NEET MDS Lessons
Physiology
Bile - produced in the liver and stored in the gallbladder, released in response to CCK . Bile salts (salts of cholic acid) act to emulsify fats, i.e. to split them so that they can mix with water and be acted on by lipase.
Pancreatic juice: Lipase - splits fats into glycerol and fatty acids. Trypsin, and chymotrypsin - protease enzymes which break polypeptides into dipeptides. Carboxypeptidase - splits dipeptide into amino acids. Bicarbonate - neutralizes acid. Amylase - splits polysaccharides into shorter chains and disaccharides.
Intestinal enzymes (brush border enzymes): Aminopeptidase and carboxypeptidase - split dipeptides into amino acids. Sucrase, lactase, maltase - break disaccharides into monosaccharides. Enterokinase - activates trypsinogen to produce trypsin. Trypsin then activates the precursors of chymotrypsin and carboxypeptidase. Other carbohydrases: dextrinase and glucoamylase. These are of minor importance.
Proteins:
- about 50 - 60% of the dry mass of a typical cell
- subunit is the amino acid & amino acids are linked by peptide bonds
- 2 functional categories = structural (proteins part of the structure of a cell like those in the cell membrane) & enzymes
Enzymes are catalysts. Enzymes bind temporarily to one or more of the reactants of the reaction they catalyze. In doing so, they lower the amount of activation energy needed and thus speed up the reaction
As the contents of the stomach become thoroughly liquefied, they pass into the duodenum, the first segment of the small intestine. The duodenum is the first 10" of the small intestine
Two ducts enter the duodenum:
- one draining the gall bladder and hence the liver
- the other draining the exocrine portion of the pancreas.
From the intestinal mucosal cells, and from the liver and gallbladder. Secretions from the pancreas and bile from the gallbladder enter the duodenum through the hepatopancreatic ampulla and the sphincter of Oddi. These lie where the pancreatic duct and common bile duct join before entering the duodenum. The presence of fatty chyme in the duodenum causes release of the hormone CCK into the bloodstream. CCK is one of the enterogastrones and its main function, besides inhibiting the stomach, is to stimulate the release of enzymes by the pancreas, and the contraction of the gallbladder to release bile. It also stimulates the liver to produce bile. Consumption of excess fat results in excessive bile production by the liver, and this can lead to the formation of gallstones from precipitation of the bile salts.
The acid in the chyme stimulates the release of secretin which causes the pancreas to release bicarbonate which neutralizes the acidity
The bulk of the pancreas is an exocrine gland secreting pancreatic fluid into the duodenum after a meal. However, scattered through the pancreas are several hundred thousand clusters of cells called islets of Langerhans. The islets are endocrine tissue containing four types of cells. In order of abundance, they are the:
- beta cells, which secrete insulin and amylin;
- alpha cells, which secrete glucagon;
- delta cells, which secrete somatostatin, and
- gamma cells, which secrete a polypeptide of unknown function.
Beta Cells
Beta cells secrete insulin in response to a rising level of blood sugar
Insulin affects many organs. It
- stimulates skeletal muscle fibers to
- take up glucose and convert it into glycogen;
- take up amino acids from the blood and convert them into protein.
- acts on liver cells
- stimulating them to take up glucose from the blood and convert it into glycogen while
- inhibiting production of the enzymes involved in breaking glycogen back down (glycogenolysis) and
- inhibiting gluconeogenesis; that is, the conversion of fats and proteins into glucose.
- acts on fat (adipose) cells to stimulate the uptake of glucose and the synthesis of fat.
- acts on cells in the hypothalamus to reduce appetite.
Diabetes Mellitus
Diabetes mellitus is an endocrine disorder characterized by many signs and symptoms. Primary among these are:
- a failure of the kidney to retain glucose .
- a resulting increase in the volume of urine because of the osmotic effect of this glucose (it reduces the return of water to the blood).
There are three categories of diabetes mellitus:
- Insulin-Dependent Diabetes Mellitus (IDDM) (Type 1) and
- Non Insulin-Dependent Diabetes Mellitus (NIDDM)(Type 2)
- Inherited Forms of Diabetes Mellitus
Insulin-Dependent Diabetes Mellitus (IDDM)
IDDM ( Type 1 diabetes)
- is characterized by little or no circulating insulin;
- most commonly appears in childhood.
