PHS 3342
Physiological Regulation of Intake, Distribution, Protection and
Elimination
January – April, 2018
Course Description:
Part 2 of a comprehensive study of human physiology with an emphasis on regulatory mechanisms. This course
includes the physiology of the cardiovascular, immune, respiratory, renal and digestive systems. It is assumed that
students have a basic knowledge of chemistry, physics and biology.
Recommended Text:
The course text is: L. Sherwood & C. Ward. Human Physiology; From Cells to Systems, Nelson Education, 3rd
Canadian Edition and it can be purchased at the main University Bookstore or online (www.agorabookstore.ca). This
textbook comes with an Access Code to MindTap that provides interactive learning exercises, definitions, practice
quizzes and some animations with self-testing. Course notes will be posted by each lecturer on the course web site
(see below) so that you can download and print them before each new lecture series.
Student Evaluation:
The midterm exam is worth 32% of your final mark. There will be a final exam in April that is worth 60% of your
final mark. All exams will include a mix of multiple choice and short essay-style questions. If you have to miss an
exam due to illness, you must notify the course coordinator (J. Carnegie) before the exam takes place. You
also have 5 school days from the day of the exam to provide appropriate medical documentation indicating
that you were seen by your family physician or by University Health Services on or before exam day and
found by that health care provider to be too ill on exam day to write your exam. Only then will you be eligible
to write a deferred exam. If you do not write the regular exam or the deferred exam, you will obtain a zero for
that section of the course. For those of you with approved medical documentation, the deferred midterm exam will
take place on Wednesday, February 21 in RGN 3248 and beginning at 2 PM. The deferred final exam will take place
during June. The remaining 8% of your mark will come from online assignments that will be given to you throughout
the course by Drs. Carnegie, Hébert and Leddy; more information will be given about these assignments in class and
the due dates for the Aplia assignments available via MindTap are indicated on the last page of this document.
Course Web Site: Brightspace
Link to MindTap for the Aplia Assgnments: You can find this on Brightspace and due dates for
assignments re indicated on the last page of the syllabus.
.
Course Coordinator:
Dr. Jackie Carnegie, Department of Cellular & Molecular Medicine,
Room 3144 Roger Guindon, 451 Smyth Road
tel: 613-562-5800, ext. 8072
email: jcarnegi@uottawa.ca
Office hours by appointment
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SOME HELPFUL HINTS
1.
2.
3.
ATTENDANCE: The professors teaching this course devote a considerable amount of time to the preparation and delivery
of quality lectures. Lectures provide valuable opportunities to listen to explanations of challenging concepts, to ask questions
in order to better understand course material, to make yourself aware of information being emphasized by the instructor, and
to review material at the end of a topic. We are limited in our abilities to help you learn if you are not in class!
QUOTATION FROM FELLOW STUDENT WHO COMPLETED THE COURSE EVALUATION LAST YEAR WHEN
ANSWERING QUESTION AS TO HOW THE COURSE COULD BE IMPROVED: Really not much, honestly. Difficult
material at times but success in this course is dependent on the effort put in. All professors involved have done more
than enough to help us students out.
EXAMS: The exam format incorporates both multiple choice questions and questions that require written answers. These
questions will test both your retention and your comprehension of the course content. Questions requiring written answers will
usually be short answer (5-7 marks) questions. Common errors made by students when answering these questions are to:
a. Not write enough. For example, a 6-mark question requires 6 well-presented pieces of information. While this can often
be accomplished in ½-1 exam page, it requires the writer to be concise, to stay on topic and to provide significant
material that pertains to the question being asked.
b. Not answer the question. Sometimes students read the question too quickly and then write 1 or 2 pages of information
that may be correct, but that have little to do with the question being asked. While the information is not wrong, marks
cannot be given for material that does not pertain to the question itself.
c. Not demonstrate understanding of the material being discussed. Short answer questions should be seen as your
opportunity to demonstrate what you know and understand. You want to convince the professor marking the answer
that you have a clear understanding of the information you are presenting and of its significance to the physiological
process being described. Be clear, be concise, and write as neatly as you can.
d. Prepare at the last moment. There is a considerable amount of material presented in this course and almost all marks
are derived from each student’s performance during exams. For this reason, it is essential that you discipline
yourselves to set aside at least 2 hours each week to review course content and to prepare for upcoming lectures. You
cannot learn and comprehend all of the necessary information in the last night or two before an exam. You need to
work with this material throughout the duration of the course in order to ensure success at exam time.
