Physiology Exam 2021

latest

Devanshi Patel
[COMPANY NAME] [Company address]
01. Physiology as a science. The concept of
function. Methods physiological
research.
 Physiology is the science about the regularities
of organisms vital activity in connection with the
external environment.
 The goal of physiology is to explain the physical
and chemical factors that are responsible for the
origin, development, and progression of life.
 Methods of physiology.
• Observation:- note all changes and based
on that data conclusions will be determine.
• Experiment:-two kind of experiment are
there: acute and chronic. Acute will be done
 giving anesthesia and may accompanied by
nerve cut off whereas chronic will be first
performed on animals.
• Examination:- examine patient with
different diseases using different apparatus.
• Stimulation:- stimulate different process by
means of computer or artificial apparatus.
For eg; kidney apparatus or apparatus for
circulation.
02. The formation and development of
physiology in the nineteenth century.
 In 19 century physiology separated of
anatomy and became the independent
science.
 Majandi studied the physiology of nerves
system.
 Bernar studied the physiology mechanisms
of development of digestive juice and their
digestion properties, the role of liver in
supporting the sugar level in blood.
 Yung worked out the three component
theory of color perception.
 Gelmgolths developed this theory and
creation the theory of hear perception.
 Phylomaphytsky worked out the theory of
cyclic functioning of nerves system.
 Phylomaphytsky and Basov worked the
operation of suturing the gastric fistula on
dogs.
 Phylomaphytsky and Pirogov worked the
method of anesthesia intravenous.
 Gering worked out the theory of the color
vision.
 Gering and Braier described the reflex of
nervus vagus, which control the breathing.
 Boydich formulated the “all or none” low,
which say that cardiac muscle can contract
in full or noncontract.
 Ludvig described the theory of uropoiesis.
 Kennon created the doctrine about
 homeostasis.
 G.Selye studied the stress-syndrome.
03. Contribution work I.M. Syechenova,
I.P. Pavlova, P.C. Anohin, P.H. Kostyuka
to the world of physiology.
 Sechenov published the book “Reflexes of
brain" introducing electrophyrology and
neurophysiology in laboratories.
 I.P Pavlova-Nobel for physiology and
medicine. He also gave the classification of
higher nervous activity.
 P.C Anohin-theory of functional systems
and concept of systemogenesis
 P.H Kostyuk-1st to introduce
microelectrode studies of nervous system in
USSR. He proved presence od Ca2+ channels
in neuronal cell membranes.

04. Ukrainian physiological school.

 In 1593 - opened the first high medical
school near Lviv – Zamoiska academy.
 In 1594 this school became the university and
it has given the doctor degree.
 In 1661 - opened the Lviv University with
the medical faculty.
 In 1805 - opened the Charkiv University
with the medical faculty.
 In September 1842 developed the chair of
physiology of health people in the medical
faculty of Kiev University.
 In 1865 -opened the Odessa University.
05. Potential calm the nerve cell
mechanisms of formation, size,
physiological role. (resting membrane
potential)
Resting membrane potential is defined as the
electrical potential difference (voltage) across the
cell membrane (between inside and outside of the
cell) under resting condition, when cell is not
stimulated. It is different in different cells.
 It is constant or stable.
 It is negative inside relative to outside
 It depends on
• Concentration difference of k+ across the
membrane
• Permeability of na+ and k+ during resting
state.
• Na-k pump
 The resting potential exists because ions(Na,
k,Cl,Ca) are concentrated on different sides of the
membrane.
 Na+ and Cl- more concentrated outside the
cell. • K+ and organic anions and proteins are
more concentrated inside the cell.
 Na+ and k+ is permeable to cell membrane
during resting state.(na-k pump)
 The sodium-potassium pump (a membrane
protein) exchanges three Na+ ions for two K+
ions. Na influx and k efflux takes place.
 (size)…Resting membrane potential of most
cells ranges from - 65 to – 85 mV. • In most
neurons the resting potential has a value of
approximately −70 mV.
 The resting membrane potential of large
nerve fibers when not transmitting nerve signals
is about –90 millivolts.(guyton) Mechanism
 Inactive state of neurons when they are
negatively charged and are not conducting a
nerve impulses, must receive electrical message
(stimulus) to activate it.
 When a stimulus comes usually through axon
terminals in form of chemical
(neurotransmitters) the negative nature of
cell is lost and the cell turns positive due to
Na+ inflow inside cell.
 Now the cell exacts its function, like
contraction for muscle. With the help of Na-K+
pump, which pumps NA+ back out the cell returns
to it negative state, being ready to be stimulated
again.
 P-cant pass through cell membrane ,inside
neuron
 K-can pass, inside
 Na-can pass, outside
 Cl-can pass, outside
 Functions:-
• The resting potential is mostly determined by
the concentrations of the ions in the fluids on
both sides of the cell membrane and the ion
transport proteins that are in the cell
membrane.
• It allows the excitable cells(neurons,muscle etc)
to experience rapid change and to perform
specific functions.

06. The action potential of nerve cells, the

mechanisms of formation, size,
physiological role.
An action potential is a rapid rise and subsequent
fall in voltage or membrane potential across a
cellular membrane with a characteristic pattern.
Sufficient current is required to initiate a voltage
response in a cell membrane; if the current is
insufficient to depolarize the membrane to the
threshold level, an action potential will not fire.
Terms you have to know
 Polarization:- a state in which membrane is
polarized at rest, negative inside and positive
outside
 Depolarization:-the membrane potential
becomes less negative than the resting
potential (close to zero).
 Repolarization:- restoration of normal
polarization state of membrane.
 Reverse-polarization:-the inside of cell
becomes positive relative to outside
 Action potential:- the momentary change in
the electrical potential of the cell to passes the
impulse. Rapid depolarization, when partial
depolarization reaches the threshold then the
sodium gated channels open and the rapid
influx of sodium takes place.  Mechanism:-
• Sodium ion rush in via permeable membrane
and take the potential to threshold (-70mv to
+40mv)
 • Voltage gated sodium channels opens and rapid
influx of ions takes place.
• Positive feedback take place.
• More na+ influx makes membrane to achieve
reversepolarisation and so the inside will be
more positive and thus the channels will be
inactivated.
• K+ channels open and the ions moves outwards
• Negative feedback take place
• The membrane again restore its resting
membrane potential.
 Action potential is a rapid, reversible and
conductive change of the membrane potential
after the cell is stimulated.
 Nerve signals are transmitted by the action
potential. Transmitted In both directions.
 (size)….. there is no big or small action
potentials in one nerve cell-all action potential
for one nerve cell is same , either it does not
reach the threshold or fully fired (all or none
law) there is no in between.
 A threshold or suprathreshold stimulus
applied to a single nerve fiber always initiate
the same action potential with constant
amplitude, time course and propagation
velocity. 07. Changes in the excitability of
cells during stimulation.
 Excitable cell is a cell that can generate an
action potential at its membrane in response to
depolarization and may transmit an impulse
along the membrane.
 Excitability is an intrinsic membrane property
that allows a cell to generate an electrical signal
or AP in response to stimuli of sufficient
magnitude.
 A certain minimum charge must be applied to
the cell membrane to elicit a regenerative
action potential
 Excitability can be altered by temperature as
a result of temperature-dependent changes in
RMP, generation of APs, velocity of AP
propagation, duration of AP.
 The alterations in membrane excitability are
reflected in alterations in neuromotor functions
like sensory transduction, motor reflexes, organ
function etc.
 The decreased in membrane excitability
occurs with the persistent low levels of resting
potential or by genetic mutations that results in
loss of Na+ channel function. 08. The laws
and conditions of the excitation of
nerve fibers.
• When a nerve is subjected to a threshold
stimulus it undergoes excitation or it is
stimulated.
• Normally nerve impulses pass in one
direction only but the may be conducted in
either direction too.
 Laws
• The law of physiological and anatomical
continuity of a nerve.
Conduction of stimulation along the
nerve is impossible after its cutting as
 the anatomical continuity will
disturbed.
• Law of isolated conduction along the nerve
fibers.
• Two-way of conduction of stimulation in nerve
fiber.
a) Condition of carrying
• Anatomic integrity of nerve‘s filament.
• Physiological full value.
b) Laws of carrying
• Double-sided conduction.
• Isolated of conducting.
• Conducting of excitation without attenuation

09. Mechanisms of excitation of nerve

fibers.
 In Myelinated nerve fibers
• Myelinated axons only allow action potentials
to occur at the unmyelinated nodes of Ranvier
that occur between the myelinated
 internodes. It is by this restriction that
saltatory conduction propagates an action
potential along the axon of a neuron at rates
significantly higher than would be possible
without the myelination of the axon (150 m/s
compared to 0.5 to 10 m/s).
• As sodium rushes into the node it creates an
electrical force which pushes on the ions
already inside the axon. This rapid conduction
of electrical signal reaches the next node and
creates another action potential, thus
refreshing the signal. In this manner, saltatory
conduction allows 3 electrical nerve signals to
be propagated long distances at high rates
without any degradation of the signal.
• Although the action potential appears to jump
along the axon, this phenomenon is actually
just the rapid, almost instantaneous,
conduction of the signal inside the myelinated
portion of the axon. In myelin filaments
conducting of excitation is done from node of
Ranvier to node of Ranvier.
 In unmyelinated nerve fibers
There are 3 stages of propagation of action
potential:
• Resting stage: It is the resting membrane
potential before action potential begins. The
membrane is said to be polarized during this
stage because of -90mV negative membrane
potential that is present.
• Depolarization stage: After stimulus, axonal
membrane becomes permeable to Na+ ions
and allows them to diffuse into the axon.
This inflow of positive ions cause negative
potential of membrane to actually overshoot
beyond the zero level and become
somewhat positive. This is called
depolarization.
• Repolarization: Na+ channels close and +
channels open. Rapid diffusion of K+ ions to
exterior regain original negative potential.
Voltage gated ion channels open when the
reversal of neighboring potential is detected.
 In this way the excitation is transmitted
along the axon.

010. Mechanisms of excitation transfer

through the neuromuscular synapse.
 A neuromuscular junction is a chemical synapse
between axons of motor-neurons and skeletal
muscles. Motor neuron is able to transmit a
signal to the muscle fiber, causing muscle
contraction.
 The neurotransmitter released from the
presynaptic terminal is acetylcholine (Ach), and
the postsynaptic membrane contains a nicotinic
receptors.
 The myoneural junction, the specialized area
where a motor nerve terminates on a skeletal
muscle fiber, is the site of a transmission process.
The contacts between autonomic neurons and
smooth and cardiac muscle are less specialized,
and transmission is a more diffuse process.

Mechanism
 Muscles require innervation to function—and
even just to maintain muscle tone, Synaptic
transmission at the neuromuscular junction
begins when an action potential reaches the
presynaptic terminal (depolarization) of a motor
neuron, which activates voltage-dependent
calcium channels to allow calcium ions to enter
the neuron. 
calcium uptake
release ACh into
synaptic cleft.
Synaptic vesicles fuse
with plasma
membrane and empty
their contents into the
cleft by exocytosis.
 Diffusion of Ach
to
the postsynaptic membrane (muscle end plate)
and binding of Ach to nicotinic receptors.
 Nicotinic receptors (nAChRs) are ionotropic
receptors (Na+ and K+ ion channel), they serve as
 ligand-gated ion channels. The binding of ACh to
the alpha subunit of receptor causes a
conformational changes that opens the central
core of the channel and increases its
conductance to Na+ and K+.
 These depolarize the muscle fiber, causing a
cascade that eventually results in muscle
contraction.

011. Resting potential and action potential

of skeletal and smooth muscle cells,
mechanisms of formation, magnitude,
physiological role.
Resting potential in skeletal muscles
 The resting membrane potential in skeletal
muscle cells is similar to that in neurons, i.e. −70
to −90 mV.
 Unlike nerve cells, where the resting membrane
potential is predominantly a result of K+
permeability, skeletal muscle cell resting
membrane potential receives a significant
contribution from Cl− conductance.
 When muscle contracts, there is leakage of K+
from the cell. With repeated activity there is run-
down of the K+ concentration gradient across the
sarcolemma.
 Without the Cl− current to maintain resting
membrane potential, the muscle would not
repolarize sufficiently to regenerate the active
state of the channels responsible for generation
of succeeding action potentials.
Action potential in skeletal muscles
 Skeletal muscle action potential is generated
when the motor endplate potential is sufficient
to raise the surrounding sarcolemma potential
above the threshold for activation of the voltage
gated Na+ channels that are abundant
throughout the sarcolemma.

Resting potential in smooth muscles

 The resting membrane potential of smooth
muscles is -60 to -50 millivolt i.e. less negative
 than the skeletal muscle fibers. They are not
innervated by the motor endplates.
 The autonomic nerve fibers make the diffuse
junctions with smooth muscles. These junctions
release neurotransmitters which binds to
receptors
 The activation of receptors causes the opening of
ion channels.
Action potential in smooth muscles
 The sodium ions contribute very little to the
depolarization of smooth muscles. On the other
hand, calcium ions are majorly involved in
smooth muscle depolarization.
 Once the ion channels are opened, the calcium
ions diffuse into the smooth muscle cells from
the extracellular fluid.

 The calcium channels are very slow. The open

slowly and remain open for more time as
compared to the sodium channels. Thus, the
depolarization in smooth muscles has more
duration than the skeletal muscles.
 The calcium ions diffusing into the cell during
depolarization are necessary for the contraction
to occur. In this way, the contraction and
depolarization are coupled.

012. Types of muscle contractions, single

and tetanic; isotonic and isometric.
Electromyography
 Simple: Muscle contraction is the activation of
tension-generating sites within muscle fibers. In
physiology, muscle contraction does not
necessarily mean muscle shortening because
muscle tension can be produced without changes
in muscle length, such as when holding a heavy
book or a dumbbell at the same position. The
termination of muscle contraction is followed by
muscle relaxation. (for more refer que “10”) 
Tetanic:
• It is the result of repeated stimuli at such
short intervals that the muscle fiber (or
 muscle) doesn’t have time to fully relax
before it is called upon to contract again.
• A tetanic contraction is a sustained muscle
contraction evoked when the motor nerve
that innervates a skeletal muscle emits
action potentials at a very high rate. During
this state, a motor unit has been maximally
stimulated by its motor neuron and remains
that way for some time. This occurs when a
muscle's motor unit is stimulated by multiple
impulses at a sufficiently high frequency.
Tetanic contraction is usually normal (when
holding up a heavy load).
Types of muscle contraction based on length of
muscle fiber or tension of the muscle:
 Isotonic contraction: It is the type of muscle
contraction in which the tension (load) remains
the same and length of muscle fiber is altered
(iso=same, tonic=tension). Example: simple
flexion of arm, where shortening of muscle fiber
occur but tension remains same.
 Isometric contraction: It is the type of muscle
contraction in which the length of fiber remains
the same and tension increases. These increased
tension is measured and there is no shortening.
Example: pulling any heavy object when muscle
become stiff and strained with increased tension
but length is same.
Electromyography: A test to evaluate the response
of muscle against nerve stimulation. It uses
electrodes to translate the signals into graph. 013.
The concept of reflex. The structure and
function of the reflex arc of links.
 Reflex arc is the anatomical nervous pathway for
a reflex action, including at its simplest a sensory
nerve and a motor nerve with a synapse in
between.
 Reflex arch is designed to administer unconscious
automatic actions which are determined to be
protective in nature to keep the body in
homeostasis
 There are two types: autonomic reflex arch
affecting inner organs , and somatic reflex arch
affecting muscles
 It is a type of protective mechanism and it
protects the body from irreparable damages.
 A simple reflex arc includes five components.
• Receptor (skin) is the end organ, which receives
the stimulus. When receptor is stimulated,
impulses are generated in afferent nerve.
• Afferent Nerve or sensory nerve transmits
sensory impulses from the receptor to center.
• Center receives the sensory impulses via
afferent nerve fibers and in turn, it generates
appropriate motor impulses. Center is located
in the brain or spinal cord.
• Efferent Nerve or motor nerve transmits motor
impulses from the center to the effector organ.
• Effector Organ (muscle) is the structure such as
muscle or gland where the activity occurs in
response to stimulus. Afferent and efferent
 nerve fibers may be connected directly to the
center. In some places, one or more neurons
are interposed between these nerve fibers and
the center. Such neurons are called connector
neurons or internuncial neurons or
interneurons

014. Receptors, their classification,

mechanisms of arousal.
:
 Cholinergic uses acetylcholine as a
neurotransmitter from the parasympathetic
nervous system.
• Nicotinic
receptors are found
in the somatic
system on the motor
end plates of skeletal
muscle 6 cells and in
the ANS on all
postganglionic
neurons and the
 hormone producing cells of the
adrenal medulla. ACh binding to
a nicotinic receptor is excitatory.
• Muscarinic receptors (named for
muscarine, a mushroom poison)
are found in effectors that are
stimulated by cholinergic fibers.
The effect is inhibitory or
excitatory based on the target.

 Adrenergic uses norepinephrine/epinephrine

as a neurotransmitter which comes from the
sympathetic nervous system. The sympathetic
nervous system is responsible for the fight-
orflight response,
which includes
widening the pupils
of the eye,
mobilizing energy,
and diverting blood
flow from non-
essential organs to
 skeletal. • Alpha: excitatory • Beta: inhibitory,
except in the cardiac muscle where it is
excitatory

 Classification by stimulus modality

• Chemoreceptors
• Thermoreceptors
• Nocicoreceptors
• Mechanoreceptors
• Photoreceptors
 Classification by origin of stimuli
• Exteroreceptors
• Interoreceptors
• Proprioreceptors is the physiological
and psychological state of being awoken or of
sense organs stimulated to a point of
perception.
• It involves activation of the ascending reticular
activating system (ARAS) in the brain, which
mediates wakefulness, the autonomic nervous
 system, and the endocrine system, leading to
increased heart rate and blood pressure and a
condition of sensory alertness, mobility, and
readiness to respond.
• Arousal is mediated by several different neural
systems. Activity within the ARAS is regulated
by neurons that release the neurotransmitters
acetylcholine, norepinephrine, dopamine,
histamine, and serotonin.
• Activation of these neurons produces an
increase in cortical activity and subsequently
alertness. Arousal is important in regulating
consciousness, attention, alertness, and
information processing.

015. The mechanisms and patterns of

transmission of excitation in central
synapses.
 The main excitatory transmitter in the brain is
the amino acid glutamate. The main inhibitory
transmitters in the brain are the amino acids
 glycine (in the spinal cord) and gamma-amino
butyric acid (GABA, in the rest of the CNS).
 Although both ionotropic and metabotropic
glutamate receptors are found at many
synapses, rapid excitation occurs when the
cation-selective pore of the ionotropic
glutamate receptor allows
sodium ions to enter and
depolarize the
postsynaptic
cell, like at the
neuromuscular junction.
 Although central
synapses operate in a
manner similar to the
neuromuscular junction,
they are very diverse. In
particular, while the
neuromuscular junction is
an extremely powerful,
reliable connection formed
 by many synapses acting in parallel, many
central excitatory connections are rather weak,
and cannot by themselves reliably fire the
postsynaptic cell.
 Instead, the cooperative action of several, or
many, inputs is often required. This means that
a neuron ―computes and communicates some,
hopefully useful, function of its inputs.

016. Types central inhibition. Mechanisms

of presynaptic and postsynaptic inhibition.
 An active nervous process arising in the
central nervous system and leading to the
suppression or prevention of excitation.
 Postsynaptic inhibition, occurs due to the
release of an inhibitory neuro-transmitter from
presynaptic terminal instead of an excitatory
neurotransmitter substance. It is also called
direct inhibition. Inhibitory neurotransmitters
are gamma-aminobutyric acid (GABA),
dopamine and glycine. It involves the action of
a specific mediator on the postsynaptic
membrane of a neuron, and
  Presynaptic inhibition, which Is based on a
depolarization of a presynaptic nerve ending at
the point of contact with another axonal nerve
ending.
 All types of inhibition occurring in
conditioned reflex activity are regarded as
forms of central inhibition.
The conditioned reflex are inhibited by some
factors. The inhibition id of two types:
• External or indirect inhibition
It is inhibited by some stimulus. For eg, sudden
noise can abolish conditioned reflex
• Internal or direct inhibition
It is by the internal factors of the body.
− Extinction of conditioned reflex
− Conditioned inhibition
− Delayed conditioned reflex
− Differential inhibition
017. Summation of excitation and
inhibition of neurons in the CNS.
 Summation is the fusion of effects or
progressive increase in the excitatory
postsynaptic potential
in postsynaptic neuron when many presynaptic
excitatory terminals are stimulated
simultaneously or when single presynaptic
terminal is stimulated repeatedly.
 Increased Excitatory postsynaptic Potential
triggers the axon potential in the initial segment
of axon of postsynaptic neuron.
 Summation is of two types:
 • Spatial Summation When the action
potential is produced by fusion of
Excitatory postsynaptic Potential develop
from many presynaptic terminal is called
spatial summation. Spatial summation
occurs when many presynaptic terminals
are stimulated simultaneously.
• Temporal Summation All Excitatory
postsynaptic Potential overlap and
summate with each other, so that action
potential is generated in postsynaptic
neuron. Temporal summation occurs
when one presynaptic terminal is
stimulated repeatedly. Thus, both spatial
summation and temporal summation
play an important role in facilitation of
response.

018. Motor reflexes of the spinal cord,

their reflex arc, the physiological
significance.
  Spinal cord has 2 kinds of tracts: ascending
and descending. Ascending tracts are sensory
descending are motor.
 It conducts impulses from integrating center
to effector
 Reflex Arc : nerve impulses follow nerve
pathways as they travel through the nervous
system. The simplest of these pathways, which
include only a few neurons, is called the reflex
arc.
Components:
• Afferent limb
• Central component
• Efferent limb.
Role:
 Reflexes are automatic, unconscious to
changes, either inside or outside the body.
Reflexes maintain homeostasis (autonomic
reflexes) – heart rate, breathing rate, bp,
digestion.
 Reflexes also carry out the automatic actions
of swallowing, sneezing, coughing, vomiting.
 Reflexes maintain balance and posture; e.g.,
spinal reflexes control trunk and limb muscles.
 Brain reflexes involve reflex center in
brainstem; e.g., reflexes for eye movement.

019. Conduction function of the spinal

cord.
Conduction: The spinal cord functions primarily in
the transmission of nerve signals from the motor
cortex to the body, and from the afferent fibers of
the sensory neurons to the sensory cortex.
 It is also a center for coordinating many
reflexes and contains reflex arcs that can
independently control reflexes and central
pattern generators.
 Conducting function of the spinal cord is as
follows: gray matter sends impulses from the
peripheral nerves in the organs to other parts of
the Central nervous system.
 The conductors that make up the white
matter transmit signals from receptors of skin,
muscles, and internal organs. The impulses are
 then transferred via short paths to other
segments of the spinal cord, and the long – to
the brain.

020. Motor hindbrain reflexes,

decerebratiоn rigidity.
 The Hindbrain is located at the rear of the
skull and is the lowest portion
of the brain. Hindbrain parts
include the medulla, the
cerebellum and the pons.
• The medulla is where the
spinal cord enters the skull. It
is responsible for controlling
breathing, heart rate,
regulating reflexes, and maintaining an
upright posture of the body.
• The cerebellum are two (2) rounded
structures located besides the medulla. It
is responsible for coordinating motor
activity (movements of the body), so that
 extensive damage of the cerebellum can
cause failure to even stand up.
• The pons serves as the bridge towards
the midbrain. It is a cluster of neuronal
fibers surrounding the reticular
formation (discussed below), and is
responsible for monitoring sleep and
arousal by coordinating with the
autonomic nervous system. Also it
transmit information from the spinal
cord to the forebrain.
Decerebrate rigidity
 Decerebrate rigidity (DR) in humans results
from a midbrain lesion and is manifested by an
exaggerated extensor posture of all extremities.
 It is characterized by shortening and
lengthening reactions and
can be modified by tonic
neck, labyrinth and phasic
spinal reflexes.
 Decerebrate rigidity
is characterized by
 extension of all four limbs and the trunk. It is
caused by a lesion in the rostral brainstem
(midbrain or pons). Opisthotonos may be
associated with decerebrate rigidity if the
rostral lobes of the cerebellum are damaged.
 Decerebrate and Decorticate posturing can
indicate that brain herniation is occurring or is
about to occur. Brain herniation is an extremely
dangerous condition in which parts of the brain
are pushed past hard structures within the
skull.
 In herniation syndrome, which is indicative of
brain herniation, decorticate posturing occurs,
and, if the condition is left untreated, develops
into decerebrate posturing.

021. Motor reflexes midbrain, their

physiological importance.
Midbrain, also called mesencephalon, region of the
developing vertebrate brain that is
composed of the tectum and
tegmentum.
 This is the most superior part of
the brain stem. The corpora
quadrigemina, the red nucleus, the
substantia nigra, the cerebral peduncles, and
the cell bodies of two cranial nerves are located
in the midbrain.
 The anterior quadrigeminal Dobies are the
primary optic nerves and involved In certain
reflexes responding to light stimuli, including
the Visual orientation reflexes.
 Reflex movements of the eyes are induced by
impulses conveyed to the eye muscles from the
nuclei of the oculomotor and trochlear nerves.
 The anterior quadrigeminal Dobies Take part
In pupillary reflexes.
 The posterior quadrigeminal Dobies are the
primary centers. They are involved in the
performance of sound orientation reflexes: the
 pricking up of the ears of the Animals, Turing of
the head and body towards a New sound.
 The midbrain serves important functions in
motor movement, particularly movements of
the eye, and in auditory and visual processing.
 Functions of the mesencephalon include:
• Controlling Responses to Sight
• Eye Movement
• Pupil Dilation
• Regulate Muscle Movement
• Hearing

022. Cerebellum and its functions.

The cerebellum is located behind the top part of the
brain stem (where the spinal cord
meets the brain) and is made of two
hemispheres.
 The cerebellum receives
information from the sensory systems,
the spinal cord, and other parts of the
brain and then regulates motor
movements.
 Functions of cerebellum:
• Regulation of posture and equilibrium, and
muscle tone
• Coordination of posture and slow
determined movements
• Coordination of fast determined
movements. Cerebellum inputs and
outputs:
• Coordinate voluntary movements such as
balance, speech and also important in
learning motor behaviours.
 The 3 deep nuclei are:
 • fastigial - concerned with balance; sends
information mainly to the vestibular and
reticular nuclei
• dentate and
• interposed - both concerned with voluntary
movement; send axons mainly to the
thalamus and red nucleus.
All 3 receive inputs from sensory afferent tracts and
from the cerebellar cortex.

023. Thalamus its functions.

The thalamus is a small structure within the brain
located just above the brain stem
between the cerebral cortex and the
midbrain and has extensive nerve
connections to both.
 The main function of the
thalamus:
• To relay motor and sensory signals to the
cerebral cortex
• Regulates sleep, alertness and wakefulness
 • The thalamus may also be involved in the
regulation of some types of memory
• It also regulates the senses of sight, sound,
taste, touch and the sense of where the
person's body is in space
• The thalamus decides which signals from
the ears, eyes, mouth and skin to relay to its
area in the cerebral cortex.
024. The limbic system, the hypothalamus,
their function.
Limbic system: It is a complex system of cortical and
sub-cortical structures that form a
ring around the hilus of cerebral
hemisphere.
 It is located on both side of the
thalamus, beneath the cerebrum. 
Limbic system is one of the oldest
part of the brain. It is not only
responsible for our emotional lives but also
many higher mental function, such as learning
and formation of memories.
  The primary structures within the limbic
system includes amygdala, hippocampus,
thalamus, hypothalamus, basal ganglia and
cingulate gyrus.
 It also includes the olfactory bulbs, anterior
thalamic nuclei, fornix, columns of fornix,
mammillary body, septum pellucidum,
habenular commissure, para-hippocampal
gyrus, entorhinal cortex, and limbic midbrain
areas.
 It has 4 components:
• Archi-cortical structure: hippocampus,
dentate gyrus.
• Paleo-cortical structure: piriform cortex,
olfactory lobe.
• Juxtallo-cortical structure: cingulate gyrus
of limbic cortex
• Subcortical structure: amygdaloid complex,
septal and caudate nuclei
Function of limbic system
  Olfaction: piriform cortex and amygdaloid
nucleus from the olfactory centers.
 Regulation of endocrine glands:
Hypothalamus plays a major role in regulation
of endocrine secretion.
 Regulation of autonomic functions:
Hypothalamus regulates autonomic function
such as heart rate, blood pressure, water
balance, body temperature.
 Regulation of food intake: Along with
amygdaloid complex, the feeding center and
satiety center present in hypothalamus regulate
food intake.
 Role in emotional state
 Role in memory
 Role in motivation
 Regulation of sexual functions.

025. Basal nuclei, their function.

Basal ganglia are the scattered masses of gray
matter submerged in subcortical
substance of cerebral hemisphere. Basal
ganglia form the part of extra pyramidal
system, which is concerned with motor
activities.
 Components of basal ganglia:
It include three primary components:
• Corpus striatum
• Substantia nigra
• Subthalamic nucleus of Luys  Function of
basal ganglia
Basal ganglia form the part of extrapyramidal
system, which is concerned with integration
and regulation motor activities. Various
functions of basal ganglia are:
• Control of muscle tone
• Control of motor activity
• Regulation of voluntary movements
• Regulation of conscious movements
• Regulation of subconscious movements
 • Control of reflex muscular activity
• Control of automatic associated
movements
• Role in arousal movements
• Role in neurotransmitters in the function of
basal ganglia like dopamine, GABA,
acetylcholine, substance P etc.
Among them dopamine, GABA have inhibitory
function.

026. Sensory, motor and associative

cortex, their function.
 Sensory cortex includes portions of the
cerebral cortex which function is to process and
make sense out of information from our senses
like vision, auditory, olfaction, gustation and
touch.
 It is responsible for perception and
integration of cutaneous and kinesthetic
sensations. It receives sensory impulses from
cutaneous receptors (touch, pressure, pain,
temperature) and proprioceptors. Area 1 is
 concerned with sensory perception. Areas 3
and 2 are involved in the integration of these
sensations.

 Frontal lobe forms one third of the cortical

surface. This part of cerebral cortex is also
called
excito-motor cortex or area
 Frontal lobe of cerebral cortex is divided into
two parts:
• Precentral cortex, which is situated
posteriorly
• Prefrontal cortex, which is situated
anteriorly.
 Precentral cortex is further divided into three
functional areas:
• Primary motor area
• Premotor area
• Supplementary motor area
 The primary area contains very large
pyramidal motor neurons that send their fibers
 all the way to the spinal cord through the
corticospinal tract and therefore have almost
direct communication with the anterior motor
neurons of the cord for control of either
individual muscles or small groups of muscles.
 The premotor area mainly sends its signals
into the primary motor cortex to excite multiple
groups of muscles. Some of these signals pass
directly to the motor cortex through subcortical
nerve fibers, but the premotor cortex also has
extensive connections with the basal ganglia
and cerebellum, both of which transmit signals
back by way of the thalamus to the motor
cortex.
Function:
 Primary motor area is concerned with
initiation of voluntary movement and speech.
• It activates alpha and gamma motor
neurons and this is called as coactivation.
• Activation of gamma neurons causes
contraction of intrafusal fibers leading to
increase in muscle tone.
  Premotor area is concerned with control of
postural movements by sending motor signals
to axial muscles. Concerned with coordination
of movements.
 Supplementary area is not understood clearly
but it is concerned with coordinated skilled
movements.


