Anaphy Midterms Reviewer ➢ The sympathetic nerves never cause vasoconstriction
of blood vessels of the heart or brain.
THE CARDIOVASCULAR SYSTEM
Action Potential Of The Cardiac Muscle
➢ Phase 0: depolarization
o Sodium rapidly into the cell (calcium slowly
into the cell)
➢ Phase 1
o Sodium channels close
➢ Phase 2: Plateau Phase
o Potassium rapidly out of the cell
o Calcium slowly into the cell
o Calcium from extracellular space and
sarcoplasmic reticulum = plateau
➢ Phase 3: Rapid Repolarization
o Calcium channels close
o Potassium rapidly out of the cell
o Potassium and sodium ion positions reverse
➢ Phase 4: Resting Potential
o Leaky potassium channels
o Sarcolemma impermeable to sodium
o ***long absolute refractory period in cardiac
muscle cells: phase 0 to phase 3
o The second action potential cannot be
initiated
o Protective mechanism against tetanus (state
of maximal contraction)
See more: https://youtu.be/v7Q9BrNfIpQ
Sympathetic Receptors in the Blood Vessels
Neural factors: Autonomic Nervous System
➢ The sympathetic center in the medulla of the brain is
activated to cause vasoconstriction during these times:
o When we stand up suddenly after lying down,
gravity causes blood to pool very briefly in the
vessels of the legs and feet, and blood
pressure drops. This activates
pressoreceptors, also called baroreceptors in
the large arteries of the neck and chest. They
send off warning signals that result in reflexive
vasoconstriction, quickly increasing blood
pressure back to the homeostatic level.
o When blood volume suddenly decreases, as
in hemorrhage, blood pressure drops, and the
heart begins to beat more rapidly as it tries to
compensate. However, because blood loss
reduces venous return, the heart also beats
weakly and inefficiently. In such cases, the
sympathetic nervous system causes
vasoconstriction to increase the blood
pressure so that (it is hoped) venous return
increases and circulation can continue. This
phenomenon also happens during severe
dehydration.
o When we exercise vigorously or are
frightened and have to make a hasty escape,
generalized vasoconstriction occurs except in
the skeletal muscles. The vessels of the
skeletal muscles dilate to increase the blood
flow to the working muscles.
CO2 Transport in the Blood
➢ Carbon dioxide is 20x more soluble in plasma
compared to oxygen.
o Most carbon dioxide is transported in plasma
as bicarbonate ion (HCO3−), which plays a
very important role in buffering blood pH.
o Carbon dioxide is enzymatically converted to
bicarbonate within red blood cells; then the
newly formed bicarbonate ions diffuse into the
plasma.
➢ A smaller amount of the transported CO2 (20-30%) is
carried inside the RBCs bound to hemoglobin.
o Carbon dioxide binds to hemoglobin at a
different site from oxygen, so it does not
interfere with oxygen transport.
➢ Before CO2 can diffuse out of the blood into the alveoli,
it must first be released from its HCO3- form.
o HCO3- must enter the RBCs, where they
combine with H+ to form carbonic acid
(H2CO3).
o Carbonic acid quickly splits to form water and
carbon dioxide, and carbon dioxide then
diffuses from the blood into the alveoli
Arteries vs Veins Function
STRUCTURAL DIFFERENCES
Arteries Veins
Thick walls Thin walls
Heavier tunica media Thinner tunica media
Carry blood away from the Carry blood back toward the
heart heart
Able to expand as blood is Blood pressure too low to
forced into them force it back to the heart
Recoil passively as the blood Larger veins have valves
flows off into the circulation that prevent backflow of
during diastole blood like those in the heart
Must have stretchy, strong
walls
Smaller lumens Larger lumens
Thinner tunica externa Thicker tunica externa
Conductive System of the Heart
o Atrial cells beat about 60 times per minute,
o Ventricular cells contract more slowly (20–40 times per
minute).
o Without some type of unifying control system, the heart
would be an uncoordinated and inefficient pump.
