PHYSIOLOGY - Last moment revisions

Muscle Physiology Muscle form 40 to 50% of body mass. About 600 muscles are identified. Classification of Muscles: Depending on striations: Striated(Skeletal & Cardiac) & Nonstriated(smooth) Depending on Control: voluntary(Skeletal) & Involuntary(Cardiac & smooth) Depending on situation: Skeletal, Cardiac & Smooth. Muscle fiber or cell has a length b/w 1 4cm (Average 3cm) & diameter from 10 100microns. 1 myofibril contains 1500 myosin filaments & 3000 actin filaments Sarcomere is the structural & functional unit of skeletal muscle. Length 2.5 to 3.2 mm. Sarcomere lies b/w two Z lines Each myofibril consists of alternate light (I or J band) & dark band (A or Q band). Each sarcomere consist of thin (Actin) & thick (myosin) filaments. Myosin filament is present throughout the A band. No movement of myosin during muscular contraction. Actin filaments are formed by 3 types of proteins called actin, tropomyosin & troponin. The skeletal muscle is formed by 75% of water, 20% of proteins & 5%of organic substances. Troponin: is formed by 3 subunits; Troponin I attached to F actin; Troponin T attached to tropomyosin; Troponin C attached to calcium ions. Following are the muscle proteins; Myosin; Actin; Tropomyosin; Troponin; Actinin; Titin; Desmin; Myogen & Myoglobulin. There is no movement in the myosin filament during muscle contraction. Actin filaments slide over the myosin filament during muscle contraction. Tropomyosin covers the active sites of actin. Rheobase: this is the least possible, i.e. (minimum) strength (Voltage) of stimulus which can excite the tissue. Chronaxie: it is the minimum time, at which a stimulus with double the rheobasic strength (voltage) can excite the tissue. Chronaxie of skeletal muscle is shorter than that of cardiac and smooth muscles. Cold lengthens chronaxie. whereas vagal stimulation shortens chronaxie.

Refractory period is the period at which the muscle does not show any response to a stimulus. Skeletal muscles are purely aerobic & dont have any fuel reserve. Dark, light bands & troponin are absent in smooth muscle. The study of electrical activity of the muscle is done by electromyography. The muscle ruptures when it is stretched to about 3 times its equilibrium length. Cardiovascular system The syncytium of called physiological syncytium because there is no anatomical continuity of the fibers. SA node the pace maker is a small strip of modified cardiac muscle is situated in the superior part of lateral wall of right atrium, just below the opening of superior vena cava. AV node is situated in the right posterior portion of interatrial septum. Bundle of his run on either side of the interventricular septum. Rhythmicity of different parts of heart: o SA node o AV node o Atrial muscle o Ventricular muscle o Atrial muscle fibres o Internodal fibers o AV node o Bundle of his o Purkinje fibers : 70 to 80 / min : 40 to 60 / min : 40 to 60 / min : 20 to 40 / min : 0.3 meter / second : 1.0 meter / second : 0.05 meter / second : 0.12 meter / second : 4 meter / second

Velocity of impulse at different parts of the conductive system.

o Ventricular muscle fibers : 0.5 meter / second Cardiac cycle includes systole & diastole which practically includes the events of ventricles. When heart beats at the normal rate of 72/min, the duration of cardiac cycle is 0.8 sec. The duration of systole is 0.27 sec & that of diastole is 0.53 sec. The subdivision with duration are o Systole Isometric contraction = 0.05 sec

 o Diastole

Ejection period Protodiastole

= 0.22 sec = 0.04 sec = 0.08 sec = 0.11 sec = 0.19 sec = 0.11 sec

Isometric relaxation Rapid filling Slow filling Atrial systole

Total duration of cardiac cycle = 0.27 + 0.53 = 0.8 sec.

Atrial systole: atrial contract & a small amount of blood enter the ventricles. Isometric contraction: all the valves are closed, ventricles undergo isometric contraction & pressure in the ventricles is increased. Ejection period: semilunar valves opened, ventricles contract & blood is ejected out. Protodiastole: this is the first diastole. The semilunar valves are closed at the end of this period. Isometric relaxation: all the valves are closed, ventricles undergo isometric relaxation & pressure in the ventricles is reduced. Rapid & slow filling: Atrioventricular valves are opened, ventricles relax & filling occurs. Pressure difference Pressure Right Atrium Max (mm of Hg) Min (mm of Hg) End systolic volume is 70 90 ml End diastolic volume is 130 150 ml. 02 02 23 5 80 78 56 78 25 120 120 25 Left Atrium Right Ventricle Left Ventricle Systemic Aorta Pulmonary artery

 Cause for cardiac murmurs Systolic murmur Diastolic murmur Continuous murmur 1. 2. 3. 4. 5. Incompetence of AV valve Stenosis semilunar valves Anemia Septal defect Coarctation of aorta of 1. 2. Stenosis of AV valve Incompetence semilunar valves of Patent ductus arteiosus

Electrocardiography: Duration o o o o o Interval B/W 2 thick lines: (5mm) = 0.2 second Interval B/W 2 thin lines (1mm) = 0.04 second Interval B/W 2 thick lines: (5mm) = 0.5 mV Interval B/W 2 thin lines (1mm) = 0.1 mV 25 mm or 50 mm / second

Amplitude

Speed of the paper Normal heart rate is 72 / min Tachycardia: increase heart rate above 100 / min. Waves of normal ECG Wave segment P wave Atrial depolarization Ventricular repolarization 0.08 0.10 Q=0.1 0.2 R=1 S=0.4 Onset of P P R wave wave to interval onset of Q Ventricular repolarzation Atrial depolarization AV node & conduction through 0.18 (0.12 to 0.2) 0.2 0.3 / From to Cause Duration (second) 0.1 Amplitude (mV) 0.1 to 0.12

QRS complex

T wave

Onset of Q Q T wave end wave End ST segment wave wave of S & of & T interval

Electrical activity in ventricles.

0.4 0.42 -

0.08 -

onset of T

In hyperkalemia, ECG shows a tall T wave. In hypokalemia, ECG shows depressed S-T segment. Heart sounds. Heart sounds First Occurs during Isometric contraction & ejection period Second Protodiastole & part of isometric relaxation Closure semilunar valves of Closure AV valves of Long, soft, & low pitched. Resembles the word LUBB Short, sharp, 0.10 014 Precedes or appears 0.09 sec after summit of wave Third Rapid filling Rushing blood ventricles of into Low pitched 0.07 0.1 B/W wave Q wave. Fourth Atrial systole Contraction of atrial musculature Bradycardia: decrease in rate below 60 / min. Inaudible sound 0.02 0.04 B/W wave P & P & T Cause Characteristics Duration (sec) 0.10 0.17 Relation to ECG R wave

