Course outline
Textbooks: required
"Human Physiology: An Integrated Approach" by Dee Unglaub Silverthorn (7th or newer ed.)
“Physiology labs manual for medical students” Joanna Lewin-Kowalik [Ed] 1st ed.
To be purchased from the University Editorial Office website:
http://wydawnictwo.sum.edu.pl/product_info.php?cPath=45&products_id=163
recommended -
"Physiology" by Linda S. Costanzo (4th ed. or newer)
"Color Atlas of Physiology" by Stefan Silbernagl, Agamemnon Despopoulos (5th ed. or newer)
"Textbook of Medical Physiology" by Arthur C. Guyton, John E. Hall (12th ed. or newer)
"Medical Physiology" by Rodney A. Rhoades, David R. Bell (4th ed. or newer)
"Review of Medical Physiology" by William F. Ganong (22nd or earlier ed.)
PHYSIOLOGY COURSE OUTLINE
Physiology I
1. Internal environment: homeostasis, body fluids, acid-base balance
General organization of the cell, body fluids compartments, internal environment - definition, homeostasis - definition, main determinants, main features responsible for movements of water and solids in the living organism - diffusion, osmosis, osmotic pressure, tonicity, changes of cell volume in different extracellular tonicity, surface tension.
Acid and base - definition according to Brönsted theory, buffer - definition, examples, principal buffers in body fluids, Henderson-Hasselbalch equation for bicarbonate buffer; acidosis: respiratory and metabolic, uncompensated and compensated; alkalosis: respiratory and metabolic, uncompensated and compensated
2. Internal environment: blood
Blood and plasma volume - methods of measurement, functions of blood, peripheral blood cells - kinds, numbers, sources. RBC - life story of red blood cells. Hemoglobin - structure, functions, metabolism. Transportation of oxygen in the blood, hemoglobin saturation curves - effects of CO2 , H+, temperature, DPG. Transport of CO2 in the blood. Anemias - types and causes. Inorganic and organic constituents of plasma, plasma proteins: classes, functions, sources. Hemostasis: consecutive steps following vessel injury, clotting factors, intrinsic and extrinsic pathways of clotting, thrombolysis, anticoagulants. Defense function of blood: types of immunologic reactions, classes of immunoglobulins. Blood groups.
3. Excitability
General and functional organization of the nerve cell. Excitable cell membrane, transmembrane proteins, transport of ions and other small molecules across cell membrane, voltage-gated and ligand-gated channels: examples. Membrane potential, resting potential - definition, Donnan effect, equilibrium potential, Nernst equation. Excitability - definition, stimulus - definition. Na+/K+ ATPase - role in maintaining stable membrane potential. Action potential - phases: threshold, upstroke, overshoot, downstroke, undershoot, ionic background. Changes of excitability of the nerve cell membrane during action potential - refractory period: absolute and relative. “All or none” law. Conduction of action potential: serial and saltatory; factors influencing velocity of conductions, block of conduction in the nerve fiber. Orthodromic & antidromic conduction.
4. Muscles
Muscle types. General organization of mammalian skeletal muscle. Classification of fiber types in skeletal muscles Neuromuscular junction, transmission of impulse. Molecular mechanism of muscle twitch. Electro-mechanical coupling in skeletal muscle - role of calcium ions. Length-tension relationship in skeletal muscle. Tetanic contraction – types, relation to refractory period. Regulation of force of contraction. Sources of energy for muscle contraction. Smooth muscles - types of smooth muscles: multi-unit, single-unit, vascular. Steps in excitation-contraction coupling in smooth muscle: sources and role of calcium ions. Various agents influencing smooth muscles: neurotransmitters, humoral factors, hormones.