Forms majority part of the cerebral
cortex.  Also called Prefrontal cortex, was
considered as in-excitable to electrical stimulation.
Hence, it was called the silent area or association
area. This area is the anterior part of the frontal
lobe of cerebral cortex. It occupies the medial,
lateral and inferior surfaces and includes orbital
gyri, medial frontal gyrus and the anterior portions
of superior, middle and inferior frontal gyri.
 The association areas are also site for long
memory, and they control such human
functions as language acquisition, speech,
musical ability, mathematical ability, complex
 motor skills, abstract thought, symbolic
thought, and other cognitive functions.
Connections of prefrontal cortex
• Afferent fibres - Come from: hypothalamus,
corpus striatum, amygdala, midbrain
• Efferent fibres - Projected to: thalamus,
hypothalamus, tegmentum, caudate nucleus,
pons.
Functions:
 It forms the center for the higher
function like emotional, learning, memory
and social behavior. Short term memory
is also registered here.
 It is the centre of planned actions’
 It is called organ of mind
 Responsible for personality of an
individual
 Responsible for autonomic changes
during emotional condition
027. General plan of the autonomic
nervous system. Autonomic reflexes, their
reflex arc.
 It is a division of the peripheral
nervous system that supplies visceral
organs, smooth muscles and glands.
 It regulates body functions such as
heart rate, digestion, respiratory rate etc.
 Forms majority part of the cerebral
cortex.
Autonomic reflex
They are classified in three groups
• Visceral-visceral / somato-autonomic /
viscero-muscular
• Cutaneous visceral / dermato-visceral
• Viscero-cutaneous / visceral-dermal /
splanchno-fascial
Part of reflex (reflex arc)
 • Sensory part – receptors present in many
organs, walls of blood vessels and lymphatic
vessels consists of interoreceptors, dendrites
of sensory neurons.
• Central part
• Efferent part
028. Synapses autonomic nervous system
and their mediators.
 A junction that mediates information transfer
from one neuron:
• To another neuron
− Called neuro-synapses or just synapse
• To an effector cell
− Neuromuscular synapse if muscle
involved
− Neuroglandular synapse if gland involve

 Presynaptic neuron – conducts impulses

toward the synapse
 Postsynaptic neuron – transmits impulses
away from the synapse  Two major types:
• Electrical synapses
• Chemical synapses
 Other types of synapse are
• Axo-dendritic
• Axo-somatic
• Axo-axonic
• Dendro-dendritic
• Dendro-somatic
 Neurotransmitters found in the nervous
system are:
• EXCITATORY
− Acetylcholine
− Dopamine
− Histamine
− Nonepinephrine
− Epinephrine
 − Glutamate
− Serotonin
• INHIBITORY
− GABA
− Glycine

029. The impact of the sympathetic

nervous system in visceral functions.
  Fight or Flight Response: When the entire SNS
is activated, there is a cascade of reactions from
all the organ systems of the body, which
prepare the individual to deal with an
emergency. This includes an increase in heart
rate, bronchial dilation, increase in cardiac
output, and dilation of pupils. The SNS could
also be activated in response to long-term
psychological or
emotional stress.
 Regulating
Body
Temperature: The
SNS has a number
of roles to
maintain
homeostasis. It
regulates body
temperature,
both by mobilizing
fat reserves to enhance heat production and by
changing blood flow to the skin. The SNS can also
stimulate sweat glands to cool the body down.
 Cardiovascular Effects: It regulates minute
changes to the cardiovascular system.
• When there is a change in posture, from
sitting to standing, for example, the cardiac
output needs to change to accommodate this
alteration.
• Similarly, during intense exercise, the body
needs to focus on delivering nutrients and
oxygen to skeletal muscle and quickly
removing the metabolic waste generated in
the tissue. It can even modulate circadian
rhythms and there is usually a surge of SNS
activity during the transition from sleep
towards awakening.
 General Effects: the key endocrine targets for
the SNS is the adrenal medulla, which is
stimulated to secrete epinephrine and
norepinephrine, to enhance the effect of the
neuronal activity of the SNS.
• During extreme conditions, like a blockage in
the coronary artery leading to heart failure,
the sympathetic nervous system can have a
 productive effect, increasing the force of
cardiac muscle contraction, and mediating
higher blood pressure.
• Comparatively, the SNS has shorter axons
than the parasympathetic nervous system
and also acts more quickly.
• Also, SNS promotes ejaculation and vaginal
constriction.
• In the lateral parts of the spinal cord on the
thoracic-lumbar level are present sympathetic
center of Yakobson, whose activity regulated
by brain stem

030. The impact of the parasympathetic

nervous system in visceral functions.
 The PNS is the body’s “rest & digest” state.
 Parasympathetic Nervous System controls
the body’s response during normal situations
where there is no perceived threat.
 It is the counterbalance to the Sympathetic
Nervous System and restores the body to a
state of calm.  Breathing and heart rates
are returned to normal, muscles
relax, saliva and stomach secretions
increase, stimulating the digestive
tract to process
food and
eliminate wastes.
 The PNS
cause release of
secretions in the
female that
decrease
friction. Also in
the female, the

parasympathetics innervate the fallopian

tubes, which helps peristaltic contractions
and movement of the oocyte to the uterus
 for implantation. The secretions from the
female genital tract aid in sperm migration.
It promotes erection of genitals.
 The PN (and SN to a lesser extent) play a
significant role in reproduction.

031. The role meta-sympathetic system in

the regulation of visceral functions.
Meta-sympathetic nervous system
• Just like SNS and PNS, it is a part of ANS. Its cells
have no direct connection with the high
centers: this connection is established through
mono- and polysynaptic sensory and afferent
units of sympathetic and parasympathetic
nature.
• It includes the complex of micro-ganglia
situated in the walls of visceral organs and
having marked motility activity (heart, ureters,
intestine, stomach)
• Meta – sympathetic part of autonomic nervous
system is intramural ganglions, which are in the
 organs walls. Reflector arc are present in the
wall of organs too.
• It regulated by sympathetic and
parasympathetic system. It has sensory,
interneuronal, moving chain and own
mediators.
• Impulses initiated in visceral receptors are
relayed via afferent autonomic pathways to
central nervous system, which integrate at
various levels and transmit via efferent
pathways to visceral effectors.

032. Properties of hormones, their main

influences. The mechanism of action of
hormones on target cells.
Hormones are chemical messengers, synthesized by
endocrine glands. Based on chemical nature,
hormones are classified into three types:
 Proteins and polypeptides:
 • They are the large and small peptides.
• Hormones secreted by the anterior and
posterior pituitary gland, the pancreas
(insulin and glucagon), the parathyroid gland
(parathyroid hormone), placenta and many
others.
• They don’t penetrate cell membrane but
binds to membrane receptors.

 Steroids
• These are synthesized from cholesterol or its
derivatives.
• They are secreted by the adrenal cortex
(cortisol and aldosterone), the ovaries
(estrogen and progesterone), the testes
(testosterone), and the placenta (estrogen
and progesterone).
• They penetrate cell membrane  Tyrosine
derivatives:
• They are two types, thyroid hormones and
adrenal medullary hormones
 • They are secreted by the thyroid (thyroxine
and triiodothyronine) and the adrenal
medullae (epinephrine and norepinephrine).
There are no known polysaccharides or
nucleic acid hormones.

 Hormones acts by combining with receptors to

form hormone-receptor complex.
 The combination of hormone and receptor then
usually initiates a cascade of reactions within the
cell.
 Either all or almost all hormonal receptors are
very large proteins, and each cell has some 2000
to 10,000 receptors.
 Each receptor is usually highly specific for a
single hormone (or hormones closely related to
it);
 Obviously, the target tissues that are affected by
a hormone are those that contain its specific
receptors.
 There are three such mechanism:
• By altering permeability of cell membrane
Neurotransmitters in synapse or neuromuscular
junction act by changing the permeability of
postsynaptic membrane. • By activating
intracellular enzyme Protein hormones and the
catecholamines act by activating the
intracellular enzymes.
First messenger: a hormone which acts on a target
cell is called first messenger.
Second messenger: hormone- receptor
complex activates the enzyme of the cell and
causes the formation of another substance
called the second messenger.
Cyclic AMP: cAMP acts as
second messenger for
protein hormones and
catecholamines. It stimulates
the enzymes (protein kinase
A) inside the cell and
produces response,
 depending upon the function of target cell
through these enzymes.
• By acting on genes Thyroid and steroid
hormones execute their function by acting on
genes in the target cells. As hormone enters the
cell and forms hormone receptor complex and
binds with DNA. This increases the mRNA
transcription. Then, mRNA moves out of
nucleus and activates ribosome and produces
large amount of proteins.

 The location of receptors for the different types

of hormones are generally the following:
• cell surface receptors: protein, peptide,
catecholamine hormones;
• in the cytoplasm: steroid hormones;
• in the nucleus: metabolic thyroid hormones.
033. The role of the hypothalamic-pituitary
system in regulation of the endocrine
glands.
Hypothalamus
 A collection of specialized cells that are located
in the lower central part of the brain is called the
hypothalamus.
 The
hypothalamus
is the main link
between the
endocrine and the
nervous systems. The
nerve cells of the
hypothalamus control
the pituitary gland by
stimulating or
suppressing the
hormone secretions.
 Hypothalamus sends information that is sensed
by the brain to pituitary triggering production
hormones.
 The pituitary gland is divided into two parts: the
anterior lobe and the posterior lobe.

Hormone of anterior pituitary.

 Hypothalamus controls the secretions of anterior
pituitary gland by secreting releasing hormones
and inhibitory hormones. It secretes seven
hormones.
• Growth hormone-releasing hormone-stimulates
growth of bones and tissues
• Growth hormone-releasing polypeptide
• Growth hormone-inhibiting hormone or
somatostatin
• Thyrotropin-releasing hormone-stimulates
thyroid gland to produces thyroid hormones.
• Corticotropin-releasing hormone-stimulates
adrenal glands to produce hormones.
• Gonadotropin-releasing hormone- activates
gonadal hormones
• Prolactin-inhibiting hormone (PIH)-activates
production of milk in lactating mothers.
 These hormones are secreted by discrete
areas of hypothalamus and transported to
anterior pituitary by the hypothalamo-
hypophyseal portal blood vessels.
Hormone of posterior pituitary
 Hypothalamus is the site of secretion for the
posterior pituitary hormones.
• Antidiuretic hormone (ADH)- controls water
balance
• Oxytocin- triggers uterus contractions in the
women who is in labor
• ADH and oxytocin are secreted by supraoptic
and paraventricular nuclei.
Control of Adrenal cortex
 Anterior pituitary regulates adrenal cortex by
secreting adrenocorticotropic hormone (ACTH).
ACTH secretion is in turn regulated by
corticotropin-releasing hormone (CRH), which is
secreted by the paraventricular nucleus of
hypothalamus
Control of Adrenal medulla
 Dorsomedial and posterior hypothalamic
nuclei are excited by emotional stimuli. These
hypothalamic nuclei, in turn, send impulses to
 adrenal medulla through sympathetic fibers and
cause release of catecholamines, which are
essential to cope up with emotional stress

034. The role of somatotropin,

triiodothyronine and thyroxine, insulin
regulation of physical and mental
development of the organism.

 Also called as growth hormone and it is

released from anterior pituitary glands.
 GH is responsible for the general growth of
the body.
 It increases the size and number of cells by
mitotic division and stimulates cell
differentiation.
 Hypersecretion of GH causes enormous
growth of the body, leading to gigantism.
 Deficiency of GH in children causes stunted
growth, leading to dwarfism.
 GH also acts on the metabolism of all the
three major types of foodstuffs in the body, viz.
proteins, lipids and carbohydrates. Effect on
protein metabolism It increases protein by:
• Increasing amino acid transport through cell
membrane
• Increase RNA translation
• Increase transcription of DNA and RNA •
Increase anabolism and decrease catabolism of
proteins.
Effect on fat metabolism
• Mobilize fats from adipose tissue.
• Stimulates decomposition of lipids
(lipolysis)
• Stimulates oxidation of fatty acids.
Effect on carbs metabolism
• Inhibits conversion of glucose into fats.
• Activates exit of glucose from liver
• Increase blood glucose and glucagon
• Promotes glycogen decomposition.
 • Growth stimulation in children
• Increase basal metabolic rate
In Growth
 Attainment of adult stature requires thyroid
hormone.
 Thyroid hormones act synergistically with
growth hormone and somatomedins to
promote bone formation.
 Thyroid hormones stimulate bone maturation
as a result of ossification and fusion of the
growth plates. In thyroid hormone deficiency,
bone age is less than chronologic age.
In Central nervous system (CNS)
Perinatal period
 Maturation of the CNS requires thyroid
hormone in the perinatal period.
 Thyroid hormone deficiency causes
irreversible mental retardation. Because there
is only a brief perinatal period when thyroid
hormone replacement therapy is helpful.
Adulthood
  Hyperthyroidism causes hyperexcitability and
irritability.
 Hypothyroidism causes listlessness, slowed
speech, somnolence, impaired memory, and
decreased mental capacity.
In Autonomic nervous system
 Thyroid hormone has many of the same
actions as the sympathetic nervous system
because it up-regulates b1 -adrenergic
receptors in the heart. Therefore, a useful
adjunct therapy for hyperthyroidism is
treatment with a βadrenergic blocking agent,
such as propranolol.
In Basal metabolic rate (BMR)
 O2 consumption and BMR are increased by
thyroid hormone in all tissues except the brain,
gonads, and spleen.
 The resulting increase in heat production
underlies the role of thyroid hormone in
temperature regulation.
 Thyroid hormone increases the synthesis of
Na+ , K+ -ATPase and consequently increases
 O2 consumption related to Na+ –K+ pump
activity. In Cardiovascular and respiratory
systems
 Effects of thyroid hormone on cardiac output
and ventilation rate combine to ensure that
more O2 is delivered to the tissues.
 Heart rate and stroke volume are increased.
These effects combine to produce increased
cardiac output.
 Excess thyroid hormone can cause high
output heart failure.
 Ventilation rate in respiration is increased.
In Metabolic effects
 Overall, metabolism is increased to meet the
demand for substrate associated with the
increased rate of O2 consumption.
Effect on carbs metabolism
• Glucose absorption from the gastrointestinal
tract is increased.
 • Glycogenolysis, gluconeogenesis, and glucose
oxidation (driven by demand for ATP) are
increased.
Effect on fats metabolism
• Lipolysis is increased.
Effect on protein metabolism
• Protein synthesis and degradation are
increased.
• Increase translation and stimulates RNA
polymerase 1 and 2 and thereby Increases
synthesis and decomposition of proteins
• The overall effect of thyroid hormone is
catabolic.

Insulin acts on the liver, adipose tissue, and

muscle.
Effect on carbs metabolism
Insulin decreases blood glucose concentration by
the following mechanisms:
 • It increases uptake of glucose into target cells
by directing the insertion of glucose
transporters into cell membranes. As glucose
enters the cells, the blood glucose
concentration decreases.
• It promotes formation of glycogen from glucose
in muscle and liver, and simultaneously inhibits
glycogenolysis.
• It inhibits gluconeogenesis. Insulin increases the
production of fructose 2,6-bisphosphate,
increasing phosphofructokinase activity.
• In effect, substrate is directed away from
glucose formation.
Effect on fat metabolism
Insulin decreases blood fatty acid and ketoacid
concentrations.
• In adipose tissue, insulin stimulates fat
deposition and inhibits lipolysis.
• Insulin inhibits ketoacid formation in the liver
because decreased fatty acid degradation
 provides less acetyl CoA substrate for ketoacid
formation.
Effect on protein metabolism
• Insulin decreases blood amino acid
concentration.
• Insulin stimulates amino acid uptake into cells,
increases protein synthesis, and inhibits protein
degradation. Thus, insulin is anabolic. d. Insulin
decreases blood K+ concentration.
• Insulin increases K+ uptake into cells, thereby
decreasing blood [K+ ]

035. The role of calcitonin and parathyroid

hormone in the regulation of sustainability
concentrations of calcium and phosphate
in the blood.
Calcitonin is secreted by the parafollicular cells or
clear cells (C cells), situated amongst the follicles
in thyroid gland. It is a peptide hormone.
On Blood Calcium Level
 • It decreases the blood calcium level and
thereby counteracts parathormone.
• Calcitonin reduces the blood calcium level by
acting on bones, kidneys and intestine.
• Promotes transferring of calcium from blood to
bone also enhance excretion of calcium into
urine.
Effect On bones
• Calcitonin stimulates osteoblastic activity and
facilitates the deposition of calcium on bones.
• At the same time, it suppresses the activity of
osteoclasts and inhibits the resorption of
calcium from bones. It inhibits even the
development of new osteoclasts in bones.
Effect On kidney
• Calcitonin increases excretion of calcium
through urine, by inhibiting the reabsorption
from the renal tubules. Effect On intestine
• Calcitonin prevents the absorption of calcium
from intestine into the blood.
On Blood Phosphate Level
• With respect to calcium, calcitonin is an
antagonist to PTH.
• But it has similar actions of PTH, with respect to
phosphate.
• It decreases the blood level of phosphate by
acting on bones and kidneys.
Effect On bones
• Calcitonin inhibits the resorption of phosphate
from bone and stimulates the deposition of
phosphate on bones.
Effect On kidney
• Calcitonin increases the excretion of phosphate
through urine, by inhibiting the reabsorption
from renal tubules.

On blood calcium level

• PTH plays an important role in maintaining
blood calcium level. It also controls blood
 phosphate level. It promotes moving of calcium
from bones into blood.
• It maintain the blood calcium level within the
critical range of 9 to 11 mg/dL.

Effect On bones
• Resorption of calcium from bones by acting on
osteoblasts and osteoclasts of the bone.(by
their proliferation).
Effect On kidney
• PTH increases the reabsorption of calcium from
the renal tubules along with magnesium ions
and hydrogen ions.
• It increases calcium reabsorption mainly from
distal convoluted tubule and proximal part of
collecting duct.
• PTH also increases the formation of 1,25-
dihydroxycholecalciferol (activated form of
vitamin D) from 25-hydroxycholecalciferol in
kidneys
Effect On GI tract
• PTH increases the absorption of calcium ions
from the GI tract indirectly.
• It increases the formation of 1,25-
dihydroxycholecalciferol in the kidneys.
• This vitamin, in turn increases the absorption of
calcium from GI tract.
On blood phosphate level
PTH decreases blood level of phosphate by
increasing its urinary excretion. It also acts on
bone and GI tract.
Effect On Bone
• Along with calcium resorption, PTH also
increases phosphate absorption from the
bones.
Effect On Kidney
Phosphato-uric action
• It is the effect of PTH by which phosphate is
excreted through urine.
 • PTH increases phosphate excretion by inhibiting
reabsorption of phosphate from renal tubules.
• It acts mainly on proximal convoluted tubule.

Effect On Gastrointestinal Tract

• Parathormone increases the absorption of
phosphate from GI tract through calcitriol.

036. Synthesis and role of hormones of the

pancreas in the regulation of the functions
of the organism.
 Endocrine function of pancreas is performed
by the islets of Langerhans. Human pancreas
contains about 1 to 2 million islets.
 Islets of Langerhans consist of four types of
cells:
• A cells or α-cells, which secrete glucagon
• B cells or β-cells, which secrete insulin
• D cells or δ-cells, which secrete somatostatin
 • F cells or PP cells, which secrete pancreatic
polypeptide.

Action of glucagon It is a
polypeptide in nature Role:
• activates the decomposition of glycogen in liver
• activates gluconeogenesis
• inhibits glycolysis
• activates lipolysis
Action of insulin
• Effect on carbohydrates: increases the
permeability of membranes for glucose,
activates glucokinase (hexokinase) in glycolysis,
 activates TAC (citrate synthase), activates PPC
(G6-PDH), activates glycogen synthase,
activates pyruvate- and alpha-кetoglutarate
dehydrogenase, inhibits gluconeogenesis,
inhibits the decomposition of glycogen
(glucose-6-phosphatase)
• Effect on protein: increases the permeability of
membranes for AA, activates synthesis of
proteins and nucleic acids, inhibits
gluconeogenesis
• Effect on lipid: activates of the lipids synthesis,
promotes the saving of fats activating the
decomposition of carbohydrates, inhibits
gluconeogenesis
• Effect on mineral: activates Na/K-АТP-аse

Action of somatostatin
• Somatostatin acts within islets of Langerhans
and, inhibits β and α cells, i.e. it inhibits the
secretion of both glucagon and insulin
 • It decreases the motility of stomach, duodenum
and gallbladder
• It reduces the secretion of gastrointestinal
hormones gastrin, CCK, GIP and VIP
• Hypothalamic somatostatin inhibits the
secretion of GH and TSH from anterior pituitary.
That is why, it is also called growth
hormoneinhibitory hormone (GHIH).
Actions of pancreatic polypeptide
• Exact physiological action of pancreatic
polypeptide is not known.
• It is believed to increase the secretion of
glucagon from α-cells in islets of Langerhans.
037. Synthesis and role of hormones of
the thyroid gland (T3, T4) in the
regulation of the functions of the
organism.
Thyroid gland secretes three hormones:
 • Tetraiodothyronine or T4 (thyroxine) [major] •
Tri-iodothyronine or T3
• Calcitonin.
Role in regulation of functions:
Metabolic Rate:
 Thyroid hormones increase metabolic rate, as
evidenced by increased O2 consumption and
heat production.
 Thyroid hormones increase the activity of the
membrane-bound Na/K–ATPase in
many tissues, and it can be argued that it is
the increased pumping of Na+ that
accounts for most of the increase in
metabolic rate.
 Thyroid hormones are absolutely necessary
for normal brain maturation and essential for
normal menstrual cycles.
Growth and Maturation (T4 and T3 Anabolic
Hormones)
 Fetal growth rates appear normal in the
absence of thyroid hormone production (i.e., if
the fetus is hypothyroid).
  However, without adequate thyroid
hormones during the perinatal period,
abnormalities rapidly develop in nervous
system maturation.
 Synapses develop abnormally and there is
decreased dendritic branching and
myelination. These abnormalities lead to
mental retardation.
 These neural changes are irreversible and
lead to cretinism unless replacement therapy
is started soon after birth.
Lipid Metabolism:
 Thyroid hormone accelerates cholesterol
clearance from the plasma.
 Thyroid hormones are required for
conversion of carotene to vitamin A, and, as a
consequence, hypothyroid individuals can
suffer from night blindness and yellowing of
the skin.
Carbohydrate metabolism:
 Thyroid hormone increases the rate of
glucose absorption from the small intestine.
Cardiovascular effects:
 Thyroid hormones have positive inotropic and
chronotropic effects on the heart.
 The increased contractility is partly direct and
partly indirect: they increase the number and
affinity of β-adrenergic receptors in the heart,
thereby increasing the sensitivity to
catecholamines.
 Acting on the SA node, they directly increase
heart rate.
 Cardiac output is increased, and both heart
rate and stroke volume are elevated.
 Systolic pressure increases are due to
increased stroke volume, and diastolic
pressure decreases are due to decreased
peripheral resistance.
 Thyroid hormones in the normal range are
required for optimum cardiac performance.
Additional effects:
 Thyroid hormones maintain the ventilatory
response to hypoxia, increase erythropoietin,
and increase gut motility and bone turnover.
  Hypothyroidism is associated with an
increased prolactin. TRH in excess amounts will
stimulate prolactin.
038. Physiology of the female reproductive
system, its functions, synthesis and the
role of female sex hormones.
 The principal organs of the human female
reproductive tract, the most important of
which are the ovaries, fallopian tubes, uterus,
and vagina.
  The female hormonal system, like that of the
male, consists of three hierarchies of
hormones, as follows:
• A hypothalamic releasing hormone,
gonadotropin-releasing hormone (GnRH)
• The anterior pituitary sex hormones,
folliclestimulating hormone (FSH) and
luteinizing hormone (LH), both of which are
secreted in response to the release of GnRH
from the hypothalamus
• The ovarian hormones, estrogen and
progesterone, which are secreted by the ovaries
in response to the two female sex hormones
from the anterior pituitary gland.
Estrogen [steroid]
Secreted by: In a normal non-pregnant woman,
estrogen is secreted in large quantity by theca
interna cells of ovarian follicles and in small
quantity by corpus luteum of the ovaries.
  A small quantity of estrogen is also secreted
by adrenal cortex. In pregnant woman, a large
amount of estrogen is secreted by the placenta.
 Estrogen is present in three forms in plasma:
• β-estradiol
• Estrone
• Estriol.
 All the three forms of estrogen are present in
significant quantities in plasma.
 The quantity and potency of β-estradiol are
more than those of estrone and estriol.
Function of estrogen: Major function of estrogen is
to promote cellular proliferation and tissue growth
in the sexual organs and in other tissues, related to
reproduction.
 In childhood, the estrogen is secreted in small
quantity.
 During puberty, the secretion increases
sharply, resulting in changes in the sexual
organs.
 Effects of estrogen are:
• Effect on Ovarian Follicles
− Estrogen promotes the growth of ovarian
follicles by increasing the proliferation of
the follicular cells. It also increases the
secretory activity of theca cells
− Has both negative and positive feedback
effects on FSH and LH secretion.
• Causes maturation and maintenance of the
fallopian tubes, uterus, cervix, and vagina.
• Causes the development of female secondary
sex characteristics at puberty.
• Causes the development of the breasts.
• Up-regulates estrogen, LH, and progesterone
receptors.
• Causes proliferation and development of
ovarian granulosa cells.
• Maintains pregnancy.
• Lowers the uterine threshold to contractile
stimuli during pregnancy.
• Stimulates prolactin secretion (but then blocks
its action on the breast).
Progesterone
Secreted by: In non-pregnant woman, a small
quantity of progesterone is secreted by theca
interna cells of ovaries during the first half of
menstrual cycle.
 In pregnant woman, large amount of
progesterone is secreted by the corpus luteum
in the first trimester. In the second trimester,
corpus luteum degenerates.
Functions: Progesterone is concerned mainly with
the final preparation of the uterus for pregnancy
and the breasts for lactation.
 The effects of progesterone are:
• Has negative feedback effects on FSH and LH
secretion during luteal phase.
• Maintains secretory activity of the uterus
during the luteal phase.
• Maintains pregnancy.
• Decrease frequency and intensity of uterine
contractions to prevent expulsion of
implanted ovum.
 • Raises the uterine threshold to contractile
stimuli during pregnancy.
• Participates in development of the breasts.
039. Physiology of male reproductive
system, synthesis and role of male sex
hormones.
Testosterone
 After neonatal period, testosterone plasma
concentration falls to 0 until puberty, when it
causes growth of male reproductive organs and
development of secondary sexual
characteristics (facial and body hair, deeper
voice, greater muscular mass etc.).
 It is produced by Leydig cells found inside
testes.
 It is responsible for appearance of sexual
dimorphism in fetus – high concentration of
testosterone during gestation leads to
development of male sexual organs.
Actions of testosterone
• Differentiation of epididymis, vas deferens, and
seminal vesicles
• Pubertal growth spurt
• Cessation of pubertal growth spurt (epiphyseal
closure)
• Libido
• Spermatogenesis in Sertoli cells (paracrine
effect)
• Deepening of voice
• Increased muscle mass
• Growth of penis and seminal vesicles
 • Negative feedback on anterior pituitary
Actions of dihydrotestosterone
• Differentiation of penis, scrotum, and prostate
• Male hair pattern
• Male pattern baldness
• Sebaceous gland activity
• Growth of prostate

040. The main effects of glucocorticoid

and mineralocorticoid on the body,
their synthesis.
include cortisol and its derivatives;
it is often nicknamed as stress hormone.
 Its production is regulated by ACTH and its
blood concentration is dependent on the time
of the day and is highest in the morning, this is
known as diurnal cortisol curve.
Actions of glucocorticoids:
 Arousal/psychological: around 30 minutes after
waking up cortisol concentration is increased by
 about 50%, it has function in waking up and
mental alertness.
• Moreover, cortisol is released in stressful
situations and its concentrations are
increased in chronic stress.
 Stimulation of gluconeogenesis.
Glucocorticoids increase gluconeogenesis by the
following mechanisms:
• They increase protein catabolism in muscle
and decrease protein synthesis, thereby
providing more amino acids to the liver for
gluconeogenesis.
• They decrease glucose utilization and
insulin sensitivity of adipose tissue.
• They increase lipolysis, which provides
more glycerol to the liver for
gluconeogenesis.
 Anti-inflammatory effects:
• Glucocorticoids induce the synthesis of an
inhibitor of phospholipase A2.
(Phospholipase A2 is the enzyme that
 liberates arachidonate from membrane
phospholipids, providing the precursor for
prostaglandin and leukotriene synthesis.)
Because prostaglandins and leukotrienes
are involved in the inflammatory response,
glucocorticoids have anti-inflammatory
properties by inhibiting the formation of
the precursor (arachidonate)
• Glucocorticoids inhibit the production of
interleukin-2 (IL-2) and inhibit the
proliferation of T lymphocytes
• Glucocorticoids inhibit the release of
histamine and serotonin from mast cells
and platelets.
 Suppression of the immune response:
glucocorticoids inhibit the production of IL-2 and
T lymphocytes, both of which are critical for
cellular immunity. In pharmacologic doses,
glucocorticoids are used to prevent rejection of
transplanted organs.
 Maintenance of vascular responsiveness to
catecholamines: cortisol up-regulates alpha-1
 receptors on arterioles, increasing their
sensitivity to the vasoconstrictor effect of
norepinephrine.
• Thus, with cortisol excess, arterial pressure
increases; with cortisol deficiency, arterial
pressure decreases.
are produced in the adrenal
cortex and influence salt and water balances. The
primary mineralocorticoid is aldosterone.
Aldosterone secretion   is under tonic control by
ACTH, but its concentration is maintained via
 Renin-angiotensin-aldosterone system and is
dependent on production of renin, which is
caused by lowered blood sodium concentration,
and also is regulated by
 Serum potassium level.

Renin–angiotensin–aldosterone system:
 • Decreases in blood volume cause a decrease in
renal perfusion pressure, which in turn
increases renin secretion.
• Renin, an enzyme, catalyzes the conversion of
angiotensinogen to angiotensin I.
• Angiotensin I is converted to angiotensin II by
angiotensin-converting enzyme (ACE).
• Angiotensin II acts on the zona glomerulosa of
the adrenal cortex to increase the conversion of
corticosterone to aldosterone.
• Aldosterone increases renal Na+ reabsorption,
thereby restoring extracellular fluid (ECF)
volume and blood volume to normal.
Hyperkalemia increases aldosterone secretion.
• Aldosterone increases renal K+ secretion,
restoring serum [K+] to normal. This in turns
increases blood volume and blood pressure.
041. General characteristics of the blood
system. Composition and functions of
blood.
 Blood is a fluid connective tissue
 It is made up of cellular elements and an
extracellular matrix. Cellular elements refers to
formed elements like RBCs (45%) and WBCs and
cell fragments called platelets (<1%).
extracellular matrix called plasma (55%).
 It is red in colour because of more oxygen
contain.
 Its Ph is 7.4  It consist of:
• blood circulated through the blood
circulatory system
• blood forming organs
• blood destroying organs
• regulatory apparatus.
 Plasma consists of water 91% and have
inorganic chemicals (sodium, calcium,
 potassium, magnesium, chloride, bicarbonate,
phosphate, sulfate– 0,9 %) and organic
chemicals (proteins: serum albumin, serum
globulin, fibrinogen– 8 %,others: – 1,1 %).
 Hormones, carbohydrates, fats and enzymes
are present in the blood.
 Volume: in adult = 5L; in newborn baby= 450mL
Blood functions:
• Gas transport – blood carries oxygen from lung
to the tissues and carbon dioxide in reverse
direction.
• Transport of nutritional substances for all cells
(glucose, amino acids, fatty acids, vitamins etc.).
Blood carries final products of metabolism
(urea, uric acid, bilirubin, creatinine etc.) from
tissues to kidney.
• Regulation of different processes. Blood creates
and carries local hormones (hormonoids) to the
target organs. 4. Thermoregulation – heat
change between tissues and blood.
 • Osmotic function – maintenance of the osmotic
pressure in blood vessels.
• Protective function – blood has antibodies and
leucocytes, which perform phagocytosis.
• Detoxification – blood enzymes can neutralize
(split) different toxic substances.
• Coagulation, the response to a broken blood
vessel, the conversion of blood from a liquid to
a semisolid gel to stop bleeding
• Homeostasis.
042. Electrolytes in blood plasma.
 The body contains a large variety of ions, or
electrolytes, which perform a variety of
functions. Some ions assist in the transmission
of electrical impulses along cell membranes in
neurons and muscles. Other ions help to
stabilize protein structures in enzymes
 Plasma consists of water 91% and have
inorganic chemicals like sodium, calcium,
potassium, magnesium, chloride, bicarbonate,
phosphate, sulfate
 All of the ions in plasma contribute to the
osmotic balance that controls the movement of
water between cells and their environment.

