Key Terms & Concepts

Anatomy and Physiology HTHSCI 1H06B, W2023

You should be able to describe and/or demonstrate an understanding of the following:

*this is not an exhaustive list…

01 - Cardiovascular Anatomy

 Heart: Location (Mediastinum), Base vs Apex, Major Landmarks (SVC, IVC, Pulm. Trunk, Aorta)
 Relational Anatomy: Structures Above, Below, Anterior & Posterior to Heart
 Surface Features: Anterior & Posterior (Atria, Ventricles, Great Vessels, Sulci)
 Sulci: Coronary Sulcus (L&R), Interventricular Sulcus (anterior & posterior)
 Coronary Vasculature
o Coronary Arteries: Left (Circumflex, LAD), Right (Marginal, Posterior Interventricular)
o Coronary Veins: Left (Great Cardiac), Right (Small, Anterior, Middle), Coronary Sinus
 Pericardium: Fibrous, Parietal & Visceral (Serous/Epicardium) -> Cardiac Tamponade
 Heart Wall
o 3 layers (Epicardium, Myocardium, Endocardium)
o Differences between L&R Ventricle (Thickness, Workload)
o Inflammation: Epicarditis (Pericarditis), Myocarditis, Endocarditis
 Chambers: Path of Blood Flow (2 Closed Circuits, Location of Oxy & Deoxy Blood)
 Heart Valves (what is their function?)
o Atrioventricular: Tricuspid vs Bicuspid (Mitral); Role of Chordae Tendineae & Papillary m.
o Semilunar: Pulmonary vs Aortic
o Fibrous Skeleton (4 Functions)
o Heart Sounds: Orientation of Heart determines direction of Echo (Valve Closure); where
to place stethoscope during auscultation
o Valve disorders: Stenosis vs Prolapse; Murmur

02 - Cardiovascular Development

 Postnatal (Adult) vs Fetal Circulation (where does vascular resistance differ and why?)
o Changes in vascular resistance at birth (Pulmonary vs Systemic Circuits)
o Adult vs Fetal (where is pressure higher, Right or Left side of Heart and why?)
 Fetal Circulation
o Specializations: Placenta, Umbilical Vein, Ductus Venosus, Foramen Ovale, Ductus
Arteriosus, Umbilical Arteries
 What do these structures become in the adult?
o Where does Oxy & Deoxy Blood mix in the Fetus?
 Development of the Tubular Heart
o Major Stages: Fused Tube, Sacculation, Elongation, Folding, Septal Formation.
o Structures: Truncus Arteriosus, Bulbus Cordis, Ventricle, Atrium, Sinus Venosus
 What portion(s) of the adult heart do they become?
 Division of the Truncus Arteriosus
o Aorticopulmonary (Spiral) Septum
o Role in proper development of Semilunar Valves (probs = Stenosis, Enlargement)
o Persistent Truncus (the 3-chamber heart)
  Patent Ductus Arteriosus
 Formation of Interatrial Septum (steps from Septum Primum -> Foramen Ovale)
o Operation of Valve of Foramen Ovale (before & after parturition)
o Patent Foramen Ovale (ASD)
 Formation of Interventricular Septum
o VSD
 Formation of Atrioventricular Valves
 CHD’s – items to consider
o Shunt vs Obstruction
o Left to Right vs Right to Left
 Consequences of Patent Ductus Arteriosus (L to R Shunt)
 Consequences of Stenotic Pulmonary Valve (R to L Shunt via Foramen Ovale)
o Acyanotic vs Cyanotic
 Tetralogy of Fallot (the big one!) – the ‘t’ is silent…it’s French…

03 - Cardiac Physiology

 Components of Cardiac Conduction System (& their roles)

o SA Node, AV Node, Bundle of His, L & R Bundle Branch, Purkinje Fibers
 Cardiomyocytes (Syncytium, Intercalated Disks -> desmosomes & gap junctions)
 AP in individual cardiomyocytes
o 3 phases (Na+, Ca2+ and K+ movement)
o Significance of Refractory Period (no tetanus!)
 ECG
o P Wave, P-Q interval, QRS Complex, S-T segment, T Wave
o Link-up phases of Cardiac AP with Mechanical Events of Cardiac Cycle
 Phases of Cardiac Cycle (Ventricular Diastole & Systole, Isovolumetric Contraction/Relaxation)
 Put it all together! (Cardiac AP, Mechanical Events (Cycle), Heart Sounds, Ventricular P & Vol.,
Aortic P)
 Progression from Isovolumetric Contraction to Ejection Phase
 SV = EDV – ESV (normal values for each @ rest)
 CO = HR x SV (normal values for each @ rest)
o 3 Factors affecting SV (Preload, Contractility, Afterload)
 Preload
 Frank-Starling Law (More Stretch = More Contractility)
 Factors affecting Preload (HR, Venous Return)
 Contractility (Positive vs Negative Inotropic Agents)
 Afterload (Arterial BP)
 HR (normal value @ rest)
o Definitions of Tachycardia & Bradycardia
o Factors Affecting HR (Autonomic, Chemical & Other)
o Describe effects of sympathetic vs parasympathetic NS on heart