- It results from destruction of the beta cells of the islets.
- The destruction results from a cell-mediated autoimmune attack against the beta cells.
- What triggers this attack is still a mystery, although a prior viral infection may be the culprit.
Non Insulin-Dependent Diabetes Mellitus (NIDDM)
Many people develop diabetes mellitus without an accompanying drop in insulin levels In many cases, the problem appears to be a failure to express a sufficient number of glucose transporters in the plasma membrane (and T-system) of their skeletal muscles. Normally when insulin binds to its receptor on the cell surface, it initiates a chain of events that leads to the insertion in the plasma membrane of increased numbers of a transmembrane glucose transporter. This transporter forms a channel that permits the facilitated diffusion of glucose into the cell. Skeletal muscle is the major "sink" for removing excess glucose from the blood (and converting it into glycogen). In NIDDM, the patient's ability to remove glucose from the blood and convert it into glycogen is reduced. This is called insulin resistance. NIDDM (also called Type 2 diabetes mellitus) usually occurs in adults and, particularly often, in overweight people.
Alpha Cells
The alpha cells of the islets secrete glucagon, a polypeptide of 29 amino acids. Glucagon acts principally on the liver where it stimulates the conversion of glycogen into glucose (glycogenolysis) which is deposited in the blood.
Glucagon secretion is
- stimulated by low levels of glucose in the blood;
- inhibited by high levels, and
- inhibited by amylin.
The physiological significance of this is that glucagon functions to maintain a steady level of blood sugar level between meals.
Delta Cells
The delta cells secrete somatostatin. Somatostatin has a variety of functions. Taken together, they work to reduce the rate at which food is absorbed from the contents of the intestine. Somatostatin is also secreted by the hypothalamus and by the intestine.
Gamma Cells
The gamma cells of the islets secrete pancreatic polypeptide. No function has yet been found for this peptide of 36 amino acids.
Normal Chemical Composition of Urine
Urine is an aqueous solution of greater than 95% water, with a minimum of these remaining constituents, in order of decreasing concentration:
Urea 9.3 g/L.
Chloride 1.87 g/L.
Sodium 1.17 g/L.
Potassium 0.750 g/L.
Creatinine 0.670 g/L .
Other dissolved ions, inorganic and organic compounds (proteins, hormones, metabolites).
Urine is sterile until it reaches the urethra, where epithelial cells lining the urethra are colonized by facultatively anaerobic gram-negative rods and cocci. Urea is essentially a processed form of ammonia that is non-toxic to mammals, unlike ammonia, which can be highly toxic. It is processed from ammonia and carbon dioxide in the liver.
Alveolar Ventilation: is the volume of air of new air , entering the alveoli and adjacent gas exchange areas each minute . It equals to multiplying of respiratory rate by ( tidal volume - dead space).
Va = R rate X (TV- DsV)
= 12 X ( 500-150)
= 4200 ml of air.
Basic Properties of Gases
A. Dalton's Law of Partial Pressures
1. partial pressure - the "part" of the total air pressure caused by one component of a gas
Gas Percent Partial Pressure (P)
ALL AIR 100.0% 760 mm Hg
Nitrogen 78.6% 597 mm Hg (0.79 X 760)
Oxygen 20.9% l59 mm Hg (0.21 X 760)
CO2 0.04% 0.3 mm Hg (0.0004 X 760)
2. altitude - air pressure @ 10,000 ft = 563 mm Hg
3. scuba diving - air pressure @ 100 ft = 3000 mm Hg
B. Henry's Law of Gas Diffusion into Liquid
1. Henry's Law - a certain gas will diffuse INTO or OUT OF a liquid down its concentration gradient in proportion to its partial pressure
2. solubility - the ease with which a certain gas will "dissolve" into a liquid (like blood plasma)
HIGHest solubility in plasma Carbon Dioxide
Oxygen
LOWest solubility in plasma Nitrogen
C. Hyperbaric (Above normal pressure) Conditions
1. Creates HIGH gradient for gas entry into the body
2. therapeutic - oxygen forced into blood during: carbon monoxide poisoning, circulatory shock, asphyxiation, gangrene, tetanus, etc.
3. harmful - SCUBA divers may suffer the "bends" when they rise too quickly and Nitrogen gas "comes out of solution" and forms bubbles in the blood