& high pitched. Resembles the word DUBB

Q wave

Arrhythmia: irregular heart beat. Sinus tachycardia: increase in discharge of impulse from SA node, upto 100 / min Sinus bradycardia: reduction in the impulses from SA node, about 40 / min Atrial flutter: Atrial rate is about 250 350 / min Atrial fibrillation: rate of 300 400 beats / min Ventricular fibrillation: rate is about 400 500 / min Bain Bridge reflex (venous reflex) is characterized by reflex increase in Heart rate on venous engorgement of the right atrium. Mary's law states that the Heart rate and Blood pressure have inverse relationship. Stokes Adams syndrome is characterized by repeated fainting attacks associated with complete heart block. Cardiac Output: o 70ml. o Stroke volume at rest is 80 - 100 ml. Minute volume: amount of blood pumped out by each ventricle in one minute. Minute volume = stroke volume X heart rate. 5 liters/per ventricle/minute. Cardiac Index: the minute volume from ventricle expressed in relation to square meter of body surface area. Normal value: 2.8 0.3 liters / 1 square meter of body surface area / minute. Ejection fraction: the fraction of end diastolic volume that is ejected out by each ventricle. Normal 60 to 65%. Cardiac reserve: the maximum amount of blood that can be pumped out by the heart above normal value. Normal healthy adult: 300 400%. Variations in Cardiac output: (Physiological) o o Less in children, females, early morning, changing from recumbent to upright position & in sleep. Increased in males, greater body build, day time, emotional upset, after meals, after exercise, high attitude, The amount of blood pumped from each ventricle. Stroke volume: the amount of blood pumped out by each ventricle during each beat -

and later months of pregnancy. Distribution of Cardiac output: Organ Liver Kidney Skeletal muscles Brain Skin, bone & GIT Heart Total Amount of blood 1500ml 1300ml 900ml 800ml 300ml 200ml 5000ml Percentage 30% 26% 18% 16% 6% 4% 100%

Factors maintaining Cardiac output: 1. 2. 3. 4. 1. 2. 3. Venous return Respiratory pump; Muscle pump; Gravity; Venous pressure; Vasomotor tone. Force of contraction Heart rate Peripheral resistance Vasomotor center: bilaterally situated in the reticular formation of medulla oblongata & lower part of pons. Motor nerve fiber of heart. sensory nerve fiber

Regulation of Heart rate:

Haemodynamics: Factors maintaining volume of flow of blood. Pressure gradient; Resistance to blood flow; Viscosity of blood; Diameter of blood vessels; Velocity of blood flow: Arterial Blood pressure: Systolic pressure: maximum pressure exerted in the arteries during the systole of heart. Normal: 120 mmHg. (range 110 140) Diastolic Blood Pressure: minimum pressure in the arteries during the diastole of the heart. Normal: 80 mmHg (range 60 90) Pulse pressure: Difference between the systolic pressure & diastolic pressure. Normal: 40 mmHg.

 Mean arterial blood pressure: this is the diastolic pressure plus one-third of pulse pressure. Normal: 93 mmHg. Variations (Physiological) o o Less in children, females before menopause, early morning & in sleep. Increased in males, greater body build, and day time, after meals, after exercise, sleep with dreams. Determinants of Arterial blood pressure: Cardiac output; Heart rate; Peripheral resistance; Venous return; Elasticity & Diameter of blood vessels; Velocity of blood flow; Viscosity of blood Regulation of Arterial blood pressure: o o o Nervous mechanism: by vasomotor center & impulse from periphery Renal mechanism: by regulation of ECF volume & rennin-angiotensin mechanism. Local mechanism Local vasoconstrictors & Local vasodilators o Hormonal mechanism: Hormones increase BP Adrenaline Noradrenaline Thyroxine Aldosterone Vasopressin Angiotensin Serotonin Venous pressure: o o o o o o o Venous pressure in Jugular vein: 5.1 mmHg (6.9 cm H2O) Venous pressure in superior vena cava: 4.6 mmHg (6.2 cm H 2O) Portal venous pressure: 10 mm Hg Hepatic venous pressure: 5 mm Hg. Hormones decrease BP Vasoactive polypeptide(VIP) Bradykinin Prostaglandin Histamine Acetylcholine Atrial natriuretic peptide intestinal

Capillary pressure: Capillary pressure in the arterial end is about 30 32 mmHg & venous end is about 15 mmHg. It is high in Kidney (glomerular capillary pressure), about 60 mmHg responsible for filtration. Low in lungs (pulmonary capillary pressure), about 7 mmHg.

 Venous pulse: (it is the pressure changes transmitted in the form of waves from right atrium to the veins near the heart) o o o o o o o o Recording of JVP is called phlebogram. Phlebogram has 3 positive waves a, c & v and 3 negative waves x, x1 & y. a wave 1st positive wave & its due to atrial systole. x wave fall of pressure in atrium, coincides with atrial diastole c wave its due to rise in atrial pressure during isometric contraction during which the AV valves bulges into atrium. x1 wave occurs during ejection period, when AV ring is pulled towards ventricles causing distension of atria. v wave occurs during isometric relaxation period or during atrial diastole. y wave due to opening of AV valve & emptying of blood into ventricle.

Nervous system Neuron is defined as the structural & functional unit of nervous system. Neuron does not have Centrosome so it cannot undergo division. Nissl bodies are organelles containing ribosomes & are concerned with synthesis of protein in neurons. Dendrites are conductive in nature & transmit impulses towards the nerve cell body. Axons are longer process of the nerve cell concerned with transmission of impulse away from the nerve cell body. The myelin sheath envelops the axon except at its ending and at the nodes of Raniver. Myelin sheath is responsible for faster conduction of impulse through the nerve fiber & also acts as an insulating material. Neurotrophins are the substances, which facilitate the growth, survival & repair of the nerve cells. A alpha (Type Ia) nerve fiber is said to be the fastest nerve with a velocity of conduction of 70 to 120 meters / second. Glial cells are very abundant and as many as 10 to 50 times as neurons. Astrocytes form supporting network in brain & spinal cord, form basis for blood brain barrier. Microglia is phagocytic in function. Oligodendrocytes are responsible for the formation of myelin sheath in CNS because schwann cells are absent there. Receptors:

o o o

Exteroceptors: give response to stimuli arising from outside the body. (Cutaneous, Chemoreceptors & Telereceptors) Interoceptors: give response to stimuli arising from within the body. Cutaneous receptors: Touch receptors: Meissners corpuscle & Merkels disc (max in lips & fingers) Pressure receptors: Pacinian corpuscles Temperature receptor o o o o o o Cold: Krauses end organ Warm: Raffinis end organ Warm receptors respond at body temperature of 30 - 45C. Cold receptors are activated at body temperature of 10C or below. Warm Sensation is carried by C Fibres. Cold Sensation is carried by A. & C fibres. on recovery)