043. The plasma proteins, their functional

significance.
 Blood proteins, also termed plasma proteins or
serum proteins, are proteins present in blood
plasma. They serve many different functions,
including transport of lipids, hormones,
vitamins and minerals in activity and
functioning of the immune system, act as
enzymes, complement components, protease
inhibitors or kinin precursors. Hemoglobin is
not a blood protein, as it is carried within red
blood cells, rather than in the blood serum.
 Proteins: serum albumin, serum globulin,
fibrinogen
Serum albumin
 Quantity of albumins: 4.7 g/dL, 55%
 Major contributor to maintaining the osmotic
pressure of plasma to assist in the transport of
lipids, bilirubin and steroid hormones.
 Buffering function – max buffering capacity 
Exerts low viscosity
Serum globulins
 Quantity of plasma globulin: 2.3 g/dL , 38%
 Contents in blood plasma
• alpha-1-globulins – 1-4 g/L,
• alpha-2-globulins – 4-8 g/L,
• beta-globulins – 6-12 g/L,
• gamma-globulins – 8-16 g/L;
 Alpha-1-fetoprotein (AFP): Clinically considered
a tumor marker for the diagnosis of
hepatocellular carcinoma or teratoblastomas.
 Alpha-2-globulins:
• Low levels of ceruloplasmin are found in
Wilson disease (hepatolenticular
degeneration), a disease due to abnormal
metabolism of copper.
 • The amount of ceruloplasmin in plasma is
also decreased in liver diseases, mal
nutrition and nephrotic syndrome.
 β Globulins of clinical importance are –
Transferrin: It plays a central role in the body's
metabolism of iron because it transports iron (2
mol of Fe3+ per mole of Tf) in the circulation to
sites where iron is required.
C-reactive protein:
• Can stimulate complement activity and
macrophages.
• Clinically important marker to predict the
risk of coronary heart disease.
 Gamma-globulins: They are immunoglobulins
with antibody activity Immunoglobulins play a
key role in the defense mechanisms of the body
There are five types of immunoglobulins IgG,
IgA, IgM, IgD, and IgE.
Fibrinogen

 Quantity-7%
 conversion of fibrinogen to insoluble fibrin is
essential for blood clotting.

044. Erythrocyte sedimentation rate (ESR),

factors that affect the ESR.
 The erythrocyte sedimentation rate (ESR or sed
rate) is the rate at which red blood cells in
anticoagulated whole blood descend in a
standardized tube in one hour.
 ESR measures the degree of inflammation
present in the body.
 Norms- in men- 2-10 mm/hr , In women- 2-15
mm/hr
Factors
Plasma Factor
Protein content of plasma
• When albumin is increased, ESR decrease
• When high molecules like globulin or fibrinogen
increase, ESR increase. (globulin concentration
increased in case of inflammation)
Plasma volume
 • When Plasma volume increases hematocrit
decreases blood stickiness decreases
ESR increases
Erythrocyte factor
The amount of erythrocyte in blood volume
• Higher amount of RBC higher the stickiness
lower ESR
• Lower amount of RBC lower stickiness
higher ESR
The ability of RBC to aggregate
• Aggregates sediments faster ESR higher
Erythrocyte shape
• Change in shape (sickle cell anemia) or its
modification (pernicious anemia) can cause
oppression of RBC ability to aggregate which
cause the increase in stickiness and that lowers
ESR.
• Steroids and salicylates increase ESR
• Cholesterol increase ESR increase
 • Bile pigments and acids increase ESR
decrease

045. The acid-base status blood as a buffer

systems of blood to maintain its
sustainability.
 A buffer is an aqueous solution that resists
changes in pH when acids or bases are added to
it.
 There are four major buffer systems that are
responsible for regulating blood pH:
• The bicarbonate buffer system, •
the phosphate buffer system, and
• the plasma protein buffer system.
•
Bicarbonate buffer system
 normal bicarbonate level in plasma is 24mmol/l
 the bicarbonate is regulated in the blood by
sodium.
NaHCO3+HCl→H2CO3+NaCl
H2CO3 +NaOH→ HCO3- +H 2O
 When NaHCO3 comes into contact with a
strong acid, such as HCl then carbonic acid
(H2CO3 ), which is a weak acid, and NaCl are
formed.
 When carbonic acid comes into contact with a
strong base, such as NaOH then bicarbonate
and water are formed. Phosphate buffer
 Any acid reacts with monohydrogen phosphate
to form dihydrogen phosphate, base is
neutralized by dihydrogen phosphate
Plasma-protein buffer
 It can bind to small amounts of acid in the
blood, helping to remove that acid (H+) before
it changes the blood's pH; bicarbonate ions
diffuse into plasma and occur exchange for
chloride ions.
 Proteins are made up of amino acids, which
contain positively charged amino groups and
negatively charged carboxyl groups. The
charged regions of these molecules can bind
 hydrogen and hydroxyl ions, and thus function
as buffers.
Hemoglobin buffer
 strongest buffer system (more than 50 % of all
buffer capacity of blood)
 there are two buffers hemoglobin - based on
reduced hemoglobin: Н Hb/Hb- and the other
on based oxyhemoglobin: Н HbO2/HbO2.
НHb + ОН– ⇄ Нb– + Н2О ;
НHbО2 + ОН– ⇄ НbО2– + Н2О,
Нb– + Н+ ⇄ ННb;
НbО2– + Н+ ⇄ ННbО2
 First form - prevails in the venous blood, and
the second form - in the arterial:

046. Red blood cells, their function.

 RBCs are also called erythrocytes.
 In men – 4,0-5,1 Tera/L; in women – 3,7-4,7
Tera/L
 RBC are biconcave disc shaped cells of 7.5 m in
diameter and 2μm thick.
 Non-nucleated
 Life span 100-120 days and then destroyed in
spleen (RBC graveyard)
 The quantity of erythrocytes may be increase –
in pregnancy, in physical training, mental work,
in newborn or decrease.
 The cytoplasm of erythrocytes is rich in
hemoglobin, an iron-containing biomolecule
that can bind oxygen and is responsible for the
red color of the cells. The cell membrane is
composed of proteins and lipids, Functions:
• Transport function. Red blood cells carry: O2,
CO2, NO, adsorbed proteins, drugs,
physiologically active substances.
• Provide acid-base balance.
• Maintaining the ionic composition of the
plasma.
• Homeostatic
047. Hemolysis of red blood cells, its
species.
 Hemolysis is the breakdown of red blood cells
and contained oxygen-carrying pigment
hemoglobin is freed into the surrounding
medium.
 It is the destruction or dissolution of RBC.
 Red blood cells normally live for 110 to 120
days. After that, they naturally break down and
are most often removed from the circulation by
the spleen.
 Hemolysis occurs normally in a small
percentage of red blood cells as a means of
removing aged cells from the blood stream and
freeing heme for iron recycling. It also can be
induced by exercise.
 It is rupturing of red blood cells and the release
of their contents into surrounding fluid.
 After they die, they are released by spleen
 Medication like acetaminophen, penicillin and
other pain medications can be used
048. Regulation of erythropoiesis.
 Erythropoiesis is the process which produces
red blood cells (erythrocytes).
 the process which produces red blood cells,
which is the development from erythropoietic
stem cell to mature red blood cell.
 It is stimulated by decreased O2 in circulation,
which is detected by the kidneys, which then
secrete the hormone erythropoietin.
Regulation
 A feedback loop involving erythropoietin helps
regulate the process of erythropoiesis so that,
in non-disease states, the production of red
blood cells is equal to the destruction of red
blood cells
 Erythropoietin is produced in the kidney and
liver in response to low oxygen levels.
Erythropoietin is bound by circulating red blood
cells; low circulating numbers lead to a
relatively high level of unbound erythropoietin,
 which stimulates production in the bone
marrow.
 Peptide hormone hepcidin may play a role in
the regulation of hemoglobin production, and
thus affect erythropoiesis. The liver produces
hepcidin. Hepcidin controls iron absorption in
the gastrointestinal tract and iron release from
reticuloendothelial tissue.
 Iron must be released from macrophages in the
bone marrow to be incorporated into the heme
group of hemoglobin in erythrocytes. There are
colonies forming units that the cells follow
during their formation. These cells are referred
to as the committed cells including the
granulocyte monocyte colony forming units.
 The secretion of hepcidin is inhibited by
another hormone, erythroferrone, produced by
erythroblasts in response to erythropoietin.

049. Types of hemoglobin and its

compounds, their physiological role.
Hemoglobin → is the iron-containing
oxygentransport metalloprotein in the red blood
cells
 Hemoglobin A1
• is present 90-95 % in adult human
• composed of 2α and 2β chains
 Hemoglobin A2
• present in 5-10 % of adult people
• 2α and 2δ chains
 Hemoglobin F
• present in fetus
• two alpha and two gamma chains
• after birth it is reduced to 15 %
• is replaced by HbA1
 Hemoglobin P (prymitive, embryonic)
• present in 7-12 week of life
• is made up of two alpha and two epsilon
chains
• is replaced by fetal hemoglobin
 Hemoglobin A3
 • found in old red blood cells
 glycosylated hemoglobin (Hb-A1c)
• present in 3-5% of people
• is important for the diagnosis of diabetes and
is present 6-15 % in diabetic patient
050. White blood cells, their function.
 They are the cells that make up the majority of
the immune system, which is the part of the
body that protects itself against foreign
substances and various types of infections.
 There are two types of White Blood Cells
• Granulocytes: have
visible granules
− Neutrophil:
defend against
bacteria or fungal
infection
− Eosinophil:
deals with parasitic
infection and allergic
reaction
 − Basophil: involved in allergic reaction and able
to release histamine - helps to trigger
inflammation and heparin – which prevents
blood from clotting

• Agranulocytes: are free of visible grains

− Monocyte- can phagocytose pathogens and
present in antigens to T-cells. They leave blood
stream to become tissue macrophages which
remove dead cell debris as well as attacking
microorganisms − lymphocyte
051. Regulation development of
leukocytes. Physiological leukocytosis.
Regulation of leukopoiesis.
 irritation of sympathetic nerves increases
number neutrophils levels
 irritation of vagus nerve reduces number of
white blood cells
 hormones like adrenaline, glucocorticoids
leads to change in number of leukocytes in
blood
 accumulation of monocytes promotes
development of prostaglandins is of erytin that
inhibits formation of colony-stimulating factor
and level of neutrophils in blood is reduced
 life span is 3-4 days
Physiological leukocytosis
It is normal, physiological reaction of organism in
some irritations.
052. Antigens and antibodies AB0 system
and CDE.
ABO system comprises two agglutinogens A and B
(whose corresponding agglutinins are α and β).
 Accordingly, there are 4 blood groups in the
ABO system:
• group A, which has A agglutinogen, α agglutinin
• group B which has B agglutinogen, β agglutinin
• group AB having both, don't have agglutinin
• group O having neither, has both agglutinin
 Both α and β agglutinins are immunoglobulin-
M (IgM), which is very effective in causing
agglutination (clumping) of red cells.
CDE system
 As given by Fisher, there are 6 major Rh
antigens D, C, E, d, c, e
 As by Wiener nomenclature, antigen denoted
as:
Rh0 , rh ' , rh " , Hr0 , hr' , hr".
 Often the two nomenclatures used
simultaneously. Thus the symbols of the signs are
in brackets: Rh0 (D) , rh '(C) , rh "(E) , Hr0 (d) , hr'
(c) , hr" (e).
 Antigen Rh0 (D) - main antigen of Rh-
system.It is found in red blood cells 85 % of
people. Anti-D agglutinins are predominantly
immunoglobulin G (IgG) and partly
immunoglobulin M (IgM). IgG does not
agglutinate red cells although they do react with
the agglutinin. Letter "d" indicates absence of D
antigen (the gene is usually deleted or otherwise
nonfunctional).
The Rhesus blood group agglutinogens were first
discovered in the erythrocytes of rhesus monkeys,
and hence the name.
 Rhesus blood group comprises a system of 3
agglutinogens: C, D, and E. However, for all
practical purposes, the term Rhesus agglutinogen
refers to the D agglutinogen which produces the
worst transfusion reactions. Accordingly, the
Rhesus system comprises only two blood groups:
the Rhesus positive (Rh positive or D+) and the
Rhesus negative (Rh negative or D–) blood groups
depending on the presence or absence of D
agglutinogen.

053. Methods definitions of blood groups.

 Determination of ABO blood group is also
called blood grouping, blood typing, or blood
matching.
 It can be determined by
• Means of a simple reaction of standard serum-
standard agglutinin sera determine presence of
antigen A and antigen B . It is used primary for
pregnant women
• Means of double reaction of standard washed
RBC- determined by standard sera along with
 standard RBC. It determines presence or
absence of isoagglutinins in plasma. It is used
for donors. More reliable and accurate
• By means of monoclonal antibodies- using
coliclones anti-A and anti-B. Most reliable

Principle of blood grouping- agglutination:

 Blood grouping is done on the basis of
agglutination. Agglutination means the collection
of separate particles like RBCs into the clumps or
masses.
 Agglutination occurs if an antigen is mixed
with its corresponding antibody which is called
isoagglutinin.
 Agglutination occurs when antigen A is mixed
with anti-A or when antigen B is mixed with antiB.
Procedure:
• Suspension of RBC is prepared by mixing blood
drops with isotonic saline solution.
 • Test sera are: antiserum A, containing anti-A or
alpha-antibody and antiserum B, containing
anti-B or beta- antibody.
• One drop of antiserum A and B are placed on
either side of slide.
• One drop of RBC suspension is mixed and
waited for 2 minutes.
• Presence of agglutination is confirmed by thick
mass of RBC.
Evaluation of results
• If agglutination occurs with antiserum A: it
contains alpha
antibody. So, the
blood group is A.
• If agglutination
occurs with
antiserum B: it
contains beta
antibody. So, the
blood group is B. •
If agglutination
 occurs with antiserum A and B: The RBC
contains A and B antigens and the blood group
is AB.
• If agglutination does not occur either with
antiserum A and B: the blood group is O.

054. Samples of blood before transfusion.

 A sample of blood will be taken before the
transfusion to check that the blood one will
receive is compatible with his own blood.
 Misidentification at blood sampling may lead
to fatal ABO-incompatible blood
transfusion, especially if the patient has not
previously had their blood group documented.
Inadequately or mis-labelled samples carry a
significantly increased risk of containing blood
from the wrong patient.

055. The mechanism of Rh conflicts during

pregnancy.
 They can only be acquired, immune (during
pregnancy when there is ingestion of Rh (-) blood
 of mother passes through the vessels of the
placenta into Rh (+) blood of the fetus).
 It will cause hemolytic disease in fetus which
is called erythroblastosis fetalis

Erythroblastosis fetalis
 Hemolytic disease is the disease in fetus and
newborn, characterized by abnormal hemolysis of
RBCs.
 It is due to Rh incompatibility, i.e. the
difference between the Rh blood group of the
mother and baby.
 Hemolytic disease leads to erythroblastosis
fetalis. Erythroblastosis fetalis is a disorder in
fetus, characterized by the presence of
erythroblasts in blood. When a mother is Rh
negative and fetus is Rh positive, inherited from
the father
 Usually the first child escapes the
complications of Rh incompatibility. This is
because the Rh antigen cannot pass from fetal
 blood into the mother’s blood through the
placental barrier. However, at the time of
parturition (delivery of the child), the Rh antigen
from fetal blood may leak into mother’s blood
because of placental detachment. During
postpartum period, i.e. within a month
after delivery, the mother develops Rh antibody
in her blood.
 When the mother conceives for the second
time and if the fetus happens to be Rh positive
again, the Rh antibody from mother’s blood
crosses placental barrier and enters the fetal
blood.
 Thus, Rh antibody which enters in fetus
causes agglutination of fetal RBCs resulting in
hemolysis.  Severe hemolysis in the fetus
causes jaundice.
 To compensate the hemolysis of more and
more number of RBCs needed, there is rapid
production of RBCs, not only from bone marrow,
but also from spleen and liver. Now, many large
and immature cells in pro-erythroblastic stage are
 released into circulation. Because of this, the
disease is called erythroblastosis fetalis.
 Ultimately due to excessive hemolysis severe
complications develop,
• Severe anemia
• Hydrops fetalis
• Kernicterus
056. Platelets, their physiological role.
Properties of platelets
 Quantity of platelets is 180-320 G/L.
 Diameter of platelets is 1-4 micrometers,
thickness – 0,5 -0,75 micrometers.
 They are little piece of megakariocytes
cytoplasm (from one megakariocytes may
develop few hundred of platelets).
 Platelets circulated in blood from 5 to 11 days
 They are destroyed in liver, lungs, spleen by
cells of macrophagal system.
Function of platelets are:
 Secretes growth factor that promotes growth
and multiplication of vascular endothelial cells,
vascular smooth cells and fibroblasts… repair
damaged vascular wall.
 Haemostatic function – platelets produce
substances, which are secure the haemostasis. Its
produce 12 platelets factors
1. proaccelerin,
2. factor, which are increase speed of
development fibrinogen in fibrin,
3. platelets thromboplastin,
4. antiheparinic factor,
5. factor which promote aggregation
of platelets,
6. thrombopoietin,
7. antifibrinolizin,
8. serotonin,
9. fibrinstabilising factor,
10. factor which activate
profibrinolisin,
11. inhibitor of thromboplastin,
 12. anti-lighting factor
 Angiotrophic function – provide trophic of
endotheliocytes of vessel wall, support structure
and functions of microvessels. These function is
realize by adhesion of platelets to
endotheliocytes and injection enzymes into
endotheliocytes. For one day near 35 G/L
platelets do this function
 transport function – transfer the enzymes,
ADP, serotonin and other
 phagocytic function – contain of platelets
help to kill viruses and antigens bodies
 regeneratory function – platelets have
growth factor, which help to grow endothelial
and muscles cells which are present in vessel wall

057. Vessel-platelet hemostasis, its

mechanisms and physiological significance,
research methods.
Mechanism Three important mechanisms bring
about hemostasis, which means the stoppage of
bleeding from an injured area.
 Local factors - These can be divided into two
types.
• Vascular spasm - A localized vascular spasm is
the first line of defence against bleeding and
is brought about by the following changes:
 − Local spasm of blood vessels which is of
myogenic origin. It lasts for upto 20
minutes,
− Vasoconstriction in large vessels which is
of reflex (neurogenic) origin
− Liberation of serotonin, a
vasoconstrictor, from the disintegrating platelets
The early vascular response reduces blood flow
and intravascular pressure and therefore
facilitates consolidation of the hemostatic plug.
• Extra-vascular - These include subcutaneous
tissue, muscle and skin, which help in
stopping bleeding by covering and thus
applying pressure over the wounded area.
 Role of platelets (platelet plug) - The platelet
plug is produced earlier than formation of fibrin
and for this reason,
• platelet plug- produce primary hemostasis.
The formation of the platelet plug that stops
bleeding from small blood vessels like
 capillaries is an important defence against
bleeding.
• fibrin- produce secondary hemostasis.
• Platelets also release serotonin, a
vasoconstrictor.
 Clotting of blood - as blood comes in contact
with extravascular tissues, reactions of clotting
are started, thrombin formed in this process
further activates release of ADP from platelets.
• The combined fibrin-platelet plug seal the
wound more effectively. The clot then
undergoes retraction, till after 24 hours its
size is only 40% of the original. Platelets and
ATP arc needed for the retraction of the clot.
Physiological significance:
• keep blood in a damaged blood vessel
• prevention and control of bleeding

058. Coagulation hemostasis, its

mechanisms and physiological significance
 Coagulation (also known as clotting) is the
process by which blood changes from a liquid to a
gel, forming a clot.
 It potentially results in hemostasis, the
cessation of blood loss from a damaged vessel,
followed by repair.
 The mechanism of coagulation involves
activation, adhesion, and aggregation of platelets
along with deposition and maturation of fibrin.
Stages of hemostasis :When a blood vessel is
injured, the injury initiates the series of reactions
resulting in hemostasis. It occurs in three stages.
 Vasoconstriction
• Immediately after the injury, the
blood vessel constricts and decreases
the loss of blood from damaged
portion.
 • Usually,
arterioles and
small arteries
are
constricted.
When the
blood vessels
are cut, the
endothelium is damaged and the collagen is
exposed.
• Platelets adhere to this collagen and
get activated.
• These platelets secrete serotonin and
other vasoconstrictors which causes
constriction of blood vessel.
 Platelet plug formation
 Platelets get adhered to the collagen of
ruptured blood vessel and secrete ADP and
thromboxane
A2 which attracts more platelets to aggregate and
form a loose temporary plug or hemostatic plug.
 Coagulation of blood
 Fibrinogen is converted onto fibrin. Fibrin
threads get attached to the plug which blocks the
ruptured part of blood vessels and prevent
further blood loss.

059. Coagulogram, methodology for

conducting and evaluating the results.
Coagulogram
 a comprehensive analysis of blood clotting
indicators. Studies of venous blood by the
method of coagulometry help assess the
condition and efficiency of functioning of various
parts of blood systems such as coagulation,
anticoagulation and fibrinolytic.
Rate of indicators
• Time of clotting by Ly-Wait – 5-10 minutes
• Time of plasma recalcification – 60-120
seconds
• Thrombotest – IV, V, VI degree
• Thromboplastin time – 12-15 seconds
 • Thromboplastin index – 80-105 %
• Concentration of fibrinogen – 2-4 g/L
• Tolerancy of plasma to heparin – 6-11
minutes
• Heparin time – 50-60 seconds
• Fibrinolysis – 15-20 %.
060. Coagulants and anticoagulants and
their role in maintaining blood in the liquid
state.

An agent that produces coagulation (Coagulation is

a complex process by which blood forms clots).

Coagulation factors:
I. Fibrinogen.
II. Prothrombin.
III. Thromboplastin, tissue pro-coagulant IV.
Calcium.
V. Proaccelerin, labile factor.
VI. Accelerin.
VII. Stable factor
VIII. Antihemophilic factor.
IX. Christmas factor, plasma thromboplastin,
cofct2 X. Stuart-Prowers factor.
XI. Plasma thromboplastin antecedent.
XII. Hageman factor, contact factor, glass factor
XIII. Fibrin-stabilizing factor, transglutaminase

 Substances which prevents coagulation of

blood are called anticoagulants.
 Anticoagulants are of three types:
• Anticoagulants used to prevent blood clotting
inside the body (in vivo).
• Anticoagulants used to prevent clotting of
blood that is collected from the body (in
vitro).
• Anticoagulants used to prevent clot in both in
vivo and in vitro
Some of the anticoagulants are:
 Heparin
• Intravenous injection of heparin postpones
clotting for 3 to 4 hours.
 Coumarin derivatives
• Dicumoral and warfarin are the commonly
used oral anticoagulants (in vivo).
• Warfarin is used to prevent myocardial
infarction (heart attack), strokes and
thrombosis.
 EDTA
• EDTA is used as an anticoagulant both in vivo
and in vitro.
• Commonly administered intravenously, in
cases of lead poisoning.
• Used as an anticoagulant in the laboratory (in
vitro). 0.5 to 2.0 mg of EDTA per mL of blood
is sufficient to preserve the blood for at least
6 hours. On refrigeration, it can preserve the
blood up to 24 hours
 Oxalate compounds
 • Oxalate compounds are used only as in vitro
anticoagulants. 2 mg of mixture is necessary
for 1 ml of blood. Since oxalate is poisonous,
it cannot be used in vivo
 Citrates: Citrate is used as in vitro
anticoagulant.

061. Mechanisms fibrinolysis, their

physiological importance.
Fibrin/fibrinogen degradative products (FDP) as well
as fibrin/fibrinogen split products (FSP).
 FDP → promote bleeding
 They inhibit binding of fibrinogen to platelets
and inhibit aggregation of platelets.
 They inhibit thrombin formation and also
destroy any thrombin formed.
 They prevent fibrin polymerization.
Mechanisms of fibrinolysis activation
There are 2 mechanisms of fibrinolysis activation:
external and internal.
 • Main internal mechanism put in action by
XIIa factor (kallikrein)
• External mechanism stimulated by protein
activators of plasminogen, which are
produce
Plasmin is produced in an inactive form, by
plasminogen, in liver. vessel
Tissue plasminogen activator (T-PA) and wall

urokinase convert
plasminogen to the
active plasmin.
T-PA is released
into the
 blood very slowly by
damaged
endothelium of
blood vessels, such
that, after several
days (when bleeding
has stopped), the
clot is broken down.
 T-PA and urokinase are inhibited by
plasminogen activator inhibitor-1 and
plasminogen activator inhibitor-2 (PAI-1 and PAI-
2).
 Plasmin further stimulates plasmin
generation by producing more active forms of
both tissue plasminogen activator (tPA) and
urokinase.
 Alpha 2-antiplasmin and alpha 2-
macroglobulin inactivate plasmin. Plasmin activity
is also reduced by thrombin-activatable
fibrinolysis inhibitor (TAFI).
Importance
 Removes formed fibrin from blood vessels and
tissues and play a role in maintaining vascular
patency in balance with blood coagulation and
resultant fibrin formation

01. General characteristics of the

respiratory system. The main stages of
breathing. Biomechanics of inhalation and
exhalation.
  Respiration provides oxygen to the
tissues and removes carbon dioxide.
• The four major functions of respiration are
pulmonary ventilation, which means the inflow
and outflow of air between the atmosphere and
the lung alveoli
• diffusion of oxygen and carbon dioxide between
the alveoli and the blood
• transport of oxygen and carbon dioxide in the
blood and body fluids to and from the body's
tissue cells
• regulation of ventilation and other facets of
respiration
Stages of breathing
 There are 2 stages of breathing:
inhalation and exhalation.
Inhalation (center – upper part of medulla
oblongata): is an active process.
 The contraction of the inspiratory
muscles and diaphragm increases
intrathoracic volume.
  It stretches the thorax and lungs. 
Normal
Mechanism :
• Contraction of external intercostal muscles.
• elevation of ribs & sternum.
• increased front- to-back dimension of
thoracic cavity.
• lowers air pressure in lungs.
• air moves into lungs
• Contraction of diaphragm • diaphragm
moves downward.
• increases vertical dimension of thoracic cavity
• lowers air pressure in lungs.
• air moves into lung
Exhalation (medulla oblongata, anterior and lateral
to the inhalation centre): is a passive process.
 The thorax and lungs recoil when the
respiratory muscles relax. Mechanism:
• relaxation of external intercostal muscles &
diaphragm.
 • return of diaphragm, ribs, & sternum to resting
position.
• restores thoracic cavity to pre inspiratory
volume.
• increases pressure in lungs
• air is exhaled.
02. An elastic thrust lungs, pleural negative
pressure in the gap.
 Elastic recoil/thrust means the rebound of
the lungs after having been stretched by
inhalation, or rather, the ease with which the lung
rebounds.
 With inhalation, the intrapleural pressure of
the lungs decreases.
 Relaxing the diaphragm during expiration
allows the lungs to recoil and regain the
intrapleural pressure experienced previously at
rest.
Elastic recoil is inversely related to lung compliance.
 This phenomenon occurs because of the
elastin in the elastic fibers in the connective tissue
of the lungs, and because of the surface tension
of the film of fluid that lines the alveoli.
 As water molecules pull together, they also
pull on the alveolar walls causing the alveoli to
recoil and become smaller.
But two factors prevent the lungs from collapsing:
surfactant and the intrapleural pressure.
Surfactant is a surface-active lipoprotein complex
formed by type II alveolar cells.
 The proteins and lipids that comprise
surfactant have both a hydrophilic region and a
hydrophobic region.
 By absorbing to the air-water interface of
alveoli with the hydrophilic head groups in the
water and the hydrophobic tails facing towards
the air, the main lipid component of surfactant,
di-palmitoylphosphatidyl-choline, reduces surface
tension.
 It also means the rate of shrinking is more
regular because of the stability of surface area
caused by surfactant.
 Pleural pressure is the pressure in the pleural
space.
 When this pressure is lower than the pressure
of alveoli they tend to expand.
 This prevents the elastic fibers and outside
pressure from crushing the lungs.
 It is a homeostatic mechanism.
Cause for Negativity of Intrapleural Pressure
 Pleural cavity is always lined by a thin layer of
fluid that is secreted by the visceral layer of
pleura.
 This fluid is constantly pumped from the
pleural cavity into the lymphatic vessels.
 Pumping of fluid creates the negative
pressure in the pleural cavity.
 Throughout the respiratory cycle intrapleural
pressure remains lower than intra-alveolar
pressure.
 This keeps the lungs always inflated.
 Intrapleural pressure becomes positive in
Valsalva maneuver and in some pathological
conditions such as pneumothorax, hydrothorax,
hemothorax and pyothorax.
• At the end of normal inspiration: –6 mm Hg
(760 – 6 = 754 mm Hg)
• At the end of normal expiration: –2 mm Hg (760
– 2 = 758 mm Hg)
• At the end of forced inspiration: –30 mm Hg
• At the end of forced inspiration with closed
glottis (Müller maneuver): –70 mm Hg
• At the end of forced expiration with closed glottis
(Valsalva maneuver): +50 mm Hg.

03. External breathing, research methods.

Indices of external breathing and their
evaluation.
External respiration - is the processes by which
external air is drawn into the body in order to
supply the lungs with oxygen, and (used) air is
expelled from the lungs in order to remove carbon
dioxide from to body.
 External respiration refers to a process of
inhaling oxygen from the air into the lungs and
expelling carbon dioxide from the lungs to the air.
 Exchange of gases both in and out of the
blood occurs simultaneously.
 External respiration is a physical process
during which oxygen is taken up by capillaries of
lung alveoli and carbon dioxide is released from
blood.

04. Anatomical and physiological "dead

space", its physiological role.
 Dead space is defined as the part of the
respiratory tract, where gaseous exchange does
not take place. Air present in the dead space is
called dead space air.
 There are two types of dead spaces
• Anatomical
• Physiological
Anatomical Dead Space
 Anatomical dead space extends from nose up
to terminal bronchiole.
 It includes nose, pharynx, trachea, bronchi
and branches of bronchi up to terminal
bronchioles. These structures serve only as the
passage for air movement. Gaseous exchange
does not take place in these structures.
 Normal range: Volume of normal dead space
is 150 mL. Under normal conditions, physiological
dead space is equal to anatomical dead space. It
is because, all the alveoli are functioning and all
the alveoli receive adequate blood flow in normal
conditions.
Physiological Dead Space
 Physiological dead space includes anatomical
dead space plus two additional volumes.
 Additional volumes included in physiological
dead space are:
• Air in the alveoli, which are non-functioning.
In some respiratory diseases, alveoli do not
 function because of dysfunction or
destruction of alveolar membrane.
• Air in the alveoli, which do not receive
adequate blood flow. Gaseous exchange does
not take place during inadequate blood
supply. These two additional volumes are
generally considered as wasted ventilation.
 Normal range: Volume of normal dead space
is 150 mL. Under normal conditions, physiological
dead space is equal to anatomical dead space. It
is because, all the alveoli are functioning and all
the alveoli receive adequate blood flow in normal
conditions. Physiological dead space increases
during respiratory diseases, which affect the
pulmonary blood flow or the alveoli 05. The
diffusion of gases in the lungs. Diffusion
lung capacity and factors on which it
depends.
 Diffusion is the spontaneous movement of
gases between the gas in the alveoli and the
blood in the capillaries of the lungs, without the
use of any energy or effort by the body. Diffusion
 capacity in human lungs for oxygen is 21-25 ml
O2/min*mm Hg.
 Factors of dependence:
• Pressure gradient: DC is directly proportional.
• Solubility of gas in fluid: DC is directly
proportional.
• Total surface area of respiratory membrane:
DC is directly proportional.
• Molecular weight of gas: DC is inversely
proportional.
• Thickness of respiratory membrane: DC is
inversely proportional.
DC= Pg * S * A /Mw * T

06. The transport of oxygen in blood.

Oxygen capacity of blood.
 O2 is transported from alveoli to the tissue by
blood in two forms:
 • As simple physical solution: O2 is dissolved in
the water of plasma and is transported in this
physical form. Amount of this way is very less.
• In combination with hemoglobin: O2
combines with hemoglobin in the blood and is
transports as oxy-hemoglobin. Transport of
O2 in this form is maximum amount 98.5%
 Hemoglobin contains four atoms of iron and
each atom bounds to one molecule of oxygen.
This form of transport have some advantages:
• O2 can be easily released from the Hb when
needed
• Hb accepts O2 readily whenever partial
pressure of O2 in blood is more. 07.
Oxyhemoglobin dissociation curve,
factors influencing its course.
 Curve that plots the proportion of
hemoglobin in its saturated (oxygen-laden) form
on the vertical axis against the prevailing oxygen
tension on the horizontal axis.
 Oxyhemoglobin dissociation curve describes
the relation between the partial pressure of
oxygen (x axis) and the oxygen saturation (y axis).
 Hemoglobin's affinity for oxygen increases as
successive molecules of oxygen bind.
Factors
 Temperature
 Ph
 concentration of 2,3-DPG in erythrocyte
 With the decrease of temperature O2 release
by oxyhemoglobin slows down, and with the
increase its accelerating.
 reducing the pH shifts the curve to the right,
due to reduce of the affinity of Hb to O2.
Increasing the pH increases the affinity of Hb to
O2 and the curve shifts to the left.
 formation of large quantities of CO2 in the
tissues increases oxygen release in tissues by
lowering its affinity with Hb.
 displacement of the curve to the right also
contributes to increased content of 2,3-DPG in
erythrocytes.