04 - Vasculature & Hemodynamics

 Aorta
 o 4 Divisions (Ascending, Arch, Thoracic, Abdominal)
o Abdominal Branches (Celiac Trunk, Superior Mesenteric, Inferior Mesenteric) ->
Structures supplied by these… we will these in detail in the GI lectures.
o Paired Branches to Glands (Suprarenal, Renal, Gonadal)
o Paired Lumbar Arteries
 Common Iliac arteries (internal and external)
 Veins
o IVC, Hepatic, Paired (Suprarenal, Renal, Gonadal, Lumbar), Ext. & Int. Iliac
o Hepatic Portal System (what is a portal system?)
 Vascular Organization
o Arteries, Capillaries, Veins
o Vessel Structure (Artery vs Vein)
 Intima (Endothelium, BM, Internal Elastic Lamina [not in veins])
 Media (Smooth Muscle, ECM, External Elastic Lamina [not in veins])
 Adventitia (Loose CT, Vasa Vasorum [large vessels only])
o Elastic vs Muscular Arteries (function of each?)
 Pressure reservoir vs distributing vessels
o Arterioles (significance?)
 Resistance vessels
o Capillaries (where the action is!) – exchange vessels
o The Microvascular Bed (Precapillary Sphincters, Thoroughfare, Redirection of flow)
o Capillaries
 Structure
 Types (Continuous, Fenestrated, Sinusoid) and where they are found
 Capillary Exchange – diffusion vs transcytosis
 Hydrostatic vs Colloid Osmotic Pressure – difference in forces at arteriole vs
venule end of capillary
 Distribution of blood in the circulatory system -> most in Systemic Veins and Venules = Blood
Reservoir

05 - Hemodynamics & Blood

 Hemodynamics
 Change in Pressures throughout circulatory system (BP lost quickly through capillaries)
 Blood Pressure (BP)
o Systolic, Diastolic, Pulse & Mean (Arterial) Pressure
o MAP = CO x TPR
o Factors affecting Vascular Resistance (TPR or SVR) – RADIUS, Viscosity, Length
o System designed to maintain flow (Flow = P/Resistance)
 P = Flow x Resistance (this means that alterations in flow or resistance will
alter BP)
 The ‘triangle’ in the equation above means ‘change in’
 Regulation of BP
o Neural vs Hormonal; Short-term vs Long-term
o Baroreceptor Reflexes
 Location of Baroreceptors
 Describe Negative Feedback involved with Baroreceptor Reflex
  Describe effects of Autonomic output on Heart and Blood Vessels
o Role of Adrenal Medulla
o RAA System – Describe steps from Renin release to effects of Angiotensin II on TPR (SVR)
and Blood Vol (what does aldosterone do?)
o ADH – you should know how this improves BP
o ANP – released in response to stretching of Atria. Causes Kidneys to lose Na + and water
= reduction in Blood Vol
 Definition of SHOCK!
o Recap of mechanisms employed in response to hypovolemic shock
 L vs R-Sided Heart Failure (where does blood pool?)

 Blood
o Functions (Transportation, Regulation, Protection)
o Components
 Plasma, WBC (Buffy Coat), RBC
 What type of tissue is it?
o Erythrocytes
 No nucleus
 Tons of Hemoglobin (2 x Beta + 2 x Alpha = 4 Hemes (4Fe 2+) = 4O2/Hb)
 Factors that help release O2 from Hb (inc. temp, inc. CO2, dec. pH)
 Life and Death of an RBC
 Where produced, stages in maturation, lifespan, site of destruction
(breakdown)
 Role of Erythropoietin (regulation by feedback)
 Recycling of the heme (role of liver; bilirubin, iron)

CV Shock Online Module

 Definition: inability of tissue perfusion to meet tissue demand for O 2

o Factors affecting O2 delivery: BP, SVR, CO, SV, Hb O2 saturation
o Factors that increase tissue O2 demand: Metabolic Rate, Infection (fever), Work of
Organs, Agitation or Pain
 Types of Shock: Cardiogenic, Obstructive, Hypovolemic & Distributive
o Which can make tissues appear blue; which make tissues appear pink?
o Cardiogenic: problems with the pump (MI, infection, ECG probs, valve problems)
o Obstructive: something obstructs blood flow/return to heart (tamponade, embolism,
pneumothorax)
o Hypovolemic: not enough blood! -> reduced preload (hemorrhage, dehydration
[diarrhea])
o Distributive: CO and blood volume are fine, just no SVR (sepsis, anaphylaxis, no SNS
output)