Intrinsic Conduction System or Nodal System
➢ The heart beats as a coordinated unit
➢ SA Node
o Crescent-shaped node located in the right
atrium
o Enforces a contraction rate of approximately
75 bpm
o Has the highest rate of depolarization in the
whole system
o Starts each heartbeat
o The pacemaker
➢ AV node at the junction of the atria and ventricles
o Where the impulse is delayed briefly to give
the atria time to finish contracting
➢ Atrioventricular (AV) bundle (bundle of His)
➢ Right and left bundle branches located in the
interventricular septum
➢ Purkinje fibers - spread within the myocardium of the
ventricle walls.
THE RESPIRATORY SYSTEM
Lung Volumes & Capacity
➢ Vital capacity (VC)
• The total amount of exchangeable air (around
4,800 ml in healthy young men and 3,100 ml
in healthy young women).
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 • TV + IRV + ERV ▪ Simple Columnar Epithelium - produces a
➢ Respiratory capacities are measured with a protective layer of bicarbonate-rich alkaline mucus
spirometer. that protects the stomach wall from being
➢ In pneumonia, inspiration is obstructed, and the IRV damaged by acid and digested by enzymes
and VC decrease. ▪ Parietal Cells - produces intrinsic factor, needed
➢ In emphysema, where expiration is hampered, the for absorption of vitamin B12 from the small
ERV is much lower than normal, and the residual intestine
volume is higher. o Produce corrosive HCl which makes the
stomach contents acidic and activates
THE GASTROINTESTINAL TRACT the enzymes (pepsinogen to pepsin)
▪ Chief Cells – produces pepsinogen
Parts of the Stomach
▪ Enteroendocrine cells - produce gastrin important
1. Mouth – The entrance of food into the digestive tract in regulating the digestive activities of the stomach
▪ Lips or labia - protect the anterior opening 4. Small Intestine – can only process a small amount of
▪ Cheeks - lateral walls food at a time
▪ Hard palate - anterior roof o Pyloric Sphincter - controls the movement of
▪ Soft palate - posterior roof chyme into the small intestine from the
▪ Uvula - a fleshy fingerlike projection of the soft stomach
palate, which dangles from the posterior edge of o C-shaped duodenum - some enzymes are
the soft palate produced
▪ Vestibule - The space between the lips and cheeks o Pancreas - produces enzymes that are
externally and the teeth and gums internally delivered to the duodenum through the
▪ Oral cavity proper - the area contained by the teeth pancreatic ducts
▪ Tongue – occupies the floor of the mouth ➢ Liver - forms bile which enters the duodenum through
▪ Lingual frenulum - secures the tongue to the floor the bile duct
of the mouth and limits its posterior movements o The main pancreatic and bile ducts join at the
duodenum to form the flasklike
2. Walls of the Alimentary Canal Organs hepatopancreatic ampulla.
*from inner to outer: Mucosa – Submucosa - o All structural modifications, which increase
Muscularis Propria – Serosa the surface area, decrease toward the end of
*It contains the submucosal nerve plexus & myenteric the small intestine.
nerve plexus that help regulate the mobility and o Local collections of lymphatic tissue (called
secretory activity of the GI tract. Peyer’s patches) found in the submucosa
▪ Mucosa - Innermost layer increase in number toward the end of the
o Moist mucous membrane that lines the small intestine.
hollow cavity or lumen of the organ o The remaining (undigested) food residue in
o Composed of the following: the intestine contains huge numbers of
▪ Lamina Propria bacteria, which must be prevented from
▪ Muscularis Mucosae entering the bloodstream if at all possible.