08. Transport of carbon dioxide in blood.

 Carbon dioxide is transported in the blood
from the tissue to the lungs in three ways:
• Bicarbonate ion (HCO3-) - 70% CO2; •
Carboxyhemoglobin (HHbCO2) - 23% CO2 :
• Carbonic acid (H2CO3) - 7% CO2 : a part of
dissolved CO2 in plasma combines with
water to form carbonic acid.
 The transfer of CO2 from tissues to blood
cells also occurs by diffusion. The average
tension of CO2 in blood is 40 mm Hg and in
tissues - 50-60 mm Hg.
 Approximately 75% of carbon dioxide is
transport in the red blood cell and 25% in the
plasma.
 Carbon dioxide is more soluble in blood than
is oxygen; about 5 to 7 percent of all carbon
dioxide is dissolved in the plasma. Carbon
 dioxide has the ability to attach to hemoglobin
molecules
 In the bicarbonate buffer system, the most
common form of carbon dioxide transportation
in the blood

09. The physiological role of the

respiratory tract, regulation of their
lumen.
 The respiratory tract is the
path of air from the nose to the
lungs. It is divided into two
sections: Upper Respiratory
Tract and the Lower Respiratory
Tract.
Upper respiratory tract
Includes Nostrils, Nasal
Cavities, Pharynx, Epiglottis,
and the Larynx.
Lower respiratory tract
Includes Trachea, Bronchi, Bronchioles, and the
Lungs.
  Function:
• Warming.
• Moisturizing.
• responsible for the exchange of carbon
dioxide and oxygen
• remove metabolic waste products
• keep pH levels in check
• Clearing the air Inhaled air: t 18-22° C, 45-55%
In the bronchi: t 37 ° C, 100

010. Respiratory center, its structure,

regulation of breathing.
 The centers in the medulla oblongata and pons
that collects sensory information about the level of
oxygen and carbon dioxide in the blood and
determines the signals to be sent to the respiratory
muscles. Stimulation of these respiratory muscles
provide respiratory movements which leads to
alveolar ventilation. Respiratory centers are
situated in the reticular formation of the
brainstem, the respiratory centers are classified
into two groups:
 Medullary Centers:
• Inspiratory center
• Expiratory center  Pontine Centers:
• Pneumotaxic center
• Apneustic center
Inspiratory center: Inspiratory center is situated in
upper part of medulla oblongata. This center is also
called dorsal group of respiratory neurons. It is
formed by nucleus of tractus solitarius. Function: it
is concerned with inspiration.
Expiratory center: It is situated in medulla
oblongata anterior and lateral to the inspiratory
center. It is also called ventral group of respiratory
neurons. It is formed by neurons of nucleus
ambiguous and nucleus retro ambiguous Function:
this center is inactive during quiet breathing and
inspiratory center is the active, but during forced
breathing or when the inspiratory center is
dysfunctional it becomes active.
Pneumotaxic center: This center is situated in the
dorso-lateral part of reticular formation in upper
pons. Function: Control medullary respiratory
center, inhibits apneustic center so that inspiratory
center is inhibited.
Apneustic center: Situated in the nucleus of
reticular formation of lower pons. Function:
Increases depth of inspiration by acting directly on
dorsal group neurons.

011. The mechanism of first breath of a

newborn child.
 At this point, baby’s lungs, which were filled
with fluid during pregnancy, must suddenly fill
with oxygen from the air.
 The fluid in the lungs is removed through the
blood and lymph system, and is replaced by air.
 Baby’s lungs must be able to exchange
oxygen for carbon dioxide.
 At the same time, vigorous blood circulation
in the lungs will begin. The first few breaths
after birth may be the most difficult breaths
baby will take for the rest of her life.
  There are a couple of things that will
stimulate baby to take her first breath.
Hormonal and other changes during labor slow
down or stop the production of fluid in the
lungs, and may initiate the reabsorption of fluid
from the lungs.
 This process is unlikely to have occurred if
labor was very short or did not occur at all, for
example, if baby was delivered by caesarean
section. Furthermore, physical stimulation and
handling during delivery will encourage your
baby to breathe.
 There are probably many other factors that
stimulate baby’s first breath, but they have not
been identified yet.
012. The role of mechanoreceptors in the
regulation of breathing.
 Receptors are stimulated by dust, caustic
gases, bronchial secret and alien bodies. It
causes a cough reflex, which is expressed in a
quick exhalation on a background of narrowing
of the larynx and contraction of bronchial
 smooth muscle, which remains long after the
reflex.
 Cough reflex is the main pulmonary reflex of
the vagus nerve . - Irritation causes hyperpnoe,
bronchoconstriction, laryngeal spasm, mucus
hypersecretion, but never accompanied by
cough.
 Receptors are most sensitive to three types of
stimuli:
• tobacco smoke, numerous passive and
irritational chemicals
• damage and mechanical stretching of airways
during deep breathing, and pneumothorax
• pulmonary embolism, pulmonary capillary
hypertension and pulmonary anaphylactic
phenomena.
013. The role of the central and peripheral
chemoreceptor’s in regulating breathing.

 The central chemoreceptors are the type of

chemoreceptors. The chemoreceptors that are
 present in the brain are called central
chemoreceptors.
 They are situated in deeper part of medulla
oblongata close to dorsal group of neurons and
exit 9-10 cranial nerves. This area is known as
chemo-sensitive area and neurons are called
chemoreceptors.
Action
• They are very sensitive to increase in hydrogen
ion concentration.
• Hydrogen ion cannot cross the blood- brain
barrier and blood cerebrospinal fluid barrier.
• On the other hand if carbon dioxide increases in
blood as it is a gas, it can cross both of the
barriers and after entering into the brain it
combines with water to form carbonic acid.
• As carbonic acid is unstable it immediately
dissociates into hydrogen and bicarbonate ions.
• The hydrogen ion now stimulates the central
chemoreceptors which stimulate dorsal group
 of respiratory center (inspiratory group) and
increase rate and force of breathing.
They detect changes in the pH of spinal fluid. They
can be desensitized over time from chronic hypoxia
(oxygen deficiency) and increased carbon dioxide.

 Peripheral chemoreceptors (carotid and

aortic bodies) and central chemoreceptors
(medullary neurons) primarily function to
regulate respiratory activity.
 This is an important mechanism for
maintaining arterial blood pO2, pCO2, and pH
within appropriate physiological ranges.
 For example, a fall in arterial pO2
(hypoxemia) or an increase in arterial pCO2
(hypercapnia) leads to an increase in the rate
and depth of respiration through activation of
the chemoreceptor reflex.
 Chemoreceptor activity, however, also affects
cardiovascular function either directly (by
 interacting with medullary vasomotor centers)
or indirectly (via altered pulmonary stretch
receptor activity)
Action
• They are very sensitive to reduction in partial
pressure of oxygen.
• Whenever, the partial pressure of oxygen
decreases these chemoreceptors become
activated and send impulses to inspiratory
center and stimulate them.
• Thereby, increases the rate and force of
respiration and rectifies the lack of oxygen.

014. Regulation of respiratory

exertion.(while exercise)
 oxygen consumption and carbon dioxide
formation can increase.
 In moderate exercise, respiratory rate
increases to 30/min and tidal volume increases
 to 2000ml and pulmonary ventilation rise to
60L/min

Factors affecting pulmonary ventilation during

exercise:

• High centers: Rate and depth of respiration

increase during the onset of exercise.
Sometimes, even the thought of exercise
increases the rate and force of respiration. It
 is a psychic phenomenon due to the
activation of higher centers like sylvian cortex
and motor cortex of brain.
• Chemoreceptors: These receptors are
stimulated by exercise induced hypoxia and
hypercapnia and send impulses to respiratory
center, which increase rate and force of
respiration.
• Proprioceptors: these are activated during
exercise, send impulses to cerebral cortex
through the somatic afferent nerves.
Cerebral cortex in turn causes
hyperventilation by sending impulses to the
medullary respiratory centers.
• Body temperature: body temperature
increases muscular activity, increases the
ventilation by stimulating the respiratory
centers
• Acidosis: It develops during exercise and also
stimulates the respiratory centers, resulting
in hyperventilation.
015. Automatism heart. Gradient
automatism.
 Automatism of heart - the ability of cells of
the heart conducting system to produce
independently bioelectric impulses, that cause
its excitement.
 Structures of conducting system have
different degrees of automaticity. It is
established the socalled gradient of
automaticity. It manifests itself in a reduced
ability to automatism of different structures of
the conducting system according to their
distance from the sine-atrial node.
 Thus, if the sine-atrial node number of action
potentials riches the level of 60-90 imp / min,
and in the cells of Hiss node - 30-40 imp / min,
 so in the fibers of Purkinje – less than 20 imp /
min.
Gradient of automaticity caused by different
spontaneous permeability cell membrane of
conduction system to Ca2 +.
 Based on the fact, that the sine- atrial node
imposes its rhythm to the departments of
conduction system, that lying lower, it is called
pacemaker or pacemakers of first order.
 Pacemaker of second order is atrio-
ventricular node.
 Pacemaker third order – it is Hiss node and its
ramifications
SA-node – 60-90 /min
AV – node – 40-60 /min
Hiss bundle – 30-40 /min
Purkinje fibers - <20/min

016. The action potential atypical

cardiomyocytes mechanisms of
physiological role.
  Entry of sodium and calcium in cardiac cells
leads to accumulation of positive ions inside
cells.
 Upon reaching by membrane potential critical
point of the depolarization (about -60 mV),
action potential spontaneously arises and
spread by conduction system, and thence to the
contractile myocardium.

• Phase 0 - fast depolarization rapid opening of Na+

channels and Na+ entry into the cell
• Phase 1 –fast initial repolarization reduce of
permeability to Na +, with a simultaneous
increase of it for K + and Cl-
• Phase 2 – slow repolarization plateau Ca2 +
enters the cell through slow Ca2 + channels
• Phase 3 – fast ending repolarization the gradual
closure of Ca2+ channels, while opening
Caexcitable K + channels, which leads to K + out
of the cell
• Phase 4 –spontaneous diastolic depolarization
phase of slow spontaneous diastolic
depolarization, which is due entrance through the
membrane of cardiomyocytes Ca2 + and Na +.
017. Conducting system of the heart. The
sequence and speed of conduction of
excitation in the heart.
 SA node AV node Hiss bundle
Purkinje fibers(septal) Purkinje fibers(right
and left branch)
 Along with this, heart consists of three
bundles
• Bundle of Kent – right ventricle side
• Bundle of James – atrial septa
• Bundle of Maheym – left ventricle side
 Conduction velocity
• In atrial muscle – 0.3-0.5 m/sec
 • Internodal pathway – 0.03 m/sec
• AV node – 0.03 m/sec
• AV bundle – 0.04 m/sec
• Delay in AV nodal and bundle system –
0.13m/sec + 0.03m/sec
• From SA to AV node – 0.16 m/sec
• Hiss bundle – 3-4m/sec

018. The action potential of ventricular

contractile cardiomyocytes, mechanisms of
phase, physiological role.
 Entry of sodium and calcium in cardiac cells
leads to accumulation of positive ions inside cells.
 Upon reaching by membrane potential critical
point of the depolarization (about -60 mV), action
potential spontaneously arises and spread by
conduction system, and thence to the contractile
myocardium.
• Phase 0 - fast depolarization rapid opening of Na+
channels and Na+ entry into the cell
• Phase 1 –fast initial repolarization reduce of
permeability to Na +, with a simultaneous
increase of it for K + and Cl-
• Phase 2 – slow repolarization plateau Ca2 +
enters the cell through slow Ca2 + channels
• Phase 3 – fast ending repolarization the gradual
closure of Ca2+ channels, while opening
Caexcitable K + channels, which leads to K + out
of the cell
• Phase 4 –spontaneous diastolic depolarization
phase of slow spontaneous diastolic
 depolarization, which is due entrance through the
membrane of cardiomyocytes Ca2 + and Na +.

019. Changes in the excitability of

cardiomyocytes during arousal.
 Excitability - the ability of heart to excitation (or
move to a state of physiological activity). The
excitability is typical for cells of the conducting
system of the heart and contractile myocardium.
 The excitability of the heart muscle during
excitation changes.

 If you compare the action potential with

excitability, it shows that during the 0, 1 and 2
phases cell completely non-excitable or refractory.
 This is so-called the absolute refractory period,
when the cell is not able to respond to the
stimulus of any strength (is caused by inactivation
of Na +- channels).
 During phase 3 relative refractory period take
place. During this period under threshold irritation
can cause excitement. That is, in this period there
is a recovery of excitability. Each electrical impulse
can trigger cardiac muscle contraction normally
only once.
 Contraction of the heart is triggered by elevation
of intracellular calcium influx. A normal heart
generates 60 to 100 impulses in 1 minute at
resting state. The myocytes have Long refractory
period during which they do not respond to any
electrical impulses.
 Role of a Long Refractory Period – prevent
ventricles from contracting at too high rates so
that enough time is allowed for refill of the
ventricles. Excitation > Ca2+ >contraction 020.
Conjugation excitation and emission in
the myocardium. Mechanisms of
contraction and relaxation of the
myocardium.
Mechanism of contraction

When an action potential passes over the cardiac
muscle membrane, the action potential spreads
into the cardiac muscle fiber along the membrane
of the transverse tubules (t-tubules).
 The t-tubules action potential in turn act on
the membrane of the longitudinal
sarcoplasmic tubules to cause the release of
Ca+ ions into the muscle sarcoplasm from the
sarcoplasmic reticulum.
 Ca+ ions diffuse into the myofibrils and
catalyze the chemical reactions.
 Ca+ ions also diffuse into the sarcoplasm
from ttubules themselves at the time of action
potential, which opens voltage dependent
calcium channels in the membrane of t-
tubules.
 Ca+ entering the cell then activates Ca2+
release channels, also called ryanodine
receptor channels triggering the release of
Ca2+ into sarcoplasm which in turn causes
contraction.

Mechanism of relaxation
The relaxation of cardiomyocytes occurs as a
result of repolarization of the membrane. It is
based on the fact that the impact of
repolarization removes Ca2 + from the contractile
proteins.
 After that Ca2 + captures by pumps of
cisterns of sarcoplasmic reticulum. Ca2 + is
also displayed in the interstitial liquid due the
pump work of cell membranes.
 The main process, that determines the
relaxation of cardiomyocytes – the removal of
calcium ions from the sarcoplasm, resulting in
decreasing of
Ca2 + concentration in it. Thus, complexes of Ca2
+ with troponin C break, tropomyosin shifts
according to actin filaments and closes their active
centers – contraction is 021.
terminated.
Formation electrogram of the heart
muscle fibers, wave dipole properties

repolarization depolarization and muscle
fiber, the concept of vector.
Electrocardiography - is the process of recording
the electrical activity of the heart over a period of
time using electrodes placed on the skin. These
electrodes detect the tiny electrical changes on
the skin that arise from the heart muscle's
electrophysiologic pattern of depolarizing and
repolarizing during each heartbeat
• If the dipole vector directed towards the positive
electrode of lead – ECG will show positive wave
• If the dipole vector directed toward the negative
electrode lead – electrocardiogram will show
negative wave
• If the dipole vector is perpendicular to the axis of
abduction, then electrocardiogram writes isoline.


The p-wave represents depolarization of the

atria. Atrial depolarization spreads from the SA
node towards the AV node, and from the right
atrium to the left atrium.
 The PR interval is measured from the beginning
of the P wave to the beginning of the QRS
complex.
• This interval reflects the time the electrical
impulse takes to travel from the sinus node
through the AV node

 The QRS complex represents the rapid
depolarization of the right and left ventricles. The
ventricles have a large muscle mass compared to
the atria, so the QRS complex usually has a much
larger amplitude than the P-wave
 The T wave represents the repolarization of the
ventricles. It is generally upright in all leads except
aVR and lead V1.
 The ST segment connects the QRS complex and
the T wave; it represents the period when the
ventricles are depolarized.
022. Formation of the propagation of
excitation electrocardiogram heart.
 The spread of excitation in the atria and AV
node
• The spread of excitation in the atria The
excitement that arise in Sino- atrial node, is
conduct through the atria at a speed of 0,8-
1,0 m / s. At first depolarization covers the
right atrium , and then – left atrium. Time of
coverage by excitation of both atria – 0,1 sec.
• Conduction of excitation in the atrioventricular
node With the transfer of excitation from the
atria to the ventricles its delay in atrio -
ventricular node is observed.  This is due to
the low density of Na + channels.
 This delay is important for sequential excitation
and contraction of atria and then the ventricles.
The speed of excitation spread through
atrioventricular node is about 0,02 m / s.
The spread of excitation in the ventricles
 The speed of the excitation through the His-
node and the Purkinje fibers is 1-1,5 m / s.
 The process of ventricular depolarization begins
at the middle third of the interventricular septum
and extends to the top and side walls of the right
and left ventricle.
 Basal parts of the ventricles and the upper third
of the interventricular septum are depolarized at
last.
 Next delay of excitation - in the place of contact
of Purkinje fibers with contractile myocytes.
 It is the result of summation of action
potentials, which contributes to the
synchronization of myocardium’ excitation.
 The speed of excitation conduction within
ventricles averages 0,3-0,9 m / s.
Conduction velocity .
 0.03 m/sec internodal pathway to AV node
 0.09 m/sec AV node itself
 0.04 m/sec penetrating AV bundle
 Total delay in the AV nodal and AV bundle
system
= 0.13 m/sec + 0.03 m/sec from SA to AV node =
0.16 m/sec
023. Electrocardiographic leads.
 A standard 12-lead ECG report (an
electrocardiograph) shows a 2.5 second tracing of
each of the twelve leads.
 The first is the limb leads (I,II, and III), the
second is the augmented limb leads (aVR, aVL,
and aVF), and the last are the precordial leads
(V1-V6).
• Lead I: Potential difference between right
arm and left arm. Vector oriented to 0º
• Lead II: Potential difference between right
arm and left leg. Vector oriented to 60º
• Lead III: Potential difference between left
arm and left leg. Vector oriented to 120º.
• aVR: Right arm absolute potential, vector
oriented at -150º.
• aVL: Left arm absolute potential, vector
oriented at -30º.
• aVF: Left leg absolute potential, vector
oriented at 90º.
• V1: This chest lead registers potentials
from the atria, part of the septum and the
right ventricle anterior wall. In the 4th
intercoastal space on right side of sternum.
• V2: The electrode for this precordial lead
rests over the right ventricle wall.
Therefore, the R wave is slightly bigger
than in V1, followed by a deep S wave. In
the 4th intercostal space on the left side of
sternum.
• V3: It is the transitional lead between the
electrocardiogram left and right potentials,
as the electrode rests over the
interventricular septum. The R and S waves
are almost identical. At level of 4th rib on
left parasternal line.
• V4: The electrode for this chest lead rests
over the left ventricle apex, where the
 walls are thicker. Therefore, it presents a
tall R wave followed by a small S wave
(right ventricle depolarization). In 5th
intercostal space on left mid-clavicular line.
• V5 & V6: These electrocardiogram leads are
situated over the Left Ventricle
myocardium, which has thinner walls than
in V4.
Therefore, the R wave is not as tall as in V4,
preceded by a small q wave (septum
depolarization). In 5th intercoastal space on
left mid axillary line.

024. Characteristics teeth, segments,

ECG intervals.
 P wave: the duration of P wave from its
beginning on isoline to its end
• Normal value: 0,1 sec.
• Amplitude - Normal value: up to 2,5 mm.
 P-Q interval and segment on ECG: the duration
of P-Q segment starting from the end of P wave
to the beginning of Q (R) wave
• normal value: up to 0,12 sec
P-Q interval is measured starting from the
beginning of P wave to the beginning of Q (R) wave

• normal value: 0,12 – 0,2 sec.

 Q wave: the duration of Q wave from its
beginning on isoline to its end
• Normal value: 0,03 sec
• Amplitude -Normal value: up to 25% of R
wave in the given lead
 R wave: the duration of R wave from its
beginning on isoline to its end
• Normal value: 0,03 – 0,04 sec
• Amplitude - Normal value: up to 20 mm in
standard and unipolar limb leads and up to
25 mm in unipolar chest leads
 S wave: the duration S wave from its beginning
on isoline to its end
• Normal value: up to 0,03 sec
• Normal value: up to 5 mm in standard and
unipolar limb leads and up to 20 mm in
unipolar chest leads
 T wave: The duration of T wave from its
beginning on isoline to its end
• Normal value: 0,16 – 0,24 sec)
• Amplitude - Normal value: 5-6 mm in
standard and unipolar limb leads and 15-17
mm in unipolar chest leads
 S-T segment: Determine the deviation of S-T
segment from isoline (normally in standard and
 unipolar limb leads it is on isoline and can deviate
for up to ± 0,5 mm.
• In unipolar chest leads V2 and V3, a larger
deviation can be observed - upwards to 2
mm, and in V4, V5, V6 – downwards no more
then 0,5 mm.
 Q-T interval: the duration of Q-T interval from
the beginning of Q wave to the end of T wave
• Normal value: 0,35 – 0,45 sec
025. Procedure for ECG analysis.
Analysis of Electrocardiogram.
 Determining of impulse origin (Determine the
source of excitation on ECG). To determine the
excitation source (pacemaker) should follow heart
a standard sequence of positive leads for atrial P
wave, ventricular complexes QRST interval
duration and PQ (R) normally, electrical impulse
arises in the sinoatrial node and ECG in the
second standard lead recorded positive P wave
before each complex QRST. This talk about sinus
rhythm.
 Heart rhythm evaluation Heart rhythm is
evaluated by measuring R-R interval duration.
Normally adjacent R-R intervals duration may
differ from each other no more than 0.1 s. Usually
II lead should be examined.
 Determining of heart rate. In proper rhythm 60
s is divided by R-R duration in seconds, which is
calculated using paper printing speed parameters.
 Evaluation of ECG voltage: If in bipolar limb
leads the lowest R wave is smaller than 5 mm and
RI+RII+RIII is less than 15 mm, the ECG voltage is
decreased. Otherwise it is normal  EMP
direction determining:
• visual method: needs measuring R amplitude
in all bipolar limb leads. If RII>RI>RIII, the EMP
direction is near 30º-69º, that is normal;
• graphical method with the use of Bailey
coordinate system. If we shift the ECG lead
vectors in Einthoven’s triangle so that they all
cross in the center, being parallel to original
leads axes, we’ll get the Bailey’s coordinate
system.
 Upward waves have positive meaning and
downward ones are negative. General amplitude
is then put on corresponding axis with (+) or (-)
sign. In these points draw perpendicular lines to
lead axis. Determine cross point of two
perpendiculars. When you join this point to
Bailey’s co-ordinate center you’ll get the EMP
direction vector moving from the center. The
angle α is determined between this line and
positive part of the axis and the standard leads.
026. Cardiac cycle, its phases and their
physiological role.
 Cardiac cycle: 1st diastole phase During the
diastole phase, the atria and ventricles are
relaxed and the atrioventricular valves are open.
• De-oxygenated blood from the superior and
inferior vena cava flows into the right atrium.
The open atrioventricular valves allow blood
to pass through to the ventricles.
 • The SA node contracts triggering the atria to
contract. The right atrium empties its
contents into the right ventricle. The tricuspid
valve prevents the blood from flowing back
into the right atrium.
 Cardiac cycle: 1st systole phase During the
systole phase, the right ventricle receives
impulses from the Purkinje fibers and contracts.
The atrioventricular valves close and the
semilunar valves open. The de-oxygenated blood
 is pumped into the pulmonary artery. The
pulmonary valve prevents the blood from flowing
back into the right ventricle. The pulmonary
artery carries the blood to the lungs. There the
blood picks up oxygen and is returned to the left
atrium of the heart by the pulmonary veins.
 Cardiac cycle: 2nd diastole phase In the next
diastole period, the semilunar valves close and
the atrioventricular valves open. Blood from the
pulmonary veins fills the left atrium. (Blood from
the vena cava is also filling the right atrium.) The
SA node contracts again triggering the atria to
contract. The left atrium empties its contents into
the left ventricle. The mitral valve prevents the
oxygenated blood from flowing back into the left
atrium.
 Cardiac cycle: 2nd systole phase During the
following systole phase, the atrioventricular
valves close and the semilunar valves open. The
left ventricle receives impulses from the Purkinje
fibers and contracts. Oxygenated blood is
pumped into the aorta. The aortic valve prevents
 the oxygenated blood from flowing back into the
left ventricle. The aorta branches out to provide
oxygenated blood to all parts of the body. The
oxygen depleted blood is returned to the heart
via the vena cava.

027. Cardiac mechanisms of their origin.

PCG its analysis.
 Phonocardiogram (or PCG) is a plot of high-
fidelity recording of the sounds and murmurs
made by the heart with the help of the machine
called the phonocardiograph. It is graphical
record of heart sounds.
 Thus, phonocardiography is the recording of all
the sounds made by the heart during a cardiac
cycle.
 The sounds result from vibrations created by
closure of the heart valves, there are at least two:
 The first when the atrioventricular valves
(tricuspid and mitral) close at the beginning of
systole and the second when the aortic valve and
pulmonary valve
(semilunar valves)
close at the end of
systole.
 It allows the
detection of
subaudible sounds
and murmurs, and
makes a permanent
record of these
events.
028. The types and value of
echocardiography.
 Echocardiography: Echocardiography is a
diagnostic test that uses ultrasound waves to
create an image of the heart muscle
 It is a method of investigation of structure and
mechanical functioning of the heart
 Kinds of echocardiography There are 4 kinds of
echocardiography:
• one-measure (M),
• two-measure (D), • contrasting,
• Doppler.
M (movement)-regime of echocardiography has 3
pose.
 1st pose use for valuation of movement of
aorta walls, it diameter, aortic valves during
systole and diastole, chamber of left atrium.
 2nd pose help to value condition of mitral
valve.
 3rd pose help to value left ventricle.
D-echocardiography -ultrasonic sound radiated
by probe, which quickly move in boundary line
900. Investigation determine in 3 spaces:
 of long axis,
 of short axis,
  4 chamber of heart
Contrast echocardiography- doctor quickly inject
biological substance. On the end of needle form a
micro bulb of gases, which are moving by blood
stream to heart and may be investigate in a right
part of heart. It need for identification of chambers
and big vessels, presents of shunts between
chambers.
Doppler-These reflected waves have a lower
frequency than the transmitted wave because the
red cells are moving away from the transmitter
crystal. This is called the Doppler effect. The very
high frequency sound wave is intermittently cut off,
and the reflected wave is received back onto the
crystal and amplified greatly by the electronic
apparatus. Another portion of the apparatus
determines the frequency difference between the
transmitted wave and the reflected wave, thus
determining the velocity of blood flow.
029. The advantages over other methods
of echocardiography of the heart and its
limitations.
 Echocardiography: Echocardiography is a
diagnostic test that uses ultrasound waves to
create an image of the heart muscle.
Echocardiography is one of the most important
non-invasive techniques used in the diagnosis of
heart disease today.
 Description-Echocardiograms are obtained
by reflecting high frequency sound waves
(ultrasound) off various structures of the heart,
then translating the reflected waves into one
and two-dimensional images.
 The advantages of echocardiography over
other diagnostic techniques are many. It is
painless and ideal for diagnosing problems in
children and pregnant women for whom X-rays
would be inappropriate. It generally requires no
preparation of the patient. Echocardiography
also is the preferred method for identifying
 intracardiac masses, such as tumors and blood
clots. It can be used to monitor the
effectiveness of treatment for high blood
pressure by taking periodic measurements of
the size of the left
ventricle and the thickness of its wall
 When combined with the Doppler
technique, which records changes in frequency
of sound waves, echocardiography can be used
to measure blood flow through heart valves and
calculate pressure differences across valves.

030. The mechanisms of self-regulation of

heart: the law of Frank-Starling, effect
Anrep, phenomenon Boudichi.
The Frank–Starling law of
the heart represents the relationship between
stroke volume and end diastolic volume.
 The law states that the stroke volume of the
heart increases in response to an increase in the
volume of blood in the ventricles, before
 contraction (the end diastolic volume), when all
other factors remain constant.
 increased filling of the heart with blood
leads to increased force of heart contractions
 Force of contraction depends upon preload
and afterload

Preload: It is the stretching of the cardiac muscle

fibers at the end of diastole, just before contraction.
It is due to increased ventricular pressure. Thus,
force of contraction and cardiac output is directly
proportional to preload.
Afterload: It is the force against which the ventricles
must contract and eject the blood. This force is
determined by arterial pressure. Thus, force of
contraction and cardiac output is inversely
proportional to afterload.
Physiological role
 The Frank-Starling mechanism allows the
cardiac output to be synchronized with the
venous return, arterial blood supply and
humoral length, without depending upon
external regulations.
 The physiological importance of the
mechanism lies mainly in maintaining left and
right ventricular output equality
 It is an autoregulation method in which
myocardial contractility increases with
afterload. It was experimentally determined
that increasing afterload caused a proportional
linear increase in ventricular inotropy.
 This effect is found in denervated heart
preparations, such as the Starling Preparation,
and as such, represents an intrinsic
autoregulation mechanism.

 Positive Boudich effect causes an increase

in cardiac output due to the increased force of
contraction of heart muscles.
  Negative Boudich effect in heart failure and
other diseases of heart, such as cardiomyopathy
and coronary artery disease.
031. Features of heart activity when
overloaded by volume and pressure.
Volume overload refers to the state of one of the
chambers of the heart in which too large a volume
of blood exists within it for it to function efficiently.
  Ventricular volume overload is
approximately equivalent to an excessively high
preload. It is a cause of cardiac failure.
Causes
 may be considered according to which
chamber is affected.
Left ventricular volume overload
• Valvular heart disease
• Aortic regurgitation
• Mitral regurgitation, also causing left atrial
volume overload
• Congenital heart defects
• Patent ductus arteriosus
Pressure overload refers to the pathological state of
cardiac muscle in which it has to contract while
experiencing an excessive afterload.
 Pressure overload may affect any of the
four chambers of the heart, though the term is
most commonly applied to one of the two
ventricles.
  Chronic pressure overload leads to
concentric hypertrophy of the cardiac muscle,
which can in turn lead to heart failure,
myocardial ischaemia or, in extreme cases,
outflow obstruction.
Causes
 Any obstruction to the outflow of one of
the chambers of the heart can lead to pressure
overload.
Left ventricular pressure overload
• Aortic stenosis
• Hypertension
• Coarctation of the aorta
Right ventricular pressure overload
• Pulmonary stenosis
• Pulmonary hypertension

032. The mechanism of influence of

sympathetic nerves on heart activity.
Sympathetic nerves are cardioaccelerators in
function and carry impulses from vasoconstrictor
area to the heart.

Sympathetic Tone
  Sympathetic tone or cardioaccelerator
tone is the continuous stream of impulses
produced by the vasoconstrictor area.
 Impulses pass through sympathetic
nerves and accelerate the heart rate.
 Under normal conditions, the vagal tone
is dominant over sympathetic tone.
 Whenever vagal tone is reduced, the
sympathetic tone becomes powerful.
 Under resting conditions, the vagal tone
is dominant over sympathetic tone.
• Effect of Stimulation of Sympathetic Nerves
 Stimulation of sympathetic nerves increases
the rate and force of contraction of heart.
 The effect depends upon the strength of
stimulus.
Mechanism:

Cardio-acceleration by sympathetic stimulation is
due to the release of neurotransmitter substance,
noradrenaline (binds to beta1 receptor and gives
positive effects)

033. Mechanisms parasympathetic nerves

influences on heart activity.

 In the medulla oblangata the nucleus of vagus

nerve located.

Stimulation of the parasympathetic nerves
innervating the heart (the vagus nerve) causes
acetylcholine to be released at the vagal endings.
 Impulses from different parts of the body
regulate the heart rate through vasomotor
center, by altering the vagal tone.
 Vagal tone is also called cardioinhibitory tone
or parasympathetic tone.
 Parasympathetic stimulation cause decrease in
heart rate and contractility, causing blood flow
to decrease.
• Effect of Stimulation of Vagus Nerve
Stimulation of right vagus nerve – Vagal escape
 Right vagus supplies mainly SA node.
 Stimulation of right vagus in experimental
animals such as dog, with a weak stimulus
causes reduction in heart rate and force of
contraction.
 Stimulation with strong stimulus causes
stoppage of heart due to inhibition of SA node.

 If the stimulus is continued for some time,
the ventricle starts beating; but the rate of
contraction is slower than before.
This is because of vagal escape.
 Vagal escape refers to escape of ventricle
from inhibitory effect of vagal stimulation.
 If stimulation of vagus nerve is stopped,
heart starts beating normally.
Stimulation of left vagus nerve – heart block
 Left vagus supplies mainly the AV node.
 Stimulation of left vagus in dog with a weak
stimulus causes a slight reduction in rate of
ventricular contraction.
 Stimulation of left vagus causes inhibition of
AV node.
 Because of inhibition of AV node, some of
the impulses from SA node are not conducted
to ventricles.
 This is called the partial heart block.
 The ratio between atrial contraction.