06 - Blood, Hemostasis & Lymphatics

 Blood Groups
o ABO
 Antigen vs Antibody
  Understand Compatible Donor Blood Types
 Note: blood donations are usually only RBCs, but may also be whole blood
(RBC’s + plasma which contains Ab’s…)
o Rh
 Hemolytic Disease of Newborn
 Hemostasis
 Platelets (Thrombocytes)
o Production (Megakaryoblast)
o Function (Platelet Plug, Promote Vasospasm & Clotting)
 Hemostasis
o 3 Mechanisms involved (Vasospasm, Platelet Plug, Blood Clot)
 Platelet Plug formation (Adhesion, Release Reaction, Aggregation)
 Role of ADP, Serotonin and TXA2 in this process (which activate
more platelets, and which promote vasospasm?)
o Blood Clot (a Cascade leading to -> Stable Fibrin Threads; 3 Steps involved)
 Thrombus (clot in a healthy vessel)
 Step 1 (Extrinsic & Intrinsic Pathway >>> activate (complex to form)
Prothrombinase
 Prothrombinase = Factor X + V + Ca2+
 How is each pathway (Extrinsic & Intrinsic) activated?
 Step 2 (Common Pathway) >>> Activate Thrombin
 Step 3 (produce Insoluble Fibrin Threads >>> Strengthened Threads)
 Role of Liver and Vit K in production of coagulation factors (not discussed in
detail, but good to know – consult your text…)
o Clot Retraction (fibrin & platelets) & Vessel Repair (endothelium & fibroblasts)
o Clot Lysis (Fibrinolysis)
 tPA >>> Plasmin >>> Fibrin threads dissolved
 how to prevent / break-up clots (do not need to memorize meds used!)
 Lymphatic System
o Components
o Function
 Return tissue fluids
 Carry out immune functions (adaptive)
 Transport of dietary fats (more detail provided later in the GI lectures)
o Dynamics of Capillary exchange revisited
 Hydrostatic pressure vs osmotic pressure (colloid)
 What passes the capillary wall, what stays in the lumen
o Overall structure (Capillaries, Lymph Nodes, Thoracic Ducts)
 Promoting lymphatic flow (Valves, Skeletal & Respiratory Pump)
 Areas drained by Left Thoracic vs Right Lymphatic Ducts
 Anatomy of a lymph node:
 Afferent & Efferent vessels – why more afferents?
o Common Lymph Node Locations (inguinal, axillary, cervical)
o Other Lymphoid Tissues
Note: Important aspects of this system will be presented again in the immunology lectures (e.g.
role of lymphatics).
07 - Immune I (Innate Immunity)

 Definition of Immunity
 Four Classes of Pathogens (extracellular vs intracellular)
o Bacteria, viruses, fungi, parasites
 Lymphatic System structures & Function
o Primary vs Secondary Lymphatic organs / tissues
 Contrast features of Innate vs Adaptive Immunity
 3 Levels of Immunity (Surface Barriers, Innate Internal Defenses, Adaptive Immunity)
 List cells of Innate vs Adaptive Immunity
o Which cells link both worlds?
st
 1 Line of Defense - Surface Barriers (Skin & Mucus Membranes)
o Describe how Mechanical, Chemical and Microbiological barriers function to prevent
infection.
nd
 2 Line of Defense – Innate Internal Defenses
o Describe how Antimicrobial Proteins, Natural Killer cells, Phagocytes and Inflammation
prevent / eliminate infection.
o Antimicrobial proteins
 Interferons, Complement, Iron-binding Proteins, Antimicrobial Proteins
 Complement – opsonization, MAC, inflammation
o Natural Killer cells – describe their function (perforin, granzyme, pro-inflammatory
cytokines)
o Phagocytosis – describe the 5 steps
 What 3 innate immune cells are phagocytes?
 How do phagocytes ‘see’ pathogens? (PRRs vs PAMPs)
o Inflammation
 What is the purpose / function of inflammation?
 Describe the 3 steps
 What 2 cells help initiate inflammation? (macros, mast cells)
 What major cell types are recruited from circulation? (neutros, monos)
 Describe the 5 cardinal signs of inflammation (English & Latin terms)
o Fever – what is it, what causes it (pyrogens) and how does it help?

08 - Immune II (Adaptive Immunity)

 Compare and Contrast Features of Innate vs Adaptive Immunity (know this slide!)
o Adaptive = MEMORY (the reason why vaccination works)
o Adaptive = 3rd (and final) line of defense…
 Importance of having innate & adaptive immunity
 Compare and Contrast cells of the Adaptive Response
o B cells & T cells – where they are developed and educated
o B cell & Tcell receptors – how they detect antigens / communicate with other immune
cells
o Function of CD4+ vs CD8+ T cells
 Definitions – Antigen, Epitope, etc.
 Professional APCs (Dendritic Cells, Macrophages, B-cells) >> bridge gap between Innate &
Adaptive – how are they unique?
 o Importance of Antigen Processing and Presentation by APCs
o Presentation of Antigen via MHC (aka HLA)
o Antigen processing (Intracellular [CD8 killer] vs Extracellular [CD4 helper]) pathways
 Describe the difference between Humoral vs Cellular Immunity
o Cellular Immunity
 Types of T cells (helper vs cytotoxic)
 Why T cells require antigen processing and presentation
 Need for co-stimulation to activate helper T cells
 Helper T cells provide help to B cells & Macrophages
o Humoral Immunity
 B cells differentiate into plasma cells – secret antibodies
 B cells activated with or without help from T cells
 Which mechanism forms memory?
 What type of Abs are produced?
 Antibody structure & classes
 Function of different Ab classes / isotopes
 Localization of Abs – where are they found?
 Which one crossed the placenta?
o Time frame of immune responses – infection to adaptive immunity
 Primary vs Secondary immune responses
 Which has a lag phase?
 Which relies on memory cells?
o Types of Immunity
 Natural – Active vs Passive
 Acquired – Active vs Passive
 Geography of the Adaptive Response
o Antigen at Tissue > APC to Lymph Node > Ag presentation to Naïve T-cell >> Killer T-cells
produced and/or T-cell helps B-cell > copious Ab production > Threat Neutralized