Lecture Schedule
MONTH
January
Tuesdays
08:30-10:00
SITE GO 103
9
B-1
16
B-3
23
30
CV-2
CV-4
Fridays
10:00-11:30
SITE GO 103
12
B-2
B-4 &
19
CV-1
26
CV-3
2
CV-5
March
April
13
K-2
27
K-4
6
R-1
13
R-3
20
R-5
27
GI-1
3
GI-2
10 (10:00)
9
16
PROFESSOR
Blood
J. Carnegie
Cardiovascular
System
(jcarnegi@uottawa.ca)
Midterm exam (32% final mark (Blood &
Cardiovascular System)
R. Hébert
Renal System
6
February
TOPIC
K-1
K-3
STUDY WEEK: FEBRUARY 19-23
2
9
16
23
K-5
R-2
R-4
R-6
GI-2
GI-3
6
GI-4
Renal System
Respiration
Gastrointestinal
(rlhebert@uottawa.ca)
R. Hébert
(rlhebert@uottawa.ca)
J Leddy
(jleddy@uottawa.ca)
J Carnegie
(jcarnegi@uottawa.ca)
Exam period for Winter Term is April 13-26 (Exam worth 60% of final mark)
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PHS3342 Course Objectives
Blood and the Cardiovascular System (Dr. J. Carnegie)
1. Blood
1.1. Describe the composition of blood (plasma & formed elements)
1.2. Erythrocytes:
1.2.1. Describe the structure and function of RBCs; structure and properties of hemoglobin
1.2.2. Describe erythropoiesis, mechanisms of control, and life cycle of erythrocytes
1.2.3. Distinguish between the various types of anemias and, specifically between sickle cell anemia and
sickle cell trait; define polycythemia and provide an example of each of polycythemia vera, secondary
polycythemia and artificial polycythemia
1.3. Leucocytes
1.3.1. Define: margination, diapedesis, chemotaxis; explain the roles of selectins and integrins in leucocyte
margination
1.3.2. List the different types of leucocytes and assign 1-2 primary functions to each
1.3.3. Briefly describe the production of leucocytes and its regulation
1.3.4. Distinguish between: leukemia, infectious mononucleosis and leukopenia
1.4. Hemostasis:
1.4.1. Explain the principal steps and justify the role of platelets and clotting factors in this process
1.4.1.1.
Distinguish between intrinsic and extrinsic pathways to prothrombin activator
1.4.1.2.
Explain the role of the fibrinolytic system in blood clotting
1.4.1.3.
Distinguish between: procoagulant, anticoagulant, thrombolytic agent, giving examples of
each
1.4.2. Describe the ABO and Rh systems of blood typing and explain the basis of transfusion reactions
2. Introduction to the Immune System
2.1.
Distinguish between the non-specific (innate) and specific (adaptive) mechanisms of defence
3. The Heart
3.1.
3.2.
3.3.
3.4.
3.5.
3.6.
Trace the pathway followed by blood in both the pulmonary and systemic circuits
Describe the internal and external anatomy of the heart
Define: blood flow, blood pressure, resistance and define resistance in terms of blood vessel radius
Justify the importance of the coronary circulation
Briefly compare the physiological properties of cardiac muscle cells with those of skeletal muscle cells
Compare the electrical properties of contractile cardiac muscle cells with those of autorhythmic cardiac