Pain receptors: free (naked) nerve ending. (sensation which return earliest Chemoreceptors: Taste: Taste buds Smell: Olfactory receptors Hearing: hairs cells of organ of corti in the internal ear. Vision: Rods & Cones in retina for visual sensation. Stretch receptors, baroreceptors, chemoreceptors & Osmoreceptors

o o

Viseroreceptors: Proprioceptors: give response to change in position labyrinthine, muscle spindle, golgi tendon, pacinian

corpuscle, muscle, tendon & fascia. Neurotransmitters: o Excitatory neurotransmitter: is responsible for the conduction of impulse from the presynaptic neuron to the postsynaptic neuron. o Inhibitory neurotransmitters: inhibits the conduction of impulse from the presynaptic neuron to the postsynaptic neuron. Group Name GABA Amino acids Glycine Glutamate Action Inhibitory Inhibitory Excitatory

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Aspartate Adrenaline Noradrenaline Amines Dopamine Serotonin Histamine Others Nitric oxide Acetylcholine

Excitatory Inhibitory & Excitatory Inhibitory & Excitatory Inhibitory Inhibitory Excitatory Excitatory Excitatory

Superficial reflexes: Reflex Corneal Conjunctival Stimulus Irritation of cornea Irritation conjuctiva Nasal Irritation of nasal mucus membrane Sneezing Motor nucleus of V cranial nerve Pharyngeal Irritation membrane Uvular Irritation of Uvula Raising of Uvula Nuclei of X of Retching gagging of Nuclei of X of Response Blinking of eye Blinking of eye Center Pons Pons

pharyngeal mucus

cranial nerve

cranial nerve Superficial cutaneous reflexes Reflex Stimulus Response Center spinal segment involved Irritation of skin at the Scapular interscapular space Contraction drawing scapula Stroking Upper abdominal the costal margin the Ipsilateral contraction movement of of abdominal muscle & T6 to T9 in of of C5 to T1

scapular muscles &

abdominal wall below

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umbilicus

towards

the site of stroke Stroking abdominal Lower abdominal wall the at Ipsilateral contraction movement umbilicus the site of stroke Stroking the skin at Cremasteric upper & inner aspect of thigh Gluteal Stroking the skin over glutei Stroking the sole Plantar flexion & Contraction of glutei L4 to S1, S2 L5 to S2 Elevation of testicles L1, L2 of of towards T10 to T12 abdominal muscle &

umbilical & iliac level

Plantar

adduction of toes Stroking the dorsum of glans penis Stroking the perianal region Contraction bulbocavernous Contraction of anal sphincter of

Bulbocavernous

S3, S4

Anal

S4, S5

Deep reflexes Reflex Stimulus Response Center spinal segment involved Tapping middle of the Jaw jerk chin with slightly opened mouth Biceps jerk Percussion tendon Percussion tendon jerk radial Percussion of tendon of triceps Extension forearm Supination & C7, C8 of of biceps Flexion of forearm Closure of mouth Pons V cranial nerve C5, C6

Triceps jerk Supinator or periosteal

C6 to C8

over distal end (Styloid process) of radius

flexion of forearm

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reflex Wrist tendon or finger reflex Knee reflex Ankle reflex Pathological reflexes: Babinskis sign: there is dorsiflexion of great toe & fanning of other toes. Seen in UMN lesion, also in infants & normal persons with deep sleep. Spinal cord: Extends from foramen magnum to 1st lumbar vertebra. Length 45 cm in male & 43 cm in females. Below the lumbar enlargement, the spinal cord rapidly narrows to a cone shaped termination called Conus medullaris. Spinal corresponds to 31 pairs of spinal nerves. (C-8; T-12; L-5; S-5; C-1) Grey matter is the collection of nerve cell bodies, dendrites & parts of axons. White matter is a collection of myelinated & nonmyelinated nerve fibers. Neurons in the grey matter of spinal cord Neurons in Anterior gray horn Alpha motor neurons; Gamma motor neurons & Renshaw cells Neurons in lateral gray horn Intermediolateral horn cells Neurons in posterior gray horn Substania gelatinosa of Rolando; Marginal cells; Chief sensory cells & Clarkes column of cells. Ascending tracts of Spinal cord: Situation Anterior white funiculus Tract Anterior spinothalamic tract Function Crude touch sensation jerk or Percussion tendon of Achilles Plantar flexion of foot L5 to S2 jerk or Percussion ligament of patellar flexion Percussion tendons of wrist Flexion corresponding finger Extension of leg L2 to L4 of C8, T1

Patellar tendon

Achilles tendon

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Lateral spinothalamic tract Ventral spino cerebellar tract

Pain & temperature sensation Subconscious sensations Subconscious sensations Concerned with spinovisual reflex Pain & temperature sensations Conciousness & awareness Proprioception Proprioception Tactile sensation Tactile localization Tactile discrimination Vibratory sensation Conscious kinesthetic sensation stereognosis kinesthetic kinesthetic

Dorsal spino cerebellar tract Lateral funiculus white Spinotectal tract Fasiculus dorsolateralis Spinoreticular tract Spinoolivary tract Spinovestibular tract Fasciculus gracilis Posterior white funiculus Fasciculus cuneatus

Descending tracts of Spinal cord: Situation Pyramidal tracts Tract Anterior tract Lateral tract Medial fasciculus Anterior vestibulospinal tract Extra Pyramidal tracts Reticulospinal tract Lateral tract vestibulospinal longitudinal Coordination of reflex ocular movement Integration of movements of eyes & neck Maintenance of muscle tone & posture Maintenance of position of head & body during acceleration Coordination movements. Control of muscle tone. Control of respiration & blood vessels. Tectospinal tract Rubrospinal tract Control of movement of head in response to visual & auditory impulses. Facilitatory influence on flexor muscle tone. of voluntary & reflex corticospinal Function corticospinal Control voluntary movements Forms upper motor neurons

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Olivospinal tract

Control of movements due to proprioception.

Effect of upper motor neuron & lower motor neuron lesion: Effects upper motor neuron lower motor neuron lesion Hypotonic Flaccid type of paralysis Present Lost Absent Lost Lost Absent Individual muscles are affected present

Muscle tone Paralysis Clinical observation Wastage of muscle Superficial reflexes Plantar reflex Deep reflexes Clonus Electrical activity Muscles affected Clinical confirmation

Hypertonic Spastic type of paralysis No wastage Lost Abnormal babinskis sign Exaggerated Present Normal Groups of muscles are affected in Absent

Fascicular EMG

twitch

Action of sympathetic & parasympathetic divisions of ANS: Effector organ Sympathetic division Parasympathetic division Eye Ciliary muscle Pupil Lachrymal secretion Relaxation Dilatation Decrease Decrease in secretion & Salivary secretion vasoconstriction Contraction Constriction Increase Increase secretion vasoconstriction Motility GIT Secretion sphincters Gall bladder Urinary bladder Detrusor muscle Internal sphincter Sweat glands Heart rate & force Blood vessels Inhibition Decrease constriction Relaxation Relaxation Constriction Increase in secretion Increase Constriction of all blood Acceleration Increase Relaxation contraction contraction Relaxation decrease Dilatation in &

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vessels except those in heart & skeletal muscle Bronchioles Dilatation Constriction