5. Heart
General organization of cardiovascular system. The role of heart valves. Morphology of the heart and cardiac muscle. Automaticity - definition. Slow and fast fibers. Structure of the conduction system of the heart. Propagation of depolarization in the heart. Membrane potential and action potential in the pacemaker tissue and a cardiac muscle fiber – ionic background. Electro-mechanical coupling in a cardiac muscle, the role and sources of Ca2+. ECG - theory of the method, typical elements of the record, correlation with the electrical activity of the heart. Blocks of conduction. Heart as a pump, stroke volume, cardiac output - values and methods of measurements - Fick's principle. Intrinsic regulation of heart pumping - the Frank-Starling mechanism. Factors controlling cardiac output. Heart sounds. Innervation of the heart - chrono-; ino-; dromotropic effects. Factors affecting heart rate. Terms related to changes in heart rate. Cardiac cycle - systole and diastole and their sub-phases, changes in intraventricular pressure and volume. Reflexes of the heart. Factors contributing to control of cardiac output.
6. Circulation
Various types of blood vessels in humans. Biophysical laws considering circulatory system: Relationship between flow, pressure & resistance; Laminar and turbulent flow; Poiseuille-Hagen formula - main factors influencing vascular resistance; Law of Laplace; Bernoulli’s principle. Constant flow of the blood in different parts of circulatory system - relationships between pressure, velocity and total cross-sectional area of the vessels. Arterial pressure - main factors influencing this parameter. Pulse pressure. Venous circulation. Mechanisms affecting venous blood return to the right atrium. Constant pulsatile flow - “Windkessel effect”. Capillary circulation - filtration and reabsorbtion in capillaries, Starling forces. Edema - definition, causes of extracellular edema. Factors involved in control of arterial pressure. Vasomotor center in the medulla and its influence on resistance vessels diameter. Baroreceptors and their role in the regulation of blood pressure. Nervous and local control of blood flow. Substances secreted by the endothelium. Hormones participating in the regulation of arterial pressure blood flow in tissues. Circulation through special regions: cerebral, coronary, placental and fetal, skin. Shock - definition, main causes.
7. Respiration
General anatomy and functions of the respiratory system. Mechanism of inspiration and expiration. Intrapleural pressure - pneumothorax. Total lung capacity, vital capacity, tidal volume, residual volume. Forced vital capacity and forced expiratory volume; obstructive and restrictive changes. Pulmonary ventilation, Alveolar ventilation. Dead space: anatomical and functional – size and functions. Ventilation/perfusion ratio, pulmonary shunt. Surface tension of alveoli and surfactant. Pressure-volume curves (lungs and thorax). Compliance and elastance. Composition of atmospheric, alveolar and expired air. Volume and tension of gases in the blood. Respiratory membrane, diffusing capacity. Exchange of gases in lungs and tissues. The carriage of gases. Hypoxia - types. Influences of increased and decreased atmospheric pressure on respiration, decompression sickness, respiration at high altitude, diving. Interactions between cardiovascular and respiratory systems. Regulation and control of respiration, peripheral and central chemoreceptors. Apnea – types.
Physiology II
1. Gastrointestinal tract
General structure of GIT. Daily secretion of GIT juices. General principles of digestion Chewing and swallowing - phases of swallowing reflex, swallowing center, dysphagia - clinical importance of this symptom. Saliva - amount and composition, salivary glands - innervation, formation of saliva. Digestion in the oral cavity. Anatomy and histology; motility of different parts of GIT. Stomach - anatomical and histological structure. Motility of the stomach. Gastric juice - amount, composition, phases of its secretion. HCl secretion, pH of gastric juice, roles of HCl in the stomach. Digestion in the stomach. Duodenum as a target of pancreatic juice and the bile. Digestion in the duodenum, pH, reflexes emptying the stomach. Exocrine role of the pancreas - pancreatic juice. Pancreas - anatomy; secretion of pancreatic juice - volume, composition, pH, phases of secretion. Digestion of proteins, sugars and absorption of digestion products. Bile - production, amount, composition, role of gall bladder. Digestion of lipids and absorption of products of lipids digestion in different parts of GIT. Small intestine - anatomy; motility; influence of innervation and hormones; intestinal juice; digestion of disaccharides; absorption of electrolytes, water and vitamins. Large intestine - anatomy; motility; functions; role of intestinal bacteria. Liver- functions of the liver.
