BIOM2015 final

The 4 types of Glu receptor types

"Iontropic" (allow passage of ions, i.e. Na+, Ca2+). Can be told apart by drugs. 1. NMDA 2. AMPA 3. Kinate 4. mGluR The different receptors have a lot of diversity, and each is made of different subunits. Mixing these in different ways will create slightly different properties, i.e. slightly better/worse attraction to Glu, response, or allowing ions ot flow through.

Arteries as a pressure reservoir

"The combination of stiffness and flexibility enables arteries to perform one of their major functions - acting as pressure reservoirs (storage sites for pressure) to ensure a continual, smooth flow of blood through the vasculature even when the heart is not pumping blood (diastole)."

CKD facts

"silent killer" up to 90% loss of function possible before symptoms appear (blood in urine, nasuea, vomiting, fatigue, restless legs, dysponea). Common and growing health problem (1 in 3 at risk) 21% increase in deaths since 2001 Very expensive for the healthcare system.

Benzodiazepines and GABA-A

(A) empty receptor is inactive, and the coupled Cl- channel is closed. (B) Binding of GABA causes the channel to open, hyperpolarising the cell. (C) Binding of GABA is enhanced bt benzodiazepine, resulting in a greater entry of Cl-. Hyperpolarises even more.

Law of LaPlace

(Alveoli) the magnitutde of inward directed collapsing pressure is proportional to the surface tension, and inversly proportional to the radius. (P=2T/r)

ECG waves

(Lead II) P: atrial contraction/depolarization QRS: ventricular contraction/depolarization (atrial repolarization hidden) T: ventricular repolarization (simultaneously with vestricular depol.) PR interval: AV nodal delay. ST segment: ventricles are contracting and emptying. TP segment: Ventricles are filling and relaxing.

Natriuretic peptides (NPs)

(NP; which inhibit Na+ reabsorption to decrease blood volume/blood pressure). These stimulate sodium and water excretion to lower BP and blood volume. Produced by the cardiomyocytes in the atria (ANP) or ventricles (brain NP - BNP). NP release is triggered by stretch of the heart chamber (increased blood volume and pressure). Overall, causes and is corrected by) reduced arterial pressure and increases water and sodium excretion in urine.

Liver structure and function

(anterior view mostly). Main functions of liver and gallbladder: metabolic regulation, blood circulation & filtration, bile production. Functional organisation - portal triad: hepatic artery, hepatic vein, and bile duct. Bile = water and ions (dilution and buffer for acids in chyme), bilirubin (from Hb), cholesterol, bile salts.

macula densa cells

(chemoreceptors) - part of ascending limb of loop of Henle that detects changes in NaCl content of filtrate.

renal corpuscle hydrostatic pressure

(pushing force): Glomerular capillary BP: Pressure if blood inside the glomerular capillaries. Efferent arteriole has a smaller radius than afferent arteriole = high pressure. 50 mmHg. Favours filtration. Bowman's capsule hydrostatic pressure: Pressure of fluid inside Bowman's capsule. Opposes filtration.

Apoptosis vs necrosis

- Necrosis causes cells to swell and burst, whereas apoptotic cells shrink and condense. - Necrosis has pro-inflammatory signaling, cytokine production, and caspase activation, while apoptosis has caspase activation and inhibition of mRNA translation. - Necrosis has mottled chromatin condensation, and apoptosis has chromatic condensation and DNA fragmentation. - Both have loss of membrane asymmetry; necrosis losses membrane permeability and apoptosis membrane remain impermeable.

Renal faliure remifications

- Ureimc toxicity - retention of waste products - Metabolic acidosis - inability of kidneys to adequately secrete H+ - Potassium retention - Sodium retention - phosphate and calcium imbalance - loss of plasma proteins - increased "leakiness" of glomerular membrane - inability to vary urine concentrations - hypertension - anemia -depression of the immune system

Drugs and synapses: antagonist

- blocks the synthesis / destroy vesicles by enzymes that degrade - block release by terminal buttons - activate autoreceptors and thus inibition of release - receptor blocker (postsynaptic)

Asthma emergency?

- fever >38 celcius - wheezing / coughing that doesn't get better with a reliever. - peak flow <80% - difficulty breathing that doesn't get better. - too weak / tired. Triggers can icnlude allargens, irritants viral resp. infections, exercise, and changes in weather.

Factors associated with high longevity

- high median income - college education or better - occupations in managment or professional settings - diet emphasizing fruit, veggies, fish, and green tea - lifestyle that included eastern healing techniques

Drugs and synapses: agonist

- increase synthesis of the neurotransmitter - destory degrading enzymes - increase release by terminal buttons - bind to autoreceptors to block inhibitory effects on neurotransmitters release - bind to postsynaptic receptors - block postsynaptic receptors

Insulin treatment limitations

- selecting the right dose and right timing can be tricky. - different GI index food have different affects on blood glucose. - Any variation outside normal range causes damage as treatments do not mimic accurate normal glucose control. - need of consistent blood glucose monitoring. - injections are the only viable option.

GH pathway

-Binds to GH-R in liver, stimulates release of somatomedins (IGF-I,II, insulin like growth factors) which promote growth in bones and soft tissue. -In the liver, increases protein synthesis and gluconeogenesis, and stimulates IGF production. -Binds to GH-R in muscle and adipose tissue, while decreasing fat deposits (increases muscle mass by stimulating aa's uptake, and decreases fat deposits in adipose tissue by decreasing glucose uptake and increasing lipolysis).

Hydrophilic hormones

-Cannot cross the membrane -Rely on membrane receptor activation -Membrane proteins produce second messengers

Forces promoting alveolar collapse

-elasticity of stretched elastin fibers in lung connective tissue -alveolar surface tension

proximal convuluted tubule (PCT)

-reabsorbs about 65% of glomerular filtrate (water, ions, all organic nutrients) -abundant mitochondria provide ATP for active transport - right after the renal corpuscle

Classic amyloid plaque hypothesis (AD)

1) Amyloid precursor protein (APP) is broken down by series of secretases. 2) During the process, an insoluble fragment of APP (= Aβ-42) accumulates and is deposited outside the cell. 3) The insoluble, "sticky," nature of the Aβ-42 helps other fragments gather into plaque. The different secretases can cut in different locations along the APP. Beta tends to cut first, but it's usually gamma-secretase that makes the error. The difference in the cut is two amino acids and these extra two are insoluble.

Division of PNS

1. Afferent (sensory): - Sensory stimulai - Visceral stimulai 2. Efferent (motor) - Somatic NS -> motor neurons -> skeletal muscle - ANS -> sympathetic NS / parasympathetic NS

IBD pharmacology

1. Anti-inflammatory drugs: aminosalicylates, corticosteroids 2. immunomodulators (suppressors) azathioprine, mercaptopurine cyclosporine 3. biological therapy (TNF-a inhibitors)

Importance of calcium

1. Bones and teeth structure 2. Resting membrane potential 3. Normal excitability maintenance of nerves and muscle cells 4. Involved in neurotransmitter and hormonal release 5. Muscle contraction (skeletal and cardiac) 6. Enzymes activation 7. Blood coagulation 8. Milk production

Lowe GIT digestion phases

1. Cephalic phase -preparing the stomach for food. Short (minutes), neural mechanism. 2. Gastric phase - stomach acts on food. Long (3-4 hrs) with a neural, hormonal and local mechanism. 3.Intestinal phase: maximise absorption (control rate of gastric emptying to maximise digestive & absorptive functions of small intestine).

Cephalic phase

1. Cephalic phase -preparing the stomach for food. Short (minutes), neural mechanism. -Stimulation of mucus, enzyme, and acid production -Increase volume of gastric juice - Emotional affect - anger increases gastric secretion, fear / anxiety reduced secretion and contraction

Long term memory classification

1. Declerative (expilict): things you know that you can tell others. a. episodic: breakfast this morning. b. semantic: the name of the PM. 2. Procedural (non-declarative, implicit): things you know that you can show by doing. a. skill learning, i.e. riding a bike. b. priming: like a word you heard recently. c. conditioning: salivating when you see a nice steak.

Oral cavity functions

1. Ingestion and sensory analysis of material before swallowing. 2. Mastication. 3. Lubrication by mixing mucus and salivary secretion. 4. Limited digestion of carbs and lipids (salivary amylase and lipase).

NMDA vs GABA-A

1. NMDA accept glutamate, GABA-A accept GABA. 2. NMDA allow flow of ions such as Na+, Ca2+ (excitatory), while GABA-A allows flow of Cl- (inhibatory). 3. Glycine is a positive allostic of NMDA only, so are polyamines. 4. Benzodiazepines are GABA-A agonists (even more inhibition). 5. NMDA is blocked by a magnesium ion.

Muscle spindle types

1. Nuclear bag - muscle length and velocity (dynamic) detection. 2. Nuclear chain - muscle length (tonic) detection.

Exceptions for the antagonistic nature of the sympathetic with parasympathetic activity:

1. Only arterioles and veins are innervated, and by sympathetic only. 2. Most sweat glands are inenrvated by sympathetic only, and the postganglionic fibres of these secrete ACh. 3. Salivary glands are innervated by both divisions but not antagonistically.

Sympathetic communication after the preganglionic fibre

1. Postganglionic fibre -> target (noradrenaline) 2. a sympathetic ganlgion -> circulatory system (noradernaline & adrenaline) -> target (noradernaline & adrenaline)

Division of ANS

1. Sympathetic: preganglion (ACh) -> nicotinic receptors (autonomic ganglion) -> postganglion (adrenaline / noradrenaline) -> effector cells alpha-1, alpha-2, beta-1, beta-2. 2. Parasympathetic: preganglion (ACh) -> nicotinic receptor (autonomic ganglion) -> postganglion (ACh) -> muscarinic receptor

hyperpolarisation of hair cells

1. Tip links slacken and close channels when seterocilia bend away from tallest member. 2. no K+ enters, hair cell hyperpolarasies. 3. Ca2+ channels close. 4. No neurtransmitter is released. 5. No AP occurs.

Depolarisation of hair cells

1. Tip links strech and open channels when seterocilia bend toward tallest member. 2. K+ enters, hair depolarises. 3. Depol. open voltage gated Ca2+ channels. 4. Ca2+ entry causes greater release of neurotransmitter. 5. More neurotransmitter leads to higher rate of AP.

Vasopressin action

1. blood borne ADH binds with receptors on the basolateral membrane of a principal cell in the distal / collecting tubule. 2. this binding activates the cAMP second-messenger system within the cell. 3. cAMP increases the opposite luminal membrane's permeability to H2O by promoting the insertion of AQP-2 water channels into the membrane, which is impermeable to water without ADH. 4. water enters the tubular cell from the tubular lumen through the inserted water channels. 5. water exits the cell through water channels (AQP-3, AQP-4) permanently positioned at the basolaeteral border, and then enters the blood, being reabsorbed.

Accessory organs digestion steps

1. chyme entres the duodenum. Lipids, cards -> CCK (Cholecystokinin) acid (H+) -> secretin 2. CCK & secretin into blood. 3. CCK -> pancreas digestive enzymes. Secretin -> pancreas HCO3- and mucus. 4. Secretin -> liver HCO3 into bile, 5. CCK -> gallbladder contracts and relaxation on sphinter allows bile to enter duodenum. 6. PRODUCT: secretion of digestive enzymes, buffer, and bile for chemical digestion

elderly and dehydration

1. decresed total body water (from 70% in newborn, 60% in childhood, to 50% due to less muscle mass). 2. altered sense of thirst 3. decrease in urine concentrating ability. 4. decrease in vasopressin effectiveness

Ear structure

1. external ear - pinna (alters sound and location), external auditory meatus, and tympanum. 2. Middle ear - transmits airborne sound waves to fluid filled inner ear; amplifies sound energy. 3. Inner ear - cochlea (contains receptors for conversion of sound into nerve impulses which makes hearing possible), and vestibular apparatus (necessary for sense of equilibrium).

Gastric contraction of the stomach

1. gastric emptying a downward movement of the peristaltic contraction and a relaxation of the pyloric sphincter. Peristaltic contrations the stomach, moving the chyme towards the duodenum. 2. gastric mixing is the back and forth motion due to the pyloric sphincter being closed, but peristaltic contractions still occur.

Glomerular filtration: membrane

1. glomerular capillary wall: has pores (fenestrations) and allows passage of most plasma components except large proteins and cells. 2.Basement membrane: gel-like zone, physical membrane barrier (can't fit through), and has an electrical barrier (negative charge repels proteins). 3.Podocyte filtration slits (food process): capillaries lined with podocytes (cells with long foot process), adjacent to podocyte interlace - spaces between process are called filtration slits.

How do we make urine?

1. glomerular filtration- when blood plasma is flitered. Nodiscriminant filtration of a protein free plasma from the glomerulus into Bowman's capsule. 2. tubular reabsorption- back into blood supply to maintain blood volume. selective movement of substances from the tubular lumen into peritubular capillaries. 3. tubular secretion- excretion. Selective movement of substances from the peritubular capillaries to tubular lumen. 80% of the plasma that enters the glomerulus is not filtered and leaves through the efferent arteriole.

Overall fucntion of the endocrine system

1. nutrient, water, and electrolyte metabolism 2. adopting to stress 3. promoting growth and development 4. RBC production regulation 5. Controlling reproduction 6. +ANS, circulation and digestion regulation and integration.

Asthma first aid

1. sit the person upright and give reassurance, don't leave them alone. 2. without delay give 4 separate puffs of a blue reliever (i.e. ventolin). Best given with a spacer, with 4 breaths between each puff. 3. Wait 4 minutes. If there's little to no improvement, repeat steps 2+3. 4.If there's still little to no improvement, call an ambulance and repeat steps 2+3 until it arrives.

Stomach fuctions

1. temporary storage of food. 2. Secretion (HCl, pepsinogen, intrinsic factors, gastric lipase) 3. Digestion, both mechanical (smooth muscle contraction) and chemical (proteins and fats). 4. Some absorption (water, ions, alcohol, aspirin 5. Mixing bolus and gastric juices into chyme.

Golgi tendon organ reflex

1. tension on tendon activates sensory neuron 2. sensory neuron stimulates interneuron 3. interneuron inhibits motoneuron 4. tension on tendon is reduced -determines if the muscle is too contracted --never monosynaptic beaucse it has to work through an inhibitory neuron

Forces keeping alveoli open

1. transmural pressure gradient; 2. pulmonary surfactant; 3. alveolar interdependence.

Swallowing reflex steps

1. when bolus of food reaches pharynx, swallowing reflex is triggered. 2. The larynx moves upwards and the epiglottis tips over the glottis to prevent food from entering the trachea. 3. The oesophageal sphincter relaxes and allows the bolus to enter the oesophagus. 4. After food entered oesophagus, larynx moves downwards to allow breathing again. 5. Waves of peristalsis in the oesophagus move the bolus down to the stomach.

Alcohol abuse: CVD (1)

1.alcohol alters the permeability of the SR. alcohol has a negative effect on the integrity and function of the actin-myosin complex and the mitochondria. 2.alcohol-induced arrhythmias maybe caused by in the threshold for ventricular fibrillation. Other mechanisms include electrolyte disturbances, a lack of oxygen to the heart muscle, and increase in basal plasma levels of the substances involved in transmitting impulses from nerves to muscles (i.e., catecholamines). 3. high blood concentrations of alcohol reduce the O2 supply to the cardiac muscle and interfere with O2 requiring metabolism in the heart.

sound wave transmission

1.tympanic membrane is struck by sound, vibrates 2. middle ear transfers vibrations 3. waves in fluid in cochlea set basilar membrane in motion In details: Tympanic membrane vibrates when struck by sound waves -> middle ear transfers vibrations through ossicles to oval window (entrance to cochlea) -> waves in cochlear fluid set basilar membrane (within the cochlea of the inner ear is a stiff structural element that separates two liquid-filled tubes that run along the coil of the cochlea, the scala media and the scala tympani) into motion -> receptive hair cells are bent as basilar membrane is deflected up and down -> mechanical deformation of specific hair cells is transduced into neural signals that are transmitted to auditory cortex in temporal lobe for sound perception.

Gastric phase

2.Gastric phase - stomach acts on food. Long (3-4 hrs) with a neural, hormonal and local mechanism. - Distention - stretch receptors and histamine. - pH change - chemoreceptors. -Proteins + ENS - gastrin. -Actions: chemical and mechanical digestion.

Intestinal phase

3. Intestinal phase: maximise absorption (control rate of gastric emptying to maximise digestive & absorptive functions of small intestine). - Long (hours) - Mechanism: neural & hormonal - distension in duodenum and cease gastric phase activities. - Chyme contents (lipids, cards, pH); decreased stomach secretions and contractions. Stimulates endocrine secretions (CCK, secretin). - Actions: reduce motility, stimulate accessory organs.