Resting membrane potential of various cells of the body. Resting membrane potential of a skeletal muscle is -90mV. Resting membrane potential of a smooth muscle is -50 to -75mV. Resting membrane potential of a cardiac muscle is -85 to -95mV. The resting membrane potential in the nerve fiber is -70mV. The resting membrane potential in the rods is -40mV. The resting membrane potential of inner ear cell is -60mV. Brain stem: (medulla oblongata, Pons & Midbrain) Pathway for ascending & descending tracts b/w brain & spinal cord. Important centers for regulation of vital functions in body. Medulla oblongata Respiratory centers: inspiratory & expiratory. Vasomotor center: B.P & Heart rate. Deglutition center: Pharyngeal & Oesophageal stage. Vomiting center: induce vomiting. Superior & inferior salivatory nuclei: controls secretion of saliva. Cranial nerve nuclei: nuclei of 10, 11 & 12 cranial nerves. Vestibular nuclei: Pons Bridge b/w medulla & midbrain. Forms pathway connecting cerebellum with cortex. Nuclei of 5 to 8th cranial nerve. Pneumotoxic & apneustic centers for regulation of respiration. Midbrain: (Consist of 2 parts Tectum & cerebral peduncles) Tectum: center for light & auditory reflexes. Cerebral peduncles: control of muscle tone Control of complex & skilled muscular movements, movement of eye balls Thalamus: Ovoid mass of gray matter, situated B/L in diencephalons) Relay center: for sensations (also called functional gateway). Center for integration of sensory impulses: determining the quality of sensations(discriminative & affective nature) Center for sexual sensations.

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Role in arousal & alertness reactions. Center for reflex activity Center for integration of motor functions. Hypothalamus: Control the secretion of Ant. & Post Pituitary hormones & adrenal cortex & medulla. Control of Autonomic nervous system; Heart rate; B.P; Body temp; Food intake (satiety, hunger &thirst); water balance; sleep & wakefulness. Role in behaviour & emotional changes. Regulation of sexual function & response to smell. Role in circadian rhythm. Cerebellum: Vestibulocerebellum: regulates tone, posture & receiving impulse for vestibular apparatus. Spinoncerebellum: regulates tone, posture & equilibrium by receiving impulses from proprioceptors in muscles, tendons & joints, tactile receptors, visual receptors & auditory receptors. Corticocerebellum: concerned with the integration & regulation of well coordinated muscular activities. Different parts are represented in an upright manner in cerebellum. (opp: in cerebrum) Basal ganglia: (concerned with motor activities of extra-pyramidal system) Control of voluntary motor activity, muscle tone, reflex muscular activity, associated movements. Role in arousal mechanism. Cerebral cortex: Primary motor area (concerned Pre central Frontal lobe cortex (Post. Part) Pre motor area with Area 4S suppressor area. Inhibits movements initiated by area 4. Area 6 concerned with coordination of movements initiated by area 4. Area 8 frontal eye field. Area 44 & 45(brocas area) motor area for speech. Concerned with co-ordinated skilled movements. Area 9 to 14, 23, 24, 29 & initiation of voluntary movements & speech) Area 4 center for movement

Pre

Supplementary motor area Silent area

or

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frontal cortex (Ant. Part)

association area Center for higher functions emotion, learning, memory.

32. Center for planned action. Seat of intelligence. Personality of individual. Area 1 concerned with

sensory perception Somesthetic area I Parietal lobe Somesthetic area II Somesthetic association area Primary auditory area Area 2 & 3 integration of these sensations. Spatial recognition. Recognition of intensity, similarities & diff. B/W stimuli Concerned with perception of sensation. Synthesis of various sensations perceived by S.Area-I. Stereognosis. Area 41, 42 & wernickes area Temporal lobe Auditopsychic area Area of equilibrium Primary visual area Occipital lobe concerned with perception of auditory impulses, analysis of pitch, determination of intensity & source of sound Area 22 interpretation of auditory sensation Maintenance of equilibrium Area 17 perception of visual impulse Visual association area Area 18 Interpretation of

visual impulses Occipital eye field Area 19 - Movements of eye

Limbic system: (It is a group of cortical & sub cortical structures which form a ring around the hilus of cerebral hemisphere) Regulation of olfaction, autonomic functions (B.P, water balance & body temp). Control of circadian rhythm. Regulation of sexual function. Role in emotional state, memory & motivation. Retention of recent memory. Most developed part of Limbic System Hippocampal formation Major efferent from Limbic system goes to Mid brain reticular formation. Main function of Limbic system is to Control the emotional behaviour.

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Proprioceptors: (These are receptors which give response to change in the position of different parts of the body). Muscle spindle: gives response to change in length of muscle. Golgi tendon organ: gives response to change in force developed in muscle. Pacinian corpuscle: pressure receptor in fascia, tendon & joints. Free nerve endings: Vestibular apparatus: Give response to rotatory movements or angular acceleration of the head. Responsible for detecting the position of head during different movements. EEG: (ELECTROENCEPHOLEGRAM) Alpha rhythm: Frequency: 8 to 12 waves / sec Amplitude: 50U. Most marked in parieto-occipital area. Obtained in inattentive brain as in drowsiness & light sleep. Beta rhythm: Frequency: 15 to 60 waves / sec Amplitude: 5 - 10U. Recorded during mental activity or mental tension or arousal state. Delta rhythm: Frequency: 1 to 5 waves / sec Amplitude: 20 - 200U. Seen in tumour, epilepsy, increased intracranial pressure & mental depression. Theta rhythm: Frequency: 4 to 8 waves / sec Amplitude: 10U. Seen in children below 5 years. SLEEP: Sleep requirement: Newborn infants: 18 to 20 hours. Growing children: 12 to 14 hours. Adults: 7 to 9 hours. Old persons: 5 to 7 hours. Types of sleep: Rapid eye movement sleep(REM) Non rapid sleep(NREM) eye movement

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Eye balls move Dreams occur Muscle twitching 20 to 30% of sleep

Absent Absent Absent 70 to 80% of sleep

Normal amount of C.S.F. in man is 150 C.C, Sympathetic nervous system is controlled by Posterior hypothalamic nuclei Parasympathetic nervous system is controlled by Anterior nuclei and part of middle nuclei of hypothalamus. EYE: Refractory power is measured in dioptre (D). Refractory power of cornea is 42D. Refractory power of lens is 23D. Refractory power of eye at rest is 59D. Focal length of cornea is 24mm. Focal length of lens is 44mm. The wave lengths of visible light are approximately 397 to 723 nm. There are about 6 million cones & 12 million rods in human eye. Rods are responsible for dim light or night vision or scotopic vision. Cones are responsible for colour vision, sensitive to day light & acuity of vision. Rhodopsin is the photosensitive pigment of rods cells. Photosensitive pigment in cones are o Porpyropsin Red o Iodopsin Green o Cyanopsin Blue Electroretinogram is the instrument to record the electrical basis of visual process. Test for visual acuity snells chart (distant vision) & Jaegers chart (near vision). Test for color blindness Ishiharas colour chart. Mapping of visual field perimetry. Nearest point at which the object is seen clearly is about 7 to 40cm. Farthest point is infinite. Myopia (short sightedness) is corrected by concave lens. Hypermetropia (long sightedness) is corrected by convex lens. Astigmatism is corrected by cylindrical lens. Presbyopia is corrected by convex lens. EAR:

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Ear is sensitive to sound between 1000 to 4000Hz range. Hairs cells in organ of corti are the receptors for auditory sensation. Sound becomes painful above 140db. Auditory centers 41, 42 & also auditopsychic area 22. Sense organ of taste sensation is taste buds. There are about 10,000 taste buds & each taste bud is replaced in every 10 days. Each taste bud consists of 4 types of cells and is supplied by about 50 nerve fibres. Receptors are type III cells of taste buds. Taste center opercular insular cortex (lower part of post central gyrus). Bitter taste has very low threshold 1 in 2,000,000. Sweet taste has high threshold 1 in 200. Locations of taste buds are: sweet tip; salt dorsum; sour side; bitter posterior.