09 - Respiratory Anatomy

 Thoracic Cage
o 12 thoracic vertebrae, 12 pairs of ribs & costal cartilages + sternum
o Difference between True, False & Floating ribs
o Features of ribs (Facets, Demi-facets, Costal Angle, Costal Groove)
o Muscles of Breathing
 Quite inspiration = External Intercostals, Diaphragm
 Forced inspiration = + Sternocleidomastoid & Scalenes (elevate upper ribs)
 Quiet expiration = passive (elastic recoil of the lungs + surface tension in alveoli)
 Forced expiration = Internal Intercostals + Abdominal muscles (fix/depress lower
ribs)
o The intercostal VAN
 Intercostal nerve = thoracic spinal nerves
 Intercostal veins and arteries (where blood comes from and where it goes to)
o Diaphragm
 Supplied by phrenic nerve (C3,4,5)
 Structures that pass through the diaphragm (aorta, esophagus & IVC) + others
  Upper Respiratory Tract
o Cavities (Nasal, Oral), Tubes (Pharynx and its 3 divisions, Trachea, Esophagus), Epiglottis
 What type of epithelium are they lined by?
o Nasal Cavity (Structure & Function)
 Nasal Concha, Nasal Meatus, 4 Nasal Sinuses – with mucus membrane
 Filter & Condition (Heat & Humidity)
o Larynx - Epiglottis – all the wonderful things it can do!
 Lower Respiratory Tract
o Trachea (C-shaped cartilage)
o Carina (cough reflex, 1st division = primary bronchi)
o Primary Bronchi (longer on the left, serve L&R lungs, cartilage rings)
o Secondary Bronchi (serve lobes of lung)
 Lobes of lung (3 right, 2 left, horizontal & oblique fissures, lingula, cardiac notch)
 Supported by plates of cartilage
o Tertiary Bronchi (10 right, 8* left, serve Bronchopulmonary segments -> importance?)
o Bronchioles – branch many times until we get Terminal bronchioles
 Cartilage replaced by smooth muscle (bronchoconstriction) and elastic fibers
 Lobule (acinus) = terminal bronchiole + arteriole, venule and lymphatics
o Respiratory bronchiole (where gas exchange begins!)
 Respiratory bronchiole -> alveolar ducts -> alveolar sacs -> alveolus
o Two circulations (Bronchial vs Pulmonary)
o The gas exchange membrane up-close
 Alveolar cell types (Type I & II Pneumocytes, Alveolar Macrophage)

10 - Ventilation Mechanics

 Ventilation (definition; Boyles Law: PV=k) -> where an increase in pressure = decrease in volume
 Respiration (definitions; significance of partial pressures)
 Tissues Respiration
o Aerobic vs Anaerobic
o How is CO2 produced in both cases
o Know this!!! H+ + HCO3-  H2O + CO2 You will see it again & again…
 Spirometry (Lung Volumes)
o Tidal, IRV, ERV, Vital Capacity (Tidal + IRV + ERV), RV, TLC (RV + Vital Capacity)
o Functional Residual Capacity (end of quiet expiration; inward elastic recoil of lung =
outward recoil of thoracic cage)
 Minute (VE) vs Alveolar (VA) ventilation
o Definition & Significance of Dead Space
 Impedances that inhibit ventilation
o Elastance (stiff balloons) & Resistance (narrow straws)
o Elastance: Alveolar elastic tissue, alveolar fluid, & surfactant
o Elastance vs Compliance (consider effects of lung fibrosis & insufficient surfactant vs loss
of elastic tissue in emphysema)
o Resistance = related to pressures needed to maintain flow
o Increased Resistance = airway obstruction (Asthma, COPD)
 Ventilation
 o Significance of Intrapulmonary Pressure (P IP) & Pleural Pressure (Ppl)
o –ve PIP = inspiration; +ve PIP = expiration; PIP same as atmosphere = no air flow
o Ppl is always negative during quiet breathing
 Due to opposing forces acting on the pleural cavity – e.g. elastic recoil of lung
(collapse) and rib cage (expand)
 Becomes more negative during Inspiration (i.e. fluctuates during breathing
cycle)
 Understand the changes in pressures during the breathing cycle – intra
pulmonary and intra pleural