muscle cells
3.7. Explain how the intrinsic conduction system of the heart allows it to function as a pump.
3.8. Explain what is an ECG tracing and the nature of the information it is providing
3.9. Explain the events occurring during each phase of the cardiac cycle
3.9.1. Distinguish between valvular obstruction and valvular insufficiency
3.10. Define cardiac output in terms of heart rate and stroke volume
3.11. Describe in detail the mechanisms for the regulation of heart rate & stroke volume
4. Blood vessels and hemodynamics
4.1. Compare and contrast the structure of the walls of arteries, capillaries and Define blood flow, blood pressure,
resistance, peripheral resistance
4.2. Illustrate the changes in blood pressure throughout the various vessels of the circulatory system
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4.3. Explain the factors that affect resistance and justify the importance of arterioles in the control of peripheral
resistance
Define systolic and diastolic arterial pressure, pulse pressure and mean arterial pressure
Identify and justify the value for mean capillary blood pressure
Express blood pressure in terms of cardiac output and peripheral resistance
Distinguish between intrinsic and extrinsic mechanisms of regulation of blood flow to capillary beds, in terms
of goals, mechanisms and regulation
4.8. Describe the classification of capillaries, providing sample locations for each capillary subtype
4.9. Explain the forces that act to influence exchange at the arterial and venous ends of capillaries
4.10. Summarize the strategies used by the venous system to promote venous return
4.11. Justify the role of the lymphatic system in maintaining blood volume
4.12. Describe the composition of the cardiovascular centre and distinguish between the roles of the sympathetic
and parasympathetic nervous systems in the regulation of the cardiovascular system
4.4.
4.5.
4.6.
4.7.
Renal System (Dr. R. L. Hébert)
1. Describe the nephron as the functional unit of the kidney
1.1. describe the gross anatomy of the kidneys, including the blood & nerve supplies
1.2. describe the structure of a nephron; differentiate between cortical & juxtamedullary nephrons
1.3. describe the functional anatomy of the filtration membrane
1.4. define net filtration pressure
1.5. influence of size and charge of dextran on its filtrability
2. Define the main function of the kidneys
2.1. define glomerular filtration, tubular reabsorption, tubular secretion; differentiate between filtrate & urine
2.2. define glomerular filtration rate; be aware of normal value
2.3.
calculate the clearances of different substances
2.4. define renal plasma flow, renal blood flow, filtration fraction
2.5. define the juxtaglomerular apparatus
2.6. define the autoregulation of the kidney
3.
Define the mechanism of urine formation by the kidneys
3.1. define the composition of the urine
3.2. explain the countercurrent multiplier system
3.3. explain the countercurrent exchanger system
3.4. define the regulation of body fluid by the kidney
3.5. explain the excretion of hypoosmotic and hyperosmotic urine
3.6. explain the influence of ADH on urine concentration and urine dilution
4.
Define the transport processes of sodium: Indicate the importance of tubular reabsorption;
4.1. distinguish between active and passive tubular reabsorption; link tubular reabsorption with different regions
of the renal tubules
4.2. define the transport properties of the proximal tubule, thick ascending limb, distal convoluted tubule, cortical
collecting duct
4.3. HCO3- reabsorption by the proximal tubule.
4.3.1.
define the role of intercalated cells
4.3.2.
describe acid-base regulation by the kidney
4.4
define the renin-angiotensin-aldosterone system
4.5
explain the characteristics of glucose transport
4.6
describe the regulation of micturition
4
Respiratory System (Dr. J. Leddy)
1. Anatomy
1.1. Describe the gross structure of the airways, lungs and pleural coverings.
1.2. Describe the structures of each one of the components of the conduction and respiratory zones.
1.3. Identify the mechanism by which particles are cleared from the airways.
2. Pulmonary Mechanics
2.1. Draw a normal spirogram, labeling the lung volumes and capacities. List the volumes that comprise each of
the four capacities. Identify which volume and capacities cannot be measured by spirometry and describe the
concept by which such volumes can be measured (helium dilution method).
2.2. Identify the forces that generate the negative intrapleural pressure when the lung is at functional residual
capacity, and predict the direction that the lung and chest wall will move if air is introduced into the pleural
cavity (pneumothorax).
2.3. Explain the roles of the diaphragm & accessory muscles during inspiration & expiration.
2.4. Draw the pressure-volume (compliance) curves for the lungs, chest wall, and respiratory system on the same
set of axes. Show and explain the significance of the resting positions for each of these three structures.
2.5. Define the factors that determine total lung capacity, functional residual capacity, and residual volume.
Describe the mechanisms responsible for the changes in those volumes that occur in patients with
emphysema and pulmonary fibrosis.
2.6. Diagram how pleural pressure, alveolar pressure, airflow, and lung volume change during a normal quiet
breathing cycle. Identify on the figure the onset of inspiration, cessation of inspiration, and cessation of
expiration. Describe how differences in pressure between the atmosphere and alveoli cause air to move in
and out of the lungs.