TONGUE:

SMELL: Olfactory mucus consists of 10 to 20 million olfactory receptor cells. Human nose can distinguish 2000 to 4000 different odours.

GASTRO INTESTINAL SYSTEM GIT is a tubular structures extending from the mouth up to anus with a length of about 30 feet. A normal healthy adult consumes about 1kg solid diet & about 1 2 liters of liquid diet / day. Auerbachs plexus regulate the movements of GIT. Meissners plexus regulate the secretory functions of GIT. Auerbachs plexus is present between the middle circular muscle layer & outer longitudinal muscle layer & its major function is to regulate the movements of GIT. The total volume of GIT secretions per day is about 8000 ml. Properties & composition of Saliva: Volume: 1000 1500 ml / day, (70% by submaxillary glands). Reaction: pH 6.35 6.85. Specific gravity: 1.0002 1.012 Composition: 99.5% water & 0.5% solids. Digestive enzymes: salivary amylase (carbohydrate splitting) & lingual lipase (lipid splitting enzyme).

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Substances like mercury, potassium iodide, lead & thiocyanate are excreted through saliva. Saliva contains highest conc. of K+. Volume of stomach is 50 ml when empty & can expand up to 4 liters. Properties & composition of gastric juice: Volume: 1200 1500 ml / day. Reaction: pH 0.9 1.2. Specific gravity: 1.002 1.004 Composition: 99.5% water & 0.5% solids. Digestive enzymes: Pepsin, Gastric lipase & other gastric enzymes.

Action of pepsin: attacks peptide bonds adjacent to aromatic amino acids by hydrolysis. Action of gastric lipase: weak lipolytic enzyme becomes active only when pH is between 4 & 5. Action of HCL: activates pepsinogen into pepsin, bacteriolytic action, causes acidity of the chime & provides acid medium for the action of enzyme. Gastrin is one of the GIT hormones secreted by G cells present in pyloric glands of stomach. Action of Gastrin: stimulates the secretion of pepsinogen & Hcl by gastric glands, increases the motility of stomach, secretion of pancreatic juice & production of hormones by pancreas.

Pancreas is a dual organ & has endocrine & exocrine function. Properties & composition of Pancreatic Juice: Volume: 500 800 ml / day. Reaction: pH 8 8.3. Specific gravity: 1.010 1.018 Composition: 99.5% water & 0.5% solids. An adult pancreas has 2.5-7.5 lac islets. Total volume of pancreatic secretion per day is 2.5 liters. Pancreas is the only organ that contains Trypsinogen. Ascariasis can also cause acute pancreatitis. Serum amylase and lipase levels are usually not elevated in chronic pancreatitis.

Duodenum is the principal site of iron absorption.

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Most sensitive method for assessing pancreatic exocrine function is Secretin Stimulation Test. Blood flow reaching the liver via portal versus hepatic artery is 4: 1. Hepatic venous pressure is 5 mm Hg. Most common complaints resulting from disorders involving the GIT include pain and alteration in bowel habit. Most potent stimulus for bile secretion is bile salt. Best stimulus for CCK secretion is Fat. Properties of Bile: o o o o Volume: 800 1200 ml / day Reaction: alkaline pH: 8 8.6 Sp. Gty: 1010 - 1011 Water: 97.6% Solids: 2.4%

Composition of Bile: o o

Bile is stored in gall bladder; it undergoes many changes in quality & quantity. There is increase in conc. of bile salts, bile pigments, cholesterol, fatty acids & lecithin. Functions of bile salts: o Emulsification of fats, due to emulsification, fat globules are broken down into minute particles. o o o Absorption of fats. Stimulate the secretion of bile from liver. Prevention of gall stone formation. Volume: 1800 ml / day Reaction: alkaline pH: 8 8.3 Sp. Gty: 1010 - 1011 Proteolytic tripeptidase. o Amylolytic enzymes: sucrase, maltase, isomaltase, lactase, dextrase & trehalase. enzymes: peptidases amino peptidases, dipeptidase &

Properties of succus entericus: o o o o

Enzymes of succus entericus: o

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Lipase & enterokinase

Bacterial flora of large intestine synthesizes folic acid, Vit B12 & Vit K. Vomiting center is situated bilaterally in medulla oblongata near the nucleus tractus solitarius. Segmentation contraction & pendular movement are involved in mixing of food in small intestine. Peristaltic movements peristaltic rush are the two movements involved in the pushing of chyme towards aboral end on intestine. Desire for defecation is elicited by an increase in the intrarectal pressure to about 20 to 25 cm H2O. Gastrointestinal hormones: Hormone Source secretion Gastrin G cells of 1. Stimulates the secretion of gastric juice. 2. Increase the gastric motility. Stimulates the release of pancreatic hormones. cells of Stimulates secretion of watery, of Actions

stomach; duodenum, jejunum, Ant. Pit & Brain Secretin S

duodenum, jejunum & ileum Cholecytokinin I cells in

alkaline & pancreatic secretions.

Stimulates contraction of gall bladder; Activates motility; secretin; Increases Inhibits gastric of secretion

duodenum, jejunum & ileum

enterokinase & intestinal motility. Gastric inhibitory peptide (GIP) K cells in & Inhibits gastric secretion motility & of gastric juice, insulin

duodenum jejunum

increase

secretion.