*** NOTE: Midterm up to here; first 10 lectures + 1 online shock module ***
Details will be posted on avenue

11 - Gas Exchange & Control of Breathing

 760 mmHg = atmospheric pressure @ sea level

 Dalton’s Law of Partial Pressures
 Diffusion of gasses based on difference in partial pressures
o Nomenclature: I = inspired, A = alveolar, a = arterial, v = venous
o Changes in partial pressure of O2 and CO2 as gasses move throughout the body
 Alveolar Gas Exchange
o Effect of blood flow on gas exchange
o Effect of increased diffusion barrier (water) on gas exchange
o Significance that CO2 is more soluble than O2
o Ventilation-Perfusion matching (VA/Q)
 Conditions where there is “mismatch”
 How we compensate (pulm arteriolar Constriction vs Relaxation)
 Gas Transport
o CO2
 3 ways CO2 is carried in blood (Dissolved, HCO3-, Carbamino-Hb)
 Role of Carbonic Anhydrase (RBC’s)
o O2
 2 ways O2 is carried in blood (Dissolved, Hemoglobin)
o Hemoglobin
 Binds CO (carbon monoxide) much better than O 2
 Binds 4 O2
 Cooperative - O2 binding makes more O2 binding easier
 O2-Hb Dissociation curve
 Significance of “Flat Top” & “Steep Slope”
 Shift to right (Inc. PCO2, Inc. Temp, Dec. pH) = easy unloading of O 2!
 Control of Breathing (ventilation) --- goal is to maintain arterial blood gas levels
 Neural control
o Medulla (Dorsal & Ventral Respiratory Groups) -> Muscles of Breathing
o Pons -> Smoothness, Intensity & Frequency via influence on DRG and VRG
o Inputs to Pons (and Medulla)
 Cerebral Cortex (voluntary control)
 Hypothalamus (stress, emotion, pain)
  Peripheral Chemoreceptors (fine control)
 Baroreceptors
 Muscle & Joint Receptors
 Lung Stretch & Irritant Receptors
 Etc.
 Chemoreceptors (Central & Peripheral)
o Central
 Ventral Medulla
 Monitors PaCO2 via H+ (CO2 + H2O <=> HCO3- + H+)
o Peripheral
 Carotid bodies & Aortic arch
 Monitor PaCO2, PaO2, arterial pH

12 - GI 1 Mouth & Esophagus

 The Alimentary Canal (inside = outside) – know the parts of the tube.
 Mastication = chew; Deglutition = swallow
 Gustation (to taste)
o 5 tastes
o Taste buds found in Papillae (Vallate, Fungiform, Foliate)
o Facial (VII), Glossopharyngeal (IX) & Vagus (X) convey taste
 Appreciation of food requires Smell (Olfaction) as well!
o CN I
o Neurons through Cribiform Plate of nasal cavity
 Dentition:
o Types of teeth
o Deciduous & Permanent (full complement is 32 in adults)
o Enamel (hardest substance in body, Calcium carbonate & Calcium phosphate)
 Mastication
o Tongue
 Keeps food on your teeth!
 4 Intrinsic muscles (Hypoglossal n.)
 4 Extrinsic muscles (Hypoglossal n., Vagus n.); which one lets you stick out your
tongue?
 What’s so special about the hyoid bone?
o Muscles of mastication
 6 muscles; 4 innervated via Trigeminal n., 2 by Facial n.
o Blood supply (Temporal, Maxillary, Facial a. & v.)
 Digestion
o Begins in mouth
o Amylase from Parotid (mostly) & submandibular; Lipase from Sublingual gland
o Controlled by PNS & SNS
 Deglutition
o Voluntary, Oropharyngeal, & Esophageal phases
o Structures involved: Tongue, Uvula, Epiglottis, UES, Esophagus, LES.
 Esophagus
o Blood supply & structures surrounding Esophagus (where does it pierce the diaphragm?)
 o Histology (one of two places where Stratified Squamous Epithelium found in GI tract…)
o Inner Circular & Outer Longitudinal muscle (Peristalsis)
 GERD – maybe?
o What is it? (Importance of Diaphragm as a sphincter)

