Anatomy & Physiology I &II
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Exam 3 March 31, 2015 Circulation Function serves as a highway for blood vessels to travel around the body Anatomy (A) ● systemic circui(leaving hea : aorta→ large arteries→ medium arteries→ arterioles→ capillary bed ○ highest pressure is leaving the heart (in this case it is the aorta) ■ as distance from L heart increases, pressure decreases (indirect relationship) ● systemic circui(returning to heart): capillary bed→ venules→ small veins→ medium veins→ Large veins→ SVC/IVC ○ lowest pressure is in the right atrium ● Layers of the arteries (elastance vessels) ○ Tunica adventiti outermost layer (connective tissue) ○ Tunica media middle muscle layer ■ thicker in arteries than veins ○ Tunica intima innermost layer ■ “endothelium” ■ in contact with the blood ● Capillariessmallest blood vessels in the body (7 µm in diameter) → size of one RBC ○ most numerous blood vessels in the body ○ composed of only tunica intima (epithelium) ○ precapillary sphincters direct blood in the body based on need ■ places thneed more blood experiencvasodilatioto increase perfusion of blood to a capillary bed ● working muscles, stomach when it is digesting food ■ places that do not need as much blood experience vasoconstriction which redirects blood to other areas of the body ● shut down of digestion due to fight or flight ● Veins (capacitance vessels = high capacity) ○ Tunica adventiti outermost layer of connective tissue ○ Tunica media middle muscle layer ■ thinner than arteries ○ Tunica intimainnermost layer in contact with blood ■ “endothelium” ■ only SOME veins have valves, not all Anatomy (B) ● Deoxygenated blood trace from Right knee to Left face ○ ● Deoxygenated blood from R brain ○ ● Deoxygenated blood from D thoracic aorta to the stomach to the R thumb ○ Anatomy (C) special circulations ● hepatic portal system ● Fetal circulation ○ ductus venosu within the liver connects umbilical vein and the IVC ○ ductus arterios connects left pulmonary artery to the arch of thbypassses the pulmonary circulation ○ foramen ovaleopening between the RA and VA gets blood from left atrium and sends it to the ductus arteriosus Physiology ● BP=CO x TPR… Blood Pressure=cardiac output x total peripheral resistance ● Assessing BP ○ normal blood flow is calllaminarwhile turbulentblood flow is a rough disruption of laminar blood flow. ○ Palpatory method This is how it works: take your index and middle finger and feel on the patient’s wrist (near the thumb so you can palpate the radial artery) for their pulse. Keep your fingers there as you inflate the cuff until their pulse stops. Then you slowly deflate the cuff until you begin to feel a pulse again. This wionly a systolic measure. ○ Auscultatory metho Place the cuff on the patient’s bicep, stethoscope on the upside of the elbow (where it bends) and inflate the cuff until their pulse ceases. Slowly deflate the cuff and listen for the first heart sound (phase I of the cardiac cycle) you hear. This is your systolic BP. Continue listening until the heart sounds cease (phase V). This is your diastolic BP. ○ Hypertension(High BP) has a systolic value of 140> and/or a diastolic value of 90>... Normotensive (normal BP) has a systolic value of <120 and a diastolic value of <80 ■ Prehypertension: 120139/8089 ■ Stage 1 hypertensio: 140159/9099 ■ stage 2 hypertensio 160>/100> ○ BP equipment ■ sphygmomanometer measure pressure ● Mercury Sphyg. Aneroid Sphyg. Electronic Sphyg. most accurate ● bladder is what fills with air ● valve ● gauge what you get your readings off of ■ stethoscope ● ear pieces ● hold the bell and listen with the diaphragm ○ Korotkoff sounds ■ phase I loud thuds systolic ■ phase II blowing sounds ■ phase III lesser thuds ■ phase IV thumping, muting → diastolic in children and pregnant women ■ phase V nothing → diastolic ● Blood pressure regulation ○ short term regulation ■ baroreceptors are located in the carotid sinuses and aortic arch. The baroreceptor reflex changes the peripheral resistance (TPR), heart rate, and stroke volume in response to changes in BP. ● increase stretch(higher BP) decreases heart rate, ■ chemoreceptors are sensitive to oxygen, CO2, and pH levels of the blood ● CO2 is direct relationship, pH is indirect, O2 is indirect ■ Epinephrine and norepinephrine increased HR, SV and vasoconstriction ○ Long term regulation ■ reninangiotensin syst renin is released by the kidneys (reresponse to low BP. Renin promotes production of angiotensin II wcauses vasoconstrictio and an increase in aldosterone secretion ■ vasopressin (ADH) ADH is released from the posterior pituitary in response to a substantial decrease in BP which causes vasoconstriction ■ Atrial natriuretic factor (ANF/ANH/AN ANH is released from the cardiac muscle cells wheatrial BP increase and/or a stretch is sensed in the wall of the right atrium. This hormone stimulates an increase urine production, causing a decrease in blood volume and BP ■ fluidshift mechanis movement of fluid