Chapter 25: Water, Electrolytes, & Acid-Base Balance (28) 14 a day

Be able to describe fluid balance, electrolyte balance and acid-base balance.

Which body systems are involved in maintaining this balance? How?
Urinary
Water, electrolyte, pH
Respiratory
CO2 & water loss
Digestive
Water, electrolyte absorption
Integumentary
Water, electrolyte loss
Endocrine
Hormonal control of electrolyte and water
Nervous
Electrolyte & water
Cardiovascular
Hormone control of electrolyte
Bicarbonate buffer system
Lymphatic
Interstitial fluid return to cardiovascular
What are the major fluid compartments in the human body? What is their general composition?
How does fluid composition vary for different members of the population (young, old, men,
women)
Infants have higher percentage of fluid at 75% fluid by weight.
Elderly have lowest percentage of fluid at 45%
Children and young middle aged adults are generally in between
Intracellular fluid is fluid within our cells
o 2/3 of fluid are within our cells.
o Barrier enclosing it is the plasma membrane.
o Most distinct
Extracellular fluid is fluid outside of cells.
Proteins and Anions: Proteins, phosphate, bicarbonate, chloride, other
o Has interstitial fluid which is fluid that surrounds and bathes the cells
Composes of 2/3 of extracellular fluid
o Has blood plasma or intravascular fluid, which is fluid within the blood vessels.
1/3 of extracellular fluid
Cations: Potassium, magnesium, sodium, calcium
Proteins and Anions: Proteins, Phosphate, bicarbonate, chloride, other
(a) A net movement of water from the blood plasma into the intracellular compartment (ICF)
occurs following fluid intake. (b) A net movement of water from the intracellular
compartment into the blood plasma occurs when one is dehydrated.
How does exchange occur between the compartments?****
Fluid movement occurs continuously in response to change in relative osmolarity
(concentration). Water moves between osmosis between two compartments until water is
equl.
What are water gains? Water losses?
Water Intake = Water Loss/ Fluid intake=fluid output is fluid balance
Gains (fluid intake)
o Addition of water to the body
o Preformed Water: water absorbed from food and drink taken into the GI tract.
2300 mmliters of fluid intake per day.
o Metabolic Water: water produced daily from aerobic cellular respiration. 200 mml
of fluid per day.
o Only way to increase fluid in the body is through fluid intake from the flood and
drink we consume.
Losses (fluid output)
o Loss of water from the body that must equal fluid intake to maintain fluid
balance. Fluid is lost by
Breathing also Expired Breath
Sweating
Cutanueous transpiration: Evaportation of water directly through the skin
Defecation/ feces (also lost in vomiting)
Urination (only one body can control)
o Amount of water loss depends upon physical activity, environmental conditions,
and internal conditions of the body.
What is insensible water loss? Obligatory water loss?
Categories of losses
Sensible loss: Measurable, and includes fluid lost through feces and urine
Insensible loss: not measurable. Includes both fluid lost in expired air and
fluid lost from the skin through sweat and cutaneous transpiration.
o Obligatory and Facultative Water Loss
Loss of water that occurs regardless of state of hydration of the body.
Includes water lost through breathing and through the skin as well as fluid
lost in the feces and small amount of urine produced to eliminate wastes
from body.
Facultative Water loss:
Controlled water loss
Depends on degree of hydration of the body and is hormonal
regulated in DCT, collecting tubules, and ducts in nephrons of
kidney.
When body is overhydrated, hormonally controlled of this water
loss plays a big role in eliminating excess fluid.
Obligatory fluid output always occurs regardless of hydrated state
of the body. Therefore, hormonal regulation of urine can decrease
fluid loss when body is dehydrated, but inhibit completely.
Overtime the body continues to become more and more dehydrated
unless fluids are replaced.
What is the main regulator of water intake? How does the thirst center work? Effects?
Main regulator = Thirst (to bring more water in)
Fluid intake increases blood volume. The additional volume of blood causes: Blood
pressure increases, and if water gain exceeds solute gain, then blood osmolarity
decreases.
Fluid output decreases blood volume. Therefore, blood pressure is lower, and if more
water is lost than solutes, blood osmolarity increases.
Fluid intake is regulated by various stimuli that either activate or inhibit the thirst center
located within the hypothalamus
Stimuli to Turn on the Thirst Center
Stimuli for activating the thirst center, which occurs when fluid intake is less than fluid
output, include the following:
Decreased salivary secretions. Saliva production decreases, mucous membranes
are not as moist, when less fluid is available. Sensory input is relayed from
sensory receptors in the mucous membranes of the mouth and throat to the thirst
center.
Increased blood osmolarity. Occurs from insufficient water intake and
dehydration. The increase in blood osmolarity stimulates sensory receptors in the
thirst center directly, and hypothalamus to initiate nerve signals to the posterior
pituitary to release (ADH). ADH stimulates the thirst center. This stimulation of
the thirst center occurs with as little as a 23% increase in ADH.
Decreased blood pressure. When fluid intake is less than fluid output, blood
volume decreases and blood pressure. Renin is released from the kidney in
response to a lower blood pressure Renin initiates the conversion of
angiotensinogen to angiotensin II. An increase of 1015% in the concentration of
angiotensin II within the blood stimulates the thirst center. This mechanism is
especially important when extreme volume depletion occurs; for example, when
an individual is hemorrhaging.
When the thirst center is activated, nerve signals are relayed to the cerebral cortex, and
we then become conscious of our thirst. If we take fluid into the body by drinking or
eating, water is absorbed from the digestive system into the blood, and the water then
moves into the interstitial space and ultimately into the cells.
Stimuli to Turn off the Thirst Center
Stimuli for inhibiting the thirst center are produced when fluid intake is greater than fluid
output. All of these stimuli (except distension of the stomach, described here) oppose stimuli
that activate the thirst center. These include the following:
Increased salivary secretions. When body fluid level is high, salivary secretions
increase, and the mucous membranes of the mouth and throat become moist.
Sensory input to the thirst center decreases.
Distension of the stomach. Fluid entering the stomach causes it to stretch, and
inhibitory sensory impulses are relayed to the thirst center. (Note that an empty
stomach does not stimulate the thirst center; rather, only a stretched stomach wall
will inhibit the thirst center.)
Decreased blood osmolarity. Blood osmolarity decreases when additional fluid
enters the blood. In response, the thirst center is no longer stimulated directly, and
the hypothalamus decreases stimulation of ADH release from the posterior
pituitary.
Increased blood pressure. Blood volume and blood pressure increase with the
addition of fluid. This rise in blood pressure inhibits the kidney from releasing
renin, and the subsequent production of angiotensin II decreases. A decrease in
angiotensin II results in a reduced stimulation of the thirst center.
The stimuli that inhibit the thirst center can be divided into two categories, depending upon both
the time required to inhibit the thirst center and their level of accuracy in reflecting the hydrated
state of the body. Stimuli that immediately inhibit the thirst center, but are less accurate
concerning the hydrated state, include both the moistening of the mucous membranes and
distension of the stomach. Signals from these stimuli will inhibit the thirst center for
approximately 30 to 45 minutes, which is long enough for the absorption of fluids from the