13 - GI 2 Basic Plan, Peritoneum & Stomach

 The “Basic” Plan

o Four layers of the GI wall and their function
o Mucosa, Submucosa, Muscularis, Serosa
 Enteric NS (controlling/coordinating Peristalsis)
o Myenteric & Submucosal Plexi
o Pacemaker cells (ICC’s)
o Regulation by the ANS
 Peritoneum
o Parietal vs Visceral Peritoneum
o 5 Peritoneal folds (Falciform Ligament, Greater Omentum, Lesser Omentum, Mesentery,
Mesocolon)
o List some retroperitoneal structures in the abdominal cavity
 Stomach
o To the Basic Plan add: Rugae & an Oblique muscle layer (lots o’ churning!)
o Regions: Fundus, Cardia, Body, Pyloric (Antrum, Canal, Pylorus)
o Lesser & Greater Curvatures
o Its purpose in life is to create Chyme…
o Make Acid, Digest Proteins, Produce Intrinsic Factor & absorbs few substances
o Blood Supply: from Celiac Trunk (R&L Gastro-omental (Greater Curve), R&L Gastric
(Lesser Curve)), Short Gastric a.
 Drainage similar >>> all into Hepatic Portal Vein
o Histology
 Mucosa contains Gastric Pits
 Pits contain: Mucus Cell, Parietal cell (HCL, intrinsic factor), Chief Cell (Pepsin,
lipase) & G cell (Gastrin)
 How HCL is made…remember C02 + H20  H2CO3- + H+ ?
 Phases of Digestion (from a gastric perspective)
o There are 3 - describe
o Feedback in Gastric Phase to maintain stomach pH
o Describe the influence of the other two phases on Stomach activity
 Control of Gastric Emptying
o Effects of Gastrin vs CCK, Secretin & enterogastric reflex
o Duodenum controls this (Carbs fast, Fats slow)
 Emesis (vomiting) - maybe
o Vomit (why and how does this occur?)

14 - GI 3 Intestines

 Small Intestine
 o To the Basic Plan add: Villi (microvilli = brush border), Plicae circularis
o 3 parts: Duodenum, Jejunum & Ileum
o General features of each
o Blood Supply: Superior Mesenteric a. & v.
o Villi
 Massive inc. Surface Area
 Cells include: Absorptive, Goblet, Enteroendocrine & Paneth
o Brunner’s Gland (only in Duodenum): what does it secrete?
o Large aggregation of MALT (Payer’s Patches) in Ileum
o How to protect Small Intestine from acidic Chyme
o Secretin = release of Bicarb-rich fluid from Pancreas
o CCK = release Pancreatic enzymes
o Two patterns of Motility (segmentation, MMC)
o Digestive Enzymes
 Carbohydrates (Amylase is the big one, do not worry about Lactase, Maltase,
Sucrase)
 Proteins (Pepsin, Trypsin, Chymotrypsin, Carboxypeptidase); what’s special
about Trypsin???
 Fats (Lipases)
 Nucleic Acids (Nucleases)
o Fat Digestion
 Fat + Bile salt = Micelle
 Micelle repackaged into Chylomicron via Absorptive cell
 Onwards to the Lacteal
o Fluid & Electrolyte balance (most Water absorbed in Small Intestine)
o Vitamin Absorption
 Large Intestine
o To the Basic Plan add: Smooth Mucosa & Tenia coli
o Begins @ the Ileocaecal Valve
o Anatomy: Cecum, Appendix, Ascending, R Hepatic Flex, Transverse, L Splenic Flex,
Descending, Sigmoid
o Histology: very Smooth Mucosa (Absorptive cell & Goblet cell)
o Colonic Movements: Peristalsis & Haustral Contractions
o Diarrhea & constipation (acidosis & alkalosis)
o Bristol stool chart (for fun)
 The End (Rectum & Anus)
o Voluntary & Involuntary Sphincter
o The Defecation Reflex (describe this)

15 - GI 4 Liver, Gallbladder & Pancreas

 Liver
o Anatomy
 4 Lobes, Falciform Lig. & Round Lig., Porta Hepatis
 Ducts (L&R Hepatic, Common Hepatic, Cystic, Common Bile, Pancreatic, Ampula
of Vater)
  Arteries & Veins (Hepatic a. (Celiac Trunk), Hepatic Portal v., Hepatic v.)
o Histology
 Cell types (Hepatocytes, Kupffer Cells, Sinusoidal Endothelial Cells)
 Hepatic Lobule
 Portal Triad (Portal a., Portal v., Bile Duct)
 Central Vein, Bile Canaliculi
o Roles
 Process Sugars (Gluconeogenesis vs Glycogenolysis)
 Process Amino Acids (Ammonia -> UREA)
 Process Fats (Bile Salts (Emulsification) & Lipoproteins (role of VLDL, LDL, HDL))
 Process Vitamins (Fat soluble (A, D, E & K; importance of each?))
 Synthesize Proteins (Albumin, Angiotensinogen, Clotting factors, etc.)
 Detoxification
 Store & Transport Iron (Ferritin vs Transferrin) >>> RBC breakdown (Bilirubin)
 Digestion (Bile; Bile Salts, Cholesterol, Bilirubin, Electrolytes) >> stimulate bile
secretion with Secretin
 Gallbladder
o Store bile until needed (can lead to stones (cholesterol))
o Release bile (CCK, Parasympathetic stimulation)
 Pancreas
o Anatomy (Head, Body, Tail; Pancreatic Duct, Ampulla of Vater (hepatopancreatic duct),
Accessory Duct), Arteries & Veins
o Exocrine f’n (Bicarb & Enzymes; Release with Secretin & CCK respectively)
o Endocrine f’n (Insulin (Beta Cell) vs Glucagon (Alpha Cell) > effects on blood glucose?