from the interstitial spaces into the capillaries response to a decreasin blood pressure in maintain blood volume. ■ stressrelaxation respo an adjustment of smooth muscles of the blood vessels inresponse to a change in blood volume Pathophysiology ● atherosclerosisdeposition of plaques of fatty material on the tunica intima ● hypertensionP of 140>/90> ● circulatory shoc commonly known as shock, is a lifethreatening medical condition of low blood perfusion to tissues resulting in cellular injury and inadequate tissue function ● Deep Vein thrombosis (DVT) blood clots develop in a deep set vein (usually in the legs) Lymphatic system Function ● fluid balance in tissues, absorbs fats from the small intestine, and defends against microorganisms and foreign substances Anatomy ● Lymphatic vessels have valves that ensure oneway flow of lymph. ○ Lymphatic capillaries join to form vessels. ○ lymph nodes are along the vessels. ○ After passing through lymph nodes, vessels turn into lymphatic trunks and lymphatic ducts. ■ trunks and ducts empty into the blood at thoracic veins (junctions of the internal jugular and subclavian veins). ■ lymph from the lower limbs, pelvis, and abdomen; the left thorax; the upper left limb, and the left side of the head and the neck enters left thoracic veins. ■ Thoracic duct is the largest lymphatic vessel ● Lymphatic Tissue reticular connective tissue that contains lymphocytes and other cells ○ can be surrounded by a capsule (lymph nodes, spleen, and thymus), or lymph tissue can be non capsulated (diffuse lymphatic tissue, lymphatic nodules, tonsils). ○ Mucosa associated lymphoid tiss nonencapsulated lymphatic tissue located in and below the mucous membranes of the digestive, respiratory, urinary, and reproductive tracts. ○ Diffuse lymphatic tissuconsists of dispersed lymphocytes and has no clear boundaries ○ Lymphatic nodules small aggregates of lymphatic tissue ■ Peyer’s patche nodules of lymphatic cells that aggregate to form bundles or patches and occur usually only in the lowest portion (ileumsmall he intesti.Their full function is not known, but they do play a role in immunologic response and contain B and T cells similar to those found in peripheralymph nodes. ○ Tonsilslarge groups of lymphatic nodules in the oral cavity and nasopharynx ■ Three groups: palatine tonsils, pharyngeal tonsils, and lingual tonsils ○ Lymph nodes Lymphatic tissue in the node is organized into the cortex and medulla. Lymphatic sinuses extend through the lymphatic tissue. ■ substances in the lymph are removed by phagocytosis, or stimulate lymphocytes (or oth) ■ Lymphocytes leave the lymph node and circulate to other tissues ○ The spleenin the LUQ of the abdomen ■ foreign substances stimulate lymphocytes in the white pulp (periarterial lymphatic sheath and lymphatic nodules). ■ foreign substances and defective red blood cells are removed from the blood by phagocytes in the red pulp (splenic cords and venous sinuses) ■ it s a limited reservoir for blood ■ most blood flows through the spleen in a few seconds. ○ The Thymus a gland in the superior mediastinum and is divided into a cortex and a medulla. ■ lymphocytes in the cortex are separated from the blood by reticular cells. ■ Lymphocytes produced in the cortex migrate through the medulla, enter the blood, and travel to other lymphatic tissues where they can proliferate. ● Lymphatic cells ○ Chemotactic factors are parts of microorganisms or chemicals that are released by damaged tissues ○ Chemotaxis is the ability of white blood cells to move to tissues that release chemotactic factors. ○ Diapedesis squeezing through blood vessel walls into an area of infected tissues ○ Neutrophilssmall phagocytic cells vs. Macrophages are large phagocytic cells ■ macrophages can engulf more than neutrophils. ■ macrophages in connective tissue protect the body at locations where microbes are likely to enter, and macrophages also clean blood lymph. ○ Basophils and mast cel release chemicals that promote inflammation ○ Eosinophilsrelease enzymes that reduce inflammation Physiology ● Immunity the ability to resist the harmful effects of microorganisms and other foreign substances. ● Innate Immunit present in an individual at birth ○ Mechanical Mechanisms prevent the entry of microbes/or remove them ■ Ex.: skin and mucous membranes/tears, saliva, and mucus). ○ Chemical Mediatorspromote phagocytosis and inflammation ■ Compliment can be activated by either the lectin, alternative, or classical pathways. Compliment lyses cells, increases phagocytosis, attracts immune system cells, and promotes inflammation. ■ Interferons prevent viral replication. They are produced by virally infected cells and move to other cells, which are then protected. ● Inflammatory response ○ can be initiated in many ways: ■ Chemical mediators cause vasodilation and increase vascular permeability, which allows the entry of other chemical mediators. ■ Chemical mediators attract phagocytes ■ the amount of chemical mediators and phagocytes increased until