Formation of plasma proteins
ERYTHROCYTES
Metabolism in RBC
Life span of RBC
Physiologically red cell count increases in the following
Polycythemia
Anemia
Erythropoiesis (Fig. 6.1)
Hematopoietic stem cells
Committed and unipotent stem cell
Proerythroblast
Early normoblast
Intermediate normoblast
Late normoblast
Reticulocyte
Erythrocyte
Regulation of erythropoiesis
Hypoxia
Erythropoietin
Thyroxine, cortisol and growth hormone
Androgens
Vitamin B12 (cyanocobalamine)
Folic acid
Pyridoxine (vit B6)
Metals
LEUCOCYTES
Granulocytes
Neutrophil
Phagocytic defence
Release of bactericidal agents
Physiological rise in neutrophil count is observed in the following
Pathological rise in neutrophil count can be seen in the following
Eosinophil
Basophil
Agranulocytes
Lymphocytes
Monocytes
Tissue macrophage system
Leucopoiesis
Regulation of leucopoiesis
Leukemias
Leukopenia
THROMBOCYTES (PLATELETS)
Formation of platelets
Functions of platelets
• Formation of platelet plug
• Release of vasoconstrictor substances
• Platelets help in blood coagulation
• Clot retraction
• Repair of damaged endothelium
Disorders of platelets function
Thrombocytopenic purpura
HEMOSTASIS (BLOOD COAGULATION)
Factor I Fibrinogen
Factor II Prothrombin
Factor III Tissue thromboplastin
Factor IV Calcium
Factor V Proacclerin
Factor VII Proconvertin (Serum prothrombin conversion accelerator)
Factor VIII Anti-hemophilic globulin factor (AHG)
Factor IX Christmas factor
Factor X Stuart factor
Factor XI Plasma thromboplastin antecedent (PTA)
Factor XII Hageman's factor
Factor XIII Fibrin stabilizing factor
Process of clotting
Role of platelets
Generation of prothrombin activator
Intrinsic pathway (Fig. 6.5)
Extrinsic pathway (Fig. 6.6)
Formation of fibrin (Role of fibrin stabilizing factor)
Fibrinolysis
Inhibitors of clotting (Mechanisms which keep the blood in a fluid state)
Antithrombin III
Protein C
Heparin
Vascular endothelium
Fibrinolysis
Intravascular thrombosis
Anticoagulants
Salts
Drugs
Heparin
Dicoumarol
Tests for clotting
Clotting time
Bleeding time
Prothrombin time
Thromboplastin generation test
Clotting disorders
Hemophilia
Hemophilia A or classical hemophilia
Hemophilia B or Christmas disease
BLOOD GROUPS AND TRANSFUSION
Law of blood grouping
Inheritance of blood groups
Cross matching
Rh factor
Rh incompatibility
Transfusion of blood
Changes during storage of blood
Effects of incompatible transfusion
IMMUNITY
Innate immuntiy
Barriers
Phagocytosis
Complement system
C – reactive protein
Interferons
Natural killer cells
Acquired immunity (Fig. 6.10)
Antigen recognition by clonal selection
Acquired immunity (Fig. 6.10)
How does antibodies function?