digestive system into the blood plasma.
Once fluids are absorbed, blood osmolarity decreases (with an accompanying decrease in ADH
release), and both blood volume and blood pressure increase (with an accompanying decrease in
renin release and production of angiotensin II). These are less immediate stimuli but more
accurately reflect the body's state of hydration.
Dehydration
output > intake
As little as 1% decrease in body water causes:
Quenching Thirst
Immediate: Drink the water, mouth gets wet, and stomach is descended
(baroreceptors send signal to hypothalamus)
Later: Blood osmolality or blood pressure goes back to normal
How is water output regulated be sure you know the role of ADH, aldosterone, and atrial
natriuretic factor (hormone) well. Know the how/when/why these hormones are made and their
mechanism of action.
Urine:
Volume: limit how much we loose and make it more concentrated
Na+: regulate through aldosterone
Hormones
ADH: aquaporins make it possible for water to come out.
Aldosterone: open sodium potassium pumps, increase water retention by inserting
sodium potassium pumps. Sodium increases concentration in medulla.
Atrial Natriuretic Factor: block aquaporin and decrease adh and aldosterone and
increase urine volume.
Neural: increase in BP recognized by baroreceptors. Decreased sympathetic stimulation
of afferent arteriole leads to increased pressure in glomerulus leading to increased
filtration and increased urine output.
Recall that fluid output is regulated through the kidneys by controlling urine output.
Four major hormones are involved in regulating urine output: angiotensin II,
antidiuretic hormone (ADH), aldosterone, and atrial natriuretic peptide (ANP).
Angiotensin II, ADH, and aldosterone help decrease urine output. These three hormones
function to maintain both blood volume and blood pressure.
In contrast, ANP increases urine output to decrease both blood volume and blood
pressure. The specific mechanisms employed by each of these hormones in regulating
fluid output in the kidneys also function in regulating some electrolytes (e.g., Na
+
).
25.4a Angiotensin II 995
Angiotensin II stimulates vasoconstriction to increase blood pressure, decreases fluid
output by the kidney to maintain blood volume, activates the thirst center, and stimulates the
release of aldosterone and antidiuretic hormone.
25.4b Antidiuretic Hormone (ADH) 996
Antidiuretic hormone (ADH) stimulates the thirst center to increase fluid intake,
decreases fluid output from the kidney to maintain blood volume, and decreases blood
osmolarity. In high doses, ADH is a vasoconstrictor.
25.4c Aldosterone 998
Aldosterone (ALDO) stimulates reabsorption of both Na
+
and water to maintain blood
volume and blood pressure. However, blood osmolarity is unchanged. Potassium ions are
normally secreted except under conditions of low pH; then excess H
+
is excreted.
25.4d Atrial Natriuretic Peptide (ANP) 999
Atrial natriuretic peptide (ANP) decreases blood volume and blood pressure by causing
vasodilation and increasing fluid outputboth processes that occur from stimulation of
ANP directlyand through the inhibition of renin-angiotensin system, antidiuretic
hormone, and aldosterone.
What are the water imbalances? Be able to describe them. What are the causes? Effects?
Symptoms (if appropriate)?
A fluid imbalance occurs when fluid output does not equal fluid intake.
Fluid imbalances can be organized into five categories that include volume depletion,
volume excess, dehydration, hypotonic hydration, and fluid sequestration.
Two questions
o Does the fluid imbalance change the osmolarity (concentration) of body fluid?
o Is the fluid imbalance caused by an excess or deficiency of body fluid?
Fluid Imbalance with Constant Osmolarity
o Fluid imbalances with constant osmolarity and volume decreases occur when isotonic
fluid is lost or gained. Volume depletion also known as hypovolemia (too little volume
of water) occurs when isotonic fluid loss is greater than isotonic fluid gain. Examples of
conditions that result in volume depletion include hemorrhage, severe burns, chronic
vomiting, diarrhea, or the hyposecretion of aldosterone (a hormone that stimulates both
Na
+
and water reabsorption in the kidney;).
Volume excess occurs when isotonic fluid gain is greater than isotonic fluid loss. This
typically results when fluid intake is normal, but there is decreased fluid loss through the
kidneys (e.g., from either renal failure or aldosterone hypersecretion). In both volume
depletion and volume excess, there is no change is osmolarity. Consequently, there is no
net movement of water betwee Volume Excess
o ECF = isotonic
o Renal failure or excess aldosterone
Water Intoxication (Water toxicity)
o Sweating = water loss, but also
o Rapidly drink lots of water
What happens to plasma Na+ conc.
ECF?
Excess ADH
Hyponatremia (symptoms?) convulsion, affect mental state
o So, add salts (electrolytes) when replacing water like this!
o Also can be cause by intentional overhydration
Hypernatremia symptoms:
Common symptoms include:
Abnormal mental status
Confusion
Decreased consciousness
Hallucinations
Possible coma
Convulsions
Fatigue
Headache
Irritability
Loss of appetite
Muscle spasms or cramps
Muscle weakness
Nausea
Restlessness
Vomiting
o n fluid compartments.
o
Fluid Imbalance with Changes in Osmolarity
Certain types of fluid imbalance involve fluid loss or gain that is not isotonic. Dehydration can
result from profuse sweating, diabetes mellitus (glucose will pull water out of cells),
hyposecretion of antidiuretic hormone (ADHa hormone that stimulates water reabsorption in
the kidney;), insufficient water intake, or overexposure to cold weather, diarrhea, vomiting In
each case, the water loss is greater than the loss of solutes, and the blood plasma becomes
hypertonic. Consequently, water shifts between fluid compartments with a net movement of
water from the cells into the interstitial fluid and then into blood plasma. Body cells may become
dehydrated as a result. Osmolarity of blood is increases (solute concentration ) volume is
decreased.
Hypotonic hydration is also called water intoxication, or positive water balance. It can
result from ADH hypersecretion, but it is generally caused from drinking a large amount
of plain water following excessive sweating. An example would be some amateur
athletes who run marathons, and drink plain water instead of using an electrolyte-
enhanced solution. Both Na
+
and water are lost during sweating, and drinking water
replaces only the water, but not the solutes. The blood plasma then becomes hypotonic to
the other fluid compartments. Fluid moves from blood plasma into the interstitial fluid,
and then into the cells. Cells may become swollen with fluid.
One of the consequences of extreme hypotonic hydration is cerebral edema. Brain cells become
impaired as they swell with excess fluid. The person may experience headaches, nausea, or both.
Convulsions, coma, or death may result in severe cases. In addition, some individuals have died
after having been forced or enticed to drink excessive amounts of water (e.g., fraternity hazings
and water-drinking contests).
DISTRIBUTION
Fluid Sequestration
Fluid sequestration (skwes-trshn; sequestro = to lay aside) differs from the other fluid
imbalances because total body fluid may be normal, but it is distributed abnormally. Fluid
accumulates in a particular location, and it is not available for use elsewhere. Inflammation,
prevention of flow.
Edema is an example of fluid sequestration in which fluid accumulates in the interstitial
space around cells, and is characterized by puffiness or swelling. Anatomic or
physiologic changes that can result in edema are listed in. Notice as you review the
contents of this table that edema is generally a result of abnormal changes in the
cardiovascular system (heart or blood vessels), blood composition, or changes to lymph
vessels (the vessels that return fluid to the cardiovascular system). These changes alter
the net filtration pressure (NFP) at systemic capillaries, causing additional fluid to either