Digestion of Carbohydrates: Area Mouth Stomach Small Juice Saliva Gastric juice Pancreatic Pancreatic Polysaccharides Enzyme Salivary amylase Gastric amylase Substrate Polysaccharides Weak amylase End Product Disaccharides The action is

negligible Disaccharides

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intestine

juice

amylase

Disaccharides

dextrins, maltose & maltriose Monosaccharides

Succus entericus

Sucrase Maltase Lactase Dextrinase Trehalase

Disaccharides

Glucose

Skin Skin is the largest organ in the human body. The normal body temperature varies is between 35.8 37.30. Axillary temperature is slightly lower, while rectal temp. is slightly higher. Heat lose center is situated in pre-optic nucleus of ant. Hypo thalamus. Heat gain center is situated in post. Hypothalamic nucleus. Primary motor center for shivering is situated in post. Hypothalamus, near the wall 3rd ventricle. RESPIRATORY SYSTEM The major phospholipids present in the surfactant are di-palmitoylphosphatidyl choline. Surfactant is secreted by type II alveolar epithelial cells. Total peripheral resistance falls about 50% in moderate exercise. Cyanosis is detectable when arterial oxygen saturation falls below 75% corresponding to PO2 of 40 mmHg. 250ml of oxygen enters the body per min and 200 ml of CO2 is excreted. 5 ml of 02 is transported to the tissues by 100 ml blood in every cycle Pulmonary alveolar macrophages form called "Dust cells". Size and strength of respiratory muscles is 30-40% above normal in athletes whereas it is 20-30% less in physically weak people. There are about 300 million alveoli in man. There is no stimulation of ventilation by hypoxia until the alveolar O2 falls below 60 mm Hg. Oxygen transported from lung to tissues in chemical combination is 97%. In a healthy adult, 24 hour production of CO2 is about 330 liters. Diffusion capacity for carbon dioxide as compared to that of 02 is 20 times.

25

Average area of the alveolar walls in contact with capillaries in both lungs is about 70 sq. m. Diffusion capacity of lungs for CO2 is 10-30 ml/min/mmHg. Normal composition of venous blood is PO 2 - 40 mmHg, PCO2 -46 mm Hg and Hb saturation 75%. Peak expiratory flow rate is 400-500 L/mt. The presence of Hb increases the 02 carrying capacity of the blood by 70 fold. Intra-pleural pressure (recoil pressure) required to prevent collapse of the lung 4 mm Hg in presence of surfactant. Intrapleural pressure at the end of deep inspiration is - 4 mm Hg. Intrapleural pressure during expiration is - 2 mm Hg. Compliance of the normal lungs and thorax combined 0.13 liter/cm, of H2O. Compliance of the normal lungs alone is 0.22 liter/cm of H2O. During normal quiet breathing only 2-3% of the total energy expenditure is needed for pulmonary ventilation. The amount of alveolar air replaced by new atmospheric air with each breath is only l/7th. Expired air contains 2/3rd alveolar air + l/3rd dead space air. 63% of carbon dioxide is transported as bicarbonate form 97% of O2 is transported by Hb, rest 3% is in dissolved state in the water of the plasma and cells. Carbon mono oxide binds with Hb. 230 times more strongly than ()2. Under resting conditions each 100 ml of blood transports 5 ml of O2 to tissues and carries 4 ml of CO2 from tissues to the lungs. Death occurs usually when the pH of the blood falls to 6.9. The decrease in 02 affinity of Hb when the pH of blood falls is called Bohrs effect. The degree of stimulation of chemoreceptors depends on arterial PO2. Spirometer cannot measure Functional Residual Capacity. Functional residual capacity is measured by Nitrogen wash out or single breath oxygen method. Most potent respiratory stimulant is carbon dioxide. Kausmaul breathing is seen in diabetic ketoacidosis and it is not a feature of Hypercapnic acidosis. Hering-breuer reflex: impulses from stretch receptors. Peripheral chemoreceptors are carotid & aortic bodies.

26

Respiratory centers: o o Inspiration dorsal group of neurons near tractus solitarius nucleus. Expiration ventral group situated in ventral part of medulla.

Normal value of FEV 1 in an adult male is 80%. Muscles of Inspiration Diaphragm and External Intercostals muscle (Others Stcrnocleidomastoid, Serratus anterior). Muscle of Expiration Internal Intercostal muscle. (Rectus abdominis). Intra alveolar pressure during inspiration 1 mm Hg. Tidal volume: 500 ml. Inspiratory reserve volume: 3300 ml. Expiratory reserve volume: 1000 ml. Residual volume: 1200 ml. Respiratory minute Volume in a normal person is 6.0 L/min. Inspiratory capacity: 3800 ml. Vital capacity : 4800 ml. Total lung capacity: 6000 ml. Functional residual capacity in a male is 2.2 liters. Normal dead space air volume 150 ml. Timed vital capacity in 1sec is 83%. Timed vital capacity in 2 sec is 94%. Oxygen dissociation curve is S shape or sigmoid shape. Shift to right Decrease pH Increase in temp Excess of 2, 3 DPG Increase PCO2 (Bohr effect) Decrease PO2 Shift to left Increase pH decrease in temp Foetal blood -

ENDOCRINE SYSTEM Hormone which acts on the target cell is called as 1st messenger. Cyclic AMP is the most common 2nd messenger for protein hormones. Other 2nd messengers are Ca++, Calmoduline, Inositol triphosphate(IP3) & cyclic GMP. Anterior pituitary hormones are o Growth hormone or somatotropic hormone

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o o o o o

Thyroid stimulating hormone Adenocorticotropic hormone Follicle stimulating hormone Luiteinizing Hormone or interstitial cell stimulating hormones in males Prolactin. Antidiuretic hormone or vasopressin Oxytocin

Posterior pituitary hormones are o o

ADH causes conservation of body water & contraction of vascular smooth muscle. Gigantism is due to the hyper secretion of growth hormone in childhood or in the pre-adult life before the fusion of epiphysis of bone with the shaft. Acromegaly is due to hyper secretion of GH in adults after the fusion of epiphysis with shaft of the bone. Dwarfism is a disorder of GH reduction in infancy or early childhood. Diabetes insipidus is a syndrome developed due the defiency of ADH. Hormone responsible for uterine contraction during labour & letting down of milk is Oxytocin. The anterior pituitary has the largest blood flow of any tissue in the body. Anterior pituitary hormones with diabetogenic effect GH, ACTH, TSH, and PRL. Pigmentation is not a feature of panhypopituitarism. Hormones of thyroid gland are o o o Thyroxine (T4) 90% Triiodothyronine (T3) 10% Calcitonin disease is an auto-immune disease which causes

Potency of T3 is four times more than that of T4. Graves hyperthyroidism.(exophathalmic goiter) Cretinism is hypothyroidism in children & myxedema due to hypothyroidism in adults. Parathormone is secreted by para thyroid gland & its main function is to increase the blood Ca++ level by mobilizing Ca++ from bone. Calcitonin reduces the blood Ca++ level by decreasing the bone re-absorption. Tetany results from hypocalcaemia, caused by hypoparathyroidism. Pancreatic hormones are o Alpha cell Glucagons

28

o o o

Beta cells Insulin Delta cells Somatostatin F or PP cells Pancreatic polypeptide

Insulin is the only anti diabetic hormone secreted in the body. Glucagons actions are antagonistic to that of insulin. Somatostatin inhibits the secretion of both glucagons & Insulin. Hormones of Adrenal cortex are o Mineralocorticoids (secreted by zona glomerulosa) o Aldosterone ( Na+ & excretion of K+) 11 deoxy corticosterone Cortisol Corticosterone Dehydroepiandrosterone Androstenedione Testosterone

Glucocorticoids (zona fasiculata)

Sex hormones (zona reticularis)

Cushing syndrome is a disorder characterized by obesity due to hyper secretion of glucocorticoids. Conns syndrome is primary aldosteronism. Addisons disease is chronic adrenal insuffiency. Hormones of Adrenal medulla (Catecholamines) are o o o Adrenaline or epinephrine Noradrenaline or norepinephrine Dopamine

Pheochromocytoma is a condition in which there is excessive secretion of catecholamines. Melatonin is secreted by parachymal cells of pineal gland, acts on gonads. Severe stress can raise ACTH and cortisol level by 20 folds. Fetal lung maturation depends on increased fetal Cortisol just before birth. Human prolactin causes synthesis of milk in the female breast. The half life of circulating growth hormone in humans is 20 to 30 minutes.

