restrictive
Anatomy and Physiology Notes
Hypo = less; Hyper = more; Carina is the point in between the two bronchus. This is slightly right of the center, so it is closer to the right bronchus. The right bronchus also has less convergence (left bronchus curves a little to make place for the heart), so debris is more likely to enter the right main bronchus. Goblet Cells secrete mucus in trachea Laryngeal Cartilages are primarily made of hyaline cartilage (this is the same for most
cartilages) Conduction Zone in respiratory system starts in nasopharynx and ends in terminal bronchioles (ends where oxygen exchange occurs); It is where air is carried before oxygen and carbon dioxide are exchanged The brainstem has a group of nuclei that regulates the breathing rate, depth, and speed. These are called the Dorsal Group. When these are hurt, the person stops breathing, and this is usually the cause of death in
car accidents. Protect the back of your neck! BGP, or Bisphosphogliceride is an indication of decreased affinity in oxygen; more BPG = less affinity for oxygen Oxygen Dissociation Curve shifted right has lower O2 Affinity; shifted left has higher affinity Apnea is a lack of breathing (straight line) Tachypnea is fast breathing (narrower curves) Bradypnea is very slow breathing (longer curves) Orthopnea is dyspnea when lying down
Dyspnea is difficulty breathing and shortness of breath Apneustic Breathing is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release. Hyperpnea is deeper breathing (bigger curves) Hypopnea is small, shallow breaths (smaller curves). Hypoxia is less oxygen. Arteries go from the heart to other systemic organs Pulmonary Arteries carry
deoxygenated blood, while Normal Arteries carry oxygenated blood Epithelium is primarily in the inside of organs and in histology, it is represented by pink and purple colors (People dye thin slices and put them under microscope, so only certain tissues carry the dye making it pink and purple) FVC is the Forced Ventilation Capacity or how much you can forcibly expire or inspire FEV is Forced Expiratory Volume. If it says FEV1 it
means how much someone can expire in 1 sec. FIV is Forced Inspiratory Volume. If it says FIV1 it means how much someone can inspire in 1 sec. If you have extreme asthma or some other diseases, you may have to force out your breaths and your FEV1 would be much less. Somatostatin is a digestive enzyme secreted by the small intestine. Jaundice is when the liver gets inflamed and bile gets into the bloodstream creating a
yellow color in the skin. Immune System Antigens are proteins that stick to our blood cells. There are A, B, and O antigens (ABO Antigens), and these determine whether your blood type is A, B, AB, or O. If you need a blood transfusion, you can only get your blood type and O, because O blood has very few antigens so it is virtually harmless to you if you get O blood. If you are AB blood, you can get any blood, because you have A, B,
and you can get O blood too! RH Factor is another important antigen in matching blood types. You can have RH positive or RH negative blood, and if it is positive, you can only get blood from positive and negative, but if you have RH Negative, you can only pget negative RH blood. If affected by wrongly transfused blood, the body doesn’t recognize foreign blood, and so your antibodies try destroying transfused blood. This
leads to immune system confusion, so sometimes your own cells are destroyed (HIV or Autoimmune Disorders where your immune system works against yourself). Hemolysis is a very common end result of wrongly transfused blood. If a newborn baby has RH positive and the mother is RH negative, the mother’s body would treat the Baby’s blood as foreign, and the baby would be attacked by antibodies. THIS ONLY HAPPENS
AT BIRTH NOT IN WOMB. This causes Hemolytic Anemia. The baby turns yellow/colorless due to loss of blood and it can be easily identified today because we check for blood type during pregnancy. Hemo = blood related Hemolysis = blood cells destroyed Autoimmunity the immune system is going against and attacks the body’s own tissues or cells. Usually a midlife disorder. HIV (Human Immunodeficiency Virus) is a virus that
attacks the immune system’s T Helper Cells. This makes the body very vulnerable to viruses normal to everyday life, which is usually the cause of death. It can also cause Anemia and it makes you weak until you die. Anemia is low red blood cell count. You need iron to recreate red blood cells so iron replacement is a treatment for Anemia. This only works for smaller amounts of blood, though, so it can’t be a replacement for blood
transfusion if you get a lot of blood loss. Leukopenia is low white blood cell count Leuko = white Multiple Sclerosis is when your body attacks your own neurons (A part of your neurons called Myelin). Autoimmunity to Myelin. If Myelin Sheath is gone, the neuron network becomes much slower, and sometimes connection is lost, so you can lose function of parts of your body. Usually affects the Optic Nerve causing loss of vision or
double vision (diplopia). Disease usually affects young adult women. It also attacks the Cerebellum causing loss of balance and coordination (ataxia). Speech can be slurred. Loss of urinary control. Most times it shows up overnight, so one day you just wake up with loss of vision or imbalance. SYMPTOMS COME AND GO (relapsing remitting), because your body can rebuild Myelin Sheath, but sometimes it is destroyed again.
Diagnosis with an MRI, where you would see white patches on the brain from MRI. Sometimes they do a lumbar puncture, where they poke your spinal cord to get spinal fluid. If your spinal fluid has a protein oligoclonal band, you have Multiple Sclerosis. Axon is the part that connects two neuronal cells. Covered by a lipid layer called Myelin Sheath to make communication between neurons much faster. Some Myelin Sheaths
are in the Spinal Cord. The Central Nervous System is made up of the brain and the spinal cord. Hashimato Thyroiditis is a disease where you get hypothyroidism, which is where thyroid hormone (T3 and T4)is lacking due to an Autoimmune attack. Typically on young women who feel lethargic and who gain weight and they slow down. Weight gain is due to slowed fat digestion. Thyroid Stimulating Hormone (TSH) is
overactive trying to get more thyroid, but thyroid hormones are too low. Fat accumulates around eyes Graves Disease is where you get hyperthyroidism, so you get bulging eyes with less fat around them. Opposite of Hashimato Thyroiditis. Anaphylaxis is where you get an inflammatory reaction across the body due to any allergen, and you get a slight swelling all around your body. This can make the epiglottis block your
airway due to inflammation, which could make it life threatening. Epinephrine is used to stop the reaction. It is a type 1 hypersensitivity allergic reaction. Histamine is a buzzword for type 1 hypersensitive reactions and IgE is for any allergen. Myasthenia Gravis is an Autoimmune disorder where your ACH receptor doesn’t work so their neural connection between brain and muscle is destroyed. It can be reversed. Can cause
drooping eyelids and diplopia because of weaker muscles. Attacking cells are usually located in the thymus, so if there is a tumor in thymus (Thymoma), this may cause Myasthenia Gravis. Usually relatively young patients. Contact Dermatitis is a type 4 hypersensitivity reaction, so Immune Complexes like Antibodies and Antigens are involved. Your skin has a reaction when it touches certain things. Lung and Breast Cancer are
most common cancers Blood Cancer is Leukemia Asthma is an obstructive lung disease where mast cells are activated. Fibrosis restrictive lung diseases when the lung loses its elasticity
Embolism - a blood clot that blocks areas of the body. It can block blood supply to certain parts of the body, so the tissue dies (lung tissue can die due to pulmonary embolisms, but this can also happen to the brain tissue or anywhere else) Pulmonary Embolism blood float blocked, blood obstructed. Tissue doesn’t get blood thus dies. Pulmonary ischemia lung tissue collapse, not functional anymore. Grafts = an external tissue
donor (transplanted kidney or something like that). Compliance is the lung’s ability to stretch and expand. Falciform Ligament is a tissue connecting two lobes in the lungs. Ligaments are thick tissues that connect things. Polyps are balloon-like growths (hollow/fluid inside). These can pop and bleed. These can evolve into cancer. Alcoholic Hepatitis - not caused by virus, excess consumption of alcohol causes inflammation of
liver Metabolic Rate - rate of body functions.