the cause of inflammation is destroyed.The tissue then undergoes repair. ○ Local inflammatio produces the symptoms of redness, heat, swelling, pain, and loss of function. ○ Symptoms of systemic inflammati include increase in neutrophils, fever, and shock. ● Adaptive immunity ○ antigenslarge molecules that stimulate an adaptive immune system response ○ Haptenssmall molecules that combine with large molecules to stimulate an adaptive immune system response ○ B cel responsible for humoral immunity (or antibodymediated immunity) ■ responsible for producing antibodies ■ originate in Bone marrow ■ B cell activation requires two distinct signals, and results in B cell differentiation into memory B cells or plasma cells. ● 1. signal occurs upon antigen binding to B cell receptors (BCRs). ● 2. occurs via either a thymusdependent or a thymusindependent mechanism. Most B cell responses to antigen require the interaction of B cells with T helper cells (thymusdependent activation). Presentation of an antigenclass II MHC complex on a B cell enables it to act as an antigenpresenting cell (APC) to T cells. T cell receptors (TCR) on T helper cells bind to the antigencomplexed class II MHC molecule on the B cell surface resulting in T cell activation. The activated T cell then provides a second activation signal to the B cell, which can occur through a variety of proteins. ○ Tcellsare involved with cellmediated immunity ■ central part of our immune system ■ originate from tTymus gland ■ T cell activation requires at least two signals to become fully activated. ● 1. Engagement of the T cell antigenspecific receptor (TCR) by the antigenmajor hitocompatibility complex (MHC), ● 2. subsequent engagement of costimulatory molecules. These signals are transmitted to the nucleus ○ MHC class I display antigens on the surface of nucleated cells which results in the destruction of the cells→ pairs with CD8 receptors ■ ○ MHC class II display antigens on the surface of antigenpresenting cells resulting in activation of immune cells→ pairs with CD4 receptors ■ ● Antibody mediated Immunity ○ The variable region of an antibody combines with the antigen. The constant region activates a complement or binds to the cells ○ 5 classes of antibodies: ■ IgG, IgM, IgA, IgE, IgD ○ antibodies affect the antigen in many ways: ■ antibodies that bind to the antigen interfere with antigen act or bind the antigen together ■ Antibodies act as opsonins (increase phagocyto by binding to the antigen and to macrophages ■ Antibodies canactivate complement through classical pathway ■ Antibodiesattach to mast cells or baso and cause threlease of inflammatory chemicalswhen the antibody combines with the antigen ○ The primary responseresults from the first exposure to an antigen, B cells form plasma cells which produce antibodies and memory cells ○ The secondary responseresults from exposure to an antigen after a primary response, and memory B cells quickly form plasma cells and additional memory cells ● Cell mediated immunity ○ antigen activates effector T cells and produces memory T cells which learn from their experience of fighting a particular infection and so can use the most effective strategy to manage the same infection later ● Acquired Immunity ○ Active natural Immuni results from natural exposure to an antigen ○ Active artificial immu results from deliberate exposure to an antigen (vaccines) ○ Passive natural Immunit results from the transfer of antibodies from a mother to her fetus or baby ○ Passive artificial Immun results from a transfer of antibodies (or cells) from an immune animal to a nonimmune animal Effects of Aging on the Lymphatic System & Immunity ● aging has little effect on the ability of the lymphatic system to remove fluid from tissues, absorb fats from the digestive tract, or remove defective RBCs from the body. ● Decreased T Helper cell proliferation results in decreased antibodymediated immunity and cellmediated immunity response to antigens ● The primary and secondary responses decrease ● ability to resist intracellular pathogen increase with age Pathophysiology ● Tonsillitiswelling and infection of the tonsils ● Appendicitisinflammation and infection of the vermiform appendix ● Elephantiasislymphatic obstruction resulting in chronic edema (excess of watery fluid collecting in the cavities or tissues of the body), which leads to fibrosis and elephantlike thickening of the skin Respiratory System ● Function transport and exchange of gases in the blood regulation of blood, pH, voice production, protection against microorganisms ○ closely linked to the cardiovascular system and the urinary system ● Anatomy ○ Nose Breadth ■ External Nares (nostrils) → Nasal septum (divides the nose) → nasal conchae (grooves covered in simple squamous epithelium to warm, moisten and filter → Paranasal sinuses → nasopharynx → oropharynx ○ Mouth Breadth ■ Oral sphincter (Lips) → Buccal cavity→ Hard palate→ soft palate→ oropharynx ○ Common passage way ■ oropharynx→ epiglottis→ laryngopharynx→ larynx (contains vocal cords) → trachea → Primary Bronchi→ Hilus→ Secondary bronchi→ tertiary bronchi→ bronchioles→ Terminal Bronchioles→Respiratory Bronchioles→ Alveolar ducts→ Alveolar Sacs→ Alveoli ● black is the conducting zonered shows the area where respiration occurs ■ External Nares (nostrils) → Nasal septum (divides the nose) → nasal conchae (grooves covered in simple squamous epithelium to warm, moisten and filter → Paranasal sinuses → nasopharynx → oropharynx ● ○ Histology ■ anterior vestibule (nose) contain hairs that trap debris ■ nasal cavity is lined with PCCE in order to trap debris and move it to the pharynx ■ PCCE (upper respiratory tract) ■ simple squamous epithelium ● Type I cells of alveoli ● olfactory epithelium ○ Cytology ■ Type 1 found on the walls of the alveoli ■ Type 2 is the surfactant fluid which decreases surface tension of the alveoli so there is less resistance ■ Type 3 is found in the macrophages ○ Spirometry ■ Vital capaci maximum amount of air exhaled after filling to maximum extent possible ● VC=TV+IRV+ERV or ERV=VCTVIRV ■ Tidal volum amount of air inhaled and exhaled during normal resting breathing ■ Expiratory reserve volume (E max amount of air expelled from lungs by forceful exhaling after the end of normal tidal volume ■ Inspiratory reserve volume (I amount of air inhaled in excess of normal inspiration during quiet breathing ● IRV=VC(TV+ERV) ■ Inspiratory capac max amount of air inhales from the normal endexpiratory level ● IC=VCERV ■ Total lung capaci max volume of air lungs can hold with distended to greatest possible extent ● TLC=VC+RV ■ Residual Volume the volume of air remaining in the lungs after a maximal expiratory effort. ● Physiology ○ Respiration Ventilation The exchange of gases between the air Movement of air into and out of the lungs and blood (external) and the blood and tissues (internal) ○ Boyle’s Law The pressure of a gas is inversely proportional to the volume of its container ■ Higher pressure in a smaller container ○ Dalton’s Law of partial Press in a mixture of gases, the total pressure equals the sum of the partial pressure exerted by each gas ■ adds up to 760 mmHg, O2 is 20.95%, N2 is 78.09%, CO2 is .03% ○ Henry’s Law The amount of gas which dissolves in a liquid is proportional to both the partial pressure and the solubility of the gas ○ O2 and CO2 diffusion gradients ■ Oxygen moves from the alveoli (PO2= 104 mmHg) into the blood (PO2=40 mmHg). PO2 in the blood decreases (PO2=95 mmHg) because of mixing with deoxygenated blood. Oxygen moves from the tissue capillaries (PO2=95 mmHg) into the tissues (PO2=40 mmHg). ● 10440 when alveoli to blood ● 9540 when mixed with deoxygenated blood ■ Carbon dioxide moves from the tissues (PCO2=45 mmHg) into the tissue capillaries (PCO2=40 mmHg). Carbon dioxide moves from the pulmonary (PCO2=45 mmHg) into the alveoli (PCO2=40 mmHg ● 4540 always ○ Gas Transport ■ Hemoglobin and oxygen transport ● oxygen is transported by hemoglobin (98.5%) and dissolves in the plasma (1.5%) ● Oxygenhemoglobin dissociation curve shows the hemoglobin almost completely saturated when PO2 is 80 mmHg or above. At lower partial pressures, hemoglobin releases oxygen. ○ Shift Righ due to a decrease in pH, an increase in CO2, or an increase in temperature which results in a decrease in the ability of hemoglobin to hold oxygen ○ Shift Leftdue to an increase in pH, a decrease in CO2, or a decrease in temperature which results in an increase in ability of hemoglobin to hold onto oxygen ○ Control of Ventilation ■ Medulla respiratory center consists of the dorsal respiratory group and the ventral respiratory group ● Dorsal respiratory group stimulates the diaphragm ● Ventral respiratory group stimulates the intercostal and abdominal muscles ■ Pontine respiratory group is involved with switching between inspiration and expiration ● when stimuli from receptors of other parts of the brain exceed a threshold level, inspiration begins. ● When a stimuli of expiratory neurons exceeds a certain threshold, inspiration is inhibited. ■ CARBON DIOXIDE IS THE MAJOR REGULATOR OF RESPIRATION!! ● increase in CO2 (decrease in pH) causes a greater rate and depth of respiration ○ when we exercise there is an increase in COs so thats why we breath heavier. ■ Oxygen levels in the blood affect respiration when a 50% or greater decrease from normal levels exists. ■ HeringBreuer Reflex stretch of the lungs during inspiration can inhibit the respiratory center and contribute to an end of inspiration. ■ touch, thermal, pain can modify ventilation ● Effects of Aging on the Respiratory System ○ Vital capacity and max minute ventilation decrease with age due to weakening respiratory muscles ○ Residual volume and dead space increases due to increased diameter of respiratory passageways→ alveolar ventilation decreases ○ Increase in resting TV compensates for decreased alveolar ventilation, loss of alveolar walls (surface area, and thickening of alveolar walls ○ The ability to remove mucus decreases Pathophysiology ● asthma