 Stimulation of left vagus with strong stimulus
causes stoppage of ventricular contraction,
which is called complete heart block.
 This is because of the inhibition of AV node.
034. Humoral regulation of the heart.
Effects of catecholamines
 These are transmitted by alfa- and
betaadrenoreceptors.
 Adrenalin and noradrenalin stimulate heat
activity and cause positive regulatory effects:
• Positive inotropic effect - increasing strength
of heart contractions
• Positive chrono-tropic effect - increasing
heartbeat rate
• Positive dromo-tropic effect - increasing
heart conductibility
• Positive bathmo-tropic effect - increasing
excitability of heart muscle.
• Nor-epinephrine increases permeability of
cardiac fiber membrane to Na+ and Ca2+
 Sex hormones also have impact on heart
activity.
 Effects of acetylcholine leads to increase of K+
permeability through cell membrane in
 conductive system, which leads to
hyperpolarisation and cause such effects to the
heart activity:
• Negative inotropic, chrono-tropic,
dromotropic and bathmo-tropic effect.
 Effect of thyroid hormones
• Thyroid hormones increase transmission process
in ribosome and nucleus of cells.
• Intracellular enzymes are stimulated due to
increasing protein synthesis.
• Also increases glucose absorption and uptake of
glucose by cells, increases glycolysis and
gluconeogenesis
• All these effects of thyroid hormones lead to
increase activity of mitochondria in heart cells and
ATP formation in it.
• So, both activity of heart muscle and conduction
of impulses are stimulated Effects of
adrenocortical hormones
• Aldosterone causes increasing Na+ and Cl- in
blood and decreases K+.
• This is actually for producing action potential in
the heart.
• Cortisol stimulates gluconeogenesis and increase
blood glucose level.
Hormones of islets of Langerhans effects.
• Insulin promotes facilitated diffusion of glucose
into cells by activation glucokinase that
phosphorilates glucose and traps it in the cell,
promotes glucose utilization, causes active
transport of amino acids into cells.
• Glucagon stimulate gluconeogenesis, mobilizes
fatty acids from adipose tissue, promotes
utilization free fatty acids foe energy and
promotes gluconeogenesis from glycerol.
• So both hormones can increase strength of
heartbeat.

035. Dependence of the heart to change

the ionic composition of the blood.
• Ionic basis of the action potential of the cardiac
ventricular muscle fiber cell:
• The action potential of cardiac ventricular muscle
fiber cell includes the following phases:
• Phase 0 (upstroke): initial rapid depolarization is
about +20 mV are due to opening of the
voltagegated Na+ channels with rapid Na+ influx.
• Phase 1 (partial repolarization): initial rapid
repolarization is due to K+ efflux (K+ outflow)
followed the closure of Na+ channels when the
voltage reaches at nearly +20 mV.
• Phase 2 (plateau): subsequent prolonged plateau
is due to slower and prolonged opening of the
voltage-gated Ca+2 channels with Ca+2 influx,
Ca+2 enter through these channels prolong
depolarization of the membrane.
• Phase 3 (rapid repolarization): final repolarization
is due to opening of the voltage-gated K+
channels at zero voltage with rapid K+ outflow (K+
efflux) followed the closure of Ca+2 channels and,
this restores the membrane to its resting
potential.
• Phase 4 (complete repolarization): The membrane
potential goes back to the resting level (-90 mV)
 restoration of the resting potential. This is
achieved by the Na+-K+ pump that works to move
the excess K+ in and the excess Na+ out.

036. Functional types of blood vessels.

There are five types of blood vessels:
 The arteries, which carry the blood away from
the heart;
 the arterioles
 the capillaries, where the exchange of water
and chemicals between the blood and the tissues;
 the venules; and
 the veins, which carry blood from the capillaries
back towards the heart.
Arteries
 Arteries carry blood
away from the heart. 
Pulmonary arteries
transport blood that has a
low oxygen content from the
right ventricle to the lungs.
  Systemic arteries transport oxygenated
blood from the left ventricle to the body tissues.
 Arteries face high levels of blood pressure
as they carry blood being pushed from the heart
under great force. To withstand this pressure,
the walls of the arteries are thicker, more
elastic, and more muscular than those of other
vessels.
 The largest arteries of the body contain a
high percentage of elastic tissue that allows
them to stretch and accommodate the pressure
of the heart. Arterioles
 They are the narrower arteries that branch
off from the ends of artery.
 Have thin walls and decreased blood
volume and pressure.
Capillaries:
 The smallest, thinnest and most numerous
of the blood vessels, form the connection
between the vessels that carry blood away from
the
 heart (arteries) and the vessels that return
blood to the heart (veins).
 Capillaries connect arterioles on one end
and venule to other.
 The primary function of capillaries is the
exchange of materials between the blood and
tissue cells.
Venules:
 Similar to arterioles, but comes from the
end of the veins.
Veins:
 Carry blood toward the heart.
 After blood passes through the capillaries, it
enters the smallest veins, called venules.
 From the venules, it flows into progressively
larger and larger veins until it reaches the heart.
 In the pulmonary circuit, the pulmonary
veins transport blood from the lungs to the left
atrium of the heart.
037. Arterial pulse mechanism of
properties, methods.
 The arterial pulse is a measurement of the
heart’s contraction rate because a pulse wave is
created when the left ventricle contracts.
 The arteries expand in response to this
contraction and increase in volume.
 Once expanded, the arteries will contract
forcing blood to circulate to the capillaries and
then to the veins.
 The carotid pulse is the most accurate
reflection of central aortic pulse.
 The arterial pulse rate can be palpated in
any of the body’s accessible.
 Pulse pressure is the difference between
the systolic and diastolic blood pressure. (sp-dp)
• It represents the force that the heart
generates each time it contracts.
• For example, if resting blood pressure is
120/80 mm Hg, then the pulse pressure is
40 mmHg.
Properties:
 A pulse is the tactile palpation of an artery
of the heartbeat by fingertips.
 The pulse may be palpated in any place that
allows an artery to be compressed near the
surface of the body, such as at the neck (carotid
artery), wrist (radial artery), at the groin
(femoral artery), behind the knee (popliteal
artery), near the ankle joint (posterior tibial
artery), and on foot (dorsalis pedis artery).
 Pulse (or the count of arterial pulse per
minute) is equivalent to measuring the heart
rate
The normal pulse rates at resting stage, in beats per
minute (BPM)
The following is the variation of pulse rate according
to age:
• newborns (below 3 months): 100-150 BPM
• infants (3-6 months): 90-120 BPM
• infants (6-12months): 80-120 BPM
• children (1-10years): 70-130 BPM
• children above 10years and adults: 60-100 BPM
The pulse rate can be used to check overall heart
health and fitness.
Generally, lower is better, but bradycardia can be
dangerous.

038. Blood pressure, factors that

determine its value.
 The pressure of the blood in the circulatory
system, often measured for diagnosis since it is
closely related to the force and rate of the
heartbeat and the diameter and elasticity of the
arterial walls.
 Factors:-
• 1.Cardiac output
• 2.Peripheral vascular resistance
• 3.Volume of circulating blood
• 4.Viscosity of blood
• 5.Elasticity of vessels walls
Cardiac output is the volume of blood flow from the
heart through the ventricles, and is usually
measured in litres per minute (L/min).
Peripheral vascular resistance refers to compliance,
which is the ability of any compartment to expand
to accommodate increased content.
Volume of circulating blood is the amount of blood
moving through the body.
Increased venous return stretches the walls of the
atria where specialized baroreceptors are located.
Baroreceptors are pressure-sensing receptors.
Viscosity of blood is a measure of the blood’s
thickness and is influenced by the presence of
plasma proteins and formed elements in the blood.
Elasticity of vessel walls refers to the capacity to
resume its normal shape after stretching and
compressing. Vessels larger than 10 mm in diameter
are typically elastic.
039. Lines blood pressure. [types]
 Systolic pressure –

pressure exerted on
arterial walls during
ventricular
contraction.

 Diastolic pressure –
lowest level of arterial
pressure during a
ventricular cycle
  Pulse pressure –
the difference
between systolic
and diastolic
pressure

 Mean arterial
pressure (MAP) –
pressure that propels
the blood to the
tissues .The map is sp
minus dp

040. The method of recording blood

pressure.
 Arterial pressure is most commonly
measured via a sphygmomanometer.
 There are mainly three methods to measure
BP.
• Auscultatory
• Palpitation
• Oscillometric

Auscultatory method
• The subject must be relaxed sitting on the chair
with the lower arm kept on table or support.
• The blood pressure cuff is placed on the subject’s
right arm, allowing 1inch gap between the bottom
of the cuff and the crease of the elbow.
• The brachial pulse is palpated just above the
angle of the elbow in antecubital fossa.
• The cuff pressure is inflated quickly to a pressure
about 30mmHg higher than the systolic pressure
determined by palpation.
• Then air is let out of the cuff at a rate such that
cuff pressure falls at a rate of 5mmHg per second.
• At some point the person listening with the
stethoscope will begin to hear sounds with each
heartbeat. This point marks the systolic pressure
and the sounds are called Korotkoff sound.
• As the pressure is lowered further, the character
of the Korotkoff sounds should change and at
some point, the sounds will disappear. The
pressure reading at this point gives the diastolic
pressure.

041. Circulation in capillaries. Mechanisms

of transcapillary exchange.
Microcirculation
 Flow of blood from arteriole to venule through
the capillary bed

 It consists of 3 components:
 • Haemo-microcirculation (arterioles,
precapillary, capillary, postcapillary, venules,
venules, arterioles venules anastomosis)
• Substance’ transport to intercticium, where
some hydrostatic and oncotic pressure creates
• Lymphatic vessels – their walls more thin than
in arterials and don’t contain basal membrane.
Intercellular cracks – they are the main way of
penetration of tissue fluid into the lumen of
lymphatic vessels
Transcapillary exchange
Transport of substances across the capillary wall
occurs by 3 major mechanisms:
• Diffusion (according to concentration gradient).
• Filtration (according to pressure gradient)
• Vesicular transport (transcytosis).
• Mediated (membrane) transport:
 This occurs in capillaries of brain only and
involves secondary active transport.
 Example: Transport of glucose; moves by
cotransporters in cell membrane.
042. Blood circulation in the veins, research
methods. Factors that provide blood flow to the
heart.
Blood flow in veins
• Blood flows through the blood vessels, including
the veins, primarily, because of the pumping
action of the heart, although venous flow is aided
by the heartbeat, the increase in the negative
intrathoracic pressure during each inspiration,
and contractions of skeletal muscles that
compress the veins (muscle pump). Venous
pressure
• Venous pressure is pressure of blood, which are
circulated in veins.
• Venous pressure in healthy person is from 50 to
100 mm H2O.
• Increase of venous pressure in physiological
condition may be in the action of physical activity.
Determine of venous pressure is called
phlebotonometry and give for doctors information
about activity of right atrium.
Venous return
• Flow of blood returning to the heart (up arrow on
the venous side).
• Because this is the flow of blood to the heart, it
determines preload for the ventricles (assuming
normal ventricular function).
Factors that provide blood flow to the heart.
• The amount of blood passing through the
coronary vessels (CBF) is directly proportional to
the work done by the heart
i.e. cardiac work → CBF and cardiac work →
CBF.
 The following factors modify the coronary blood
flow (CBF):
Nervous Factors:
 The effect of the autonomic nerves to the heart
on the coronary arteries is indirect through their
effect on cardiac metabolism.
a) Stimulation of sympathetic → cardiac
metabolism → coronary vasodilatation → CBF.
b) Stimulation of parasymp → cardiac
metasbolism → coronary vasoconst. → CBF.
Chemical Factors:
a) Metabolic factors:
cardiac metabolism causes O2tension (local
hypoxia), CO2, K+, lactic acid & adenosine in the
cardiac muscle → coronary vasodilatation → CBF.
cardiac metabolites → active hyperemia during
cardiac activity is equal to auto regulation of CEF O2
lack (hypoxia) is the most effective coronary
vasodilator.
It produces coronary vasodilatation through:
Direct action on coronary blood vessels and
Release of chemical substances such as adenosine
(from ATP) which is a potent coronary vasodilator.
b) Hormones
Thyroxin → cardiac metabolism → coronary
vasodilator → CBF.
Other Factors:
Heart Rate: Excessive in the heart rate→
diastolic period → coronary filling causes CBF.
Mechanical factors
Ventricular systole → of the intra-myocardial
pressure → compression of the coronary vessels →
CBF mainly in the
left coronary artery

043. Characteristics
afferent link in the
regulation of
vascular tone.
 Sensory
innervations of heart and vessels is present by
nerve ending.
 Receptors divided by it function on
mechanoreceptors, which are reacted on the
changing of arterial pressure and
 chemoreceptors, which are reacted on the
changing of chemical
composition of blood.
 Irritation for mechanoreceptors is the
speed and level of tissues stretching by increase
or pulse wave of blood pressure.
 Angioreceptors are present at all vessel
system and have the whole receptor field, it
maximal presents at the main reflector zones:
 aortic, sino-carotid, in the vessels of
pulmonary cycle of the blood circulation.
 At the answer on the each systolic increase
of arterial pressure, mechanoreceptors of that
zones generate impulses, which disappeared in
the diastolic decrease of pressure.
 Minimal threshold of excitation of
mechanoreceptors is 40 mm Hg, maximal is 200
mm Hg.
 Increase of pressure higher than that level
don’t lead to addition increase of impulsion.
 044. Characteristics central element in
the regulation of vascular tone.
 Central mechanisms, which regulate
connection between level of cardiac output and
tone of vessels, working by help of complex of
nervous structures, which named vasomotor
center.

Structures of vasomotor center are present in spinal

cord, medulla oblongata, hypothalamus, cortex of
big hemispheres.
 Spinal level of regulation is in the lateral
root of thoracic and lumbar segments and
consist of nervous cells, axons of which produce
the vasculo-constrictors fibers.
That neurons support their level of excitation by
help of impulses from higher structures of nervous
system.
 Vasomotor center of medulla oblongata is
the main center of regulation of blood flow. It
 located on the bottom of 4 ventricle, in it upper
part.
Vasomotor center divided on pressor and depressor
zones.
Pressor zone support increase of arterial pressure. It
connect with the increase of tone of resistive
vessels.
• Also increase frequency and strength of heart
contraction and as result minute volume of
blood flow.
• Regulatory influences of neurons of pressor
zone act by help of increase of tone of
sympathetic nervous system on heart and
vessels.
Depressor zone support decrease of arterial
pressure, heart work.
• It is the place of changes the impulses, which
are coming from mechanoreceptors of reflector
zones and cause central inhibition of tonic
impulses of vasoconstrictors.
045. Characteristics of efferent neural link
in the regulation of vascular tone.
 Neural mechanism of efferent regulation of
blood flow act by
• Preganglionic sympathetic neurons, body of
which present in the anterior root of
thoracic and lumbar part of spinal cord and
• Postganglionic neurons, which are present
in para- and prevertebral sympathetic
ganglion.
• Preganglionic parasympathetic neurons of
nucleus of n. vague, nucleus of pelvic nerve,
which present in sacral part of spinal cord,
and their postganglionic neurons.
 For whole visceral organs, there is efferent
neurons of meta-sympathetic nervous system,
which are present in the intramural ganglion of
their wall.
 All neurons is the end way from efferent and
central influences, which thought the adrenergic,
 cholinergic and other mechanism of regulation act
on heart and vessels.

046. Characteristics of efferent humoral

regulation of vascular tone.
Influences of catecholamine's and vasopressin on
the vessel tone:
• These vessels contract and relax over a wide
range of luminal dimensions; this property,
termed tone.
• Influences of catecholamine's from adrenal
glands determined by presents of different
kinds of adrenoceptors – α and β.
• Connection of hormones with α–adrenoceptors
act constriction of vessel wall, with β–
adrenoceptor - relaxation.
• Adrenalin connect with α– and β–adrenoceptor,
• norepinephrine with α–adrenoceptor.
Adrenalin has strong action on vessels.
• On artery and arterioles of skin, digestive
organs, kidneys and lungs it has constrictive
 influences; on the vessels of skeletal muscles,
brain and heart - dilatators.

047. Regulation of blood flow by changing

the position of the body.
• Change body position from vertical to horizontal
and vice versa is followed by redistribution of
blood.

• Under the influence of gravity veins in lower

half of the body are dilated and may contain
additional near 0,5 l of blood.
• After this, the impulsions from baroreceptors is
activated and resistive vessels are contracted,
mainly in skin and muscles.
• At the same time rate of heartbeat increases,
which permit make up for cardiac output. In
 insufficient reflex regulation orthostatic
unconsciousness may occur.
Change of blood circulation during orthostatic pose
• Change the body pose from horizontal to
vertical
• Depot of blood in the vein of down part of body
• Decrease of blood flow to heart
• Decrease of stroke volume.
• Decrease of impulsation from
mechanoreceptors of aortic arc
• Activation of pressor part of vasomotor center
• Increase of frequency and force of heart beat,
vascular spasm.
Change of blood circulation during clinostat pose
● Change the body pose from vertical to horizontal
● Increase of blood flow to heart
● Increase the stroke volume
● Increase of impulsation from mechanoreceptors
of aortic arc
● Activation of depressor part of vasomotor centre
● Inhibition of pressor part of vasomotor centre
● Decrease of frequency and force of heart beat,
dilation of vessels

048. Blood circulation with physical loading

its regulation, methods of research.
At normal exercise at sea level,
Pulmonary Circuit
• Blood flow (CO): large increase
• Pulmonary arterial pressure: slight increase
• Pulmonary vascular resistance: large decrease
• Pulmonary blood volume: increase
• Number of perfused capillaries: increase
• Capillary surface area: increase, i.e., increased
rate of gas exchange
Systemic circuit
• PO2: no significant change, hemoglobin still
fully saturated
 • PCO2: until one approaches maximal O2
consumption, there is no significant change;
thus the increase in ventilation is proportional
to the increase in metabolism
• Mean arterial pressure: slight increase.
Exercising skeletal muscle
• Blood flow increases.
• Capillary pressure increases.
• Capillary filtration increases.
Regulation of blood flow:
• In physical exercises impulses from pyramidal
neurons of motor zone in cerebral cortex passes
both to skeletal muscles and vasomotor center.
• Than through sympathetic influences heart
activity and vasoconstriction are promoted.
• Adrenal glands also produce adrenalin and
release it to the blood flow.
• Proprio-receptor activation spread impulses
through interneurons to sympathetic nerve
centers.
 • So, contraction of skeletal muscle during
exercise compress blood vessels, translocate
blood from peripheral vessels into heart,
increase cardiac output and increase arterial
pressure

049. Restoration of blood flow in blood

loss.
 In changing blood volume, volumes
receptors in vena cava or atria are activated.
 These impulses spread to both medulla
oblongata and osmolality regulating neurons in
hypothalamus.
 In consequence decreasing blood volume
heart activity rises through sympathetic
activation and vasopressin in released from
hypophysis.
Bleeding
 Decrease of impulsion from
mechanoreceptors and increase from
chemoreceptors of aorta arc and carotid sinus.
This results in,
 • Increase of influences of sympathetic nervous
on heart leads to Increase of heart beat and the
strength of heart contraction.
• Increase of influences of sympathetic nervous
on heart leads to Spasm of vessels and decrease
of capacity of circulatory bed.
 Decrease of filtration in kidneys glomerulus.
• Activation of rennin-angiotensin-aldosterone
system.
• Thus, the Angiotensin II formed, acts on the
vessel that had spasm.
• And increase reabsorption of sodium and water
and increase of volume of blood circulation.
050. Features of circulation in the blood
vessels of the brain and its regulation.
 Circulation in blood vessels of brain is called
cerebral circulation.
 Stoppage of blood flow to brain for 5
seconds leads to unconsciousness and, also to
irreparable damage to brain cells.
Cerebral blood vessel:
  Brain receives blood from the basilar artery
and internal carotid artery.
 Branches of these
arteries form circle of
Willis.
 Venous drainage is by
sinuses, which open into
internal jugular vein.
Normal cerebral blood flow:
 Normally, brain
receives 750 to 800mL of blood per minute.
 It is about 15 to 16% of total cardiac output
and about 50 to 55mL/100g of brain tissue per
minute.
Regulation of blood flow: Cerebral circulation s
regulated by three factors:
Autoregulation:
 Brain regulates its own blood flow by means
of autoregulation.
 It depends on
 • Effective perfusion pressure •
Cerebral vascular resistance.
 Effective perfusion pressure is the balance
between mean arterial blood pressure and
venous blood pressure divided by resistance.
 Autoregulation is possible when mean
arterial blood pressure is between 60 to 140
mmHg. When vascular resistance is more, the
blood flow to brain is less.
Chemical factors:
 chemical factors which increases the blood
flow:
• Decreased oxygen tension: increases blood
flow by vasodilation.
• Increased carbon dioxide tension iii.
• Increased hydrogen ion concentration: as
hydrogen ion causes vasodilation in blood
vessel of brain.
Nervous factors:
 Cerebral blood vessels are supplied by
sympathetic vasoconstrictor fibers.
 But in pathological conditions, sympathetic
nerves cause constriction of cerebral blood
vessel, lead to reduction in blood flow.

051. Features of circulation in the blood

vessels of the heart and its regulation.
 The peripheral circulatory system comprises
two sets of blood vessels: systemic and
pulmonary vessels.
• Systemic vessels transport blood through
essentially all parts of the body from the left
ventricle and back to the right atrium.
• Pulmonary vessels transport blood from the
right ventricle through the lungs and back to
the left atrium .
 Both the blood vessels and the heart are
regulated to ensure that the blood pressure is
high enough to cause blood flow in sufficient
quantities to meet the metabolic needs of the
tissues.
 The cardiovascular system ensures the survival
of the tissues in the body by supplying
nutrients to and removing waste products
from them.
 From mechanoreceptors of aorta arc sensory
information transmit by left depressor (aortic)
nerve, brunch of n.vagus to the medulla
oblongata.
 Excitation from mechanoreceptors of carotid
sinus zone lead by Sino carotid nerve (branch
of glossopharyngeal nerve) to the medulla
oblongata.

052. Features of pulmonary circulation and

its regulation.
 Pulmonary circulation is otherwise called
lesser circulation.
 Blood is pumped from right ventricle to lungs
through pulmonary artery.
 Exchange of gases occurs between blood and
 alveoli of the
lungs at
pulmonary
capillaries.
 Oxygenated
blood returns to
left atrium
through the
pulmonary veins.
 Thus, left
side of the heart
contains oxygenated or arterial blood and the
right side of the heart contains deoxygenated or
venous blood.

053. Mechanisms of lymph. The movement

of lymph vessels. Formation of lymph
 Fluid efflux normally exceeds influx across
the capillary walls, but the extra fluid enters the
lymph and drains through them back into the
blood.
  This keeps the interstitial fluid pressure
from rising and promotes the turnover of tissue
fluid.  The normal 24-hour lymph flow is 2-4
L.
Mechanism of lymph flow
 Lymph flow is due to movements of skeletal
muscle, the negative intrathoracic pressure
during inspiration, the suction effect of high

velocity flow of blood in the veins in which the

lymphatic vessels terminate, and rhythmic
 contractions of the walls of the large lymph
ducts.
 Since lymph vessels have valves that
prevent backflow, skeletal muscle contractions
push the lymph toward the heart.
 Pulsations of arteries near lymphatic vessels
may have a similar effect.

01. General characteristics of the digestive

system. Digestion in the mouth.
 Digestion is the mechanical and chemical
breakdown of food into smaller components that
are more easily absorbed into a blood stream.
 The digestive system is a group of organs
working together to convert food into energy
 and basic nutrients to feed the entire body.
Digestive system is made up gastrointestinal
tract (GI tract) or alimentary canal is a 30ft canal
which start from mouth and passes to anus. GIT
is formed by two types of organs-
• Primary organs- mouth, pharynx,
oesophagus, stomach, SI, LI.
• Accessory organs- teeth, tongue, salivary
gland, pancreas, liver, gall bladder.
 Inside the mouth, there is a kind of mechanical
digestion (action of mastication) and chemical
digestion (wetting contact of saliva and action of
salivary enzymes)
 Saliva secretion results in initiation of
carbohydrates and lipid digestion. Alpha amylase
begins digestion of carbohydrates into
disaccharides before reaching small intestine,
lipase initiate digestion of ingested lipids. Food is
mixed and broke into small particle to form
bolus and pass to oesophagus and then it carries
to rest part of digestive system.
 Six major functions take place in the digestive
system:
• Ingestion • Secretion • Mixing and
movement
• Digestion • Absorption • Excretion
02. The composition of saliva, its
role in digestion.
 Saliva is produced in and secreted from salivary
glands. The basic secretory units of salivary
glands are clusters of cells called an acini.
 These cells secrete a fluid that contains water,
electrolytes, mucus and enzymes, all of which
flow out of the acinus into collecting ducts.
 By day produce 0,8-1,5 L of saliva.
 Human saliva is 99.5% water and 0.5% solids. It
consists of organic and inorganic substances.
organic inorganic

Enzymes- Na
amylase(ptyalin),
DNAase, RNAase
 Maltase, lipase, Ca
lysozyme, phosphatase
Others-mucin K
Lactoferrin, antibodies Bicarbonate
IgA Chloride
albumin phosphate
Role of saliva in vitality of
human
Digestive function
• Preparation of food for swallowing.
• Moistening of solid food
• Dissolving of substances
• Primary hydrolyzing of carbohydrates
• Neutralize the stomach juice
• Digestive function through enzyme(amylase,
maltase, lipase)
In-digestive function
• Appreciation of food taste
• Role in speech
• Excretory function
 • Cleansing and protective function
• Antibacterial properties
• Regulation of body temperature and water
balance.

03. Mechanisms of saliva, primary and

secondary saliva.
 In the mouth cavity, three pair of big salivary
glands and a lot of small buccal glands opens.
 Submandibular and sublingual glands consist of
the cells of serum and mucous types and secrete
serous and mucus types of saliva. (thick
secretion). It is viscous and contains mucin.
 Parotid glands consist of the serum types cells
and secrete serous type of saliva. (thin secretion).
Contains zymogens, antibodies and inorganic
ions.
 Saliva formation is a two stage process.
• Formation stage that involves acini cells which
secretes a primary secretion that contains
ptyalin and mucous in a ionic solution(similar to
plasma).
 • Duct system… it is a modification stage where
the primary secretion flows in ducts and ionic
composition of saliva is modified.
 The secretary acini cell produces primary saliva
which is isotonic in nature and has an electrolyte
composition similar to that of plasma.
 Initial Formation Stage:
• Stimulation of the parasympathetic nerve, or
mainly muscarinic cholinergic receptors,
initiates intracellular second messenger events
of acinar cells, the signal transduction system
involves the release of Ca2+ from intracellular
stores.
• The increase in intracellular Ca2+ levels leads to
the Cl– channels at the apical membrane to
open and an influx of Cl– into the lumen.
• Secretion of primary saliva is due to
transcellular Cl transport: Cl is actively taken up
into the cell (secondary active transport) from
the blood and is released into the lumen via
anion channels, resulting in a -ve transepithelial
 potential of lumen that drives Na into the
lumen.
 Modification in ducts :
• Primary saliva is modified in excretory ducts,
forming Secondary saliva. As it passes through
the ducts, Na+ and Cl- are reabsorbed (without
water) and K+ & HCO3- is released in the lumen
and becomes hypotonic because Na and Cl
reabsorption is greater than K, HCO3 secretion.
• Stimulation of the sympathetic nerve, or
ßadrenergic receptors, causes exocytosis but
less fluid secretion.
• Activation of ß-adrenoceptors increases the
intracellular cyclic adenosine
monophosphate(cAMP) level, which is the
primary second messenger for amylase
secretion. cAMP is thought to activate protein
kinase which may regulate the process by which
cells release the contents of their secretory
granules. This involves the fusion of the granule
membrane with the luminal plasma membrane
 of the secretory cell followed by rupture of the
fused membranes.
 Further, high salivary flow- high Na and Cl due
to less reabsorption.
 Low salivary flow- low conc. Of Na and Cl due to
high reabsorption.
 Saliva secretion per day 1.5 L.

04. Regulation of salivation. The impact of

autonomous systems nerve quantity and
quality of saliva.
 The production of saliva is stimulated both
by the sympathetic nervous system and the
parasympathetic. Both stimulates the
secretion of saliva but in a different way.
 Via sympathetic innervation :- saliva is
thicker and have high organic materials, this is
because it activates acinar cells and cause
vasoconstriction. Neurotransmitter is
noradrenaline. Sympathetic stimulation of
saliva is to facilitate respiration.
  Via parasympathetic innervation:- saliva
contains large amount of water with relatively
low organic materials and this is because
parasympathetic fibers activate acinar cells
and dilate the blood vessels of salivary gland.
Neurotransmitter is acetylcholine.
Parasympathetic stimulation is to facilitate
digestion.

05. Composition and properties of gastric

juice, methods of research.
 Gastric juice is a mixture of secretions from
different gastric glands in the lining of stomach.
 There are 2 types of glands:
• Oxyntic (gastric) glands – HCl, pepsinogen,
intrinsic factor and mucus.
• Pyloric glands (peptic and chief cells) –
produce non active enzymes (pepsinogen).
There are 7 pepsinogens and they are
hydrolyzed proteins.
 Properties:
• Secrete 2.5L/day.
 • Gastric Juice is highly acidic with a pH of
0.8 to 1.5 (in some books 1-3)
 Composition:
• Gastric glands contains 99.5% water
and 0.5% solids.
• Solids are organic and inorganic
substances.
• Gastric Juice contains hydrochloric
acid (opt. pH 0.8 ); pepsinogen (opt.
pH 3.2-3.5), potassium chloride (kcl),
sodium chloride (nacl), intrinsic factor,
and mucus. Its’ essential constituents
are the digestive enzymes pepsin and
rennin.
 Role:
• in digestion of proteins, by activating
digestive enzymes, and making ingested
proteins unravels so that digestive
enzymes break down the long chains of
amino acids.
 Gastric acid is produced by cells in the lining of
the stomach, which are coupled in feedback
 systems to increase acid production when
needed.
Organic Inorganic
Enzyme: pepsin HCL
Renin (animals) Na
Gastric lipase Ca
Gelatinase K
Urease HCO3
Other: mucus Chloride
Intrinsic factor Phosphate, sulphate

06. Mechanisms of secretion of

hydrochloric acid, its role in the digestive
process.
 It is secreted by parietal or oxyntic cell.
 The capacity of the stomach to secrete HCl is
almost nearly related to parietal cell numbers.
When stimulated, parietal cells secrete HCl at a
concentration of roughly 160 mM (ph-0.8).
 The acid is secreted into large cannaliculi, deep
invaginations of the plasma membrane which are
continuous with the lumen of the stomach.
 Formation of HCl is an active process that takes
place in canaliculi of parietal cells of gastric gland.
The energy for this process is derived from
oxidation of glucose. The hydroxyl ions formed in
this process rapidly combine with carbon dioxide
to form bicarbonate ion, a reaction cataylzed by
carbonic anhydrase.
 The CO2 derived from metabolic process and
blood combines with water and forms carbonic
acid in the presence of carbonic anhydrase
enzyme
 As carbonic acid is much unstable, it
immediately dissociates into hydrogen ion and
bicarbonate ions. The H ion is actively pumped
into the parietal cell. Simultaneously, Chloride ion
derived from sodium chloride also pumped into
the parietal cell.
 The bicarbonate ion(HCO3−) is exchanged for a
chloride ion(Cl−) on the basal side of the cell and
the bicarbonate diffuses into the venous blood,
leading to an alkaline tide phenomenon.
 Potassium(K+) and chloride(Cl−) ions diffuse
into the canaliculi by conductance channels.
 Hydrogen ions are pumped out of the cell into
the canaliculi in exchange for potassium ions, via
the H+/K+ ATPase (proton pump)
 The key player in acid secretion is a H+/K+
ATPase or "proton pump" located in the
cannalicular membrane. This ATPase is
magnesium-dependent.
 Thus, the Chloride ion and H ion combines to
form hydrochloric acid.
 Gastric HCl simultaneously activates
pepsinogen, an endopeptidase that advances the
digestive process by breaking the now-exposed
peptide bonds, a process known as proteolysis.
 Factors stimulating secretion of HCl: Gastrin,
Histamine, Vagal stimulation (vago-vagal reflex).
 Factors inhibiting secretion of HCl: Secretin,
Gastric inhibitory polypeptide, peptide YY
(peptide tyrosin)

 Role of HCl
• Participates in protein breakdown.
• Major factor in converting inactive pepsinogen to pepsin.
• Provide optimal pH for pepsin action.
• Antibacterial efficacy- inhibit pathogenic bacterial
growth.
•Provides acid medium, which is necessary for the action of
hormones.
• An increase in HCl and decreasing pH level also signal
gastric motility to turn on to move the partially digested
bolus of food along digestive tract.
 07. Home (brain) stomach phase
regulation of gastric secretion (cephalic)
CEPHALIC PHASE : Secretion of gastric juice by the
stimuli arising from head region (cephalus) is called
cephalic phase.