Structure of antibody and its subtypes
Regulation of immunity
Abnormalities of immune mechanisms
HEMOGLOBIN
Structure of hemoglobin
Types of hemoglobin
Derivatives of hemoglobin
Fate of hemoglobin
Blood indices
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin (MCH)
ANEMIAS
Classification of anemias
Laboratory investigations and cell picture
I. Anemia due to decreased formation of red cells
Nutritional anemias
Lack of vit B12
Folic acid deficiency
Iron deficiency
Suppressed bo ne marrow function (Aplastic anemia)
Chronic diseases
Renal disease
Hypothyroidism
II. Anemia arising from increased destruction of RBC
Corpuscular defect
Hereditary spherocytosis
Sickle cell anemia
Thalassemia
G-6-P-D (glucose-6-phosphate dehydrogenase) deficiency
Extracorpuscular defect
III. Anemia resulting from blood loss
Effects of anemia
ANSWER KEYS
7:
Cardiovascular System
ORGANIZATION
Central pumping organ
Valves in the heart
Systemic circulation
Pulmonary circulation
Hemodynamics of circulation
Flow in Windkessel vessels
Flow in capillaries
Pressure decline in the arterial system
Peripheral resistance and pressure
Critical closing pressure
Radius of the vessel and pressure
CARDIAC MUSCLE
Structure of cardiac muscle
Properties of cardiac muscle
Electrical properties
Pacemaker potential
Electrical potential from Ventricular muscle
Mechanical properties
Automaticity
Refractory period
All or none law
Excitation-contraction coupling
Force-velocity relationship
Length-tension relationship
Factors affecting myocardial contraction
Hyperkalemia
Hypercalcemia
Conductivity
Rhythmicity
CARDIAC IMPULSE
Origin of cardiac impulse
Conducting system of the heart (Fig. 7.9)
SA node
AV node
Ventricular excitation
Bundle of His
Purkinje fibers
Myocardium
ELECTROCARDIOGRAM
Objectives of ECG
Methods of recording
Unipolar augmented limb leads
Precordial chest leads (Fig. 7.13)
ECG waves
P wave
QRS
T wave
U wave
PR interval
QT interval
ST segment
J point
Mean electrical axis
Vectorcardiography
Conduction defects (Fig. 7.18)
Arrhythmias of the heart
Myocardial infarction
CARDIAC CYCLE
Events in ventricular systole
Ventricular diastole
Pressure-volume relationship in cardiac cycle
Ejection fraction
Timing of events
HEART SOUNDS
First sound
Second sound
Third sound
Fourth sound
Correlation of heart sounds with ECG
Murmurs
CARDIAC OUTPUT
Regulation of cardiac output
Preload to the heart
Factors influencing venous return (preload)
Determinants of venous return
Inotropic and chronotropic effects
Afterload to the heart
Determination of cardiac output
Fick method
Indicator dilution technique
Distribution of cardiac output
REGULATION OF HEART AND BLOOD VESSELS
Neural control of heart
Cardiac center
Innervation of heart
Parasympathetic innervation
Reciprocal relationship
Cardiac reflexes
Bainbridge reflex
Reflex from atria
Reflex from left ventricle
Coronary chemo reflex
Sinoaortic reflex
Chemoreceptor reflex
Reflex from periphery
Reflex from higher centers
ARTERIAL BLOOD PRESSURE
Normal values
Recording of arterial blood pressure
Indirect methods
Variations in values
Age
Sex
Posture
Muscular exercise
Emotional excitement
Digestion
Maintenance of arterial blood pressure
Peripheral resistance
Arterial hypertension
Regulation of arterial blood pressure
Vasomotor center
Short-term regulation of arterial blood pressure
Reflex from baroreceptors
Chemoreceptor reflex
Reflexes from heart
Higher centers
Direct stimulation of medullary center (Cushing reflex)
Circulating hormones
Long-term regulation of arterial blood pressure
ARTERIAL PULSE
VENOUS PRESSURE
Venous circulation
Venous pressure
Venous pulse
REGIONAL CIRCULATION
Determinants of local blood flow
Autoregulation of blood flow
Release from endothelium
Nitric oxide
Endothelins
CORONARY CIRCULATION
Phasic blood flow
Regulation of coronary blood flow
CEREBRAL CIRCULATION
CUTANEOUS CIRCULATION
Reactive hyperemia in regional circulation
CAPILLARY CIRCULATION (MICROCIRCULATION)
LYMPHATIC CIRCULATION
Regulation of lymph flow
Factors increasing lymph flow
Functions of lymphatic circulation
FETAL CIRCULATION
Fetal respiration
Changes at birth
CARDIOVASCULAR CHANGES IN MUSCULAR EXERCISE
Cardiac responses to exercise
Stroke volume
Circulatory responses
Regional blood flow
Arteriovenous O2 difference
Anaerobic threshold
Respiratory changes
Changes in muscle
CIRCULATORY SHOCK
Hypovolemic shock
Immediate compensatory reactions
Long-term compensatory mechanisms
Treatment of hypovolemic shock
Refractory shock
Low resistance shock (Distributive shock)
Cardiogenic shock
CARDIAC FAILURE
GRAVITY INDUCED CHANGES IN CVS
Effects of acceleration and deceleration on CVS
Acceleration
Deceleration
ANSWER KEYS
8:
Respiratory Physiology
MECHANICS OF RESPIRATION
Intrapleural pressure
How is intrapleural pressure created?