▪ Surface Epithelium – simplest
columnar HORMONES & HORMONELIKE PRODUCTS THAT ACT
IN DIGESTION
• Esophagus – stratified
Hormone Source Secretion Action
squamous epithelium Stimulus
▪ Submucosa – beneath the mucosa Gastrin Stomach Food in the Stimulates
o Soft connective tissue containing blood stomach esp the release of
vessels, nerve endings, MALT, and digested gastric juice
lymphatic vessels proteins; Ach & stomach
o MALT stands for Mucosa Associated released by emptying
Lymphoid Tissue & Lymphatic Vessels. It nerve fibers
combats bacteria from the unsterile food Intestinal Duodenum Food in Stimulates
that we eat. Gastrin stomach gastric
▪ Muscularis Propria - A muscle layer made up of an secretion and
inner circular layer and an outer longitudinal layer emptying
of smooth muscle cells Histamine Stomach Food in Activates
▪ Serosa - The outermost layer of the wall stomach parietal cells
to secrete
o As half of a serous membrane pair, the
hydrochloric
visceral peritoneum consists of a single
acid
layer of flat, serous fluid–producing cells. Somatostatin Stomach & Food in the Inhibits
o The visceral peritoneum is continuous Duodenum stomach is secretion of
with the slippery parietal peritoneum, stimulated by gastric juice
which lines the abdominopelvic cavity by sympathetic and
way of a membrane extension, the nerve fibers pancreatic
mesentery. juice &
3. Stomach emptying of
▪ Cardia - named for its position near the heart stomach and
o Surrounds the cardio esophageal gallbladder
sphincter, through which food enters the Secretin Duodenum Acidic chyme Increases
stomach from the esophagus. and partially output of
▪ Fundus - The expanded part of the stomach lateral digested pancreatic
foods in the juice rich in
to the cardiac region.
duodenum bicarbonate
▪ Body – the midportion of the stomach
ions & bile
o The convex lateral surface is the greater output by the
curvature liver.
o The concave medial surface is the lesser It also inhibits
curvature gastric
o As it narrows inferiorly, the body mobility and
becomes the pyloric antrum gastric gland
▪ Pylorus – the funnel-shaped terminal part of the secretion.
stomach Cholecys- Duodenum Fatty chyme Increase
o Continuous with the small intestine tokinin (CCK) and partially pancreatic
through the pyloric sphincter, or pyloric digested juice.
valve proteins in Stimulates

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 the gallbladder to
duodenum expel stored
bile. Relaxes
sphincter.
Gastric Duodenum Food in Inhibits
Inhibitory duodenum secretion of
Peptide (GIP) gastric juice.
Stimulates
insulin
release.
Small Intestine: Structures That Increase The Absorptive
Surface
▪ Villi - fingerlike projections of the mucosa that give it a
velvety appearance and feel.
o Within each villus is a rich capillary bed and a
modified lymphatic capillary called a lacteal.
The mucosal cells absorb the nutrients into
the capillaries and the lacteal.
▪ Microvilli - Tiny projections of the mucosa cells’
plasma membrane give the cell surface a fuzzy
appearance, sometimes referred to as the brush
border.
o The plasma membranes bear enzymes that
complete the digestion of proteins and
carbohydrates in the small intestine.
▪ Circular Folds - Also called plicae circulares. Deep
folds of both mucosa and submucosa layers.
o Unlike the rugae of the stomach, the circular
folds do not disappear when food fills the
small intestine. Instead, they form an internal
“corkscrew slide” to increase surface area
and force chyme to travel slowly through the
small intestine so nutrients can be absorbed
efficiently.
5. Large Intestine – larger in diameter than the small
intestine (1.5 meters or 5 ft long)
o Its major functions include drying out the
indigestible food residue by absorbing water
and eliminating these residues from the body
as feces.
o It extends from the ileocecal valve to the anus
and frames the small intestine on 3 sides
o Subdivisions include the cecum, appendix,
colon, rectum, and anal canal.
6. Teeth
▪ Deciduous Teeth – AKA baby teeth or milk teeth. A
baby’s first set of teeth.
o Begins to appear around 6 months In which
the lower central incisors come first.
o A baby has a full set (20 teeth) by 2 years old.
▪ Permanent Teeth – the second set of teeth
o From 6-12 years old, the deeper, permanent
teeth, enlarge and develop, the roots of the
milk teeth are reabsorbed, and they loosen
and fall out.
o By the end of adolescence, all of the
permanent teeth but the third molars have
erupted.
o From 17-25 years old, the third molars
(wisdom teeth) emerge. Although there are 32
permanent teeth in a full set, the wisdom teeth
often fail to erupt; sometimes they are
completely absent.
▪ Teeth Classification
o Chisel-shaped incisors - for cutting
o Fanglike canines (eyeteeth) - for tearing or
piercing
Premolars (bicuspids) and molars have broad crowns with
rounded cusps (tips) - for crushing and grinding
Reflexes in the GI Tract
1. Ingestion – an active voluntary process. As the food is
mixed with saliva, salivary amylase begins the
digestion of starch, chemically breaking it down into
maltose.