leave the capillaries or remain in the interstitial space.
Definition: too much fluid in extracellular fluid
Causes: lymph vessel blockage, bruising, damage to the basement membrane
Third-spacing
o Internal hemorrhage
o Surgical deadspace: no air before but now you have air.
o Etc.
Involve volume, concentration, or distribution among compartments
Main Catgories
o Deficiency
o Excess
o Distribution Issues
DEFIENCY
Infants are most vulnerable
o Because they have highest percentage of body weight of water
Fluid recall with dehydration
o More concentrated extracellular space so you pull fluid out of cells
Effects of fluid deficiency?
o Dizziness, light headedness, passing out, nausea (first signs of heat stroke)
How do changes in extracellular fluid affect intracellular fluid volume?
What are the roles of electrolytes? What are the major electrolytes in the human body?
Electrolytes are any substance that dissociates in solution to form cations and anions.
Include: salts, acids, bases and negatively charged proteins.
Role of electolytes
o Chemical reactants (are cofactors of enzymes)
o Generate electrical potential across cell membranes
o Create osmotic gradients & cause water flux into compartments
o Maintain acid-base balance
Cations
o positive charge
o Sodium, potassium, iron, calcium, magnesium, hydrogen ion
Anions
o negative charge
o Chloride, phosphate, sulfates, HCO-3, OH-, proteins
Body fluids also contain charged organic molecules
Small % of molecules in fluids are non-electrolytes like glucose
Major electrolytes are: Sodium, potassium, iron, calcium, magnesium, hydrogen ion,
Chloride, phosphate, sulfates, HCO-3, OH-, proteins
What are the sources of intake and output for electrolytes?
What is osmolarity? Why does it matter?
What determines Osmolarity?
Measure of solute concentration
Moles per liter
More Concentrated (there is more solutes)
Glucose
dissolves into 1 particle
NaCl
dissolves into 2 particles
Osmoles/L = osmolarity of solution
Know the major function and control mechanisms for Sodium (Na+), Potassium (K+), calcium,
and chloride (this includes how its homeostatic levels are regulated; hormones that have other
effects on it; disorders associated with excess or too little of the electrolytes (name and
description); its role in the body; links to other electrolytes)
SODIUM:
Functions
Enable cells to depolarize (depolarization)
High extracellular, low intercellular
Nerve action potential, muscle potential
Important maintaining osmotic balance of ECF.
99% in ECF, 1% in ICF
Principal cation in ECF
Balance: get this from our diet
Table salt and processed foods
Loss through urine
Regulated by three hormones:
Aldosterone, ADH, ANH (also help regulate fluid balance)
Control
Retention
-sodium potassium pump being put in by aldosterone
-aldosterone helps you retain sodium
Effects
-Retain more water.
Stimuli for Aldosterone release
Effects
-low blood pressure (baroreceptors in the kidney detect it.) kidney
secretes renin, -angiotensis and then adrenal and then
aldosterone.
Low sodium levels
ANF: blocks aldosterone secretion and closes sodium potassium pumps.
Estrogen & glucocorticoids: cause you to retain sodium
Progesterone
Imbalances
Hypernatremia
Too much sodium
Edema (increase osmolality )
High blood pressure because you have high levels of sodium
Nerves become hypersensitive which leads to muscle and nerve twitching
Rapid depolarization
Slow repolarization and delay next action potential
Hyponatremia
Too little sodium
Very slow depolarization
Lower blood pressure
POTASSIUM
Functions
Repolarization
Important intracellular
Not as important of maintaining osmotic fluid
Linked to Na+ Homeostasis because of
Sodium potassium pump
Largely an intracellular cation = tight range in blood
Increase extracellular concentration
90% is reabsorbed where?
Proximal convoluted tubule
Adjustments are made where? Distal convoluted tubule
Aldosterone effects?
If extracellular levels of potassium too high you'll produce aldosterone and
secrete excess potassium
IMBALANCES
Hypokalcemia: low potassium
Hyperkalcemia: high potassium
CALCIUM
Functions
Muscle contraction
Bone growth and density
Repolarization in the heart because of slow calcium channels.
In order to release a neurotransmitter, you need calcium
Homeostasis
Tightly regulated blood level
Ca++ exists in 3 forms in the blood
IMBALANCES
Hypercalcemia
Hypocalcemia
CHLORIDE
Most common extracellular anions
Diffuses easily between compartments
Secreted by?
Stomach in the form of Hydrochloric Acid
Also indirectly adjusted by aldosterone why?
Because chloride ions usually follow the sodium.
Found in lumen of stomach
Obtained in table salt and processed foods
Lost in urine and dependent on blood plasma sodium.
Levels are correlated with sodium
Follows sodium
MAGNESIUM:
In the bone or within cell
After K+ most abudundatn cation in ICF
Participates in over 300 enzyme reactions
Assist in movement of sodium and potassium across plasma membrane
Important in muscle relaxation
Obtained in diet from beans and peas, leafy stuff. Lost in body sweat and urine.
Blood plasma levels are regulated through kidney.
Regulation of Chloride, Potassium, Magnesium
Chloride ions
Predominant anions in ECF
Magnesium ions
Capacity of kidney to reabsorb is limited
Excess lost in urine
Decreased extracellular magnesium results in greater degree of reabsorption
Potassium ions
Maintained in narrow range
Affect resting membrane potentials
Aldosterone increases amount secreted
Terms
Hyperkalemia: abnormally high levels of potassium in extracellular fluid
Hypokalemia: abnormally low levels of potassium in extracellular fluid.
Regulation of Calcium Ions
Regulated within narrow range
Elevated extracellular levels prevent membrane depolarization
Decreased levels lead to spontaneous action potential generation
Terms
Hypocalcemia
Hypercalcemia
PTH increases Ca
2+
extracellular levels and decreases extracellular phosphate levels
Vitamin D stimulates Ca
2+
uptake in intestines
Calcitonin decreases extracellular Ca
2+
levels
Regulation of Phosphate Ions
Under normal conditions, reabsorption of phosphate occurs at maximum rate in the
nephron
An increase in plasma phosphate increases amount of phosphate in nephron beyond that
which can be reabsorbed; excess is lost in urine
Hypophosphatemia: reduced absorption from intestine due to vitamin D
deficiency or alcohol abuse.
Hyperphosphatemia: renal failure, chemotherapy, hyperparathyroidism
(secondary to elevated plasma calcium levels)
STOP
What is pH? What are the effects of pH in the body?
What is pH?
measure of the amount of hydrogen ion concentration
Negative law of the base 10 to the hydrogen ion concentration.
normal range of ph- 7.35-7.45
less then 7.35 is acidosis: 7.2 is acidic= acidosis
more then 7.5 is alkalosis
acidic is where we find more hydrogen ions
also known as acid base balance
What are the effects of pH?
Proteins: pH denatures proteins
Concentration gradients:
Hormone actions:
What is an acid? What is a base? What are buffers?
Acids
anything that contributes to hydrogen ions
increases hydrogen ion concentration which equals lower ph.
Have fixed and volatile acid
Bases
anything that takes hydrogen ion out
reduces amount of hydrogen ion in solutions and results in a higher Ph.
Acids and bases
Grouped as strong or weak
Buffers: Resist changes in pH, act quickly and temporarily to prevent pH changes.
Strong acid: you dissociate; HCL gives up all hydrogen ions
Weak acid: carbonic acid dissociates to an equilibrium
Weak acid with weak bases make a buffered system
What are the major types of buffer systems in the human body? How do they work? Be able to
rate which is fastest, which is slowest? Which can handle the most H
+
?
Bicarbonate buffering system:
o Most important buffer system in ECF
o Consist of bicarbonate ion and carbonic acid
o Bicarbonate (HCO-3) is the weak base while carbonic acid (H2CO3) is the weak
acid.
o Strong acid is buffered to produce a weak acid or a strong base if buffered to
produce a weak base.
o This system buffers against pH changes in the blood.
o
o The addition of acid is buffered in equation (5) by the weak base HCO
3