 This phase of gastric secretion is regulated

by nervous mechanism.
 The gastric juice secreted during this phase
is called appetite juice.
 Secretion of this phase are rich in enzyme
and HCL.
 During this phase 30% of total amount of
gastric juice is secreted. Nervous mechanism
regulates cephalic phase through reflex action.
 Two type of reflexes occur.
• Unconditioned reflex: - it is due to parasympathetic influence
and beginning from receptors of tongue and other receptors
of the oral cavity. From these receptors impulses pass
through the fibers of n. trigeminus, n. facialis, n.
glossopharyngeus, n. vagus to the medulla oblongata.
Impulses return to stomach by n. vagus. Except neuron
influences this phase has humoral influences – brunch of n.
 vagus produce hormone gastrin. These phase is very short.
This is the inborn reflex when the food is placed in mouth
and stimulates the secretion. This food stimulates taste buds
and other receptors in mouth thus sensory impulse pass via
glossopharyngeal and facial nerve to hypothalamus. Efferent
impulse pass from here to stomach wall via vagal efferent
nerve fibers.
• Conditioned reflex: the sight, smell, hearing or thought of
food induces the gastric secretion. Impulse from sensory
organs pass through afferent fibers to cerebral cortex.

08. Gastric phase regulation of gastric

secretion.
GASTRIC PHASE: Gastric secretion controlled by-
neuronal and hormonal pathways.
NEURONAL
The stomach or gastric phase depends on the
quantity of food, which are present in stomach.
It has vago-vagal reflexes (by mean of central
nerves system) and local – peripheral reflexes,
which are closed in stomach walls.
 Vago-vagal reflex- Vagovagal reflex is the
reflex which involves both afferent and efferent
 vagal fibers. Entrance of bolus into the stomach
stimulates the sensory(afferent) nerve and
generates sensory impulse. These impulses are
transmitted to dorsal nucleus of vagus, located
in medulla oblangata. This nucleus in turn send
efferent impulses to stomach to secrete gastric
juice.
 Local- peripheral reflex- After entering the
food into the stomach, the food particles
stimulate the local nerve plexus present in the
wall of stomach. These nerve fibers release
acetylcholine which stimulate the gastric glands
to secrete gastric juice and also stimulate
secretion of gastrin.
HUMORAL MECHANISM by the production of 2
gastric hormones-
• Gastrin- the enzyme of GIT secreted by G
cell present in pyloric glands. Gastrin
stimulates the secretion of pepsinogen and
HCl by the gastric glands. Duration of these
phase is longer and quantity of juice is
much high
 • Histamine
09. Intestinal phase regulation of gastric
secretion.
 Intestinal phase is the secretion of gastric
juice when chyme enters the intestine. Initially
the gastric secretion increases but later is stops.
 Intestinal phase is regulated by neuronal
and hormonal control. This phase has two
subphases.
 Initial stage: Chyme enters the intestine
stimulates the duodenal mucosa to release
gastrin, which is transported to stomach by
blood. There increases the gastric secretion.
 Later stage: After the initial increase, there
is complete stoppage of gastric juice secretion,
which is inhibited by 2 factors:
• Enterogastric reflex: inhibit gastric
secretion and motility due to irritation in
the intestinal mucosa by chemical
substances in chyme. Mediated by
Auerbach plexus and vagus.
 • Gastro intestinal hormones: Presence of
chyme in the intestine stimulates the
secretion of many GI hormones from
intestinal mucosa and other structures. All
these hormones inhibit gastric secretion.
Eg- secretin, Cholecystokinin.

010. Structure and properties of pancreatic

juice.
 Volume of secretion per day: 500 to 800
ml/day.
Reaction: highly alkaline with a pH of 8 – 8.3
 Pancreatic juice contains 99.5% of water and
0.5% of solids. The solids are organic and
inorganic substances. Bicarbonate content is
very high in pancreatic juice about 110 to 150
mEq/l.
 Pancreatic juice is a liquid secreted by the
pancreas, which contains a variety of enzymes,
including trypsinogen, chymotrypsinogen,
elastase, carboxypeptidase, pancreatic lipase,
nucleases and amylase.
 The pancreas is located in the visceral region,
and is a major part of the digestive system
required for proper digestion and subsequent
assimilation of macronutrient substances
required for living .
 Pancreatic juice is alkaline in nature due to the
high concentration of bicarbonate ions.
Bicarbonate is useful in neutralizing the acidic
gastric acid, allowing for effective enzymic
action.
 Pancreatic juice secretion is regulated by the
hormones secretin and cholecystokinin, which is
produced by the walls of the duodenum upon
detection of acid food, proteins, fats and
vitamins.
 Pancreatic secretion consists of an aqueous
bicarbonate component from the duct cells and
enzymatic component from the acinar cells.
 A clear alkaline secretion of the pancreas
containing enzymes that aid in the digestion of
proteins, carbohydrates, and fats
●Proteolytic enzyme: Trypsin and chymotrypsin –
break down protein to peptides and amino acids
●Amylolytic: Pancreatic amylase – breaks down
starch and glycogen to maltose
●Lipolytic: Lipase – breaks down fat to fatty acids and
glycerol

011. Phases of secretion of the pancreas.

 There are three phase of pancreatic secretion
Cephalic, gastric and intestinal phase.
 Cephalic Phase
• This phase provides 20% (acc to some books)
of the total pancreatic secretion, Regulated
by nervous mechanism through reflex action.
Two types of reflex action:
• Conditioned- the sight, smell, hearing or
thought of food induces the pancreatic
secretion. Impulse from sensory organs pass
 through afferent fibers to cerebral cortex.
From the cortex the impulse pass through
vagal efferent and reach pancreatic acini,
vagus nerve secrete acetylcholine thus
stimulates the pancreatic secretion.
• Unconditioned- this is the inborn reflex when
the food is placed in mouth and stimulates
the secretion. Taste bud receptor>afferent
sensory impulse>nucleus vagus>efferent
motor impulse>vagus nerve>pancreatic
acini>inc. secretion.
 Gastric Phase
• This phase is initiated by the presence of
food within the stomach. This phase is
regulated by hormonal control. The hormone
involved is gastrin. When food enters the
stomach, gastrin is secreted from the
stomach and when this gastrin is transported
to the pancreas through blood, it stimulates
the secretion.0

 Intestinal Phase
 • Provides about 70% (major) of secretion,
regulated by hormonal control. This phase is
initiated by emptying of stomach contents
into the small Intestine and involves release
of both secretin and cholecystokinin which
stimulate pancreatic ductal cells to synthesize
aqueous sodium bicarbonate solution. The
generation of aqueous sodium bicarbonate
solution washes out all of the inactive
pancreatic enzymes waiting within the
pancreatic ducts into the duodenum where
they activated as discussed previously.
• Hormones inhibiting pancreatic secretion:
pancreatic polypeptide, somatostatin,
peptide YY, peptide like ghrelin and leptin.
012. Composition of bile and its role
in the processes of digestion,
methods of research.
 Volume- 800-1200 ml/day
 Nature- alkaline, basic nature
 Ph- 8-8.6
 Colour- golden yellow and green

• Bile acids are a group of steroid acids that

make up the bile. Human bile
predominantly contains cholic, deoxycholic
acid and (lithocholic acid and alcoholic acid
in small amounts)
• Bile acids are conjugated with taurine or
glycine residues to give anions called bile
salts.
• Primary are those which are synthesized by
the liver. And secondary are those which
results from the bacterial action in the
colon.

• Role of bile in digestion

• Bile contains bile acids, which are critical for

digestion and absorption of fats and
fatsoluble vitamins in the small intestine.
• Emulsification of fats- Bile salts help to
lower the surface tension of water and thus
emulsify fats in the intestine and dissolve
fatty acids and water-insoluble soaps. The
presence of bile in the intestine helps the
digestion and absorption of fats and the
absorption of fat-soluble vitamins A, D, E
and K.
• Bile salts are activators of lipase.
• Bile salts are reabsorbed from the intestine
and pass back to the liver where they
 stimulate further secretion of the bile
(cholagogue action).
• Bile neutralize the acid chyme from the
stomach.
• Bile is an important channel for the
excretion of some substances like bile
pigments, many drugs, toxins, and various
inorganic substances such as copper, zinc
and mercury.
• Fat digestion is not complete in the absence
of bile.
• Bile salts keep cholesterol in solution in
gallbladder bile. In the absence of bile salts,
cholesterol becomes precipitated. This
results in the formation of gall-stones.
• Bile acts as a surfactant, helping to emulsify
the lipids in food. Bile salt anions are
hydrophilic on one side and hydrophobic on
the other side; consequently, they tend to
aggregate around droplets of lipids to form
micelles, dispersion of food fat into micelles
provides a greatly increased surface area
for the action of the enzyme
 • increases the absorption of fats, it is an
important part of the absorption of the
fatsoluble substances, such as the vitamins
A, D, E, and K.
• act as bactericides, destroying many of the
microbes that may be present in the food.
• Inhibits act of stomach protease
• Increase tone and motor function of
intestines
• Decrease the activity of intestinal
microflora.
013. Regulation of secretion of bile and
bile secretion.
Adult humans produce 400 to 800 ml of bile daily,
and other animals proportionately similar amounts.
The secretion of bile can be considered to occur in
two stages:

• Initially, hepatocytes secrete bile into

canaliculi, from which it flows into bile
ducts. This hepatic bile contains large
quantities of bile acids, cholesterol and
other organic molecules.
• As bile flows through the bile ducts it is
modified by addition of a watery,
bicarbonate-rich secretion from ductal
epithelial cells.
  Bile secretion is one of the major functions of
the liver, which serves two main purposes:
• the excretion of hepatic metabolites-
including bilirubin, cholesterol, drugs and
toxins
• the facilitation of intestinal absorption of
lipids and fat-soluble vitamins.
 The gall bladder stores and concentrates bile
during the fasting stage.
014. Composition and properties of
intestinal juice. Regulation of its secretion.
 Composition: 99.5% water and 0.5% solids.
Solids are organic and inorganic.
Organic:
• Proteolytic enzymes- aminopeptidase,
tripeptidase, dipeptidase.
• Amylolytic enzymes: sucrase, maltase,
lactase.
• Lipolytic enzymes: lipase.
 • Other than enzymes- Mucus, intrinsic factor
and defensins. Immunoglobulins,
leukocytes, epitheliocytes (200g per day)
Inorganic:
Na, K, Ca, HCO3, sulphate, chloride.
 Properties:
• Intestinal juice also called succus entericus
refers to the clear to pale yellow watery
secretions from the glands lining the small
intestine walls.
• The intestinal juices are secreted by
Brunner’s gland present in upper duodenum.
• This juices are alkaline in nature having a pH
of 8.3 and are secreted about 1.8L/day.
• The enzyme trypsin present in pancreatic
juice in the inactive form trypsinogen, it is
activated by the intestinal enterokinase
enzyme to active form trypsin.
• Trypsin can then activate other protease
enzymes (trypsinogen, chymotrypsinogen,
 procarboxypeptidase) and catalyze the
reaction pro-colipase → colipase.
• Colipase is necessary, along with bile salts, to
enable lipase function.
 Regulation of secretion
• Nervous regulation by vagus nerve.
Stimulation of Parasympathetic nerves
causes vasodialation and increases the
secretion.
• Hormonal regulation by cholecystokinin,
secretin. when chyme enters the Small
Intestine, intestinal mucosa secretes
enterocrinin, secretin, Cholecystikinin. These
hormones promotes the secretion by
stimulating the intestinal mucosa.
• Local nervous reflex: when chyme enters the
Small Intestine, the mucosa is stimulated by
tactile stimuli or irritation, it causes
development of reflexes and thus stimulates
the intestinal juice secretion.
• mechanical stimulation produced by the
presence of food.
015. Cavity and membrane digestion.
 Digestion process takes place in the abdominal
cavity. All the digestive organs are present
below the diaphragm and above to urinary
bladder. The enzymes secretion by various
organs together make up the process of
digestion complete.
 In digestive system we have two type of
digestion cavity and membrane digestion.
 Membrane digestion occur on external surface
of the membrane of enterocytes. Enzymes
which take part in membrane digestion has two
origin
• synthesized by enterocytes and
structurally associated with the external
surface of their membrane
• and enzymes adsorber from the intestinal
cavity
 Membrane digestion depends on the rate AT
chich substances pass from liquid medium onto
The surface and under normal conditions that
 depends upon intestinal motility. Cavity
digestion occur In gastrointestinal tract under
influence of enzymes secreted by digestive
organ such as stomach, pancreas.

016. The absorption in the digestive canal.

The mechanisms of absorption of sodium
and water.
Absorption of water and its mechanism
 Water has to be absorbed in the
gastrointestinal tract mainly in the jejunum and
ileum, with smaller quantities being absorbed by
the colon.
 The small intestine must to absorb daily 7-8 L of
water that is the sum of 1.5 L of water average
intake and 7L of additional fluid secretion
contained in salivary, gastric, biliary and
pancreatic secretions. Approximately 0.1L /day
of water is eliminated in the feces
 Water is driven through the intestinal
epithelium passively, by osmosis.
  Water absorption is dependent on the absorption of
solutes such as (Na+ and Cl−). Na+ is absorbed from
the intestinal lumen, most use the cotransport with
glucose and amino acids and the Na+/H exchange,
which allow Na+ ions to move from the lumen into
the enterocyte.
 Absorption of water occur In whole part of
digestive system but the biggest absorption of
water occur In large intestine.

Absorption of sodium and its mechanism

 The luminal concentration of Na+ and Cl-
steadily decreases from the duodenum to the
colon. That of Na+, for example, is
approximately 145 mmol/l in the duodenum,
125 mmol/l in the ileum and only 40 mmol/l in
the colon.
 Na+ is absorbed by various mechanisms, and
the Na+-K+-ATPase on the basolateral cell
membrane is the primary driving mechanism for
all of them.
 Firstly, Na+ and Cl- are transported from the
lumen into the enterocytes. Then they are
transported across the basolateral membrane
into the intestinal interstitium.
 Na+ passively influxes into cells of the
duodenum and jejunum in three ways through a
Na+-glucose, Na+-amino acid and Na+-(di or tri-)
peptide co transport system.
 Na+ ions in the lumen of the ileum are
exchanged for H + ions, while Cl- is exchanged
for HCO; at the same time.
 Resuming, most Na+, Cl- and, by subsequent
osmosis, H20 is absorbed by this 86
electroneutral transport mechanism.
 Na+ in the colon is mainly absorbed through
luminal Na+ channels. This type of Na+ transport
is electrogenic and aldosteronedependent. The
related mechanism either leads to K + secretion
or drives Cl- out of the lumen. 017.
Mechanisms absorption of proteins.
 It is an active process that needs energy. -
Energy needed is derived from hydrolysis of
ATP. - It occurs in small intestine. - Absorption of
amino acids is rapid in the duodenum and
jejunum, but slow in the ileum.
 Protein is found in meat, eggs, dairy products
and beans, and is used by the body to build
muscle and organs. Protein molecules are quite
large. Chewing helps break proteins down into
smaller particles for digestion. Chemical protein
digestion starts in the stomach, where enzymes
start to soften the protein molecules. A number
of enzymes, including substances from the
pancreas, then break down protein into its
component amino acids in the small intestine.
 Absorption across the microvillus membrane of
single amino acid, di and tri peptides occurs.
Tripeptides are broken down by hydrolases. The
amino acids are liberated intramurally or on the
surface of villi by brush border enzymes that
degrade proteins into peptides that are one,
two or three amino acids long. Similar to glucose
 and galactose, many amino acids are
transported across the mucosal membrane in a
sodium-linked process that uses the energy
dependent Na+/K+-ATPase pump.
 A variety of Na+-dependent active transport
systems have been identified for the transport
of tripeptides, dipeptides and amino acids.
Dipeptides and tripeptides can be absorbed as
intact molecules by a symport carrier which is
driven by an H + gradient. Amino acids generally
are much more rapidly absorbed as dipeptides
and tripeptides than as free amino acids.
 Almost all of the ingested protein is absorbed
by the intestine. Any protein that appears in the
stool derives from the bacteria within the colon
or from cellular debris.

018. Mechanisms absorption of fats.

 The major site of lipids absorption is the upper
jejunum. Triglycerides, with 6 to 10 carbon
atoms, are absorbed better because they are
more completely broken down by pancreatic
lipase and they form micelles more easily. The
 absorption of vitamins A, D, E, and K requires
bile salts.
 The following are stages of the lipids absorption
in the small intestine:
• The lumenal phase: involves,
(a) lipids emulsification in the stomach and
upper intestine for the optimal enzymatic
activity of the pancreatic gland. The action of
the lipase in the lumen converts one mole of
the triglyceride to 2 moles of fatty acid plus 1
mole of the 2-monoglyceride.
(b) The mix of aqueous and hydrophobic
zones then forms around the enzyme. (c)
The third process within this stage involves
micelle formation. Emulsified products of
lipid metabolism are the main compounds
for the micelle formation. They facilitate
close contact between the products of fat
digestion and the wall of the small intestine.
The mixed micelles in the unstirred water
layer of the microvillus membrane surface
give up their contents for absorption across
 the apical membrane. Lipids inside the
micelles cross the basal enterocytes'
membrane by simple diffusion.
• The intracellular phase: occurs inside the
enterocytes. Lipids, cholesterol and the
lipidsoluble vitamins earlier removed rapidly
from the micelles once the micelles make
contact with the microvilli. Once inside the
enterocytes, the digested lipids enter are
reconstituted with the help of the
endoplasmic reticulum enzymes.
Monoglycerides and fatty acids are rapidly
reconstituted to form triglycerides.
• In the lymphatic phase: Chylomicrons enter
lymphatics of the villi and drain into the
systemic veins. Intestinal lipid absorption is
associated with a marked increase in lymph
flow. This increase in lymph flow plays an
important role in the transfer of lipoproteins
from the intercellular spaces to the central
lacteal. Almost all digested lipids are totally
reabsorbed by the time the chyme reaches
 the mid jejunum, with the most of the
absorption occurring in the duodenum. The
undigested fats are excreted out of lipids.

019. Mechanisms absorption of

carbohydrates.
 The carbohydrates can be only absorbed in the
form of monosaccharides. Amylases break down
carbohydrates into several disaccharides including
maltose, isomaltose, and a-dextrins.
 The brush border enzymes convert the
disaccharides into monosaccharides that can be
absorbed.
 Fructose, glucose and galactose are three
endproducts of carbohydrates metabolism in the
gastrointestinal tract that can be absorbed in the
small intestine.
 When the disaccharides are not broken down to
monosaccharides and remain as osmotically
active particles in the digestive system, causing
diarrhea.
 Fructose is transported across the intestinal
mucosa by facilitated diffusion and it moves along
a concentration gradient. It is transported
independent by glucose transporter 5 into
enterocytes by facilitated diffusion and from
enterocytes into blond by glucose transporter 2
 Glucose and galactose is absorbed by the same
glucose transporter 1 is active transport which
carries sodium ion. From enterocytes glucose go
through glucose transporter 2 with concentration
gradient and go out by sodium-potassium ATPase.
They are transported by way of a
sodiumdependent transport system that uses
adenosine triphosphate and the Na+/K+-ATPase
pump as an energy source.
 Both sodium and glucose must attach to the
transport carrier before either can be transported
into the cell. The concentration of glucose builds
up in the intestinal cell until a diffusion gradient
develops causing glucose to move into the body
fluids. Sodium is transported out of the cell by the
energy dependent Na+/K+-ATPase pump. This
 creates the gradient needed to operate the
transport system.

020. The motor function of the intestines,

the types of cuts, their regulation.
 Motor functions of the small intestine includes
all the movements in the intestine which are
essential for mixing of chyme.
 There are four types of movements in small
intestine:
• Mixing movements: Mixing movements are
responsible for proper mixing of chyme
with digestive juices such as pancreatic,
bile, and intestinal juices. The mixing
movements are: - Segmentation
movements : involves contractions of the
circular muscles in the digestive tract. These
contractions are the common type of
movements of small intestine, which occur
in a rhythmic fashion. So, these
contractions are also called rhythmic
segmentation contractions. The length of
 relaxed segment is same as that of
contracted segment. So, these contractions
chop the chyme many times. This helps in
mixing of chyme with digestive juice. -
Pendular movements: small portion of
intestine sweep forward-backward or up
and down resembling a pendular fashion.
• Propulsive movements : cause food to move
forward along the tract at an appropriate
rate for digestion and absorption. basic
propulsive movement of the gastrointestinal
tract is peristalsis.
- Peristaltic movements: the wave of
contraction followed by a wave of
relaxation of muscle fibres. In GI tract, it
always travels in aboral direction.
Stimulation of smooth muscle of
intestine initiates the peristalsis.
Peristaltic movements start at any point
in the intestine and travel to anal end
- Peristaltic rush
 stimuli that can initiate peristalsis
include irritation of the epithelium
lining the gut and extrinsic nervous
signals that excite the gut. peristalsis
requires an active myenteric plexus and
migrating myoelectric motor complex.
peristalsis involves one-way motion in
the caudal direction
• Peristalsis in fasting (migrating motor
complex).
• Movements of villi.

 Regulation
It is regulated by the enteric nervous system but
is influenced also by hormones and external
innervation. By neural
− The movement of contents through the GIT
is controlled by neurons located in the
submucosal and myenteric plexus.
 − The axons from the cells bodies in the
myenteric plexus innervate the circular and
longitudinal smooth muscle layer.
− These neurons receive impulses from local
receptors located in the mucosal and muscle
layer and extrinsic input from the
parasympathetic and sympathetic nervous
system. As in general, the parasympathetic
nervous system tends to slow its activity.
By hormonal
− gastrointestinal hormones and peptides, which
may exert endocrine, paracrine, or neurocrine
activity, resulting in inhibitory (eg, peptide YY)
or excitatory (eg, vasoactive intestinal peptide).
021. The physiological importance of
proteins and their transformation in the
body.
 Protein forms hormones, enzymes, and
antibodies. It is part of fluid and electrolyte
regulation, the buffering effect for pH, and
transporter of nutrients.
 Proteins are made of carbon, hydrogen, oxygen,
and nitrogen, an inorganic molecule, the thing
that clearly distinguishes them from the other
macronutrients.
A. Amino acids are the building blocks of proteins.
B. Polypeptide are a group of amino acids bonded
together 10-100 or more.
 immunological – Antibodies They can travel
through the bloodstream and are utilized by the
immune system to identify and defend against
bacteria, viruses, and other foreign intruders
 responsible for movement. Examples include
actin and myosin
 Energetic function – degradation of proteins
produce 10-15% of total energy
 Regulation - Hormone Several hormones are
peptides and proteins. They play an important
role in the regulation of metabolic reactions.
 Play important role in biochemical reaction
 Enzymes - are proteins that facilitate
biochemical reactions. They are often referred to
as catalysts because they speed up chemical
reactions.
 Transport function Proteins - are carrier
proteins which move molecules from one place to
another around the body. Examples include
hemoglobin
and cytochromes. Hemoglobin transports oxygen
through the blood via red blood cells.
Transformation in body
 During protein metabolism, some protein is
converted to glucose in a process called
gluconeogenesis, the formation of glucose from
non-carbohydrate sources. the amount of protein
 converted to glucose is quite small, except under
conditions of intense exercise or metabolic
starvation. Under these conditions amino acids
produce the major source of glucose for blood
sugar maintenance.
 The first step in protein metabolism is to break
it into its constituent amino acids. These are
absorbed into the blood stream.
 The second step is to break down the amino
acids into their constituent parts—catabolism.
This removes the nitrogen or amino group from
the amino acids. The process is called
deamination.
 Deamination breaks the amino group down into
ammonia and what is termed the carbon
skeleton. Ammonia is converted to urea, filtered
through the kidneys, and excreted in urine. The
carbon skeleton--which is composed of carbon,
hydrogen, and oxygen--can then by used either for
protein synthesis, energy production (ATP), or
converted to glucose by gluconeogenesis. 022.
Nitrogen balance, protein minimum,
optimum protein, biological value
proteins.
 nitrogenous balance: ratio between the
amounts of nitrogen entered the organism and
nitrogen removed from the organism. It may be
positive, negative and neutral
 Positive nitrogen balance means that the intake
of nitrogen into the body is greater than the loss
of nitrogen from the body, so there is an increase
in the total body pool of protein is associated with
periods of growth, hypothyroidism, tissue repair
and pregnancy, during recovering after severe
diseases, at the using of anabolic medicines.
 Negative nitrogen balance This means that the
amount of nitrogen excreted from the body is
greater than the amount of nitrogen ingested. is
associated with burns, serious tissue injuries,
fevers, hyperthyroidism, wasting diseases, during
periods of protein starvation and full fasting,
senile age, destroying of malignant tumor,
poisoning by some toxins.
 Zero nitrogenous balance – the amount of
nitrogen removed from the organism is equal to
the amount of nitrogen entered the organism. It
occurs in healthy adult people.
 Minimum of proteins is minima quantity of
protein In which save nitrogen balance ;It daily
quantity is near 50 gram of protein. Optimum of
proteins is a quantity of protein In food, which
completely secure necessity of organism. It is 80-
100 grams of protein. Biological value of proteins:
one gram of protein gives to organism 4,1kcal of
energy. In daily quantity must be including amino
acids, which are do not synthesis in organism
023. The physiological significance of fats,
their transformation in the body.
 Provides 9 Kcalories per gram; it is an
energyyielding nutrient.
 They are stored energy (adipose tissue), organ
protection, temperature regulator, insulation
such as myelin that covers nerve cells, lipid
membrane around cells, and emulsifiers to keep
fats dispersed in body fluids.
 Lipids are made of organic molecules carbon,
hydrogen, and oxygen. Fats consist of glycerol
fatty acids joined by an ester bond.
Energetic role (fuel molecules)
Components of membranes (structural role)
Precursors for many hormones (steroids)
Signal molecules (prostaglandins)
Protective role (lipids surround important
organs)
Enzyme cofactors (vitamin K)
Electron carriers (ubiquinone)
 Lipids In human organism digested to
cholesterol and fatty acid.
derivates of cholesterol: bile acids, steroid
hormones and vitamin D.
derivates of fatty acids: prostoglandins,
tromboxans, leukotrienes.

024. The physiological significance of

carbohydrates, their transformation in the
body.
Physiological role of carbohydrates
 Energetic role Energy is released in process
decomposition of carbohydrates and used for
functioning of the cells (50-60% of total energy. 
Anticoagulant Heparin is a polysaccharide
(carbohydrate) which acts as anticoagulant and
prevents intravascular clotting
 Antigen Many antigens are glycoproteins (which
contains oligosaccharide) in nature and give
immunological properties to the blood.
 Regulating role Many Hormones like FSH
(Follicular Stimulating Hormone which takes part
in ovulation in females) and LH (Leutinizing
Hormone) are glycoproteins and help in
reproductive processes
 Reserve food for the body excess glucose in the
body is converted to glycogen
 Carbohydrates form other bio molecules:
Carbohydrates in excess are converted into other
biomolecules of physiological importance like
fats, by fatty acid synthesis reaction in the cell for
storage in the body and use in times of starvation.
 As reaction intermediates or accessories:
Carbohydrates participate as reaction
intermediates in some vital reactions. For
example, Vitamin B2 i.e Riboflavin has ribose
sugar
 Constitute genetic material: Carbohydrates
form a part of genetic material like DNA and RNA
in the form of deoxyribose and ribose sugars
 They are constituents of all the cellular
organelles like cell membrane, mitochondria,
nucleus, endoplasmic reticulum etc
In human organism carbohydrates are digested to
monoglycerides such as glucose, galactose, fructose
which perform important role In the body for
example glucose is used in energy production
Metabolic pathways
• Carbon fixation, or photosynthesis, in which
CO2 is reduced to carbohydrate.
• Glycolysis - the oxidation metabolism of glucose
molecules to obtain ATP and pyruvate
• Pyruvate from glycolysis enters the Krebs cycle,
also known as the citric acid cycle, in aerobic
organisms after moving through pyruvate
dehydrogenase complex.
• The pentose phosphate pathway, which acts in
the conversion of hexoses into pentoses and in
NADPH regeneration. NADPH is an essential
antioxidant in cells which prevents oxidative
damage and acts as precursor for production of
many biomolecules.
• Glycogenesis - the conversion of excess glucose
into glycogen as a cellular storage mechanism; this
prevents excessive osmotic pressure buildup inside
the cell
• Glycogenolysis - the breakdown of glycogen
into glucose, which provides a glucose supply for
glucose-dependent tissues.
• Gluconeogenesis - de novo synthesis of glucose
molecules from simple organic compounds. An
example in humans is the conversion of a few
amino acids in cellular protein to glucose.
025. The regulation of metabolism of
proteins, fats and carbohydrates.
Regulation of protein metabolism(by
hormone)
 The regulation of protein metabolism involves the
activation of cellular pathways in skeletal muscle
that transduce signals to the machinery regulating
mRNA translation.

Insulin, Growth Hormone and Insulin like
Growth Factor-I (IGF-1) play a dominant role in
the day-to-day regulation of protein
metabolism.
 insulin appears to act primarily to inhibit
proteolysis while GH stimulates protein
synthesis. Insulin Increases the permeability of
membranes for AA. Activates synthesis of
proteins and nucleic acids Inhibits
gluconeogenesis.
 Hormone of cortex of epinephrine gland
glucocorticoids Stimulate catabolic processes in
connective, lymphoid and muscle tissues
Activate protein synthesis in liver Stimulate
aminotransferases Stimulate the urine
biosynthesis
 Somatotropic hormone Promotes the entrance
of AA into cells, Inhibits catabolism of proteins
and AA Activates the synthesis of proteins, DNA,
RNA.
 
 Catecholamines accelerate the decomposition
of proteins
Insulin Increases the permeability of membranes
for AA Activates synthesis of proteins and
nucleic acids Inhibits gluconeogenesis.
 The hormones glucagon, glucocorticoids and
adrenaline are all increased in catabolic states
and may work in concert to increase protein
breakdown in muscle tissue and to increase
amino acid uptake in liver for gluconeogenesis.

Regulation of fat metabolism (by hormone)

 Lipid metabolism is the synthesis and
degradation of lipids in cells, involving the
breakdown or storage of fats for energy and
the synthesis of structural and functional
lipids, such as those involved in the
construction of cell membranes.
 Somatotropic hormone Stimulates the
decomposition of lipids (lipolysis) Stimulates
the oxidation of fatty acids
 
 Lipotropic hormones mobilization of
lipids from depot;
Insulin Activates of the lipids synthesis Promotes
the saving of fats activating the decomposition
of carbohydrates Inhibits gluconeogenesis
 Glucagon Activates lipolysis
 By iodine containing hormone Activate
the exit of lipids from depot, its
decomposition and oxidation Glucocorticoids
Activate lipolysis Activate the conversion of
FA into carbs.
Regulation of carbohydrates metabolism (by
hormone)
 Somatotropic hormone Antiinsulin
hormone – activates insulinase of liver
Activates the exit of glucose from liver
Inhibits the conversion of glucose into fat
 Insulin Increases the permeability of
membranes for glucose Activates

glucokinase (hexokinase) in glycolysis
Activates TAC (citrate
synthase)Activates PPC (G-6-PDH)
 Activates glycogen synthase Activates
pyruvate- and alpha- Ketoglutarate
dehydrogenase Inhibits gluconeogenesis
Inhibits the
 decomposition of glycogen (glucose-
6phosphatase)
 Glucagon Activates the decomposition of
glycogen in liver Activates gluconeogenesis
Inhibits glycolysis
 iodine containing hormone Accelerate the
absorption of carbohydrates in the intestine
Activate the decomposition of glycogen
 Glucocorticoids Increase the glucose level
Activate gluconeogenesis Inhibit hexokinase
(glycolysis).

026. Physiological significance of

watersoluble vitamins.
 There are 9 water soluble vitamins are:
B1 thiamine
B2 riboflavin
B3 niacin
B5 pantothenic acid
B6 pyridoxine
B7 biotin
B9 folate
 B12 cobalamin
C ascorbic acid

 Folate: Body needs folate to create DNA.