Alcohol abuse: CVD (2)

4. Increased sympathetic activity, plasma catecholamines, and decreased sensitivity of baroreceptors and ionised magnesium in plasma. 5. AFib and cardiomyopathy can predispose a person to either the formation of blood clots or the propagation of existing clots. 6. Antithrombotic effects of alcohol and alcohol-induced hypertension may predispose a drinker to a haemorrhagic stroke. 7. Acetaldehyde (a metabolite of alcohol) and free radicals may contribute to protein synthesis. Alcohol can increase the expression of a certain gene (i.e., c-myc), which can promote programmed cell death, resulting in muscle cell loss.

AD incidence

5-10% of people >65 years old will develop AD 50% of people >85 years old will be affected 100% of 100 year olds will be affected.

Major functions of GIT

6 steps, 4 key processes (with !) - ingestion - motility ! - digestion ! - secretion ! (small intestine, stomach, accassory organs). - absorption ! - elimination

Hrmonal control of Na+ reabsorption

8% of Na+ reabsorption is hormonally controlled via the: 1. RAAS system (aldosterone can go straight into the cell, and it promotes insertion of additional Na+ channels and pumps in the tubular cell membrane). 2. Natriuretic peptides (NP; which inhibit Na+ reabsorption to decrease blood volume/blood pressure).

contractile cells of the heart

99% of the heart's cells. Do the mechanical work of pumping. These working cells nirmally don't auto-initiate.

CysLTs

= cysteinyl leukotrines. Slow reaction smooth muscle stimulating substance.

tachycardia and bradycardia

>100 bpm <60 bpm

CKD risk

>60 years have DM family history high BP have CVD obesity smoker aboriginal and torres strait islanders (4 times more likely)

Glutamate (Glu) overview

A "common currency" in the CNS. It can be converted into almost 4 amino acids (GABA, glycine, aspartate, glutamate/glutamine), whatever is needed then. Glu within the CNS usually comes from either glucose or glutamine; there's almost nine entering the CNS after the first few years of life.

Prolactinoma

A benign tumor of the pituitary gland that causes it to produce too much prolactin. Can cause compression of the pituitary gland and optic chiasm. Treatment aims to reduce size of tumor and excess prolactin secretion. Dopamine agonists (synthetic) to inhibit prolactin production (bromocriptine) or inhibit both synthesis and release of prolactin (cabergoline). Non-responsibe cases may need surgery or radiotherapy. Hormone replacement therapy (HRT) may be necessary for other pituitary hormones.

podocytes

A cell with branching tentacle-shaped extensions that constitutes the barrier through which blood is filtered in the glomerulus of the kidney.

Asthma

A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing. During an episode, smooth muscle tightens (surrounding the airways), inner lining swells up, mucus production increases.

closed circulatory system

A circulatory system in which blood is confined to vessels and is kept separate from the interstitial fluid.

secondary hypertension

A definite cause can be established. Only about 10% overall. Hypertension that occurs secondary to another kown primary problem. Potential causes: kidney tumor, atherosclerosis of renal artery, pheochromocytoma.

COPD (chronic obstructive pulmonary disease)

A group of lung diseases that block airflow and make it difficult to breathe. 1. Chronic bronchitis. a log term inflammation of the lower respiratory airways. Prolonged edematous tickening of the lining and over production of thick mucus. 2. Asthma 3. Emphysema. Irreversible collapse of smaller airways and breakdown of alveolar walls. Protein digesting enzyme is excessively secreted and destroys lung tissue. COPD patients have early dynamic small airway closure, making expiration harder.

Glu receptor: kinate

A less understoof Glu receptor.

Adrenal medulla

A modified sympathetic ganglion that on stimulation by preganglionic fibre secretes hormones into the blood.

Pulmonary surfactant

A phospholipoprotein that lays between water molecules in the fluid lining of the alveoli, lowering the alveolar water tension. Prevent sall alveoli from collpsing into big alveoli (maintain stability). The greater the surface tension, the less complint the lungs are. Water molecules try to be close to one another, so the liquid tension shrinks. The surfactant reduces the exteent to which the hydrogen bonding between the water molecules. So- 1. increases pulmonary compliance; 2. reduces lung tendency to recoil (collapse).

Negative feedback

A primary mechanism of homeostasis, whereby a change in a physiological variable that is being monitored triggers a response that counteracts the initial fluctuation. Maintains a narrow level range.

Dehydration

A serious reduction in the body's water content. 1. water loss - insufficient fluid intake, increased plasma osmolarity 2. salt loss - deficiet in both water and salt. Diarrhoea, vomiting, blood loss, sweating. Will lead to increased thirst -> increase water intake, and increase vasopressin -> decrease water excretion.

vestibulo-ocular reflex (VOR)

A short-latency reflex that helps stabilize images on the retina during head movement; preserves image on the centre of visual field. Based on input from semicircular canal, muscle strech receptors in neck, urtricle (otolith organ in the inner ear). Does not depend on visual input,works in darkness. Clinical significance: test for brainstem fucntion in comatose patients - if brainstem is intact, the eyes will move conjugately away).

basilar membrane

A structure that runs the length of the cochlea in the inner ear and holds the auditory receptors, called hair cells. The fibres of the basilar membrane become progressively wider and more flexible from the base of the cochlea to the apex. As a result, each area of the basilar membrane vibrates preferentially to a sound frequency. High-frequency sound waves cause maximum vibration of the area of the basilar membrane nearest to the base of the cochlea; medium-frequency waves affect the centre of the membrane; and low-frequency waves preferentially stimulate the apex of the basilar membrane.

Alveolar surfance tension

A thin luquid film that ines each alveolus and is responsible for the transmuarl pressure gradient and the at rest lower-than-atm. intrapleural pressure.

Weber test procedure

A tuning fork is placed in the middle of the forehead, above the upper lip under the nose over the teeth, or on top of the head equidistant from the patient's ears on top of thin skin in contact with the bone. The patient is asked to report in which ear the sound is heard louder.

Eosinophil

A type of WBC, 1-3%, "acid loving." takes part in immunity reactions.

Mild-moderate AD brain

AD spreads through the brain. The cerebral cortex begins to shrink as more and more neurons stop working and die. Mild AD signs can include memory loss, confusion, trouble handling money, poor judgment, mood changes, and increased anxiety. Moderate AD signs can include increased memory loss and confusion, problems recognising people, difficulty with language and thoughts, restlessness, agitation, wandering, and repetitive statments.

Free radiacal

AKA reactive oxygen species (ROS). Oxidative stress: presistent imbalance in which oxidant>antioxidant. If neurons are unable to repair damage cause by ROS, apoptosis is induced. In addition, the unstable nature of ROS makes them capable of inflicting major cell damage by causing breaks and mutations in DNA, by inactivating proteins and enzymes, by oxydizing sugars, and by inducing lipid peroxidation among polysaturated FFAs of lipoproteins of the cell membrane.

Kidney transplant

AU: 846 since since 2010, 11%ages 15-64 on dialysis received a transplant. Avg waiting time: 4 years. Heart beating due to brain death is better due to kidneu perfusion, but non-heart beating donors should be considered from additional source despite delayed graft function.

Hyperlipidaemia

Abnormally elevated levels of any or all lipids (CH, triglycerides) and/or lipoproteins (5 types: LDL, HDL, Chylomicrons, VLDL, IDL) in the blood. Risk factors include familial history, secondary causes such as poor diet and diabetes, and drugs such as diuretics and estrogens. It's idiopathic.

major neurotransmitters of CNS

Acetylcholine (ACh) Biogenic amines: norepinephrine, dopamine, seratonin Amino acids: GABA, glycine, glutamate, aspartate

AChE

Acetylcholinesterase. ACh has such a short duration of action, as it is metabolised quickly. Inhibiting AChE will increase ACh in the synapse. BuChE is another form of AChE.

Cholinergic receptors

Ach receptors, nicotinic and muscarinic.

GABA-B receptors

Activation of the heterodimer (a macromolecular complex formed by two protein monomers, or single proteins, which are usually non-covalently bound) inhibits adenylyl cyclase activity via G-protein that, in addition, increases outwards K+ and reduced calcium ions conductance; both channel effects reduce postsynaptic excitability. These receptors can occur pre- or postsynaptic.

Expiration

After inspritpry muscles relax, diaphragm goes back to its dome shape and the ribcage goes down. It's passive. As the lungs recoil, the intra-alveolar pressure rises. Forced expiration - expiration can become active; it emptie out the lungs more, and faster, i.e. during exercie. Expiratory muscles contract to reduce the volume of the thoracic cavity and lungs. Abdominal wall muscles increase the intra- abdominal pressure, which further pushes the diaphragm upwards. The itnernal intercostals flatten the chest wall.

IBD risk factors

Age > 30 Family history smoking (altough can sometimes help UC) NSAIDs Geography - urban areas, industrialised, country, northern climate.

Hyperthyroidism pharmacology

Aims to initially supress excessive TH, followed by surgery (remove part) / radiotherapy (kill thyroid cells) to ablate the gland. Anti-thyroid drugs that inhibit iodination and block the production of TH within the gland (Carbimazole, Methamazole, Propylthiouracil (PTU)). PTU also decreases metabolism of T4 to T3 in periphery. Beta blockers to temporarily relieve symptoms.

CVD Pharmacology

Aims to treat the cause and precipitating factors, and to enhance ventricular function. oACE inhibitors (also for hypertension) oAngiotensin II antagonists (also for hypertension if ACE inhibitors weren't good) oLoop diuretics (also for hypertension) oSelected β-blockers (also for hypertension) oDrugs that increase cardiac contractility (inotropic agents, positive inotropic increases)

Airflow in the lungs

Air flows down its pressure gradient, so the intra-alveolar pressure must be less than atn. during inspiration, and higher during expiration. Boyle's law: at a constant temp. the pressure exerted by a gas in a closed container depends on the gas' volume. high V = low P. This is the intra-alveolar pressure brought by muscle activity.

Pneumothorax

Air in the pleural cavity caused by a puncture of the lung or chest wall. Traumatic pneumothorax occurs after some type of trauma or injury has happened to the chest or lung wall. The trauma can damage chest structures and cause air to leak into the pleural space. Non-spontaneous. There are two major types of spontaneous pneumothorax: primary and secondary. Primary spontaneous pneumothorax (PSP) occurs in people who have no known lung disease, often affecting young males who are tall and thin. Secondary spontaneous pneumothorax (SSP) tends to occur in older people with known lung problems, such as COPD patients.

Alcohol and memory

Alcohol blocks LTP in the hippocampus but does not affect LTP induced 1 hr prior to use.

Moderate alcohol consumption: reduced platelet function

Alcohol's antithrombotic effects appear to be related to platelet granule secretion and inhibition of thromboxane A2 production. Alcohol also may affect the structural integrity of activated platelets by interfering with granule fusion, which results in changes in platelet shape. Increased blood clotting time and reduced thrombotic complications of artherosclerosis

Nicotinic receptors

All ANS preganglionic neurons; ACh receptors; autonomic ganglions.

Adrenergic receptor types

Alpha 1 - Calcium second messenger; excitatory response; contraction of smooth muscle. Arterioles, most sympathetic target tissue. Alpha 2 - Blocks cAMP production, inhibatory response; relaxation of smooth muscle. Digestive system. Beta 1 - cAMP second messenger, excitatory response; heart (and some in the kidney, liver) Beta 2 - cAMP second messenger; inhibatory response, relaxation of smooth muscle. Bronchioles, arterioles.

Pelvic floor exercises

Also known as Kegel exercises. Improve the strength of pelvic floor muscles and consists of repetitive contractions of muscle groups. Find the right muscles, make sure the technique is correct, set a routine, and maintin it.

Types of dementia

Alzheimer's Disease Vascular Dementia Lewy Body Dementia Frontotemporal Dementia

Vital Capacity (VC)

Amount of air exhaled after a maximal inspiration. IRV + TV + ERV.

Inspiratory Reserve Volume (IRV)

Amount of air that can be forcefully inhaled after a normal tidal volume inhalation

Cardiac Output (CO)

Amount of blood pumped in 1 minute (~5 L). SV x HR Co throughout the body changes during exercise.

Intensity (sound)

Amount of energy in a wave; determined by the amplitude, relates to perceived loudness

Endothelin

Antagonists: i.Example: Bosentan, a competitive antagonist of endothelin. ii.Endothelin is a small peptide released by endothelial cells, which causes a transient small lowering of BP, but is followed by a long-lasting increase in BP. Can also induce hypertrophy, hyperplasia, and fibrosis (scar tissue), as does Ang II. Inhibitors: i.Example: Omapatrilat ii.Atrial natriuretic peptide (ANP), released by the atria, activates guanylate cyclase to produce vascular relaxation. iii.ANP is broken down by the endopeptidase into inactive fragments. Omapatrilat inhibits endopeptidase leading to lowering of BP.

UI pharmacology

Anticholinergics - surpress Parasym. NS, relaxes detrusor muscle. Urge UI. Alpha-adranergic agonists - stimulates SNS, increases tone of internal sphincter. Stess UI. Alpha-adranergic blockers - surpress SNS, relaxes the internal sphincter. Overflow UI. 5-alpha-redutase inhibitors - reduced the size of the prostate. Overflow UI in males.

arteries and veins

Arteries have a great deal more smooth muscle within their walls than veins, thus their greater wall thickness. This is because they have to carry pumped blood away from the heart to all the organs and tissues that need the oxygenated blood. The endothelial lining of each is similar. they have three layers: tonica adventitia (outer) - endothelium tonica media (middle) - smooth muscle tonica intima (inner) - elastic tissue arteries have a pulse and pushes blood away from the heart. veins have valves to prevent back flow and veins carries blood back to the heart. The smooth muscle is what dialates and contract

LTP: the synapse, high levels

At high levels of synaptic activity, increased Glu release allows more Na+ to enter with greater depolarisation, forcing the magnesium out of the NMDA channels. The increase Ca2+ inflow activates protein kinases. High levels activate AMPA enough to activate NMDA, which allows inflow of calcium ions, acting as a second messenger activating protein kinase 1 (CAMKII, makes AMPA more sensitive to Glu via phosphorylation -> quicker NMDA recruitment in the future) and protein kinase 2 (via NO, healps the release of Glu). LTP, long term potentiation, occurs int he hippocampus.

LTM: the synapse, low levels

At low levels of synaptic activity glutamate binds to both receptors, but MG2+ in the NMDA receptor precent a calcium influx. There is a net depolarisation of the postsynaptic cell. •When we have low levels of synaptic activity, glutamate is released. It crosses the synaptic cleft and begins to interact with the receptors on the post-synaptic side. •AMPA contribute to the depolarisation. When Glu binds and allows movement of Na+ in, it causes depolarisation. At low levels of activity NMDA is "not bothered." With magnesium blocking the channel, calcium is declined, and no sufficient depolarisation is generated to activate the NMDA receptors.

Adrenergic receptor definition

At the effector organs (targets) of postganglionic sympathtic fibres:

Varicosities

At the terminal branches of a neuron; have numerous swellings that simultaneously release neurotrasnmitters over a large area of the inervated organ.

CKD diet and lifestyle changes

Balanced ad adequate diet - no excess protein, restricted salt intake, restricted K+ intake if needed, and calorie restriction in ovese patients. Regular exercise Smoking cessation Reduced cola intake

BMR

Basal metabolic rate - thyroid controlled - the most important regulator of the body's rate of oxygen consumption and energy expenditure at rest.

Can you empty out your lungs?

Because we can't completely empty out our lungs even during maximal expiration, gas exchange can continue between the blood flowing through the lungs and remaining alveolar air.

Isoprenaline

Beta agonist. Used to treat bradycardia, heart block, and rarely, asthma.

Ketamine

Binds to the same deep site within the channel of NMDA, where they block ion movement into the neuron. Ketamine has been found to bind to opioid µ receptors and has a variety of effects, including analgesia, anaesthesia, and hallucinations. It is currently used for induction of general anaesthesia, usually in combination with a sedating drug.

PCP

Binds to the same deep site within the channel of NMDA, where they block ion movement into the neuron. PCP was once used an as anaesthetic agent but was discontinued when bizarre psychotic reactions and behaviours occurred in its users. Since then, it is used as an illegal hallucinogen under the street name "angel dust."

Micturation innervation

Bladder: sympathetic T12-L2, parasympathetic S2-4. Bladder neck: sympathetic. Somatic pudneal nerve (S2-4)

Dialysis principles

Blood is cleansed by exchanging solutes and fluid between the blood and dialysis solution (dialysate) Blood is separated by a semi-permeable membrane, artifical or biological.

CKD and hypertension

Both a cause and complication of CKD. Hypertension increases the rate of progression of CKD and predisposes patients to CVD. Causes: ECF expension (fluid), overactive RAAS (less common). Treatment? removing excess fluid during dialysis, by restricting Na+ intake and by administering anti-hypertensive drugs. In most cases, CKD causes hypertension is due to water and sodium retention.

IBD differentiation

Both diseases are diffrentiated by the location of the inflimmation: - UC occurs in the innermost lining of large intestine (colon and rectum) - Crhon's causes inflammation that often spread deep into the affected tissues (transmural). and by the nature of the alterations in the intestinal wall.