2. Kidneys
Main function of kidneys. Anatomy and histology of kidney. Structure of the nephron. Structure of glomerulus. Blood flow in kidneys. Mechanism of filtration. Factors affecting GFR. Hormones and autacoids influencing GFR. Ultrafiltrate - volume, composition, methods of measurements. Clereance of inulin and PAH. Effective renal plasma flow. Autoregulation of renal blood flow. Fates of primary urine in different parts of nephron. Tubular reabsorption and secretion. Mechanism of paracellular and transcellular transport pathways. Reabsorbtion of water, electrolites, glucose, bicarbonates, aminoacids. Fates of glucose in the nephron. Mechanism of hyperosmotic urine formation - countercurrent mechanism. The role of Henle loop and urea. Endocrinal function of kidney. Hormonal control of renal function: renin-angiotensin-aldosteron; ADH; glucocorticoids. Amount and composition of the urine. Factors affecting diuresis. Micturition reflex. Role of kidneys in the body fluids equilibrium, acid-base balance and blood pressure regulation.
3. Endocrinal system
Hormones - chemical structures, synthesis and mechanisms of action; regulation of hormones secretion; target organs and bio-feedback, endocrine, paracrine and autocrine signaling, mechanisms of intracellular signaling, Characteristic of the principal classes of hormones. Hypothalamus as a central level of endocrinal regulation. Hypothalamic hormones. Anatomical and functional relationships between hypothalamus and pituitary gland. The role of pituitary gland in hormonal regulation - hormones secreted by different parts of pituitary gland - structure, target organs, role, abbreviations.
Thyroid gland - structure. Synthesis of T3 and T4. Main actions of thyroid hormones. Effects of their hyper - and hyposecretion. Ca2+ regulating hormones. Pancreas - structure of endocrinal part. Hormones of pancreas and their metabolic role. Types of human diabetes. Types and effects of insulin deficiency. Influence of insulin on various tissues. Adrenal gland - anatomical structures. Adrenal medulla - hormones and their influence on different targets. Types of adrenergic receptors. Adrenal cortex - zones and their products. Control of glucocorticoid secretions. Glucocorticoids actions. Mineralocorticoids - mechanism of release and physiological role. Adrenal androgens.
Pattern of gonadotropin secretion throughout life. Ovary as an endocrine gland. Hormonal regulation of menstrual cycle: hypothalamic hormones, gonadotropins, sex hormones, changes in the endometrium. Pregnancy - hormonal activity of placenta. Endocrine regulation of parturition. Testes as an endocrine and reproductive organs. Male sex hormones and their influence on different organs and tissues.
4. Metabolism
Overviews of energy balance – energy equivalent of foodstuffs. ATP as a main high-energy compound. Calorie – unit of energy. Overview of energy production in the cell. Main terms concerning gross metabolism – anabolic and catabolic processes. Energetic efficiency – definition, examples. General rules concerning energy transformation.
Basal Metabolic Rate – definition, basal condition for measuring BMR. Methods of measurements of BMR – direct and indirect calorimetry. RQ – definition, values. O2 consumption as a basis for indirect calorimetry. Calculation of BMR – examples. Factors affecting BMR. Specific dynamic action of foodstuffs. Energy sources during exercise.
5. Thermoregulation
Heat balance – heat gained vs. heat lost. Mechanisms of heat loss – radiation, conduction, convection, evaporation – examples; sweat – glands, composition of sweat, innervation of glands. Temperature – regulating mechanism activated by cold or heat. Body temperature control – hypothalamic center, sensors, involvement of cardiovascular and respiratory systems. Set-point of the hypothalamic temperature center – effect of changes on different thermoregulatory reactions. Body temperature under different conditions. Counter-current heat transfer – arterial and venous blood as a heat carrier. Skin circulation in the thermoregulatory responses – changes in the skin color. Fever – chain of events leading to rise in body temperature. Fever vs. hypothermia. Body organs – participation in total heat production – at rest and during exercise.