2. Propulsion – composed of two types.
i. Swallowing (AKA Deglutition) – a complex
process that involves the coordinated activity
of several structures (tongue, soft palate,
pharynx, and esophagus).
o During the Buccal (voluntary) phase, the food
is chewed and mixed with saliva, and the
bolus (food mass) is pushed into the pharynx
by the tongue.
o During the Pharyngeal-esophageal
(involuntary) phase
▪ Food is moved via the pharynx &
esophagus
▪ Primarily controlled by the vagus
nerve that promotes the digestive
organs’ mobility
▪ All routes that the food might but
can’t take are blocked.
▪ The tongue blocks off the mouth,
and the soft palate closes off the
nasal passages.
▪ The larynx’s opening rises into the
respiratory passageways & is
covered by the epiglottis.
▪ Food is moved through the pharynx
and into the esophagus by wavelike
peristaltic contractions of their
muscular walls—first the longitudinal
muscles contract, then the circular
muscles contract.
ii. Peristalsis
▪ The tongue blocks off the mouth, and the soft palate
closes off the nasal passages.
▪ The larynx rises so that its opening (into the respiratory
passageways) is covered by the flaplike epiglottis.
▪ Food is moved through the pharynx and then into the
esophagus inferiorly by wavelike peristaltic
contractions of their muscular walls—first the
longitudinal muscles contract, and then the circular
muscles contract.
3. Mechanical Breakdown - chewing and mixing of food in
the mouth by the teeth and tongue
o Physically fragments food into smaller
particles, increasing surface area and
preparing food for further degradation by
enzymes.
o Segmentation in the small intestine moves
food back and forth across the internal wall of
the organ, mixing it with the digestive juices.
4. Digestion - large food molecules are chemically broken
down to their building blocks by enzymes.
o Small Intestine: The microvilli bear several
important brush border enzymes, that break
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 down double sugars into simple sugars and
complete protein digestion.
o Small Intestine: Intestinal juice itself is
relatively enzyme-poor, and protective mucus
is probably the most important intestinal gland
secretion.
o Small Intestine: Foods entering the small
intestine are deluged with enzyme-rich
pancreatic juice delivered via a duct from the
pancreas and bile from the liver.
5. Absorption – the transport of digestive end products
from the lumen of the GI tract to the blood or lymph.
o The small intestine is the major absorptive
site.
o Bacteria residing in the large intestine also
make vitamin K and some B vitamins.
o What is finally delivered to the large intestine
contains few nutrients, but that residue still
has 12 to 24 hours more to spend there.
o The colon itself produces no digestive
enzymes.
o About 500 mL of gas (flatus) is produced each
day, much more when certain carbohydrate-
rich foods are eaten.
6. Defecation – the elimination of indigestible residues
from the GI tract via the anus in the form of feces.
o As the feces are forced through the anal
canal, messages reach the brain giving us
time to decide whether the external voluntary
sphincter should remain open or be
constricted to stop the passage of feces.
o The rectum is generally empty, but when
feces are forced into it by mass movements
and its wall is stretched, the defecation reflex
is initiated.
o Defecation reflex is a spinal (sacral region)
reflex that causes the walls of the sigmoid
colon and the rectum to contract and the anal
sphincters to relax.
THE ENDOCRINE SYSTEM
Endocrine Messenger Systems/G Protein Mssngr System
1. Guanosine Triphosphate (GTP) - binding proteins that
couple hormone receptors to adjacent effector
molecules. Have an intrinsic GTPase activity,
o Used in the adenylate cyclase, Ca2+–
calmodulin, and inositol 1,4,5-triphosphate
(IP3) second messenger systems.
o Has three subunits: alpha (a), beta (β), and
gamma (γ).
o The alpha-subunit can bind either guanosine
diphosphate (GDP) or GTP.
o G proteins can be either stimulatory (Gs) or
inhibitory (Gi). Stimulatory or inhibitory activity
resides in the αlpha subunits, which are
accordingly called s and i.