Pancreas structure

Both endocrine (hormones) and exocrine (digestive enzymes). Between the exocrine cells the are a million clusters, "islands" of endocrine cells known as islets of Langerhans (1-2% of the pancreas' mass). These have different cell types within them: - Beta cells (most abundant) are the site of insulin production (60% of total islets mass) - Alpha cells produce glucagon (25% of islets mass) - Delta cells create somatostatin (inhibits uptake of nutrients from GIT)

Pancreas structure

Both endocrine and exocrine; see picture.

Enzymes activated by necrosis

Calpains: proteolytic enzymes regulated by calcium ion concentration. Cysteine-aspartic proteases, "caspases," cleaving proteins between aspartate and cysteine residues. Cathepsin: a proteinase from lysosomes which also takes part in cell autolysis and self-digestion of organelles. Calcium is a common factor in this cascade leading to necrosis.

Weber test

Can detect unilateral (one-sided) conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). Sensorineural hearing ability is mediated by the inner ear composed of the cochlea with its internal basilar membrane and attached cochlear nerve (cranial nerve VIII).

Hyperthyroidism

Can result from: 1. Grave's disease (autoimmune) - body produces too much thyroid stimulating immunoglobulin (TSI), and antibody that targets TSH receptors on thyroid cells. Stimulates secretion and growth of thyroid similar to TSH, with no negative feedback. Grave's disease can cause exophthalmos (bulging eyes) and fat behind the eye sockets, making it hard to close the eyes. 2. Tumor causing hypersecretion. Symptoms: elevated BMR (tendency to lose weight), increased heat production (excessive respiration and poor heat tolerance), HR increase and contractility to the point of palpitations, excessive alertness to the point of anxiousness. Goiter can occur when TSH or TSI excessively stimulate the thyroid, but can by present in hypothyroidsm as well.

Hypothyroidism

Can result from: 1. Primary thyroid failure 2. Secondary (as TRH, TSH deficiency, or both). 3. Inadequate iodine intake Symptoms: Overall BMR decrease, poor cold tolerance, weight gain tendency, fatigue, slow and weak pulse. Myxedema - puffy appearance of hands, face, and feet.

Cardiac Glycosides

Cardiac glycosides inhibit the Na+-K+ pump, which impairs the exchange between sodium and calcium. Stores of calcium within the myocardium are releases and the membrane becomes more permeable to them. The increased calcium increases force of contraction.

Heath Ledger

Cause of death: acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine. •BDZs: oDiazepam (panic/anxiety) oAlprazolam (phobia/anxiety) oTemazepam (insomnia) •Doxylamine: sedative antihistamine, short-term cold relief. •Hydrocodone: semi-synthetic opioid, orally active narcotic and antitussive. •Oxycodone: opioid analgesic These were in non-toxic doses but combined caused death.

Glial cells

Cells in the nervous system that support, nourish, and protect neurons. outnumber neurons 10:1. support communication, receptor expression, and electrical coupling.

Thirst

Centre located in the hypothalamus, acts in concert with vasopressin, nonphysiologic influences on fluid intake. Fluid intake often influenced by habit and sociological factors.

Lewy-body affected areas

Cerebral cortex, which controls information processing, perception, thought, and language. Limbic cortex: emotions and behaviour Hippocampus: forming new memories Midbrain and basak ganglia: involved in movement Brain stem: regulating sleep and maintaining alertness

Glu receptor: AMPA

Chemically mediated channel that opens on binding of Glu, and premits the entry of Na+ ions. This leads to the formation EPSP at the post-synaptic neuron. Quite ordinary excitatory function. `

Neuromodulators

Chemicals released in the nervous system that influence the sensitivity of the receiving neuron to neurotransmitters. Change occurs over minutes/hours/days. Associated with "shower events" i.e. growth, learning, and protein synthesis,

Asthma late phase

Chemotaxins and chemokines lead to infiltration fo cytokine - releasing Th2 cells and monocytes, and activation of infammaoty cells particularly eosinophils -> 1. mediator CysLTs, neuropeprides -> airway inflimmation + airway hyper-activity -> bronchospasm, wheezing, coughing. 2. EMBP (eosinophil major basic protein), ECP (eosinophilic cationic protein) -> epithelial damage. Stopped by glucocorticoids.

Angina

Chest pain caused by myocardial ischemia. Usually transient and if blood flow is restored, no permanent damage results. Discomfort may radiate to the neck, lower jaw, left arm, and so on. Pain is presumably caused by the build-up of lactic acid or abnormal stretching of the ischaemic nerve fibres. Detection by ECG during an episode or stress test is possible.

Muscarinic receptors

Cholinergic receptors that are located postsynaptically in the effector organs such as smooth muscle, cardiac muscle, and glands supplied by parasympathetic fibers.

IBD (inflammatory bowel disease)

Chronic intestinal inflammation that results from immunological abnormalities and triggered by genetic and environmental factors. Two forms: Ulcerative colitis (UC), Crohn's disease (CD). IBD is idiopathic and can be debilitating and sometimes lead to life-threatening complications.

Tetnus

Clostridium tetani spores germinate and produce the tetnus toxin. The toxin migrates to the CNS, wth clinical pattern of generalised tetnus of severe spasms and rigidity of the voluntay muscles. The toxin blocks glycine release from interneurons in the spinal cord, resulting in reflex hyperactivity and violent muscle spasms.

Alveolar structure

Clusters of thin walled cells, inflatable. At the terminal branches of bronchi. The walls are a signle layer of type II alveolar cells, which secrete pumonary surfactant (a phospholipoprotein) which facilitates lung expension. Tiny pores in the walls take part in collateral ventilation.

Organ of Corti strucutre

Coiling around the inside of the cochlea, the organ of Corti contains the cells responsible for hearing, the hair cells. The bottom of these cells are attached to the basilar membrane, and the stereocilia are in contact with the tectorial membrane. Inside the cochlea, sound waves cause the basilar membrane to vibrate up and down. This creates a shearing force between the basilar membrane and the tectorial membrane, causing the hair cell stereocilia to bend back and forth. This leads to internal changes within the hair cells that creates electrical signals; mechanically gated ions channels open. Auditory nerve fibers rest below the hair cells and pass these signals on to the brain. So, the bending of the stereocilia is how hair cells sense sounds.

VaD early signs

Common early signs of wide spread small vessel diseas include impaired planning and judgment, uncontrolled laughing and crying, inability to pay attention, impaired social function, and difficulty finding words. An MRI and brain imaging may show these changes.

distal convuluted tubule (DCT)

Connects with the kidney's collecting tubules. Secretion of ions, acids, drugs, and toxins.Variable reabsorption of water, sodium, and calcium (under hormonal control).

Penfield's work on memory

Conscious epileptic patients, stimulating cortex prior to removal. His patients reported all kinds of sensations and memories during these operations, all done under local anaesthetic, using stereotaxic instruments. Conclusion? Memories are stored very diffusely throughout the brain

Stomach anatomy

Consists of the Fundus (top), Body (middle), Pylorus (bottom), and Antrum (exit). Lesser curvature is the inside curve, Greater Curvature is the outside curve. Rugae is the internal, folded lining of the stomach.

Pupillary light reflex (PLR)

Constriction of the pupils in response to light and dilation of the pupils when the light is removed. Allows testing for integrity of sensory and motor functions of the eye. Lack of PLR or an abnormal reflex can be casued by optic nerve damage, oculomotor nerve damage, brain stem death, and depressant drugs, i.e. barbituates.

Asthma warning signs

Coughing, wheezing, hunched over poosture, vomiting, fatigue, reduced space between ribs when breathing, fast breathing, restless/sleepless, shortness of breath, anxiety.

vibration of the stapes

Creates enough force to cause vibration of oval window: The mechanical vibrations of the stapes footplate at the oval window creates pressure waves in the perilymph of the scala vestibuli of the cochlea. These waves move around the tip of the cochlea through the helicotrema into the scala tympani and dissipate as they hit the round window.

withrawal reflex

Crossed extensor coupled with withrawal reflex: Avoids injury (protective). Forms basis of locomotor circuits. In the leg that feels the pain, the reflex inhibits - in the spinal cord - the motor neuron to the extensor muscle, and stimulates the motor neuron to the flexor muscle. In the opposite leg, the reflex stimulates - in the spinal cord - the motor neurons to the extensor muscle and inhibits the motor neurons to the flexor muscle (supports).

Necrosis

Death of a cell or group of cells because of injury, disease or other pathological state. Cells lose their ability to control their membrane permeability. They swell, and chromatin is digested and later extensively hydrolyzed. Cytoplasm and organelle membrane are disrupted and cell lyses. Inflammation and activation of immune system commonly occur at sites necrosis.

Biguanides (Metformin) - type II DM

Decreases gluconeognesis, increases glycolysis, increases peripheral glucose uptake (increases insulin sensitivty) Use: first line in type 2 diabetes (causes modest weight loss too) Can be used in patients wihtout islet function Side effects: diarrhoea, dypepsia, lactic acidosis.

Hypertension pharmacology

Dietary & lifestyle changes can be enough when at prehypertension phase. Important anyways. Treatment with anti-hypertensives (not first-line treatment) All ACE inhibitors end with -pril; All Ang II end with -sartan, and beta blocker with -prolol.

Segmentation GIT

Digestive motility; mechanical digestion of food by moving it forward then backwards, mixing it with digestive enzymes which help with absorption. Happens in small and large intestine.

Peritoneal dialysis stages

Drain, fill, dwell (does not require the use of blood to leave the body).

Women and UI

During pregnancy, there is pressure on the pelvic floor and muscles are streched. After menopause, the pelvic floor is weakened and atrophy of the urethral and vaginal wall. weight gain and gynaecological issues may happes.

How is fluid balance regulated?

ECF is controlled by the kidneys: water reabsorption to maintain osmolarity, and salt (sodium) reabsorption to maintain volume and blood pressure as salt can hold some water in it. ECF fluid consists of water and solutes (i.e. sodium).

Does RAAS help restore blood volume & pressure?

ECF water volume must be increased. AngII also stimulates thirst and vasopressin release.

CKD symptoms

Early stage: often no symptoms Middle stages: anaemia, fatigue, early signs of bone disease, increased BP, general unwell feeling Later / end stage: high BP, inability to filter waster products / maintain homeostasis.

CKD TREATMENT

Early/middle stage: diet & lifestyle changes, pharamacological interventions. End stage: dialysis, transplant.

Urine output and elderly

Elderly subjects are less able to concentrate urine. Vasopressin levels do not change with the aging and may even increase, but diurnal variations in vasopressin may be dampaned (caross day/night cycle), and the receptors less sensitive.

Asthma immediate phase

Eliciting agent -> mast cell mononuclear cells -> spasmogens, chemotaxins and chemokines (that lead to late phase). Spasmogen (+CysLTs, histamine, PGD2) lead to bronchospasm which can reversed by beta-2 agonists, CysTL receptor antagonist, and thrphyline.

Bile release and recycling

Endocrine response: CCK releases due to chyme in duodenum. Neural response: vagal nerve -> smooth muscle of hepatopancreatic sphincter. Contraction of gallbladder and dialation of sphincter lead to bile release. This ejects the bile into the duodenum throught the duodenal ampulla. Bile salts break down lipi droplet in the lumen of the digestive tract (emulsification). 95% of bile salts re-absorbe at the terminal ileum.

Granular cells (juxtaglomerular, or JG cells)

Enlarged, smooth muscle cells of arteriole Secretory granules contain enzyme renin Mechanoreceptors; sense blood pressure in afferent arteriole

Plasma movement in nephron

Enters via afferent arteriole, and leaves via efferent arteriole.

nephron loop (loop of Henle)

Establishes the osmotic gradient Descending limb: highly permeable to water (lots of aquaporins) and doesn't reabsorb Na+. (water out) Ascending limb: actively reabsorbs NaCl and impermeable to water. These different reabsorption capabilities of the limbs allow the gradient to be formed. The filtrate equilibrates with the medullary interstitial fluid in the descending loop of Henle as water leaves the tubule through aquaporins. The filtrate cocentration decreases in the ascending loop as Na+ and Cl- are pumped out of it. Filtrate leaving the loop of Henle has a lower concentration than the interstitial fluid (100 mOsm).

IBD causes

Exact cause is unclear; idiopathic. Four major factors influence IBD - genetic susceptibility, dysregulated immune response, epithelial barrier function impairment, and environmental factors (external).

GH abnormalities

Excess: In children - giganstism. In adults - acromegaly (enlarged extremities, thickening of soft tissues, usually due to pituitary tumor. Deficiency: Adults - no major symptoms Children - "pituitary dwarfism." Lack of GH or GHRH, max 1.2m stature, normal body proportions, poor muscle developments. If diagnosed before puberty, HRT can be used (recombinant hGH) and give near normal growth.

Control of pancreatic digestive enzyme secretion

Fat and protein products in duodenal lumen -> increase CCK release from duodenal mucosa --(positive feedback)> pancreatic acinar cells -> increase of secretion pancreatic digestive enzymes into duodenal lumen (digests the fats and proteins in first step).

reabsrption mechanism

Filtrate entering the tubular system has the same solute concentration as the ECF; a gradient must be produced to allow reabsorption. 1.Na+ is reabsorbed by active (ATP) transport to produce concentration and electrical gradients. 2.Movement of Na+ produces an electrical gradient that favours the movement of anions into the ECF (i.e. Cl-). 3.Movement of Na+ and anions increases the solute % in the ECF and water follows via osmosis. 4.Movement of water into the ECF concentrates the remaining solutes in the lumen allowing passive diffusion of solute into the ECF (i.e. urea).

Pre-clinical AD brain

First signs are noticed in the entrohinal cortex, then hippocampus. Affected regions begin to shrink as nerve cells die. Changes can begin 10-20 years before symptoms appear. Memory loss is the first sign of AD.

pain perception pathway

First, nerve endings in the finger sense the injury to the finger (sensory neurons) and they send impulses along axons to the spinal cord. The incoming axons form a synapse with neurons that project up to the brain. The neurons that travel up the spinal cord then form synapses with neurons in the thalamus, which is a part of the midbrain. The thalamus organizes this information and sends it to the sensory cortex, which interprets the information as pain and directs the nearby motor cortex to send information back to the thalamus. Again, the thalamus organizes this incoming information and sends signals down the spinal cord, which direct motor neurons to the finger and other parts of the body to react to the pain.

Venous return and veins

Fluid moves in both directions on squeezing an fluid-filled tube in the middle. The venous valves, squeezed by skeletal muscles, premit blow flow towards the heart, and prevent backflow.

Blood pressure, osmotic pressure

Fluid tends to be forced out of a capillary bed by __________ while __________ tends to draw fluid into the capillary bed.

patellar tendon reflex (knee jerk reflex)

From image. This is the fastest reflex in the body.

GABAergic

GABAergic means "pertaining to or affecting the neurotransmitter GABA". A synapse is GABAergic if it uses GABA as its neurotransmitter. A GABAergic neuron produces GABA. A substance is GABAergic if it produces its effects via interactions with the GABA system, such as by stimulating or blocking neurotransmission.

GFR regulation

GFR is regulates by the glomerular capillary blood pressure and remains constant when mean arterial BP fluctuates within a normal range (80-180 mmHg). The glomerulus is protected from changes in arterial pressure by adjusting the diameter of the afferent arteriole. Filtration facts: 20% of plasma entering the kidneys is filtered, 180 L/day, avg. plasma volume = 2.75 L, and plasma is filtered 65 times a day. I.e. increased arterial BP = increase in glomerular capillary BP and net filtration pressure = increase in GFR Vasoconstriction decreases GFR.

Control of GH synthesis and release

GH is controlled by GHRH, GHIH, and feedback by +/- somatomedins from the liver. Hypothalamus -> GHRH (growth hormone releasing hormone) or Somatostatin (=GHIH, growth hormone inhibiting hormone) -> anterior pituitary -> GH -> Liver (somatomedins, IGF-1,II to target cells) and general metabolism (plasma binding protein, increases lipolysis, reduces muscle glucose uptake) Negative feedback: IGF-I,II (somatomedins) to anterior pituitary and hypothalamus GH to hypothalamus Also influenced by thyroid (low TH= low growth), glucocorticoids, steroid, sex seroids, and insulin (low insulin = low growth, and vice versa).

Functions of the respiratory system

Gas exchange, regulation of blood pH, voice production, humidify air, heat exchange

Dopamine (DA)

Generally speaking, dopamine is an inhibitory input. It can be both excitatory and inhibitory, depending on the receptors present. Normally, DAergic neurons from substantia nigra inhibit the GABAergic output from the striatum, whicle cholinergic neurons are excitatory. In PD, the loss of DA neurns leads to overactivity of the ACh component, with activation of GABA release and rigidity.

Risk factors: age and CVD

Genetic Immobility/sedentary lifestyle hyperlipidemia obesity poor diet (high salt, sat. fats, low fibre) alcohol abuse smoking diabetes depression

nephron structure

Glomerular capsule, proximal tubule, loop of henle, distal tubule, collecting duct

Excitotoxicity mechanism

Glu binds to glutamate receptors and triggers influx of sodium and calcium ions, along worth water into presynaptic neurons. Neurons swell, toxicity, and apoptotic death is initiated. As these neurons die, they too release Glu and the cascade continues. Most agree that glutamate plays the central role in the ischemia induced brain damage and neuronal death by way of intracellular calcium.