16 - Renal Physiology I (Glomerular Function)

 Renal Anatomy
o Renal Capsule
o Cortex & Medulla
o Pyramids, Papillary tips
o Minor Calyx, Major Calyx, Renal Pelvis
 Nephron (Filter, Reabsorb, Secrete)
 Anatomy (Afferent & Efferent a., Renal Corpuscle (Glomerulus + Capsule), Tubules, Collecting
Duct, Peritubular Capillaries
o Corpuscle = Filtrate
o Tubules = Reabsorption & Secretion
 Glomerulus, Proximal CT, Loop of Henle, Distal CT, Collecting Duct (which ones are permeable vs
impermeable to H20?)
 Juxtaglomerular Apparatus (alters blood flow through Afferent a.; Renin, Erythropoietin)
 Filtrate: no large proteins or formed elements (cells)
o What we need we reabsorb…
 Renal Corpuscle
o Afferent & Efferent a., Visceral & Parietal layers of Capsule, Capsular Space, Fenestrated
Glomerular Capillaries, Basal Lamina (charge filter), Podocyte (Pedicels)
o Net Filtration Pressure (10 mmHg) > 3 factors influencing this?
 o Regulation of GFR
 Autoregulation via Myogenic mechanism (afferent arteriole smooth muscle) vs
Tubuloglomerular Feedback mechanism (Macula Densa of Juxtaglomerular
Apparatus and Adenosine)
 Low BP and increased SNS cause renin release – describe the mechanism (RAA
pathway)
 Regulation by other mechanisms (ANP, Angiotensin II & SNS)

17 - Renal Physiology II (Tubular Function)

 Nephron (Filter, Reabsorb, Secrete)

 Anatomy (Afferent & Efferent a., Renal Corpuscle (Glomerulus + Capsule), Tubules, Collecting
Duct, Peritubular Capillaries
o Corpuscle = Filtrate
o Tubules = Reabsorption & Secretion
 Glomerulus, Proximal CT, Loop of Henle, Distal CT, Collecting Duct (which is permeable to H 20?)

 Reabsorption: Active Trans, Osmosis (Obligatory vs Facultative (ADH)) > where do the diff types
of Osmosis occur?
 Paracellular vs Transcellular routes
 Passive Transport: Paracellular, Facilitated (e.g., Glucose), and Leakage Channels (e.g., K + & Cl-)
 Active Transport: Primary (e.g., Na+/K+-ATPase) vs Secondary (e.g., Glucose & Amino Acids with
Na+)
o Symporter (e.g., Na+/Glucose, Na+/amino acid, N+-K+-2Cl-) vs Antiporter (Na+/H+)

 Micturition
o Structures (Detrusor m., Int. & Ext. Urethral Sphincter, Urethra)
o Explain the reflex!
 Parasympathetic, sacral spinal cord, involuntary & voluntary sphincter.

18 - Renal III (Urine & Renal Function)

 Short Loop Nephron (how we make dilute urine)

o PCT reabsorbs solutes (filtrate osmolarity = kidney interstitial fluid osmolarity)
o Descending limb mainly permeable to water but not ions
o Bottom of loop, filtrate is concentrated
o Ascending limb impermeable to H2O (solutes reabsorbed (NK2Cl), filtrate is dilute)
o Collecting Duct (CD) impermeable to H 2O in the absence of ADH
 Long Loop Nephron (how we make concentrated urine)
o All steps the same as above, except in CD where ADH allows water to leave filtrate
therefore making it concentrated (all due to high osmolarity of surrounding tissue which
is set up by thick ascending limb of LOH)
 Fine-tuning Urine Production
o ADH (aquaporin 2 = increased H2O permeability of Collecting Duct)
o Angiotensin II (Constrict Arterioles > Inc. BP throughout body)
o Aldosterone (Inc. Na+ & Cl- reabsorption in Collecting Duct)
 Kidney Function
 o Blood Tests (BUN, Creatinine)
o Renal Plasma Clearance
 Volume of Plasma Cleared per Unit Time
 Clearance depends upon: GFR, Reabsorption, Secretion
 S (ml/min) = (UxV)/P
 S = zero for glucose & amino acids
 S = GFR (120-140ml/min; e.g. Creatinine, Inulin; NOT Secreted or
Reabsorbed)
 S < 120-140 (urea – filtered, partly reabsorbed)
 S > 120-140 (Penicillin; filtered and secreted)

19 - Acid-Base Balance

 Understanding the pH scale (negative log of [H +])

 pH of various body fluids…which is most variable?
 Acidosis vs Alkalosis (physiological that is…)
 Buffers (definition?)
o Proteins & Amino acids
o Bicarbonate (don’t forget Carbonic Anhydrase)
o Phosphate (don’t worry about this one)
 Acidosis
o Respiratory (poor ventilation; too much CO2 retained)
o Non-respiratory (metabolic)
 Anaerobic metabolism
 Kidney dysfunction
 Ketoacidosis (lipid metabolism)
 Too much ethanol
 Everyday metabolism (makin’ acids)
 Diarrhea
 Alkalosis
o Respiratory (hyperventilation) – too little CO2
o Non-respiratory (metabolic)
 Vomiting
 Too much Bicarb
 Constipation
 Compensation
o Respiratory (to breathe or not to breathe, that is the question!)
o Renal (Bicarb vs H+ (Na+/H+ antiporter))
 Determining acid/base status and/or compensation – some examples provided in lecture