Disease
Pathophysiology (What is wrong)
Symptoms/Findings/Patient (What patient experiences)
Diagnosis (Imaging, lab)
Treatment or Outcome
Respiratory S
COPD (emphysema,
Chronic Obstructive lung disease – due to chronic bronchitis or emphysema. Smoking
Difficulty pushing air out/long expiration. Mucus obstructing airways. Goblet cells increase. Cough, dyspnea.
Wheezing
Bronchodilators
chronic bronchitis)
common cause.
Decreased vascularity on x ray
Steroids
Asthma
Inflammatory airway disease. Bronchial hyperreactivity., spasms. Obstructive. Polens,
Same as above. Attacks of cough, infections can follow. Shortness of breath, tight chest.
Wheezing
Same As above
allergens can initiate. Mast cells activated, inflammatory substances released.
IgE detected
Emphysema
Alveolar tissue destruction, decrease in alveolar surface for gas exchange, loss of
Use intercostal muscles for regular breathing, labored breathing, air trapped inside creating alveolar dead
elasticity, enlarged alveoli pressure capillaries, collapsed airway during expiration
space, barrel chest
Pneumonia
Infection of the lungs. Typically, bacterial (strep, mycoplasma, chlamydia, legionella)
Cough, shortness of breath, fever, sweating, chills, yellow or bloody mucus, rapid shallow breathing, fatigue,
X-ray opacity, MRI/CT
Antibiotics, oxygen, prevention by vaccines
or viral, rarely fungal esp in immunocompromised.
loss of appetite
Sleep Apnea
Breathing stops intermittently during sleep. Obstructive (muscles of pharynx/larynx
Day time sleepiness, loud snoring, sudden awakening, dry mouth
Sleep studies
CPAP – continuous positive airway pressure
block airway) and central (brain, cardiac control dysfunction)
by a machine, supplemental oxygen
Cystic Fibrosis
Genetic disorder with thick sticky mucus clogging airways. Pancreas, liver, kidney also
Salty skin, chronic cough, frequent lung infections, poor growth in children. Can develop bronchiectasis.
Sweat test, genetic testing for CFTR protein
involved. Diagnosed by age 2.
Clubbing skin.
gene mutations. Life expectancy to age 40.
Tuberculosis
Caused by mycobacterium tuberculosis; ERADICATED in the west, so if the patient
Coughing blood, constant cough; Loss weight and appetite (only if there is also a cough); night sweat is
Diagnosed with night sweat, weight loss,
Isoniazid and rifampin(Specific Antibiotics)
has been to Africa or Asia, it is likely.
common (also with cough)
cough, fever, tired, anorexia
Disease
Digestive 5
Ulcers
Pathophysiology (What is wrong)
Symptoms/Findings/Patient (What patient experiences)
Bloating, abdominal pain, rarely bleeding – discoloration of stool, anemia due to slow blood loss
Cancers
Peptic (stomach) or duodenal. Related to H. pylori virus. Erosion
of mucosal lining. Acidity, drugs e.g. NSAID or aspirin, smoking
Esophageal (squamous cell 90% adenoca 10%), gastric (mostly
adenoca or lymphoma rarely) small intestine/colon/rectal
(commonly adenoca).
Diarrhea
Can be a symptom of many disorders
Lactose
Intolerance
Hepatitis
Genetic Lactase deficiency, unable to digest lactose (type of
sugar, common in milk)
Hep A, Hep B and Hep C common forms. Inflammation of Liver
due to viruses that prefer the liver. This is the reason for bile
problems (jaundice and dark urine, because the bile isn’t
released into the right areas so it goes into the blood)
Inflammation of appendix
Too much sugar in blood, so insulin (from pancreas) isn’t
sufficient to lower Blood Sugar.
Appendicitis
Diabetes
Disease
Immunology
HIV/Immunodefic
iencies
Multiple Sclerosis
Rheumatoid
Arthritis
Hashimoto
Thyroiditis
Graves Disease
Anaphylaxis
Diagnosis (Imaging, lab)
Treatment or Outcome
Esophagus: Vomiting blood, heartburn, swallowing difficulty, chest pain
Stomach: Bloating, indigestion, pain. Related to alcohol, obesity, H pylori, drugs, chronic ulcers
Colon: Rectal bleeding, blood in stool, weight loss, abdominal pain, anemia, constipation or diarrhea. Usually spread to liver or lungs. More
in developed countries. 3-4th most common cancer. Polyps can evolve into cancer. Adenomatous Polyps evolve into Colorectal Cancer.
Loss of electrolytes and water in stool. Infections eg parasites, virus, bacteria or food intolerance or tumors or inflammatory bowel diseases
can be the cause.
Diarrhea, cramps or bloating when consume dairy products.
Esophagus: Barium X ray, MRI, endoscopy, biopsy, PET
scan
Stomach: endoscopy
Colon: Colonoscopy, occult blood test
Stool exam, Neutrophils indicate bacteria, eosinophils
indicate parasites, blood indicate ca or ulcer
Hep A: fecal oral route
Hep B: sexual blood transmission
Hep C: blood transmission, tattoos, needles or blood transfusion
Jaundice, dark urine and malaise (tiredness) in all
Right lower abdominal pain, pain in McBurney Point
High Blood Sugar, loading liver, turning it to fatty liver. Hyperglycemia (high blood sugar) and Hypoglycemia (low blood sugar from excess
insulin pumped can cause fainting or death)
Vaccine for Hep and B, not for C
H pump blockers, diet, avoid aspirin
like drugs, antibiotic for H pylori
Surgery, Chemo or radiotherapy;
esophagoal and stomach fatal, colon
treatable
Lactase pills before meals
Ab levels in blood is diagnostic
Rest, hydration, antivirals. Avoid
contact. Can lead to cirrhosis (fibrosis of
hepatic tissue) or hepatic cancer.