Gestational DM

Glucose intolerance associated wtih pregnancy Most likely in 3rd trimester. Beta cells are unable to meet increased demand. Resolves after birth, but increases risk for T2DM.

glutamate and pain

Glutamate is the predominant excitatory neurotransmitter used by primary afferent synapses and neurons in the spinal cord dorsal horn. Glutamate and glutamate receptors are also located in areas of the brain, spinal cord and periphery that are involved in pain sensation and transmission. AMPA: AP in dorsal horn neuron, transmission of pain message NMDA: increased Ca2+, initiates second msg. system, increase excitability of dorsal horn neuron.

Glycine receptors

GlyR is an ionotropic receptor that produces its effects through chloride current. It is one of the most widely distributed inhibitory receptors in the central nervous system and has important roles in a variety of physiological processes, especially in mediating inhibitory neurotransmission in the spinal cord and brainstem. Glycine receptors are pentamers of 5α, 3α:2β or 2α:3β each with a chloride ion channel. There are 4 known α subunit and no metabotropic forms (ionotropic receptors). Synapse clearance: transporter with GlyT1 into astrocytes, and GlyT2 into presynaptic neurons.

Dementia defenition

Gradual loss of cognitive function. A variety of types exist.

Action of HCl

H+ and Cl- released as ions and combined the lumen. Maintains stomach lumen pH of 2. Converts pepsinogen into pepsin (active), a proteolytic (protein digesting enzyme). It destroys most pathogens as well.

Regulation of GIT function

Has central and local control. Involuntry control includes external stimulai, affecting the CNS (medulla) and long reflexes. Voluntary control includes ingestion and swallowing, or defecation (i.e. chewing and swallowing initially). An example for integrated neural regulation: Salivation: Mechanoreceptors and chemoreceptors in the mouth (simple reflex), while thinking of/ smelling/ seeing food (cerebral cortex, cinditioned reflex) activate the salivary centre in the medulla -> autonomic nerves -> salivary glands -> salivary secretion increases.

Parasympathetic dominance

Heart and SV (Decrease) Blood vessels (Decrease) Lungs, airways (Decrease/ constrict) GI tract (Increase, relaxation of sphincters) Gallbladder (Contraction = emptying) Urinary Bladder (Contraction = emptying) Eyes, pupils (Decrease, constrict) Genitals (Erection) Exocrine glands (Increases some sweat glands, a lot of watery saliva) Endocrine glands (Increases insulin)

sympathetic dominance

Heart and SV (Increase) Blood vessels (Increase) Lungs, airways (Increase/dilate) GI tract (Decrease, contraction of sphincters) Gallbladder (Relaxation) Urinary Bladder (Relaxation / decrease output) Eyes, pupils (Increase/ dilate) Liver (Glycogenolysis - breakdown of glycogen) Adipose cells (Lipolysis) Genitals (Orgasm) Brain activity (Increase / alertness) Exocrine glands (Increases some sweat glands, a bit of thick saliva) Endocrine glands (Decreases insulin, increases adrenaline & noradrenaline)

Overall CVS structure

Heart: pump; establishes pressure gradient needed for blood flow to tissues. Blood vessels: passageways for blood to be distributted from heart to all parts of the body, and back. Blood; transport medium (connective tissue) which materials being transported are dissolved or suspended.

Memory classification

How long the memory lasts: 1. short term memory (second, minutes) --> working memory (active maintenance). 2. Long term memory (hours, years).

CKD pharmacology

Hypertension medication: ACE inhibitors, then Ca2+ channel blockers, diuretic or beta blocker if needed. Bone disease: phosphate binders (revent absorption from GIT), vitamin D supplements. Hyperkalaemia: cease ACE inhibitors and AngII reeptor antagonists, potassium wasting diuretics. And more.

Somatomedins

IGF-I: Causes proliferation of chondrocytes (cartilage cells) at epiphyseal plates which increases bone growth. Stimulates osteoblast activity to increase bone thickness. Promotes soft tissue growth through hyperplasia and hypertrophy. IGF-II: Promotes soft tissue and organ growth by increasing protein, DNA, and RNA synthesis.

Water balance

If the ECF becomes too concentrated, it becomes hypertonic to the ICF, and water moves into the ECF causing the cells to shrink = dehydration. When the ECF becomes too dilute, it becomes hypotonic to the ICF and water moves out of the ECF into the cells causing them to swell = over-hydration. Overall, to maintain contain water volume in the body, water intake must equal water output. Water reabsorption is osmotically linked to Na+ reabsorption.

Telomeres and aging

If the telomeres are too short, cells age. Certain inherited diseases are characterized by a defective telomerase, which results in damaged cells. However, if telomerase activity is high, telomere length is maintained, and cellular senescence is delayed. This is the case in cancer cells, which can be considered to have eternal life. Among people older than 60, those with shorter telomeres were three times more likely to die from heart disease and eight times more likely to die from infectious disease.

Asthma hypertrophied smooth muscle

In airways. Most asthma patients will have an abnormal growth factor in the smooth muscle of the airways.

Case of HM

In his 20's he was having 10 seizures and blackouts a weeks, and was unresponsive to medication of the day. Underwent experimental epileptic surgery, procedure called "bilateral medial temporal lobe resection." His IQ actually increased from 104 to 118 after the surgery, and his epilapsy was cured. He was left with profound anterograde amnesia and partial retrograde amnesia (about 2 yearsprior to surgery). Had "no real memory of anything that happened since the surgery, couldn't retain factual knowledge for more than several minutes."

Severe AD brain

In severe AD, extreme shrinkage occurs in the brain. Patients are completely dependent on others for care. Symptoms include weight loss, seizures, skin infections, groaning, moaning, or grunting. Increased sleeping, loss of bladder or bowel control. Death usually occurs from aspiration pneumonia or other infections. Caregivers can turn to a hospice for help and pallative care.

Glutamate (Glu) and Glutamine (Gln)

In the CNS, released Glu is captured partly by neurons and partly by astrocytes, which convert most of it to Gln. Gln is transported out of the astrocytes by GlnT (Gln Transporter) and taken up by the neuron which use it to synthesise Glu. Glu --(glutaminase)--> Glu --(vGluT)--> vesicle, Glu.

Calcium in the body

In the body: 99% in bones and teeth, 0.9% in soft tissues, 0.1% extracellular and found in ECF with half bound to plasma membrane proteins, and other half "free" and able to diffuse and pass through the membrane. into interstitial fluid to interact with cells. Must be maintained at constant levels. Only free calcium is biologically active and is considered a single pool.

GABA

In vertebrates, GABA acts at inhibitory synapses in the brain by binding to specific transmembrane receptors in the plasma membrane of both pre- and postsynaptic neuronal processes. This binding causes the opening of ion channels to allow the flow of either negatively charged chloride ions into the cell or positively charged potassium ions out of the cell. This action results in a negative change in the transmembrane potential, usually causing hyperpolarization (IPSP). GABA is synthesised from Glu by the enzyme "glutamic acid decarboxylase" (GAD), and only GABAergic neurons have GAD. Very little GABA is found outside the CNS.

ADH and volume

Increase in osmolarity is detected by hypothalamic osmoreceptors (dominant factor in controlling thirst and ADH secretion), which leads to stimulation of hypothalamic neurons. These: 1. increase thirst, hoping to increase water intake -> decrease in plasma osmolarity. 2. release ADH (causes arteriolar vasoconstriction, relieving arterial pressure) which increases water permeability of distal collecting duct and increase in water reabsorption, as well as decrease in urine output -> increase in plasma volume. increased plasma volume relieves dropping ECF volume (increases it). Reduced ECF is what causes drop in arterial BP, which will be detected by left atrial volume receptors (important in large changes), stimulating the hypothalamic neurons as well.

Asthma patients' RV

Increased RV; the bronchoconstriction in the small airways means that we lose a lot of pressure during expiration (airway resistance increases), leading to early dynamoc small airway closure and air-trapping (reduced RV, reduced ERV).

Moderate alcohol consumption: Increased plasma HDL

Increased plasma HDL can be due to increased production of two principal protein constituents of HDL in the liver. Can also be due to increased activity of the enzyme LPL, which enhances the transfer of lipids and apolipoproteins from VLDL and chylomicrons. Reduce risk of artherosclerosis and CVD

Parathyroid hormone (PTH)

Increases blood Ca2+ and involved in bone maintenance. Essential to life. Prevents hypocalcaemia. Secreted in response to changing plasma levels. Bone action: Short term: stimulates membrane calcium pumps in osteocytes, moving calcium from bone fluid to plasma in central canal. Long term: stimulate osteoclasts, inhibits osteoblasts, increases plasma calcium and phosphates. Kidney action: Decreases calcium loss by increasing tubular reabsorption of calcium and decreased tubular reabsorption of phosphates (reabsorb = body wants to keep, otherwise out through urine). Intestine action: Indirectly increases absorption of calcium and phosphates in the small intestine by stimulating vitamin D activation.

Glucagon (function)

Increases blood glucose levels by stimulating liver to break down glycogen into glucose (glycogenolysis) and gluconegenesis. Inhibits glycogen synthesis. Promotes hepatic ketone production (ketogenesis of fatty acids into ketone bodies. Inhibts hepatic protein synthesis, promotes protein catabolism (overall little effect on blood amino acids level).

Airway resistance

Influences ariflow rate. The primary deteminant of resistnace is the radius of the conducting airway; F=(delta)P/R, where P is the pressure gradient (atm. and intra-alveolar), and F is the airflow rate. The smaller the radius, the higher the resistance. In a healthyperson, the radius is large enough that resistance remains low making the (delta) pressure the primary airflow rate determinant.

How LTM creation works

Information flows in the hippocampus, and the behaviour of certain synapses in the CA1 region is consistent with them being essential for this form of long-term memory. Slices of the hippocampus can be removed and its CA1 neurons studied with recording electrodes (record the electrical activity). Rapid and repeated stimulation of presynaptic neurons evokes APs in the postsynaptic neuron more easily with time, making it more responsive.

IBD pathogenesis

Initiating triggers, such as genetic facors and environmental factors create an area with an impaires intestinal epithelial barrier function (1). An abnormal immune response. Disturbance in the balance between gut commensal bacteria and host response in the intestinal mucousa: (2) acute intestinal inflammation, (3) chronic inflammation with faliure of regulatory mechanisms (activation of T cells which produce pro-inflammatory mediators). (4) tissue distruction and complications, such as fibrosis, stenosis, abscess, fistula, cancer, and extra-intestial symptoms.

Type I DM treatment

Insulin replacement, lifestyle changes to reduce spikes, and regular blood monitoring. Acute: ketoacidosis: crystalline zinc (immediate acting). HCO3- to relieve acidosis and K+ to avoid hypokalaemia. IV insulin. Chronic (long-term): insulin therapy with different kinds of insulin: - Long acting - slow onset, prolonged peak of action, low basal concentration throughout the day. Bovine-porcine utralente - has more prolonged course of action in humans, ;long half-life, but dosage determination is difficult. - Intermediate acting: dissolves gradually when injected. Types: NPH insulin, lente (mix or ultralente and semilente).

Fed state and higher blood glucose (stimulates:)

Insulin secretion by beta cells: Increases glucose transport into cells by recruiting GLUT-4 glucose transporter (except liver, brain, and exercising muscles are insulin-independent). Insulin binds with receptors on the membrane of target cells causing a reaction/pathway which signals GLUT-4 containing vesicles to fuse with the membrane and allow glucose to enter the cells. Stimulates glycogenesis (glucose to glycogen) in skeletal muscles and liver. Inhibits glycogenolysis and glyconeogenesis. Decreases blood FFA and stimulates fat storage. Inhibits lipolysis. Promotes uptake of fatty acids from blood and their conversion into triglycerides in adipose tissue. Decreases blood amino acids by increasing their transport into tissues, promoting protein synthesis for the amino acids and inhibits protein catabolism.

Lung pressures

Intrapleural pressure: Within the pleural sac/cavity. It's the pressure exerted outside the lungs within the thoracic cavity, and its at about 756 mmHg. Intra-alveolar pressure: Pressure of air in alveoli, always equalizes with atmospheric pressure; alveoli are connected to the atmosphere via the tubing of the airways. At about 760 mmHg. The intrapleural pressure is sub-atm. as the elastic lungs want to pull away from the thoracic wall (inwards) because of the alveolar surface tension. The intrapleural pressure prevent that as the intrapleural cavity is full of fluid which cannot exand, creating a vacuum.

Stem cells therapy (CNS)

Introducing stem cells into areas of generation as well as genetic engineering - such treatment has been researched for PD for many years, with minimal success. Modern medicine, pharmacology, nutrition, and exercise are known to extend life - antioxidant, diet, gum, hygiene, clean water, chemical clean-up, air purification, reduce smoking, exercise, refrigeration.

Tenus lockjaw

Invloves spasms of the masseter muscle. It is an early symptom, followed by progressive rigidity and violent spasms of the trunk and limb. Spasms of the pharyngeal muscles cause difficulty swallowing and death usually results from respiratory paralysis.

IBD treatment

Is either step-up: First drugs, then surgery if needed. Or top-down (surgery first). Nutritional support throughout. Treatment leads to symptom relief, long-term remission, or reduced risk of complications. Aims to reduce the inflammation. (top) Surgery Biological agents immunomodulators Prednisone / budesonide aminosalicylates (bottom)

Ischemic stroke: exchitotoxicity

It is used to be thought that deprivation of oxygen and glucose downstream from a blood clot was the cause of neural cell death in stroke cases. Neurons starved of oxygen and glucose release excessive amounts of glutamate from their presynaptic termini. It is this toxic cascade of glutamate spreading to neighboring brain receptors that result in the devastating effects of stroke. Any damage to CNS tissue resulting in release of excess glutamate or prevention of glutamate transporters from working can induce excitotoxicity.

Diabetes mellitus complications

Ketoacidosis - liver uses FFAs (-> ketones), decreases blood pH, which leads to respiratory distress and coma. Hyperkalaemia hyperosmolar state (severe dehydration), an osmotic shift in fluid from cells. Hypoglycaemia from overuse of insulin. Anxiety, sweating, weakness, syncope, and coma. Chronic increased blood glucose damages blood vessels. Microangiopathies include cariomyopathy, nephropathy, neuropathy, and retinopathy. Macroangiopathies include coronart artery disease, myonecrosis, peripheral vascular disease, and stroke. Diabetic foot- poor healing of wounds.

Type I DM

Lack of insulin production by autoimmune destruction of beta cells. Unclear how it happens, a mix of genetics, a trigger (such as diet or a virus), and the development of autoimmune bodies. Symptoms: polydipsia, polyuria, polyphagia (loss f glucose in urine), weight loss, and fatigue. Sudden onset, incurable, and fatal if not treated.

PD treatment

Levodopa (L-dopa), a precursor of dopamine, is the major initial drug used. It can cross the BBB and is presumed to be taken up by dopaminergic neurons which then convert it to dopamine centrally.

Bile salt function

Lipid digestion and absorption; absorption of fat-soluble vitamins (A,D,E,K). Cholesterol synthesis and degradation. Emulsification by bile salts: Bind to and break apart fat globules, increasing the surface area for lipase. Packaged into micelles, diffuse across the gut membrane and exocytose into the lymphatic system.

Fats

Lipids (fat-soluble molecules) are transported in a protein capsule, and the size of that capsule, or lipoprotein, determines its density. The lipoprotein density and type of apolipoproteins it contains determines the fate of the particle and its influence on metabolism.

Proposed analgestic pathway

Local anaesthetics block AP by blocking the voltage gated Na+ channels (i.e. dentist). Other possible ways to reduce pain? Cold -> slower AP. Gray matter surrounding cerebral aqueduct, a narrow canal that connects 3rd and 4th ventricular cavities -> reticular formation ->endogenous opiate

Thyroid gland structure

Located just below the larynx Has two lobes on either side of the trachea, connected by the isthmus. Follicular cells are the major secreting cells (T3, T4) and are arranged into hollow spheres, forming a functional unit called follicle. Within the rings of cells there's colloid, where some TH is exracellularly stored (made of mosty Tg = thyglobulin) within which there's TH in various stages of synthesis.

Tactile hairs

Long, brittle hairs on the face that are very sensitive; for example, whiskers.

Frontotemptoral dementia (FTD, Pick's disease)

Loss of cells in frintal and temporal lobes of the brain. leading to tissue shrinkage and reduced function, impairing emotions, speaking and understanding speech, some movement, behaviours. Least common form of dementia, but contributes to 10-15% of cases, due to deposits of protein.

Calcitonin

Lowers blood calcium levels; produces in C cells in response to high plasma calcium. It decreases bone resorption (effects osteoclasts) and calcium resorption in the kidneys. Can be used as a synthetic drug to treat hypercalcemia. The body usually doesn't have any calcitonin in the blood.