20 - Urogenital Anatomy

 UG Anatomy - Development
o Homologues: Ovary – Testes; Round Ligament – Gubernaculum; Labia Majora –
Scrotum; Glans Clitoris – Glans Penis; Crus of Clitoris – Corpora Cavernosa.
o More on development later in the Intersex Online Module…
  Kidney stones
o Get hung up @ Renal Pelvis, Brim of Iliopsoas m., Junction Ureter/Bladder
o May cause dilation of renal pelvis (hydronephrosis) or ureters (hydroureter)
o Outer Circular & Inner Longitudinal smooth muscle (opposite of GI layout)
 Pelvis
o 3 bones of Os Coxae vs 5 bones of Pelvic spine
o Differences between Male (android) & Female (gynecoid) pelvis
 Subpubic angle, A/P diameter, Transverse diameter, Shallow/Deep, Angle of
Coccyx
 False vs True pelvis
o Differences in lumbar spine – Male vs Female (note adaptation in Pregnancy)
 Female Reproductive
o Uterine Position = Anteverted & Anteflexed (angled forward with respect to vagina and
flexed forward with respect to cervix) – variations have no effect on fertility
o Rectouterine cul-de-sac (pouch of Douglas; out back), Vesicouterine pouch (out front)
o Ovaries, Fallopian Tube (AKA Uterine Tube: Fimbriae), Uterus, Cervix, Vagina, Labia
Minus & Majora
o Ligaments (Uterosacral, Round, Ovarian (suspensory), Broad)
o Muscles of Perineum (help support pelvic floor and form sphincters at openings of
Urethra, Vagina & Anus (focus on Levator Ani group & Deep transverse Perineus) – you
may ignore the others!
 Anatomy of female bladder and related structures
 Histology of the Vagina (nonkeratinized stratified squamous)
o Cervical histology (simple columnar); Pap smear @ the transition zone
 Male Reproductive
o Testicles, Epididymis, Vas Deferens (Ductus Deferens), Prostate (junction of Urethra, Vas
Deferens & Seminal Vesicles), Prostatic Urethra, Membranous Urethra (Bulbourethral
Glands), Penile Urethra
o Penis (Crus, Corpora Cavernosum, Corpus Spongiosum (Penile Urethra))
o Male bladder and relational anatomy (i.e., what structures lie around it)

21 - Reproductive Physiology I

 Oogenesis (making eggs)

o Start with 2 million > @ puberty, only
300,000
o Only ONE is released per ovarian cycle!
o Primary oocyte (prophase of meiosis I)
 o Figure to right helps explain steps involved in meiosis (note only one cell at the end of
meiosis II will become an ovum (egg), whereas all four will become sperm in males).
o Egg development = Ovarian Cycle
 Follicular Phase (variable length)
 Follicular development with FSH
 Ovulation with LH
 Lots o’ Estrogens from Granulosa cells
 Luteal Phase (fixed @ 14 days)
 Occurs after Ovulation
 Corpus Luteum produces lots o’ Progesterone in addition to Estrogen
o Ovulated Secondary Oocyte
 Corona Radiata
 Zona Pellucida
 Polar Body (from Meiosis I)
o Hypothalamic/Pituitary/Gonadal – Axis (HPG-axis)
 GnRH (hypothalamus) > LH & FSH (Ant. Pituitary) > Follicular development (FSH)
& Steroid production (LH) > Sex Steroids INHIBITS GnRH
 Ovulation due to LH surge (SWITCH to Positive Feedback induced by Estrogen)
o Menstrual (Uterine) Cycle
 Menses, Proliferative, Secretory (which Steroids present when?)
 Endometrium (Stratum Basalis & Functionalis), Myometrium
 Functionalis lost each Menstrual (Uterine)Cycle
 Rescuing the Endometrium
 hCG keeps Corpus Luteum alive (i.e., maintain Progesterone levels)
 Developing placenta eventually takes over steroid production
 Progesterone = Endometrial Gland Secretion & Quiet Myometrium
 If Fertilized Egg Implants too late, then not enough hCG to keep Corpus
Luteum alive!
 Spermatogenesis (making sperm)
o Construction (Acrosome, Head, Midpiece, Tail); Function of each?
o 400 million Sperm / day; Need >20 million to be fertile!
o Sertoli Cells = Nurture Sperm; Leydig Cells = Steroid Production (Testosterone)
 FSH for Sperm Production
 LH for Steroid Production
o Sperm is NOT Semen!
 Tiny fraction of Semen is Sperm
 Bulbourethral glands = Alkaline fluid + Mucus (why?)
 Seminal Vesicles = Alkaline fluid + Fructose + Clotting Proteins + Prostaglandins
(why?)
 Prostate Gland = Citric acid + Protein Digesting Enzymes (why?)
o Path of Sperm from Testes to Penile Urethra
To be continued…