Increased Leucocytes count in blood
High blood sugars + white dots (fat) in liver on CT
scan; glucose in urine test
Surgery, antibiotics
Fibrous food, cutting down on sugar
and carbs, and insulin pumps/injection
Pathophysiology (What is wrong)
Symptoms/Findings/Patient (What patient experiences)
Diagnosis (Imaging, lab)
Treatment and/or Outcome
Human Immunodeficiency Virus infection. If not treated causes AIDS (Acquired
ImmunoDeficiency Syndrome). Transmitted via blood, sexual contact or breast
milk. Virus causes weakened immune system, specifically attacks helper T cells
Autoimmune disorder. Myelin of central nervous system cells targeted. Nerve
conduction slows without myelin.
Autoimmune disease. Chronic inflammation of joints, usually distal small eg hand
and feet, later on knees, elbows involved. Rheumatoid Factor (RF) increases in
blood, and CCP, ESR, and CRP would also be elevated in blood test.
Autoimmune destruction of thyroid hormone producing cells. Hypothyroidism.
Tiredness, swollen lymph nodes, fever, night sweats, weight loss. Recurrent pneumonia.
Low CD4 cell count, frequent opportunistic infections, such
as pneumocyctis carini, tuberculosis, candidiasis or herpes.
Antigen or antibody blood or spit tests can diagnose.
Plaques visible on MRI indicating myelin loss.
Lumbar puncture for oligoclonal band
Rh factor detected in blood, elevated CRP(C-reactive
protein), ESR.
X ray – for joints and bone deformities.
High TSH, low thyroid hormones
No cure but antiretroviral therapy
(ART) drugs decrease viral load.
Stavudine, fuzeon, zidovudine
Immunesuppressants
Steroids
NSAIDs, steroids
Overproduction of thyroid hormones due to autoimmune response.
Hyperthyroidism.
Depends on area of CNS involved. Vision loss, diplopia, muscle weakness, numbness, balance problem, dizziness, speech urination
problems, depression. Young patients, more females. Symptoms can come and go (relapsing remitting attacks) or progress slowly.
Swollen painful joints, deformity, bone erosion, morning stiffness, fatigue, fever. Usually symmetric. Skin, lungs, kidneys and heart may
be involved.
Middle age women more likely. Sensitivity to cold, sluggishness, sleepiness, constipation, goiter, puffy face, brittle nails, dry skin, hair
loss, large tongue. Rheumatoid arthritis or diabetes may accompany. Heart problems, myxedema
Young women more likely. Anxiety, irritability, large thyroid gland (goiter), weight loss, bulging eyes, palpitations, sleep problems,
moist skin, heat sensitivity
T3, T4 replacement therapy,
levothyroxine
Radioactive thyroid
Antithyroid medications
Surgery
Epinephrine
Tachycardia, breathing trouble, swelling of airway, abdominal pain, nausea vomiting, hypotention
Allergic emergency
Usually fade in 24 hours.
Type 1 hypersensitivity reaction
Antihistaminics
Example - scabies
Weakness and rapid weakness of voluntary muscles, after repetitive use.
Arm and muscle weakness, double vision (diplopia), drooping eyelids (ptosis), chewing, swallowing and breathing. Most patients
Anti acethycholine receptor Antibodies in blood. EMG.
IVIG
Acetylcholine receptor antibody blocks acetylcholine neurotransmission. Ach
present with eye symptoms.
Thymus MRI may show tumor. Clinical improvement with
Thymectomy
antibodies originate from thymus. Thymomas can cause myasthenia.
Babies born to myasthenic mother can have the symptoms temporarily.
edrophonium (Tensilon) injection.
Arthus Reaction
Acute, localized inflammatory reaction typically after vaccination. Local type III
hypersensitivity (immune complex Ag/Ab mediated) reaction.
Serum Sickness
Immune complex mediated HTS reaction
Rash, fever, facial swelling, polyarthritis 1-2 weeks after the exposure to allergen. Eg: snake bite or amoxicillin. May lead to anaphylaxis.
Contact
Type IV Hypersensitivity reaction (delayed hypersensitivity). Itchy allergic
Bumps and blisters, scaly skin, tenderness, burning usually limited to area of exposure.
Patch test with potential allergens
Steroids
Dermatitis
immune reaction -rash due to an irritant substance eg jewelry, plants, cosmetics,
poison ivy. Occurs within days of exposure.
Infection Elevations: ESR (Erythrocyte Sedimentation Factor), CRP (C reactive Protein),
Hypersensitivity and Allergies: 4 Main Types of Hypersensitivity: Type I: reaction mediated by IgE antibodies. Type II: cytotoxic reaction mediated by IgG or IgM antibodies. Type III: reaction mediated by immune complexes. Type IV: delayed reaction mediated by cellular response.
Deficiencies Xeropthalmia – Vit A deficiencyPernicious Anemia – Vit B12 deficiency – ileum damage or gastrectomyScurvy – Vit C deficiency – bleeding gumsRicketts – Vit D deficiency – bowed legs, delayed bone maturity
Cheat Sheet Immune System Innate (nonspecific) defense is the first line of defense always prepared to respond within minutes to protect the body from foreign substances. First line of defense is skin and mucosa. Next comes the internal defenses like antimicrobial proteins, phagocytes, and other cells to inhibit the invaders’ spread throughout the body. Second line of defense usually creates inflammation. Made of: Surface
Barriers - Skin and Mucous Membranes; Internal Defenses - Phagocytes, Natural Killer Cells, Inflammation, Antimicrobial Proteins, and Fever. Mucous Membranes are membranes surrounding many body cavities that open to the exterior (digestive, respiratory, urinary, and reproductive tracts), and also some internal organs. These secrete mucus, and other protective substances to defend against microorganisms. Adaptive
(specific) defense systems are the fighting forces with more powerful, but slower weapons to attack specific substances. Made of: Humoral Immunity - B Cells; Cellular Immunity - T Cells. Immune System and Adaptive System both release many similar defensive molecules, and proteins released during innate responses alert cells from the adaptive system. Pathogens are harmful, disease-causing microorganisms. Lymphocytes
are types of white blood cells that include T, B, and natural killer variants. Main type of cell found in Lymph. Help in immune responses. Skin and Mucous Membranes produce the following protective chemicals: Acid - The acidity of skin, vaginal, and stomach secretions— the acid mantle—inhibits bacterial growth. Enzymes - Lysozyme—found in saliva, respiratory mucus, and lacrimal fluid of the eye—destroys bacteria.