Proprioception

Means "sense of self". In the limbs, the proprioceptors are sensors that provide information about joint angle, muscle length, and muscle tension, which is integrated to give information about the position of the limb in space. The muscle spindle is one type of proprioceptor that provides information about changes in muscle length. The Golgi tendon organ is another type of proprioceptor that provides information about changes in muscle tension.

blood pressure (BP)

Measurement of pressure exerted by blood against walls of blood vessel. Depends on volume of blood contained within vessels and compliance of vessel walls.

Memory from HM's case

Medial temporal lobe are critical from forming types of long term memories. HM was able to remember a list of 6-7 digits (normal range) and tap a sequence of 5 blocks (normal range) = relatively intact short term memory. "forgetting occured the moment his focus shifted." Forming (consolidating) new episodic memories is dependent on the hippocampus (medial temporal lobe).

Alzheimer's disease (AD)

Memory deterioration greater than normal aging. Progressive and terminal - eventual loss of abilities to perform simple tasks. Anterograde & retrograde amnesia for explicit (declarative) memory. Impaired short-term memory & implicit memory for verbal and perceptual material. •Caused by the gradual death of neuron and their synapses in the cerebral cortex and hippocampus. Eventually leading to death of life-sustaining neurons in the lower brain regions. •May develop anxiety, aggression, agitation, and loss of social skills. •Takes about 10 years to debilitate, with death usually due to an illness or infection, not AD itself.

Memory storage

Memory storage = memory consolidation. Changes the memory from a liable/ vulnerable state to a stronger, more permanent state.

Microtubules and tau proteins: neurofibrillary tangles

Microtubules are like railroad tracks that transport nutrition andother molecules. Tau-proteins act as "ties" that stabilise the structure of the microtubules. In AD, tau proteins become tangled, unstabilising the structure of the microtubules. Loss of axonal transport results in cell death.

Micturation reflex

Micturation reflex is involuntary and controlled at the spinal cord; filling of bladder stimulates strech receptors. This triggers parasym. stimulation of the bladder muscle (contrction), and the internal sphincter opens. This reflex inhibits the motor neurons innervating the external urethral sphincter, and voluntary signals from the cerebral cortex can over ride it.

Baclofen

Modulates GABA-B receptors in the presence of GABA, with the potential to decrease neurotransmitter release in excitatory spinal pathways, and increasing inhibitory pathway activity by working presynaptically. Spasticity, which leads to involuntary tight ot stiff muscles, can be treated with baclofen as it reinforces inhibitory input in the CNS. May be done throguh permanent pump which is placed in the abdomen with a catheter that goes to the spinal cord.

Secretion (renal)

Most substances are secreted from plasma into the filtrate. Reduces their concentration in the blood. Commonly secreted substances: •K+: % is low in the ECF due to membrane excitability. Its secretion happens from distal tubule and collecting duct, controlled hormonally - aldosterone). K+ will either be secreted through filtrate or have a K+ channel in the basal lateral membrane, which it cycles in and out of the cell. •Organic ions: bodily derived ions (prostaglandins and epinephrine). Xenobiotics (foreign to the body, i.e. drugs. Secretion occurs in the proximal tubule (organic anion/cations transporters). •and H+ or HCO¬3¬—(bicarbonate).

Water reabsorption

Most water is reabsorbed through aquaporins in the distal tubule and collecting duct. The water permeability of the distal tubule and collecting duct is controlled by vasopressin-dependent insertion of aquaporins into the luminal membrane.

transepithelial transport

Movement of substances through, rather than between, adjacent epithelial cells connected by tight junctions. Renal reabsorption.

Ascending

Moving upward; rising

Atropine

Muscarinic antagonist. Selectively blocks acetylcholine (ACh) at the muscarinic receptors, thereby blocking the parasympathetic effects. Increases heart rate. Used to counteract some nerve agents, decreases saliva production during surgery.

Inspiration

Muscles: diaphragm, external intercostals. Contraction increases the volume of the thoracic cavity. Diaphragm descends about 1cm with quiet breathing, and about 10cm with heavy breathing.

Mice experiment: LTP

Mutant mice lacking the NMDA Glu receptors in CA1 pyramidal cells of the hippocampus show severe deficiencies in spatial memory tasks. These animals had no obvious abnormalities, but preformed far worse than normal mice in water maze tests. Subsequently, analysis of the CA1 region was assessed, and tetanic stimulation to this region failed to produce LTP. On the other hand, genetically engineered mice that have more of the NMDA receptors, and enhanced LTP. These mice were "smart mice," substantially better at several memory tasks than normal mice were.

Proteins misfolding

Mutations in genes which encode the protein components of fibrillar aggregates are genetically associated with the inherited forms of all neurodegenerative diseases. The familial forms usually have an earlier onset and greater severity than sporadic cases and they are also associated with a greater load of protein aggregates.

AD treatment (Memantine)

NMDA antagonist. Usually used in combination with Donepezil for severely affected patients. Used for thinking and psychomotor. Memantine works by blocking NMDA receptor ion channel. At high concentrations, it can inhibit learning and memory. At low concentrations, however, it can promote synaptic plasticity and preserve against excitotoxic destruction due to death of neurons.

TZDs (thiazolidinediones) - type II DM

New Group of Anti Diabetic Drugs, Decrease Insulin Resistance by Binding to Peroxisome Proliferator Activated Receptor Gamma, which is a Transcriptional Regulator of the Genes involved in Glucose Metabolism. Side effects: water retention and oedema.

Hexamethonium

Nicotinic antagonist. Formerly for chronic hypertension. Blocking nicotinic receptors will knock out sympathetic and parasympathetic NS.

VaD treatment

No specific drugs to treat symptoms of vascular dementia, but some AD medication provide some slight improvement. Reducing further damage to blood vessels may be the best strategy, if possible.

Propranolol

Non-selective beta-blocker. Hypertension treatment, irregular HRs, and more.

Atherosclerosis

Not enough space in the arteries for good blood flow; Deposition of atherosclerosis plaque. High LDL can't float too well in the blood and will deposit. Immune reaction will occur, monocytes, will try to take up the cholesterol but will become big and "foam" cells. (how it happens is not too important to remember).

Alpha-glycosidase inhibitors type II DM

Not technically hypoglycaemic, but the slows rate of entry of glucose into bloodstream by decreasing the digestion of carbs in small intestine. Competitive inhibitor of enzymes in the brush border of the small intestine. Side effects: diarrhoea, bloating, flatuence

Hair cells and NA+

Notice that here Na+ is high on the outside, not the inside. So - •Inner hair cells: main sensory organ, single line, receptor potential following bending of stereocilia. •Outer hair cells: receive efferent input, move to amplify the waves in the basilar membrane (prestin, a transmembrane protein that mechanically contracts and elongates), and tunes and enhances responses by inner hair cells.

Peritoneal dialysis

Occurs inside the body, dialysate enters the peritoneal cavity and the peritoneal ccavity acts as the filtration membrane between the blood and dialysate. Requires the placement of an abdominal catheter.

Haemodialysis (HD)

Occurs ourside the body, blood is cleansed in the dialysis chamber and then returned to body. Requires seccessful vascular access.

UI risk factors

Older age female gender pregnancy childbirth obesity benign prostatic tumor TIIDM dementia neurological disorder possibly menopause?

Aging and memory

Older people had difficulty remembering a list of 20 names, both after 20 mins and 1 day, in the absence of dementia. Can affect them remembering to take their medications in a set time, or planning activities? This may be due to reduced frontal cortex activation, with a loss of dopamine receptors, or neuronal size. Support for this theory is mixed.

Most affected neurons in AD

On the neural level, the most severely affected neuronal population are those which secret ACh, qnd their associated synapses. The pathways include that which project from the basal forebrain to the cerebral cortex as well as the hippocampal regions.

Organ of Corti movement

Organ of Corti. A, Upward movement of the basilar membrane tilts the hair bundles toward the longer stereovilli, opening transduction channels. B, In inner hair cells, depolarization causes enhanced transmitter release. C, In outer hair cells, depolarization causes prestin (motor protein) to contract. D, Downward movement of the basilar membrane tilts the hair bundles away from the longer stereovilli, closing transduction channels.

Dysphagia signs

Oropharylgeal: food spillage from mouth, excessive drooling, sense of difficulty initiating the swallow, residual food, choking, coughing, alteration of voice after eating,drinking, or taking medication, COPD, and recurrent pneumonia or increased asthma. Oesophageal: food sticking to throat or chest, neck pain, chest pain, heartburn, regurgitation of food or pills, coughing when lying down or after meals, recurrent pneumonia, increased asthma, and COPD.

Bone cells

Osteoblasts: synthesis and secrete collagen as well as promote deposition of calcium-phosphate crystals (hydroxyapatite). Create bone matrix. Osteocytes: essential role in exchange of calcium between ECF and bone (maintain bone matrix) Osteoclasts: promote resorption of bone (breakdown on bone matrix).

Kidney structure

Outer cortex, inner medulla (renal pyramids),Urine drains from renal pyramids into renal pelvis. Urine leaves via the ureter. Its functional unit is the nephron

ECG leads

Overall 2 leads: Limb leads I, II, III are bipolar and with the unipolar aVR, aVL, and aVF they create 2 triangles (one on the chest, and another between the limbs). The tracing record the difference in potential between two electrodes. In unipolar leads there are still 2 electrodes, but only one records and the other is set to 0 as a neutral reference point. The right leg electrode serves as a ground and doesn't record at all. Chest leads V1-V6 are unipolar, and mainly record the AP of the cardiac musculture immediately between the electrode in 6 different locations around the heart.

GH general function

Overall, it acts to redistribute nutrients towards production processes such as growth. Highest in utero with two more major spurts around 2 and 15 years of age. Anabolic - growth; increases thickness and length of long bones, increases the size. Metabolic - increases lipolysis, increases circulating FFAs, decreases glucose uptake by muscles. Increases blood glucose.

Parkinson's disease pathology

PD is due to the selective loss of dopaminergic neurons in the substantia nigra of the brain, a major origin of the dopaminergic innervation of the striatum, a main function of which is regulation of posture and muscle tone. In healthy individuals, there is a balance between dopamine (DA) and ACh. Death of DA neurons leads to imbalance. Effective treatment may include either or both an increase of DA or decrease of the effects of Ach within the brain, so that initial balance is somewhat restored. Post-mortem brains of PD patients may have only 10% of normal dopamine levels.

Calcium metabolism abnormalities

PTH hypersecretion - hyperparathyroidism: Most frequently caused by parathyroid adenomas. Increased calcium metabolism which can cause bone softening and fractures. Increased calcium excretion by kidneys can cause polyuria, polydipsia, and nephrocalcinosis (storage of calcium in kidneys). Decreased excitebility of nerves and muscles (weakness, depression, and coma). Can also cause nausea, constipation, and increases peptic ulcers incidence. PTH hyposecretion - hypoparathyroidism Most frequently caused by gland destruction, leads to severe hypocalcaemia which causes increased nerve and muscle excitability, which can lead to death by asphyxiation. Mild cases can cause cramps, twitches, and tingles. Hypocalcaemia can be caused by higher demand for calcium in pregnancy (lactation), lack of vitamin D (rickets in children, osteomalacia in adults), or change in blood pH (alkalosis -> less free calcium).

Ureters

Paired muscular tubes, 30 cm long, exits each kidney at the medial border in the close proximity to renal artery and vein. Carry urine to the urinary bladder.

Thyroid C cells

Parafollicular cells (also called C cells) are neuroendocrine cells in the thyroid for which the primary function is to secrete calcitonin. They are located adjacent to the thyroid follicles and reside in the connective tissue. These cells are large and have a pale stain compared with the follicular cells.

Postganglionic neurotransmitter

Parasympathetic: ACh Sympathetic: Noradrenaline

Preganglionic neurotransmitter

Parasympathetic: Noradrenaline Sympathetic: Noradrenaline

Glutamate receptors: drug targets

Penetration of the blood-brain-barrier (BBB) is a challange, and it is difficult to selectively block function as Glu is generally used throughout the CNS. One drug used in the past is now illegal - PCP. Only 2 drugs in current medical use, both lipid soluble and can cross the BBB: ketamine (anaesthesia, depression), which reduced excitation, and memantine (Alzheimer's).

Clinical trials (CNS)

People with Alzheimer's disease and those with mild cognitive impairment who want to help scientists test new treatments may be able to take part in research studies, otherwise known as clinical trials. These research studies are done on people to find out whether a new drug or treatment is both safe and effective. New therapies are tested on people only after laboratory and animal studies show promising results.

Oral Glucose Tolerance Test (OGTT)

Performed to confirm a diagnosis of diabetes mellitus and to aid in diagnosing hypoglycemia. Normal: 2 hour glucose <7.8 mmol/L, Fasting <6.1 mmol/L Impaired fasting glycaemia: 2 hour glucose <7.8 mmol/L, Fasting 6.1-7.0 mmol/L Impaired glucose tolerance: 2 hour glucose >7.8 mmol/L, Fasting <7.0 mmol/L DM: 2 hour glucose >11.1 mmol/L, Fasting >7.0 mmol/L

Oxidative stress

Presistent imbalance in which oxidant>antioxidant. If neurons are unable to repair damage cause by ROS, apoptosis is induced. Oxidative stress is a cause and consequence of inflammation, which is a general aspect of neuronal cell loss.

strech reflex

Primary purpose is to resist tendency for passive stretch of extensor muscles by gravitational forces when person is standing upright. It stretches the muscle itself, which in response, contracts. So, these are for posture, and happen in our main posture muscles, such as in the leg. They happen constantly but are very small and frequently, so we don't realise.

Vitamin D (and calcium regulation)

Produced in skin or ingested; most ingested is lost in feces. Vitamin D promotes calcium absorption by increasing calcium transport across intestinal epithelium. Promotes intestinal phosphates absorption too. Increase bone resorption and stimulates calcium and phosphates resorption in the kidneys.

Structural variation of GIT wall supports functional variation

Protective (oral cavity, pharynx, oesophagus, and anal canal): hardened, protect from ood coming through. Secretory (stomach): vast network of secretory cells. Absorptive (Small intestine): lots of inward folding villi to max absorpation area. Absorptive/protective (large intestine): mainly a large mass by this point, the food is tough so the tissue is hardened again to prevent damage.

Water reabsorption numbers

Proximal tubule: 65%; Passive, osmotically follows sodium Loop of Henle: 15%, Passive, osmotically follows NaCl. Distal tubule and collecting duct: 20% Passive, hormonally controlled •Distal tubule and collecting duct can actually "unpair" water and sodium reabsorption to change plasma osmolarity. With overhydration, no further water reabsorption occurs in the distal tubule or collecting duct if vasopressin is absent. During dehydration, release of vasopressin causes insertion of aquaporins and reabsorption of water in the distal tubule and collecting duct.

Sodium reabsorption numbers

Proximal tubule: 67%, aids in reabsorption of glucose, aa's, water, cl-, and urea. Loop of Henle: 25%, allows production of urine of varying concentrations. Distal tubule & colecting duct: 8%, regulates ECF volume 9hormonally controlled). Descending limb of Henle is the only place Na+ is not reabsorbed.

RAAS (renal)

RAAS begins with the secretion of renin by the granular cells. Renin activates angiotensinogen into AngI. In the lungs: AngI is convereted into AngII via ACE. AngII triggers release of aldosterone from the adrenal cortex. Aldosterone stimulates Na+ reabsorption from distal tubule and collecting duct. Renin secretion is stimulated by decreased stretch of the granular cells or decreased NaCl in the distal tubule detected by the macula densa cells. It can also re stimulated the sympathetic NS. Granular cells can also detect drop in BP.

Atrial Flutter

Rate:Atrial 250-350 Ventricular: 100 -175 (ventricle can't keep up) P: Irregular or absent, often "saw tooth" QRS: Normal Conduction: AV Block (2:1 > 3:1, 4:1) Rhythm: Regular (usually) - Often underlying cardiac disease

Glu receptor: NMDA

Receptor channel which premits Ca2+ entry when open. This one is unusual as it is both chemically gates and voltage dependent. It is closed by both a gate and a magnesium ion, physically blocking the channel. When AP is enough, the magnesium on leaves. Glycine is a positive allostaric modulator (indirectly influences the effects of a primary ligand) of NMDA receptor and it's Glu response (Glu effect is amplified).

Moderate alcohol consumption: red wine

Red wine contains flavonoid & phenolic compounds with significant antioxidant properties that inhibit LDL oxidation. Protects againt LDL oxidation thus reduce risk of CVD

Moderate alcohol consumption: reduced cell prolifecation

Reduced cell proliferation can be due to Blocking the action of the enzyme HMG-CoA reductase has been shown to suppress cell proliferation among other effects (l CH), and thus may provide another way to reduce plaque formation and slow atherosclerosis. Results from cellular signaling, thus reduce risk of CVD.

Moderate alcohol consumption: Reduced inflammatory process

Reduced inflammatory process can be due to disruption of the transcription factor NF- KB function. NF-KB regulates, at least in part, the copying of genetic information of three cellular adhesion molecules on the endothelial cell surface. Reduce artherogenesis, the precursor of artherosclerosis.