Intrapleural pressure during respiratory cycle
Measurement of intrapleural pressure
Effect of gravity on intrapleural pressure
Intrapulmonary pressure
Transpulmonary pressure
Pressure-volume relationship in lungs Compliance of lungs
Compliance in emphysema
Lung surfactant
Functions of surfactant
Production of surfactant
Interdependence of alveoli for stability
Airway resistance
Work done during breathing
DEAD SPACE
Physiological dead space
ALVEOLAR VENTILATION
Ventilation-perfusion ratio
PULMONARY CIRCULATION
Blood flow in different zones of lungs
Regulation of blood flow in lungs
Physiological shunt
Pulmonary blood volume
DIFFUSION OF GASES
Factors affecting diffusion of gases
Composition of gases
Collection of gases
TRANSPORT OF RESPIRATORY GASES
Transport of oxygen
Reactions between Hb and oxygen
Oxygen dissociation curve
P50 in oxygen dissociation curve
Bohr's effect (Fig. 8.14)
Oxygen carrying capacity
Oxygen content of blood
Hb with CO
Oxygen transport in methemoglobin formation
Transport in sickle cell anemia
Dissociation curve of fetal Hb
Transport of carbon dioxide
Transport as simple solution
Transport as carbamino compounds
Transport as bicarbonate
Chloride shift
Haldane's effect
Carbon dioxide content in blood
REGULATION OF RESPIRATION
Neural control of respiration
Dorsal group
Ventral group
Pontine center Pneumotaxic center
Mechanism of rhythmic breathing
Respiratory reflexes (Fig. 8.21)
Hering-Breuer reflex
Hering-Breuer inflation reflex
Hering-Breuer deflation reflex
Reflex from lung irritant receptors
Reflex from J receptors
Reflex from proprioceptors of respiratory muscles
Chemical regulation of respiration
Reflexes from chemoreceptors
Peripheral chemoreceptors
Central chemoreceptor
Peripheral chemoreceptors
Presence of hypoxia together with rise in PCO2
Respiration during exercise
Influence of higher centers on respiratory centers
Proprioceptive input from muscles, tendon and joints
Type of metabolism
Respiration during sleep
Sleep apnea syndrome
Abnormal breathing
Periodic breathing
HYPOXIA
Decreased PO2 in arterial blood (Arterial hypoxia or hypoxic hypoxia)
Decreased rate of blood flow (stagnant hypoxia)
Reduced oxygen carrying capacity (anemic hypoxia)
Inactivation of respiratory enzymes in the tissues (histotoxic hypoxia)
Effects of high altitude on respiration
Mountain sickness
Acclimatization to high altitude
RESPIRATORY DISORDERS
Asphyxia
Cyanosis
Cyanosis depends on:
Dyspnea
Decompression sickness
Emphysema
Oxygen therapy
Hyperbaric oxygen therapy
ARTIFICIAL RESPIRATION AND LUNG FUNCTION TESTS
Lung function tests
Tidal volume
Rate of breathing
Inspiratory reserve volume
Inspiratory capacity
Expiratory reserve volume
Residual volume
Functional residual capacity
Vital capacity
FEV1
MVV (maximum voluntary ventilation)
Breathing reserve and dyspneic index
PEFR
Closing volume
ANSWER KEYS
9:
Renal Physiology
NEPHRON
Tubular part of nephron (Fig. 9.2)
Loop of Henle
DCT
Collecting duct
RENAL BLOOD FLOW
Measurement of renal blood flow
Autoregulation of renal blood flow
Myogenic
Tubuloglomerular feedback (Fig. 9.4)
Renal oxygen consumption
Sympathetic stimulation
GLOMERULAR FILTRATION
Mesangial cells and GFR
Permeability of charged particles
Factors determining GFR (FIG. 9.8)
Determination of GFR
Filtration fraction (FF)
Factors that affect GFR
TUBULAR FUNCTION
Formation of urine
PCT
Reabsorption of glucose and amino acids
TmG
Water reabsorption
Potassium
Cl− and HCO− 3
Secretion in PCT
Glomerulotubular balance