2. Adenylate Cyclase Mechanism
o Step 1: Hormone binds to a receptor in the cell
membrane
o Step 2: GDP is released from the G protein
and replaced by GTP, which activates the G
protein. The G protein then activates or
inhibits adenylate cyclase. If the G protein is
stimulatory (Gs), then adenylate cyclase will
be activated. If the G protein is inhibitory (Gi),
then adenylate cyclase will be inhibited.
Intrinsic GTPase activity in the G protein
converts GTP back to GDP.
o Step 3: Activated adenylate cyclase then
catalyzes the conversion of adenosine
triphosphate (ATP) to CAMP.
o Step 4: CAMP activates protein kinase A
which phosphorylates specific proteins,
producing highly specific physiologic actions.
o CAMP is degraded to 5’-AMP by
phosphodiesterase, which is inhibited by
caffeine. Therefore, phosphodiesterase
inhibitors would be expected to augment the
physiologic actions of cAMP.
3. IP3 Mechanism
o Hormone binds to a receptor in the cell
membrane (step 1) and, via a G protein (step
2), activates phospholipase C (step 3).
o Phospholipase C liberates diacylglycerol and
IP3 from membrane lipids (step 4).
o IP3 mobilizes Ca2+ from the endoplasmic
reticulum (step 5). Together, Ca2+ and
diacylglycerol activate protein kinase C (step
6), which phosphorylates proteins and causes
specific physiologic actions (step 7).
4. CA2+-Calmodulin mechanism
o Hormone binds to a receptor in the cell
membrane (step 1) and, via a G protein, has
2 actions: opens cell membrane Ca2+
channels and releases Ca2+ from the
endoplasmic reticulum (step 2). These two
actions produce an increase in intracellular
[Ca2+] (step 3).
o Ca2+ binds to calmodulin (step 4), and the
Ca2+–calmodulin complex produces
physiologic actions (step 5).
5. Steroid Hormone and Thyroid Hormone Mechanism
o Steroid (or thyroid) hormone diffuses across
the cell membrane and binds to its receptor
(step 1).
o The hormone-receptor complex enters the
nucleus and dimerizes (step 2).
o The hormone-receptor dimers are
transcription factors that bind to steroid-
responsive elements (SREs) of DNA (step 3)
and initiate DNA transcription (step 4).
o New messenger RNA is produced, leaves the
nucleus, and is translated to synthesize new
proteins (step 5).
o The new proteins that are synthesized have
specific physiologic actions.
Glucose Metabolism
➢ After a carbohydrate-rich meal, thousands of glucose
molecules are removed from the blood and combined
to form the large polysaccharide molecules called
glycogen which is then stored in the liver. This process
is glycogenesis.
➢ Later, as body cells continue to remove glucose from
the blood to meet their needs, the blood glucose level
begins to drop. At this time, liver cells break down the
stored glycogen by a process called glycogenolysis.
➢ The liver cells then release glucose bit by bit into the
blood to maintain blood glucose homeostasis.
➢ If necessary, the liver can also make glucose from
noncarbohydrate substances, such as fats and
proteins. This process is gluconeogenesis.
➢ Some of the fats and fatty acids picked up by the liver
cells are oxidized for energy (to make ATP) for use by
the liver cells themselves.
➢ The rest are broken down into simpler substances such
as acetic acid and acetoacetic acid and then are
released into the blood or stored as fat reserves in the
liver.
Actions & Effects of Hormones
➢ Growth
o Attainment of adult stature requires thyroid
hormone.
o Thyroid hormones act synergistically with
growth hormone and somatomedins to
promote bone formation.
o 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.
➢ Central Nervous System (CNS)
o 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
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 helpful, screening for neonatal
hypothyroidism is mandatory.
o Adulthood
▪ Hyperthyroidism causes
hyperexcitability and irritability.
▪ Hypothyroidism causes listlessness,
slowed speech, somnolence,
impaired memory, and decreased
mental capacity.
➢ Autonomic nervous system
o Thyroid hormone has many of the same
actions as the sympathetic nervous system
because it up-regulates beta1-adrenergic
receptors in the heart. Therefore, a useful
adjunct therapy for hyperthyroidism is
treatment with a β-adrenergic blocking agent,
such as propranolol.