Type II DM

Reduced sensitivity to insulin with strong association to obesity and lifestyle, as well as genetics. Risk factors: obesity, smoking, certain ethnicities, family history, low birth weight, Cushing's disease. Insulin levels are high but tissues are resistant. Predisposing conditions: Metabolic syndrome (syndrome X). Obesity ("apple shape"), high plasma triglycerides, low HDL, high BP. Pre-diabetes conditions such as impaired fasting glaecemia or glucose tolerance.

Metaprolol, atenolol

Reduces heart rate in the treatment of hypertension. Selectively blocks β1 adrenergic receptors thereby reducing the sympathetic effects on the heart. Treatment for some tachycardia, hypertension, and chest pain (due to poor oxygen flow).

Lewy-Body dementia (BLD)

Refers to both Parkinson's disease dementia and dementia with Lewy bodies; the earliest symptoms of these two differ but reflect the same underlying biological changes in the brain. Over time, will display similar symptoms of cognitive, physical, sleep, and behavioral patterns. Abnormal diposits called "Lewy bodies," made of a protein called alpha-synuclein. This protein forms into clumps inside neurons, starting in areas of the brain that control aspects of memory and movement. This process causes neurons to work less effectively and eventually die.

Kidney functions

Regulates the ECF (maintains homeostasis), which includes interstitial fluid and plasma. oECF volume - water and sodium balance oElectrolyte composition - sodium, chloride, potassium, calcium, hydrogen, bicarbonate, sulfate, phosphate, and magnesium. oOsmolarity - 300 mOsm/L Acid-base balance Waste disposal oi.e. urea and foreign compounds (drugs, etc.) Hormone production o eryhtropoietin, renin, vitamin D activation

Endocrine definision

Release chemicals into the bloodstream / tissue.

Exocrine definition

Releases chemicals through ducts to outside the body/ another surface within the body.

RAAS (renin-angiotensin-aldosterone system)

Renin is released by kidneys in response to decreased blood volume; causes angiotensinogen to split & produce angiotensin I; lungs convert angiotensin I to angiotensin II; angiotensin II stimulates adrenal gland to release aldosterone & causes an increase in peripheral vasoconstriction

Vitamin E and statins (CNS)

Research has shown that vitamin E slows the progress of some consequences of Alzheimer's disease by about 7 months. Scientists now are studying vitamin E to learn whether it can prevent or delay Alzheimer's disease in patients with mild cognitive impairment, or MCI. Medicines already used to help reduce the risk of heart disease may help lower the chances of developing Alzheimer's disease or may slow its progression. Clinical trials of drugs known as statins have begun to see if they might help slow down the progression of Alzheimer's disease.

Preventing telomere shortening

Research sowed that physical exercise of the professional athletes led to activation of an enzyme called telomerase, which helped to stabilise telomeres. his reduced the telomere shortening in leukocytes, a type of white blood cell that plays a key role in fighting infection and disease. Omega 3 is can protect telomeres shortening. Also: magnesium, vitamin-C, vitamin-D, and selenium. Avoid smoking, stress, and limit alcohol intake. Avoid refined carbs such as grains and sugars, do interval exercise at least 3 times a wekk, and get sufficient quality sleep. Take multivitamins/minerals and omega 3.

Action potential of cardiac contractile cells

Resting: Na+ and Ca2+ channels are closed at resting TMP. Depolarization: - Fast Na+ channels start to open one by one and Na+ leaks into the cell, further raising the TMP. - membrane potential approaches −70mV, the threshold potential in cardiomyocytes, i.e. the point at which enough fast Na+ channels have opened to generate a self-sustaining inward Na+ current. - The large Na+ current rapidly depolarizes the TMP to 0 mV and slightly above 0 mV for a transient period of time called the overshoot; fast Na+ channels close. - L-type ("long-opening") Ca2+ channels open when the TMP is greater than −40 mV and cause a small but steady influx of Ca2+ down its concentration gradient. Early repolarization: Some K+ channels open briefly and an outward flow of K+ returns the TMP to approximately 0 mV. The plateau phase Repolarization: Normal transmembrane ionic concentration gradients are restored by returning Na+ and Ca2+ ions to the extracellular environment, and K+ ions to the cell interior. The pumps involved include the sarcolemmal Na+-Ca2+ exchanger, Ca2+-ATPase and Na+-K+-ATPase.

Main criterion for effectivness of drugs

Secondary, adaptive events which may result with the drug presence on receptors. Individual expreiences of drugs effects vary, and can be the main effectivness criterion.

TRH (thyrotropin releasing hormone)

Secreted by hypothalamus --> triggers pituitary gland to secrete TSH. Cold exposure increases secretion in newborns (-> increases TSH and TH) to increase heat production.

Afferent

Sensory, towards CNS

Salbutamol (Ventolin)

Short acting beta-2 andrenergic receptor agonist. Used for the relief of bronchospasm in asthma or COPD.

Apoptosis

Shrinks, develops bubble-like blebs on their surface. Have degradation of chromatin, breaks into small membrane-wrapped fragments, and phagocytic cells then engulf the cell fragments and secrete cytokines that inhibit inflammation. Cell contents are not released to initiate immune process.

Sleep and memory

Sleep is good for memory; information learned prior to sleep is remembered better. LTP is induced during REM (can remember our dreams?).

UI surgery

Slings - provide support to the urethra and closure at times of exertions. Used for stress UI. Suspension procedures - bladder and urethra are elevated and sutured to pelvic bone. Bulking agents - injected into tissue surrounding the urethra to keep it closed.

Gallstones

Small crystals that form from bile in the gallbladder. Saturation by bilirubin / cholesterol.

Muscle spindles

Small sensory organs that are enclosed within a capsule. They are found throughout the body of a muscle, in parallel with extrafusal fibres (typical muscle fibers).

Other factors that raise blood glucose (not glycogen or insulin related)

Somatosatins (delta cells) surpress glucagon release from alpha cells, as well as the release of insulin, gastrin and secretin. Adrenaline can inhibit beta cells, increase blood glucose (increases glycogen breakdown and lipolysis). Can be caused by stress. Cortisol increases gluconeogenesis and antagonises insulin. ACTH (polypeptide tropic hormone produced by and secreted by the anterior pituitary gland) increases the release of cortisol and enhances release of fatty acids from adipose tissue. GH antagonises insulin. TH increases glycogen breakdown and absorption of sugars in the intestine.

Insulin treatment classification

Sources: - Bovine- allergic reaction possible, also antibodies can decrease efficiency. - Porcine- better allergy profile. - Recombinant human insulin / insulin analogues - most common form, purer, more expensive. Duration of action: - Crystalline zinc insulin (very fast, very short acting). - Semilente (zinc suspension) only from bovine/porcine. - "Regular" insulin. Administration: IV for acute situations, subcutaneous for regular management.

Nigrostriatal pathway

Starts in substantua nigra and projects into striatum, involved in initiation of movement.

Fecal microbiotica transplantation (FMT)

Stool transplant - fecal bacteria from healthy individuals introduced into affected patient to restore colonic microflora. Originally used in Clostridium difficile infections (CDI). Very recently, used for IBD: preliminary daya promising for some, mode of action unknown. Attempts to restore the "normal dialouge" between the gut microbes and the immune system.

Large intestine overview

Storage of waste, water reabsorption, defecation. Tonic contraction of longitudinal muscles (Teniae coli) form pouches (Haustra). Contents progress slowly via segmentation.

Large intestine structure

Storage, absorption (water, sodium, vitamins). Outer muscularis externa - taenia coli. Goblet cells of intestinal glands: mucus, HCO3. Bacteria- fermentation of undigested carbs. Acid production.

Vascular Dementia (VaD)

Strokes may be caused by blockage of major vessels; memory issues may begin as mild changes and worsen gradually as result of multiple minor strokes. Can co-exist with dementia Second most common type of dementia. Symptoms? Vary based on the severity of the blood vessel damage and the region of the brain affected. May have confusion, disorientation, trouble with speech, vision loss, and/or paralysis.

heart valves

Structures within the heart that open and close with the heartbeat to regulate the one-way flow of blood. Maintain pressure before systole. Pulmonary valve (the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps.) Aortic valve (between the left ventricle and the aorta. Closes off the lower left chamber that holds the oxygen-rich blood before it is pumped out to the body. Opens to allow blood to leave the heart.) Two Atrioventricular (AV) valves to prevent backflow of blood from the ventricles into the atria. Tricuspid - Right AV valve. Bicuspid / mital - Left AV valve.

Permanent changes to LTM require:

Synthesis of new proteins and structures. CREB (cyclic-AMP response element binding protein) is activated in LTP and activates the expression of other genes. It interacts with gene transcription for growth factors and can create new synapses. These create new connections for repeated communication. It leads to the production of more ions channel receptors nd new synapses, which cement the synaptic connection between two repeatedly communicating neurons. It is thought that when a particular stimulus is repeatedly presented, a particular circuit of neurons in activated.

Glycine synthesis

Synthesis: glycine is also a conversion product of Glu via Glu-transaminase. By vesicular inhibitory amino-acid transporter (VIAAT) prior to release, glycine is packaged into vesicles.

Sympathomimetic effect - TH

TH increases target cell responsivness to catecholamines and effects the CVS system by increasing the heart's responsivness. i.e. tachycardia and hyperthyroidism.

Urine Transport, Storage, and Elimination

Takes place in the urinary tract: Ureter-transports urine toward the urinary bladder Urinary bladder- temporarily stores urine prior to elimination Urethra- conducts urine to exterior

IBD: TNF

Targeting tumpr necrosis factor (TNF). TNF-specific antibodies may alleviate IBD by simultaneously suppressing several pro-inflammatory pathways in patients.

AD histopathology

Temporal lobe of the AD brain, revealing intracellular neurofibrillary tangles and extracellular amyloid plaques. Amyloid plaque at higher magnification. Neurofibrillary tangle with sparring of the nucleus (centre) at higher magnifications.

Tuning fork tests

The Rinne and Weber tests help distinguish between a conductive hearing loss (CHL) and sensorineural Hearing Loss (SHL).

Expiratory Reserve Volume (ERV)

The additional volume of air that can be forcibly exhaled after normal exhalation

Venous return

The amount of blood returned to the heart by the veins.

Coronary occlusion

The blood within the heart is not the one supplying oxygen and nutrients to the heart as it travels too quick for that. The heart has its own systemic circuit connections, referred to as "coronary circulation." Coronary arteries receive blood through opening in the aorta called the "coronary ostia." The coronary veins carry blood from cells and empty into the right atrium through the opening of a large vein called the "coronary sinus."

cognitive reserve

The brain's ability to operate effectively even when there is disruption in functioning. = amount of damage the brain can sustain before change in cognition is evident. People vary in the cognitive reserve they have, due to genetics, education, occupation, lifestyle, etc. At some point, depending on a person's cognitive reserve and unique mix of genetics, environment, and life experience, the balance may tip in favour of the disease process that will ultimately lead to dementia.

Capillaries exchange (wall transport)

The capillaries have walls that are only one cell thick and allow exchange of substances with tissue fluid. Not all capillary beds are open at the same time. Contraction of a sphincter muscle closes off the bed and then blood flows through an arteriovenous shunt bypassing the capillary bed. Water filled pores, lipid soluble pass through wall (O2, CO2), vesicular transport of proteins, plasma proteins circulation, and small water-soluble molecules pass through pores.

AD causes: theory

The current theory is multifactorial and complex, but focus on a few things: 1. The Aβ complex formation -> whether the amyloid plaque in the brain can be cleared -> amyloid beta burden, deposited within the brain. 2. Neurofibillary tangles 3. Atherosclerosis? 4. Lipid transport can impact lifestyle and contribute to atherosclerosis (diet?) 5. Inflammation? Alzheimer's has a lot of mechanisms of inflammation. In the brain, how does it contribute to cell death?

Age effect on thirst

The elderly have a higher plasma osmolarity at rest; they feel less thirsty when dehydrated. Feelings of thirst are reduced in the young (but not in elderly) when plasma volume is restored after dehydration - due to accute head-out water immersion. Could be due to cardiovascular changes in elderly, i.e. baroreceptor function or responsiveness). The elderly are sensitive to changes in plasma osmolarity, but kess so to changes in plasma volume.

Systolic Blood Pressure (SBP)

The greatest arterial blood pressure, resulting from systole (the contracting phase of the heart). Avg. 120 mmHg.

Omega 3

The high level of omega-3 fatty acids consumed by the Inuit reduce triglycerides, heart rate, blood pressure, and atherosclerosis.

LTP protein kinase 1 (CAMKII)

The influx of calcium ions into the neuron activates an enzyme called calcium-calmodulin-dependent kinase II (CAMKII). Kinases attach phosphate groups to proteins and alter their function. CAMKII phosphorylates th AMPA receptors, which makes them more permeable to sodium ions, increasing the resting potential of the cell and making it more sensitive to incoming impulses. There is also evidence that the activity of CAMKII increases the number of AMPA receptors at the synapse. The ability to make transgenic mice has provided tools to test this model of LTP.

alpha and gamma motor neurons

The intrafusal fibres are innervated by an efferent neuron known as the gamma motor neuron (MN). (The efferent that innervate extrafusal fibers are known as alpha motor neurons). The role of the gamma MN is to maintain muscle spindle sensitivity, regardless of muscle length. So- gamma firing rate affect the sensitivity (length) of the intrafusal muscle fibres.

Sodium balance

The kidneys control Na+ reabsorption to maintain ECF volume & blood pressure. Na+ and ECF anions (HCO¬3¬- and Cl-) contribute 90% of ECF osmotic activity. ECF retains enough water to maintain osmolarity at 300 mOsm/L. Lose salt -> lose ECF water and blood volume/blood pressure. Add salt -> retain more water in ECF and increase blood volume/blood pressure. To maintain constant salt load, salt intake must equal salt output. Nearly all Na+ is reabsorbed from the filtrate, and is reabsorbed along the length of the tubule and plays different roles at each site.

Amnesia

The loss of memory or being unable to remember. Retrograde : loss of memory before injury. Anterograde: loss of memory, or ability to remember, after injury.

Diastolic Blood Pressure (DBP)

The lowest arterial pressure, resulting from ventricular diastole (the resting phase). Avg. 80 mmHg.

Gross anatomy of GI tract

The lumen is inside the GIT.

Stomach's mucous

The mucous provides a protective barrier from pepsin, with a 7pH buffer zone (mucous coating chief and parietal cells = impermeable to HCl) Buffer zone maintained by HCO3-.

collecting duct

The portion of the nephron where water reabsorption is regulated via antidiuretic hormone (ADH). Several nephrons empty into each collecting duct, and this is the final region through which urine must passon its way to the ureter. reabsoprtion or secretion of sodium, potassium, hydrogen, and bicarbonateions. Variable rebsorption of water.

Transmural pressure gradient

The pressure difference across the lung wall (intra-alveolar pressure is greater than intrapleural pressure) that stretches the lungs to fill the thoracic cavity, which is larger than the unstretched lungs

Forces involved in GF (glomerular filtration)

The rate which filtrate is produced depends on opposing forces in the renal corpuscle: hydrostatic pressure (pushing force): Glomerular capillary BP Bowman's capsule hydrostatic pressure: osmotic pressures (pulling force): Plasma-colloid osmotic pressure

Glycine receptors ligands

The receptor can be activated by a range of simple amino acids including glycine, β-alanine and taurine, and can be selectively blocked by the high-affinity competitive antagonist strychnine. Strychnine is a toxin obtained from seeds of an evergreen tree, and it blocks the access of glycine to its receptors. Such block results in a greater excitatory response (inhibition of inhibition) and normal stomulation leads to severe muscle spasms. Caffeine is a competitive antagonist of GlyR.

Stomach cells

The stomach is very acidic, and the tissue cannot be directly exposed to the acid; there are gastric pits within the mucosa of the stomach. •Mucous cells - mucous secretion •Parietal cells - HCl, intrinsic factors •Chief cells - pepsinogen, gastric lipase •Enteroendocrine cells - histamine & gastric (act on parietal cells and contractions of stomach wall). •Regenerative stem cells - replace cells lost during chemical digestion.

lung elasticity

The tendency of the elastin fibers to return to their original position away from the chest wall after being stretched. Compliance is how much change in the lung volume results from a given change in the transmural pressuregradient.

TH function

The thyroid hormones act on nearly every cell in the body. They act to increase the basal metabolic rate, affect protein synthesis, help regulate long bone growth (synergy with growth hormone) and neural maturation, and increase the body's sensitivity to catecholamines (such as adrenaline) by permissiveness. Thyroid hormone leads to heat generation in humans. The thyroid hormones are essential to proper development and differentiation of all cells of the human body.

Pain neurotransmitters

The two best known neurotransmitters are excitatory and can be down regulated with endorphins. 1. Substance P: activates ascending pathway that transmit nociceptive signals to higher levels for further processing. 2. Glutamate: major excitatory neurotransmitter. CNS has built in analgesic system which suppress transmission in pain pathways as they enter spinal cord. It does depend on presence of opiate receptors - endogenous opiates - endorphins, enkephalins, dynorphin.