Protein-digesting enzymes in the stomach kill many different microorganisms. Mucin - Mucin dissolved in water forms thick, sticky mucus that lines the digestive and respiratory passageways. This mucus traps many microorganisms. In contrast, the mucin in watery saliva traps microorganisms and washes them out of the mouth into the stomach where they are digested. Defensins - Mucous membranes and skin secrete small
amounts of broad-spectrum antimicrobial peptides called defensins. Defensin output increases dramatically in response to inflammation when surface barriers are breached. Using various mechanisms, such as disruption of microbial membranes, defensins help to control bacterial and fungal colonization in the exposed areas. Other chemicals - In the skin, some lipids in sebum and dermcidin in eccrine sweat are toxic to bacteria.
The body uses numerous nonspecific cellular and chemical means to protect itself, including phagocytes, natural killer cells, antimicrobial proteins, and fever. The inflammatory response enlists macrophages, mast cells, all types of white blood cells, and dozens of chemicals that kill pathogens and help repair tissue. These protective tactics identify potentially harmful substances by recognizing (binding tightly to) surface
carbohydrates present on infectious organisms (bacteria, viruses, and fungi) but not on human cells. Mast Cells are inflammatory cells that release histamine, and they are part of the inflammatory response cascade. Histamine is a chemical involved in allergic reactions. It is released from mast cells when your body feels threatened. It creates a cascade of other reactions where other cells are activated. Phago = Eat;
Phagocytes are white blood cells that destroy and eat pathogens that get through skin or mucosa. Neutrophils are the most abundant type of white blood cell, and when they encounter infectious material in tissues, they become phagocytic. Macrophages (Big Eaters) are the most voracious phagocytes, and they derive from white blood cells called monocytes that leave the bloodstream, enter tissue, and develop into
macrophages. Fixed Macrophages live in particular organs (Stellate Macrophages live in the liver). Phagocytosis is when the phagocyte engulfs matter. It does this by binding to the particle with cytoplasmic extensions, and then it pulls the particle inside, enclosed in a membrane-lined vesicle. The resulting phagosome then fuses with a lysosome to form a phagolysosome. Next, lysosomal enzymes digest particles, leaving a
residual body. Finally, Exocytosis of the vesicle removes indigestible and residual material from the cell. Phagocytic attempts are not always successful, because the pathogen must adhere to the phagocyte, and this is only possible if the pathogen’s carbohydrate “signature” is recognized. Many bacteria have external capsules to conceal their carbohydrate signatures, which stops phagocytes from binding to them. Our immune
system can stop these pathogens by coating them with opsonins. Opsonins are part of the complement system, and they are proteins that bind to pathogens and provide “handles” for phagocytes to bind to easily. Pathogens are covered by opsonins through opsonization (to make tasty), and this accelerates phagocytosis of that pathogen. Some pathogens like tuberculosis bacillus and certain parasites are resistant to
lysosomal enzymes and can even multiply within the phagolysosome. In this case, other immune cells called helper T cells release chemicals that stimulate the macrophage, activating additional enzymes that produce a lethal respiratory burst. These kill pathogens by: releasing destructive free radicals like superoxide, producing oxidizing chemicals like Hydrogen peroxide and a substance identical to household bleach,
and increasing the phagolysosome’s pH and osmolarity, which activates other protein-digesting enzymes. Neutrophils also pierce the pathogen’s membrane by using defensins. Neutrophils kill themselves as they fight, whereas Macrophages don’t. When phagocytes can’t ingest their targets due to size, they can release toxic chemicals into extracellular fluid. Natural Killer Cells are defensive cells that lyse and kill cancer
cells and virus infected body cells before the adaptive immune system is activated. Part of a small group of large granular lymphocytes. Nonspecific. They detect general abnormalities in cells like the lack of “self” cell-surface proteins called MHC*. Then they kill by directly contacting the target cell and inducing it to undergo apoptosis (programmed cell death). Natural Killer Cells also secrete chemicals that enhance the
inflammatory response. *MHC (major histocompatibility complex) is a variety of protein molecules on the external surface of all our cells. Assuming your immune system has been properly “programmed,” your self-antigens are not foreign or antigenic to you, but they are strongly antigenic to other individuals. (This is the basis of transfusion reactions and graft rejection.) Among the cell surface proteins that identify a cell as self is a
group of glycoproteins called MHC proteins. Genes of the major histocompatibility complex (MHC) code for these proteins. Because millions of combinations of these genes are possible, it is unlikely that any two people except identical twins have the same MHC proteins. Each MHC protein has a deep groove that holds a peptide, either a self-antigen or a foreign antigen. As we will describe shortly, T lymphocytes can only
bind antigens that are presented (displayed to them) on MHC proteins. Inflammatory Response is a response triggered by the immune system whenever body tissues are injured by physical trauma (a blow), intense heat, irritating chemicals, or infection by viruses, fungi, or bacteria. It has several benefits like: Preventing the spread of damaging agents to nearby tissues, disposing of cell debris and pathogens, alerting the
adaptive immune system, and setting the stage for repair. Cardinal signs of short-term inflammation include: redness, heat, swelling, pain, and possibly impaired function. Inflammatory Chemical Release is a chemical “alarm” at the start of the inflammatory process. Inflammatory chemicals are released into the extracellular fluid by injured or stressed tissue cells, proteins circulating in the blood, and immune cells. Mast cells
are a key component of the inflammatory response that release potent inflammatory chemicals called histamine. Macrophages and certain boundary tissues such as epithelial cells lining the gastrointestinal and respiratory tracts have special membrane receptors that allow them to recognize invaders and sound chemical alarms. These membrane receptors, called toll-like receptors (TLRs), play a central role in triggering the
immune response. There are 11 types of human TLRs, each recognizing a particular class of attacking microbe (One type responds to glycolipid in cell walls of tuberculosis bacterium and another type responds to Salmonella). When activated, TLRs release inflammatory chemicals like cytokines. During the Inflammatory response, exudate (fluid containing clotting factors and antibodies), seep from the blood into tissue spaces.