Changes in loop of Henle
Changes in DCT
Water reabsorption in DCT
Changes in collecting duct
Urea reabsorption
URINE CONCENTRATION
Counter current multiplier system
Counter current exchanger system
Role of collecting duct
Role of urea in medullary hypertonicity
Free water clearance
Factors affecting concentrating ability of kidney
REGULATION OF BODY WATER BALANCE
Determination of TBW and ECF
Osmolality and body fluid volume
Regulatory responses to fall in ECF volume
Stimulation of thirst
Secretion of ADH (vasopressin)
Stimulation of sympathetics
Stimulation of renin-angiotensin
Secretion of aldosterone
Peritubular capillary oncotic pressure
Regulatory mechanisms when ECF volume is increased
Inhibition of thirst
Absence of sympathetic stimulation
Inhibition of angiotensin and aldosterone
Secretion of ANP and BNP
Secretion of PGE2
REGULATION OF SODIUM BALANCE
Regulatory mechanisms in increased salt intake (Fig. 9.19)
Changes in GFR
Starling's effect in PCT
Pressure diuresis and Pressure Natriuresis
Inhibition of angiotensin and aldosterone secretion
Secretion of ANP and BNP
(Atrial natriuretic peptide)
(Brain natriuretic peptide)
Regulatory mechanisms when salt intake is low
Fall in GFR
Starling's effect
Sympathetic stimulation
Glomerulotubular balance
Tubuloglomerular feedback
Secretion of angiotensin II and aldosterone
Inhibition of ANP
Diuretics and sodium balance
ACID BASE BALANCE
Types of metabolic acids added to the ECF
Volatile acids
Nonvolatile acids
Organic acids
Buffer systems in body fluids
Respiratory mechanisms in pH regulation
Renal mechanisms in acid base regulation
Mechanism in PCT
In DCT and collecting duct
Ammonium Secretion
Factors affecting renal H+ secretion
PCO2 level
Carbonic anhydrase
Mineralocorticoid
Plasma K+
Clinical evaluation of acid base balance
pH of arterial blood
Clinical measurement of acid base disorders include
Compensation in acid base disorders
Measurement of anion gap
JUXTAGLOMERULAR APPARATUS (JGA)
Renin-angiotensin
MICTURITION
TESTS TO ASSESS RENAL FUNCTION
Clearance studies
Inulin clearance (Fig. 9.23)
Endogenous creatinine clearance
Urea clearance
PAH clearance
Filtration fraction (FF)
Renal concentration test
Renal diluting ability
Urine analysis
Blood examination
Intravenous pyelography
ANSWER KEYS
10:
Skin and Body Temperature
SKIN
Epidermis
Dermis
Glands
Sweat glands
Apocrine glands
Eccrine glands
Functions of skin
Protective
Body temperature regulation
Sensory function
Synthesis of vit D
Storage function
Protection against UV rays of sun
BODY TEMPERATURE REGULATION
Variations of body temperature
Recording of body temperature
Sources of heat production
Heat loss from the body
Regulatory mechanisms (Table 10.1)
Temperature regulating centers
Body responses to rise in temperature
Ways of dissipating heat from the body
Body response to decrease in body temperature
Mechanisms for reducing the heat loss
Ways of increasing heat production
Effects of hyperthermia
Fever
Hypothermia
11:
Gastrointestinal System
DIGESTIVE SECRETIONS
Salivary secretion
Innervation of salivary gland
Composition
Duct cells function
Regulation of secretion
Functions of saliva
Gastric secretion
Composition of gastric juice
Functions of HCl
Functions of gastric juice
HCl secretion (Fig. 11.5)
Agents causing secretion of acid and its inhibition (Fig. 11.6)
Regulation of gastric secretion
Neural regulation
Hormonal regulation
The secretion of gastrin also occurs in the following conditions