often of allergic origin that is marked by continuous paroxysmal breathing and wheezing ○ either exercised induced, allergen exposures, or bad areas ● tuberculosisacute or chronically high virulence caused by the tubercle bacillus, found in any of the tissues of the body, but especially in the respiratory tract. Characterized by fever, night sweats, loss of weight from absorption of toxic products of tissue destruction by allergic manifestations that involve inflammatory infiltrations, formation of tubercles, cessation, and fibrosis ● lung canceruncontrolled cell division in the lungs ● cystic fibrosihereditary disease that appears in early childhood. Involves a generalized disorder of exocrine glands, and is marked by faulty digestion due to deficiency of pancreatic enzymes, by difficulty in breathing (due to blockage of airways by mucus) ● bronchitisacute or chronic swelling of the bronchial tubes ● emphysema distension, progressive loss of elasticity, and eventual rupture of the alveoli; accompanied by laboring breathing, husky cough, and frequently by impairment of heart action ● pneumothorax collapsed lung due to a lack of pressure gradient between the thoracic cavity and atmosphere ● obstructive vs. restrictive lung di lung disease cased by obstruction (most fall into this category) vs. a lung disease caused by reduced functioning lung tissue (scarring, gunshots) ● carbon monoxide poisoning Exam 4: Urinary, Digestive, Nutrition, Electrolyte Balance Urinary system Function ● filter and clean the blood to eliminate waste ● regulate blood volume, ion concentration, and pH ● regulate blood pressure ● stimulate production of RBCs ● synthesis of vitamin D Anatomy ● Urinary Trace: renal artery→ hilus→ segmental artery→ interlobar artery→ arcuate artery→ interlobular artery→ afferent arteriole→ glomerulus→ ○ efferent arteriole→ peritubular capillaries→ interlobular vein→ arcuate vein→ interlobar vein→ renal vein→ IVC ○ Bowman’s space→ proximal convoluted tubule→ descending loop of Henle→ ascending loop of henle→ Distal Convoluted tubule→ collecting duct→ papilla→ minor calyces→ major calyces→ renal pelvis→ ureters→ urinary bladder→ internal urethral sphincter→ urethra→ external urethral sphincter→ exit ● Proximal convoluted tubule wall contains glucose transporters ● ADH receptors are located in the collecting duct ○ secreted by the posterior pituitary gland and increases water permeability in the distal tubules and collecting ducts. ■ ADH increases urine volume, increases blood volume, and thus increases blood pressure ■ ADH release is stimulated by increased blood osmolality or decrease in blood pressure. ● juxtaglomerular apparatus consists of the macula densa (part of the distal tubule) and the juxtaglomerular cells of the afferent arteriole. ● Bladder histology ○ the walls of the ureter and the urinary bladder consist of transitional epithelium, a lamina propria, a muscular coat, and a fibrous adventitia. ■ transitional epithelium permits reversible changes in size. ● Bladder Trigone smooth triangular region of the internal urinary bladder formed by the two ureteral orifices and the internal urethral orifice. ● Kidneys Physiology ● Urine is produced by the process of filtration, reabsorption, and secretion. ● Urinalysis assessing the physical, chemical, or microscopic examination of the urine ○ normal constituents of urine: 95% water, 5% solutes such as urea and NaCl. yellow to amber. Average pH of 6.0 specific gravity of 1.000 (can range from 1.000 to 1.025). Glucose is not detected in normal urine. Should be no protein present. ○ abnormal constituents of urine: glucose, protein, blood, keytones, low/high pH, fruity smell ● autoregulation of Glomerular filtration rate (GFR) determines the amount of primary filtrate entering the nephron. ○ normal GFR is 125 mL/min ○ filtration membrane is fenestrated endothelium, basement membrane, and slitlike pores found by podocytes. ● urine movement ○ urine flow through the nephrons and ureters ● blood pressure regulation ○ Renin is produced by the kidneys in response to low blood pressure or decreased concentration of Na+. Renin combines with angiotensinogen (produced by the liver). Renin cleaves angiotensinogen into angiotensin I. Angiotensin I travels to the lungs where it comes into contact with an enzyme called ACE which cleaves AI into angiotensin II. AII causes production of aldosterone and also acts as a vasoconstrictor causing a decrease in urine production and an increase in blood volume. This increases blood pressure. ○ ANH is produced by the heart in reponse to a stretch due to high blood pressure. This inhibits ADH production and reduces the ability of the kidney to concentrate urine. ○ erythropoietin (EPO) stimulates RBC production. ● Effects of aging on the urinary system ○ gradual ↓ size of kidney ■ ↓ in renal blood flow ○ ↓ in number of functional nephrons ○ ↓ secretion of renin and synthesis of vitamin D ○ ↓ ability for the nephron to secrete and absorb Pathophysiology ● kidney stone (renal calculi) stones develop and cause painful obstructions in the urinary tract. Males are 4x more likely to get a kidney stone. ● nephrotic syndrome excretion of 3.5 g or more of protein in urine per day ● dialysisrocessing then purifying of the blood by machine ● kidney transpla surgical procedure to place a kidney from a live or deceased donor into a person whose kidneys no longer function properly. ● renal failu progressive and irreversible loss of renal function affecting all regulatory functions of the kidneys. 