Stroke Volume (SV)

The volume of blood pumped forward with each ventricular contraction. Affected by increased symp. activity and/or increased end diastolic volume (can be increased via venous return).

sound waves in the cochlea

The wave motion is transmitted to the endolymph inside the cochlear duct. As a result, the basilar membrane vibrates, which causes the organ of Corti to move against the tectoral membrane, stimulating generation of nerve impulses to the brain.

AD treatment (acetylcholinesterase inhibitors)

There are currently three acetylcholinesterase inhibitors in wide-spread use. For attention, thinking, and memory. Rivastigmine: resembles ACh and is metabolised by both AChE and BuChE, although it binds pseudo-irreversibly to these enzymes (thus preventing breakdown of ACh). For milk to moderate severity. Donepezil and galantamine: rapidly reversible in their binding to AChE and slow the breakdown of ACh.

Two types of hair cells

There are two types of hair cells: inner hair cells and outer hair cells. These cells have stereocilia or "hairs" that stick out.

outer hair cells

These cells have a special function within the cochlea. They are shaped cylindrically, like a can, and have stereocilia at the top of the cell, and a nucleus at the bottom. When the stereocilia are bent in response to a sound wave, anelectromotile response occurs. This means the cell changes in length. So, with every sound wave, the cell shortens and then elongates. This pushes against the tectoral membrane, selectively amplifying the vibration of the basilar membrane. This allows us to hear very quiet sounds.

GHB (gamma hydroxybutyrate)

Thought to bind to GABA-B receptors, causing sedative effects, as well as binding to newly identified GHB receptors which are excitatory, so the net result with GHB is a summative one. A "date rape drug", GHB has effects anecdotally comparable to alcohol and ecstasy use, such as euphoria, disinhibition, and enhanced sensuality. At higher doeses, GHB may induce nausea, dizziness, drwosiness, agitation, visual distrubances, depressed breathing, amnesia, unconsciousness, and death.

TSH function

Thyroid stimulating hormone; maintains the structural integrity of the thyroid gland (size). Too much TSH - hypertrophy of thyroid gland (increased size of follicular cells) and hyperplasia (increased number of follicular cells). Inhibited by TH hormone (negative feedback mechanism).

Principle of therapy, endocrine

Too much hormonal activity: - inhibitors to block synthesis/ release - antagonists to block effects - stimulation of rapid breakdown to prevent action - conteract symptoms - sometimes surgical ablation or restriction of the hormone producing tissue Too little hormonal activity: - stimulate synthesis - hormone replacement therapy (HRT) - native agonists - decrease hormone breakdown to prolong its "life" - increase sensetivity of target organs/tissue - counteract symptoms - regenerative medicine (regain normal activity?)

Renal secretion transporters

Transporters are non-selective. Transport many substances based on chemical structure. Different drugs competitively bind same transporter -> slower rate of excretion from body.

GABA receptor

Two general classes of GABA receptor are known: GABA-A in which the receptor is part of a ligand-gated ion channel complex GABA-B metabotropic receptors, which are G protein-coupled receptors that open or close ion channels via intermediaries (G proteins)

primary hypertension

Underlying cause is unkown; about 90% cases fall in this category. Also known as essential or idiopathic hypertension. Potential causes: excessive salt intake (increase in plasma volume and osmotically retain water), defects in salt management by kidneys, excess ADH, and NO (dilator) or endothelin (constrictor) abnormalities.

Golgi tendon organ

Unlike muscle spindles (which are located in parallel with muscle fibers), the Golgi tendon organs are in series with muscle fibers, located in the tendons that attach muscle to bone. The sensory dendrites of the Golgi tendon organ afferent are interwoven with collagen fibrils in the tendon.

Excretion

Urine composition is very different than filtrate. Important molecules are reabsorbed eg glucose, amino acids). Waste products are concentrated (i.e. urea, drugs). Ions & water vary depending on blood concentration.

Rinne test

Used primarily to evaluate loss of hearing in one ear. It compares perception of sounds transmitted by air conduction to those transmitted by bone conduction through the mastoid. Thus, one can quickly screen for the presence of conductive hearing loss.

GABA reuptake

Various reuptake transporters are used in the brain, with GAT1 being presynaptic and GAT2/3 on glial cells. Recycled GABA can be reused or degraded by GABA transaminase to glutamate.

Vasopressin (ADH)

Vasopressin is a hormone that is also known as ADH. It's produced by the hypothalamic neurons and stored and secreted from the posterior pituitary. It is released when ECF osmolarity is too high or blood pressure is very low. It's action is proportional: more vasopressin = more aquaporins.

IBD stem-cell therapy

Via hematopoietic stem cells (HSCs, different blood stem cells) or mesenchymal stem/stromal cells (MSCs, lost of different stem cells). HSC transplantation: to destroy "autoreactive" immune cells responsible for disease chronicity, and re-establish gut tolerance to gut microbes. MSC transplatation: in perianal Chron's, diposited locally into fistula tracts. Aims to down-regulate local immune response and induec wound healing.

Small intestine epithelium

Villi: finger-like projections of the mucosa. Microvilli: increase intestinal surface area x600. Dense vasuculture and lacteal (lymphatic) network. Secretory cells: - goblet cells: mucins to buffer acid. - paneth cell: gut immunity - submucosal glands: mucus, HCO3. - stem cells

total volume capacity of lungs

Vital capacity + residual volume.

End Diastolic Volume (EDV)

Volume of blood in the ventricles at the end of diastole ("preload"). Affected by venous return.

Defecation (control)

Voluntary: impulses from cerebral cortex -> voluntary motor nerve to external anal sphincter -> external anal sphincter relaxation. Involuntary: 1. feces move into and distend the rectum, stimulating strech receptors there. The receptors transmit signals along afferent fibres to spinal cord neurons. 2. spinal reflex is initiated, as parasympathetic motor (efferent) fibres stimulate colon, relaxing the internal anal sphincte. 3. if it is convenient to defecate, voluntary control kicks in.

Michael Jackson

Was given the combination of the following drugs on the night of his death: Valium (diazepam) Atvian (lorazepam) x2 Versed (Midolazam) x2 Diprivan (Propofol) It is possible that the combined effects of the GABA-A receptors is what led to his demise, affecting the respiratory and cardiac centres int he brain stem.

UI interventions

Weight loss Reduction of caffeine and alcohol intake Kegal exercises for pelvic floor muscles Bladder training - resist the urge to urinate Timed voiding - scheduled

Type II DM treatment

Weight loss, no smoking, reduce hypertension, dietary control. Monitoring blood glucose levels. Oral hypoglycaemic agent only in initial staged when changing lifestyle or if poor blood glucose control persists. Aims: - Increase insulin secretion (beta cells stimulates - sulfonylureas). - Increase insulin sensitivity in target organs TZDs, "Avandia". - Reduce liver glucose output (biguanides "metformin) - Decrease carbs absorption rate in GI tract (alpha-glycosidase inhibitor)

How LTM is created

When an axon of cell A excited cell B and repeatedly or persistently takes part in firing it, some growth process or metabolic change takes place in one or both cells so that A's efficiency as one of the cells firing B is increased." Optimising connectivity between neurons? A and B will reinforce each other, and information will be more easily accessed next time. "Learning may refer to a more or less permanent change in the behaviour which occurs as a result of practice."

Glu receptors: pathway

When bound with Glu: AMPA & kinate receptors conduct sodium/calcium ions, which initiates postsynaptic depolarizatin. NMDA only get involved when AP is strong enough. Kainate and AMPA cause higher depolarisation when involved the NMDA. Membrane potential changes intiate the release of the magnesium ion that blocks NMDA receptors. Calcium influx through NMDA channels may set off a chain of events that establish long term potentiation.

Small dynamic airway closure

When frictinal losses cause the airway pressure to fall below the surrounding elevated intrapleural pressure, the small, non-rigid airway are compressed closed, blocking further expiration and trapping air in the alveoli. The amount of air left after thid closure is the residual volume (RV).

Coactivation of alpha and gamma motor neurons

When the extrafusal fibres have been stimulated to contract by alpha MN activation, the gamma MN is simultaneously excited. This is known as alpha-gamma coactivation. The gamma MN stimulates contraction in the two ends of the intrafusal fibre, readjusting its length and keeping the central region of the intrafusal fibre taut, which is necessary to keep the muscle spindle afferent responsive.

Golgi tendon organ mechanism

When the muscle contracts, the collagen fibrils are pulled tight, and this activates the Golgi tendon organ afferent Because changes in muscle tension will provide different degrees of pull on the tendon, the Golgi tendon organ provides information about muscle tension. You might think that muscle stretch would also pull on the tendons and stimulate the Golgi tendon organ afferent. In truth, most of the force of a stretch is absorbed by the muscle itself, so a muscle contraction is a much better stimulus for the Golgi tendon organ.

Asthma and ventilation

When we breathe air, we humidify and warm it up. In asthma, when there's less ventilation (bronchospasm), V/Q (rate) does not equal 1. (V = ventilation, Q = perfusion). Q is not matched by V, as ventilation is lowe than perfusion. A physological shunt occurs, where a vessel that lets blood flow through doesn't take part in gas exchange as it is not getting oxygen.

Muscle spindle structure

Within a muscle spindle, there are several small, specialized muscle fibers known as intrafusal fibers. Intrafusal fibres have contractile proteins (thick and thin filaments) at either end, with a central region that is devoid of contractile proteins. The central region is wrapped by the sensory dendrites of the muscle spindle afferent. When the muscle lengthens, and the muscle spindle is stretched, this opens mechanically-gated ion channels in the sensory dendrites, leading to a receptor potential that triggers action potentials in the muscle spindle afferent.

Retirment and brain engagment

Working helps keep your mind and body active, which we know reduce risk of dementia. Strategies for success: Active social life, regular exercise, healthy diet, mental stimulation, quality sleep, stress management.

CVD (cardiovascular disease)

a disease that affects the heart or blood vessels. kills about 40% of Australians, and accounts for 12% of health expenditure.

glue ear

a form of non-bacterial chronic otitis media; characterized by a persistent viscous effusion (fluid).

pacemaker cells

a group of cells located in the right atrium that sends out signals that make the heart muscle contract and that regulates heartbeat rate. Autoarythmic cells. Do not contract, but initiate a signal.

Secretin

a hormone that regulates water homeostasis throughout the body and influences the environment of the duodenum by regulating secretions in the stomach, pancreas, and liver. It is a peptide hormone produced in the S cells of the duodenum, which are located in the intestinal glands.

reticular formation

a nerve network that travels through the brainstem and plays an important role in controlling arousal

CCK (Cholecystokinin)

a neuropeptide released by duodenal and jejunal cells that modulates gastric relaxation in response to feeding.

CKD diagnosis

a progressive loss of renal function due to renal damage an estimated or measures GFR <60 ml/min/1.73 M^2 that is present for >3 months with or without kidney damage OR evidence of kidney damage with or without decreased GFR that is present for >3 months as evident by the following: albuminuria, haematuria, stractural abnormalities, and pathological abnormalities (from biopsy)

LVH (left ventricular hypertrophy)

a thickening of LV myocardium, a consequence of increased workload during hypertension.

Asthma action plan

a written plan that the person develops with his or her healthcare provider that details daily management of the condition as well as how to handle an asthma attack

Nephron types

a.Cortical nephrons: 80%, short loop of Henle, and mostly in cortex. These have peritubular capillaries for absorptions. b.Juxtamedullary nephrons: 20%, long loop of Henle, dips deep into medulla. Have vasa recta instead of peritubular capillaries.

ventricular fibrillation (V-fib)

abnormal heart rhythm which results in quivering of ventricles. Uncoordinated, chaotic contraction. Multiple signals travel in all directions around the ventricles; very irregular trace with no detectable pattern. If circulation is not returned within 4 minutes (i.e. electrical shock), irreversible brain damage occurs.

Control of pancreatic aqueous NaHCO3-

acid in duodenal lumen -> increase in secretin release from duodenal mucosa --(positivefeedback)> pancreatic duct cells -> increase in secretion of aqueous NaHCO3- into lumen (neutralises the acid in the first step).

Atrial Fibrillation (A-Fib)

an irregular and often very fast heart rate originating from abnormal conduction in the atria. No definite P wave. Chaotic atrial contraction.

Capillaries

any of the fine branching blood vessels that form a network between the arterioles and venules. only have and endothelial layer.

Arterioles and Venules

arterioles are the smallest artery (smaller baranches) in the body. venules are the smallest veins in the body. These are formed when capillaries re-join and return blood to hurt.

Bladder training for UI

behavioural intervention to re-establish control. aims to improve bladder caacity to reduce frequency, urgency, and nocturia. takes 3-6 months or more, starting with short term achievable goals and a bladder diary, and attempting to delay emptying (i.e. by 30 mins). Increase delay time until goals are achieved.

Excitotoxicity

cell death resulting from the toxic actions of excitatory amino acids such as glutamate. Calcium ions are very tightly regulated by cells, and low internal concentrations require energy to maintain.

CNS complexity

change occurs with time, as via neurotransmitters, neuromodulators, and neurotropic compounds.

Parkinson's disease (PD)

chronic, degenerative central nervous disorder characterized by fine muscle tremors, rigidity, and a slow or shuffling gait. Risk factors of neurodegeneration of dopaminergic neurons: •Age - most important •Family history •Male •Exposure of environmental elements, including manganese and iron, pesticide, and more. •Trauma, emotional stress, repetitive head injury.

Krause's corpuscles

cold receptors

Dysphagia

condition in which swallowing is difficult or painful, can be due to: - neurological disorders, such as stroke - mehanical blockage such as cancer - inflammatory disease such as reflux - medications up to 50% of nursing home residents experience difficulty swallowing.

Filtrate

contains substances we want to keep, and most of it gets reabsorbed.

myocardial infarction (MI)

death of cardiac muscle due to ischemia (heart attack)

Aging and the kidneys

decrease in: kidney mass nephron number kidney blood flow GFR

CKD and bone disorders

decrease serum Ca2+, increased phosphate, serum activated vitmain D. Kidneys have reduced capacity to activate vitamin D, which reduced Ca2+ absorption in the intestine. PTH is secreted to compensate -> hyperparathyroidism causes increased bone resorption leading to bone weakness and pain.

Appetite control and aging

decreased in energy expenditure, sense of smell, and exercise, leads to decreased appetite, combined with abnormal hunger or satiety control, can lead to anorexia and malnurishment. Appetite is controlled by the hypothalamus, which receives both hunger and satiety signals. Satiety signals are up-regulated in the elderly.

Hyposecretion

deficient hormone production by an endocrine gland, can be primary (gland abnormality) or secondry (deficieny in tropic hormone).

Timbre (sound)

describes the quality of the sound

Mean Arterial Pressure (MAP)

diastolic pressure + 1/3 pulse pressure. Affected by total peripheral resistance (TRP) and CO.

monosynaptic reflex

direct communication between sensory and motor neuron

Nociceptors

don't adapt to sustained or repetitive stimulation (tonic). •Mechanicals (i.e. crushing, cutting, pinching) •Thermal •Polymodal (all kinds of damaging stimuli) - aching, dull, bad

ECG

electrocardiogram; a recording of the part of the electrical activity of the heart that reaches the body's surface, not a direct recoding of the activity. An overall activity, not of a single AP. Represents thecomparison in voltage detected by two elctrodes, not the AP.

IBD diagnosis

endoscopy & biopsies -upper GI (mouth to duodenum) -ileo-colonsopy (terminal ileum to anus) Clinical signs, haematology, radiology, excluding enteric infections. Extra intestinal ,anifistasions of IBD: musculoskeletal, dermatological, hepatopancreatobiliary, ocular, renal, pulmonary: abdominal pain and cramping, reduced appetite, unintended weight loss, diarrhoea, blood in stool, unexplained fever lasting more than 1-2 days.

osmotic gradient

established in the renal medulla (interstitial fluid becomes more concentrated towards the renal pelvis). The loop of Henle plays an important role in establishing and maintaining the osmotic gradient in the renal medulla; the juxtamedullary nephrons spans the depth of the medulla and controls the osmotic gradient.

Hypersecretion

excessive hormone production by an endocrine gland that can be caused by tumors or overstimulation.

Interventions for age related cvs changes

exercise, omega 3 supp., moderate alcohol consumption, stop smoking, high soluble fibre intake, weight loss

Functional Residual Capacity (FRC)

expiratory reserve volume + residual volume

Net filtration rate

forces favouring filtration minus forces opposing filtration.

papillary duct

formed by merger of several collecting ducts, delivery of urine to minor calyx.

renal corpuscle

glomerulus (tuft of capillaries, surrounded by podocytes) and bowman's (glomerular) capsule (funnel for catching filtrate). production of filtrate, "early urine." very similar to plasma.

Ruffini corpuscles

heavy touch, pressure, joint movements and skin stretching

Urinary bladder

hollow, muscular sac that holds and stores urine temporarily. Periodically empties to the outside for the body through the urethra. The detrusor muscle contracts to push urine our of the bladder.