Phases of gastric secretion
Cephalic phase
Gastric phase
Intestinal phase
Pancreatic secretion
Composition
Peptidases
Trypsin, chymotrypsin and elastase
Nucleases
Lipase
Phospholipases
Amylase
Trypsin inhibitor
Regulation of pancreatic secretion
Control in cephalic phase
Regulation in gastric phase
Regulation in intestinal phase
Secretin
CCK (pancreozymin)
Clinical importance
Bile
Composition of bile
Bile salts
Bile pigments
Phospholipids
Cholesterol
Functions of bile
Enterohepatic circulation of bile salts
Regulation of bile secretion
Bile independent fraction of biliary secretion
Bile dependent fraction of biliary secretion
Release of bile from gallbladder
Gallbladder
Gallstones (cholelithiasis)
Cholecystography
Cholecystectomy
Intestinal secretion
Regulation of secretion
Neural
Hormonal
GASTROINTESTINAL HORMONES
Gastrin
Regulation of gastrin secretion
Inhibition of gastrin secretion
CCK-pancreozymin
Regulation of CCK secretion
Secretin
Regulation of secretin
GIP (gastric inhibitory peptide)
Regulation of GIP
VIP (vasoactive intestinal polypeptide)
Enterogastrones
Other GI hormones
Motilin
Neurotensin
Substance P
GRP (Gastrin releasing peptide)
Somatostatin
Glucagon
Enkephalins
Peptide YY
Ghrelin
LIVER FUNCTIONS
Functional anatomy
Metabolic functions
Synthetic
Excretory
Storage
Detoxification
Destruction of blood cells
Formation of blood cells
Jaundice
Hemolytic (prehepatic)
Hepatic
Obstructive (posthepatic)
Liver function tests
BSP excretion test
van den Bergh's reaction
Estimation of transaminases and isocitrate dehydrogenase
Prothrombin time
Estimation of serum bilirubin
Galactose tolerance test
GI MOTILITY
Deglutition
Oral stage
Pharyngeal stage
Esophageal stage
Disorders of swallowing
Achalasia
Gastric motility
Movements of stomach
Receptive relaxation
Mixing of food (digestive peristalsis)
Gastric emptying
Gastroduodenal pressure cycle
Factors influencing emptying
Duodenal factors influencing gastric emptying
Enterogastric reflex
Vomiting
Small intestine motility
Segmental peristalsis
MMC (migrating motor complex)
Gastroileal reflex
Large intestine
Motility of large intestine
Haustral contractions
Mass peristalsis
Defecation
DIGESTION AND ABSORPTION OF FOOD
Carbohydrates
Digestion of starch
Digestion of Sucrose and Lactose
Absorption of glucose and galactose
Galactose
Fructose absorption
Digestion and absorption of proteins
Absorption of amino acids
Digestion and absorption of fat
Digestion of lipids
Absorption of digested fat
Absorption of water and electrolytes
NaCl absorption
Chloride secretion
Cl− and HCO3− absorption
Absorption of vitamins
Absorption of Ca++
Absorption of iron
ENERGY BALANCE
Basal metabolic rate
Measurement of basal metabolic rate
Physiological variations of BMR
Multiple Choice Questions
ANSWER KEYS
12:
Endocrine System
GENERAL CONSIDERATIONS
Chemical nature of hormones
Synthesis and secretion of protein hormones
Half life of protein hormones
Synthesis and secretion of amines
Steroid synthesis and secretion
Mechanism of action of hormones
Hormones acting on the membrane receptors
Receptor diseases
Second messengers (Table 12.4)
Adenylyl cyclase system
Phosphatidyl inositol system (IP3)
Calcium-calmodulin system
Tyrosine kinase system
Transcription and translation effects
Circadian rhythm
Regulation of secretion
Measurement of hormones
Radioimmuno assay
Pituitary gland
ANTERIOR PITUITARY (ADENOHYPOPHYSIS)
Control of anterior pituitary secretion
Regulation of anterior pituitary gland secretion by feedback mechanisms