➢ Basal metabolic rate (BMR)
o 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.
o Thyroid hormone increases the synthesis of
Na+,K+-ATPase and consequently increases
O2 consumption related to Na+–K+ pump
activity.
➢ Cardiovascular and respiratory systems
o Effects of thyroid hormone on cardiac output
and ventilation rate combine to ensure that
more O2 is delivered to the tissues.
o Heart rate and stroke volume are increased.
These effects combine to produce increased
cardiac output.
o Ventilation rate is increased.
➢ Metabolic effects
o Overall, metabolism is increased to meet the
demand for substrate associated with the
increased rate of O2 consumption.
o Glycogenolysis, gluconeogenesis, and
glucose oxidation (driven by demand for ATP)
are increased.
o Lipolysis is increased.
o Protein synthesis and degradation are
increased. The overall effect of thyroid
hormone is catabolic.
o High levels of I– inhibit organification and,
therefore, inhibit the synthesis of thyroid
hormone (Wolff–Chaikoff effect).
➢ Coupling of MIT and DIT
o While MIT and DIT are attached to
thyroglobulin, two coupling reactions occur
(step 5):
▪ When two molecules of DIT
combine, thyroxine (T4) is formed.
▪ When one molecule of DIT
combines with one molecule of MIT,
triiodothyronine (T3) is formed.
• More T4 than T3 is
synthesized, although T3 is
more active.
▪ Iodinated thyroglobulin is stored in
the follicular lumen until the thyroid
gland is stimulated to secrete thyroid
hormones.
➢ Stimulation of thyroid cells by TSH
o When the thyroid cells are stimulated,
iodinated thyroglobulin is back to the follicular
cells by endocytosis (step 6). Lysosomal
enzymes then digest thyroglobulin, releasing
T4 and T3 into circulation (step 7).
o Leftover MIT and DIT are deiodinated by
thyroid deiodinase (step 8). The I2 that is
released is reutilized to synthesize more
thyroid hormones. Therefore, deficiency of
thyroid deiodinase mimics I2 deficiency.
➢ Binding of T3 and T4
o In the circulation, most of the T3 and T4 is
bound to thyroxine-binding globulin (TBG).
o In hepatic failure, TBG levels decrease,
leading to a decrease in total thyroid hormone
levels, but normal levels of free hormone.
o In pregnancy, TBG levels increase, leading to
an increase in total thyroid hormone levels,
but normal levels of free hormone (i.e.,
clinically, euthyroid).
➢ Conversion of T4 to T3 and reverse T3 (rT3)
o In the peripheral tissues, T4 is converted to
T3 by 5’-iodinase (or to rT3).
o T3 is more biologically active than T4.
o rT3 is inactive.

Thyroid Hormones Synthesis

DISCLAIMER: Lahat ay sa book/ppt ang reference ko
Synthesis of Thyroid Hormones (Stimulated By TSH) mapwera sa first topic na cardiac action. At pwedeng may
mga hindi ako naisama or mali na naisama.
➢ Thyroglobulin is synthesized from tyrosine in the
thyroid follicular cells, packaged in secretory vesicles,
and extruded into the follicular lumen.
➢ The iodide (I–) pump, or Na+–I– cotransport
o is present in the thyroid follicular epithelial
cells.
o actively transports I– into the thyroid follicular
cells for subsequent incorporation to thyroid
hormones (step 2).
o is inhibited by thiocyanate and perchlorate
anions.
➢ . Oxidation of I– to I2
o is catalyzed by a peroxidase enzyme in the
follicular cell membrane (step 3).
o I2 is the reactive form, which will be
“organified” by combination with tyrosine on
thyroglobulin.
o The peroxidase enzyme is inhibited by
propylthiouracil, which is used therapeutically
to reduce thyroid hormone synthesis for the
treatment of hyperthyroidism.
o The same peroxidase enzyme catalyzes the
remaining organification and coupling
reactions involved in the synthesis of thyroid
hormones.
➢ Organification of I2
o At the junction of the follicular cells and the
follicular lumen, tyrosine residues of
thyroglobulin react with I2 to form
monoiodotyrosine (MIT) and diiodotyrosine
(DIT) (step 4).

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