ACE inhibitors (CVD)

i.Adverse effects: Hypotension, dizziness and headaches are common. — related to reduction of SVR ii.Dry unproductive cough - role of bradykinin? iii.Hyperkalaemia: ACE Inhibitors -> reduced Ang Il -> reduced aldosterone -> reduced K+ excretion iv.Contraindicated in renal stenosis - (kidney relies on intrarenal Ang Il to maintain filtering pressure).

Ang. II receptor antagoists (CVD)

i.Examples: Losartan, Candesartan. ii.Mechanism: still RAAS, allows production of ang II but blocks its interaction with AT1 receptors. Should be more effective than ACE inhibitors as they block all physiological actions of ANG II independent of the formation of the hormone. Does not affect bradykinin. iii.No adverse effects. Side effects include dizziness, headache, and hypotension to some extent. No clinically significant hyperkalaemia. iv.Contraindicated in renal stenosis.

Diuretics

i.Examples: frusemide, Hydrochlorothiazide ii.These increase urine volume (=reduce blood volume) by an action within the renal tubules, usually inhibiting sodium reabsorption from the filtrate into the blood. iii.Only problem associated can be overdoing (dehydration, hypotension, electrolyte imbalance). iv.Different types based on precise site of action, i.e. loop diuretics at ascending limb of loop of Henle.

Β- blockers

i.Examples: metoprolol, propranolol ii.Mechanism: still unclear. Possibilities: 1.Down-regulation of vasoconstrictors such as Ang II and endothelin. 2.Up-regulation of endogenous vasodilators such as NO and prostacyclin. 3.Block renin release -> block Ang II and aldosterone. 4.Decrease sympathetic drive?

Calcium entry blockers

i.Examples: nifedipine, verapamil ii.Calcium is important in the CVS for VSMC contraction, myocytes contraction, and SA/AV nodes contractions. iii.Decreased entry of calcium through its channels produces vasodilation, decreased force of contraction, and slowing of cardiac conduction.

incontinence (UI)

inability to control bladder and/or bowels in sufficient amount or frequency to constitue a social or health problem. A heterogenous condition that ranges in severity.

otitis media

inflammation of the middle ear

sphygmomanometer

instrument used to measure blood pressure

heart block

interference with normal conduction of electrical impulses that control activity of the heart muscle. Ventricle occasionally fails to be stimulated and thus do not conduct following the atria.

Stress UI

involuntary loss of urine associated with effort or exertion on sneezing or coughing or laughing. common in women during pregnancy, after childbirth, and after menopause due to weakened pelvic floor muscles. can occur in men following prostate surgery.

Overflow UI

involuntary loss of urine associated with over distention of the bladder, or if it's not completely emptied. increased pressure overcomes sphincter control. causes include obstruction and underactive detrusor muscle.

Urge UI

involuntary passage of urine occurring soon after a strong sense of urgency to void. bladder muscles become overactive. can be caused due to enlarged prostate, irritation (i.e. stones), neurological disorders, and is often idiopathic.

Referred pain

is pain felt in other parts of the body other than the actual source.

Reabsorption (Renal)

is selective movement of substances from tubules back into blood. Reabsorbed substances travel back into the venous system via peritubular capillaries. 180 L/day plasma is filtered, 178.5 is reabsorbed. 60-70% filtrate is reabsorbed in the proximal tubule (with appx. All organic nutrients). Loop of Henle - 25% water and sodium reabsorbed. Distal tubule and collecting duct - hormonally controlled reabsorption of water and sodium.

digestive accessory organs

liver, gallbladder, pancreas

myocardial ischemia

loss of blood supply to heart muscle tissue of myocardium due to occlusion of coronary artery; may cause angina pectoris or myocardial infarction

Functional UI

loss of urine caused by factors outside the urinary tract that interfere with the ability to respond in a socially appropriate way to the urge to void (environmental factors; sensory, cognitive, and mobility issues) - lack of recognition of need to urinate. causes: dementia, mobility issues, poor eyesight, poor dexterity.

Hypertension

major independent risk factor for CVD; 2 million affected in AU. Only about 19% of those are adequately treated. Untreated will die from either stroke, MI, or renal failure. It is a failure of BP control or a compensation mechanism. I.e. baroreceptors adapt or "reset" to operate at higher levels. There are two types: primary and secondary.

Hyperkalaemia consequences

medical emergency, depolarises cardiac myocytes (from -90 to -80 mV). Severe cases cause cardia arrythmias, such as V-fib.

Glu receptor: mGluR

metabotropic receptor: coupled tophospatidylinostidol metabolism. metabotropic receptors are indirectly linked with ion channels on the plasma membrane of the cell through signal transduction mechanisms, often G-proteins (like this one). Has seven transmembrane domains that span the cell membrane. These activate biochemical cascades, leading to the modification of other proteins, as for example ion channels. This can lead to changes in the synapse's excitability, for example by presynaptic inhibition of neurotransmission, or modulation and even induction of postsynaptic responses.

Efferent

motor, away from CNS

descending

moving downward

Retrograde amnesia

occurs following a trauma i.e. a concussion. STM is erased before information is transferred to the LTM. Severe trauma can also interfere with accessing of LTM.

Anterograde amnesia

occurs following trauma to temporal lobes. Patients have functioning LTM but lack the ability to form new memories of different types. Certain agents, such as alcohol and benzodiazepines "close the hippocampus to new input" thus inducing anterograde amnesia without affecting the ability to consolidate previously formed memories. Because input is prevented, new memories are more likely to be consolidated as new memories do not interfere

Major structures of the GIT

open ended muscular tube, about 4.5m in a living adult. Mouht, salivary glands, pharynx, pharyngo-esophageal sphincter, oesophagus, trachea, gastroesophageal sphincter, accessory organs (liver, pancreas, gallbladder), stomach, small intestine, large intestine, rectum, anus.

Hydrophobic hormones

penetrate plasma membrane and enter nucleus act directly on the genes changing target cell physiology estrogen, progesterone, thyroid hormone act on nuclear receptors take several hours to days to show effect due to lag for protein synthesis

Rinne test procedure

performed by placing a 512 Hz vibrating tuning fork against the patient's mastoid bone and asking the patient to tell you when the sound is no longer heard. Once the patient signals they can't hear it, the still vibrating tuning fork is then placed 1-2 cm from the auditory canal. The patient is then asked again to indicate when they are no longer able to hear the tuning fork.

Illness and dehydration

possible causes: swallowing malfunction (dysphagia) reduced appetite acute pathology (i.e. fever, vomiting) cognitive disorders mobility communication problems medication (i.e. diuretics, laxatives) lack of attention from caregivers or social isolation

Asthma Medications

preventers: inhaled, oral, control inflimmation in the lungs on a daily basis. relievers: inhaled, provide relief from symptom within minutes. Relax the muscle arounf the airways for up to 4 hours. symptom controllers: long acting relievers, relax muscles up to 12 hours.

Inotropic agents (digoxin)

primarily replaced by ACE inhibitors due to toxicity. Digoxin is the only cardiac glycoside still in use in the region. It increases the contractility of the heart's muscle and depresses the conducting tissue while increasing myocardial excitability. Can also treat A-fib. Digoxin comes from Digitalis purpurea.

Function of ANS

regulation of visceral activity (i.e. circulation, digestion, sweating, papillary size).

Pacinian corpuscles

respond to deep pressure and vibration

free nerve endings

respond to pain and temperature

osmosis (renal)

selective reabsorption of water in the nephrons that helps control ECF osmolarity. It's defined as the movement of water from an area of low osmolarity to an area of high osmolarity.

Meissner's corpuscles

sensitive touch receptors in the dermis

Korotkoff sounds

series of sounds that correspond to changes in blood flow through an artery as pressure is released; turbulent flow.

UI types

stress urge overflow function some can experience mixed symptoms

pelvic muscles

supports the bladder and urethra. can be weakened by many factors, such as back pain history, not keeping active, being pregnant, overweight, ongoing constipation, heavy lifting, chronic cough or sneeze, previous injury to pelvic floor, and growing older.

Newborn respiratory distress syndrome

symptoms produced as a result of an insufficient amount of pulmonary surfactant being produced to reduce the alveolar surface tension to manageable levels.

Micturtion

the action of voiding urine from the body...peeing! internal urethral sphincter: smooth muscle, involuntary. external urethral sphincter: skeletal muscle, voluntary.

Glomerular filtration rate (GFR)

the amount of filtrate the kidneys produce each minute. Avg: 125 ml/min. GFR depends on net filtration pressure, and anything that alters net filtration pressure will change GFR.

Endocrine

the body's "slow" chemical communication system; a set of glands that secrete hormones into the bloodstream or tissues.

Persitalsis

the involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wavelike movements that push the contents of the canal forward. Happens in the oesophagus, stomach, and both intestines.

Hearing

the neural perception of sound energy. It involves the identification of sound ("what") and localisation ("where"). Sound is sound waves, travelling ibration of air, consisting of alernate regions of compression refraction of air molecules.

Total Peripheral Resistance (TPR)

the resistance to the flow of blood through the entire systemic circulation. affected by arteriolar radius and blood viscosity.

Benzodiazepine and memory

there is a retrograde enhancement for individuals who use BZDs while studying, perhaps due to reduced interference, enhanced consolidation and enhanced retrieval. Benzodiazepines do not activate the receptor (GABA-A) directly; they increase frequency of chloride-channel opening produced by GABA. Combination of different receptor subunits lead to varying sensitivities to BZDs.

Dehydration sign and symptoms

thirst dry mouth, lips, eyes headache decreased urine output weakness lethargy, confusion dizziness, worse when standing crying w/o tears seizures, coma

Inspiratory Capacity (IC)

tidal volume + inspiratory reserve volume

Pitch

tone, depends in frequency

Fast pain

travels myelinated fibers at 12 to 30 m/s Sharp, localized, stabbing pain perceived with injury Stimulation of mechanical and thermal nociceptors

Slow pain

travels unmyelinated fibers at 0.5 to 2 m/s Longer-lasting, dull, diffuse feeling Poorly localised Stimulation of polymodal nocireceptors

Hypertrophy

triggers include mechanical signals (i.e. stretch), and chemical signals (i.e. growth factors). Hypertrophy is a classic sign of heart failure. The cells get bigger, after long term hypertension, long term increased workload on the heart. Hypertrophy can happen to athletes, which are healthy. Increased blood storage, increased ECM (extra cellular matrix, i.e. collagen). Increased ECM can make the heart too stiff. Physiological vs. pathological. Can be secondary to mechanical problems such as faulty valves or consistently increased workload such as in hypertension.

Urethra

tube leading from the urinary bladder to the outside of the body. straight and short in females, moch longer in males with passageway for borh urine and semen.

Tidal Volume (TV)

volume of air inhaled or exhaled in a normal breath

Hearing loss

• Conductive: glue ear, foreign material, otitis media. • Sensorineural: Presbycusis - age related loss, noise damage, latrogenic - ototoxic drugs.

Hyperkalaemia

• Excess in renal disease, in which potassium is not excreted adequately, acidosis, medication (i.eACE inhibitors),a dn increased dietary K+. • When severe tissue damage occurs, potassium is released from the cells Most CKD patients are susceptible to it due to reduced ability to excrete K+ in the urine Can cause arrythmias.

Weber test results

•A normal Weber test has a patient reporting the sound heard equally in both sides. •In an affected patient, if the defective ear hears the Weber tuning fork louder, the finding indicates a conductive hearing loss in the defective ear. Also, in the affected patient, if the normal ear hears the tuning fork sound better, there is sensorineural hearing loss on the other (defective) ear.

Lipoproteins and lipids

•Chylomicrons carry triglycerides (fat) from the intestines to the liver, to skeletal muscle, and to adipose tissue. •VLDL carry newly synthesised triglycerides from the liver to adipose tissue. •IDL are intermediate between VLDL and LDL. They are not usually detectable in the blood. •LDL carry cholesterol from the liver to cells of the body. •HDL collect cholesterol from the body's tissues and take it back to the liver.

Age related changes to CVS

•Decreased arterial compliance •Increased incidence of atherosclerosis which may lead to hypertension •Decreased myocardial muscle mass •Cardiomegaly •Leaking valves •Reduced HR, inability to respond to sudden cardiovascular challenges, i.e. exercise.

GABA-A manipulation

•GABA bind to a unique receptor site on the GABA-A receptor between the alpha/gamma subunits. •Benzodiazepines bind to the border between the alpha/gamma subunits at a positive allosteric site, resulting in a conformational change in the GABA binding site, making it more sensitive (greater affinity) to GABA and increasing the inward cl- current, which may lead to generalised anxiolytic (reduced anxiety) and sedative effects. Different subunits give different BNZ effects. •Alcohol (ethanol) is also an allosteric moderator.

Ageing theories

•Genetic clock: genes determine length of life, and the genetic make up acts as a genetic clock, switches on genes that lead to aging. •Immune function: deterioration of the body's immune system may cause aging •Metabolic: molecular structure of cells become unstable, which leads to errors in cell maintenance and repair, which can accelerate disease or aging. •Wear and tear: life stresses such as pollution and disease cause aging. •Error: errors in cell reproduction happen and older cells don't repair easily or reproduce correctly. New cells are not quite exact copies, as such can lead to aging. •Somatic mutation: environmental insults cause genetic damage which accumulates over lifetime and affects body functions, resulting in aging.

glomerular filtration (GF)

•High pressure in glomerulus; as blood travels through glomerulus some plasma is pushed out into Bowman's capsule (GF). Solution is called filtrate (=plasma without proteins). •Filtrate still has water, electrolytes, nutrients (i.e. aa's, glucose), waste products, and urea. Large proteins that are not filtered will stay in the arteriole.

Small intestine overview

•Keyrole in digestion and absorption of nutrients. Most digestion and 90% nutrients absorption. •From pyloric sphincter (stomach / SI junction) to ileocecal sphincter (SI/LI junction). •Three segments: -Duodenum (25cm) -Jejunum (2.5m), middle segment, most chemical digestion & nutrient absorption. -Ileum - 3.5m, joins large intestine at ileocecal sphincter.

Diseases affecting GFR

•Kidney stones - obstructs urinary tract (eg. Ureters). •Burns - damage the integumentary system; loss of protein-rich plasma. o Hydrostatic Bowman's capsule pressure will increase. On the GLF - will decrease overall, as the force that increases in an opposing force. We will produce less filtrate.

Learning and memory definitions

•Learning: changes in our nervous system as a result of experience. Only a small portion of what we learn every day gets stored into memory so that it can be recalled at a later time. •Memory: how these changes are maintained over time for retention of information, skills, or thoughts.

Rinne test results

•Normal hearing: air conduction should be greater than bone conduction and so the patient should be able to hear the tuning fork next to the pinna (outer ear) after they can no longer hear it when held against the mastoid. •If the patient is not able to hear the tuning fork after it is moved from the mastoid to the pinna, it means that their bone conduction is greater than their air conduction. This indicates there is something inhibiting the passage of sound waves from the ear canal, through the middle ear apparatus and into the cochlea (i.e., there is a conductive hearing loss).

Pancreatic enzymes

•Proteolytic enzymes (protease, peptidase) activated in duodenum, Trypsinogen (inactive) -> trypsin (active) -> activates others. Breaks down proteins into di/tripeptide nucleic acids. •Pancreatic amylase: breaks down strach / glycogen into simpler sugars. •Pancreatic lipase: breaks down lipids into FFAs and monoglycerides. •Nucleases: breaks down nucleic acids (DNA,RNA) into nucleotides.

Aging and CVD lifestyle

•Salt: average consumption is well above recommended. Excess can lead to fluid retention, stroke, CVD, hypertension, LVH, and oedema. •Immobility: leads to increased TRP, incidence of obesity or oedema or blood clotting (and thus MI or stroke) and decreases myocardial muscle mass and CVD fitness. •Obesity is an independent risk factor for CVD - hypertension, hyperlipidaemia, glucose intolerance, DMII, inflammatory markers, sleep apnoea/ hyperventilation, and prothrombotic state.

Dementia risk factos

•Smoking •Diabetes •Hypertension •Apolipoprotein E status •Coronary artery disease •High dietary saturated fat, cholesterol It is also risky to change these drastically! There is the added problem of cognitive decline amongst the elderly, as is. People having been living for longer and longer.

Gallbladder

•Stores bile, 40-70 mL when full •Concentrates bile •Release of bile (hormonal & neural stimulation)

Malnourishment in aging

•Swallowing difficulty, poor dentition... •Decrease BMR, physical activity, and food intake. Decrease in sense of smell. •44% of homebound patients are malnourished, with up to 85% in nursing home residents. •Protein energy malnutrition (PEM) can lead to pressure ulcers, increased incidence of hip fractures, cognitive impairment, postural hypotension, infections, and anaemia. •Treatment should include nutritional therapy, dental treatment, tube feeding if needed, diet "liberalisation," treatment of depression, and correct swallowing techniques.

Fluid balance in the body

•Water is the most abundant molecule in the body (F: 50% M: 60%). •The two fluid compartments in the body are the ECF (33%) and ICF (66%)