Hormones of anterior pituitary
Adrenocorticotrophic hormone (ACTH)
Actions
Regulation of secretion
Thyroid stimulating hormone (TSH)
Gonadotrophins
Prolactin
Growth hormone (somatotrophin)
Actions of growth hormone
Metab olic effects
Protein anabolic effect
Lipolytic effect
Hyperglycemic effect
Growth effects
Bone growth
Visceral growth
Regulation of growth hormone secretion
Disorders of growth hormone secretion
Dwarfism
Gigantism
Acromegaly
Hypopituitarism
Physiology of growth
Role of other hormones
Thyroxine
Insulin
Cortisol
Sex steroids
Growth factors
IGF (insulin-like growth factor)
PDGF (platelet derived growth factor)
FGF (fibroblast growth factor)
EGF (epidermal growth factor)
NGF (nerve growth factor)
TGF (tumor growth factor)
Inhibins and activins
POSTERIOR PITUITARY (NEUROHYPOPHYSIS)
Synthesis
Vasopressin (antidiuretic hormone)
Actions
Reduces free water clearance in kidney
Contraction of mesangial cells
Inhibits renin secretion
Arteriole constriction
Secretion of ACTH
Regulation of vasopressin secretion
Regulation by blood volume
Other factors
Disorders of ADH secretion
Diabetes insipidus
Oxytocin
Actions
Contraction of uterine myometrium
Milk ejection
Regulation of oxytocin secretion
THYROID GLAND
Thyroid hormones
Synthesis (Fig. 12.6)
Iodide trapping
Thyroglobulin
Oxidation of iodide
Organification
Coupling
Secretion
Plasma levels of T3 and T4
Extra thyroidal pool
Metabolism
Agents inhibiting synthesis of thyroid hormones
Wolf-Chaikoff effect
Inhibition of iodide transport
Goitrogens
Regulation of thyroid gland function
Thyroid hormone receptors
Actions of thyroid hormones
Metabolic effects
Calorigenic action
Growth and development
Carbohydrate metabolism
Fat metabolism
Neurological effects
On sympathetic nervous system
On CVS
Skeletal muscle
Other actions
Disorders of thyroid gland secretion
Hypothyroidism
Cretinism
Symptoms
Hypothyroidism in adults
Myxedema
Hyperthyroidism
Thyrotoxicosis
Other symptoms of Grave's disease
Thyroiditis
Hashimoto's thyroiditis
Goitre
ADRENAL GLAND
Histology of the gland
Synthesis of corticosteroids
Hormones of adrenal cortex
Transport in blood
Metabolism
Diurnal variation of cortisol secretion
Mechanism of action of ACTH
Mechanism of action of cortisol
Regulation of cortisol secretion
Physiological effects of cortisol
Metabolic actions
Carbohydrate sparing effect
Lipolytic effect
Protein catabolic effect
Antigrowth effects
On bone
On muscle
Stimulation of gastric secretion
Facilitates renal free water clearance
Stimulates erythropoiesis
Increases neutrophils in the circulation
Permissive effect on blood vessels
Stress adaptation
Increases excitability of neurons
PHARMACOLOGICAL ACTIONS
Anti-allergic effects
Anti-inflammatory effect
Immunosuppressant effect
Involution of lymphoid tissue
Adrenal androgen
Actions of adrenal androgen
Congenital adrenal hyperplasia
Aldosterone
Actions of angiotensin II
Factors causing release of aldosterone
Actions of aldosterone
Na+ reabsorption
Regulation of body fluid volume
Aldosterone escape
Aldosterone in acid base balance
Aldosteronism
Secondary hyperaldosteronism
Uses of aldosterone antagonist
Disorders of adrenocortical secretion
Addison's disease
Cushing's syndrome
Adrenal medulla
Synthesis and secretion of catecholamines
Metabolism of catecholamines
Physiological effects
On CVS
Metabolic actions
Regulation of secretion
Selective secretion
Disorder of adrenal medullary secretion
Pheochromocytoma