.
Bicarbonate binds the excess H
+
and becomes the weak acid H
2
CO
3

. In
comparison, with the addition of base as in equation (6), the weak acid H
2
CO
3

releases H
+
. As it does so, it becomes a weak base (HCO
3

), and water is formed.

The net result again is that a strong acid is buffered to produce a weak acid, or a
strong base is buffered to produce a weak base.
Phospahte Buffer System
o Found in ICF
o Buffering metabolic acid produced by cells because phosphate is the most
common anion within cells.
o Has weak base and weak acid
o Hydrogen Phosphate is weak base and Dihydrogen phosphate is weak acid.
o The addition of acid, shown in equation (3), is buffered by the weak base
(HPO
4
2
) that binds the H
+
to become a weak acid (H
2
PO
4

). In contrast, the
addition of base, as in equation (4), causes the weak acid H
2
PO
4

to release H
+
. As
it does so, it becomes the weak base HPO
4
2
, and water is formed. As with the
protein buffering system, the net result is either a strong acid buffered to produce
a weak acid or a strong base buffered to produce a weak base.
Protein Buffer System
o Has proteins within cells and in blood plasma
o Accounts fro three quarters of chemical buffering in body fluids.
o Amine group of amino acids acts as weak base to buffer acid while carboxylic
acid of amino acids acts as a weak acid to buffer base.
o
o With the addition of strong acid, shown in equation (1), the weak base (NH
2
) of
the protein buffering system binds the H
+
that was added to the solution. This
weak base becomes a weak acid (NH
3
+
) as a result. The net effect is elimination of
a strong acid (H
+
) and the production of a weak acid (NH
3
+
). In comparison, the
addition of strong base, as in equation (2), causes the weak acid (COOH) of the
protein buffering system to release H
+
, and as it does so, it becomes a weak base
(COO

). The net effect is removal of a strong base (OH

) and the production of a

weak base (COO

).
o Proteins are in both cells and blood, their buffering systems help minimize pH
changes throughout the body.
o Only exception is CSF where there are no proteins.
o Proteins that help buffer pH changes in body include: intracellular proteins,
plasma proteins, and hemoglobin in erythrocytes.
What are natural sources of acids in your body (not just from food)?
What are the roles of buffer systems, CO
2
and Kidney secretion of H
+
in maintaining pH?
Be able to describe the bicarbonate buffer system, the phosphate buffer system, and the protein
buffer system. Also be able to explain how they work. What are the components of a buffer
system? ABOVE
How does the respiratory mechanism adjust the pH? Be able to describe how it works?
VOLATILE ACID: carbonic acid produced when carbon dioxide combines with water.
Regulated by the respiratory system through regulation of respiratory rate.
Can adjust body pH in 1-3 minutes
Can adjust more hydrogen ions
Respiratory system is a physiological buffer to maintain acid base balance but does so by
regulating the level of volatile carbonic acid.
Respiration Rate and Blood pH.The respiratory system normally eliminates CO
2
at the
same rate that cells produce it; thus, blood Pco
2
of 3545 mm Hg is maintained under
normal conditions. (a) An abnormal increase in respiratory rate decreases blood Pco
2
,
driving the chemical reaction to the left. Subsequently, blood H
+
concentration decreases,
increasing blood pH. (b) An abnormal decrease in respiratory rate increases blood Pco
2
,
driving the chemical reaction to the right. Subsequently blood H
+
concentration increases,
decreasing blood pH.
How does kidney excretion of H+ work as a buffer? ****
Metabolic reactions produce large amounts of acids
Kidneys vs. Lungs for elimination?
What about bases?
Can be elminated form kidneys if your too basic like bicarbonate ions.
Fixed Acids is regulated by the kidney through the reabsorption and elimination of
HCO-3 and H+.

What is compensation? What is acidosis? What is alkalosis?