29

BLOOD Blood is a connective tissue in fluid form. Blood is 5 times viscous than water. Blood cell count is greater in children than adult. RBC is microcytic in iron defiency anaemia, prolonged forced breathing & increased osmotic pressure. RBC is macrocytic in megaloblastic anaemia, muscular exercise & decreased osmotic pressure in blood. Punctate basophlism is seen in lead poisoning. Goblet ring is seen in certain types of anaemia like malaria. Red cell vol. can be determined by radio isotope 51 Cr. Cyanosis appears when the reduced Hb cone, of the blood in the capillaries is more than 5 gm/dl. In vitro, coagulation is initiated by factor XII. Life of RBC's in adult human body is 120 days. Average life span of RBC in a newborn is 100 days. Average life span of RBC in transfused blood is 90 days. Life span of transfused platelets is 4 days. Life span of platelets is 9-12 days. Complete erythropoiesis occurs in 7 days. Erythropoiesis occurs in o In first trimester RBC's are formed in Yolk sac. While in second trimester liver is the main organ. Third trimester in liver & bone marrow. o o o Upto age of 5 6 yrs red bone marrow of all bones. 6 20 yrs red bone marrow of all bones & all membranous bones. After 20 yrs all membranous bones & ends of long bone.

Hb starts appearing in intermediate normoblastic stage of erythropoiesis. Nucleus disappears during late normoblastic stage. Factors needed for Erythropoiesis: erythropoietin, thyroxine, interleukins 3, 6, 11, stem cell factors, Vit B, C & D. (maturation factors Vit B12 & folic acid). The iron remains in ferrous state. The affinity of Hb for CO2 is 20 times more than for O2. The affinity of Hb for CO is 200 times more than its affinity for O2. Adult Hb consists of 2 alpha & 2 beta chains. Fetal Hb consist of 2 alpha & 2 gamma chains.

30

In sickle cell anemia, the 2 alpha chains are normal but 2 beta chains are abnormal. In Hb C, beta chains are abnormal. Bilirubin is the final product formed from the destruction of Hb. Total quantity of the iron in the body is 4gm. 1 mg of iron is excreted every day through faeces. Normocytic normochromic anaemia is seen in aplastic aneamia. Marcocytic normochromic anaemia seen in folate deficiency, Vit B12 & hypothyroidism. Pernicious anaemia or addsion's anaemia is marcocytic normochromic anaemia. Microcytic hypochromic is seen in iron deficiency, thalassemia, heamoglobinopathies & heamolytic anaemia. ESR decreases afibrinogenemia. Character 1. ESR Normal Male: 3 7 mm / hr Female: 5 9 mm / hr 2. PCV (Packed cell Male: 40 45 % Female: 38 42 % in allergic conditions, sickle cell anaemia, polycythemia &

volume) (Hematocrit) 3. MCV (Mean

90 cu (78 90 cu)

corpuscular volume) 4. MCH corpuscular Hb) 5. MCHC (Mean 30% (13 38%) (Mean 30 pg (27 32pg)

corpuscular Hb Conc.) 6. 7. 8. Colour index WBC D.C Neutrophils Eosinophils Basophils Monocytes Lymphocytes 50 70% 24% 01% 2 6% 20 30 % 1 (0.8 1.2) 4000 11,000 / cmm

31

9. 10. 11. 12. 13.

Platelet count Bleeding time Clotting time Prothrombin time Activated thromboplastin time(APTT) partial

2,50,000( 2 lakhs 4 lakhs) 3 6 min 3 8 min 12 sec 25 40 sec

14.

RBC Adult male Adult female Birth

4 5.5 millions / mm3 5 millions / mm3 4.5 millions / mm3 8 10 millions / mm3

15.

Heamoglobin Adult male Adult female New born 14 18 gm / dl 12 16 gm / dl 16 22 gm /dl

16.

RBC Diameter 7.5 5 liters

17.

Blood volume

Granulocytes are neutrophils, eosinophils & basophils. Agranulocytes are monocytes & lymphocytes. Monocyte is the largest lymphocyte. In hemophilia clotting time is prolonged in presence of normal bleeding time. Christmas disease occurs due to deficiency of factor IX. Clotting factors Factor I Factor II Factor III Factor IV Factor V Factor VI Factor VII Factor VIII Factor IX Fibrinogen Prothrombin Thromboplastin Calcium Pro accelerin (labile factor) No such factor Stable factor Anti hemophilic Christmas

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Factor X Factor XI Factor XII Factor XIII Blood group: Group A B AB O

Stuart-power Plasma thrombplastin antecedent Hegman (Conduct) Fibrin stabilizing factor (Fibrinase)

Antigen in RBC A B A&B No antigen

Antibody in serum Anti B () Anti No anti body Anti A & Anti B

Universal recipient are Blood Group 'AB because it does not contain either Anti A ab or anti B ab. Universal donor is Blood Group "()" because it docs not contain either A or B agglutinogen (antigen). Commonest blood group is O. Diseases associated with blood groups: o o Group A C.A stomach Group O duodenal ulcer

Normal basic acid output is 5-10 mmol/hour. Blood is stored in the blood bank at 40C. The number of iron Heme in one Hb molecule is 4. The number of O2 molecules carried by one Hb molecule is 4. Mean corpuscular diameter is 7.5 nm. Maximum concentration of Hb normally found in RBC's is 34%. In arterial blood, saturated Hb with 02 is 97%. Thromboxane A2 is synthesized by platelets and promotes vasoconstriction and platelet aggregation. In sickle cell anemia, valine is substituted for glutamic acid. Platelets are derived from megakaryocytes. Pus contains Dead neutrophils, macrophages and necrotic tissues. Cardiac output in anemia is above normal while in polycythemia is about normal. Agglutinins are either IgM or IgG. In Erythroblastosis fetalis, mother is Rh-, father is Rh+, foetus is Rh positive. Hapatoglobin is a plasma protein responsible for carrying free Haemoglobin. Usual anticoagulant used for transfusion is a citrate salt.