HORMONAL REGULATION OF CALCIUM AND PHOSPHORUS METABOLISM
Role of calcium
Calcium metabolism
Phosphorus metabolism
Importance of phosphorus
Physiology of bone
Osteoblasts
Bone mineral salt
Osteoclasts
Parathyroid hormone (PTH)
Actions of PTH
Resorpti on of calcium from bone
Increased reabsorption of Ca++ from distal tubules of kidney
Absorption of calcium from the intestine
Regulation of PTH secretion
Calcitonin
Actions of calcitonin
On kidney
Calcitriol
Actions
Intestine
Bone
Kidney
Other hormones acting on bone
Estrogen
Glucocorticoids
Thyroxine
Disorders of Ca++ and PO4 balance
Hyperparathyroidism
Pseudohypoparathyroidism
Hypoparathyroidism (Tetany)
ENDOCRINE FUNCTION OF PANCREAS
Insulin
Synthesis and secretion
Regulation of secretion
Carbohydrate
GI hormones
Amino acids
Islet hormones
Autonomic nerves stimulation
Free fatty acids
cAMP
Ions
Pattern of insulin secretion in response to rise in plasma glucose
Metabolism of insulin
Mechanism of action of insulin
Actions of insulin
Transport of glucose into the cell
On carbohydrate metabolism
Fat metabolism
Protein metabolism
Electrolyte metabolism
Action on ion permeability
Diabetes mellitus
Preparations of insulin
Oral hypoglycemic agents
Glucagon
Actions
Carbohydrate metabolism
Fat metabolism
Protein metabolism
Mechanism of action
Regulation of glucagon secretion
Somatostatin
Actions
Pancreatic polypeptide
REPRODUCTIVE SYSTEM
DEVELOPMENT OF GONADS AND GENITALIA
Gonadal sex
Genitalia development
Sex chromatin (Barr body)
Abnormalities of sex development
Genetic disorders
True hermaphroditism
Pseudohermaphroditism
Puberty
Precocious puberty
TESTIS
Epididymis
Sertoli cells
Spermatogenesis
Endocrine function of testis
DHT
Biosynthesis of testosterone
Transport of androgens
Metabolism
Mechanism of action of testosterone
Actions of testosterone
Development of genitalia
Puberty changes
Spermatogenesis
Anabolic effect
Action on skeleton
Effect on sebaceous glands
Effect on scalp hair
Stimulation of erythropoiesis
Male behavior and libido
Actions mediated by DHT
Endocrine regulation of testis
Semen
Seminal vesicle secretion
Prostatic secretion
Sperms
FEMALE REPRODUCTIVE SYSTEM
Ovary
Oogenesis
Follicular development (Fig. 12.32)
Ovarian steroids
Estrogens (Figs 12.33A and B)
Synthesis
Actions of estrogen
On ovary
Effect on uterine myometrium
Uterus size
On endometrium
Action on cervix
On vagina
Mammary gland
On bone
Other actions of estrogen
Progesterone
Actions
On uterine myometrium
On endometrium
On cervix
Thermogenic effect
On mammary gland
Other actions of progesterone
Other hormones from ovary
Regulation of ovarian endocrine function
Menstrual cycle
Phases of menstrual cycle
Preovulatory phase
Changes in ovary
Changes in uterine endometrium
Hormonal changes
Ovulation
Basal body temperature test
Spinnbarkeit effect of cervical mucus
Fern test
Estimation of urinary pregnanediol
Postovulatory phase
Changes in ovary
Changes in endometrium
Endocrine changes
Menstrual phase
Fertilization
Implantation
PLACENTA
Functions of placenta
Hormones of placenta
HCG
HPL (human placental lactogen)
Progesterone
Estrogen
Actions of estrogen during pregnancy
Relaxin
PHYSIOLOGICAL CHANGES DURING PREGNANCY
Endocrine glands
Renal system
Respiration
Blood
CVS
Digestive system
Morning sickness
PARTURITION
LACTATION
CONTRACEPTION
Mechanism of action of oral contraceptives
IUCD
Rhythm method
Norplant
Methods in male
Condoms
Coitus interruptus
Vasectomy
ANSWER KEYS
INDEX
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