4 stages. ● urinary tract infect infection of the kidneys, ureters, bladder, or urethra ● uremia syndrome of renal failure including elevated blood urea and creatinine levels accompanied by fatigue, anorexia, nausea, vomiting, pruritus, and neurological changes. Water, Electrolytes, AcidBase Balance Water ● osmosis ● three fluid compartments ○ intracellular (inside cells) ■ difference between intracellular and extracellular concentration is water movement ○ extracellular (interstitial and plasma) (outside the cell) ■ increase in extracellular osmolality or a decrease in BP stimulates the sense of thirst. ■ Wetting the oral mucosa or stretch of the gastrointestinal tract inhibits thirst ■ Routes of water loss ● evaporation from the respiratory system or the skin (perspiration) ● vomiting or diarrhea ● kidney function diluted urine ■ ↑extracellular f= ↓aldosterone secreti↑ ANH secretion,↓ADH secretions↓ sympathetic stimulation of afferent arterioles. ■ ↓ extracellular f= ↑ aldosterone secreti↓ ANH secretion↑ ADH secretion ↑ sympathetic response ○ blood ● water balance = intake vs output Electrolytes (Na, K, Cl, K, Ca, Mg) ● Hypernatremiaserum Na+ concentration above 145 mEq/L ○ Causes: increased intake of sodium. this is rarely dietary, but more often fluid therapy (IV fluid). Excess sodium retention owing to the hypersecretion of aldosterone. Insufficient water intake or excessive water loss without a proportionate loss of sodium. Common in elderly hospital patients ○ Signs/Symptoms shrinkage of nerve cells which causes confusion, neuromuscular excitability, seizures, and coma. High urine specific gravity (>1.03), elevated hematocrit, elevated concentration of plasma protein. ○ Treatment gradually giving water or 5% dextrose in water orally, unless the patient is unconscious or unable to swallow, otherwise it is given intravenous. ● Hyponatremiaserum Na+ concentration below 135 mEq/L. ○ Causes: reduced renal excretion of water due to renal failure, congestive heart failure, and cirrhosis. Excessive Na+ loss through vomiting, diarrhea, sweating and burns which is replaced with just plain water. Drugs such as thiazide diuretics ○ Signs/Symptoms: Similar to Hypernatremia! Swelling of neurons which can cause lethargy, headache, confusion, stupor, neuromuscular excitability, seizures and coma. Weight gain, edema, ascites, distilled jugular veins. Low urine specific gravity (<1.020) ○ Treatmentchange in medications ● Hyperkalemiaserum K+ concentration above 5.0 mEq/L ○ Causes: excess potassium intake due to IV fluid or overuse of salt substitutes, inadequate K excretion due to renal failure or aldosterone hypersecretion, or maldistribution of K between the intracellular and extracellular fluids. Acidosis. Certain drugs ○ Signs/Symptoms: muscular weakness, neuromuscular excitability, cardiac arrest. ○ Treatment:dietary modification or a change in medications ● Hypokalemia serum K+ concentration of less than 3.5 mEq/L ○ Causes: inadequate intake, excessive loss, or maldistribution of K+ due to heavy sweating, vomiting, diarrhea, and laxative abuse. Insulin can have severe and fatal hypokalemia if insulin is taken without K+ supplements. ○ Signs/Symptoms: makes the cells less excitable so one will see muscle weakness, loss of muscle tone, depressed reflexes, and irregular heartbeat. Depressed ventilation or even respiratory arrest, constipation, nausea, vomiting, and intestinal bloating. ○ Treatment: eating potassiumrich foods such as bananas and vegetables. IV can even be given but it must be done slowly because potassium irritates the blood vessels. AcidBase Balance ● acidosis ○ respiratory ■ caused by emphysema because the diseased lungs cannot expel CO2 as fast as the body produces it ○ metabolic ■ cause by diabetes mellitus because incomplete fat oxidation produces ketone acids which build up in the blood. ○ compensated ■ compensated by the kidneys ○ uncompensated ■ kidneys do not respond and compensate ● Alkalosis ○ respiratory ■ caused by hyperventilation because the lungs expel CO2 faster than the body produces it. ○ metabolic ■ caused by chronic vomiting due to a decreased stomach acid in the body. ○ compensated ■ compensated by the respiratory system by adjusting breathing rate ○ uncompensated ■ respiratory does not compensate Digestive System Function ● ingestion eating ● mastication chewing ● deglutition swallowing ● propulsion movement of food along the digestive tract ○ peristalsiseries of wavelike muscle contractions that moves a bolus of