Compensation: response of physiological buffering system to acid base distrurbances that
results in return of blood pH to normal.
Happen in kidney function, increase respiration rate, and locally you would have buffer
system employed
Ineffective buffer system that does not return pH to normal then pH disturbance is
uncompensation.
Acidosis: arterial blood pH below 7.35
Alkalosis: arterial blood pH abover 7.45
Be able to describe what is happening in respiratory alkalosis and respiratory acidosis.
Respiratory Acidosis: (INCREASE)
The most common acid-base disturbance occurs because of reduced elimination of CO
2

by the respiratory system. This is defined as occurring when the Pco
2
in the arterial blood
becomes elevated above 45 mm Hg. Causes include the following
o Injury to the respiratory center, perhaps caused by trauma or by poliovirus
infections
o Disorders of the nerves or muscles involved with breathing, such as the loss of
muscle strength associated with muscular dystrophy
o Airway obstruction
o Decreased gas exchange due to reduced respiratory surface area or thickened
width of the respiratory membrane (these two conditions are associated with
emphysema or pulmonary edema, respectively)
Continued impairment results in the accumulation of CO
2
in the blood that ultimately
causes an increase in blood H
2
CO
3
and a subsequent increase in H
+
concentration.
Infants are more susceptible to respiratory acidosis because their smaller lungs and lower
residual volume do not eliminate CO
2
as effectively. CO
2
accumulates in the blood, with
a subsequent increase in carbonic acid (H
2
CO
3
).
Respiratory Alkalosis (DECREASE)
o Occurs when the Pco
2
decreases to levels below 35 mm Hg due to an increase in
respiration. Faster breathing (hyperventilation) may occur in response to the
following:
o Severe anxiety
o Any condition in which an individual is not receiving sufficient oxygen (e.g., as
might occur when climbing to a high altitude where there is a decrease in the
partial pressure of oxygen [Po
2
]; during congestive heart failure; as a result of
severe anemia; or due to low blood pressure)
o Aspirin overdose (a condition that stimulates the respiratory center)
o Continued elimination of CO
2
results in decreased levels of blood CO
2
that in turn
cause a decrease in blood H
2
CO
3
and lowered H
+
concentration.
Be able to describe what is happening in metabolic acidosis and metabolic alkalosis.
Metabolic Acidosis DECREASE
The most common metabolic acid-base disturbance occurs as a result of a decrease in
HCO
3

. This decrease may result from an excessive loss of HCO

3

, but more generally it

occurs when there is an accumulation of fixed acid. The excess H
+
binds with HCO
3

to
form H
2
CO
3
; thus, HCO
3

levels in the blood decrease. Metabolic acidosis occurs when

arterial blood levels of HCO
3

fall below 22 mEq/L. This condition is usually caused by

unhealthy changes in physiologic processes that were described earlier in the chapter (see
figure 25.12a). These include the following:
o Increased production of metabolic acids, such as ketoacidosis from diabetes
mellitus, increased lactic acid from anaerobic respiration, or excessive production
of acetic acid from excessive intake of alcohol
o Decreased elimination of acid due to renal dysfunction
o Increased elimination of HCO
3

as a result of severe diarrhea

Infants are especially vulnerable to this condition also, because they produce larger amounts of
acidic metabolic wastes due to a higher metabolic rate.
Metabolic Alkalosis (increase)
Metabolic alkalosis is defined as arterial blood levels of HCO
3

that exceed 26 mEq/L. A

loss of H
+
or an increase in HCO
3

can bring about this condition (see figure 25.12b).