Because of this, folate plays an extremely
important role in preventing birth defects during
early pregnancy. Folate also helps maintain the
health of red blood cells.
 B1 Thiamine: thiamine plays a vital role in the
transmission of nerve impulses by keeping nerves
healthy. Thiamine also allows body to break down
alcohol and metabolize carbohydrates and amino
acids.
 B2 Riboflavin: riboflavin helps body
metabolize carbohydrates, protein and fats.
Riboflavin also protects the health of body’s cells
and enhances the function of some of the other B
vitamins, niacin and vitamin B12.
 Niacin: Niacin protects the health of your skin
cells and keeps digestive system functioning
properly. Niacin may also help body metabolize
fat.
 Pantothenic Acid and Biotin: Pantothenic acid
and biotin allows body to obtain energy from the
macronutrients carbohydrates, protein and fat.
Body also uses pantothenic acid to produce
hormones and cholesterol.
 Vitamin B6: Vitamin B6 acts as a coenzyme. It
plays a vital role in the creation of nonessential
amino acids and helps body break down glycogen,
which is the storage form of the simple sugar
glucose. Vitamin B6 also helps body metabolize
carbohydrates, protein and fat and keeps your
immune system and nervous system healthy.
 Vitamin B12: Vitamin B12 keeps nervous
system functioning properly and red blood cells
healthy. Body also needs vitamin B12 to
metabolize fatty acids and amino acids and to
synthesize the DNA in your cells.
 Vitamin C: body needs vitamin C to make
collagen, the most plentiful protein in body.
Vitamin C also acts as an antioxidant, helping to
reduce the risk of developing chronic diseases like
heart disease and cancer.
027. Physiological significance of fatsoluble
vitamins.
 There are 4 fat soluble vitamins.
 Vitamin D (cholecalciferol, antirikets): In
response to hypocalcemia, helps normalize serum
calcium levels. Vitamin D helps in bone
maintenance and immune system regulation. 
Vitamin A(carotene, anti-xeropthalmic): Retinoic
acid and retinol act as growth regulators,
especially in epithelium Retinal is important in rod
and cone cells for vision. Thus, it is important for
proper vision, body growth, immune function,
reproductive function.
 Vitamin K: Anti- hemorrhagic (menaquinone,
bacteria; phytoquinone, plants) Carboxylation of
glutamic acid residues in many Ca2+-binding
proteins, importantly coagulation factors II, VII, IX,
and X, as well as protein C and protein S
 Vitamin E: Anti- sterile (alpha-tocopherol)
Antioxidant in the lipid phase. Protects membrane
lipids from peroxidation.
028. Methods for determining energy
person. The respiratory coefficient.
Technique for measuring energy expenditure.
 Oxygen Analysis Measurement of the oxygen
uptake by the body in order to calculate energy
expenditure requires that the volume of expired
air must be known and that the oxygen content to
use a formula that requires only the oxygen
percentage of the expired air. The formula
needed to calculate energy expenditure by Weir's
technique is as follows:
Energy (kcal/min) = Vstp x Oi-Oe/20 where Vstp
is the volume of air expired in litres per minutes
and Oi and Oe are the percentages of oxygen in
inspired and expired air, respectively.
 indirect calorimetry calculates heat that living
organisms produce by measuring either their
production of carbon dioxide and nitrogen waste

 The respiratory quotient (or RQ or respiratory

coefficient), is a dimensionless number used in
calculations of basal metabolic rate (BMR) when
 estimated from carbon dioxide production. It is
calculated from the ratio of carbon dioxide
produced by the body to oxygen consumed by the
body. Such measurements, like measurements of
oxygen uptake, are forms of indirect calorimetry.
It is measured using a respirometer. The
Respiratory Quotient value indicates which
macronutrients are being metabolized, as
different energy pathways are used for fats,
carbohydrates, and proteins.
The respiratory quotient (RQ) is the ratio:
RQ = CO2 eliminated / O2 consumed

029. The main exchange and its definitions

conditions, factors affecting its value.
There are 3 types of the cells' metabolic activity
taking into consideration all explained above.  The
first one, the level of activity, is the exchange
processes intensity throughout the specific cells'
function maintenance - i.e., excitation, secretion,
contraction and others (it should be not less than 100
 The second, the level of readiness, is that level of
metabolic activity which is non- active at one
concrete moment the cell has to display to be
ready for immediate work at any moment.
 The third, the level of the cell structure
preservation, is the precise level Of energy
required for the cell structure keeping. At least 15
% of the energy is required for the last one level of
energetical activity. If less, the death of the cell
occurs. Important that energetical deficits are the
main reason for the organism death.
METHODS OF ENERGY EXCHANGE DETERMINATION
Different methods are known. These methods can
be classified as direct and indirect.
Direct calorimetry: The aim of this method is to
determine directly the amount of the heat produced
by an individual throughout 24 hrs. This method is
absolutely accurate but very expensive and
cumbersome and unsuitable for routine use.
Indirect calorimetry: In this method, the heat
evolved is not directly measured. The special
respiratory chambers might be used as well as non-
 chambers method can be used. Indirect calorimetry
can be measured also using two other parameters-
the respiratory quotient and the oxygen utilized
during certain period.
 Factors affecting the exchange process:
• Age • Sex • Food • Time • Climate • Pregnancy

030. The temperature of the human body, its

daily fluctuations.
 The normal temperature range obtained by
either a mercury or an electronic thermometer
may extend from 36.2 C to 37.6 C (97 F to 100 F).
Body temperature varies with the time of day.
Usually,
it is lowest in the early morning because the muscles
have been relaxed and no food has been taken in for
several hours.
 Temperature tends to be higher in the late
afternoon and evening because of physical activity
and consumption of food. Normal temperature also
varies in different parts of the body.
 Skin temperature obtained in the axilla (armpit) is
lower than mouth temperature, and mouth
temperature is a degree or so lower than rectal
temperature. It is believed that, if it were possible
to place a thermometer inside the liver, it would
register a degree or more higher than rectal
temperature. The temperature within a muscle
might be even higher during activity. 031. The
physiological significance homeothermy.
Center thermoregulation,
thermoreceptors.
 Homeothermy: maintains a stable internal body
temperature regardless of external influence and
temperatures. The stable internal temperature is
often higher than the immediate environment.
Homeothermia are also called warm blooded
animals. They have a group of reflex responses that
are primarily integrated in the hypothalamus
operate to maintain body temperature within a
narrow range in spite of wide fluctuations in
environmental temperature.
 Thermoregulatory center located in the
hypothalamus concerned mainly with the
regulation of heat production, heat inhibition, and
heat conservation to maintain a normal body
temperature. Kinds of thermoregulatory centers
include thermogenic center, thermo-inhibitory
center, and thermo-taxic center.
 Thermoreceptors are specialized nerve cells that
are able to detect differences in temperature.
Temperature is a relative measure of heat present
in the environment. Thermoreceptors are able to
detect heat and cold thermoreceptors that are
located in the dermis, skeletal muscles, liver, and
hypothalamus .
032. The heat in the body, its regulation.
033. Heat in the body and its regulation.
 In the body, heat is produced by
• muscular exercise,
• assimilation of food
• shivering
• metabolic activities
 • by hormone thyroxine and adrenaline
• and All the vital processes that contribute to the
basal metabolic rate.
 It is lost from the body by radiation, conduction,
and vaporization of water in the respiratory
passages and on the skin. Small amounts of heat
are also removed in the urine and feaces.
 The balance between heat production and heat
loss determines the body temperature Heat in the
body is control by center of hypothalamus.
Heat loss centre: Heat loss centre is situated in
preoptic nucleus of anterior hypothalamus.
Neurons in preoptic nucleus are heat sensitive
nerve cells, which are called thermoreceptors.
• Stimulation of preoptic nucleus results in
cutaneous vasodilatation and sweating.
• Absence of this nucleus causes increase in body
temperature.
• When stimulated, it inhibits the sympathetic
activity.
 • Decrease adrenaline secretion and metabolic
rate.
• Decrease heat production
• Increase heat loss.
Heat gain centre: This centre is also known as heat
production centre. It is situated in posterior
hypothalamic nucleus.
• Stimulation of posterior hypothalamic nucleus
causes shivering.
• The absence of this nucleus leads to fall down in
temperature.
• When stimulated, it stimulate the sympathetic
activity.
• increase adrenaline secretion and metabolic
rate.
• increase heat production
• decrease heat loss.(by cutaneous
vasoconstriction)
034. Regulation sustainability of body
temperature at different ambient
temperatures.
 temperature receptors in the skin detect changes
in the external temperature. They pass this
information to the processing centre in the brain,
called the hypothalamus.
 The processing centre also has temperature
receptors to detect changes in the temperature of
the blood. The processing centre automatically
triggers changes to the effectors to ensure our
body temperature remains constant, at 37°C.The
effectors are sweat glands and muscles.
 If we are too hot or too cold, the processing
centre sends nerve impulses to the skin, which has
two ways to either increase or decrease heat loss
from the body's surface.
1. Hairs on the skin trap more warmth if they are
standing up, and less if they are lying flat. Tiny
muscles in the skin can quickly pull the hairs upright
 to reduce heat loss, or lay them down flat to
increase heat loss.
2. If the body is too hot, glands in the skin secrete
sweat onto the surface to increase heat loss by
evaporation. This cools the body. Sweat secretion
slows when the body temperature returns to
normal.
 When Body Temperature Increases When blood
with increased temperature stimulates the
thermoreceptors present in the heat loss center in
preoptic nucleus. Temperature is normalized by
two mechanisms:
• Promotion of heat loss: When body
temperature increases, heat loss center
promotes heat loss from the body by two
ways:
i. By increasing the secretion of sweat: more
water is lost from skin along with heat.
ii. By inhibiting sympathetic centers: This causes
cutaneous vasodilatation. It increases the heat
loss through sweat, leading to decrease in body
temperature.
 • Prevention of heat production: Heat loss center
prevents heat production in the body by
inhibiting mechanisms involved in heat
production, such as shivering and chemical
(metabolic) reactions.
 When Body Temperature Decreases it is brought
back to normal by two mechanisms:
• Prevention of heat loss: When body
temperature decreases, sympathetic centers in
posterior hypothalamus cause cutaneous
vasoconstriction. This leads to decrease in
blood flow to skin and so the heat loss is
prevented.
• Promotion of heat production: Heat
production is promoted by two ways:
i. Shivering: When body temperature is low, the
heat gain center stimulates the primary motor
center for shivering. During shivering,
enormous heat is produced because of severe
muscular activities.
ii. Increased metabolic reactions: Sympathetic
centers, which are activated by heat gain
 center, stimulate secretion of adrenaline and
noradrenaline and thyroid-stimulating
hormone. All these hormones accelerates the
metabolic activities in the body and this
increases heat production.

035. General description of the excretion

system. The role of the kidneys in the
process of selection. Features of the blood
supply to the kidneys.
 The excretory system consists of organs which
remove metabolic wastes and toxins from the
body. The purpose of the urinary system is to
eliminate waste from the body, regulate blood
volume and blood pressure, control levels of
electrolytes and metabolites, in purification of the
blood and regulate blood pH.
 urinary system, , consists of the kidneys, ureters,
bladder, and the urethra.
 In kidney, selection of various products takes
part. There is a kind of systematic
• Absorbed materials are glucose, proteins, some
ions such as sodium, potassium, chlorine,
calcium, magnesium, phosphate, bicarbonate
and water.
• Secreted substances are urea, waste products
such as drugs and other toxic compounds.
These are depends on the permeability of the
walls of the renal tubules.
Blood supply of kidney
 The kidneys are supplied with blood via the renal
arteries, which arise directly from the abdominal
aorta.
 Each renal artery enters the kidney via the renal
hilum, dividing into segmental branches.
Each segmental artery divides to form
interlobar arteries.
 They are situated either side every renal pyramid.
These interlobar arteries undergo further division
to form the arcuate arteries
 .These arcuate arteries divide into interlobular
arteries which pass through the cortex, dividing
one last time to form afferent arterioles.
 The afferent arterioles form a capillary network,
which Is called the glomerulus, where filtration
takes place.
 After filtration occurs, the blood moves through a
small network of venules that converge into
interlobular veins which provide blood to the
arcuate veins then back to the interlobar veins,
 which come to form the renal vein exiting the
kidney

036. Mechanisms of urine formation.

Filtration in the glomeruli and factors on
which it depends.
 There are three stages involved in the process of
urine formation. They are
• Glomerular filtration – fluid is squeezed out of
the glomerular capillary bed
• Selective (tubular) reabsorption – most
nutrients, water and essential ions are
returned to the blood of the peritubular
capillaries.
• Tubular secretion - moves additional
undesirable molecules into the tubule from
blood of peritubular capillaries.
Glomerular filtration
 Glomerular filtration depends on the renal
perfusion pressure, most importantly the
balance between afferent and efferent arteriolar
tone
 This takes place through the semipermeable
walls of the glomerular capillaries and bowman’s
capsule.
 It depends on the main three pressures. One
pressure (Glomerular blood hydrostatic
pressure) promotes filtration and two pressures
(capsular hydrostatic pressure and blood colloid
osmotic pressure )oppose filtration
 The afferent arterioles supplying blood to
glomerular capsule carries useful as well as
harmful substances. The useful substances are
glucose, amino acids, vitamins, hormones,
electrolytes, ions etc. and the harmful
substances are metabolic wastes such as urea,
uric acids, creatinine, ions, etc.
 The diameter of efferent arterioles is
narrower than afferent arterioles. Due to this
difference in diameter of arteries, blood leaving
the glomerulus creates the pressure known as
hydrostatic pressure. The glomerular hydrostatic
pressure forces the blood to leaves the
glomerulus resulting in filtration of blood.
 Capillary hydrostatic pressure of about 7.3 kPa (55 mmHg) builds up in the glomerulus.
 This pressure is opposed by the osmotic pressure of the blood, provided mainly by plasma
proteins, about 4 kPa (30 mmHg)
 Filtrate hydrostatic pressure of about 2 kPa (15 mmHg in the glomerular capsule.
 Therefore, the net pressure is: 55 - (30+15) = 10mmHg
 By the net filtration pressure of 10mmHg, blood is filtered in the glomerular capsule.
  Water and other small molecules readily
pass through the filtration slits but Blood cells,
plasma proteins and other large molecules are
too large to filter through and therefore remain
in the capillaries.
 The filtrate containing large amount of
water, glucose, amino acids, uric acid, urea,
electrolytes etc. in the glomerular capsule is
known as nephric filtrate of glomerular filtrate.
• The volume of filtrate formed by both kidneys
each minute is called the glomerular filtration
rate (GFR). In a healthy adult the GFR is about
125 mL/min, i.e. 180 liters of filtrate are formed
each day by the two kidneys.

037. Reabsorption of amino acids and

proteins in the nephron tubules.
 The amino acid and protein is reabsorbed in
pct mainly. Amino acid are reabsorbed by Na+-
independent facilitated diffusion across the
basolateral membrane individual amino acids
may have two or more Na+ dependent transport
systems with different kinetic characteristics
along the luminal membrane of the proximal
tubule, One or more Na+ ions, H+, Cl- and in the
case of acidic amino acids, K+ ion, may be
involved in the translocation of the carrier
complex. For most amino acids this process is
electrogenic positive, favored by a negative cell
interior.
 Transepithelial reabsorption of AA involves
their active import from the primary urine into
the proximal tubule epithelial cells via secondary
active transporters and then their passive
basolateral efflux via facilitated diffusion and/or
obligatory
 Exchange regulation of reabsorption of
amino acid is by hormones and xenobiotics on
renal amino acid transport systems
glucocorticoids and thyroid hormones stimulate
renal reabsorption of amino AIDS many
compounds (e.g. heavy metal complexes)
selectively damage renal amino acid
transporters resulting in urinary amino acid loss.
 Pinocytosis:- The cell membrane engulfs a
particle or protein molecule outside the cell, and
brings it into the cell.
038. Reabsorption of water.
Countercurrent mechanism reabsorption of
water.
 Aldosterone acts on the kidney at the distal
tubules and promotes the reabsorption of
sodium and water into the blood. This increases
the volume of fluid in the body, which also
increases BP.
 Most of the Water is reabsorbed by
osmosis.
Countercurrent mechanism
 The loops of Henle are set up so as to
concentrate osmolarity in the deepest part of
the medulla.
 This occurs because the ascending and
descending limbs have different permeabilities
to salt and water. In the thick ascending limb,
there is active reabsorption of ions, but this
segment is relatively impermeable to water. As a
result, these cells can make the interstitial fluid
hyperosmotic relative to the fluid inside the
tubule. In the descending limb, the opposite
occurs. These cells don’t allow ions to leave the
filtrate, but water can freely leave the main
place of reabsorption of water is 57 collecting
 duct. In Wall of collecting duct is aquaporin
channel through which water pass into
extracellular space and next to blood capillary
around collecting duct.

039. Regulation reabsorption of sodium and

glucose in the tubule nephrons.
Sodium reabsorption

 In proximal tubule. Initially it needs the

cotransporter SGLT and the Na-H antiporter then
latter it is favoured by an electrochemical driving
force.It is a passive transport as it passes along
the electrochemical gradient from the lumen into
 the tubular cell, together with water and chloride
which also diffuse passively.
 In loop of henle. Sodium is reabsorbed in the
thick ascending limb of loop of henle, , by Na-K2Cl
symporter and Na-H antiporter. It goes against its
chemical driving force, but the high electrical
driving force renders the overall electrochemical
driving force positive anyway, availing some
sodium to diffuse passively either the
transcellular or paracellular way
 In distal tubule. Sodium is transported against
an electrochemical gradient by sodium-chloride
symporters.
 Collecting tubule…its principal cells transport
sodium.
 Reabsorption of sodium is stimulated by
angiotensin II and aldosterone, and inhibited by
atrial natriuretic peptide.
Glucose reabsorption
 Reabsorption of glucose only occurs in
proximal tubules and occurs regardless of the
 concentration gradient as it is completed via
secondary active transport. It is reabsorbed
using a co-transporter with sodium.
 The realization of the potential energy
produced from sodium moving from an area of
high concentration to an area of low
concentration is enough energy to transport
glucose across the membrane into the epithelial
cells.
 The energy technically comes from the
utilization of ATP by the sodium/potassium
ATPase which keeps low sodium concentrations
within the epithelial cells giving the sodium in
the lumen a high potential energy. 040.
Secretion of substances in the nephron,
their physiological mechanism
F- filtration R-reabsorption S-secretion E-excretion
 Secretion → movement of contents from
blood enter into nephron.
 Secretion is caused mainly by active transport
and passive diffusion. Usually only a few
substances are typically waste products and
hence they are secreted into lumen of urinary
tubules by tubular epithelium from where they
would be excreted from the body. Secretion,
which occurs in the proximal tubule section of
the nephron, is responsible for the transport of
certain molecules out of the blood and into the
 urine. Secreted substances include potassium
ions, hydrogen ions, and some xenobiotics.
 Secretion occurs by active transport
mechanisms that are capable of differentiating
among compounds based on polarity.
 Secretion takes place in following parts of
nephron: Proximal convoluted tubule: A
nitrogenous waste product i.e.uric along with
several organic acids are secreted in PCT. Distal
convoluted tubule: Small amounts of hydrogen
ions and potassium ions are secreted in DCT.
 Two systems exist, one that transports weak
acids (such as many conjugated drugs and
penicillins) and the other that transports basic
substances (such as histamine and choline).
041. The role of the kidneys in ensuring
izoosmi. Mechanisms thirst.
 The kidney has a pivotal role: disturbances
can be completely corrected through changes in
H+ secretion and HCO3 − reabsorption and
production.
 HCO3 − reabsorption is modified by changes
in glomerular filtration rate (filtered load),
changes in extracellular volume and by hormones
which modify Na+ reabsorption via the Na+ –H +
exchanger in renal tubular cells. Changing the
activity of this exchanger influences H+ secretion
and, hence, HCO3 − reabsorption.
 Chronic (but not acute) changes in pCO2
influence HCO3 − reabsorption through changes
in the filtered load and, in chronic acidosis, by
the insertion of more H+ transport proteins in
renal tubular cells. Renal HCO3 − production is
linked to H+ excretion: acid buffer salts
(phosphate, creatinine), their availability and pK
and tubular fluid pH. Formation and excretion
of NH4 + buffer salts are important – acidosis
stimulates secretion of NH4 + (proximal tubule)
and NH3 (collecting duct). There is a reciprocal
relationship between extracellular K+ and NH4
+ excretion, hence HCO3 − production.
mechanism of thirst
 the 4 major stimuli to thirst are:
 • Hypertonicity: Cellular dehydration acts via
an osmoreceptor mechanism in the
hypothalamus
• Hypovolaemia: Low volume is sensed via
the low pressure baroreceptors in the
great veins and right atrium
• Hypotension: The high pressure
baroreceptors in carotid sinus & aorta
provide the sensors for this input
• Angiotensin II: This is produced consequent
to the release of renin by the kidney (eg. in
response to renal hypotension)
 body’s primary “thirst center” in the brain is the
hypothalamus.
 When the body gets low on water, the
hypothalamus increases the synthesis of an
antidiuretic hormone called vasopressin, which is
secreted by the pituitary gland and travels to the
kidneys. There, it causes water to be reabsorbed
from the urine, thus reducing urine flow and
conserving water in the body until more fluids are
consumed.
 042. The role of the kidneys in ensuring
izovolyumi.
 The kidney plays a pivotal role in the regulation of
blood volume by controlling the plasma volume
and red blood cell (RBC) mass.
 Osmoreceptors detect an increase in plasma
osmolality  An increase
in plasma osmolality
occurs when the plasma
becomes more
concentrated. This can
be produced either by
dehydration or excessive
salt intake. Stimulation of
osmoreceptors
produces sensations of
thirst, leading to increased water intake and an
increase in the amount of ADH released from
the posterior pituitary.
  Cells in the kidneys and hypothalamus are active
monitors when blood pressure and volume
decrease, kidney release renin.
 Renin acts on angiotensin 1.
 Angiotensin 1 then broken to angiotensin 2.
 Angiotensin 2 stimulates vasoconstriction, release
of hormones ADH and aldosterone and also
stimulates hypothalamus thirst center to drink
water.
Hormonal role in blood volume
Anti-diuretic hormone (vasopressin)
 It is produced by neurons in hypothalamus,
transported by axons into posterior pituitary and
released in response to hypothalamic
stimulation.Anti-diuretic hormone acts to
maintain blood pressure, blood volume and
tissue water content by controlling the amount of
water and hence the concentration of urine
excreted by the kidney.

Aldosterone
  It is produced by the adrenal gland. It acts on
kidney and helps in increasing the amount of salt
absorbed by the bloodstream, along with salt
water also reabsorbed in more quantity.
 It helps in increasing the amount of potassium
excreted in urine. It helps in increasing the
blood volume which I turn increase blood
pressure.
Natriuretic hormone
 It is produced by the atria and it helps in bringing
down the blood pressure by causing vasodilation
and stimulating kidneys to discharge more water
and sodium ions. 043. The role of the
kidneys in ensuring the sustainability of
acid-base status of blood.
 The kidneys help maintain acid-base balance by
excreting hydrogen ions into the urine and
reabsorbing bicarbonate from the urine.
 The kidneys have two very important roles in
maintaining the acid–base balance:
 • They reabsorb bicarbonate from urine.
• They excrete hydrogen ions into urine.

 Bicarbonate (HCO3−) does not have a

transporter, so its reabsorption involves a series
of reactions in the tubule lumen and tubular
epithelium.
 Acidosis causes more bicarbonate to be
reabsorbed from tubular fluid while collecting
ducts secrete more hydrogen to generate more
bicarbonate; and more NH3 buffer is formed.
 Alkalosis causes the kidney to excrete more
bicarbonate as there is reduced secretion of
hydrogen ions and more ammonium is
excreted.
 The organs involved in regulation of external
acid-base balance are - blood buffer system,
lungs and kidneys.
 Most rapidly react to changes in pH of blood
buffer system within 0.5 - 1 min. Lungs affect the
normalization of pH in 1 – 3 minutes. A
 normalizing effect on the kidneys pH change in 10
- 20 hours.

044. Visual sensory system, its structure and

function.
 The visual sensory system is a system developed
to perceive the environment through the light: it
uses light to form images of the surroundings.
 Vision begins with the eye. Images are formed in
the eye by refraction. Light waves enter the eye
through cornea, refracts, goes through the pupil
and reaches the retina.
 The pigmentation of the eye is provided by the
iris; the white part of the eye is called sclera and
 it forms the eyeball; extraocular muscles move
the eye and the eye’s orbit. The axons exit the
retina thought the optic nerve in the back of the
eye.
 Visual pathway-A pathway over which a visual
sensation is transmitted from the retina to the
brain. It consists of an optic nerve, the fibers of
an optic nerve traveling through the optic chiasm
to the lateral geniculate body of the thalamus,
and optic radiations terminating in an occipital
lobe.
 10 layers of retina
From outside to inside
 Layer of pigmented epithelium. ➢ Layer of rods and
cones. ➢ External limiting membrane ➢ Outer
nuclear layer ➢ Outer plexiform layer. ➢ Inner
nuclear layer ➢ Inner plexiform layer ➢ Ganglion cell
layer ➢ Layer of nerve fibers. ➢ Internal limiting
membrane.
045. The basic visual functions and methods of
their study.
 The basic visual functions are
 • visual acuity
• colour vision
• contrast sensitivity
• dark adaptation
• binocular vision

 Methods to study
• A standard eye chart.
• Cover test to check eye alignment.
• Manual refraction with a phoropter.
• Slit lamp exam of the front of the eye.
• Applanation tonometry (glaucoma test).*
 • Exam of retina after pupil dilation.
046. Theories of color and types of violations of
color.

There are many theories that explains the

mechanism of perception of colour by eyes.
 Thomas Young-helmholtz Trichromatic Theory.
• A/c to this theory, retina has three types of
cones. Each one posses its own photosensitive
substance. Each cone give response to one of
the primary colours i.e, red, green and blue.
• For sensation of white light all three types of
cones are stimulated equally.
 Granit Dorminator- Modulator Theory.
• Granit observed that the ganglionic cells of
retina are stimulated by whole of the visual
spectrum. He also studied the action potentials
in ganglionic cells, which are stimulated by light.
• Sensitivity curves were recorded in both light
and dark adapted eyes. On the basis of this
Granit classified ganglionic cells into two groups:
 i) Dorminators:- responsible for brightness of
light. These are further divided into
rods(respond in dark adapted eye) and cones
(respond in light adapted eye).
ii) Modulators:- responsible for different colour
sensations. These are of three typesmodulators
of blue, green, red-yellow.
 Hartridge Polychromatic Theory.
• A/c to this theory, human retina has 7 types
of receptors. All these 7 receptors are
divide into three units.
First unit- tricolour unit consisting of
receptors of orange, green, blue.
Second unit- dicolour unit consisting of
receptors of yellow and blue colour.
Third unit- dicolour unit consisting of red
and blue-green receptors.
 Hering’s theory of opposite colours.
• A/c to this theory, retina has three
photochemical substances. Each substances
produces sensation of a particular colour by
its breakdown or re-synthesis. states that
 the visual system interprets color in an
antagonistic way: red vs. green, blue vs.
yellow, black vs. white
First- white-black substance.
Second- yellow-blue substance.
Third- red-green substance.

 Colour blindness- is the failure to appreciate one

or more colours. It is divided into three types
• Monochromatism- is the total inability to
perceive colour. It is also called total colour
blindness or achromatiopsia.
• Dichromatism- in which the subject can
appreciate only two types of colours. Person
having this disease is called dichromates.
• Trichromatism- is the types of disease in
which the intensity of colour cannot be
appreciated . Person with this defect is called
Trichromats.
• Anomalous trichromats possess three types of
photo pigment in their cones, and so are truly
 trichromats. "anomalous" is that one pigment
type is shifted along the wavelength axis from
the normal position.
 Dyschromatopsia- means colour confusion due to
deficiency of mechanism to perceive colours.
047. Physiological mechanisms of pain.

 There is a theory named gate control theory for

pain. According to which, the pain stimuli
transmitted by afferent pain fibers are blocked by
gate mechanism located at the posterior gray
horn of the spinal cord. The perception of pain
depends on a neural mechanism in the substantia
 gelatinosa layer of the dorsal horn of the spinal
cord. The mechanism acts as a synaptic gate that
modulates the pain sensation from myelinated
and unmyelinated peripheral nerve fibers and the
activity of inhibitory neurons. If the gate is
opened, the pain is felt. If the gate is closed, the pain
is suppressed.
 Mechanism of gate control at spinal level.
• When the pain stimulus is applied on any part of
the body, besides pain receptors, the receptors
of other sensations such as touch are also
stimulated.
• When all these impulses reach the spinal cord
through posterior nerve root, the fibres of touch
sensations (posterior column fibres) send
collateral to the neurons of pain pathway, i.e.
cells of marginal nucleus and substantia
gelatinosa.
• Impulses of touch sensation passing through
these collaterals inhibit the release of glutamate
and substance P from the pain fibres. • This
 closes the gate and the pain transmission is
closed.
 Nociceptors are sensory receptors that are
responsible for detecting harmful or noxious
stimuli and transmitting electrical signals to the
nervous system. The receptors are present in
skin, viscera, muscles, joints and meninges to
 detect a range of stimuli, which may be
mechanical, thermal or chemical in nature.
 There are two main types of nociceptors:
• C-fibers are the most common type and
are slow to conduct and respond to
stimuli. As the proteins in the membrane
of the receptor convert the stimuli into
electrical impulses that can be carried
throughout the nervous system.
• A-delta fibers are known to conduct more
rapidly and convey messages of sharp,
momentary pain.
• Quick a-delta myelinated nerve fibers and
C-fibers without myelin. The ascending
fibers are included in spinothalamic tract,
which passes through the spinal cord and
reach medulla oblongata. Here there are
second order sensory neurons of
spinomesencephalic tract. Fibers of
spinothalamic tract synapse with
thirdorder neurons in the thalamus, which
 in turn project to the postcentral gyrus of
the contralateral cerebral hemisphere.
Information about the pain from head, face and
mouth cavity ascend to central nervous system by
sensory fibers of cranial nerves, for instance facial,
glossopharyngeal, vagus and trigeminus nerves.
Central nociceptive neurons lay in nucleus of
thalamus, hypothalamus, mesencephalon central
gray substance, reticular formation and
somatosensoric fields of brain cortex.
048. Opiate and nonopiat antinociceptive body
systems and their importance.
 Antinociception - the action or process of
blocking the detection of a painful or injurious
stimulus by sensory neurons
• To antinociceptive neuro-endocrine system
belong nervous structures, which are
concentrated, obviously, in brain stem.
• High intensity of pain stimuli permits
activation of these structures, which contain
neurons capable to release endogenous
opioids.
 • To such structure belong, for instance,
prefrontal cortex, hypothalamus, central
gray substance, medial thalamic nuclei and
limbic system.
 Anti-nociceptive system :
• In brain and digestive tract are located
receptors, which bind to morphine.
• Investigation endogenous ligands of these
receptors give ability to reveal two similar
pentapeptides, called encephalin, which bind to
opioid receptors: met-encephalin and ley-
encephalin. Such chemicals are known as opioid
peptides.
• Encephalins are containing in nerve endings of
digestive tract and many parts in brain. It
function as neurotransmitters. These peptides
are present in gelatinous substance. In injecting
into brain stem, opioid peptides manifestate
analgetic effect. Encephalins also may slow
down intestines peristaltic.
 Opioid (narcotic) analgesics are derived from or related
to the Opium. They bind to opioid receptors, which
 present in many regions of the nervous system and are
involved in pain signaling and control. There are four
groups of opioid receptors: delta, kappa, mu, and
sigma.
 Non-onopioid (non-narcotic) analgesics include
acetaminophen, the most commonly used over-
thecounter pain medicine. Other drugs are not
technically part of the analgesic family, but are
nonetheless considered analgesics in practice. These
include nonsteroidal anti-inflammatory drugs (NSAIDs).
Aspirin and acetaminophen are two of the most widely
used analgesics and are effective for mild to moderate
headache and pain of musculoskeletal origin.