food from the esophagus to the stomach. ● mixing ○ segmentationrhythmic mixing of chyme with digestive enzymes in the small intestine ● secretionrelease of water, acids, enzymes, buffers, and salts into the digestive tract ● digestionchemical breakdown of food into small organic fragments for absorption ○ mechanical physical digestion of the food ○ chemicalprocess in which enzymes and other chemicals are used to break foods into their smaller chemical building blocks ● absorptionuptake of organic substrates, electrolytes, vitamins, water acro s epithelium ● elimination (defecation) excretion Anatomy ● Digestive tract is also called the alimentary canal ○ Buccal cavity (mouth) ■ hard palate, soft palate, frenulum, tongue, teeth, tonsils ○ oropharynx ○ esophagus ■ epiglottis, U/L esophageal sphincters ○ stomach (gastric region of digestive tract) ■ Histology: external serosa, muscle layer, submucosa, and simple columnar epithelium ■ cardiac region, fundus, body, pylorus ■ mixing waves churn the stomach contents with the secretions to form chyme. Peristaltic waves move the chyme into the duodenum. ○ pyloric sphincter ○ small intestine ■ peristalsis occurs here to move the materials towards the large intestine ■ Histology (moving inward): external serosa, muscle, submucosa, and simple columnar epithelium. Also contains villi and microvilli in order to increase surface area for absorption ● duodenum, jejunum, ileum ○ Ileocecal valve ○ Large intestine ■ cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum ● hepatic flexure, splenic flexure, haustra, veriform appendi ■ haustra the pouches of the large intestine ■ histology: simple columnar epithelium ■ defecation (elimination of feces) occurs here ○ anus ■ internal anal sphincter (smooth muscle), external anal sphincter (smooth muscle) ● accessory organs ○ tongue ○ Teeth ■ 20 as a child which are then replaced by 32. ● Incisors, canines, premolars, molars ○ used for mastication. Incisors cut food, canines hold and grasp the food, and the premolars and molars are for crushing and grinding food. ○ Salivary glands ■ produce serous secretions and mucus secretions which contain enzymes that break down carbohydrates into monosaccharides. ● glands are the parotid (largest gland near the back of the mouth near the ear), submandibular (which is near the angle of the mandible), and sublingual (under the tongue). ○ Liver ■ synthesizes bile which contain bile salts that emulsifies fat. ■ the hepatic portal vein and the hepatic ducts connect to the liver. ○ Gallbladder ■ small sac on the inferior side of the liver that is used for bile storage and secretion for fat emulsification ● cholecystokinin stimulates gallbladder contraction ● cholelisthiasis is the formation of gallstones ● cholecystectomy is the surgical removal of the gallbladder ■ cystic duct connect to the common bile duct ○ Pancreas ■ retroperitoneal ■ has an endocrine and exocrine function. Exocrine function is to produce digestive enzymes such as amylase, lipase, trypsin. Endocrine function is to produce insulin for blood sugar regulation ■ Histology ● mucosaepithelium (simple columnar epithelium; stratified squamous epithelium) lamina propria (loose connective tissue) muscularis mucosae (smooth muscle) ● submucosa loose connective tissue, blood vessels, lymphatic vessels (lacteals), nerves glands (some places) ● Muscularistwo layers of smooth muscle (encircling and longitudinal); except three layers in the stomach ● serosa or adventi serosa is areolar tissue covered by simple squamous epithelium ○ located in peritoneal cavity ○ adventitia is fibrous connective tissue ■ located outside peritoneal cavity Physiology ● peristalsis ● segmentation ● regulation ● absorption of carbohydrates, proteins, and lipids Regulation ● neural ○ parasympathetic ○ sympathetic digestion is shut down during sympathetic reaction due to a decreased need for digestion during a fight or flight situation. ○ enteric ● hormonal ○ ghrelin “hunger hormone” ○ NPY “hunger hormone” ○ leptin signals satiety ● chemical ○ refer to nutrition slides Nutrients ● carbohydrates ○ broken down into monosaccharides in the mouth, stomach, and small intestine by amylase, maltase, lactase and sucrase ● proteins ○ broken down into smaller polypeptide chains and amino acids in the stomach and small intestine by pepsin, trypsin and peptidases ● lipids ○ broken down into fatty acids and glycerol by lipase in the stomach and small intestines. ● water mostly absorbed by the small intestine. ● vitamins ● ions Na, K, Ca, Cl, Mg, and P are actively transported. Aging ● mucus layer, connective tissue, muscles, secretions all tend to decrease with age which makes an older person more susceptible to infection and toxic agents. Pathophysiology ● stomach ulcr unprotected and painful erosion of the stomach lining frequently caused by the bacteriHelicobacter pylori ● ulcerative col nonspecific inflammatory disease of the colon with an unknown cause. Characterized by diarrhea with discharge of mucus or blood, cramping