This causes local swelling called edema, that presses on adjacent nerve endings contributing to pain. Pain is also caused by a release of bacterial toxins and the sensitizing effects of released prostaglandins and kinins (hormones/chemical mixture) because prostaglandins constrict blood vessels. Aspirin and other anti-inflammatory drugs produce analgesic (pain reducing) effects by inhibiting prostaglandin synthesis. The
surge of edema into tissue spaces sweep foreign material for processing in the lymph nodes. Clots create scaffoldings for permanent repair and they isolate the injured area and they prevent bacteria and other harmful agents from spreading. Some bacteria like streptococcus have evolved enzymes that break down clots allowing them to invade surrounding tissues. Phagocyte Mobilization - Soon after inflammation begins,
phagocytes enter the damaged area. The neutrophils lead and macrophages follow. After them, a group of plasma proteins known as the complement is activated and elements of the adaptive immune system (lymphocytes and antibodies) also enter the damaged area. 1. Leukocytes release chemicals called leukocytosis-inducing factors. In response, neutrophils enter the blood from red bone marrow. This leukocytosis is
a characteristic of inflammation (increase in white blood cells). 2. Margination is where inflamed endothelial cells sprout adhesion molecules (CAMs) that signal the location of injury. When neutrophils encounter CAMs they slow down and roll along the surface to get a foothold. When activated by inflammatory chemicals, CAMs on neutrophils bind tightly to endothelial cells. Margination refers to phagocytes clinging to the inner
walls of the capillaries and postcapillary venules. 3. Diapedesis is continued chemical signaling prompting neutrophils to flatten and squeeze between endothelial cells of the capillary walls. 4. Chemotaxis - Inflammatory chemicals act as homing devices or more precisely chemotactic agents. Neutrophils and other WBCs migrate up the chemotactic agents gradient to the site of injury (positive chemotaxis). Within an hour after
the inflammatory response started, neutrophils have collected at the site and are devouring any foreign material present. Monocytes are fairly poor phagocytes that follow neutrophils into injured areas. Within 12 hours of leaving the blood and entering the tissues, they swell and develop large numbers of lysosomes, becoming macrophages with great appetites. These late-arriving macrophages then replace neutrophils on the
battlefield. Macrophages are the major part in disposing cell debris after acute inflammation subsides. They predominate at sites of prolonged (chronic) inflammation. Inflammation’s goal is to clear injured areas of pathogens, dead tissue cells, and any other debris so that tissue can be easily repaired. Once that is complete the healing usually occurs quickly.. In severely infected areas, the dead or dying neutrophils, broken
down tissue cells, and living and dead pathogens accumulate in the wound creating a creamy yellow pus. If inflammatory mechanisms fail to clear areas of debris, collagen fibers may be laid down which walls off the sac of pus, forming an abscess. Abscesses need to be drained before healing can occur. A person may harbor pathogens walled off in granulomas for years without displaying any symptoms. However, if the person’s
resistance to infection is ever compromised, the bacteria may be activated and break free, leading to clinical disease symptoms.Viruses—essentially nucleic acids surrounded by a protein envelope—lack the cellular machinery to generate ATP or synthesize proteins. They do their “dirty work” in the body by invading tissue cells and taking over the cellular metabolic machinery needed to reproduce themselves. Some infected
cells secrete small proteins called interferons (IFNs) to help protect cells that have not yet been infected. he IFNs diffuse to nearby cells, which they stimulate to synthesize proteins that “interfere” with viral replication in still-healthy cells by blocking protein synthesis and degrading viral RNA (Figure 21.5). Because IFN protection is not virus-specific, IFNs produced against a particular virus protect against other viruses, too. The
IFNs are a family of immune modulating proteins produced by a variety of body cells, each having a slightly different physiological effect. IFN alpha (α) and beta (β) have the antiviral effects that we’ve just described and also activate natural killer cells. Another interferon, IFN gamma (γ), or immune interferon, is secreted by lymphocytes and has widespread immune mobilizing effects, such as activating macrophages.
Because both macrophages and natural killer cells can also act directly against cancerous cells, the interferons have an indirect role in fighting cancer. Genetically engineered IFNs have found a niche in treating several disorders including hepatitis C, genital warts, multiple sclerosis, and hairy cell leukemia. The Complement System refers to a group of at least 20 plasma proteins that normally circulate in the blood in an
inactive state..These proteins include C1 through C9, factors B, D, and P, plus several regulatory proteins. Complement provides a major mechanism for destroying foreign substances in the body. Its activation unleashes inflammatory chemicals that amplify virtually all aspects of the inflammatory process. Activated complement also lyses and kills certain bacteria and other cell types. (Luckily our own cells are equipped with
proteins that normally inhibit complement activation.) Although complement is a nonspecific defense mechanism, it “complements” (enhances) the effectiveness of both innate and adaptive defenses. Cells and their functions in the Immune Response: B Cells - Lymphocytes that mature in bone marrow. Induced to replicate by antigen binding, usually followed by helper T cell interactions in lymphoid tissues. Its
progeny (clone members) form plasma cells and memory cells. Plasma Cells - Antibody-producing “machine”; Produce huge numbers of antibodies (immunoglobulins) with the same antigen specificity. Plasma cells are examples of Effector B Cells. Helper T Cells (T^h) - An effector CD4 T cell central to both humoral and cellular immunity. It stimulates production of cytotoxic T cells and plasma cells to fight invaders, activates
macrophages, and acts both directly and indirectly by releasing cytokines. Three major subsets (T^h1, T^h2, and T^h17). Cytotoxic T Cells (T^c) - An effector CD8 T cell. Activation usually requires helper T cell involvement. Its specialty is killing virus-invaded body cells and cancer cells, also involved in rejection of foreign tissue grafts. Regulatory T Cell (T^reg) - Slows or stops activity of immune system. important in
controlling autoimmune diseases; several different populations exist. Memory Cells - Descendant of activated B cell or any class of T cell; generated during initial immune response (primary response). May exist in body for years after, enabling it to respond quickly and efficiently to subsequent infections or encounters with the same antigen. Antigen-presenting Cell (APC) - Any of several cell types (dendritic cell,
macrophage, B cell) that engulfs and digests antigens that it encounters, then presents parts of them on its plasma membrane (bound to an MHC protein) for recognition by T cells bearing receptors for the same antigen. This function, antigen presentation, is essential for activation of T cells and normal cell-mediated responses. Macrophages and dendritic cells also release chemicals (cytokines) that activate many
other immune cells. Molecules and their functions in the Immune Response: Antigen - Substance capable of provoking an immune response. Typically a large, complex molecule (e.g. protein or modified protein) not normally present in the body. Antibody (immunoglobulin or Ig) - Protein produced by B cell or by plasma cell. Antibodies produced by plasma cells are released into body fluids (blood, lymph, saliva, mucus,
etc.), where they attach to antigens. This causes complement fixation, neutralization. precipitation, or agglutination, which "marks" the antigens for destruction by phagocytes or complement. Perforons, granzymes - Released by T^c cells. Perforins create large pores in the target cell's membrane, allowing entry of apoptosis-inducing granzymes. Complement - Group of bloodborne proteins activated after binding to
antibody covered antigens or certain molecules on the surface of microorganisms, enhances inflammatory response and lyses some microorganisms. Cytokines - Small proteins that act as chemical messengers between various parts of the immune system. Cytokines and their Immune Response: Interferons: Alpha and Beta - Secreted by many cells. Have antiviral effects; activate natural killer cells. Gamma - Secreted by
lymphocytes. Activate macrophages. Stimulate synthesis and expression of more class 1 and 2 MHC (major histocompatibility complex) proteins. Promotes differentiation of T^H cells into T^H1 cells. Interleukins (ILs): IL-1 - Secreted by activated macrophages. Promotes inflammation and T cell activation; causes fever (acts as a pyrogen that resets the thermostat of the hypothalamus). IL-2 - Secreted by T^h cells. Stimulates
T and B cell proliferation, T^reg cell development, and NK cell activation. IL-4 - Secreted by some T^h cells. Promotes differentiation to T^h2; promotes B cell activation; switches antibody production to IgE. IL-5 - Secreted by some T^h cells and mast cells. Attracts and activates eosinophils; causes plasma cells to secrete IgA antibodies. IL-10 - Secreted by macrophages, T^h, and T^reg cells. Inhibits macrophages and
dendritic cells; turns down cellular and innate immune response. IL-12 - Secreted by dendritic cells and macrophages. Stimulates T^c and NK cell activity; promotes Tw1 differentiation. IL-17 - Secreted by T^h17 cells. Important in innate and adaptive immunity and recruiting neutrophils. Involved in inflammation in many autoimmune diseases. Suppressor Factor - A generic term for a number of cytokines that suppress the
immune system, for example TGF-ß and IL-10. Transforming Growth Factor Beta (TGF-ß) A suppressor factor similar to IL-10. stimulates the T^reg and T^H17 cell development. Tumor Necrosis Factors (TNFs) - Produced by lymphocytes and in large amounts by macrophages. Promote inflammation; enhance phagocyte chemotaxis and nonspecific killing; slow tumor growth by selectively damaging tumor blood vessels;
promote cell death by apoptosis.