33

Earliest feature of iron deficiency anemia is decreased serum ferritin. Arneth count is used in the determination of the percentage distribution of different types of neutrophils on the basis of no: nuclear lobes. Wilsons disease is due to decrease in caeruloplasmin. EXCRETORY SYSTEM

Hormones secreted by kidney are erythropoietin, thrombopoitein, renin & 1, 25 dihydroxy cholecalciferol. 1 kidney contains about 1 1.3 millions nephrons. Ratio of corical nephrons to Juxtamedullary nephrons 85: 15. The GFR of average sized normal man is approximately 125 ml / minute or 180 liters / day. At the rate of 125 ml/min, the kidneys filter an amount of fluid equal to 4 times the TBV, 15 times the ECF vol. and 60 times the plasma volume. 1 1.5 liters of urine formed / day. Urine osmolality in diabetes insipidus is 300 mmol/L. Normal protein excretion is 50 -150 mg%. The quantity of water lost as sweat per day is 600-800 C.C Normal urea clearance is 44 ml/min. Renal blood flow is 25% of cardiac output (1300 ml blood/min). Total length of distal convoluted tubule is 5 mm. Glomerulus membrane permits the passage of substances upto 4 nm and almost totally excludes substance with size greater than 8 nm. Each glomerulus is a net work of approximately 50 parallel capillaries. Urinary osmolality in diabetes insipidus is 300 m mol/Lit. Glucose and amino acid are absorbed in proximal convoluted tubules by secondary active transport or sodium Co-transport. Descending limb of thin segment of loop of Henle is freely permeable to water. Areas impermeable to water ascending limb of thin segment thick segment of loop of Henle. Proximal half of convoluted tubule. Areas impermeable to urea Distal convoluted tubule & cortical portion of collecting tubules. Substances completely reabsorbed in PCT Glucose, proteins, amino acids, vitamins, acetoacetate.

34

Substances partially absorbed in PCTNa. K, Cl (7/8 reabsorbed in PCT). Substances secreted in PCT H+, PAH (para amino hippurate). creatinine. H+ are actively secreted in proximal tubules, distal tubules, collecting ducts. Hyperosmilality in the interstitum is the prerequisite for excretion of concentrated urine. Urea is reabsorbed from inner meduallary collecting ducts only in presence of ADH. K+ is actively secreted in Late Distal tubules and Collecting ducts. Macula densa is the epithelial cells of the distal tubule that comes to contact with the arterioles. Juxtaglomerular cells produce renin. Renin acts on angiotensinogen & convert it into angiotensin I. Renal threshold for glucose is reduced in renal glycosuria. Creatinine clearance represents GFR. Clearance test for renal function includes inulin clearance, creatinine clearance & PAHA test. PAHA test is performed to assess renal blood flow. Micturition is primarily a spinal reflex. Thick ascending loop of henle is impermeable to water. Majority of sodium absorption occur in the proximal tubule. Character pH Volume Specific gravity 4. 5 6 1000 1500 ml / day 1.010 1.025 Normal

MALE REPRODUCTIVE SYSTEM Average pH of semen is 7.5. Life span of spermatozoa within the female genital tract is upto 24 hours. Speed of human sperm in female genital tract is about 3 mm/min. Male sex hormones are called the androgens (secreted by leydig cells); testosterone, dihydro testosterone & androstenedione. Mullerian ducts gives rise to female accessory sex organs such as vagina, uterus & fallopian tube. Wolffian duct gives rise to male accessory sex organs such as epididymis, vas deferens & seminal vesicles.

35

Fetal testes begin to secrete the testosterone at about 2 nd to 4th month of embryonic life. The secretion from seminal vesicles contains fructose, phophorylcholine, fibrinogen, ascorbic acid, citric acid, pepsinogen, acid phosphatase & prostaglandin. Fructose & citrate acts as fuel for the spermatozoa. Prostatic secretion is rich in enzymes, fructose & citrate. Androgen appears to be essential for spermatogenesis. Whereas FSH is required for spermatic maturation. Testes do not produce fructose.(seminal vesicle) Sertoli cells provide nutrition to the developing sperm; secrete oestrogen & hormone binding proteins. Testosterone is synthesized from pregnanolone. Testosterone stimulates the process of spermatogenesis, also necessary for the formation of secondary spermatocyte from primary spermatocyte. Growth hormone is essential for the general metabolic processes in testis. Male sex hormone is secreted mainly by interstitial cells of Leydig. Development of male sex organ in fetal life depends on testosterone produced under the influence of HCG. Testosterone circulates in Combination with Gonadal steroid binding globulin. Hormone used for treating osteoporosis in old age Testosterone. In males FSH promotes spermatogenesis by enhancing the transport of Testosterone to seminiferous tubules and androgen binding protein synthesis from sertoli cells. FEMALE REPRODUCTIVE SYSTEM

During menstrual period, upto 20 gm of protein may be lost. Quantity of blood expelled during normal menstral cycle is 40 ml (approx) & serous 35 mls. FSH level is high in post menopausal women. Ovarian hormones are estrogen and progesterone Ovulation occurs on the 14th day of menstrual cycle in a normal cycle of 28 days. Oxytocin causes contraction of smooth muscles of uterus & enhances labour. Hormones secreted are HCG, Oestrogen, progesterone & human chorionic somato mammo tropin.

36

Relaxin is a hormone secreted from the maternal ovary during the later periods of pregnancy. Biological test for Pregnancy can be performed only after 2 3 weeks of conception. LH is concerned with follicle maturation and ovulation. Menopausal hot flushes are due to LH surge. Estrogen increases the secretion and ciliary beating in fallopian tubes. Estrogen changes the cuboidal lining of vagina to stratified. Estrogen changes the break down of glycogen into lactate in vagina. Estrogen initiates breast development. Estrogen causes early epiphyseal closure. Estrogen causes water retention. Important function of progesterone is to promote secretory changes in endometrium. Progesterone is the hormone for maintenance of pregnancy. Progesterone inhibits ovulation. The most important function of progesterone is to promote secretory changes in endometrium. WATER & ELECTROLYTE / ACID-BASE BALANCE

In human beings the total body water varies from 45 75 % of body weight. Total water in the body is about 40 liters. (ICF forms 55% & ECF forms 45%). The volume of interstial fluid is about 12 liters. The volume of plasma is about 2.75 liters. Osmolality is the measure of a fluids capability to create osmotic pressure, also called as osmotic conc. of a solution. Osmolarity is the no: of particles / per liter of solution. Isotonic solutions are having same effective osmolality as body fluids. Eg: 0.9% Nacl solution & 5% glucose solution. The insensible water loss from the body is about 600 to 800 ml. per day. The quantity of water lost as sweat per day is 600 800 C.C. The normal pH of plasma is 7.4 Acidosis is pH below 7.38 Alkalosis is pH above 7.42 Respiratory acidosis: primary excess of carbonic acid

37

Due to hypoventilation as in respiratory diseases & neural diseases. As in lactic acidosis, diabetic ketoacidosis, uremic acidosis & diarrhea. Due to hyperventilation as in hypoxia, neural diseases & psychological conditions.

Metabolic acidosis: primary deficiency of bicarbonate o Respiratory alkalosis: primary deficiency of carbonic acid o

Metabolic alkalosis: primary excess of bicarbonate o As in vomiting & treatment with diuretics.

38