2.7. Draw a normal pulmonary pressure-volume (compliance) curve (starting from residual volume to total lung
capacity and back to residual volume), labeling the inflation and deflation limbs. Explain the cause and
significance of the hysteresis in the curves.
2.8. Define compliance and identify two common clinical conditions in which lung compliance is higher or lower
than normal.
2.9. Define surface tension and describe how it applies to lung mechanics, including the effects of alveolar size
and the role of surfactants. Define atelectasis and the role of surfactants in preventing it.
2.10. Describe the principal components of pulmonary surfactant and explain the roles of each.
2.11. Describe the effects of airway diameter and turbulent flow on airway resistance.
2.12. Describe how airway resistance alters dynamic lung compliance.
2.13. Describe the regional differences in alveolar ventilation in healthy and diseased lungs and explain the basis
for these differences.
3. Alveolar Ventilation
3.1. Define partial pressure and fractional concentration as they apply to gases in air. State Dalton’s Law and
Henry’s Law. Use them to describe the levels of O2, CO2, and N2 in atmospheric and alveolar air.
3.2. List the normal airway, alveolar, arterial, and mixed venous PO2 and PCO2 values. List the normal arterial
and mixed venous values for O2 saturation, [HCO3-], and pH.
3.3. Define and contrast the following terms: anatomic dead space, physiologic dead space, wasted (dead space)
ventilation, total minute ventilation and alveolar minute ventilation.
3.4. Describe the concept by which physiological dead space can be measured.
3.5. Define and contrast the relationships between alveolar ventilation and the arterial PCO2 and PO2
3.6. Describe in quantitative terms the effect of ventilation on PCO2 according to the alveolar ventilation equation.
3.7. Be able to estimate the alveolar oxygen partial pressure (PAO2) using the simplified form of the alveolar gas
equation.
3.8. Define the following terms: hypoventilation, hyperventilation, hypercapnea and hyperpnea.
4. Pulmonary Circulation
4.1. Contrast the systemic and pulmonary circulations with respect to pressures, resistance to blood flow, and
response to hypoxia.
4.2. Describe the regional differences in pulmonary blood flow in an upright person. Define zones I, II, and III in
the lung, with respect to pulmonary vascular pressure and alveolar pressure.
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4.3. Describe the consequence of hypoxic pulmonary vasoconstriction on the distribution of pulmonary blood
flow.
5. Pulmonary Gas Exchange
5.1. Name the factors that affect diffusive transport of a gas between alveolar gas and pulmonary capillary blood.
5.2. Describe the kinetics of oxygen transfer from alveolus to capillary and the concept of capillary reserve time
(i.e., the portion of the erythrocyte transit time in which no further diffusion of oxygen occurs).
5.3. Define oxygen diffusing capacity, and describe the rationale and technique for the use of carbon monoxide to
determine diffusing capacity.
5.4. Describe how the ventilation/perfusion (V/Q) ratio of an alveolar-capillary lung unit determines the PO2 and
PCO2 of the blood emerging from that lung unit.
5.5. Identify the average V/Q ratio in a normal lung. Explain how V/Q is affected by the vertical distribution of
ventilation and perfusion in the healthy lung.
5.6. Describe the normal relative differences from the apex to the base of the lung in alveolar and arterial PO2,
PCO2, pH, and oxygen and carbon dioxide exchange.
5.7. Predict how the presence of abnormally low and high V/Q ratios in a person's lungs will affect arterial PO2
and PCO2.
5.8. Describe two causes of abnormal V/Q distribution.
5.9. Define right-to-left shunts, anatomic and physiological shunts, and physiologic dead space (wasted
ventilation). Describe the consequences of each for pulmonary gas exchange.
5.10. Describe the airway and vascular control mechanisms that help maintain a normal ventilation/perfusion
ratio. Name two compensatory reflexes for V/Q inequality.
5.11. Be able to calculate the alveolar to arterial PO2 difference, (A-a)DO2. Describe the normal value for (A-a)
DO2 and the significance of an elevated (A-a) DO2.
5.12. Name ten causes of hypoxia and five causes of hypoxemia.
6. Oxygen and Carbon Dioxide Transport
6.1. Define oxygen partial pressure (tension), oxygen content, and percent hemoglobin saturation as they pertain
to blood.