Pyrogens increase body temperature and induce fevers.
Digestive System Initial Cephalic Phase is the secretion of digestive enzymes and secretions at the sight, smell or thought of food. Affects both salivary glands and the stomach. The Gastric Phase begins when food is swallowed. Intestinal Phase is associated with the duodenum. Influence release of secretions from liver and pancreas and provide feedback to the stomach. Alters secretion from the stomach and digestion activity
through neuronal and hormonal mediators. Mouth salivary glands— floor of the mouth(sublingual glands), under the tongue(submandibular glands), near the upper teeth (parotid glands). Saliva contains two important enzymes called salivary amylase and lipase and has some electrolytes and mucus as well as glycoproteins and antimicrobial agents. Serous glands - Produce secretion rich in water, electrolytes and
enzymes(parotid gland). Mixed glands - both serous cells and mucous cells (sublingual and submandibular). Secretion is mutinous and high in viscosity. Teeth (incisors-central<7yr>, lateral<8yr>. Canine(eye tooth)<11yr>. Premulars(bicuspids)-first premolar<11yr>-second premolar<12-13yr>. Molars-First molar<6-7yr>-Second molar<12-13yr>-Third molar(wisdom tooth)<17-25yr> )*2*2. And Esophagus contains two rings of smooth
muscles at the top and bottom <upper(under voluntary control and prevents the passage of food into the respiratory system) and lower esophageal sphincters( LES near the stomach, when not closed fully, leads to heartburn or reflux>. Enzyme in Mouth -Lingual lipase: lipid digestion initiates in the mouse, started by lingual lipase. -Salivary amylase(ptyalin): Carbohydrate digestion. -Lysozyme: offers a limit and non-specific and
beneficial antiseptic function in digestion. Stomach Mucous membranes of stomach — Parietal cells secrete hydrochloric acid, chief cells are digestive <enzymes>-secreted in an inactive state and become activated in the low pH of the organ. Rugae a number of ridges formed by the inner surface when the stomach is empty or contracted. Prominent near the pyloric end of the stomach, disappear when the stomach distended.
endocrine glands contained in the stomach and regulate digestion. Hormone produced by the stomach can enhance/inhibit its digestive activity including gastric, histamine, and somatostatin. Stomach digestive enzymes -Gastric lipase: acidic lipase secreted by the gastric chief cells in the fundic mucosa of the stomach. pH 3-6. Hormones or compounds produced by stomach -Hydrochloric acid (HCI): essence positively
charged hydrogen atoms (H+), produced by parietal cells. Primary function is to denature the proteins ingested, destroy bacteria or virus that remains in the food, activate pepsinogen into pepsin. -Intrinsic factor (IF): produced by parietal cells. (Vitamin B12)Initially in saliva, Haptocorrin secreted by salivary glands binds Vit.B creating a Vit.B12-Haptocorrin complex. Purpose is to protect Vitamin B12 from hydrochloric acid in the
stomach. Once entered the duodenum, haptocorrin is cleaved with pancreatic enzymes, releasing vitamin B12. IF binds Vitamin B12, creating Vit, B12-IF complex which is absorbed at the terminal portion of the ileum. -Mucin: destroy bacteria. -Gastrin: produced by G cells in response to stomach stretching occurring after foods enter it, also after stomach exposure to protein. Endocrine hormone, enters the bloodstream, returns to
the stomach where it stimulates parietal cells to produce hydrochloric acid and IF. Stomach cells -gastric chief cells: produce pepsinogen. Mainly in the body of the stomach. -Mucous neck and pit cells: produce mucin and bicarbonate to create a “neutral zone” to protect the stomach lining from the acid or irritants in the stomach chyme. -G cells: produce the hormone Gastrin. Stimulate parietal cells production of their secretion.