Causes include the following:
o Vomiting (the most common cause)
o Increased loss of acids by the kidneys with overuse of diuretics (medications that
increase urine output)
o Increased alkaline input from consuming large amounts of antacid tablets
What are the compensatory mechanisms for respiratory alkalosis/acidosis? Metabolic
alkalosis/acidosis?
The respiratory system attempts to compensate for metabolic acidosis (e.g., a complication of
uncontrolled diabetes mellitus). Respiratory rate increases as a result of increased H
+
concentration
(see fgure 25.13a). During respiratory compensation, higher than normal amounts of CO
2
are expired, as
evidenced by a lower than normal blood PCO
2
value.
Changes in the respiratory rate also may compensate for metabolic alkalosis, such as occurs with
vomiting. The normal response of decreasing respiratory rate in response to decreased blood
H
+
concentration occurs during respiratory compensation (see fgure 25.13b). However, during respiratory
compensation, this occurs to a greater degree than normal, resulting in lower than normal amounts of
CO
2
expired. The evidence is in the higher than normal blood CO
2
values that are measured.
Generally, respiratory compensation is less efective in addressing metabolic acid-base disturbances than
renal compensation. The ability to decrease respiratory rate in response to metabolic alkalosis is limited
by the development of hypoxia. As the respiratory rate decreases, PO
2
levels also decrease. When
PO
2
levels decrease below critical values, the respiratory rate is stimulated to increase. This may prevent
complete compensation for metabolic alkalosis.
Know the disorders of the urinary system. Symptoms, causes, treatments, etc.
Study Guide: Digestion & Nutrition Ch 26 & 27 23 12
This is a preliminary study guide and may undergo slight modifications based on lecture
What are the functions of the digestive system?
Digestive tract: Long tube separated into organs by serous sphincters
Ingestion: happens in the mouth. Intro of solid and liquid into oral cavity. First step
Motility: describes involuntary and voluntary muscular contractions for mixing and
moving materials through GI tract
Secretion: producing and releasing digestive enzymes, acid, and bile into GI tract. They
facilitate digestion.
Digestion: breakdown of ingested food into smaller stuff that cab be absorbed in GI tract.
o Mechanical: when ingested material is physical broken down by chewing, mixing
w/out changing chemical structure. Grinding of teeth, churning.
o Chemical: enzymes that breakdown chemical bonds to change big complex
molecules to small complex molecules that can be absorbed.
o Absorption: passive movement and active transport of digested stuff, electrolytes,
vitamins and water from GI tract into blood or lymph.
o Elimination: expulsion of indigestible components that are not absorbed through
anus.
What are the major organs of the digestive system? What are the accessory organs associated
with the digestive system?
Major Organs
Gastrointestinal Tract (digestive or alimentary canal) forms
o Oral cavity, pharynx, esophagus, stomach, small intestine, and larger
intestine, and ends at anus.
30 ft in length in adult cadaver, but due to smooth muscle tone, it is shorter in a
living person.
Within this tract, food is broken down into smaller stuff and then absorbed along
length. Materials within lumen are not part of body until absorbed
Accessory Digestive Organs: assist with digestion of food
Acc. Dig. Glands make secretions that empty into GI tract. They include:
o Salivary glands, liver, pancreas
Acc. Dig things that are not glands include:
o Teeth, tongue (chewing, swallowing), gallbladder (concentrates and store
secretion of Liver)
What are the processes that occur in the digestive system? Where do they occur? #2
What are the layers of the digestive system? What are the characteristics of each layer?
The digestive system has a distinct system of tissue layers
There is an open surface inside the GI tract lumen epithelial tissue covering
on outside
Mucosa:
Smooth muscle connective tissue that helps movment in GI tract
o Inner lining mucous membrane
Epithelium:
Type of epithelium varies along gi tract
o Pharynx and esophagus handle large amount of food:
simple squamous
o Stomach: food becomes liquid and passes to intestines.
Simple columnar apithelium for gi tract (stomach, small intestine,
large intestine)
Allows for secretion and absorption such as mucous and enzymes
o Highly folded epithelial surfaces (small intestines)
Portions that must stand abrasion are lined by (nonkeratinized,
stratified squamous epithelium)
Lamina propia:
Areolar connective tissue with small blood vessels and nerves,
mucous glands
Find lacteals in order to absorb fats
Absorption happens when stuff is moved through epithelial cell
and absorbed into blood or lymphatic capillary within lamina
propia.
Muscularis Mucosae is thin lawyer of smooth muscle.
Contractions causes slight movement in mucosa which
o Facilitate release of secretions fro mucosa into lumen
o Increases materials in lumen with mucosa (shake things up)
o Submucosa
Areolar and dense irregular connective tissue
Amount depend on region of GI tract
Large blood vessels, lymph vessels, and nerves are here
Branches of nerves are submucosal nerve plexus
Innervate smooth muscle and glands of both mucosas
Helps muscle movement when communication with nervous
system
MALT helps prevent ingested microbes from crossing and entering GI
tract and body.
Peyer Patches are lymphatic modules
o Muscularis:
A lot in stomach
Smooth muscle that mixes and propels content
More forceful contractions
2 Layers
inner circular layer constrict lumen of tube
outer layer: outer longitudinal layer shorten tube
Myenteric Nerve Plexus are axons and ganglia in btween two layers
Sends signals to continue peristalsis
Peristalsis: alternating contraction of inncer circular and outer longitudinal
to propel ingested material. (forward movement)
Mixing: back and forward motion that happens within different regions
but lacks directional movement. Purpose is to blend ingested stuff with
secretion within GI tract.
o Forms sphincter closes off lumen and control movement of materials
Adventitita or Serosa
o Outermoust
o Adventitia: areolar connective tissue disperses collagen and elastic fibers outside
peritoneal cavity.
o Serosa: covered by visceral peritoneum within peritoneal cavity, fibrous tissue on
outside
o Blood vessels and capillary beds
o Ex. Esophagus has stratified squamous epithelium in mucosa to protect lining and
stomach has three layers of smooth muscle in muscularis.
o Proetective covering that helps in attachment to abdominal wall.
MEMBRANES
Parietal Peritoneum: lines inside of body wall
Visceral perit.: reflects over and covers surface of internal organs
o Organs within abdomen are intraperotineal (stomach, small and large intestine)
o Retro: duodenus, first part of small intenstine, pancreas, ascending and
descending colon and rectum
Between two layers in thin peritoneal cavity
o Filled with fluid is peritoneal fluid which allows for organs to move freely and
reduce friction
Serosa encloses abdominal portion of digestive tract
How does the type of epithelium vary throughout the digestive tract?
What are the 2 types of movement that are possible in the digestive tract? What muscles make
these possible?
Peristalsis: alternating contraction of inncer circular and outer longitudinal to propel
ingested material.
Mixing: back and forward motin thathappens within different regions but lacks
directional movement. Purpose is to blend ingested stuff with secretion within GI tract.
Muscularis
What secretions are found throughout the digestive tract? What are their functions?
Within the digestive tract secretions are evident throughout
Hormonal, enzymatic, acidic and basic
Parts of digestive system & direction of food
Organs: esophagus, stomach, intestines, rectum, anus
Explore important structures, secretions, absorption, digestion process, movement of food
Be able to list the parts of the digestive system and the direction of food.
UPPER GI TRACT
o Oral cavity and salivary glands
o Pharynx
o Esophagus
o Stomach
Know the characteristics of each of the parts of the digestive system. What processes occur in
each part? How does food enter, how does it leave, special terms, any secretions associated with
that part of the system. Know the accessory organs and where their secretions tie into which
parts of the digestive system.

What is saliva? What is its role in digestion? What is a bolus?

SALIVA
Composed of 99.5 water and solutes
Formed as water and electrolytes are filtered from capillaries though cells.
Secreted from salivary glands
Moistens ingested food and helps it become a bolus (bls; bolos= lump), a globular wet mass of
partially digested material that is more easily swallowed
Initiates the chemical breakdown of starch in the oral cavity because of the salivary amylase it
contains
Acts as a watery medium into which food molecules are dissolved so taste receptors may be
stimulated
Cleanses the oral cavity structures
Helps inhibit bacterial growth in the oral cavity because it contains antibacterial substances including
lysozyme and antibodies (IgA) (IgA is formed by plasma cells in the lamina propria and transported
across the epithelial cells.)
o Contains water for lubrication
o Amylase
o Produced from multicellular exocrine glands outside oral cavity
o Intrinsic salivary glands contribute to the production of saliva
What is deglutition? Where is the deglutition center?
In the medulla oblangata
Swallowing
Process of moving ingested materials from oral cavity to the stomach
There are three phases
o Voluntary: after ingestion. Controlld by cerebral cortex. Ingested materials and saliva
mix. Chewing forms a bolus that is mixed and manipulated by the tounge .
o Pharyngeal: arrival of the bolus. Its involuntary.
o Esophageal: involuntary. Bolus passes through esophagus into stomach.
Be able to describe the process of peristalsis.
alternating contraction of inncer circular and outer longitudinal to propel ingested material.
(forward movement)
he process of peristalsis begins in the esophagus when a bolus of food is swallowed. The strong wave-like
motions of the smooth muscle in the esophagus carry the food to the stomach, where it is churned into a liquid
mixture called chyme.
ext, peristalsis continues in the small intestine where it mixes and shifts the chyme back and forth, allowing
nutrients to be absorbed into the bloodstream through the small intestine walls.
!eristalsis concludes in the large intestine where water from the undigested food material is absorbed into the
bloodstream. "inally, the remaining waste products are excreted from the body through the rectum and anus.