049. Physiological mechanisms of anesthesia.

 A general anesthetic is a drug that brings about a
reversible loss of consciousness. These drugs are
generally given by anesthesiologist/anesthetist in
order to induce or maintain general anesthesia to
facilitate surgery.
 Analgesics:
• May act at the site of injury and decrease
the pain associated with an inflammatory
reaction (e.g. non-steroidal
antiinflammatory drugs (NSAID)
• May alter nerve conduction (e.g. local
anesthetics): block action potentials by
blocking Na channels. Used for surface
anesthesia, infiltration, spinal or epidural
anesthesia. Used in combination to steroid
to reduce local swelling (injection near nerve
root).
• May affect the central component and the
emotional aspects of pain (e.g. opioids,
antidepressant). Problems of tolerance and
dependence
• By inactivation of nociceptors using
chloroethyl or by injection of analgesic in
tissues adjacent to nervous fibers.
• Novocain, analgene and other medicines
may prevent generation and spreading of
nervous impulses by temporarily inactivation
of ion gates
 • .Some drugs may be injected in the lumbar
space. In this case spreading impulses
through ascendant conduction is obtained.
In using common analgesia braking activity
of central neurons leads to both analgesia
and unconsciousness, which cold surgical
sleep. There are some drugs, capable
modulate activity of limbic system and cause
sedative effect.
050. Auditory sensory system, its structure and
functions, research methods.
 The auditory system is a body system that is
responsible for the sense of hearing. It is divided
into two subsystems
• The peripheral auditory system (outer ear,
middle ear and inner ear) and
• The central auditory system (from the
cochlear nucleus up to the primary auditory
cortex which is in brain)
External and middle ear are involved in hearing.
Inner ear is responsible in hearing and balance.
 External ear:- includes the auricle and external
auditory meatus and terminates in tympanic
membrane.
• Functions- Gathers sound waves
• Aids in localization
• Amplifies sound approx. 5-6 dB
 Middle ear:- is an air filled space within the
temporal bone and separated from ext. auditory
meatus by tympanic membrane, formed from 3
layers and it Vibrates in response to sound waves.
Its structure consist of – auditory ossicles, auditory
muscle and eustachian tube.
Eustachian tube- is a flattened canal extending
from middle ear to the nasopharynx and allow
the passage of air between them. Function-
Hearing.
 Inner ear:- inner ear or labyrinth is a
membranous structure inside the temporal bone.
It consists of two parts.
• The sense organ for hearing – cochlea.
 • Sense organ for balance – Vestibular apparatus.
FUNCTION- hearing and balance.

Cochlea
Cranial nerve 8
Brainstem:
• Cochlear nucleus
• Superior olivary complex Brain:
• Lateral lemniscus auditory cortex /
• Inferior colliculus temporal lobe
• Medial geniculate body

There are various tests to assess the sensation of hearing.

 Bedside tests:
• Whispering test : The examiner stands about 60 cm
away from the subject at his side and whispers some
words. If the subject is not able to hear the whisper,
then hearing deficit is suspected.
 • Tickling of watch test : Wrist watch with tickling
sound is kept near the ear of the subject. The subject
suffering from hearing defects cannot hear the
tickling sound of watch.
 Routine Tests for Hearing:
• Rinne test
• Weber test
This two tests are done by using a tuning fork with
high frequency. Mostly, a tuning fork with 512
cycles per second is used. By turning fork tests,
only the nature of auditory defect is determined.
• Audiometry: By audiometry, both nature and severity
of auditory defects can be determined. Audiometer
has an electronic vibrator, which Is used to test the
bone conduction from mastoid process into the
cochlea.
051. The functions of the external and middle ear.
External ear
 Auricle/pinna
Made up of fibro-cartilaginous
plate. In humans,
 the extrinsic and intrinsic muscles of auricles
are rudimentary and the movement is not
possible. The depression of auricle which
forms the orifice
of external auditory meatus, is called concha. It
collects and directs sound to the ear canal.
 External auditory meatus
It starts from concha and extends inside.
Meatus consists of two parts: outer
cartilaginous part and inner bony part. It is a
long tube with hairs, and directs sound to
eardrum.

Function: gather sound waves and hearing

Middle ear
Middle ear is compressed chamber located within
the temporal bone. It is
separated from ext. meatus
by a tympanic membrane. It
consists of 3 parts:
 Auditory ossicles-
consists of malleus, incus,
stapes.
 Auditory muscle- consists of two skeletal
muscles: tensor tympani and stapedius.
  Eustachian tube- is a flattened canal
extending from middle ear to the nasopharynx
and allow the passage of air between them. Thus,
maintaining air pressure at both sides of eardrum.
Structure of tympanic membrane Formed of three layers:
• Lateral cutaneous layer • Intermediate fibrous layer
• Middle mucus layer.
Function: hearing
052. The inner ear structure and function.

Inner ear
Inner ear or labyrinth is a
membranous structure
inside the temporal bone.
It consists of two parts.

 Cochlea. - The
sense organ for
hearing. It is a
coiled structure like snail’s shell. It consists of
two structures.
• Central conical axis- Modiolus- It starts from
base of cochlea and ends at apex of cochlea.
Its base forms the bottom internal auditory
meatus.
• Bony canal or tube
Compartments of cochlea
• Basilar membrane – also called membranous
spiral lamina.
• Vestibular membrane.- is also called as
reissner membrane.
 Vestibular apparatus. - Sense organ for
balance. It consists of three canal: • Scala
vestibuli • Scala tympani • Scala media.
It also consist of Organ Of Corti, it is a receptor
organ for hearing extending throughout the
cochlear duct. The organ of Corti is located in the
scala media of the cochlea between the vestibular
duct and the tympanic duct and is composed of
mechanosensory cells, known as hair cells. The
function of the organ of Corti is to transduce
auditory signals and minimise the hair cells’
extraction of sound energy
Function- hearing and balance.

053. Theories of sound perception.

Frequency theory:
• Proposed by Rinne and Rutherford.
• Theory gives an assumption that the firing rate of
the auditory nerve has a wide range of 20 to
20,000 times per second.
• This time domain represents rate at which the
auditory nerve fires.
• Frequency theory, is theorized to be processed in
the brain, rather than in the inner ear.
• The studies done in the late 20th century have
proven the Frequency Theory incorrrect in its
assumption of the firing rate of the auditory
nerve. Today, it is widely accepted that individual
nerve fibers, including that of the auditory nerve,
can only fire at a range of 300 to 500 times per
second. Neural groups can only fire with
frequencies up to 5000 Hz.
Place theory / Resonance theory:
• Proposed by Helmholtz. Theory of hearing that
states that our perception of sound depends on
where each component frequency produces
vibrations along the basilar membrane.
Most psychologists agree that hearing sound stimuli at
low frequencies by frequency theory, at high
frequencies are attributed to the place principle.
Sound stimuli in mid frequencies are believed to be
rightfully accounted to both hearing theories.
054. Vestibular analyzer, its functions, research
methods.
Vestibular analyzer is formed by semi-circular canal
and otolith organ (vestibule).
Semi-circular canals
 These are tubular structure placed at right
angles. They represent the three axis of rotation-
vertical, anterio-posterior and transverse.
 It consist of three canals
• anterior • posterior • lateral
 It also consist of the enlarged end called
ampulla. It contains receptor organ of
semicircular canal known as crista ampularis.
Ampulla of canal opens directly into the utricle,
then utricle joins by forming the common crus.
Otolith organ
 It is formed by utricle and saccule then they
together form otoliths.
 Then utricle communicates with saccule
through utriculo-saccular duct.
 Functions:
 • Receptors of semi-circular
canal gives response to rotatory
movements of the head.

• Then receptors of utricle and

saccule gives response to linear
acceleration of head.

• Vestibular analyzer causes

reflex adjustment in the
position of eyeball, head, body
during postural changes.

055. Taste sensor system, its structure, functions

and methods.
 Taste sensory system also called the gustatory
system. It includes all the structures and organs
that facilitate the taste sensation, tactile and
thermal attributes of food.
 Taste stimuli are detected by multicellular taste
receptors, within the mouth, pharynx and dorsal
tongue (called papillae).
 There are four types of papillae present on the
tongue.
 • Filiform: contains few taste buds.
• Fungiform: contains moderate number of taste buds.
• Circumvallate: contains many taste buds.
• Foliate: no taste buds.
Structure of taste buds: Taste buds is a bundle of
taste receptors cells with supporting cells. They are
large number of small molecules which report the
sensation of taste to centers in the brainstem. Taste
bud consists of:
• Taste pore
− Opening through which fluids in mouth
come into contact with surface of receptor
cells
• Taste receptor cells
− Modified epithelial cells with surface
folds called microvilli
− Plasma membrane of microvilli contain
receptor sites that bind selectively with
chemical molecules
Pathway of taste Sensory stimuli from the taste
buds are conducted to the nerve endings of
  VII (facial nerve) serves anterior 2/3 tongue,
 IX (glossopharyngeal nerve) serves posterior 1/3 of
tongue,
 X (vagus nerve) serves palate and epiglottis
 cranial nerves, related by the nucleus tractus
solitarius and converge at a high frequency on:
• The postcentral gyrus via thalamus.
• The hypothalamus and limbic system via
pons.
• Signal travel to thalamus or limbic system
and hypothalamus
• Taste fibers extend from the thalamus to
the primary gustatory area on parietal lobe
of the cerebral cortex providing conscious
perception of taste
Taste modalities The qualities of taste
distinguishable in humans are conventionally
defined as sweet, sour, salty, bitter. There is now
fifth quality of taste classified called Umami.
• Sweet sensation: The tip of the tongue is
the area most sensitive to sweet stimuli.
 • Sour sensation: The posterior half of each
side of the tongue is area most sensitive to
the sour taste sensation.
• Salty sensation: The
front half of each side
of tongue is the area
most sensitive to salty
sensation.
• Bitter sensation: The
back of the tongue is
most sensitive to it.
• Umami: chiefly found on protein rich foods

Functions: The sense of taste has a protective

function as spoiled or bitter tasting food is often
poisonous. Tasting substance also stimulate the
secretion of saliva and gastric juices.

056. Olfactory sensory system, its structure and

function, research methods.
Olfactory sensory system includes all the structures
like nose and the nasal cavities that provide the
sensation of smell through the olfactory stimuli
detected by the olfactory receptors located on the
CN1- olfactory nerve ending.
Olfaction is a chemoreception that forms the sense
of smell. Olfaction has many purposes, such as the
detection of hazards, pheremones, and food. It
integrates with other senses to form the sense of
flavour.
• Smell Olfaction, sense of smell, occurs in
response to odors that stimulate sensory
receptors located in the extreme superior region
of the nasal cavity, called the olfactory recess.
• The specialized nasal epithelium of the olfactory
recess is called the olfactory epithelium. Like
taste, smell is a chemical sense, but there are no
basic sensations for smell, as there are for touch
and taste.
Olfactory nerve pathway: include the structures:
• Nasal cavity : it is divided by nasal septum into
left and right passages and lined with mucosa.
• Olfactory epithelium : specialized type of
epithelial tissue in nasal cavities that contains
olfactory nerve cells and receptor nerve cells.
These cells send impulses to the olfactory bulb.
• Olfactory receptor cells : are the sensory
receptors located in the extreme superior region
of the nasal cavity, called the olfactory recess. On
these receptors are present the mucus secreting
Bowman Glands.
• Olfactory nerves : nerve (first cranial nerve)
involved in olfaction. Olfactory nerve fibers
extend from the mucous membrane, through the
cribriform plate, to the olfactory bulbs.
 • Cribriform plate : a porous extension of the
ethmoid bone, which separates the nasal cavity
from the brain. Olfactory nerve fibers extend
through the holes in the cribriform to reach the
olfactory bulbs.
• Olfactory bulb: bulb-shaped structures in the
forebrain where olfactory nerves end and the
olfactory tract begins.
• Olfactory tract : band of nerve fibers that extend
from each olfactory bulb to the olfactory cortex
of the brain.
• Olfactory striae : Any of three bands of fibers
(lateral, intermediate, and medial) that form the
roots of the olfactory tract.
• Olfactory cortex : area of the cerebral cortex that
processes information about odors and receives
nerve signals from the olfactory bulbs
• Output targets of the olfactory cortex
Function: The sense of smell has various functions:
• Pleasant smell triggers the secretion of saliva and
gastric juice.
 • Unpleasant smell warns of potentially spoiled
food.
• Body odour permits hygiene control.
• Other aromas influence the emotional state.
057. Somato-sensory system, its structure and
function.
 The somatosensory system is the part of the
sensory system concerned with the conscious
perception of touch, pressure, pain,
temperature, position, movement, and
vibration, which arise from the muscles, joints,
skin, and fascia. It responds to changes at the
surface or inside the body.
 The axons of sensory neurons connect with
various receptor cells. These sensory receptor cells
are activated by different stimuli such as heat and
pain, giving a name to the responding sensory
neuron, such as a thermoreceptor
which carries information about temperature
changes. Other types include
mechanoreceptors, chemoreceptors, and
nociceptors and they send signals along a
 sensory nerve to the spinal cord where they
may be processed by other sensory neurons
and then relayed to the brain for further
processing.
 Sensory receptors are found all over the body
including the skin, epithelial tissues, muscles,
bones and joints, internal organs, and the
cardiovascular system.
Somatosensory pathway
The somatosensory system is a 3-neuron system
that relays sensations detected in the periphery and
conveys them via pathways through the spinal cord,
brainstem, and thalamic relay nuclei to the sensory
cortex in the parietal lobe. It have 3 long neurons
(primary, secondary, tertiary).
• The first neuron always has its cell body in the
dorsal root ganglion of the spinal nerve (if
sensation is in parts of the head or neck not
covered by the cervical nerves, it will be the
trigeminal nerve ganglia or the ganglia of other
sensory cranial nerves).
• The second neuron has its cell body either in the
spinal cord or in the brainstem. This neuron's
ascending axons will cross (decussate) to the
opposite side either in the spinal cord or in the
brainstem.
• In the case of touch and certain types of pain, the
third neuron has its cell body in the VPN of the
thalamus and ends in the postcentral gyrus of the
parietal lobe.
• Broadly, the spinal cord contains the
− second-order neurons for the fibers
carrying pain, touch, and temperature
sensations. The medulla contains the
second-order neurons for fibers carrying
touch, position, and vibratory sensations.
− The fibers are then either conveyed to the
thalamus (where the third-order neurons
are located) or conveyed to the cerebellum.
From the thalamic nucleus, the sensory
afferents are projected to the cortical
sensory areas, where information is
integrated and analyzed
058. Biological behavior. The needs and
motivations, their role in shaping behavior.
Biological behavior
 Biological behavior relates a behavior to the
activity of the brain and other organs.
 Human behavior involves the body-mind
interaction of the various bodily factors and the
most important are:
• The sense organs, called receptors
• The muscles and endocrine glands called
effectors.
• The nervous system known as the connecting
or integrating mechanism.
 The behavior is based on the various stimuli
present in the external environment and lying
within our body. This stimuli by various sensory
experience are received by our sensory systems
known as receptors.
 After then, those impulses passed will be
processed by brain.
Biological needs
  The needs like drink, breathe, eat, sleep,
shelter, warmth, sex, clothing are basic
requirement for human survival.
 If these needs are not satisfied, then the
human body cannot function optimally.
Biological motives
 It asserts that we all have a set of needs that
must be met, including biological, physiological,
psychological, safety, love, self-esteem and
actualization.
 Human body gets motivations to fulfill needs
via internal or external environment.
Internally – these motives aroused by change in
balanced levels of body processes. The complex
web of interconnected neurons regulate
several mechanism. It takes numbers of input
(needs) and produces a single output (fulfill it)
Externally – things like money, fame, success
motivates the human to achieve various things.
 There are also various theories which explains
human motivation like:
 Maslow theory, cognitive theory, drivereduction
theory

059. Mechanisms of conditioned reflexes, their

differences of course.
Unconditioned reflexes – fixed, congenital (inborn)
reactions that combine and coordinate functions
organism.
Conditioned reflexes – new reflex reactions for the
coordination of an organism with environment
depending on the nature and conditions of external
actions. They are individually acquired system of
adaptive reactions of the person and animals.
  It arises on the basis of formation in the central
nervous system of temporary communication
between centers, some of which percept new
irritant and other control some unconditioned
reflex.
 Thus, new irritant form an environment becomes
conditional irritant. It warns person about
approach of the subsequent kinds of activity and
prepares him for future kinds of activity (eating,
avoidance of danger and another). With the help
of the conditionedreflex mechanism, the
adaptation to varied conditions of an environment
are carried out.
 Conditioned reflexes are:
• Individual • Formed during the individual life
time • Can be inhibited • Can be changed with the
changing of the external environment. • Non-
adequate stimulus – stimulus isn’t specific to the
receptors. • Cortex or higher centres involvement
is obligatory • Adjustment to the changing
conditions.
Classification of conditioned reflexes
 On a way of formation:
• Classical conditioned reflexes - are formed in
natural conditions.
• Tool conditioned reflexes - are developed
artificially. More often they represent
purposeful motor reactions. As supporting
stimulus for their development the
unconditioned reflex causing in a laboratory
animal feeling of pleasure (effect of
"award") or painful irritant, causing
avoidance reaction usually serves.
 Under the relation of conditional irritant to
unconditional:
• Natural conditioned reflexes - conditional
irritant it is related to an unconditioned
reflex. For example, a smell and how a food
looks have the direct relation to irritation by
food of tongue receptors, which starts
unconditional salivatory discharge reaction.
• Artificial conditioned reflexes - conditional
irritant has no the direct relation to an
unconditioned reflex which serves as a
 reinforcement. For example, the bell or a
light signal in natural conditions have no the
relation to unconditional salivatory discharge
reflex.
 On biological importance:
• Food conditioned reflexes - provide getting
food and digestion.
• Sexual conditioned reflexes - provide sexual
behavior.
• Protective conditioned reflexes - provide
defensive reactions.
• Statokinetic conditioned reflexes - provide
motor behavioral reactions and impellent
skills.
• Homeostatic conditioned reflexes - are directed
on maintenance of a constancy of the inner
environment of an organism.
 On a degree of complexity:
• Conditioned reflexes of the first order - the
conditioned reflex is developed on the basis of
a unconditioned reflex.
 • Conditioned reflexes of the second order - the
conditioned reflex is developed on the basis of
other conditioned reflex of the first order.
• Conditioned reflexes of the third order - the
conditioned reflex is developed on the basis of
a conditioned reflex of the second order.
• Conditioned reflexes of the higher order - are
formed only at the high organization of
nervous system. In human formation of
conditioned reflexes of the second - twentieth
order is probably.
060. Memory: types and mechanisms of formation.
Memory Types:- there are many types of memory
like:-
• Genetic memory- keeps information about
body structure and its behavior
• Biological memory- presented in both
phylogenetic and ontogenetic forms.
• Immune memory
• Psychical memory
There are two major categories of memory according
to duration:
 is our brain's system for
storing, managing, and retrieving information.
Learn more about it.
 Closely related to
"working" memory, short-term memory is the
very short time that you keep something in mind
before either dismissing it or transferring it to
long-term memory.
Types of Long-Term Memory
long-term memories are much more complex than
short-term ones. We store different types of
information (procedures, life experiences, language,
etc.) with separate memory systems.
 Explicit Memory, or declarative memory, is a type
of long-term memory requiring conscious thought.
It's what most people have in mind when they
think of a memory.
  Implicit Memory is a major form of long-term
memory that does not require conscious thought.
It allows you to do things by rote.
 Autobiographical Memory Most of us have one
part of life that we remember better than others.
Find out if you have a "memory bump"!
Mechanism of formation
 At the molecular level, the habitation effect in the
sensory terminal results from progressive closure
of calcium channels through the presynaptic
terminal membrane.  In case of facilitation-
• Facilitated synapse releases serotonin that
activates adenyl-cyclase in postsynaptic cell.
Then cyclic AMP activates protein kinase that
then causes phosphorylation of proteins.
• This blocks potassium channels 32 for minutes
or even weeks.
• Lack of potassium causes prolonged action
potential in the presynaptic terminal that leads
to activation of calcium pores, allowing
 tremendous quantities of calcium ions to enter
the sensory terminal.
• This causes greatly increased transmitter
release, there by markedly facilitating synaptic
transmission.
 Brain mechanism of memory. It’s discovered the
nervous substrate of long-term memory is mostly
cerebral cortex.
• The most important regions are temporal
lobes, prefrontal area and hippocampus.
• Experimental researches revealed that some
thalamic nucleic and reticular formation take
part in memory function.
• Reticular formation gives ascending
stimulatory influences to cerebral cortex,
which help in keeping awake condition of
cortex and provides voluntary attention.
061. Emotions, mechanisms of formation.
Biological and information theory emotions. Their
role in shaping behavior.
  Emotions are aspect of higher nervous activity that
characterize subjective attitude of person to
various stimuli arousal in surroundings. Emotional
status reflects actual needs of man and helps in its
realization. It is any conscious experience
characterized by intense mental activity and a
certain degree of pleasure or displeasure.
Mechanism of formation
 Emotional excitation is spread in the brain due to
variety of neurotransmitters (noradrenalin,
acetylcholine, serotonin, dopamine and
neuropeptides including opioids.
 Positive emotions may be explained by revealing
catecholamines and
 Negative emotions, aggression result from
production acetylcholine in the brain.
 Serotonin inhibits both kinds of emotions.
Decrease of serotonin in blood is followed by
groundless anxiety and inhibition of noradrenergic
transmission results in sadness.
Role in human behavior
  Emotions are important element of human
behavior, creation of conditioned reflexes and
mentation. Negative emotions give fusty
evaluation of current situation does it useful or
not. Mobilizing of efforts helps then to satisfy
current needs of person. Positive emotions help to
put in memory scheme of behavior, which was
useful and have lead to success.
Theories of emotions
 Biological theory of emotions (P.K. Anochkin)
considers that life course includes two main stages
of behavioral act:
• Formation of needs and motivations that
results from negative emotions and
• Satisfaction of needs that leads to positive
emotions it case of complete accordance of
image and result of action. Incomplete
compliance of suspected and real result of
action cause negative emotions and continues
behavioral act.
• Information theory of emotions (P.V. Simonov)
considers that emotions reflect strength
 human of need and possibility of its
satisfaction in current moment.
• In absence of needs emotions can’t arise.
There is also not emotional excitation, if
getting excess information about mode of
satisfaction this need.
• Lack of information already causes negative
emotions that help to recall to mind life
experience and to gather information about
current situation.
062. Language and its function physiological bases
of formation.
Language is a structured system of communication.
It is the method of communication that involves
the use of particularly all human languages globally
Function:
• Language is an essential from of
communication.
• It allows people to convey and elaborate their
perspective.
 • It is key to express feelings, thoughts and
ideas.
• However, there are many forms and styles of
language. Different counties and religions have
different ancestral languages and styles of
speaking.
• Through language, people preserve their
community’s history, customs and traditions,
memory, unique modes of thinking, meaning
and expression. They also use it to construct
their future.
• Language is pivotal in the areas of human
rights protection, good governance, peace
building, reconciliation, and sustainable
development.
Broca’s and Wernicke’s Lesions (injury) studies: It
shows that a brain area is necessary for a given task.
• Without Broca’s area, there will be no
production of speech. It lies in the prefrontal
and premotor facial region in the left
hemisphere. Motor control of larynx, lips,
 mouth, respiratory system and 34 accessory
speech muscles are initiated from here
• Without Wernicke’s area, these is no
understanding of the speech. It lies in the
posterior part of the superior temporal gyrus.
Here, the formation of thoughts and regulation
of it takes place.

 Language is transferred between the two

hemispheres of the cerebral cortex through the
corpus callosum.
 The right hemisphere is dominant in facial
expression, intonation, body language, and spatial
tasks.
 The left hemisphere is usually dominant with
respect to language, even in left-handed people.
Lesions of the left hemisphere causes aphasia.
Formation
  The facial and laryngeal regions of the motor
cortex activates muscles of facial regions,
cerebellum, basal ganglia and sensory cortex
 Transmitters such as dopamine, noradrenaline,
serotonin, and certain neuropeptides transmits
signals and this is termed as slow synaptic
transmission. This results change in the function of
the nerve cell and it may last to several seconds to
hours.
 This slow synaptic transmission can also control
the fast synaptic transmission, which in turn
enables speech, movements and sensory
perceptions.
063. Type of higher nervous activity.
Higher nervous activity (HNA) – combined function of
the cortex and the nearest brain subcortical
structures, which provides the adaptation to the
environment and determines the behavior
Lower nervous activity- is the reflex regulation of
the internal state of the body and coordination of
the activities of its individual parts
Types of higher nervous activity acc to Pavlov’s
 Pavlov classifies types of higher nervous activity
according to intensity of the excitation and
inhibition, the ratio of these processes in central
nervous system and their mobility, that is rate at
which excitation was replaced by inhibition and
wise versa. In experimental practice the following
four principle types of higher nervous activity are
met
• Strong unbalanced type, characterized by
predominance of excitation over inhibition.
• Strong well-balanced active type, characterized by
high mobility of nerve processes (excitation is well
balanced)
• Strong well-balanced passive type, characterized
by low mobility of nerve processes (inert)
• Weak type, characterized by extremely weak
development of both excitation and inhibition,
which cause fatigue and low workability.
 strong, unbalanced - choleric
strong, balanced, agile – sanguine Acc
to ancient terms strong, balanced, inert -
stolidly weak - melancholic

 Special types of human HNA

Artistic – the I signal system predominates (concrete
thinking)
Thoughtful – the II signal system prevails (abstract thinking)
Mixed – I and II signal systems are expressed equally Genius

Types of higher nervous activity of a person

according to Eysenck’s personality test
 Types of higher nervous activity of person according
to Eysenck’s classification. The set of external
manifestations of human temperament is various.
On the base of customs of different types of
temperament he revealed three personal
parameters:
• extraversion or introversion
• neurotism • psychotism.
 Extroversive person is openhearted, has high
social activity, interesting in public relations.
 − It concerned peculiarities of reticular-cortical
interconnections lay in the basis of this
personal fiche.
 Introversive person is passive emotionally
unstable and interested mainly in his inner world.
− It correlates with greater activity of septal and
hippocampal inhibitory system in the brain.
 Neurotic person is high irritable, has unbalanced
emotional status even in usual conditions.
− It correlates rate of activity of limbic and
cortical interconnections in the brain.
 Psychotic person is highly egocentric, cool people
relations and aggressive. Importance of social
medium in formation of personal temperament is
high. Personal fiches of temperament get brighter
with age.
064. Sleep, its types, phase electrical activity of the
cortex, physiological mechanisms.
Sleep: Sleep is the natural periodic state of rest for
mind and body with closed eyes characterized by
partial or complete loss of consciousness. During
sleep most of the body functions are reduced to
basal levels.
 Two centres of sleep located in brainstem: raphe
nucleus and locus coeruleus of pons.
Stages of sleep
 Awake: closed eyes (alpha waves) and open eyes
(beta wave).
• Alpha wave:
− Frequency is 8-13Hz.
− Location: Posterior half of the head and are
usually found over the occipital region of the
brain.
− Interpretation: Indicate both a relaxed
awareness. It can be Eliminated by opening
the eyes, by hearing unfamiliar sounds, by
anxiety, or mental concentration or attention.
• Beta waves
− Frequency is 14-26 Hz
− Location: the frontal and central region
 − Interpretation: associated with active
thinking, active attention and focus outside
world.
− A high level of beta wave maybe acquired
when human is in panic state.
 NREM (Non rapid eye movements) This is further
divided into three stages • N1
sleep: This is the point where a
person is in light sleep. People
often report that they feel
awake when sleeping at this
stage (Theta waves).
− Frequency is 4-7.5 Hz
− Location: thalamus,
hippocampus, cortex
− Interpretation: type 1 associated with
voluntary behavior and during REM sleep.
Any sudden noise may wake up the
person and type 2 appears during
immobility and anesthesia.
 • N2 sleep: at this stage the body is truly asleep. It
accounts for 40-50% of sleep (sleep spindles).
• N3 sleep: This is the deep sleep stage. Often
referred to as delta or slow wave sleep.
 REM (Rapid eye movement) During REM stage of
sleep, muscles are not moving except eyes. They
move rapidly and if the person wakes up at this
stage, he will feel like he was dreaming (Delta
wave).
− Frequency is 0.5-4 Hz.
− Location: cortex or thalamus
− Interpretation: associated with deep
stage of slow-wave sleep and help
characterize the depth of sleep.
Sleep cycles work in the following way:
being awake entering into N1 stage N2 stage
N3 stage followed by REM sleep.
065. Age aspects of higher nervous activity in
humans.
 In neonates (newborn) unconditioned reflexes
for the functioning of the vegetative sphere are
observed :
• respiratory
• sucking
• withdrawal reflex
• grasp reflex
• blink reflex
• plantar reflexes to pain and temperature
stimuli
• reflexes to change the position of the body
 On the 7th day, orienting reflexes to light and
sound clearly appear
 Up to 10-12 days of life, the nature of
unconditioned reflexes changes – the reflexogenic
zones of unconditioned reactions narrow
 3 -5 years – active research activity
 5-7 years – the growth of strength and mobility
of the nervous processes. increasing the working
capacity of the cerebral cortex, greater stability:
 children are able to concentrate attention for 1520
minutes and more.
 Junior school age is a very important stage in the
development of brain activity: the influence of new
requirements systematic training
 At the age of 7-10 years – the basic properties of
the nervous processes approach the
characteristics of adults
 In behavior, a marked increase in the excitability
of the central nervous system Excitation reactions
are accompanied by additional movements of the
arms, legs and trunk, just as it was in early
childhood
 The period from 13-15 years for girls and from
1517 years for boys is the most critical and
turbulent period in the development of
adolescents: there is a mental imbalance with
sharp mood transitions ,from exaltation to
depression and conversely critical attitude to the
surrounding
adults extreme sensitivity tendency to tear for girls.
 In old people, weakening of the basic nervous
processes, especially inhibition (gabbiness and
fantasy) decrease in their mobility, the inertness of
the process develops One of the first
manifestations of aging is the weakening of
memory for current events (depends on the change
in the mobility of the excitation process)
In the elderly, conditioned reflexes are inhibited
How the conditioned reflexes are inhibited?
 By external or indirect inhibition
 By internal or direct inhibition
• Extinction of conditioned reflex
• Conditioned inhibition
• Inhibition by delay
• Differential inhibition
066. Physiology of adaptation. Mechanisms of
development of adaptive reactions. General
Adaptation Syndrome.
Adaptation is process of adjustment of body
functions to surrounding conditions or some new
level of activity, which is carried out through
human's life. For instance there is adaptation to
outer temperature, oxygen supply, physical load,
emotional pressure, rate of activity, light conditions,
so on.
 Changing in outer conditions may cause
adjustment of function of one organ, for instance
rising of mass of the heart in chronic increase of
blood return to the heart. Adaptation to high
altitude etc.
 New outer conditions mobilize homeostatic
mechanisms. Energetic resources of cells are
activated at first and plastic changing are of second
order.
 First stage: is urgent adaptation or alarm stage.
It's performed due to mobilizing of functional
reserves of organs and their systems like increase
of stroke volume in heart, tidal volume in lungs, so
on. Usual level of organs activity at rest consist 1/6
- 1/10 part of potential activity. Increase of
functional activity of organ or their systems
requires rising of metabolic rate and oxygen
consumption.
 Second stage: of adaptation is morphological that
is named stage of resistance also. In case of
repeated action of all new conditions as physical
load or high altitude, so on, structural
reorganization of functioning cells occur. For
example in regular hard physical exercises rises
quantity of contractile elements in muscle cell and
number of cells in motor units.
General adaptation syndrome
It has 3 stages
 Alarm reaction stage
• At the alarm reaction stage, a distress signal is
sent to a part of the brain called the
hypothalamus. The hypothalamus enables
the release of hormones called
glucocorticoids.
• Glucocorticoids trigger the release of adrenaline
and cortisol, which is a stress hormone. The
adrenaline gives a person a boost of energy.
Their heart rate increases and their blood
 pressure rises. Meanwhile, blood sugar levels
also go up.
• These physiological changes are governed by a
part of a person’s autonomic nervous system
(ANS) called the sympathetic branch.
• The alarm reaction stage of the GAS prepares a
person to respond to the stressor they are
experiencing. This is often known as a “fight or
flight” response.
 Resistance stage
• After the initial shock of a stressful event and
having a fight-or-flight response, the body
begins to repair itself. It releases a lower
amount of cortisol, and your heart rate and
blood pressure begin to normalize. Although
your body enters this recovery phase, it remains
on high alert for a while.
• Signs of the resistance stage include:
irritability
frustration poor
concentration
 Exhaustion stage
 • This stage is the result of prolonged or chronic
stress. Struggling with stress for long periods
can drain your physical, emotional, and mental
resources to the point where your body no
longer has strength to fight stress.
• Signs of exhaustion include:
fatigue
burnout
depression
anxiety
decreased stress tolerance
The physical effects of this stage also weaken the
immune system and put at risk for stress-related
illnesses.