Located in the antrum of the stomach. Secretion by the previous cells is controlled by the enteric nervous system. Distention in the stomach or innervation by the vagus nerve (via the parasympathetic division of the autonomic nervous system) activates the ENS, in turn leading to the release of acetylcholine. Once present, acetylcholine activates G cells and parietal cells. Liver is the heaviest and largest gland in the human body &
is formed of 4 lobes. Liver release bile secretions which emulsify fats and enhance the activity of pancreatic and intestinal lipases. Bile neutralizes gastric acids when chyme enters the duodenum(absorption of vitamin K from the gut). Pancreas Its proteases are secreted in their inactive form and initially activated through a membrane-bound enzyme in the duodenum called enteropeptidase. A few molecules of an activated enzyme
can then create a cascade of active proteases. The pancreas also secretes amylases that digest carbohydrates, and lipases, phospholipases and cholesterol esterases that are involved in fat digestion and metabolism. Hormones secreted by the stomach as well as the intestine control pancreatic secretions.Both an endocrine and exocrine gland. Cells in the pancreatic parenchyma make up digestive enzymes -Ductal cells:
responsible for production of bicarbonate(HCO3), which acts to neutralize the acidity of the stomach chyme entering duodenum through the pylorus. Essential pancreatic biofeedback mechanisms to maintain pancreatic juice balance/production -Secretin: hormone produced by the duodenal “S cells'' in response to high hydrogen atom concentration(high acidity) stomach chyme, is released into the bloodstream; upon return
to the digestive tract, secretion decreases gastric emptying, increases secretion of the pancreatic ductal cells, as well as stimulating pancreatic acinar cells to release their zymogenic juice. -Cholecystokinin(CCK) peptide released by duodenal “I cells' ' in response to chyme contains high fat or protein content. Stimulate the acinar cells to release their content. Increases gallbladder contraction, resulting in bile squeezed into the
cystic duct, common bile duct and eventually the duodenum. Decreases the ton elf the sphincter of Oddi which is the sphincter that regulates flow through the ampulla of Vater. Decreases gastric activity and decreases gastric emptying, thereby giving more time to the pancreatic juices to neutralize the acidity of the gastric chyme. -Gastric inhibitory peptide (GIP) produced by the mucosal duodenal cells in response to chyme
contains high amounts of carbs, proteins and fatty acids. Main function is to decrease gastric emptying. Decreases gastric motility and is produced by duodenal mucosal cells. -Somatostatin: hormone produced by the mucosal cells of the duodenum and also the “delta cells" of the pancreas. Has a major inhibitory effect, including on pancreatic production. Main function is to inhibit a variety of secretory mechanisms. Small
Intestine. Duodenum shortest segment. Separated from the stomach by the pyloric sphincter and receives gastric chyme in small quantities when the sphincter opens. Common bile ducts and pancreatic ducts open into the duodenum, where the final stage of digestion occurs-pancreatic enzymes and membrane-bound intestinal enzymes. Also contains glands that produce alkaline secretion that neutralize chyme. Jejunum
contains both villi and microvilli. Ileum is the longest and can be nearly 3m in length. The site for absorption of vitamin B12 and reabsorption of bile salts. Enzymes/hormones produced in the duodenum -Secretin, CKK, GIP(see above) -Motilin: substance increases gastro-intestinal motility via specialized receptors called “motilin receptors”. Small intestinal enzymes -various exopeptidases and endopeptidases including
dipeptidase and aminopeptidases that convert peptones and polypeptides into amino acids. -Maltese: converts maltose into glucose. -Lactose: enzyme that converts lactose into glucose and galactose. -Sucrase: converts sucrose into glucose and fructose. Large intestine cecum, colon, rectum function as the site of water absorption, and the compaction of undigested food into feces. Majority of the gut flora in the GI tract, over
700 species of bacteria. These microorganisms help the body synthesize some B vitamins and vitamin K. Some evidence suggests that the gut microbiome can influence the onset of autoimmune disorders. Starch and saccharides - Salivary amylase (Mouth), Pancreatic amylase(small intestine) —> Oligosaccharides —> (1. Lactose —> Galactose/glucose. 2. Maltose ⇒ Glucose. 3. Sucrose —> Fructose/Glucose. <brush border
enzymes in the small intestine(dexnase, glucoamylase, lactase, Maltese, and sucrase) —> small intestine> ) Path of absorption -Glucose and galactose are absorbed via cotransport with sodium ions. -Fructose passes via facilitated diffusion. -All monosaccharides leave the epithelial cells via facilitated diffusion, enter the capillary blood in the villi, and are transported to the liver via the hepatic portal vein. Proteins - Pepsin(stomach
glands) in presence of HCI(stomach) —> Large polypeptides - Pancreatic enzymes (trypsin, chymotrypsin, carboxypeptidase) (small intestine) —> Small polypeptides, small peptides - Brush border enzymes (aminopeptidase, carboxypeptidase, and dipeptidase) (Small intestine) —> Amino acids (some dipeptides and tripeptides) Path of absorption -Amino acids are absorbed via cotransport with sodium ions. -Some dipeptides
and tripeptides are absorbed via cotransport with H+ and hydrolyzed to amino acids within the cells. -Infrequently, transcytosis of small peptides occurs. -Amino acids leave the epithelial cells by facilitated diffusion, enter the capillary blood in the villi, and are transported to the liver via the hepatic portal vein.Unemulsified triglycerides — lingual lipase — gastric lipase — emulsification by the detergent action of bile salts ducted in
from the liver(small intestine) —Pancreatic lipases(small intestine) —> Monoglycerides (or diglycerides with gastric lipase) and fatty acids. Path of absorption -Fatty acids and monoglycerides enter the intestinal cells via diffusion. -Fatty acids and monoglycerides are recombined to form triglycerides and then combined with other lipids and proteins with the cells. The resulting chylomicrons are extruded by exocytosis. -The
chylomicrons enter the lacteals of the villi and are transported to the systemic circulation via the lymph in the thoracic duct. -Some short-chain fatty acids are absorbed, moved into the capillary blood in the villi by diffusion, and are transported to the liver via the hepatic portal vein. Nucleic acids - pancreatic ratio nuclease and deoxyribonuclease(small intestine) — Brush border enzymes (nucleosidases and phosphatases) —>
Penrose sugars, N-containing bases, phosphate ions. Path of absorption -Units enter intestinal cells by active transport via membrane carriers. -Units are absorbed into capillary blood in the villi and transported to the liver via hepatic portal vein.