What are the major cells of the stomach what do they secrete?
Secretory cells
4 types of secretory cells:
Cell Secretion
mucosal cells mucous/mucin
line the stomach lumen and extend into gastric pits.
Helps prevent ulceration of stomach lining exposure to acidity of
gastric fluid and enzymes.
parietal cells HCL
intrinsic factors: absorption of b12
production of glycoprotein is essential function.
B12 is normal for erythrocytes
HCL: responsible for low pH between 1.5 and2.5 within the
stomach.
Not formed within parietal cell. Would destroy it.
Chief cells pepsinogen (gets converted to pesin. (pepsin starts digests proteins) secreted
by chief cells
Most numerous
Produce and secrete granules that contain pepsinogen.
Pepsinogen is inactive and must stay this way to prevent
destruction of chief cells.
Pepsinogen is activated following its release into the stomach.
Activated by HCL
Pepsin chemically digests denatured proteins iin the stomach into
smaller peptide framgnets.
Produce gastric lipase (limited role in fat digestion)
G Cells (Enteroendocrine cells) hormonal secretions secrete gastrin.
Gastrin is important and gets secreted by nervous cells . Stimulates
parietal and chief cells
Stimulates stomach secretions and motility.
STOPPPPP
What are the 3 phases of secretion and digestion in the stomach what is happening in each of
these stages? Where is the food? What is being digested? What enzymes/secretions are
involved, etc.?
1. Cephalic
Taste, smell, though of food (cephalic reflexes)
Chemoreceptors will stimulate hypothalamus and medulla and stimulates
production of gastrin.
Then food enters the stomach
When stomach growls
Increases motility
2. Gastric Phase
o swallow food and it gets into stomach
distension of stomach stimulates baroreceptors activates parasympathetic receptors and
local secretion of HCL
Keep secreting gastrin, hcl, and pepsinogen
Secretion
What is secreted to protect stomach lining? Mucous
More gastrin, more pepsinogen, more hcl
Acidic environment pH drops (conversion of pepsinogen to pepsin)
Secretions stop when pH reaches 2.0
Digestion
Proteins in food Broken down by pepsin (into peptide)
Milk proteins being digested. lactose digest carbs
Mixing
Rugae become stretched stomach is distended
Muscular contractions mix food for how long? 2-6 hourse
Food becomes watery mixture called?
chyme
After several hours of mixing waves of contractions (peristalsis) reach the lower end/base
of the stomach near the pyloric sphincter (starts to open up
General info/reminders
After 2-6 hours, the stomach is emptied
Some macromolecules move faster through the stomach - order:
Carbs
lipids
proteins
Remember NO absorption in the stomach except for EtOH alcohol, H2O, aspirin
(alcohol is absorbed fast gets to brain fast)
On to next phase = intestinal phase
3. Intestinal Phase
2 hormones:
1. CCK: released from small intestine in response to fatty chime.
stimulation of smooth muscle in gallbladder to contract. Causes
release of bile. Stimulate pancrease to release juice. Inihbites
stomach motility and release of gastric secretion
2. Secretin released from small intestine inrepsinse to increase in chime.
Causes release of bicarbonate from lives and ducts of pancreas. Helps
neutrialize acidic chime. Inhibits gastric secretion and motility.
Reflex opposes other two reflexes.
Protects small intestine from being overloaded with chime
Initiated with entry of acidic chime into duodenum which sends signal to medulla
oblongata.
Both hormones decrease stomach motility and secretory activity and inhibit
release of gastrin. Slows down emptying of stomach. Which allows small
intestine to continue digestion before chime is added.
How is digestion regulated (neural control)?
What is the role of the pancreas in digestion? What cells are involved? What do they secrete?
What stimulates their secretions? What do those secretions do?
Digestion in small intestine depends on secretions from pancreas & liver so, lets take a
closer look at these accessory structures
Pancreas
o Elongated organ posterior to stomach
o Contains pancreatic islets (responsible for endocrine secretion) & acini (acinar cells)
(exocrine cells and make digestive enzymes and bicarbonates)
Acini very important for digestive system simple cuboidal
o What do they do?
Make digestive enzymes and bicarbonate
Produce and release hydrolytic enzymes
Pancreatic Juice
o Acinar cells and cells from pancreatic duct produces this
o Contains: enzymes and bicarbonate and some water
o What does it do?
Gets released into duodenum and they help break down all four
macromolecules and bicarbonate will help neutralize acidity of chime. Act as
a buffer
Enzymes produced by Pancreas = 6 act in small intestine
Pancreatic -amylase
digest carbohydrates (salivary amylase) starch
Pacreatic lipase
digest fats, lipids
Nucleases
digest nucleic acid (dna and Rna)
Trypsin
Chymotrypsin
Carboxypeptidase
These enzymes are secreted by the pancrease
Are carried to the duodenum in 2 major ducts
These enzymes are secreted by the acinar cells
o Are carried to the duodenum in 2 major ducts
Pancreatic Duct/Duct of Wirsung
o Joins the common bile duct to enter the duodenum
At the hepatic pancreatic ampulla DONT NEED TO KNOW THIS POINT
Accessory Duct/Duct of Santorini
o Enters the duodenum above the ampulla
help breakdown
proteins or
peptide hb
What is the role of the liver? What are the major cells of the liver? How is it involved in
recycling? How is that associated with the digestive system? What secretions does it produce?
Where are these stored? What is the role of the gall bladder? What is the role of bile?
Important synthesis and recycling center in the body
Important in production of bile .
Nutrients are absorbed and go to the liver first
Repackaging and distribution center
External anatomy:
Left & Right Lobes (JUST KNOW THIS POINT)
Important vessels (KNOW THIS)
Hepatic vein & Hepatic portal vein
Drain blood into vena cava
Carries blood from capillary beds of gi tract, spleen and pancreas. Rich in
nutriens poor in oxygen.
Hepatic Artery
Brings oxygenated blood into liver
Common bile duct
Brings bile out of liver and dump into gallbladder
Network of vessels among cells see Fig. 22.20
Cells:
Hepatocytes
Square cells/plates of cells
Vein branches run between cells = sinusoids
Lead to a central vein to the hepatic vein
Sinusoid walls are lined with epithelium
Contain phagocytes
what are these special cells called? Kuppfer Cells What do they do?
Breaking down red blood cells
Liver recycles, but also produces & secretes:
Bile get dump into bile duct
Bile canaliculi merge with hepatic ducts bile is stored where? Gallbladder there it gets
concentrated gallbladder stores concentrates and releases bile that liver produces.
At release bile leaves via the cystic duct
This merges with the common hepatic duct to form the common bile duct which goes
to the duodenum
The liver also releases bilirubin into the duodenum for waste excretion
Stimulated by the vagus nerve & secretin stimulation
In the gall bladder
What happens?
Bile gets concentrated so small amount helps emulsify fats.
Bile emulsifies fats
Release is controlled by the hepatopancreatic sphincter (hepatocytes and pancreas)
when they are closed
Contraction of sphincter is stimulated by ?
CCK
Secretin increases the rate of production
Increase release of pancreatic enzymes and CCK does this to
In the intestines what is the function of bile?
Emulsify fats and separate them
What are the 3 parts of the small intestine? How does anatomical form of the small intestine
relate to physiological function? What activities happen in the small intestine? What hormones
are involved? What are their functions? Other secretions? Their functions?
Long tube = 20 feet in length
Divided into 3 regions
Duodenum
Shortest region follows stomach
Approx. 10 inches long
Ulcers in duodenum if there is too much acidity
C shape around the head
Receives accessory glands secretion from liver, gallbladder and pancreas.
Jejunum
8 feet
primary region for chemical digestions and nutrient absorption.
Ileum
12 feet
distal end is ileocel valve which sphincter that controls entry of meterials
into large intestine.
Absorption of digested materials continues here
Activities in the small intestine:
Absorption of macromolecules tgat were broken down into monomorers
Mechanical digestion: mixing, segmentation
Chemical digestion
Proteins in the stomach: pepsi, starch in the mouth: salivary alpha amylase
Secrete enzymes, mucous, hormones
No elimination
No ingestion
ANATOMY
Within the tube = 4 layers
Mucosa
Contains waves of ridges
Plycae these are like rugae, but they dont stretch
Increase surface area
Act as speed bumps to slwo down movement of chyme
Contains small projections: Villi larger and numerous in in jejunum
Villus these are absorptive cells
Within each villus single layer epithelial tissue
There are hair like extensions on the cell brush border Microvill that increase
surface area.
Below the epithelium = capillaries for absorption
There is also a lymph vessel = lacteal for fat absorption
Other larger molecules are not transferred through the blood
Will enter the lacteal
Goblet cells
Produce what? Mucous
What is the function of mucus? Protects the lining and facilitates
movement of material
Submucosa below villi
Contains Peyers patches = lymph nodules what do these do?
Help with filtering out and protecting body from bacteria
DIGESTION
Duodenum
Main job = secretion
Summary of secretions:
CCK
Secretin
What molecules can be digested in the S.I.
Everything
All the macromolecules
Chyme is mixed with secretions needs segmentation & peristalsis
There are nervous system controls what are they?
Parasy: is reading that there is food there
Medulla
Know which enzymes break down which macromolecules and what the products are.
How are fats absorbed? Transported?
Absorbed by lacteals
What are the functions of the large intestine? How does anatomical form of the large intestine
relate to physiological function? What activities happen in the large intestine? What compounds
are digested in the large intestine? How? What compounds are absorbed? What is flatulence?
Remaining materials move to large intestine
Structural Features
Ileum opens into L.I via the ileocecal sphincter contents enter L.I.
First structure in L.I. = cecum (blind end pouch)
Appendix:
Inflammation can happen
is attached to the surface of the cecum
Contents of the intestine can enter
contains lymphoid tissue
Takes care of cellulose digestion in animals
Turns in = sigmoid colon
Tube goes towards anus = rectum
Anus = opening to release wastes
Guarded by a sphincter
Folds of L.I. = Haustra
Histology:
Inside = no villi
Columnar cells with goblet cells (mucal secretion)
Process that churns food, moves it through the L.I.?
-peristalsis
Thick bands of
longitudinal muscle
Taeniae coli (DONT NEED TO KNOW MUCH)
Eventually, food
moves into rectum