abdominal pain. ● heartburn(acid reflux) burning discomfort behind the sternum usually related to a spasm of the cardiac sphincter where it meets the entrance to the cardiac region of the stomach. ● diarrheawatery stool ● emesisvomiting ● eructationburping ● flatulencereally?? Farting, flatulence is farting… but girls don’t do that so this is irrelevant to memorize Nutrition Function ● transfer of energy and nutrients from one living thing to another (the human body) Nutrients ● Carbohydrates (CH₂O) ingested as monosaccharides (glucose, fructose, and galactose), disaccharides (maltose, lactose, sucrose), or polysaccharides (starch, glycogen, and cellulose). ○ all are eventually converted to the usable form called glucose. ○ 12515g of carbohydrates should be ingested each day, ○ there are 4 kcal/g in a carbohydrate ○ 60% of caloric needs ○ Complex carbohydrates are ■ 100% whole grain ● Proteins ingested and broken down into amino acids. ○ used to make antibodies, enzymes, hormones, collagen, actin and myosin, hemoglobin. ■ recommended intake is .83g per kg of body weight ■ lean meats, soy, nuts, seeds ● too much puts a lot of stress from the kidneys, and excess is converted into fat ● Lipids ingested as triglycerides (95%) or cholesterol and phospholipids (5%) ○ Triglycerides are used for stored energy as adipose tissue and for insulation. Cholesterol forms steroid hormones, and is part of the plasma membrane along with phospholipids. ○ should not have more than 30%of your diet, and no more than 300mg in the form of cholesterol (<10% saturated, 20%+ unsaturated, <300 mg/day cholesterol) ○ unsaturated is liquid at room temperature ■ olive oil and canola oil are high quality unsaturated lipids ■ nuts and seeds, soybeans, olives, peanuts, and avocados, and these contain the needed or essential fatty acids ● Water for all metabolic functions ○ need 2.5 L/day from drinking, food, metabolic production ● Vitamins (coenzymes) ○ most need to be obtained by diet, some can be synthesized. ○ either fatsoluble (Vitamins A, D, E, K) or water soluble (all others) ● Ions ○ sodium, potassium, calcium, magnesium, phosphate, chloride Fiber type of carbohydrate that the body can't digest. ● helps regulate the body's use of sugars, helping to keep hunger and blood sugar in check. ● Two types:Soluble and insoluble ○ Soluble fiber dissolves in water, and can help lower glucose levels as well as help lower blood cholesterol. ■ Found in oatmeal, nuts, beans, lentils, apples, and blueberries ○ Insoluble fiber does not dissolve in water, and can help move food better through your digestive system, which promotes regularity and helps to prevent constipation. ■ Found in wheat, whole wheat bread, whole grain couscous, brown rice, legumes, carrots, cucumbers and tomatoes Glycemic indexhow foods affect blood sugar and insulin ● The lower a food’s glycemic index or glycemic load, the less it affects blood sugar and insulin levels Physiology ● glycolysisbreakdown of glucose into 2 pyruvic acid molecules, 2 NADH molecules, and 2 ATP molecules. (anaerobic in the cytosol) ● glycogenesissynthesizing glycogen by making polymers of glucose ● gluconeogenesisformation of glucose from fats or proteins. ● lipogenesisformation of lipids from glucose and amino acids ● mechanism of how oats lower cholesterol ○ First, fiber carries bile made by the liver out of the body, and the bile contains cholesterol. The liver must then work in order to replace lost bile, thus resulting in less bile available to release into the blood. Second, fiber inhibits LDL (bad cholesterol) from binding to blood vessel walls. ● metabolic state ○ absorptive sta nutrients are used as energy, or are stored ○ postabsorptiv stored nutrients are used for energy ● Metabolic rate ○ total energy expenditure in a day ■ basal metabolic rate (BMR) energy used at rest. ● 60% of metabolic rate ■ muscular activity energy used for muscle contraction ● 30% of metabolic rate ■ thermic effect of food energy used to digest and absorb food ● 10% of metabolic rate ● Temperature regulation ○ radiation heat from sun ○ conduction physical touch (hand melting an ice cube) ○ convection air or water circulating around ○ evaporation sweating/ evaporative cooling ■ greater difference between temperatures, the greater amount of heat we gain/lose Pathophysiology ● nutrient deficiencies ● disordered eating ○ anorexia nervosapathological fear of gaining calories. Thought a lot to do with the media, and women trying to fit the thin standard. Eventually becomes uncontrollable. Dramatic weight loss, bone protrusion, osteoporosis, stops period, nutrient depletion. ○ bulimiaThrowing up large amounts of food after you eat to avoid weight gain. Usually have a normal weight appearance, but dental damage is severe due to the stomach acid. Dentists usually catch this eating disorder. Alkalosis occurs too. ○ binge eatin eating huge amounts of food in short amount of time, without purging. Usually are obese.
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