Respiratory System Respiratory capacities -Total lung capacity (TLC) male: 6000ml, female: 4200ml. Maximum amount of air contained in lungs after a maximum inspiratory effort: TLC=TV +IRV + ERV + RV. -Vital capacity (VC) Male: 4800ml, Female: 3100ml. Maximum amount of air that can be expired after a maximum inspiratory effort: VC = TV+ IRV +ERV. -Inspiratory capacity (IC) Male: 3600ml, Female: 2400ml. Maximum amount of
air that can be inspired after a normal tidal volume expiration: IC = TV + IRV. -Fundamental residual capacity (FRC) Male: 2400ml, Female: 1800ml. Volume of air remaining in the lungs after a normal tidal volume expiration: FRC = ERV +RV. fetal hemoglobin has higher O2 affinity than adult hemoglobin; primarily due to much-reduced affinity to 2,3-bisphosphoglycerate .Laws: Henry’s law: the concentration of dissolved gas equals the
partial pressure of the gas multiplied by its solubility. Boyle’s law: the pressure and volume are always inversely proportional at a given temperature of a gas. It explains that when the volume of the lung increases during inspiration, the pressure in the lung will decrease. Dalton’s law: the relative concentration of gasses does not change as the pressure and volume of the gas mixture changes. The total pressure by a mixture of
gasses is equal to the sum of the partial pressures of each of the constituent gasses. Charles’s law: (law of volumes) - gasses tend to expand when heated. When the pressure on a sample of a dry gas is held constant, the Kelvin temperature and the volume will be in direct proportion.[.1. Pulmonary ventilation (commonly called breathing): Air is moved into and out of the lungs (during inspiration and expiration) so the gasses there
are continuously changed and refreshed.This includes the gas exchange in the alveoli. 2. External respiration: Oxygen diffuses from the lungs to the blood, and carbon dioxide diffuses from the blood to the lungs. 3. Transport of respiratory gasses: Oxygen is transported from the lungs to the tissue cells of the body, and carbon dioxide is transported from the tissue cells to the lungs. The cardiovascular system accomplishes this
transport using blood as the transporting fluid. 4.Internal respiration: Oxygen diffuses from blood to tissue cells, and carbon dioxide diffuses from tissue cells to blood. 1. Capillary and alveolar fused basement membrane-respiratory membrane. 2. Alveoli: surrounded by fine elastic fibers, open alveolar pores connecting adjacent alveoli allow air pressure throughout the lung to be equalized, alveolar macrophages crawl freelyCarbon
dioxide influences the pH of blood by reacting with water to form carbonic acid (H2CO3), which can dissociate to form a hydrogen ion (H+) and a hydrogen carbonate ion (HCO3-). Increasing the concentration of carbon dioxide in the blood therefore results in more H+ ions and a lower pH. 1. Respiratory zone: actual site of gas exchange - respiratory bronchioles, alveolar ducts, alveoli, all microscopic structures. 2. Conducting son:
other respiratory passageways. The respiratory epithelium is a pseudostratified ciliated columnar epithelium (closely packed cells with microscopic tiny hair-like features that appear to be arranged in layers creating columns but which are attached to basement membrane) composed of six cell types. Three of these—goblet cells, ciliated columnar cells, and basal cells—constitute 90% of the cell population. The respiratory
epithelium is separated from the lamina propria by a thick basement membrane. The epithelium is composed of five cell types: goblet cells, ciliated columnar cells, basal cells, brush cells, and cells of the diffuse neuroendocrine system (DNES). All of these cells come into contact with the basement membrane, but all do not reach the lumen. Goblet cells constitute about 30% of the total cell population of the respiratory
epithelium. They produce mucinogen, which becomes hydrated and is known as mucin when released into an aqueous environment. Once the mucin is mixed with other material in the watery environment, it is known as mucus. Just as goblet cells elsewhere, goblet cells in the respiratory epithelium have a narrow, basally positioned stem and an expanded theca containing secretory granules. Electron micrography
demonstrates that the nucleus and most organelles are located in the stem. This region displays a rich network of rough endoplasmic reticulum (RER), a well-developed Golgi complex, numerous mitochondria, and an abundance of ribosomes. The theca is filled with numerous mucinogen-containing secretory granules of varied diameters. The apical plasmalemma has a few short, blunt microvilli. Ciliated columnar cells
constitute approximately 30% of the total respiratory epithelial cell population. These tall, slender cells have a basally located nucleus and possess cilia and microvilli on their apical cell membrane. The cytoplasm just below these structures is rich in mitochondria and has a Golgi complex. The remainder of the cytoplasm possesses some RER and a few ribosomes. The cilia of these cells move the mucus and its trapped
particulate matter, via ciliary action, toward the nasopharynx for elimination (Snot). Basal cells are short cells that compose about 30% of the total respiratory epithelial cell population. They are located on the basement membrane, but their apical surfaces do not reach the lumen. These relatively undifferentiated cells are considered to be stem cells that proliferate to replace defunct goblet, ciliated columnar, and brush
cells. Brush cells (small-granule mucous cells) constitute about 4% to 5% of the total respiratory epithelial cell population. They are narrow, columnar cells with tall microvilli. Their function is unknown, but they have been associated with nerve endings. Thus, some investigators suggest that they may have a sensory role similar to gustatory cells (taste cells) of the tongue. Other investigators believe that brush cells may
merely be goblet cells that have released their mucinogen. More BPG = Less pH; BPG acts as fetal hemoglobin Phrenic nerve - controls diaphragm muscle (hiccups). Epithelial cells - Nose, Trachea, Bronchioles - Ciliated Pseudostratified Columnar Epithelium. Alveoli - Thin Squamous Epithelium. Mouth, Pharynx, Oral Cavity - Stratified Squamous Epithelium. Tongue - Fungiform, filiform (most common), circumvallate papillae.
Esophagus - Stratified Squamous Epithelium. Stomach - Simple Columnar Epithelium. Ileum/jejunum (Small intestine) - Simple columnar epithelium w goblet cells in the form of villi and crypts. Colon (large intestine) - Simple columnar epithelium w goblet cells. Goblet Cells - Secrete mucus in respiratory and intestinal system. Type 1 alveolar cells or pneumocytes - Allow Gas exchange, fluid transport. Type 2 alveolar cells or
pneumocytes - Secrete surfactant – stop collapsing of alveoli, decrease surface tension in alveoli. Clara Cells - Non ciliated low columnar secretory cells in small respiratory airways. Auerbach (Myenteric) Plexus - In muscle (between longitudinal and circular) layer of esophagus, stomach, small and large intestine. Nerve supply of GI, controls peristalsis and motility, gland secretions, water reabsorption. Meissner (submucosal)
Plexus - In submucosal layer of GI organs. Same function as Auerbach plx. Peyer’s Patches - In jejunum and ileum submucosal layer, lymphoid tissue of GI tract. Part of GALT – gut associated lymphoid tissue. Paneth cells - Specialized epithelium in small intestine in crypts/islands of Leiberkuhn. They regulate composition of intestinal flora. Antimicrobial immune function. Chief Cells - In stomach, secrete pepsin enzyme to digest
proteins. Gastrin or G Cells - In Stomach, secrete gastrin to increase acidity. Parietal Cells - In body and fundus of stomach, secrete hydrogen to form hydrochloric acid (HCl). Also secrete intrinsic factor that help absorption of Vit B12. Kupffer Cells - Major cells of liver. Acinar cells - Form 95% of pancreas. Produce lipases, proteases, and amylase.
Control factors
Change
Shift of curve
Temperature
↑
→
↓
←
2,3-BPG
↑
→
Urticaria (Hives)
Acute, severe IgE mediated allergic response. Can be life threatening. Type I
immediate hypersensitivity reaction. Histamine release, inflammatory reaction.
Allergic skin reaction to irritants e.g. food or medication. Itchy rash.
Low TSH, high thyroid hormones
CT/MRI of thyroid gland
Mechanical digestion:
Various activities aid in
presenting foods to the Gl
tract for absorption.
Mastication (chewing):
Breaks down large particles,
mixing them with saliva.
Deglutition (swallowing):
Moves (via peristalsis)
materials from mouth, to the
pharynx, on to stomach.
Gastric/intestinal motility:
Peristalsis and mixing
movements (segmentation)
facilitate formation of small
particles for absorption
(requires chemical digestion,
too).
Myasthenia Gravis
was
Hina
in
i