6.2. Draw an oxyhemoglobin dissociation curve (hemoglobin oxygen equilibrium curve) showing the relationships
between oxygen partial pressure, hemoglobin saturation, and blood oxygen content. Compare the relative
amounts of O2 carried bound to hemoglobin with that carried in the dissolved form.
6.3. Describe how the shape of the oxyhemoglobin dissociation curve influences the uptake and delivery of
oxygen.
6.4. Show how the oxyhemoglobin dissociation curve is affected by changes in blood temperature, pH, PCO2,
and 2,3-DPG, and describe a situation where such changes have important physiological consequences.
6.5. Describe how anemia and carbon monoxide poisoning affect the shape of the oxyhemoglobin dissociation
curve, PaO2, and SaO2.
6.6. List the forms in which carbon dioxide is carried in the blood. Identify the percentage of total CO2 transported
as each form.
6.7. Describe the importance of the chloride shift in the transport of CO2 by the blood.
6.8. Identify the enzyme that is essential to normal carbon dioxide transport by the blood and its location.
6.9. Draw the carbon dioxide dissociation curves for oxy- and deoxyhemoglobin. Describe the interplay between
CO2 and O2 binding on hemoglobin that causes the Haldane effect.
6.10. Explain how breathing 100% O2 can result in further arterial O2 desaturation in hypoxemic patients who
develop mucous plugging of their airways (absorption atelectasis).
6.11. Define respiratory acidosis and alkalosis and give clinical examples of each.
6.12. Describe the mechanism and function of respiratory acid base compensations.
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7. Respiratory Control
7.1. Identify the regions in the central nervous system that play important roles in the generation and control of
cyclic breathing.
7.2. Give three examples of reflexes involving pulmonary receptors that influence breathing frequency and tidal
volume. Describe the receptors and neural pathways involved.
7.3. List the anatomical locations of chemoreceptors sensitive to changes in arterial PO2, PCO2, and pH that
participate in the control of ventilation. Identify the relative importance of each in sensing alterations in blood
gases.
7.4. Describe how changes in arterial PO2 and PCO2 alter alveolar ventilation, including the synergistic effects
when PO2 and PCO2 both change.
7.5. Describe the respiratory drive in a COPD patient, and predict the change in respiratory drive when oxygen is
given to a COPD patient.
7.6. Describe the physiological basis of shallow water blackout during a breath-hold dive.
Gastrointestinal System (Dr. J. Carnegie)
1. Summarize the general anatomical features and functions of the digestive system
1.1 differentiate between the components of the alimentary canal and the accessory digestive organ
1.2 describe the histology of the GI tract wall
1.3 outline the blood supply serving the main components of the GI tract
1.4 list and provide examples of the 4 types of physiological processes that occur in the GI tract
1.5 summarize general principles pertaining to the neural and hormonal regulation of GI tract function
2. Describe the region-specific digestive activities of the GI tract and their regulation
2.1 describe the digestive activities associated with the oral cavity and their regulation
2.2 describe the voluntary & involuntary regulation of deglutition; define & indicate some potential causes of
heartburn
2.3 describe the digestive functions of the stomach and their regulation
2.4 describe the exocrine function of the pancreas and its regulation
2.5 summarize the digestive roles of the liver and gallbladder & their regulation
2.6 summarize the digestive functions of the small intestine and their regulation
2.7 summarize the chemical digestion of carbohydrates, proteins, lipids & nucleic acids
2.8 outline the processes by which the various nutrient breakdown products are absorbed by the small
intestine
2.9 describe the digestive functions (& regulation) of the large intestine
2.10 describe the neural regulation of defecation
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How to access your MindTap course
PHS3342: Physiological Regulation of Intake, Distribution, Protection and Elimination
Instructor : Jackie Carnegie
Start Date : January 08, 2018
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Due Dates for Aplia Assignments
Assignment Title
Blood
Body Defenses
Cardiac Physiology
Vascular Physiology
Respiratory Physiology
GI Physiology
Book Chapter
9
10
7
8
11
14
Available (noon)
th
Tuesday, January 16
Friday, January 19th
Friday, January 26th
Tuesday, January 30th
Tuesday, March 6th
Friday, April 6th
Due (10:00 PM)
Monday, January 29th
Monday, January 29th
Monday, February 5th
Monday, February 5th
Thursday, March 29th
Thursday, April 12th
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