From cecum L.I. extends up through ascending colon

Extends horizontally = transverse
Extends down = descending colon
Chyme remains in L.I. for how long? 2-4 hours
Digestion is completed
Amino acids are broken down how? Bacteria and produces gases (flagellants)
Carbohydrates are fermented (release gases; carbohydrates, methane)
What happens?
End up with gases
Absorption is completed
water
vitamins
Gas accumulation
= Flatulence
Smell is due to methane gas
Material not absorbed = semi-solid at the end
= feces
Contains materials that were not absorbed and waste products
Accumulates where? Rectum and get compacted
Activates in rectum
Activate baroreceptors
Leads to contraction of rectum walls (muscles)
Shortens rectum, increases pressure
Exit through anus via sphincter
Voluntary control = relaxation of sphincter
Aided by abdominal muscles
Be able to describe the process of accumulation of, neural control of, and expelling of feces in &
from the rectum. ABOVE
Be able to describe the common problems of the large intestines.
Diarrhea & Constipation
Diarrhea: too much water in the feces not enough absorption
Constipation: too much water reabsorption
Diarrhea: caused by stress
Usually caused by what irritating mucosa? Bacteria, stress, food
Chyme moves too quickly for adequate H
2
O absorption
Constipation:
Cause? Holding poop, dehydration, medication, too little fiber in the diet.
Water is limited so larger % absorbed compared to remaining in feces
Need more fluid and fiber in diet
Be able to describe the disorders of the digestive system we discussed in class. What are the
symptoms? What are the causes? What is happening? How can it be treated? I discussed quite
a few during lecture even though I didnt get to all the slides at the end.
Ulcers
stomach and duodenum
Excess acid or too little mucous
Forms a lesion eats through tissue layers
Causes
too much acid production
i.e. hypersecretion of gastric juices
too little mucous production
i.e. hyposecretion of alkaline mucus
Bacterial Infection
Which enhance hyper- or hyposecretion
Commonly occur where? Stomach and duodenum
Symptoms
Severe pain, usually 1-4 hours after eating
Weight loss
Bleeding
Treatment
Antacids
Zantac (aluminum coat)
Surgery
Lifestyle changes
Liver Problems
Cirrhosis

Cells cannot regenerate to full extent
Hepatocyte tissue gets damaged and gets replaced by fibrous tissue
Causes: alcoholism
Hepatitis
Damage by:
# alchold
Hepatitis can lead to cirrhosis
Most common cause = alcholism
Bile duct problems if it backs up then bile wont get rid of bilirubin and
damage hepatocytes
Treatment
Depends on cause
Prevent further damage

Caused by a virus there are many forms

Contracted by:
Fluids
Stds
Symptoms
Fever
Tiredness
Sore muscles
Yellowing of the skin = jaundice
Colon Cancer
caught in stage 1 is treatable and stage 4 hard to treat
Tumor formation in the large intestine
May be benign or malignant
Usually in the rectum or sigmoidal colon
Polyps must be removed and analyzed for cancer cells what process is used here?
Colonoscopy
Symptoms of polyps:
feel pain when you need to defecate
What is metabolism? What is anabolism? What is catabolism? Which release energy? How
efficient is this process? What do I mean by the statement that anabolic and catabolic processes
are often coupled? Why would that be?